Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between (...) the different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (shrink)

To date researchers planning experiments have always lived by the mantra that 'using equal sample sizes gives the best results' and although unequal groups are also used in experimentation, it is not the preferred method of many and indeed actively discouraged in literature. However, during live study planning there are other considerations that we must take into account such as availability of study participants, statistical power and, indeed, the cost of the study. These can all make allocating equal sample sizes (...) difficult, and sometimes near impossible. This, some might say, means that the study would not adhere to rigorous statistical standard (Rosenbaum and Rubin, 1985). However, here we present evidence that, not only is this a false assumption, but that we may actually gain more power in the study by actually using unequal groups. Here, data from a Sepsis Biomarker study is used, in which the aim is to predict, by biomarker level and presence, whether the patient would go on to develop sepsis. It was found that larger control groups may give more power to studies looking for an effect in the mid range but not for large or small effects. This study shows merit in the hypothesis that more power can be achieved when a larger control group is used. Published by the Ministry of Defence at dstl - Reference DSTLTR92592 P2PP2R-2016-02-23T13:39:45. (shrink)

The essay that follows is, in substance, a lecture delivered in Brussels on 7 December 2016 to the 2nd International Conference of the European Network of Japanese Philosophy. In it I argue that the strategy of qualifying nothingness as an “absolute,” which was adopted by Kyoto School thinkers as a way to come to grips with fundamental problems of Western philosophy, is inherently ambiguous and ultimately weakens the notion of nothingness itself. In its place, a proposal is made to define (...) nothingness in terms of “connectedness.” The discussion is bound on both ends by an apology for transgressing established academic boundaries. On one end, I open with a brief digression on a common ground for philosophies East and West as a mestizaje to which no tradition can claim dominance. On the other, I close with an appeal for restoring respect for the role of mythical narration as a way to bridge the connection between theory and practice without having to revert to moral absolutes, particularly as it relates to safeguarding this fragile planet of ours from the ongoing sepsis of economic “progress.”. (shrink)

Introduction: Respiratory distress (RD) is a major emergency to which infants are particularly vulnerable. It can lead to neurological sequelae and even death when treatment is not adequate and rapid. Objective: To evaluate the management of RD in infants at the CNHU-HKM in Cotonou. Methods: The study was of a transversal and analytical nature and took place over a period of 06 months, from 1st January to 30th June 2015. Included in the study were all infants hospitalised for DR. The (...) therapeutic modalities were analysed according to the recommendations of the World Health Organization. Results: A total of 96 infants were included. The hospital frequency of DR was 38%. The average age was 12 months. One in 3 infants had SaO2 less than 90% on admission, and in 58.3% of cases, the infant showed at least 3 signs of struggle. The initial assessment was as recommended. The systematic use of oxygenrequires a revision of the criteria for oxygentherapy in the unit. The three main causes were severe pneumonia (31.3%), severe malaria (18.8%) and bronchiolitis (15.6%), and their treatment was correct. However, none of the infants had been able to benefit from ventilatory support. Mortality was high (31.2%) linked to the intensity of DR (p = 0.04) and sepsis (p = 0.006). Conclusion: The procedures for the diagnosis and treatment of RD in infants at the CNHU are fairly consistent with WHO guidelines. Ventilatory support is necessary for some children with severe RD. (shrink)