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Background: Probiotics may prevent antibiotic-associated and Clostridium difficile-associated diarrhoea (AAD/CDAD). Many spinal cord injury centre (SCIC) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose- and disease-specific. In order to confirm these effects and fully evaluate the extent of probiotic effectiveness in these patients, a systematic review and meta-analysis is indicated. Methods: The following databases will be searched for relevant studies: Cochrane Library; Centre for Reviews and Dissemination (CRD) Database; CINAHL; PsycINFO; Embase; Medline; AMED; International Clinical Trials Registry Platform Search Portal and ISRCTN Registry and will hand search a list of conference proceedings. Any randomised controlled trials without restriction of publication status will be included with treatment of AAD/CDAD. Outcomes will include the effect of probiotic on the occurrence of AAD/CDAD and duration of diarrhoea, intensive care unit admission, hospital mortality and length of hospital stay. Two reviewers will independently screen the titles, abstracts or even full texts and extract data. Two other reviewers will assess study quality. Revman 5.1 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The Cochrane Collaboration's tool will be used to assess the risk of bias. Discussion: This systematic review protocol will provide information on probiotic therapy for AAD and CDAD in spinal cord injury (SCI) population. The results will be disseminated through peer-reviewed publication or conference presentation. Systematic review registration: PROSPERO CRD42015016976 [ABSTRACT FROM AUTHOR]

Summary: Objectives: The purpose of this study was to investigate the baseline muscle thickness and recruitment patterns of the transversus abdominis muscle (TAM) and the internal oblique muscle (IOM) during semisupine phonation in a group of healthy performers. Study Design: This was a 2 × 3×2 within-group, repeated-measure study in which 25 professional vocalists—12 male and 13 female performed a series of sustained pitches in differing vocal qualities. Measurements were taken with ultrasound (Sonosite Micromaxx Ultrasound System) of the baseline thickness and % recruitment during voicing, of two deep abdominal muscles—TAM and the IOM. Correlations between TAM and IOM absolute change scores, TAM and IOM percentage change scores, and changes in muscle thickness (absolute and percentage) and age were examined using Spearman''s correlations. Gender differences in the four types of change scores within each combination of pitch and quality were conducted with one-way analysis of variances. Differences in muscle thickness change 1) absolute scores and 2) percentage change in TAM and IOM, by pitch and quality (and their interactions) were analyzed using linear mixed models, using restricted maximum likelihood estimations, employing a Toeplitz variance-covariance matrix structure in SPSS (IBM, 2011). Post hoc analyses for independent variable group differences used Sidak''s correction for multiple comparisons. Alpha level was set to 0.05. Results: In terms of absolute contractions (changes in the actual millimeter thickness of the muscle), the IOM was greater than the TAM. However in terms of percentage changes in muscles during phonation, the TAM was always greater than the IOM. The TAM as a percentage change was recruited preferentially and significantly in most vocal qualities tested. Although there were differences in muscle mass and recruitment patterns between genders, and males had thicker muscle mass at rest, differences due to muscle mass were not conclusive. Conclusions: Overall this study supports the argument that the peri-abdominal muscles do indeed play a role in supporting the “performing” or athletic voice in healthy subjects, and will hopefully act as a database for further research in individuals with healthy and injured voices. [Copyright &y& Elsevier]

This systematic review plan to investigate the effectiveness of probiotic in preventing diarrhoea associated with antibiotics (AAD) and Clostridium difficile infection (CDI) in spinal cord injury (SCI) patients. CENTRAL; HTA Database; CINAHL; PsycINFO; Embase; Medline; AMED and DARE were queried from inception to 27th February 2015, with the subject heading terms "probiotics" combined with "diarrhoea", "antibiotic", "clostridium difficile" and "spinal cord injuries". All trials assessed the effectiveness of probiotic and AAD or CDI in SCI-patients were sought. 150 publications were identified, of which 2 papers (1 RCT and 1 case-control study) met inclusion criteria and were evaluated. Of these, 1,031 SCI patients were included (140 received intervention and 891 controls). Among studies examining probiotic in preventing AAD / CDI in SCI patients, one study reported the probiotic may prevent AAD (54.9% vs. 17.1%, p<0.01), two studies reported probiotic may prevent CDI. The results were considered inconclusive because of the limited number of trials conducted in the SCI population, due to the absence of sample homogeneity, thereby providing a low level of evidence for clinical practice. Further research is suggested to inform the choice, duration and dose of probiotic in preventing AAD / CDI in SCI patients. [ABSTRACT FROM AUTHOR]

Probiotics may prevent antibiotic-associatedand Clostridium difficile-associated-diarrhoea (AAD/CDAD). Many spinal cord injury centres (SCICs) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose-, and disease-specific. One to four SCICs per country (depending on population size) were contacted (UK:4; the Netherlands:3; Belgium: I; Republic of Ireland: 1) to (a) determine if they stocked probiotics; (b) determine whether the use of those probiotics was evidence-based; and (c) document their C. difficile infection (CDI) practices. All nine SCICs responded to the survey (7 physicians, 3 microbiologists, 1 nurse and 2 dietitians). Five (55.5%) stocked probiotics; five different probiotics were identified. Four probiotics were preferred choice prevention of AAD/CDAD were Lactobacillus casei Shirota (44.4%), L. casei DN-114001 (22.2%), L. acidophilus (22.2%) and a mixed-strains probiotic (Ecologic Pro-AD) (11.1%). Only one evidence base study was identified supporting the use of probiotic fo r prevention ofAAD in SCI patients. Mean CDI cases per 10,000 patient-days were 0.307 (s.d: 0.486, range 0.00 to 1.08). Definitions of diarrhoea and CDI varied among SCICs. Stocking probiotics fo r the prevention of AAD/ CDAD is not common. There is only one single study showing efficiency of a particular strain in SCI populations. The study highlighted the importance of using a standardised definition of diarrhoea when conducting AAD/ CDAD research. [ABSTRACT FROM AUTHOR]