Orientadores: José Guilherme Cecatti, Rodolfo de Carvalho Pacagnella / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:17:52Z (GMT). No. of bitstreams: 1 Polido_CarlaBetinaAndreucci_D.pdf: 9580415 bytes, checksum: 7a66fbe0b5c7b89a2918fd10375d6d95 (MD5) Previous issue date: 2015 / Resumo: Introdução: Morbidade materna grave e near miss materno são indicadores de saúde mais abrangentes, quando comparados à razão de morte materna. Esse conceito recente permite não apenas a identificação do número de mulheres que morrem durante gestação e/ou parto, mas também o estudo da prevalência de condições potencialmente ameaçadoras de vida. No entanto, pouco se conhece sobre as possíveis consequências em longo prazo após esses episódios nos diversos aspectos da vida das sobreviventes. A gestação e o parto podem modificar a resposta sexual feminina, mas poucos estudos avaliaram esse desfecho após eventos de morbidade materna grave. Objetivos: Realizar uma revisão sistemática sobre aspectos de sexualidade, incluindo função sexual, em mulheres que apresentaram qualquer tipo de complicação durante gestação ou parto. Avaliar aspectos da resposta sexual feminina em mulheres com e sem morbidade materna grave. Métodos: Revisão sistemática nas bases de dados PubMed, EMBASE e SciELO, avaliando a associação de morbidade materna geral e grave com alterações da função e/ou resposta sexual feminina. A revisão seguiu o protocolo do método proposto para estudos observacionais (PRISMA). A resposta sexual feminina foi estudada como um dos desfechos da Coorte de Morbidade Materna Grave (COMMAG). O questionário Female Sexual Function Index (FSFI) foi aplicado às mulheres expostas (com antecedente de morbidade grave) e não expostas (com antecedente de gestação sem complicações). Além do FSFI, questões gerais sobre saúde geral e reprodutiva complementaram o estudo. Resultados: Lesões perineais maiores (terceiro e quarto graus) foram avaliadas como desfechos de morbidade geral em 12 estudos, e a morbidade materna grave foi analisada em 2 estudos. A morbidade geral e a grave foram associadas com maior tempo para a retomada da atividade sexual após o parto. A morbidade também se associou a uma maior frequência de dispareunia após o parto. Escores totais do FSFI não foram significativamente diferentes entre grupos de exposição e controle. Pela heterogeneidade entre eles, os estudos individuais permitiram apenas uma síntese qualitativa dos resultados, mas não metanálise. Para avaliação da resposta sexual feminina no COMMAG, foram incluídas 638 mulheres previamente internadas durante gestação ou parto na maternidade do CAISM/UNICAMP. Dessas, 315 tinham antecedente de morbidade materna grave, e 323 eram mulheres sem complicações durante gestação ou parto. Os escores totais médios do FSFI encontrados foram abaixo dos valores de ponto de corte para suspeita de disfunção, sem diferença entre os grupos estudados. Mulheres com antecedente de morbidade materna grave retomaram atividade sexual mais tardiamente após o parto do que as do grupo controle, porém sem diferença entre os grupos a partir do terceiro mês pós-parto. A análise múltipla identificou associação de valores mais baixos de FSFI com baixo de peso materno e ausência de parceria. Conclusões: Alterações da resposta sexual feminina podem ser consequências em longo prazo da ocorrência de episódios de morbidade materna grave. Com o crescimento da população de mulheres que sobrevivem a esses episódios, a abordagem da sexualidade no seguimento dessa população se faz premente / Abstract: Introduction: Severe maternal morbidity and maternal near miss currently are better health indicators than maternal mortality ratio. Together with the identification of women who died during pregnancy and/or childbirth, the new concept allows also to investigate the prevalence of potential life-threatening conditions. However, little is known about possible long-term consequences after those episodes over several aspects of the lives of survivors. It has already been described that uncomplicated pregnancy and childbirth might modify female sexual response. Notwithstanding, only few studies have evaluated aspects of sexuality of women after episodes of severe maternal morbidity. Objectives: To perform a systematic review of aspects of sexuality, including sexual function, in women who had had any kind of complication during pregnancy or childbirth. To evaluate aspects of female sexual response in women with and without severe maternal morbidity. Methods: Investigation included a systematic review through the databases PubMed, EMBASE, and SciELO, assessing general and severe maternal morbidity associated with altered female sexual response. The review followed the protocol method proposed for observational studies (PRISMA). The female sexual response has been studied as one of the outcomes at a retrospective cohort study on maternal severe morbidity (COMMAG). The Female Sexual Function Index questionnaire (FSFI) was applied at exposed women (severe morbidity) and unexposed (pregnancy without complications). Along with FSFI, the survey included also questions on general and reproductive health. Results: Major perineal injuries (3rd and 4th degree) were evaluated as general morbidity outcomes at 12 studies, and severe maternal morbidity was analyzed at 2 studies. Compared to control group, both women exposed to general and severe morbidity delayed resumption of sexual activity after childbirth. The exposed group had also more frequently dyspareunia after childbirth. The mean total FSFI scores were similar at both groups. The heterogeneity of the studies allowed only a qualitative synthesis, and meta-analysis was not feasible. To assess female sexual response at the cohort study, 638 women who delivered at UNICAMP's maternity unit were included. 315 of them were severe maternal morbidity cases, and 323 were women who had had uncomplicated pregnancy or childbirth. The mean total scores of FSFI were similar in both groups, though below cut-off values for suspected dysfunction. Women after severe maternal morbidity resumed sexual activity after birth later, when compared to control group. However, there was no significant difference at three months. Multivariate analysis showed association of lower FSFI scores with maternal low maternal weight and no partner. Conclusions: Altered female sexual response might be a long-term consequence after episodes of severe maternal morbidity. Since there is a growing population of women who survive these episodes, proper evaluation of sexual functioning among those women should be conducted / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Objetivo: A hipertensão arterial constitui o principal fator de risco modificável para as doenças cardiovasculares e a maioria dos hipertensos necessitará de medicamento para controlar a pressão. Este estudo analisa a prevalência da hipertensão arterial referida e a utilização de anti-hipertensivos por adultos do município de São Paulo de acordo com variáveis socioeconômicas e demográficas. Métodos: Análise de dados do Inquérito de Saúde no Município de São Paulo – ISA Capital, estudo transversal, de base populacional conduzido em 2003 que possui 1668 adultos com 20 anos ou mais. Para investigar a distribuição das principais classes de anti-hipertensivos, utilização de genérico, forma de obtenção e custeio utilizou-se de um recordatório de três dias. Resultados: A prevalência de hipertensão referida foi de 16,9%, sendo maior nos indivíduos com idade mais avançada, menor escolaridade e sem ocupação. Entre os que referiam hipertensão, a prevalência do consumo de anti-hipertensivo nos três dias que antecederam a entrevista foi de 73,1%. Dos indivíduos que consumiram anti-hipertensivos 38,3% obtiveram o medicamento através do SUS e 35,3% utilizaram genéricos. As principais classes consumidas em monoterapia foram: inibidores da enzima conversora de angiotensina – IECA (41,9%) e diuréticos (24,6%). As principais associações foram: IECA + diurético (36,0%) e diurético + betabloqueador (22,3%). Conclusões: A hipertensão arterial referida se distribui de maneira desigual entre diferentes subgrupos da população. No acesso a medicamento anti-hipertensivo o SUS consegue promover equidade no fornecimento dessas drogas para a população mais desfavorecida. As classes consumidas não estão totalmente de acordo com as diretrizes de hipertensão. / Objective: Hypertension is the major modifiable risk factor for cardiovascular diseases and most of hypertensive patients will require medication for the control of blood pressure. This study analyses the prevalence of self-reported hypertension and the utilization of antihypertensive agents by adults in São Paulo City, Brazil, according to socioeconomic and demographic variables. Methods: Analysis of data from the Health Survey of São Paulo City – ISA Capital, a cross-sectional, population-based survey conducted in 2003 with 1668 adults aged 20 years or over. To investigate the distribution of the main antihypertensive drug classes, utilization of generic drugs and information about how the drugs were obtained, individuals who self-reported hypertension were asked about any drug use for high blood pressure in the previous three days. Results: The prevalence of self-reported hypertension was 16.9%. Advanced age, lower education and not having a job were independently associated with hypertension. The consumption of antihypertensive drugs was 73.1%. Among those who took antihypertensive drugs 38.3% and 35.3%, respectively, obtained the medication from the Brazilian Public Health System (SUS) and used generics. Angiotensin-converting enzyme inhibitors (ACEi) (41.9%) and diuretics (24.6%) were the most used drugs utilized as monotherapy and the most used combinations were ACEi + diuretics (36.0%) and diuretics + beta-blockers (22.3%). Conclusions: The distribution of self-reported hypertension is not equal among different subgroups of the population. The equity in the delivery of antihypertensive drugs is an important component of treatment and control of hypertension and the SUS could perform it to the less advantaged people. The classes consumed do not agree fully with the hypertension guidelines.

