Reducing candidaemia risk in urology patients: Revised algorithm & Pharmacist-Led Implementation.

BACKGROUND: Candidaemia is an invasive infection with high morbidity and mortality. All urology procedures carry risk of post-operative infection. Risk mitigation strategies include preoperative urine culture and treatment of cultured organism(s) regardless of symptoms. After zero cases of candidaemia for two years, there were five cases in elective urology patients within 15 weeks between June September 2021. This increased incidence of candidaemia amongst these patients prompted multidisciplinary investigation. METHODS: Single centre case series, in a 250-bed hospital which annually performs 2000-2500 elective urology surgeries. Affected patients were elderly with multiple comorbidities. Notably, four of five patients had prior indwelling ureteral stents. All five patients had preoperative bacteriuria requiring antibiotics and one patient had pre-operative candiduria. RESULTS: Hypotheses including sterilisation failure, surgical instrument contamination, or surgical technique issues were unfounded. We propose that pre-operative duration of antibacterial therapy, particularly in the setting of ureteral stent biofilm, is a significant factor for candiduria. A new prescribing algorithm for urology patients was devised. Antibiotic treatment duration in asymptomatic patients with indwelling urinary tract foreign material was reduced from 14 to 3 days, and from 14 to 7 days in symptomatic patients. Dedicated pharmacist resources were allocated to support this change and pre-operatively manage these patients. These interventions led to zero candidaemia cases over the subsequent 21 months, along with zero post-operative bacterial bloodstream infections. CONCLUSIONS: Prolonged pre-operative antibacterial therapy poses a risk for post-operative candidaemia, especially in patients with ureteral stents. Shortening pre-operative antibiotic courses, coupled with increased pharmacist involvement, effectively reduced candidaemia incidence.

Psychological factors associated with weight loss in obese and severely obese women in a behavioral physical activity intervention.

The behavioral processes of weight reduction are poorly understood, and responses to treatments based primarily on caloric restriction have been unfavorable. A theory-based path derived from proposed relations of physical activity, changes in psychological factors, and weight loss was separately tested with women with Class I and Class II obesity (body mass index [BMI] from 30 to 39.9 kg/m(2); n = 116), and Class III (BMI > or = 40.0 kg/m(2); n = 57) obesity. Participation in a cognitive-behavioral exercise support treatment along with nutrition education was significantly associated with changes in measures of self-efficacy, body satisfaction, and mood. Changes did not significantly differ by BMI group. Multiple regression analyses indicated that changes in the psychological factors explained 14% (Class I/II obesity group) and 22% (Class III obesity group) of the variance in exercise session attendance, and attendance was strongly related to weight loss. Implications for weight loss theory and treatment are discussed.

Psychological factors discriminating between successful and unsuccessful weight loss in a behavioral exercise and nutrition education treatment.

BACKGROUND: Psychological and behavioral characteristics that predict success or failure with weight-loss treatments are poorly understood. PURPOSE: The purpose of this study was to assess whether social cognitive theory-based factors discriminate between women who are successful and unsuccessful at weight loss. METHOD: Obese women (BMI = 30 to 45 kg/m(2)) who participated in a treatment of behavioral exercise support counseling and nutrition education were divided into quartiles based on percentage of body weight lost over 6 months. Factors based on social cognitive theory, both at baseline and change over 6 months, and exercise attendance were used to discriminate between the successful (highest quartile, M(change in body weight) = -9.3%; n = 40) and unsuccessful (lowest quartile, M(change in body weight) = 1.9%; n = 37) groups. RESULTS: Stepwise discriminant analyses indicated that body satisfaction and tension (anxiety) scores at baseline, and changes over 6 months in self-regulatory efficacy and body satisfaction, made significant contributions to predicting group membership (64% and 69% of cases were correctly classified, respectively). Attendance percentage of exercise sessions was significantly greater for the successful weight-loss group, and when added as a predictor, changes in self-regulatory efficacy and attendance made a significant contribution to predicting group membership (81% of cases were correctly classified). CONCLUSION: Further research may enable psychological determinants to better guide weight loss theory and treatments.

Relations of mood and exercise with weight loss in formerly sedentary obese women.

OBJECTIVE: To assess relations of mood changes, exercise, and weight loss among formerly sedentary obese women (N=76; Mean BMI=36.6) reporting weight loss goals. METHODS: At baseline and month 6, participants completed the Profile of Mood States scales of depression, tension, and total mood disturbance and were assessed on attendance in exercise sessions and changes in weight. RESULTS: Significant positive correlations were found between weight changes and each mood factor at baseline (r=.31 to .40) and changes from baseline to month 6 (r=.41 to .47). Multiple regression analyses suggested exercise attendance and mood changes significantly contributed to explained variances in weight changes (R(2)=.22 to .28). CONCLUSIONS: Mood factors and incorporation of exercise may have implications for health behavior theory and weight loss treatments.

Weight loss and psychologic gain in obese women-participants in a supported exercise intervention.

BACKGROUND: Physical activity is a predictor of maintained weight loss; however, causal mechanisms are unclear. Behavioral theories suggest that associated psychologic changes may indirectly affect weight loss. OBJECTIVE: We sought to test the association of a behaviorally based exercise support protocol (The Coach Approach [CA]), with and without a group-based nutrition education program (Cultivating Health), with adherence to exercise and changes in physiologic and psychologic factors, and to assess theory-based paths to weight and body-fat changes. SETTING: The study took place in YMCA wellness centers. STUDY SUBJECTS: Study participation was open to formerly sedentary obese women. DESIGN: Study participants were randomly assigned to the CA Only (CA; n = 81), The CA Plus Cultivating Health (CA/CH; n = 128), or the control (n = 64) group. We contrasted dropout and attendance rates and changes in self-efficacy (SE), physical self-concept (PSC), total mood disturbance (TMD), body areas satisfaction (BAS), and select physiologic factors during a six-month period. We also analyzed proposed paths to weight loss. RESULTS: The CA and CA/CH groups had significantly lower exercise dropout rates (χ(2) = 44.67, p < 0.001) and higher attendance rates (F = 10.02; p < 0.001) than the control group did. Improvements in body fat, body mass index (BMI), and waist circumference were significant for only the CA and CA/CH groups. Significant improvements in TMD, PSC, and BAS scores were found for all groups, with effect sizes greater in the groups incorporating the CA protocol. Within the five paths assessed, entry of changes in TMD and BAS scores into multiple-regression equations, along with SE and PSC scores, increased the explained variance in exercise session attendance from 5% (p = 0.01) to 16% (p < 0.001). Exercise session attendance was significantly associated with changes in body fat (r = -0.41; p < 0.001) and BMI (r = -0.46; p < 0.001). CONCLUSION: Counseling based on social cognitive and self-efficacy theory may increase exercise adherence and improve variables indirectly related to weight and body-fat reductions. Although decreases in body fat and BMI were obtained, they appeared less pronounced than psychologic improvements. Additional research on interrelations of physical activity, psychologic factors, and weight change is warranted for development of obesity treatments.