Reviewer ’s report  
 
Title: Probiotics use for antibiotic -associated diarrhea: a pragma tic participatory evaluation in 
nursing homes  
 
Version: 1 Date: 30 Mar 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Most comments of the reviewer are addressed. In general it has 
become a nice article.  
 
REQUESTED REVISIONS:  
 
1. Comment  2.4 reviewer 1: The explanation of the design is written in the introduction. That 
must be written in the design section.  
 
2. Comment  2.5 reviewer 1: I agree with the reviewer that the first aim isn't really an aim. Every 
one develops a protocol, and  this is written in the method section. The authors don't mention it in 
the results section, which is also an indication that it is no aim.  
 
Some additional comments:  
 
1. The section Participants has only one sentence. I expect more information about the 
participants especially about the residents. But as you see health care staff and managent also as 
participants ( I wouldn't do this) you have to say something about them too.  
 
2. In the section Implementation you describe that you had to make adaptations. How ever you 
don't say that you did a pilot, and how this pilot looked.  
 
3. Some comments regarding the section outcome evaluation:a. In the first sentence you mention 
that data were collected. Say also from which (medical data). Why not from nursing data? b. 
Diarrhoea was defined as stool looser than normal. Is this really diarrhoea?c. How did the elderly 
care physician decided that diarrhoea was the result of antibiotics and was he blinded for who got 
probiotics and who not? d. I miss a heading "statistical an alyses". e. When were the two project 
team meetings? e. First line page 12: no significant differences were found... Differences in?? f. 
Table 1. Gender: you only need to mention male or female, not both.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments  to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the public ation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curre ntly applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please g ive details below.  
 
This reviewer has been recruited by a partner organ ization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my n ame will be included 
on my report to the authors and, if the manuscript is accepted f or public ation, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made availa ble under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Probiotics use for antibiotic -associated diarrhea: a pragma tic participatory evaluation in 
nursing homes  
 
Version: 1 Date: 30 Mar 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Most comments of the reviewer are addressed. In general it has 
become a nice article.  
 
REQUESTED REVISIONS:  
 
1. Comment  2.4 reviewer 1: The explanation of the design is written in the introduction. That 
must be written in the design section.  
 
2. Comment  2.5 reviewer 1: I agree with the reviewer that the first aim isn't really an aim. Every 
one develops a protocol, and  this is written in the method section. The authors don't mention it in 
the results section, which is also an indication that it is no aim.  
 
Some additional comments:  
 
1. The section Participants has only one sentence. I expect more information about the 
participants especially about the residents. But as you see health care staff and managent also as 
participants ( I wouldn't do this) you have to say something about them too.  
 
2. In the section Implementation you describe that you had to make adaptations. How ever you 
don't say that you did a pilot, and how this pilot looked.  
 
3. Some comments regarding the section outcome evaluation:a. In the first sentence you mention 
that data were collected. Say also from which (medical data). Why not from nursing data? b. 
Diarrhoea was defined as stool looser than normal. Is this really diarrhoea?c. How did the elderly 
care physician decided that diarrhoea was the result of antibiotics and was he blinded for who got 
probiotics and who not? d. I miss a heading "statistical an alyses". e. When were the two project 
team meetings? e. First line page 12: no significant differences were found... Differences in?? f. 
Table 1. Gender: you only need to mention male or female, not both.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments  to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the public ation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curre ntly applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please g ive details below.  
 
This reviewer has been recruited by a partner organ ization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my n ame will be included 
on my report to the authors and, if the manuscript is accepted f or public ation, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made availa ble under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Probiotics use for antibiotic -associated diarrhea: a pragma tic participatory evaluation in 
nursing homes  
 
Version: 1 Date: 30 Mar 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brief or other article types: is there a clear objective?)  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (includ ing controls and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
Yes - experiments and analyses were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not,  can further 
revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Most comments of the reviewer are addressed. In general it has 
become a nice article.  
 
REQUESTED REVISIONS:  
 
1. Comment  2.4 reviewer 1: The explanation of the design is written in the introduction. That 
must be written in the design section.  
 
2. Comment  2.5 reviewer 1: I agree with the reviewer that the first aim isn't really an aim. Every 
one develops a protocol, and  this is written in the method section. The authors don't mention it in 
the results section, which is also an indication that it is no aim.  
 
Some additional comments:  
 
1. The section Participants has only one sentence. I expect more information about the 
participants especially about the residents. But as you see health care staff and managent also as 
participants ( I wouldn't do this) you have to say something about them too.  
 
2. In the section Implementation you describe that you had to make adaptations. How ever you 
don't say that you did a pilot, and how this pilot looked.  
 
3. Some comments regarding the section outcome evaluation:a. In the first sentence you mention 
that data were collected. Say also from which (medical data). Why not from nursing data? b. 
Diarrhoea was defined as stool looser than normal. Is this really diarrhoea?c. How did the elderly 
care physician decided that diarrhoea was the result of antibiotics and was he blinded for who got 
probiotics and who not? d. I miss a heading "statistical an alyses". e. When were the two project 
team meetings? e. First line page 12: no significant differences were found... Differences in?? f. 
Table 1. Gender: you only need to mention male or female, not both.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments  to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the public ation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curre ntly applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please g ive details below.  
 
This reviewer has been recruited by a partner organ ization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my n ame will be included 
on my report to the authors and, if the manuscript is accepted f or public ation, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made availa ble under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant