てんかんに対する抗てんかん薬単独療法（単剤治療） 背景 てんかんは、脳からの異常な放電により繰り返す発作が引き起こされる一般的な神経疾患である。このレビューでは2つの種類のてんかん発作について検討した：脳のある部位で始まる焦点発作と、両大脳半球で同時に始まる全般強直間代発作である。 てんかん患者の約70％は発作をコントロールすることができ、大多数の患者は抗てんかん薬単剤で発作をコントロールすることができる。現在、英国では成人および小児に対する国立医療技術評価機構（NICE）ガイドラインにおいて、新たに焦点発作と診断された患者にはカルバマゼピンまたはラモトリギン、新たに全般強直間代発作と診断された患者にはバルプロ酸ナトリウムを最初に試みるべき治療選択肢として推奨しているが、その他の抗てんかん薬も幅広く提供されている。 新たに発作と診断された患者にとって、最初に使用する抗てんかん薬の選択は非常に重要であり、発作を抑制する効果がどの程度あるか、副作用がどの程度かに関する質の高いエビデンスを考慮して決定されるべきである。また、異なる種類の発作に適した薬剤を比較検討することも重要である。 レビューの方法 本調査で対象とした抗てんかん薬は、カルバマゼピン、フェニトイン、バルプロ酸ナトリウム、フェノバルビトン、オクスカルバゼピン、ラモトリギン、ガバペンチン、トピラマート、レベチラセタム、ゾニサ...

早産児の罹患および死亡を予防するためのシクロオキシゲナーゼ阻害剤の予防的投与 レビューの論点 利用可能なシクロオキシゲナーゼ（COX-I）阻害薬（インドメタシン、イブプロフェン、アセトアミノフェン）のうち、生後72時間以内に動脈管開存症（PDA）の存在を事前に知らずに予防投与した場合に、最も安全で早産児の死亡や望ましくない結果を防ぐ効果が高いのはどれか。 背景 PDAは早産児や低出生体重児によく見られる合併症である。PDAは、肺と心臓の間に開いた血液路で、通常は生後まもなく閉鎖する。早産児では、PDAが開いたままになることが多く、生命を脅かす合併症の一因となる可能性がある。インドメタシン、イブプロフェン、アセトアミノフェンなどのCOX-I阻害薬は、PDAとそれに関連する望ましくない結果を予防できる可能性がある。3種類のCOX-I阻害薬のうち、どれが早産児の臨床結果を改善するかについては、論争が続いている。 研究の特性 PDAを有するかどうかわからないが生後72時間以内にCOX-Ⅰ阻害薬が投与された早産児（妊娠37週未満で出生した児）、低出生体重児（体重2,500g未満の児）、または早産児・低出生体重児を対象としたランダム化比較試験（参加者が2つ以上の治療群のいずれかへ無作為に割り付けられた臨床試験）について、科学データベースを検索した。対象となった試験では、インドメタシンまたはイ...

介護施設で暮らす認知症の人のための段階的な（アルゴリズムに基づいた）疼痛管理 このレビューの目的は何か 介護施設で暮らす認知症の人の痛みを、看護師がどのように管理すればよいのかを検討した。疼痛管理では、痛みを評価し、必要に応じて疼痛治療を行う。看護師が痛みを管理する方法について段階的な手引き（アルゴリズム）が存在することで、痛みや、苦痛があることを示す行動（叩く、叫ぶ、徘徊など）を減らすことができるかどうかを検討した。 レビューでは何が検討されたか？ 介護施設にいる認知症の人は、痛みを感じることが多い。しかし、痛みを感じていても介護者に伝えることができないため、気づくことが難しく、認知症のある介護施設入居者は、認知症のない入居者に比べて鎮痛剤の投与量が少ないことが分かっている。治療されていない痛みは、幸福感や健康に悪影響を及ぼす可能性があり、攻撃性などの対応が困難な行動の原因にもなる。アルゴリズム、つまり看護スタッフ向けの詳細な段階的手引きの使用は、疼痛管理を改善するように作成されている。アルゴリズムは、構造化された痛みの評価から始まり、痛みを軽減するための非薬物療法や薬物療法など、さまざまな治療ステップを設定している。痛みが検出された場合、最初のステップで記載された治療が適用される。この処置で痛みが軽減されない場合は、次のステップの治療を行う、というようにする。 レビューに含ま...

Grant to enhance evidence-informed guideline recommendations for newborn and young child health in South Africa, Malawi and Nigeria

The Global Evidence, Local Adaptation project aims to maximise the impact of evidence for poverty-related diseases by increasing the capacity of decision makers and researchers to use global research to develop locally relevant guidelines for newborn and child health. The project will support decision makers in South Africa, Malawi and Nigeria, and will build on and add value to the large-scale programme of child-health guideline development led by the World Health Organization (WHO), with adaptation and implementation led by the WHO Afro regional office, country offices and national ministries.

