Acceptability of innovative culture-based antibiotic prophylaxis strategies: a multi-method study on experiences regarding transrectal prostate biopsy.

BACKGROUND: The acceptability of innovative medical strategies among healthcare providers and patients affects their uptake in daily clinical practice. OBJECTIVES: To explore experiences of healthcare providers and patients with culture-based antibiotic prophylaxis in transrectal prostate biopsy with three swab-screening scenarios: self-sampling at home, self-sampling in the hospital and sampling by a healthcare provider. METHODS: We performed focus group interviews with urologists and medical microbiologists from 11 hospitals and six connected clinical microbiological laboratories. We used Flottorp's comprehensive checklist for identifying determinants of practice to guide data collection and analysis. The experiences of 10 laboratory technicians from five laboratories and 452 patients from nine hospitals were assessed using a questionnaire. RESULTS: Overall, culture-based prophylaxis strategies were experienced as feasible in daily clinical practice. None of the three swab-screening scenarios performed better. For urologists (n = 5), implementation depended on the effectiveness of the strategy. In addition, it was important to them that the speed of existing oncology care pathways is preserved. Medical microbiologists (n = 5) and laboratory technicians (n = 8) expected the strategy to be fairly easy to implement. Patients (n = 430; response rate 95.1%) were generally satisfied with the screening scenario presented to them. To meet the various patients' needs and preferences, multiple scenarios within a hospital are probably needed. CONCLUSIONS: This multi-method study has increased our understanding of the acceptability of culture-based prophylaxis strategies in prostate biopsy, which can help healthcare providers to offer high-quality patient-centred care. The strategy seems relatively straightforward to implement as overall acceptance appears to be high.

Glycemic and insulinemic response to selected snack bars in trained versus sedentary individuals.

The purpose of this study was to determine whether glycemic index (GI) is influenced by training state. Participants were tested in a randomized order: twice with a reference solution containing 50 g glucose and once each with 2 commercially available snack bars (Griffin's Fruitli bar and Peak Fuel's Summit bar) containing 50 g available carbohydrate. Eleven of the participants (6 men and 5 women, M + or - SD age 20.8 + or - 2.0 yr) were endurance trained (ET; VO(2max) 57.5 + or - 8.4 ml x kg(-1) x min(-1) ), and 9 participants (2 men and 7 women, M + or - SD age 22.4 + or - 1.8 yr) were sedentary (SE; VO(2max) 43.7 + or - 9.1 ml x kg(-1) x min(-1) ). After an overnight fast, participants consumed either the glucose solution or snack bar, with blood samples taken before eating and at 15, 30, 45, 60, 90, and 120 min after eating began. The mean incremental area under the curve (IAUC) of the glucose reference was 31% lower (95% CI 3-52%, p = .03), and the Fruitli bar 38% lower (95% CI 0-61%, p = .05) in ET than in SE participants. There was a trend for the IAUC for the Summit bar to be 35% lower in ET than in SE participants (95% CI -7% to 61% p = .09). There was no significant interaction between training state and test food. The GIs of the Fruitli and Summit bars was not significantly different between ET and SE participants (p = .65 and .54, respectively). ET participants had a lower glycemic response than SE participants; however, training state did not influence GI.