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

Einleitung: L-Carnitin spielt eine zentrale Rolle im Energiestoffwechsel. Da dieser in der Frühlaktation bei Hochleistungskühen besonders beansprucht und z.T. überlastet wird, ergibt sich die Frage, ob durch L-Carnitinsupplementation ein stabilerer Stoffwechsel und damit bessere Leistungen erreicht werden können. Zielstellung: Es wurde geprüft, ob bei Hochleistungskühen mit einer mittleren Milchleistung von 12000 kg/Jahr die orale Supplementation von L Carnitin im peripartalem Zeitraum bei zwei verschiedenen Applikationszeiträumen Stoffwechsel-, Leistungs- und Gesundheitsverbesserung erbringt. Versuchsanordnung: Aus einer Gesamtherde von 322 Kühen wurden 81 Tiere randomisiert auf vier Gruppen aufgeteilt. Zwei dieser Gruppen erhielten L-Carnitin (Supplementationsgruppen) und die anderen zwei Gruppen stellten die Kontrollgruppen (KG 1 n = 14/ KG 2 n = 11) dar. Von den supplementierten Gruppen erhielt Car. 1 (n = 26) von 3 Wochen (Wo.) ante partum (a.p.) bis zur Kalbung über das Futter täglich 5g L Carnitin (Carnipas®). Post partum bekamen die Tiere 1g L Carnitin von der Kalbung bis vier Wo. p.p. Parallel wurden einer zweiten supplementierten Gruppe, Car. 2 (n = 30), täglich 5g L Carnitin 3 Wochen a.p. bis zur Kalbung verabreicht. Klinische und Blutkontrollen erfolgten 28 Tage (d) a.p., drei d p.p, 28 d p.p. sowie 56 d p.p. Es wurden das Gesamtcarnitin (GC, n = 5), das freie Carnitin (FC, n = 5), Carnitinester (CE, n = 5), FFS, BHB, Bilirubin, Glucose, Cholesterol, Harnstoff, TTP, Albumin, CK, AST, Pi, Ca, Fe bei allen Tieren analysiert. Zusätzlich erfolgte die Erfassung der Laktationsleistung, der Milchinhaltsstoffe, der Rastzeit (RZ), der Zwischentragezeit (ZTZ) und der Morbidität. Ergebnisse: Das GC, FC und die CE besitzen in den supplementierten Gruppen Car 1 drei d p.p. höhere Konzentrationen als die Kontrollgruppen, die bei Car. 2 (p < 0,05) im GC und FC auch im weiteren Verlauf beobachtet wurden. Ein deutlicher Konzentrationsabfall aller L-Carnitinfraktionen vier Wo. p.p. wurde in den supplementierten Gruppen beobachtet. In den Kontrollgruppen stiegen sie zur gleichen Zeit nicht einheitlich an. Acht Wochen p.p. sanken die L-Carnitinkonzentrationen im Blut sowohl in den Kontrollgruppen, als auch in der supplementierten Gruppen weiter ab. In allen Gruppen stiegen drei d p.p. die FFS-Konzentrationen an (p < 0,05), das BHB auch in den supplementierten Gruppen, die Glucose- und Cholesterolkonzentration fielen ab (p < 0,05). Vier und 8 Wo. p.p. ließen sich ein Abfallen der FFS- (p < 0,05) und der BHB-Konzentrationen (p < 0,05) erkennen. Die Cholesterol- (p < 0,05) und verzögert auch die Glucosekonzentration stiegen an. Drei d p.p. stiegen die Bilirubinkonzentration (p < 0,05) und die AST-Aktivität (p < 0,05) an, dem ein ebensolcher Abfall (p < 0,05) folgte. Präpartal trat in der supplementierten Gruppen Car. 2 eine höhere Bilirubinkonzentration als in der Kontrollgruppe (p < 0,05) auf, was bei den AST-Aktivitäten zwischen den supplementierten Gruppen postpartal (p < 0,05) der Fall war. Drei d p.p waren niedrigere Konzentrationen des Proteins (p < 0,05), des Albumins (p < 0,05) in Car. 2 und in der Kontrollgruppe sowie des Harnstoffs (p < 0,05) in den Kontrollgruppen zu beobachten. Die CK-Aktivität nahm drei d p.p. zu (p < 0,05), um vier Wo. p.p. wieder abzufallen (p < 0,05). Gleichzeitig war einen Anstieg des Proteins (p < 0,05) und des Albumins in den Kontrollgruppen (p < 0,05), verzögert auch in den supplementierten Gruppen (p < 0,05), messbar. In allen Gruppen waren drei d p.p. niedrigere Ca- (p < 0,05), Fe- (p < 0,05) und Pi- Konzentrationen (p < 0,05) auffällig, die später wieder anstiegen. Im Verlauf war die Ca-Konzentration bei Car. 2 gegenüber der Kontrollgruppe höher (p < 0,05). Die Leistungsparameter differierten weder bei den Milchleistungs-, noch bei den Fruchtbarkeitskennzahlen gesichert. Bezüglich der Morbidität war auffällig, dass das GC und FC bei gesunden Kühen a.p. gegenüber den im Laktationsverlauf erkrankten gesichert höher war (p < 0,05). Schlussfolgerungen: Orale L Carnitinapplikation bei Kühen mit hohem Milchleistungsniveau erbrachte keine Stoffwechsel-, Leistungs- und Morbiditätsunterschiede gegenüber den Kontrollgruppen. Die Ergebnisse entsprechen aber der Hypothese einer gesteigerten ß-Oxidation durch die Carnitinsupplementation mit erhöhten BHB-Konzentrationen als Folge. Post partum gesunde Kühe hatten a.p. signifikant höhere L-Carnitinkonzentrationen als kranke.

Hintergrund: Angststörungen gehören zu den häufigsten psychischen Störungen im Jugend- und Erwachsenenalter. Ein Großteil der Betroffenen bleibt meist unbehandelt. Informationen über die Behandlungswahrscheinlichkeit bei Jugendlichen und jungen Erwachsenen in Abhängigkeit von der Störungs- und Behandlungsart, Lebensalter, Geschlecht und Komorbidität liegen bisher nicht vor. Methode: In einer repräsentativen Stichprobe 14- bis 34-Jähriger aus dem Großraum München (Early Developmental Stages of Psychopathology Studie, N = 3021) werden die Prävalenz und Lebenszeitinzidenz von Angststörungen sowie ihre Behandlungsraten mittels M-CIDI erfasst und differenziert für Lebensalter, Komorbidität und Geschlecht präsentiert. Ergebnisse: 30% der Befragten berichteten mindestens eine Angststörung in ihrem Leben. Fast die Hälfte der Betroffenen (43%) suchte irgendeine Behandlung, ein Drittel (28%) suchte einen Psychotherapeuten auf. Für die meisten Angststörungen lagen hohe Quoten psychotherapeutischer Behandlungen vor (Range: 50–61%). Jugendliche berichteten seltener als Erwachsene irgendeine Behandlung, eine psychotherapeutische Behandlung, die Konsultation eines Psychiaters oder Hausarztes. Frauen nahmen häufiger eine Psychotherapie in Anspruch als Männer. Das Vorliegen einer komorbiden Angst- oder depressiven Störung erhöhte die Behandlungswahrscheinlichkeit. Diskussion: Verglichen mit europäischen Studien berichtete die Stichprobe relativ häufig eine Behandlung, auch eine psychotherapeutische. Dies kann eine Folge des großen Behandlungsangebotes in München sein. Dennoch bleibt der Großteil der jungen Betroffenen unbehandelt. Zur Prävention langfristiger Beeinträchtigungen sowie sekundärer psychischer Störungen sollte das Versorgungssystem verstärkt auf diese Bevölkerungsgruppe ausgerichtet werden. / Background: Anxiety disorders are among the most frequent mental disorders in adolescence and adulthood. Most of the affected individuals do not receive treatment. Information about treatment use among adolescents and young adults, differentiated for the kind of treatment and anxiety disorder, age, gender and co-morbidity, is still missing. Methods: In a representative