Zhu, Fang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 171-185). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-12-17T15:49:08Z No. of bitstreams: 1 Franciele Aparecida Gutierres_.pdf: 1260633 bytes, checksum: 71c1af52b3c2bb4a3e5e9c125f0ccc1b (MD5) / Made available in DSpace on 2018-12-17T15:49:08Z (GMT). No. of bitstreams: 1 Franciele Aparecida Gutierres_.pdf: 1260633 bytes, checksum: 71c1af52b3c2bb4a3e5e9c125f0ccc1b (MD5) Previous issue date: 2018-10-20 / Nenhuma / Por se tratar de um ambiente complexo e especializado no cuidado de pacientes criticamente enfermos, a terapia intensiva tem a sua disposição uma variedade de recursos tecnológicos avançados. Para manuseio destes insumos, é necessário um profissional que apresente tanto conhecimentos técnicos quanto científicos, de acordo com a expertise desta área. No entanto, a formação generalista das graduações, nem sempre fornece subsídios suficientes para isso. A aplicação de metodologias ativas para facilitar e promover a capacitação destes enfermeiros especializados é uma preocupação atual, visto que estas buscam transformar o estudante em parte atuante no processo educacional. Educar “no” e “para o” trabalho é a proposta da educação permanente em saúde, levando o indivíduo a problematizar ações cotidianas. Construir, desenvolver e validar um material didático e instrucional para a aplicação de um Programa de Educação Permanente para Enfermeiros de Terapia Intensiva Adulto. Estudo metodológico desenvolvido pela aplicação do método Delphi (relevância) e IVC (índice de validação de conteúdo) para verificação de sua validade e confiabilidade. O conteúdo programático foi avaliado por juízes experts especialistas (Lato sensu) com cinco anos ou mais de atuação na área de terapia intensiva. O produto gerado por este estudo foi um material didático e instrucional para a aplicação de um Programa de Educação Permanente para Enfermeiros de Terapia Intensiva Adulto (guia de orientação) apresentou um IVC total de 0,99 (âmbito nacional e local), sendo este um valor acima do desejado para validação de profissionais-juízes. Conclui-se, portanto, que a presente pesquisa resultou no desenvolvimento de uma nova técnica pedagógica, apresentado em formato de guia de orientação (material didático instrucional) para aplicação de um Programa de Educação Permanente para Enfermeiros Assistenciais de Terapia Intensiva Adulto, atendendo ao objetivo principal a que se propunha. O material produzido trabalha aliado a nova tendência educacional em saúde que está sendo refletida nas Diretrizes Curriculares Nacionais, alia o fazer e o saber de forma participativa e com protagonismo no processo de ensino-aprendizagem. Pode ser aplicado tanto a novos colaboradores, a fim de promover o alinhamento dos conhecimentos, quanto a critério de atualização de profissionais com longo curso de trabalho em instituições de saúde. Contribui para a área de Enfermagem por se tratar de um instrumento que alia ensino, pesquisa e cuidado centrado no paciente, visto que traz uma visão holística das atribuições do Enfermeiro especialista. E como contribuições para área da saúde a aplicação deste programa através do uso de situações-problema leva em conta a individualidade de cada caso, por isso centra o paciente no desenvolvimento de suas ações aliando a pesquisa para a busca de evidências científicas sobre as melhores práticas assistenciais. Do mesmo modo, permite o incremento das competências perquiridas ao enfermeiro de Terapia Intensiva transformando e redesenhando a realidade de seu ambiente de trabalho. / Because it is a complex and specialized environment for the care of critically ill patients, intensive therapy has at its disposal a variety of advanced technological resources. To handle these inputs, it is necessary a professional that presents both technical and scientific knowledge, according to the expertise of this area. However, the general training of graduations does not always provide sufficient subsidies for this. The application of active methodologies to facilitate and promote the qualification of these specialized nurses is a current concern, since these seek to transform the student into an active part in the educational process. Educating "at the" and "for" work is the proposal of permanent education in health, leading the individual to problematize everyday actions. To construct, develop and validate a didactic and instructional material for the application of a Permanent Education Program for Adult Intensive Care Nurses. A methodological study developed by the application of the Delphi (relevance) method and IVC (content validation index) to verify its validity and reliability. The program content was evaluated by expert judges (Lato sensu) with five years or more of work in the intensive care area. The product generated by this study (guideline) presented a total IVC of 0.99 (national and local scope), which is a value above that desired for validation of professional judges. It was concluded that the present research resulted in the development of a didactic-pedagogical tool, presented in guidance format format (product) for the application of a Permanent Education Program for Adult Intensive Care Nurses, which was proposed. It is suggested that this Permanent Intensive Care Education Program be evaluated for its practical applicability in subsequent research, in order to serve as a basis for specialization processes, seeking to expand the professional preparation of the intensive care nurse.

