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Introduction: While there are several web-based mental health interventions, few target higher education (HE) students. Importantly, more research is needed to establish their effectiveness. Here, we provide a pragmatic evaluation of an online intervention (MePlusMe) specifically designed to improve the mental health, well-being, and study skills of HE students. Methods: In accordance with the published protocol for a feasibility study, we recruited a convenience sample of 137 HE students to participate in an eight-week intervention, with 26 participants retained at week 8. Validated measures of mood (depression and anxiety), well-being, and self-efficacy were collected at baseline, 2, 4, and 8 weeks, alongside two feedback forms assessing design and functionality (baseline) and engagement (week 4 and 8). Results: We observed significant reductions in levels of anxiety and depression as well as increases in well-being, but no changes in self-efficacy. Participants rated the system design and functionality positively and qualitative findings indicated high levels of satisfaction with MePlusMe. Discussion: Findings support both the acceptability and the effectiveness of MePlusMe. Nonetheless, modest retention rates limit the precision and generalisability of these findings. Further investigation should ascertain optimal duration of engagement, most acceptable means of outcome assessment, and further detail about obstacles to utilisation. [ABSTRACT FROM AUTHOR]

In this article, I examine patterns of literacy use in the daily life a rural community in the Papua New Guinea highlands. It is demonstrated that many of these practices do not correspond to the ways in which agencies responsible for imparting literacy, particularly the local school, intend. Instead, village concepts of prestige, chance, and reciprocity are influential in shaping literacy practices, and the uses are governed by local associations and preoccupations with modernity.

Objective: To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. Data sources: CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. Review methods: The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. Results: Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. Conclusion: Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers. [ABSTRACT FROM AUTHOR]

Surveyed male and female preservice elementary teachers regarding factors influencing their decisions to become teachers. Females were motivated by perceived intrinsic aspects of elementary teaching but emphasized perceived extrinsic aspects. Males were aware of the feminization of elementary teaching but considered a male presence in elementary schools important. Males understood they had to confront societal negativity about their career choice. (SM)

Background: Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden. Objective: This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role. Methods: In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a “think aloud” interview in week 1 and semistructured interviews at the end of weeks 2 and 6. Results: Of the 32 participants, 23 (72%) participants completed the week 2 and 16 (50%) completed the week 6 questionnaires; 66% (21/32) of carers participated in qualitative “think aloud” interviews, and 18 (56%) also participated in semistructured interviews at week 2, and 13 (41%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme “I’m more careful now and would react to signs of redness” captured participants’ reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: “When you’re not used to these things, they take time to get the hang of” and “It’s not a fun app but it is informative.” All participants (n=32, 100%) liked the microlearning approach. Conclusions: The iCare app offers a promising way to improve informal carers’ pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the views and experiences of research healthcare professionals towards their redeployment to frontline clinical roles during the COVID‐19 pandemic. Background: Healthcare professionals working in research were redeployed during the COVID‐19 pandemic to support the delivery of clinical services across the National Health Service. They are experienced clinicians with research knowledge and skills, and specific working patterns. It is important to understand how these professionals were used and supported during their transition to clinical roles during the pandemic. Method: Between July and September 2020, 15 research healthcare professionals were recruited into this qualitative study. Each participant completed a single semi‐structured interview lasting approximately 30–60 min, conducted remotely using a teleconferencing platform. Interviews were transcribed verbatim, and data analysed by the process of inductive thematic analysis with the assistance of NVivo 12.06 (Nov, 2019). Findings: Four main themes were identified from analysis of the transcripts: (a) initial personal response to the pandemic (subthemes: of anxieties due to unknown disease impact and concern for others); (b) mobilization for clinical redeployment (subthemes: motivations for voluntary redeployment, the professional challenges, personal fears and the organization and preparedness for redeployment); (c) adaptive deployment to clinical roles (subthemes: adapting to new roles and responsibilities, challenges faced and coping mechanisms), (d) reflections and learnings (subthemes: reintegration to original roles and sense of achievement). Conclusion: Research healthcare professionals are highly adaptable professionals equipped with core transferable skills. With the appropriate support, re‐familiarization and induction they are a valuable resource during the pandemic response. Implications to practice: Research healthcare professionals are experienced practitioners with transferrable skills and strong sense of duty and resilience.Induction programmes to promote recalibration to clinical settings would improve their adaptability, foster confidence and emotional well‐being.Careful consideration is required prior to mass redeployment to ensure research continuity in both COVID‐19 and other health conditions. [ABSTRACT FROM AUTHOR]