 “Despite progress in the health of newborns and children, most sub-Saharan African countries have not met the Sustainable Development Goals for under-five mortality,” said Tamara Kredo of Cochrane SA. “In the context of COVID-19, even though most children present with mild conditions, the consequences of the pandemic are being felt on health systems and services, hampering healthcare delivery to children and increasing poverty, food insecurity and inequity. To address these issues, policy makers and practitioners not only need evidence-based guidance on effective clinical care, they also need guidance on how to implement this care efficiently within the context of their own health systems, considering inequity (in health and access to services) caused by poverty and other factors.”

“MAGIC is thrilled to be partner in GELA,” said Per Olav Vandvik. “The need to allow WHO guidelines to make an impact in member states is critical. Now is the time to show this is possible and we believe this strong consortium of partners is excellently placed to get the work done.”

“Clinical practice guidelines offer a means to bridge the gap between research evidence and practice and are essential policy-implementation tools supporting implementation of effective, cost-effective healthcare,” added Kredo.

The European and Developing Countries Clinical Trials Partnership (EDCTP) has awarded three-year (2022 – 2025) funding of over 3 million Euro to a partnership coordinated by Cochrane South Africa (SA), South African Medical Research Council along with partners from the Norwegian Institute of Public Health, The Norwegian University of Science and Technology, Western Norway University of Applied Science, Stellenbosch University (South Africa), Cochrane Nigeria at the University of Calabar Teaching Hospital, Kamuzu University of Health Sciences (Malawi), Cochrane and the Stiftelsen MAGIC Evidence Ecosystem (Norway).  

 The specific objectives are to: 

1. ENGAGE: Identify child and newborn priority topics and the capacity needs of guideline panels. 
2. SYNTHESISE: Support policy makers and researchers to find, appraise and use best-available systematic reviews and guidelines. 
3. DECIDE: Support guideline panels’ capacity to contextualise global evidence using transparent, digitally supported standards and WHO methods for guideline development. 
4. SHARE: Disseminate and communicate guideline recommendations to healthcare providers and the public using innovative and user-friendly formats and digital platforms.
5. LEARN: Strengthen capacity of researchers and policy makers for all aspects of guideline development, adaptation and dissemination. 
6. EVALUATE: Monitor and evaluate policy makers’ experiences of this approach, preferences for receiving evidence, capacity development and overall impact of the project on evidence-informed decision-making processes. 

GELA will incorporate a multi-faceted, multidisciplinary research and capacity-strengthening programme using primary and secondary research, guideline-adaptation methodology and digital platforms to support delivery and dynamic local adaptation. This is enabled through a project team of African and international leaders in the field of evidence-based healthcare and guidelines methods partnering with national ministries in Malawi, Nigeria and South Africa, the WHO and its Afro regional office and the civil society group, Peoples Health Movement.

The European and Developing Countries Clinical Trials Partnership (EDCTP) is a public-public partnership between countries in Europe and sub-Saharan Africa, supported by the European Union. EDCTP focuses on enhancing research capacity and accelerating the development of new or improved medical interventions for the identification, treatment and prevention of poverty-related infectious diseases, including emerging and re-emerging diseases in sub-Saharan Africa, through all phases of clinical trials, with emphasis on phase II and III trials. 

 This project is part of the EDCTP2 programme supported by the European Union (grant number RIA2020S-3303-GELA).

 ABOUT THE PARTNERS

Cochrane South Africa

Cochrane South Africa (SA) is an intramural research unit of the South African Medical Research Council and is part of the global, independent Cochrane network of researchers, professionals, patients, carers and people interested in health. It aims to promote evidence-informed healthcare decision-making in South Africa and sub-Saharan Africa by producing high-quality, relevant, accessible systematic reviews and other synthesised research evidence.

https://southafrica.cochrane.org/about-us

Cochrane

Cochrane focuses on producing relevant and timely synthesised evidence and is a global advocate for evidence-informed health and health care. We work towards a world of improved health where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesised research evidence. Our members and supporters come from more than 130 countries, worldwide.

https://www.cochrane.org/

MAGIC

The independent non-profit Norwegian MAGIC Evidence Ecosystem Foundation was set up in 2018 to provide sustainable and professional services to our customers (e.g. MAGICapp) while pursuing the evidence ecosystem vision through continued research and innovation.