A prática da medicina vem mudando rapidamente. Nos últimos 20 anos os profissionais de saúde tem se preocupado cada vez mais com os erros que ocorrem durante o processo de cuidado dos pacientes enquanto trabalham duramente para preveni-los e mitigá-los. Tão importante quanto o erro em si é a maneira como o evento adverso é discutido e a maneira como os profissionais envolvidos no erro são abordados. O objetivo da pesquisa foi aplicar um questionário sobre erro e abordagem do erro. O instrumento foi originalmente publicado em língua inglesa e validado em português pelo método de Brislin. Responderam ao questionário 161 profissionais de saúde (enfermeiros, técnicos de enfermagem, médicos e fisioterapeutas) provenientes de 19 diferentes unidades de terapia intensiva adulto públicas e privadas da cidade de São Paulo (Estado de São Paulo - Brasil).Os resultados revelaram que profissionais do sexo masculino são mais propensos a reconhecer que cometem erros em relação a profissionais do sexo feminino com uma razão de chances de 0,21 (0,07-0,65); que profissionais oriundos de unidades públicas reportam com mais frequência que ameaça de processos {RC 0,23 (0,11 - 0,48)}, ameaça à estabilidade no emprego {RC 0,49 (0,24 - 0,99)} e personalidade de outros membros da equipe {RC 0,22 (0,09 - 0,51)} são motivos para que os erros não sejam discutidos tampouco abordados adequadamente. Estas informações levantam possíveis oportunidades para aprofundar a discussão e o tratamento de eventos adversos em unidades de terapia intensiva / The practice of medicine is changing quickly. In the last 20 years, health professionals have increasingly worried about errors that occur during the process of patient care while working hard for its prevention and mitigation.As important as the error itself is the way each adverse event is discussed as well as each professional involved in an error is approached .The goal of the research was applying a survey about error and its approach. The tool was originally published in english and afterwards validated in portuguese by the Brislin method. The survey was answered by 161 health professionals (nurses, nurse technicians, intensive care physicians and physiotherapists) coming from 19 different adult intensive care units both public and private in the city of São Paulo (São Paulo - Brazil). The results revealed that male professionals are more likely to recognize having made an error than female professionals with a odds ratio of 0.21 (0.07-0.65). It also showed that professionals coming from public units report more often that the threat of litigation {RC 0.23 (0.11 - 0.48)}, threat of unemployment {RC 0,49 (0,24 - 0,99) } and other team members personality {RC 0.22} (0.09 - 0.51) are reasons for problems not being discussed or addressed. The informations collected on this survey raise opportunities to improve the study and treatment of adverse events in intensive care units

Pacientes internados em Unidade de Terapia Intensiva (UTI) intubados em ventilação mecânica podem apresentar uma higiene bucal inadequada, foco de colonização propício à pneumonia associada à ventilação mecânica (PAVM). Entretanto, o conhecimento sobre esse assunto é limitado, sendo frequente a ausência deste conteúdo na formação dos profissionais, razão pela qual, na prática clínica, muitas vezes, a higiene bucal não é priorizada. O uso de tecnologias educacionais possibilita à equipe de enfermagem buscar conhecimento, a fim de melhorar a assistência ao paciente crítico. As diferentes maneiras de pensar o cuidado oral avançam para a aplicação de referenciais teórico-conceituais e de taxonomias, na prática clínica, no ensino de enfermagem e na pesquisa, garantindo efetivamente a aplicação do Processo de Enfermagem. Objetivo: Propor um objeto de aprendizagem, vídeo educativo, para o cuidado oral de pacientes entubados em ventilação mecânica, para a equipe de enfermagem. Método: pesquisa de desenvolvimento de objeto de aprendizagem, estudo metodológico de delineamento transversal. Adotou-se como referencial teórico os pressupostos de Vygotsky. A proposta de construção do vídeo educativo está fundamentada na literatura e constou das seguintes fases: Fase 1 pré-produção, Fase II produção e Fase III pós- produção. A estrutura do vídeo foi baseada no modelo científico do cuidar, por meio do Processo de Enfermagem e a aplicação dos sistemas de classificações NANDA-I ®, NOC e NIC. Análise: constou de duas fases: síntese da revisão integrativa e análise descritiva da validação do roteiro/script e storyboard de três peritos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa conforme Resolução 466/2012. Resultado: a construção do vídeo educativo