Exploring reasons behind patient compliance with nutrition supplements before pelvic exenteration surgery.

PURPOSE: Compliance with oral nutrition support (ONS) is poorly reported in the literature. Many factors influence compliance, which could mask the true benefits of preoperative ONS. Surgical oncology patients, including pelvic exenteration patients, are often requested by healthcare workers to consume nutrition supplements before surgery. Exploration of barriers and enablers to compliance with nutrition supplements is needed to improve patient compliance and understand the real impact of preoperative ONS. METHOD: A qualitative study using semi-structured interviews was performed to investigate enablers and barriers to preoperative nutrition supplement compliance. Twenty participants who had been asked to consume 15 nutrition supplements, either immunonutrition or standard polymeric supplements, were interviewed. Inductive thematic analysis was used to determine major themes associated with compliance. RESULTS: Twelve out of 20 participants were not compliant with recommended dosing. Well-nourished participants were more compliant than malnourished participants. Major themes associated with compliance were flavour, volume, texture, impact on dietary intake and motivation to consume supplements. Flavour differed between the two groups, negatively impacting compliance in the immunonutrition group. Volume, texture and impact on dietary intake also negatively impacted compliance whereas motivation positively impacted compliance. CONCLUSION: To overcome barriers and enforce enablers with nutrition supplement compliance, it is essential healthcare workers implement individualised interventions, taking into account nutritional status. A range of flavours, minimal volume and low viscosity supplements should be provided to address individual preference and minimise poor compliance. Better-targeted education and regular motivation are needed to improve compliance.

Experience with the intravenous totally implanted port in patients with gynecologic malignancies.

The purpose of this paper was to assess the intraoperative and long-term complications associated with intravenous totally implanted devices in women with pelvic cancers. Retrospective review of medical records was performed for 67 consecutive women with pelvic cancers who underwent port insertion. Seventy catheters were successfully placed in 67 patients. Pneumothorax occurred in three cases (4.3%), none requiring chest tube placement. Malposition of the catheter occurred in four patients (5.7%). Two infected ports (2.9%) were removed after a failed trial of antibiotics. Venous thrombosis developed in one woman, requiring removal of the system. In conclusion, semipermanent central venous catheters facilitate delivery of chemotherapy, parenteral nutrition, blood products, antibiotics, and hydration in cancer patients. This is the first report detailing the experience with a totally implanted subcutaneous port in patients with gynecologic malignancies. We demonstrate that such devices may be inserted and utilized with a low incidence of complications in this patient population.

Pelvic lipomatosis: effect of diet.

Pelvic lipomatosis is a disease of dense infiltration of benign fatty tissue within the confines of the deep bony pelvis. A case is reported of an obese, hypertensive, thirty-nine-year-old black man with the typical clinical and radiographic features of pelvic lipomatosis. Prolonged fasting produced an extensive weight loss and profound resolution of his presenting symptoms, signs, and radiologic abnormalities. Subsequent regain of weight resulted in the reappearance of the disorder, confirming that pelvic lipomatosis may be a disease of accelerated and excessive fat deposition which can be reversed by dietary restriction. The literature pertaining to pelvic lipomatosis is reviewed in detail.