MAGIC leads the work package on disseminating and communicating CPG recommendations to healthcare providers and the public. GELA will make use of innovative formats and the MAGIC authoring and publication platform (MAGICapp) to adapt, translate WHO guidelines for national and local use. MAGIC will also support development and adaptation of the guideline recommendations, customised to the needs of decision makers and making use of the GRADE EtD framework.

https://magicevidence.org/

Centre for Evidence-based healthcare, Stellenbosch University

The CEBHC is a recognised leader nationally and globally for research and practice in teaching and learning for evidence-based health care (EBHC). Based at the Faculty of Medicine and Health Sciences they support undergraduate and post-graduate training in all aspects of EBHC. They lead a Masters in Clinical Epidemiology programme recognised throughout the continent. Leads at SU have spearheaded several projects linked to evidence synthesis, knowledge translation, building capacity of policymakers and researchers for evidence-informed policymaking, and supported national and international guideline projects.  

https://www.cebhc.co.za/

NIPH

The Norwegian Institute of Public Health (NIPH) acts as a national competence institution placed directly under the Ministry of Health and Care Services. Our social mission is to provide knowledge and systematic reviews to contribute to good public health efforts and healthcare services. In this way we contribute to better health, both in Norway and globally.

https://www.fhi.no/en/

Cochrane Nigeria

Cochrane Nigeria at the University of Calabar Teaching Hospital's Institute of Tropical Disease Research and Prevention is involved in the production and dissemination of relevant and priority systematic reviews of healthcare interventions, provision of technical support for development of trustworthy clinical practice guidelines and knowledge translation activities involving the media. Our long term strategic goal is to strengthen stakeholders' capacity to use evidence to inform decisions for positive individual and population health outcomes within Nigeria and the West African sub-region.

https://nigeria.cochrane.org/

Kamuzu University of Health Sciences

Kamuzu University of Health Sciences (KUHeS) is a public-owned university established in 2019 under the act of parliament by merging the Kamuzu College of Nursing (est. 1979) and College of Medicine (est. 1991). As a key government partner, the university continues to serve the Malawi nation through provision of quality education and innovation through research as key to the health welfare of Malawi, the region and beyond. Through research the university generates evidence that informs government policies and practice in the health sector. KUHeS is an internationally recognised institution currently leading the teaching of systematic reviews, evidence-based healthcare and formulation of evidence-informed health guidelines in Malawi.

www.kuhes.ac.mw 

Wednesday, April 6, 2022

Tuesday, March 29, 2022

小児の慢性便秘におけるプロバイオティクス レビューの目的 このコクランレビューの目的は、小児（0歳～18歳）の身体的に異常がない慢性便秘の治療にプロバイオティクスが使用できるかどうかを調べることである。 この目的を達成するために、14件の研究から得られたデータを解析した。 要点 身体的に異常がない慢性便秘の治療を受けた子供の排便頻度についてプロバイオティクスとプラセボを比較した場合、結論を出すことはできなかった。2つのグループの間で治療の成功率に差がない可能性がある。 プロバイオティクスと下剤を併用した場合と、下剤のみを使用した場合を比較すると、排便の頻度や治療の成功率に差がない可能性がある。 排便回数や治療の成功率について、プロバイオティクスと酸化マグネシウムを比較した場合、結論を出すことはできなかった。 シンバイオティクス製剤（プロバイオティクスとプレバイオティクスの組合せ）を投与された小児では、プラセボと比較して排便の回数が多い可能性がある。 プロバイオティクス製剤とプラセボを比較した場合、有害事象による試験参加者の脱落におそらく差はない。 その他の比較対象については、試験から離脱した人の数が少なかったため、安全性についての結論は出なかった。 レビューでは何が検討されたか？ 小児はしばしば便秘に長期間苦しむことがり、根本となる身体的な原因が見つからない場合、それは「機能性便...

女性の腹圧性尿失禁を治療するための尿失禁手術後の感染予防を目的とした抗菌薬 レビューの論点 腹圧性尿失禁の女性が尿失禁手術を受ける場合、抗菌薬は感染予防として安全で有効か？ 背景 腹圧性尿失禁（SUI）とは、咳やくしゃみ、笑ったときなど、お腹の中の圧力が急に高くなったときに、コントロールできずに尿が漏れてしまう状態を指す。SUIの治療法のひとつに尿失禁手術がある。尿失禁手術には、大きく2つに分けられる。開腹手術（お腹を開き、尿道のそばにある腟を固定するために縫合する）か開腹手術より侵襲が少ない方法である。後者には、腹腔鏡下仙骨腟固定術（小さな切開で、腹腔鏡を使って縫合する）、スリング術（テープやメッシュを尿道の周りに通して尿道を正常位置に持ち上げ、腹壁に固定する）、コラーゲンなどのバルキング剤を膀胱頸部に注入する処置がある。手術部位や尿路の感染症は、すべての尿失禁手術の後によく見られる合併症である。予防的な抗菌薬は、術後の創感染を予防する可能性があるが、それを裏付けるエビデンスはまだ限られている。 本レビューの更新状況 2021年3月18日までのランダム化比較試験（RCT：試験中の治療法を誰もが同じ確率で受ける）、および準RCT（試験中の治療法だが誰もが同じ確率で受けるとは限らない）を検索した。 研究の特徴 我々は、2つの異なる尿失禁手術のいずれかを受け、3段階の異なる用量の抗菌...