Abstract Background Men who have sex with men (MSM) remain the group most at risk of acquiring HIV infection in Britain. HIV prevalence appears to vary widely between MSM from different ethnic minority groups in this country for reasons that are not fully understood. The aim of the MESH project was to examine in detail the sexual health of ethnic minority MSM living in Britain. Methods/Design The main objectives of the MESH project were to explore among ethnic minority MSM living in Britain: (i) sexual risk behaviour and HIV prevalence; (ii) their experience of stigma and discrimination; (iii) disclosure of sexuality; (iv) use of, and satisfaction with sexual health services; (v) the extent to which sexual health services (for treatment and prevention) are aware of the needs of ethnic minority MSM. The research was conducted between 2006 and 2008 in four national samples: (i) ethnic minority MSM living in Britain; (ii) a comparison group of white British MSM living in Britain; (iii) NHS sexual health clinic staff in 15 British towns and cities with significant ethnic minority communities and; (iv) sexual health promotion/HIV prevention service providers. We also recruited men from two "key migrant" groups living in Britain: MSM born in Central or Eastern Europe and MSM born in Central or South America. Internet-based quantitative and qualitative research methods were used. Ethnic minority MSM were recruited through advertisements on websites, in community venues, via informal networks and in sexual health clinics. White and "key migrant" MSM were recruited mostly through Gaydar, one of the most popular dating sites used by gay men in Britain. MSM who agreed to take part completed a questionnaire online. Ethnic minority MSM who completed the online questionnaire were asked if they would be willing to take part in an online qualitative interview using email. Service providers were identified through the British Association of Sexual Health and HIV (BASHH) and the Terrence Higgins Trust (THT) CHAPS partnerships. Staff who agreed to take part were asked to complete a questionnaire online. The online survey was completed by 1241 ethnic minority MSM, 416 men born in South and Central America or Central and Eastern Europe, and 13,717 white British MSM; 67 ethnic minority MSM took part in the online qualitative interview. In addition 364 people working in sexual health clinics and 124 health promotion workers from around Britain completed an online questionnaire. Discussion The findings from this study will improve our understanding of the sexual health and needs of ethnic minority MSM in Britain.

Aim: To understand the experiences of carers who were confronted by the development of impulsive and compulsive behaviours. Background: Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson's disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families. Design: An exploratory qualitative study. Methods: Using a convenience sampling approach, 13 carers were recruited to participate in semi‐structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. Results: Five main themes were identified: (a) realisation—developing awareness of ICB symptoms and their causes; (b) reacting—confronting and attempts to manage ICBs; (c) reaching out—help‐seeking and selective disclosure; (d) reframing—shifting perspectives on ICBs over time; and (e) resignation—impact on relationships and facing the future. Conclusions: The profound impact of ICBs on quality of life, relationships and economic stability was clear in the carers' accounts. Possible avenues for future clinical research are suggested. Relevance to clinical practice: The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education is always part of practice. [ABSTRACT FROM AUTHOR]

This paper explores how perceptions of risk of infecting HIV-negative partners influence condom use among Black African heterosexual couples in stable relationships with one partner living with HIV (serodiscordant relationships). Twenty-five in-depth couple and individual interviews were analysed through phenomenological reflection and writing. A major finding was that in attempts to preserve their relationships, couples debated condom use strategies based on their perceptions of risk of infecting HIV-negative partners. We recommend that HIV prevention information among Black African heterosexual couples with a partner living with HIV should be understood from the perceptions of risk from both partners. [ABSTRACT FROM AUTHOR]

This qualitative study explored parents' perspectives on their child receiving individual music therapy in a community setting in an NHS service in London, UK. Parents of children aged 6-11 receiving or recently discharged from music therapy took part. Data were collected through semi-structured interviews which were digitally recorded, transcribed, and analyzed following procedures of inductive thematic analysis. Music therapy was generally perceived to provide a nurturing environment for children, and communication with music therapists was mostly experienced as helpful, but with some perceived challenges. Parents perceived positive outcomes of music therapy, including children becoming calmer and engaging more with musical activities at home. Understanding of music therapy was perceived as an evolving process for parents. Some parents described a need for more information prior to music therapy. The findings of this study broadly support the model in the service of working with children aged 6-11 without parents generally present during sessions. However, there were indications that, for some families, a more flexible approach might be beneficial for the child. Participants' commentaries on perceived outcomes for children indicate potential for intervention studies investigating the impact of music therapy, while broader perceptions of the value of music therapy indicate a need for studies exploring reasons for effectiveness. [ABSTRACT FROM AUTHOR]