constou das seguintes fases: I Pré-produção: construção do roteiro / script e storyboard; II Produção: validação do roteiro / script e storyboard, ensaio com os atores, filmagem das cenas, desenvolvimento de imagens, narração / gravação de áudio; III Pós-produção: edição. A construção do vídeo foi fundamentada no modelo científico do cuidar em enfermagem e proporcionou a estrutura de compreensão, para a dinâmica das fases do Processo de Enfermagem e classificação da linguagem NANDA-I ®, NOC e NIC. Uma revisão integrativa da literatura sobre o tema \"cuidado oral do paciente adulto entubado em ventilação mecânica\" foi realizada e assegurou que a construção do roteiro/script e storyboard estejam atualizadas, com base em evidência científica. Os artigos foram agrupados de acordo com o nível de evidência, sendo: cinco estudos do nível II, um do nível IV, nove do nível VI e um nível VII. A edição do vídeo foi feita por um técnico áudio-visual e pesquisador; foi utilizado software Adobe ® Premiere; finalizado em 18 minutos de gravação. Conclusão: o vídeo educativo para o cuidado oral de pacientes intubado em ventilação mecânica pode proporcionar a equipe de enfermagem conhecimento científico capaz de modificar seu comportamento, por meio da educação crítica e reflexiva. Este estudo pode contribuir para o desenvolvimento de protocolos de higiene oral e assim, contribuir com estratégias para reduzir a incidência de PAVM na UTI. Os passos adotados na construção do vídeo educativo mostraram-se adequados e passíveis de serem utilizados em diversas temáticas / Hospitalized patients in Intensive Care Units (ICU) intubated for mechanical ventilation may be subject to inadequate oral hygiene, a colonization focus conducive to ventilator-associated pneumonia (VAP). However, the knowledge on this subject is limited as professional training often lacks such topic, which often leads, in clinical practice, to oral hygiene being neglected.The use of educational technology could enable the nursing staff to gain the knowledge to improve the care of critically ill patients. The different approaches to oral care have advanced to the application of theoretical and conceptual frameworks and taxonomies, both in clinical practice and in nursing education and research, effectively ensuring the application of the nursing process. Objective: To propose a learning tool, consisting of an educational video that teaches the nursing staff the oral care of intubated patients receiving mechanical ventilation. Method: To research the development of a learning tool through a methodological cross-sectional study with the assumptions of Vygotsky being adopted as the theoretical reference. The proposal to make an educational video was based on the literature and consisted of three phases: Phase 1 - Pre-production; Phase 2 - Production; and Phase 3 - Post-production. The structure of the educational video was based on the scientific model of care through the nursing process and the implementation of NANDA-I ®, NOC and NIC classification systems. Analysis: Consisted of two phases: A summary of the integrative review and a descriptive analysis of three experts on the validation of the script and storyboard. The project was approved by the Research Ethics Committee according to Resolution 466/2012. Results: The production of the educational video consisted of three phases: Phase 1 - Pre-production: Development of the script and storyboard; Phase 2 - Production: Validation of the script and storyboard, actors rehearsal, shooting the scenes, image development, recording of the audio and narrative; Phase 3 - Post-production: Editing. The production of the educational video was based on the scientific model of nursing care and provided a structure to understand the dynamics of the phases in the nursing process and the NANDA-I®, NOC and NIC classification systems. An integrative review of the literature on the topic of oral care of intubated adult patients receiving mechanical ventilation was performed and assured that the development of the script and storyboard is updated and based on scientific evidence. The articles were grouped according to the level of evidence, as follows: five level 2 studies; one level 4 study; nine level 6 studies and one level 7 study. The editing was executed by a video and audio technician and researcher. The \"Adobe ® Premiere ®\" software was used, resulting in an 18-minute-long video. Conclusion: The educational video of the oral care of intubated adult patients receiving mechanical ventilation can provide the nursing staff with scientific knowledge able to change their behavior through critical and thoughtful education. This study can contribute to the development of oral hygiene protocols and strategies to reduce the incidence of VAP in the ICU. The steps taken to produce the educational video are applicable to several other themes