脳卒中患者の認知機能障害に対する作業療法 本レビューの目的 作業療法が脳卒中後の日常生活動作や認知機能を改善するかどうかを検証した。認知とは、考える、見たり聞いたことに注意を払う、学習する、記憶する、問題を解決するなどの脳で行われる情報処理のことである。関連するすべての研究を収集し分析した結果、24件の研究を特定した。 要点 脳卒中後の認知に問題がある人の場合、作業療法を行った直後と6か月後では、シャワーや着替えなどのセルフケア活動を行う能力に、意味のある違いは、わずかから、全く無い可能性がある。作業療法は、介入直後に、これらの人々の一般的な情報処理能力や視覚的な注意を払う能力を向上させる可能性がある。作業療法は、記憶力や柔軟な思考力のいくつかの側面をわずかに改善することがある。 エビデンスの質は、ほとんどが確実性が低い、または非常に低い。脳卒中後の認知機能障害に対する作業療法による介入を検証する、よりよくデザインされた研究が必要である。 このレビューからわかったこと 脳卒中後、認知に問題が生じることはよくあり、着替えや食事、シャワーといった日常のセルフケア活動や、家事や食料品の買い物といった家庭や地域社会での活動に影響を与えることがある。 脳卒中の人は、病院やリハビリテーションセンター、または自宅で、脳卒中後のさまざまなセラピーを受けることができる。作業療法はその一つである。作...

低・中所得国の人々に、条件を付けずにお金を与えることは、健康やその他の生活の向上につながるか？ レビューの論点 低・中所得国（LMICs）の中には、政府やその他の組織が、貧しい人々や弱い人々（例えば、高齢者や孤児）に、お金を受け取るために特に何かを要求することなくお金を渡すことがある（「無条件現金給付」）。また、医療サービスを利用したり、子どもを学校に通わせるなど、必要な行動をとった場合にのみお金を受け取ることができるプログラムもある（「条件付現金給付」）。このレビューは、無条件の現金給付を受けることで、無条件の現金給付を受けない場合、無条件の金額を少なくする場合、条件付きの現金給付を受ける場合と比較して、人々の保健サービスの利用や実際の健康状態が改善するかどうかを調べることを目的としている。また、学校への出席、家畜の所有、仕事の有無、極度の貧困など、保健・医療支出を左右する日常生活条件に対する無条件現金給付の効果を評価することも目的としている。 背景 無条件現金給付は、所得に対処する社会的保護介入の一種である。無条件現金給付が条件付き給付と比較して、より効果的なのか、効果的でないのか、あるいは同等なのかは不明である。無条件現金給付が LMICs の子どもと成人の医療サービス利用と健康に関する結果に与える効果に関するエビデンスをレビューした。 本レビューの結果 LMICsの全年齢...

Specifications: Full Time (Permanent)
Salary: £60,000 per annum
Location: Flexible, UK
Application Closing Date:  Friday 15 April 2022

A wonderful new opportunity has come up on the team at Cochrane, a brilliant not-for-profit publishing organisation that facilitates global medical research. They are now looking for a new Head of Editorial who will lead the editorial operations and oversee the transition of editorial processes to a centralised system. With lots of change and growth planned, this is an exciting opportunity to join an expanding team and be involved with the strategic direction and leadership of the team.
 
Reporting into the Editor in Chief, you will have responsibility for:

• Overseeing a small team of direct and indirect reports
• Managing editorial operations for articles submitted, contributing to the development of new processes for direct submissions
• Attending editorial board meetings as part of senior management team
• Contributing to the editorial strategy for the launch of new journals and supplementary products
• Facilitating communication and collaboration among different directorates 

The ideal candidate will possess strong leadership skills and the ability to manage relationships with key stakeholders both internal and external to the business. Candidates applying do need experience with Editorial Manager as this is a new system which has been implemented. They will ideally come from an scholarly publishing background - ideally STM, and understand the importance of systematic reviews, research platforms and digital resources, and their role within research. Some experience of line management and budget management will be great, together with familiarity with a charity organisation or the healthcare sector.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

How to apply
If you're interested in finding out more about this great role, get in touch with Shalini Bhatt at Inspired Selection with your CV via s.bhatt@inspiredselection.com.

Friday, March 25, 2022 Category: Jobs

The World Health Organization (WHO) has issued an updated postnatal guideline which is supported by evidence from Cochrane Pregnancy and Childbirth reviews and one Cochrane Incontinence review.

