A Population-Based Susceptible, Infected, Recovered Simulation Model of the Spread of Influenza-Like-Illness in the Homeless versus Non-Homeless Population.

PURPOSE: To examine the prevalence and characteristics of influenza-like illness (ILI) related presentations among people experiencing homelessness compared to the general population as well as to use the Susceptible, Infected, Recovered (SIR) simulation model parameters ß and γ to model infectious interactivity, recovery rate, and population-level basic reproduction number (R0). METHODS: Using administrative health data from emergency department (ED) visits in the province of Ontario, Canada from 2010 to 2017, an SIR model was used to calculate the R0 for ILI in both the general population and the population of homeless individuals. RESULTS: From 2010 to 2017, a total of 17,056 homeless and 85,553 non-homeless individuals presented with an ILI to an ED in Ontario. The estimated infectious interactivity (ß) was lower while the recovery rate (γ) was longer for infected people experiencing homelessness. CONCLUSIONS: Our results suggest that infections of ILI will result in more secondary cases in the homeless population compared to the homed population. This evaluation of the dynamics of ILI spread in the homeless population provides insight into how illnesses such as COVID-19 may be much more infectious in this population compared to the homed population.

Applying latent tree analysis to classify Traditional Chinese Medicine syndromes (Zheng) in patients with psoriasis vulgari.

OBJECTIVE: To treat patients with psoriasis vulgaris using Traditional Chinese Medicine (TCM), one must stratify patients into subtypes (known as TCM syndromes or Zheng) and apply appropriate TCM treatments to different subtypes. However, no unified symptom-based classification scheme of subtypes (Zheng) exists for psoriasis vulgaris. The present paper aims to classify patients with psoriasis vulgaris into different subtypes via the analysis of clinical TCM symptom and sign data. METHODS: A cross-sectional survey was carried out in Beijing from 2005-2008, collecting clinical TCM symptom and sign data from 2764 patients with psoriasis vulgaris. Roughly 108 symptoms and signs were initially analyzed using latent tree analysis, with a selection of the resulting latent variables then used as features to cluster patients into subtypes. RESULTS: The initial latent tree analysis yielded a model with 43 latent variables. The second phase of the analysis divided patients into three subtype groups with clear TCM Zheng connotations: 'blood deficiency and wind dryness'; 'blood heat'; and 'blood stasis'. CONCLUSIONS: Via two-phase analysis of clinic symptom and sign data, three different Zheng subtypes were identified for psoriasis vulgaris. Statistical characteristics of the three subtypes are presented. This constitutes an evidence-based solution to the syndromedifferentiation problem that exists with psoriasis vulgaris.

Postoperative pain after intrathecal analgesia in laparoscopic liver resection: a retrospective chart review.

BACKGROUND: Intrathecal analgesia (IA) has been recommended by the enhanced recovery after surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone. METHODS: After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m2, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome. RESULTS: Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; P=0.016). CONCLUSIONS: IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

Polypharmacy and mobility outcomes.

Polypharmacy is known to be associated with negative consequences of mobility related conditions such as falls, functional decline and disability. This systematic review highlights the effectiveness of deprescribing interventions on mobility related conditions in older adults in the community dwelling reported taking five or more medications daily.

Statistical validation of Traditional Chinese Medicine syndrome postulates in the context of patients with cardiovascular disease.

OBJECTIVE: Traditional Chinese Medicine (TCM) has many postulates that explain the occurrence and co-occurrence of symptoms using syndrome factors such as yang deficiency and yin deficiency. A fundamental question is whether the syndrome factors have verifiable scientific content or are purely subjective notions. This analysis investigated the issue in the context of patients with cardiovascular disease (CVD). DESIGN: In the past, researchers have tried to show that TCM syndrome factors correspond to real entities by means of laboratory tests, with little success. An alternative approach, called latent tree analysis, has recently been proposed. The idea is to discover latent variables behind symptom variables by analyzing symptom data and comparing them with TCM syndrome factors. If there is a good match, then statistical evidence supports the validity of the relevant TCM postulates. This study used latent tree analysis. SETTING: TCM symptom data of 3021 patients with CVD were collected from the cardiology departments of four hospitals in Shanghai, China, between January 2008 and June 2010. RESULTS: Latent tree analysis of the data yielded a model with 34 latent variables. Many of them correspond to TCM syndrome factors. CONCLUSIONS: The results provide statistical evidence for the validity of TCM postulates in the context of patients with CVD; in other words, they show that TCM postulates are applicable to such patients. This finding is important because it is a precondition for the TCM treatment of those patients.