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-10-11T12:43:48Z No. of bitstreams: 1 Ângela Carissimi Susin_.pdf: 498765 bytes, checksum: c91bb6933b734860ef7cbf56ac83ebc5 (MD5) / Made available in DSpace on 2016-10-11T12:43:48Z (GMT). No. of bitstreams: 1 Ângela Carissimi Susin_.pdf: 498765 bytes, checksum: c91bb6933b734860ef7cbf56ac83ebc5 (MD5) Previous issue date: 2016-08-26 / Nenhuma / A humanização em Unidade de Terapia Intensiva (UTI) é um assunto amplamente debatido e as experiências vivenciadas neste espaço evidenciam a falta de preparo por parte da equipe multidisciplinar ao tratar o familiar como uma unidade de cuidado e a escassez de práticas humanizadoras na assistência. Elaborar estratégias de humanização e revelar pela ótica dos familiares e da equipe multidisciplinar o conceito de humanização. Estudo observacional, descritivo e exploratório, com abordagem mista. As entrevistas foram realizadas em uma UTI adulto de um hospital privado da cidade de Caxias do Sul-RS, no período de janeiro a junho de 2016, partindo das seguintes questões norteadoras: “considerando a experiência vivenciada, o que significa humanizar em uma UTI?” e “quais são suas sugestões para tornar a UTI mais humanizada?”. As análises dos dados obtidos através destes questionamentos apontam para aspectos fundamentais na assistência ao paciente crítico. Considerando a concepção de humanização, ambos grupos relacionaram a empatia, acolhimento e respeito a individualidade do paciente como fundamentais para uma assistência humanizada. Quanto às sugestões, a equipe multidisciplinar elencou a comunicação, capacitação da equipe, condições de trabalho e o estreitamento da relação equipe/paciente/família. Destas sugestões duas foram citadas também pelos familiares dos pacientes internados: comunicação e capacitação da equipe para uniformidade dos processos. Algumas estratégias foram elaboradas por meio dos dados obtidos: a reorganização da sistemática de atendimento ao familiar na visita, a flexibilização e visita estendida após avaliação da equipe multidisciplinar, a hora da informação, implantação de um grupo de trabalho hospitalar e rodas de conversa para os funcionários. A humanização é algo intrínseco, dada a nossa condição de humanos, mas atualmente, os processos de trabalho das instituições de saúde ainda são focados somente para procedimentos, protocolos e centrados no modelo biomédico o que acarreta lacunas entre a humanização e a prática. / The humanization in Intensive Care Unit (ICU) is a widely debated issue and the experiences lived in this unit show the lack of preparation by the multidisciplinary team to treat the family as a unit of care and the shortage of humanizing practices in the assistance. To develop humanization strategies and reveal the perspective of the family and the multidisciplinary team the concept of humanization. Observational, descriptive and exploratory study, with mixed approach. The interviews were conducted in an adult ICU of a private hospital in the city of Caxias do Sul-RS, in the period of January to June 2016, based on the following guiding questions: "considering the lived experience, what does it mean humanize in an ICU?"and " what are your suggestions to make the ICU more humanized?". The analysis of the data obtained through these questions pointed to fundamental aspects of assistance for the critical patient. Considering the conception of humanization, both groups related the empathy, reception and respect to the individuality of the patient as essential for a humanized assistance. As for suggestions, the multidisciplinary team outlined the communication, team training, working conditions and the strengthening of the staff / patient / family relationship. From these suggestions, two were also mentioned by family members of the hospitalized patients: communication and staff training for uniformity of processes. Some strategies were prepared over the data obtained: the reorganization of the systematic of attendance to the relative in the visit, the flexibility and extended visit after evaluation of the multidisciplinary team, the time of the information, the implementation of a hospital working group and conversation circles for employees. The humanization is something intrinsic, given our condition as humans, but currently, the work processes of healthcare institutions are still focused only to procedures, protocols and focused on the biomedical model which causes gaps between the humanization and the practice.