Cochrane has been a non-governmental organization in official relations with WHO since 2011, and a major aspect of this partnership is supporting WHO’s global health guidelines with relevant evidence synthesis.

The Cochrane Pregnancy and Childbirth Group has a long-standing collaboration with WHO on the development and updating of Cochrane reviews that inform WHO’s guidelines on global maternal and perinatal health.

In March 2022, WHO released the updated comprehensive guideline called ‘WHO recommendations on maternal and newborn care for a positive postnatal experience’. It focuses on the weeks shortly after the birth and makes 63 recommendations on maternal care, newborn care, health systems, and health promotion during the postnatal period.

The guideline draws on the evidence from a suite of systematic reviews and qualitative evidence syntheses, including 13 Cochrane Reviews. These Cochrane Reviews cover:

• Relief of postpartum pain (5 reviews; 3 recommendations) 
• Pelvic floor muscle training for pelvic floor strengthening (1 review; 1 recommendation) 
• Preventing and treating breast engorgement and mastitis (2 reviews; 4 recommendations) 
• Preventing postpartum constipation (1 review; 1 recommendation) 
• Vitamin D supplementation for term breastfed infants (1 review; 1 recommendation)
• Timing of discharge from health facilities to the home (1 review; 1 recommendation)
• Schedules for postnatal care contacts (1 review; 2 recommendations)

As well as the 12 Cochrane Reviews, a Cochrane qualitative evidence synthesis on the factors that influence the provision of postnatal care was used to help understand the acceptability and feasibility of different aspects of postnatal care, according to health workers. 

The Cochrane evidence highlights the broadened scope of the guideline, and sheds important light on some of the most common experiences of women after having a baby.

Evidently Cochrane Author Jessica Hatcher-Moore with her first baby at home, days after giving birth. Jessica had a positive first experience of birth but felt poorly prepared for what came next. Image: © Philip Hatcher-Moore

“The WHO guideline sets out clear recommendations around the common health issues women experience after giving birth. It brings renewed and due focus to the importance of a positive postnatal experience at the heart of care - because no woman should ever feel abandoned by health services after having a baby”, says Aleena Wojcieszek, a clinical epidemiologist, science communicator, and honorary research fellow at the Australian Centre of Research Excellence in Stillbirth (Stillbirth CRE). “I was excited to highlight the need for real investment in postnatal care and urgent need for high-quality research in a recently Evidently Cochrane blog. It’s written jointly with Jessica Hatcher-Moore, a new mother, and illustrates how good postnatal care should aim to meet every individual woman’s needs, leaving the new mother, her baby and family with a positive experience of this critical period in their lives.”

"Cochrane is extremely proud of this valuable work and our continued partnership with WHO", said Dr Karla Soares-Weiser, Editor in Chief of the Cochrane Library. "This particular collaboration makes it possible to translate the latest maternal and perinatal health evidence into practice quickly, which ultimately benefits more people's health."

• Read 'WHO recommendations on maternal and newborn care for a positive postnatal experience' 
• Read the Evidently Cochrane blog: 'Putting positive experiences at the centre of postnatal care' 
• Visit the Cochrane Pregnancy and Childbirth website
• Visit the Cochrane Incontinence website

 

Wednesday, March 30, 2022 Category: The difference we make

低血糖の新生児に対する経口ブドウ糖ゲルの投与 レビューの論点 低血糖症を起こした新生児に対して、経口ブドウ糖ゲル（ゲル状の砂糖を口から飲ませること）は、無治療や他の積極的治療と比較して、低血糖の是正や長期の神経発達障害の軽減に有効か。 背景 新生児の低血糖はよく見られる問題であり、特定のリスクグループ（糖尿病の母親の乳児、早産児、出生体重の小さい児および大きい児）で頻繁に発生する。血糖値の低い新生児は、幼少期の発達障害のリスクが高くなる。この状態を改善させるために、一般的には積極的な治療が行われ、しばしば粉ミルクの使用や、新生児集中治療室に入院して輸液療法を受ける必要があり、結果として母親から一時的に引き離されることになる。口の中に塗る砂糖のゲルの利用は、血糖値の低い新生児の初期ケアとして、簡単かつ低コストで行える方法である。新生児の低血糖を是正し、神経発達への長期的影響を軽減するために、経口ブドウ糖ゲルが無治療や他の積極的治療よりも有効であるかどうかを調べた。 研究の特徴 高所得国で行われた2件の研究では、合計312人の新生児を対象に、低血糖を回復させるための 経口ブドウ糖ゲルの使用を評価した。このうち157人の新生児には経口ブドウ糖ゲルを頬の内側にすり込み、155人の新生児にはプラセボゲルをすり込むかまたはゲルをすり込まず、その後通常の授乳を行った。 主な結果 経口ブドウ糖ゲ...