Background: With improved survival rates in critical care, increasing focus is being placed on survivorship and how best to support patients in returning to their former activity. Little is known about what support patients themselves view as important, and this has implications for the efficacy and acceptability of services provided. Objectives: To describe former critical care patients' perspectives on the support needed to optimize recovery. Study design: This is a qualitative exploratory study of the experiences of support received by critical care survivors. Research methodology: Semi‐structured interviews were undertaken with 12 critical care survivors recruited from a charity and a patient and public involvement group. The interviews were analysed using thematic analysis to describe patterns in the participants' experiences. Findings: Four themes of support were described: effective management of transfer anxiety, tailored information provision, timely access to services and a supportive social network. Conclusion: Survivors of critical care should be equipped with information about their critical care stay, ongoing health issues and recovery and should be provided with holistic care at home. Critical care follow up was an effective way of meeting many of these needs, but this needs to be flexible to be useful to attendees. Peer support groups (face‐to‐face and online) provided information, reassurance, a social network and an avenue for those who had longer‐lasting problems than current services provide for. Relevance to clinical practice: Whilst there are commonalities in the problems faced by critical care survivors, recovery is highly individualized, and current support services do not have sufficient flexibility to cater for this. This study shows that many survivors experience after‐effects of critical care that outlast the support they are given. These longer‐term survivors are often excluded from research studies because of fears of recall bias, resulting in poor understanding of their experiences. [ABSTRACT FROM AUTHOR]

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]

Background: Depression is a common mental disorder associated with substantial disability. It is inadequately recognised and managed, and clinicians' attitudes to this condition and its treatment may play a part in this. Most research in this area has used the Depression Attitude Questionnaire (DAQ), but analyses have shown this measure to exhibit problems in psychometric properties and suitability for the health professionals and settings where depression recognition may occur. Methods: We revised the DAQ using a pooled review of findings from studies using this measure, together with a Delphi study which sought the opinions of a panel of relevant experts based in the UK, USA, Australia, and European countries (n = 24) using 3 rounds of questioning to consider attitude dimensions, content, and item wording. After item generation, revision and consensus (agreement >70%) using the Delphi panel, the revised DAQ (R-DAQ) was tested with 1193 health care providers to determine its psychometric properties. Finally the test-retest reliability of the R-DAQ was examined with 38 participants. Results: The 22-item R-DAQ scale showed good internal consistency: Cronbach's alpha coefficient was 0.84; and satisfactory test-retest reliability: intraclass correlation coefficient was 0.62 (95% C.I. 0.37 to 0.78). Exploratory factor analysis favoured a three-factor structure (professional confidence, therapeutic optimism/pessimism, and a generalist perspective), which accounted for 45.3% of the variance. Conclusions: The R-DAQ provides a revised tool for examining clinicians' views and understanding of depression. It addresses important weaknesses in the original measure whilst retaining items and dimensions that appeared valid. This revised scale is likely to be useful in examining attitudes across the health professional workforce and beyond the confines of the UK, and may be valuable for the purpose of evaluating training that aims to address clinicians' attitudes to depression. It incorporates key dimensions of attitudes with a modest number of items making it applicable to use in busy clinical settings. [ABSTRACT FROM AUTHOR]

Bareback sex continues to fuel the HIV epidemic among men who have sex with men but despite the fact that much academic attention has been focused on the sexual behaviour of this population few authors have considered the significance of sexual position. In order to explore this relatively under-examined factor, interviews were conducted with 13 HIV-negative and unknown status gay men who had recently engaged in bareback sex. Using Interpretative Phenomenological Analysis and through the lens of sexual position, the findings were organized across three super-ordinal themes. There were some areas in which there was little difference between the men's experiences of engaging in bareback as tops or bottoms (for instance, how participants connected with barebacking partners). In other areas, however, there were clear differences in men's experiences according to sexual position, particularly in the interpersonal dynamic between tops and bottoms during bareback sex encounters, which, it is argued, were acted out in accordance with a barebacking ‘sexual script’. There were further differences by position in how individuals overcame ‘cognitive dissonance’ by invoking strategies to make their engagement in bareback sex safer and in the meanings men ascribed to bareback sex and semen exchange. These findings provide valuable insights for those working with MSM around HIV prevention. [ABSTRACT FROM PUBLISHER]