The prevalence of diabetes mellitus (DM) continues to be a global concern among health care practitioners. Without collaboration and interventions, this chronic disease, which poses a significant financial burden for health care institutions, will continue to be problematic. Promoting the use of glycemic control measures among diabetic patients is an intervention, which has the potential to reduce diabetic complications and improve outcomes. The purpose of this doctoral project was to explore available evidence through a systematic review of the best practices for glucose management. The chronic care model served as the theoretical framework. The evidence based practice question was, What is the current evidence supporting the utilization of a computer-based glucose management system (CBGMS) for inpatient diabetic adults in acute and critical care settings? A systematic review was conducted, yielding 532 studies in which 3 of the studies related to CBGMSs published from 2008 to 2017 were critically appraised. The John Hopkins Nursing Evidence Appraisal Tool with specific inclusion and exclusion criteria was utilized. Participants were adult patients (aged 18 and over) with DM in inpatient care settings who were English speaking. Interventions included the traditional paper-based sliding scale regimen versus the utilization of a CBGMS. Outcome measures included decreased length of stay, reduced cost, and glucose optimization. A conclusion was the implementation of a CBGMS has the potential to improve patient outcomes with additional research that exhibits overall benefits and implement into practice. Thus, implementation of a CBGMS can lead to positive social change by aiding in a change in practice that will ultimately ameliorate patient health outcomes.

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery. Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.

Deconditioning occurs in critically ill patients as early as 4 days after entering the intensive care unit (ICU) resulting in a loss of up to 25% peripheral muscle tone and 18% body weight by the time the patient is discharged. Early mobility (EM) has been shown to reduce complications such as neuromuscular weakness, muscle wasting, pneumonia, and the effects of prolonged periods of time on the ventilator. No formal education on EM had been provided to nurses at the clinical site. The purpose of this project was to develop an educational program on EM to promote early ambulation of critically ill ICU patients. The theory of knowledge to action was used to guide the development of the educational program. The practice-focused question addressed whether an educational program would improve nurses' perceptions of their knowledge of EM and if they would promote the use of EM among ICU patients. After a literature review to identify evidence-based practices and a protocol on EM, an educational program was developed that included a 25-item Likert-style pretest and posttest to measure percent agreement with perceptions of knowledge gained and likelihood of behavior change related to the practice of EM. Participants included 60 ICU nurses. Results demonstrated improvement in perceptions of knowledge of EM (from 74% before education to 88% after) and in likelihood of behavior change related to EM (from 69% before education to 91% after). Findings may be used to integrate EM into the ICU setting to reduce complications such as neuromuscular weakness, muscle wasting, and pneumonia. Results may also include improved patient outcomes, reduced length of stay, and increased quality of life for patients and their families, and thereby promote positive social change.

