title: Weaning children off enteral nutrition by netcoaching versus onsite treatment: a comparative study.
abstract: OBJECTIVE
  The Graz model of tube weaning has been internationally recognised as a successful and rapid tube weaning program. Beside the onsite treatment option, a telemedical counselling was specifically developed in 2009. This study aims to show outcomes of this newly invented treatment in a large sample of patients.
  
  
  METHODS
  Our retrospective open-label study compared success of onsite versus telemedical Graz-based weaning methods for patients with diverse clinical diagnoses with either nasogastric, gastric or jejunal tubes. Outcome variables were successful transition to oral feeds, partial transition to night tube feeds, and failure or interruption of intervention. Patients and physicians chose the intervention method.
  
  
  RESULTS
  Complete weaning was achieved in 153 of 169 (90.5%) children in the netcoaching group versus 170 of 209 (81.3%) of those opting for onsite treatment (no significant differences, P > 0.05). Higher partial weaning rates were observed in the onsite group (15.3% vs. 4.7%, P < 0.01, degrees of freedom = 3, χ(2) = 22.76). There were no significant differences regarding the outcomes 'weaning trial without success' (netcoaching: 0% vs. onsite: 2.9%, P > 0.05) and 'interruption of programme' (netcoaching: 4.7% vs. onsite: 0.5%, P > 0.05) between the two groups.
  
  
  CONCLUSIONS
  Despite limitations of study design, we have demonstrated similar efficacy of Graz-based less expensive netcoaching versus more expensive onsite intervention in a large referral population with chronic tube dependency with the majority transitioning to complete oral feeds.
authors.affiliation: Department for General Paediatrics and Psychosomatic, Medical University of Graz, Graz, Styria, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Marinschek
authors.forename: Marguerite
authors.initials: M
authors.lastname: Dunitz-Scheer
authors.forename: Karoline
authors.initials: K
authors.lastname: Pahsini
authors.forename: Birgit
authors.initials: B
authors.lastname: Geher
authors.forename: Peter
authors.initials: P
authors.lastname: Scheer
mesh_terms: D001317:Austria; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015596:Nutrition Assessment; D018802:Patient-Centered Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D014886:Weaning
keywords: enteral nutrition; gastric feeding tube; telemedicine; tube; tube feeding; tube weaning