sample of 14–34 year-old adolescents and young adults of the Munich area (Early Developmental Stages of Psychopathology study, N = 3,021) prevalence and lifetime incidence of anxiety disorders and treatment use are assessed using the M-CIDI and will be presented for age, co-morbidity and gender. Results: 30% of all participants reported at least one lifetime diagnosis of an anxiety disorder. Almost half of those affected (43%) received some kind of treatment; one third (28%) received psychotherapy. Psychotherapy use was frequent in most anxiety disorders (range: 50–61%). Older individuals more frequently reported any treatment, psychotherapy, consultations with psychiatrists or general practitioners. Women used psychotherapy more often than men. Co-morbid anxiety or depressive disorders increased the probability of treatment use. Discussion: As compared to European estimations, we found relatively high rates of treatment use. This may be due to the many treatment possibilities in the Munich area. Nevertheless, most young people affected do not receive treatment. Considering the long-term effects of anxiety disorders and in order to prevent secondary disorders, efforts should be increased to reach these young individuals.

Background. General population data were used to study co-morbidities between lifetime social phobia and mood disorders. Methods. Data come from the US National Comorbidity Survey (NCS). Results. Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2·9), dysthymia (2·7) and bipolar disorder (5·9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10–15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders. Conclusions. Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.

Tuberculosis (TB) and human immunodeficiency virus (HIV) are difficult conditions to manage, in tandem they pose even more challenges to public health programs in identifying coinfection to ensure that all TB cases are treated to completion of therapy (COT). The purpose of this study was to test variables that predicted COT among the HIV/TB coinfected population of non-Hispanic, U.S.-born Blacks alive at the time of diagnosis. Social determinants of health were the theoretical foundation used to guide the study based on data from the Report of Verified Cases of TB (RVCT) between 2009 and 2014. Relationships were tested between ethnic/racial group membership and the likelihood of COT, and whether any association to COT was moderated by COT eligibility; a Centers for Disease Control and Prevention calculated algorithm considering disease severity, site, age, and disease complexity. The research design was a longitudinal quantitative approach using binary logistic regression to identify correlated variables associated with COT in the final model. The results showed no statistically significant differences among racial/ethnic groups, age, and gender for COT. COT was moderated by COT eligibility; odds ratio (5.4 - 11.6) times more likely to complete therapy. This study supports positive social change for programs by providing data driven outcomes to providers that support outreach, patient education, and disease prevention. In addition, this research describes an evaluation metric based on performance to set a foundation for collaboration among partners who manage other comorbidities in the United States.