This study explores the experiences of relatives waiting. Often relatives wait for considerably long periods, especially in critical care areas, whilst their loved one, whose health status is unknown, receives care. To explore these experiences and to understand the symbolic meaning behind the participants’ stories, a grounded theory approach was utilised which is firmly rooted in the sociological theory of symbolic interactionism. A qualitative approach was employed in order to yield a rich description of the human experience often not found in quantitative studies (Jamerson, Scheibmeir, Bott, Crighton, Hinton and Kuckelman, 1996, p. 468). Similarly, the use of feminist principles to guide this study has facilitated a greater understanding of such issues as gender roles, language, power and hierarchy. Using grounded theory methodology, audio-taped interviews were conducted with six female relatives who were recruited using theoretical sampling. Simultaneous recruitment, data collection, analysis and literature review took place, as advocated and outlined by Barney Glaser and Anselm Strauss (1967). The overarching core category discovered using this approach which epitomises the waiting experience, is the balancing of both positive and negative aspects of the four codes identified. These four codes are -mothering, trust, flustered anxiety and institutional and medical power. Each code had negative aspects, such as being denied the felt need to mother the critically ill loved one, being asked to entrust the health of a loved one to people that relatives had never met, feelings of fluster and anxiety, and a perception that they would interfere with medial care if they were to be involved in their loved one’s care. Conversely, each code could potentially have a positive aspect, such as being involved in the care of the loved one, feelings of relief once the care of the loved one was entrusted to ‘professional’ health care providers, affiliating with other relatives who were waiting in similar circumstances, and receiving frequent information from staff. A final model was produced that illustrates the balance that many relatives aspire to when waiting in the Emergency Department waiting room. If the balance tips in favour of the negative aspects of the codes, a negative impact on the relative’s feelings of well being can result.

[Tuncated abstract] This research thesis consists of five sections. Section one provides the background information (chapter 1) and a description of characteristics of the cohort and the methods of analysis (chapter 2). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is one of commonly used severity of illness scoring systems in many intensive care units (ICUs). Section two of this thesis includes an assessment of the performance of the APACHE II scoring system in an Australian context. First, the performance of the APACHE II scoring system in predicting hospital mortality of critically ill patients in an ICU of a tertiary university teaching hospital in Western Australia was assessed (Chapter 3). Second, a simple modification of the traditional APACHE II scoring system, the 'admission APACHE II scoring system', generated by replacing the worst first 24-hour data by the ICU admission physiological and laboratory data was assessed (Chapter 3). Indigenous and Aboriginal Australians constitute a significant proportion of the population in Western Australia (3.2%) and have marked social disadvantage when compared to other Australians. The difference in the pattern of critical illness between indigenous and non-indigenous Australians and also whether the performance of the APACHE II scoring system was comparable between these two groups of critically ill patients in Western Australia was assessed (Chapter 4). Both discrimination and calibration are important indicators of the performance of a prognostic scoring system. ... The use of the APACHE II scoring system in patients readmitted to ICU during the same hospitalisation was evaluated and also whether incorporating events prior to the ICU readmission to the APACHE II scoring system would improve its ability to predict hospital mortality of ICU readmission was assessed in chapter 10. Whilst there have been a number of studies investigating predictors of post-ICU in-hospital mortality none have investigated whether unresolved or latent inflammation and sepsis may be an important predictor. Section four examines the role of inflammatory markers measured at ICU discharge on predicting ICU re- 4 admission (Chapter 11) and in-hospital mortality during the same hospitalisation (Chapter 12) and whether some of these inflammatory markers were more important than organ failure score and the APACHE II scoring system in predicting these outcomes. Section five describes the development of a new prognostic scoring system that can estimate median survival time and long term survival probabilities for critically ill patients (Chapter 13). An assessment of the effects of other factors such as socioeconomic status and Aboriginality on the long term survival of critically ill patients in an Australian ICU was assessed (Chapter 14). Section six provides the conclusions. Chapter 15 includes a summary and discussion of the findings of this thesis and outlines possible future directions for further research in this important aspect of intensive care medicine.