Cochrane's incidents with Instagram, Twitter, and YouTube highlight the realities of Cochrane’s call against misinformation while protecting trusted sources. Cochrane’s Instagram posts have been removed, their Instagram account has been shadow banned, a Youtube video removed, and a Cochrane Library Twitter post about winning a prestigious award for trustworthy information was tagged as misleading.

Cochrane’s health evidence syntheses are recognised as the international gold standard for high quality, trusted information. Cochrane Library reviews are used to support global and national health guidelines and policy. We advocate for evidence-informed healthcare and make our trusted evidence accessible and available to all. One way we do this is using social media to reach different audiences. 

Cochrane has been the subject of several Instagram misinformation blunders. A post about a Cochrane Review on Ivermectin for prevention and treatment of COVID-19 being removed from the platform in August 2021, and it wasn't until July 2022 that the review notification came back saying it was because it 'goes against Community Guidelines'. Also Cochrane’s Instagram account has been denied the verification blue check mark several times. 

In March 2022, the prestigious Harding Prize for Useful and Trustworthy Communication was jointly awarded to by the ONS Covid Infection Survey and the Cochrane Review of Hydroxychloroquine for COVID-19. The Harding Prize, run in association with Sense About Science and the Science Media Centre, and is supported by Sir David Harding,  goal is to draw attention to the unsung task of 'informing and not persuading' and celebrate those who were doing it well. The Harding Prize judges noted that the Cochrane Infectious Disease Group’s review of the evidence for the use of hydroxychloroquine in treating COVID-19 used clear language, communicated straightforwardly, and with balance that that there was no benefit to hydroxychloroquine which outweighed the side effects and that trials of it should be stopped. This review was done with rigorous methodology and communicated with clarity and directness, which enabled policy makers, journalists, and the public to discuss and make decisions based on the best evidence. 

It was particularly ironic that a celebratory tweet from the Cochrane Library about winning an award for useful and trustworthy communication was tagged by Twitter for being misleading. This tag does not allow it to be replied to, shared, or liked. 

The latest fumble has been a webinar video being removed from Cochrane's YouTube channel for violating Community Guidelines. The video is a recording on the topic of research integrity, where Dónal O'Mathúna discussed findings from his recent study comparing different systematic reviews of the ivermectin literature. After appealing the removal, the video has be restored back to YouTube: 'Ethics and integrity in reviewing research: lessons from ivermectin'.

“Social media platforms are starting to act on mis/disinformation by tagging posts that are deemed misleading and penalizing repeat offenders. But they don't always get it correct - we are aware that other research publishers, such as the BMJ, have also experienced similar issues with Facebook”, says Catherine Spencer, Cochrane’s CEO. “Having Cochrane blocked and posts removed, while other misleading posts remain, illustrates the system needs urgent improvement. This 'censorship' on credible sources of information such as Cochrane underscores the need to not only guard against misinformation but that we urgently need better mechanisms to protect trusted information on social media.”

“These social media blunders come after the  launch of the Cochrane Convenes Report which highlights the parallel challenges of generating trust in evidence and countering mis/disinformation and calls for concrete action to address these issues”, says Cochrane’s Editor in Chief, Dr Karla Soares-Weiser. “There is an ongoing issue with how you hold those deliberately creating and sharing mis/disinformation to account and how you form accreditation and approval for official sources of evidence that have met certain quality control standards. We need to make it easier for people to access trustworthy information – and that includes on social media or YouTube.”

Cochrane is a proud supporter of WHO’s call to action on infodemic management and is currently collaborating with science communicators at Lifeology and the Association for Healthcare Social Media. We would welcome the opportunity to discuss this recurrent issue with social media platforms directly and to work with others interested in supporting science communication. Write to us at cochrane@cochrane.org, and consider signing our call to action on trusted evidence for all in health emergencies.

• Cochrane Convenes website 
• Free Course: What is an infodemic and how can we prevent it?  Available in English, French, German, Malay, Simplified Chinese, and Spanish 
• Cochrane joint winner of 2021 Harding Prize for Useful and Trustworthy Communication