Women using addictive substances during pregnancy: the effects of substance abuse on the prenatal and postnatal development of child Blanka Nechanská Abstract Background: Substance abuse among pregnant women represents a public health issue internationally, associated with high costs to the society and at the personal level for the women and children involved. Aims: The aim of the study was to determine the basic socioeconomic characteristics of women with substance use disorder during pregnancy and selected characteristics neonatal outcomes their children. Another goal was to study the morbidity in children prenatally exposed to addictive substances by studying hospitalizations up to three years of age. Material and methods: Series of analysis within database-linkage study combining data on pregnancy and neonatal outcomes with data from in-patient treatment in CR in 2000-2014 was performed. The sample consisted of pregnant women diagnosed with substance use disorder during pregnancy and women from general population, and their children. Neonatal outcomes were gestational age, birth weight and length, preterm birth, and intrauterine growth restriction (Small-for-Gestational-Age, SGA). Information on the number of hospita- lizations, treatment time and diagnostic groups according to ICD-10 were outcomes of...

Spelberoende är ett allvarligt folkhälsoproblem som förorsakar en rad negativa konsekvenser för individer, där spelberoendet ofta är kombinerat med samsjuklighet, vilket gör problematiken mer komplex. På grund av denna problematik är det viktigt att ta reda på hur behandlare uppfattar behandlingsmetoder. Syftet med denna studie var att undersöka behandlares uppfattningar av behandlingsarbetet med personer som har spelberoende i kombination med samsjuklighet. Utifrån en kvalitativ ansats genomfördes sex semi-strukturerade intervjuer med behandlare. Materialet analyserades genom en tematisk analys. Resultatet visar att behandlarna belyser vikten av att integrera och anpassa olika metoder, teorier, besitta ett brett förhållningssätt och att samverka med andra aktörer för att kunna bemöta och behandla denna komplexa målgrupp. En slutsats är att behandlarna tycks ha en medvetenhet av behandlingsarbetet som tvärdisciplinärt där arbetet med olika behandlingsmetoder används eklektiskt. Studien påvisar behovet av ytterligare forskning och mer förebyggande arbete. / Gambling addiction is a public health problem that causes negative consequences for individuals, where gambling addiction is often combined with co-morbidity, which makes the problem more complex. Because of this problem, it is important to examinate how therapists perceive treatment methods. This study aimed to investigate therapists' perceptions of the treatment work, with people who have gambling addiction combined with co-morbidity. Six semi-structured interviews were conducted with therapists based on a qualitative approach. The material was analyzed through thematic analysis. The results indicate that the therapists highlight the importance of integrating and adapting different methods and theories, having a broad approach and cooperation with other actors to treat this complex target group. A conclusion is that the therapists seem to be aware that the treatment work is interdisciplinary where the work with different treatment methods is used eclectically. The study demonstrates the need for further research and preventive work.

Each year approximately five million people are treated in the nation's intensive care units making intensive care one of the most expensive components of the U.S. healthcare system. Of these patients, 400,000-500,000 will die annually giving the ICU the distinction of having the highest rate of mortality and complications in the hospital setting. Studies have demonstrated that one in ten patients who die each day in ICUs might survive if intensivists were present to manage clinical care and direct treatment plans (Randolph & Pronovost, 2002; Dimick, Pronovost, Heitmiller & Lipsett, 2001; Pronovost et al., 2002). The utilization of supplemental remote telemedicine has been investigated as a means of compensating for the limited resource of intensivists (Breslow et al., 2004; Rosenfeld et al., 2000). One specific use of this technology, the electronic intensive care unit or eICU®, has previously demonstrated the potential to improve physiological and economic outcomes in ICU patients through the use of integrated decision-support and patient data systems. The present study focuses on the eICU® as a 21st century technology capable of improving the quality of patient care and identifies those factors most likely to impact the success of this clinical intervention. This research utilizes a non-experimental pre-and post-intervention study design and examines patient data collected on all admissions to five ICUs managed by two regional tertiary care hospitals during a 36-month time period. Each ICU is equipped with eICU® software systems that allow intensivist surveillance of patients from a remote facility. The data is analyzed using both structural equation modeling and decision tree regression modeling to statistically evaluate the effects of patient, hospital and unit characteristics on proximal and distal outcomes in ICU patients. As the development of clinical complications subsequently affects patient length of stay, cost of stay, and mortality, it becomes increasingly imperative to seek interventions capable of reducing the risk of unfavorable patient outcomes. This study closely examines one such intervention, the eICU®.