Background: Men who have sex with men (MSM) remain the group most at risk of acquiring HIV infection in Britain. HIV prevalence appears to vary widely between MSM from different ethnic minority groups in this country for reasons that are not fully understood. The aim of the MESH project was to examine in detail the sexual health of ethnic minority MSM living in Britain.Methods/design: The main objectives of the MESH project were to explore among ethnic minority MSM living in Britain: (i) sexual risk behaviour and HIV prevalence; (ii) their experience of stigma and discrimination; (iii) disclosure of sexuality; (iv) use of, and satisfaction with sexual health services; (v) the extent to which sexual health services (for treatment and prevention) are aware of the needs of ethnic minority MSM.The research was conducted between 2006 and 2008 in four national samples: (i) ethnic minority MSM living in Britain; (ii) a comparison group of white British MSM living in Britain; (iii) NHS sexual health clinic staff in 15 British towns and cities with significant ethnic minority communities and; (iv) sexual health promotion/HIV prevention service providers. We also recruited men from two "key migrant" groups living in Britain: MSM born in Central or Eastern Europe and MSM born in Central or South America.Internet-based quantitative and qualitative research methods were used. Ethnic minority MSM were recruited through advertisements on websites, in community venues, via informal networks and in sexual health clinics. White and "key migrant" MSM were recruited mostly through Gaydar, one of the most popular dating sites used by gay men in Britain. MSM who agreed to take part completed a questionnaire online. Ethnic minority MSM who completed the online questionnaire were asked if they would be willing to take part in an online qualitative interview using email.Service providers were identified through the British Association of Sexual Health and HIV (BASHH) and the Terrence Higgins Trust (THT) CHAPS partnerships. Staff who agreed to take part were asked to complete a questionnaire online.The online survey was completed by 1241 ethnic minority MSM, 416 men born in South and Central America or Central and Eastern Europe, and 13,717 white British MSM; 67 ethnic minority MSM took part in the online qualitative interview. In addition 364 people working in sexual health clinics and 124 health promotion workers from around Britain completed an online questionnaire.Discussion: The findings from this study will improve our understanding of the sexual health and needs of ethnic minority MSM in Britain. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of research into the mental health of gay men, lesbians and bisexual men and women in the UK.Aims: To assess rates and possible predictors of mental illness in these groups.Method: A comprehensive assessment was made of the psychological and social well-being of a sample of gay men, lesbians and bisexual men and women, identified using 'snowball' sampling.Results: Of the 1285 gay, lesbian and bisexual respondents who took part, 556 (43%) had mental disorder as defined by the revised Clinical Interview Schedule (CIS - R). Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying (OR=1.4, 95% CI 1.1-2.0), but not with higher scores on the CIS-R.Conclusions: Gay, lesbian and bisexual men and women have high levels of mental disorder, possibly linked with discrimination. [ABSTRACT FROM AUTHOR]

Background: Little is known about the mental health of gay men and lesbians living in Europe.Aims: To compare psychological status, quality of life and use of mental health services by lesbians and gay men with heterosexual people.Method: Cross-sectional study in England and Wales using 'snowball' sampling.Results: Participants: 656 gay men, 505 heterosexual men, 430 lesbians and 588 heterosexual women. Gay men were more likely than heterosexual men to score above threshold on the Clinical Interview Schedule, indicating greater levels of psychological distress (RR 1.24, 95% CI 1.07-1.43), as were lesbians compared with heterosexual women (RR 1.30, 95% CI 1.11-1.52). Gay men and lesbians were more likely than heterosexuals to have consulted a mental health professional in the past, deliberately harmed themselves and used recreational drugs. Lesbians were more likely to have experienced verbal and physical intimidation and to consume more alcohol than heterosexual women.Conclusions: Awareness of mental health issues for gay men and lesbians should become a standard part of training for mental health professionals, who need to be aware of the potential for substance misuse and self-harm in this group and of the discrimination experienced by many lesbians. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a study which examined the factors influencing the choice of primary teaching as a career option among A-level students and how these factors differ between males and females. The views of males were of particular importance given the current disquiet in relation to recent trends in the recruitment of males as primary-school teachers. The paper reports that primary teaching is highly regarded as a career by all sixthformers, in that it is seen as performing a moral service to society, as being mentally stimulating and as likely to offer a high degree of job satisfaction. However, primary teaching is seen as lacking in salary and status. Male sixth-formers are aware that males are in a minority in primary schools and assert the value of a male role in younger children's educational experience. Most are also aware that they may have to confront societal negativity about males working closely with young children. This perceived negativity manifests itself in three ways. Firstly, primary teaching is seen as an occupation already dominated by females; males are much more gender-sensitive when it comes to career choice than are females. Secondly, contemporary male teenage culture sees teaching as inherently unfashionable and males indicate that a desire to enter primary teaching could evoke derision from their school peers. Thirdly, the currency of child-abuse awareness in recent years has made males wary of close contact with young children. Female sixth-formers do not report concerns about any of these factors. The paper proposes that halting the decline in numbers of male primary teachers is a task which requires the intervention and contribution of a variety of agencies and bodies, and suggests that the content and dissemination of career information on primary teaching could be reviewed. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. Methods: We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. Results: Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. Conclusions: We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia. [ABSTRACT FROM AUTHOR]

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]