Friday, October 7, 2022

生後6カ月から5歳の小児における罹病率および死亡率を低下させるためのビタミンA補充 背景 ビタミンA欠乏症（VAD）は低・中所得国における重大な公衆衛生問題であり、5歳未満の小児1億9千万人が罹患している。VADにより小児の呼吸器疾患、下痢、麻疹、視力障害などさまざまなリスクが増加しやすくなり、死に至ることもある。過去の研究では、VADのリスクがある生後6カ月から5歳までの小児に合成ビタミンAを補充すると、死亡や複数の疾患のリスクが低下する可能性が示されている。本レビューは以前のレビューの更新版である。 レビューの論点 本レビューでは、生後6カ月から5歳までの小児の疾患や死亡の予防において、合成ビタミンAの補充の効果をプラセボ（偽薬）や非介入と比較して評価することを目的とした。 レビューの方法 医学研究の結果が公表されているものと公表されていないものの両方が含まれている異なるデータベースを検索した。文献検索は2021年3月に更新された。ランダム化比較試験（RCT：参加者を1つ以上の治療群に無作為に割り付ける研究）のみを選択した。研究文献において、RCTは最善の実験的研究方法と考えられている。結果を数学的に統合し、疾患や死亡に対するビタミンAの補充の有効性について全般的な推定値を算出した。 研究の特性 今回の更新では、新たな試験は同定されなかった。本レビューでは小児1,223,85...

Tuesday, March 15, 2022

婦人科がん患者に対する手術後の周術期回復強化プログラム 背景 婦人科領域のがんは、罹患率と死亡率が著しく高い。婦人科がんの治療では、腹腔鏡（鍵穴手術）または開腹による手術療法が最も重要な治療法の一つである。手術後の回復には、十分に計画された周術期医療（手術時またはその前後のケア）が不可欠である。 近年、複数の研究者や医師により、従来の周術期医療の多くの側面が不要であり、有害でさえあるのではないかと指摘されている。たとえば、経口下剤や浣腸を使用すると、脱水症状が起きるうえに、術前のナトリウム、カリウム、カルシウム値が異常になる可能性がある。術後の回復強化（ERAS）プログラムは、手術のストレスを軽減し、従来の周術期医療の有害な面を避けることを目的としており、さまざまな分野の手術、特に消化器外科の手術に徐々に導入されている。ERASプログラムは、手術後の回復を助け、入院期間を短縮し、患者本人を大きな危険にさらすことなく病院経費を節約できる可能性がある。しかし、婦人科がんの患者に対するERASプログラムの効果はあまり知られていない。本レビューは、婦人科がん治療での周術期のERASプログラムの有益性と有害性を評価することを目的とする。 研究の特性 中国語および英語のデータベースを検索し（2020年10月現在まで）、子宮頸がん、子宮体がん、卵巣がん、子宮内膜がんを含む婦人科がんの女性747...

腹腔鏡手術時に腹腔内に送気する各種の気体について レビューの論点 腹腔鏡手術（鍵穴手術）で臓器への手術操作を容易にすることを目的とした、腹腔（お腹の中の空間）の気腹（気体で膨らますこと）に用いる各種気体の有益性および有害性は何か。 背景 現在、腹腔鏡手術は広くさまざまな腹部疾患の治療に用いられている。手術に必要な空間や視野を確保するために、腹腔内に送気する理想的な気体は安価で無色、引火性および爆発性がなく、体内から容易に排出され、患者および手術スタッフへの害が皆無のものである。この条件から、現在は二酸化炭素が最も多く使用されている。しかし、二酸化炭素の使用は心臓や肺の合併症を引き起こす可能性がある。そこで、二酸化炭素の代替となる他の気体が提案されている。 研究の特徴 2021年10月までの関連する全研究を検索した。 参加者583人を対象とした臨床試験10件を特定した。そのうちの3件（260人）は亜酸化窒素（笑気ガス）と二酸化炭素の比較、5件（177人）はヘリウムと二酸化炭素の比較、1件（146人）は室内気と二酸化炭素の比較であった。研究は、米国、オーストラリア、中国、フィンランド、イラン、オランダで実施された。試験参加者の平均年齢は19歳から62歳であった。 研究の資金源 対象となった10件の研究のうち、2件は非営利的な助成金による資金提供を受けていた。残りの8件の資金源は明記さ...

Monday, March 14, 2022

The inaugural Harding Prize for Useful and Trustworthy Communication has been jointly won by the ONS Covid Infection Survey and the Cochrane Review of Hydroxychloroquine for COVID-19.

The Winton Centre at the University of Cambridge launched the Harding Prize this year to celebrate individuals or teams who had communicated information in a trustworthy and useful way - that genuinely helped people decide what to do, or help them judge a decision made by others. The award was run in association with Sense About Science and the Science Media Centre, and is supported by Sir David Harding. The organisers wanted to draw attention to the unsung task of 'informing and not persuading' and celebrate those who were doing it well.

The Harding Prize aims to encourage evidence to be presented in a balanced, non-manipulative way, open to talking about pros and cons, and about uncertainties, designed to help the audience make up their own mind on a subject – not to lead them to the conclusions that the communicator wants them to draw.

