Evaluation of three population health capacity building projects delivered by videoconferencing in NSW.

UNLABELLED: Three population health projects in falls prevention, smoking cessation and refugee health secured funding through the NSW Telehealth Initiative. All were capacity building projects delivered through live videoconferencing sessions between April and August 2007. Videoconferencing as a mode of delivery was evaluated from the perspective of those who delivered the projects. METHOD: Qualitative semi-structured interviews with 12 key informants explored for each project: the organisation and delivery of the education sessions; the utility of videoconferencing for delivering training programs; and the perceived potential to apply videoconferencing to other functions. RESULTS: The projects were all delivered successfully through live videoconferencing. The main benefits observed were: the ability to deliver training to large numbers of people across multiple locations within a relatively short time and for reasonable costs; and the ability to improve access to high quality professional development for rural and remote workers. Technical difficulties were minor. The support required for these kinds of e-learning projects to succeed were identified. CONCLUSION: The evaluation confirmed the value of videoconferencing as a vehicle through which equity of access to learning opportunities for population health workers across NSW can be achieved.

Enabling the NSW health workforce to provide evidence-based smoking-cessation advice through competency-based training delivered via video conferencing.

Tobacco-related disease is estimated to cost the NSW health system more than $476 million in direct health care costs annually. Population-based smoking-cessation interventions, including brief intervention by health professionals, are effective and cost effective. As the prevalence of smoking in the general community declines, more highly dependent 'treatment-resistant' smokers may present a challenge to the health system. International guidelines recommend that health systems invest in training for health professionals in best practice smoking cessation. As part of the NSW Tobacco Action Plan 2005-2009, NSW Department of Health developed national competency standards in smoking cessation, designed learning and assessment materials and delivered training to more than 300 health professionals via video conference. Building the capacity of the NSW Health workforce to address smoking cessation as part of their routine practice is essential for addressing future challenges in tobacco control.

Use of communication technology among public health professionals in New South Wales, Australia.

We explored how six forms of communication technology (teleconferencing, web bulletin boards, web conferencing, videoconferencing, media streaming and satellite television) are currently being used in public health work in NSW. Twelve public health professionals working in the NSW health service were interviewed. Teleconferencing and videoconferencing were the most commonly used forms of communication technology. Factors that facilitated use included ease of access to facilities and assistance in organising and setting up the technique. Barriers to use included cost and the perception that the equipment was hard to set up and operate. Participants identified factors that assisted them to engage with these techniques.

Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review.

BACKGROUND: Total parenteral nutrition (TPN) is a specialized form of nutrition support. The complexity associated with the management of patients receiving TPN therapy has led to the development of multidisciplinary TPN teams. The purpose of this review was to critically analyze the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalized patients. METHODS: A systematic review of studies identified from the Cochrane Library (2001, Issue 4), CINAHL, Complete MEDLINE, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE, published in any language. RESULTS: Eleven studies, 4 with concurrent controls and 7 with historical controls, were eligible for inclusion in the review. Results of the studies indicate that the incidence of total mechanical complications is reduced in patients managed by the TPN team. However, the benefit of the TPN team in the reduction of catheter-related sepsis remains inconclusive. Four of the 5 studies reported fewer total metabolic and electrolyte abnormalities in patients cared for by the team, and these patients were more likely to receive their optimal caloric intake. However it was unclear if the management of the patients by the TPN team prevented the inappropriate use of TPN therapy. Although only 2 studies (n = 356) investigated total costs associated with management of patients by the TPN teams, there was evidence that a team approach is a cost-effective strategy. CONCLUSIONS: Overall, the general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter-related sepsis and metabolic and electrolyte complications. The available evidence, although limited, suggests financial benefits from the introduction of multidisciplinary TPN teams in the hospital setting.

Effectiveness of a multidisciplinary total parenteral nutrition team in the hospital setting.

BACKGROUND: Total parenteral nutrition (TPN) is a form of nutritional support that has become an essential adjunct to the management of patients who are unable to obtain adequate nutrition either via the oral or enteral route. Previous studies indicate that TPN can be administered safely and effectively to patients; however, there are associated risks with this form of nutritional support. Researchers have indicated that due to the complexity of TPN therapy a high level of knowledge and expertise is required in the management of these patients. The multidisciplinary team approach has been supported for its ability to assess the patients' nutritional status, prescribe the nutritional requirements, and reduce the incidence of metabolic complications through regular monitoring. However, contradictory views on the effectiveness of multidisciplinary TPN teams in health-care facilities have also been reported. AIM: The aim of this review was to critically analyse the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalised patients. The primary outcomes included: incidence of catheter-related complications, types of catheter-related complications, incidence of metabolic and electrolyte abnormalities, provision of nutritional requirements, estimated nutritional requirements, number of patients whose nutritional goals were met and the amount of energy and protein provided. Secondary outcomes included cost effectiveness of nutritional support teams and physician compliance with team recommendations. SEARCH STRATEGY: The literature search sought to identify both published and unpublished studies utilising various search strategies and the Internet. The Cochrane Library (2001, Issue 4) was initially searched to identify randomised controlled trials. The other electronic databases searched included CINAHL, Complete Medline, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE. Experts and company representatives were contacted to identify published reports as well as research in progress relevant to this review. Professional bodies were contacted and included the British Association for Parenteral and Enteral Nutrition (BAPEN) and the Australasian Society for Parenteral and Enteral Nutrition (AuSPEN). SELECTION CRITERIA: All randomised and non-randomised controlled trials comparing the effectiveness of multidisciplinary TPN teams, in the provision of TPN to adult hospitalised patients, were considered for inclusion in this review. Trials were included if they reported objective or subjective measures of nutritional, metabolic and catheter-related complications and cost effectiveness. To minimise publication bias studies reported in other languages were also considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: The eligibility of studies for inclusion, the methodological quality and data extraction were undertaken independently by two reviewers and cross-checked by a third reviewer. The studies included in the review have been synthesised as a narrative overview. RESULTS: Eleven studies comparing the effectiveness of a multidisciplinary TPN team in the hospital setting were analysed in this review. Six studies that investigated the incidence of total mechanical complications reported a higher incidence of these complications in patients who were managed by their physician. Catheter-related sepsis was investigated in seven studies of which five reported a reduction and two reported an increase in catheter-related sepsis in patients managed by the team. One study reported no statistically significant difference in the total metabolic and electrolyte abnormalities and four studies reported fewer of these abnormalities in patients cared for by the nutrition team. Overfeeding and underfeeding in patients not managed by the TPN team were reported in five studies. The most appropriate route of feeding was investigated in four studies. Two of the four studies reported that patients managed by the team were more likely to be fed by the most appropriate route and the findings from the remaining two studies were unclear. Cost effectiveness of the TPN team was reported in two studies and a reduction in costs was demonstrated in both studies when the patients were managed by the TPN team. Compliance by physicians to recommendations made by the TPN team was investigated in two studies, and both reported that physicians complied with at least 50% of the recommendations. CONCLUSIONS: The general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter-related sepsis. The conflicting results relating to the benefit of the TPN teams in the reduction of electrolyte and metabolic abnormalities indicate that further research is needed to clarify the impact of TPN teams on this outcome. The provision of the patients estimated energy requirements are positively influenced when managed by the TPN team; however, the evidence relating to the effectiveness of the TPN team in the provision of protein requirements remains unclear. From this review it is unclear if management of the patients by the TPN team prevented the inappropriate use of TPN. The limited data obtained from the studies provide evidence of a clinically important difference between groups in terms of cost effectiveness.