Dr Bhagteshwar Singh, and his co-authors of the Cochrane Review, published by the Cochrane Infectious Diseases Group said:  “We are honoured to receive this award. Our aim was to provide clinicians, policymakers and the public with a balanced, trustworthy, and clear account of the potential benefits and harms of hydroxychloroquine when used for COVID-19. This award confirms that our review was communicated clearly and transparently, which we are thrilled to hear.”

The organisers bought together an illustrious judging panel, comprising:

• Helen Boaden (Chair): previously Director of BBC News.
• Professor Sir Jonathan Van-Tam: Deputy Chief Medical Officer for England
• Baroness Onora O’Neill: philosopher and presenter of 2002 Reith Lectures on ‘A Question of Trust’
• Fraser Nelson: Editor, Spectator
• Helen Jamison: previously Deputy Director of the Science Media Centre.

The judges made the following comments about Cochrane as a joint winner:

As with all its projects, the Cochrane review worked to internationally agreed methodology and prioritised high quality (randomised) evidence. This particular review was a summary of the evidence for the use of hydroxychloroquine in treating Covid-19. Using clear language, it communicated straightforwardly and with balance that that there was no benefit to hydroxychloroquine which outweighed the side effects and that trials of it should be stopped. That decision was then made. 

This subject may seem minor in the UK where treatment by hydroxychloroquine was never a big part of medical discussion. However, many millions of people around the world, especially in the USA and Brazil, were encouraged by their leaders to take this treatment seriously. 

The panel felt that just as the ONS survey was the bedrock of accurate information about Covid-19 infection rates in the UK, the Cochrane approach delivered rigorous, trustworthy and balanced reviews of scientific papers communicated with clarity and directness. Such reviews enabled policy makers, journalists and the public to discuss and make decisions based on the best evidence. 

Helen Boaden, Chair of the judging panel, commented: “It's never been more important for the public and policy makers to have access to the best possible evidence before they make significant decisions for themselves or others. Both our winners set the gold standard  for clearly communicating accurate, trustworthy, transparent data without frills or spin. The panel is delighted to jointly award them the inaugural Harding Prize.”

Professor Sir David Spiegelhalter, Chair of the Winton Centre, said: “The panel considered many fine examples, and we are delighted with the examples that they chose. We had intended to have a booby, ‘weasel words’ prize for untrustworthy communication dressed up as an unbiased source. There were many possible candidates, particularly in social media and in scientific pre-prints that had not gone through any peer review. But we finally decided that it would be inappropriate to highlight, and indeed publicise, such poor practice, and instead chose to focus on the positive efforts people have made. The Royal Society’s recent report makes clear that online misinformation is best tackled, not through censorship, but by encouraging a diverse media, independent fact-checking, careful monitoring, and education.”

Tracey Brown, director of Sense about Science, said: “Statistics are the currency of public life. They are how we can describe the world and debate what is getting worse or better, and never more so than during the pandemic. We are so pleased to support the Harding prize in celebrating the individuals who have sought to equip people with the means to be part of those debates."

Fiona Fox, Chief Executive of the Science Media Centre, said: “These are fantastic winners. The brilliant thing about the ONS survey is that it was communicated independently from the government communications machine so that the media and the public got to see the numbers every week free from government messaging.  And in the middle of an ‘infodemic’ where 1000s of scientific papers of variable quality were circulating, Cochrane’s high quality review summarising where the best evidence lay on a much-hyped treatment undoubtedly saved lives.”

Emma Rourke, Director of health analysis and pandemic insight at ONS, said: :The Covid Infection Survey has required the skill and perseverance of a large and multi-talented team. At our core has been the need to communicate such an important and sensitive issue accurately to a diverse audience, and be trusted to do so. We are delighted with this award, and are gratified that the information we have provided has proved valuable to expert users and influential on policy, but also understood clearly by the public."

• Read the full Cochrane Review Chloroquine or hydroxychloroquine for prevention and treatment of COVID‐19
• Learn more about Cochrane Infectious Diseases Group
• Liverpool School of Tropical Medicine Press Release

Monday, March 14, 2022 Category: The difference we make

A new Cochrane Library editorial has published 'Protecting human health in a time of climate change: how Cochrane should respond.' 

Researchers and methodologists have an important contribution to make to the response to climate change, by producing and synthesizing evidence relevant to climate-health impacts. While Cochrane has identified climate change as a key issue in its strategic plans, this editorial explores how to translate that high-level awareness into action and what work is needed.

This webinar recording  from Denise Thomson, founder and convenor of the Cochrane Climate-Health Working Group, explains the group’s work and why they believe that evidence synthesis and knowledge translation are so important in tackling climate change. 

• Read the  Cochrane Library Editorial
• Visit the Cochrane Climate-Health Working Group

Wednesday, March 30, 2022