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  1. Article ; Online: Effect of specialist consultation on emergency department revisits among patients with uncomplicated recent-onset atrial fibrillation or flutter.

    Lane, Daniel J / Scheuermeyer, Frank X / Nemnom, Marie-Joe / Taljaard, Monica / Stiell, Ian

    CJEM

    2022  Volume 24, Issue 7, Page(s) 760–769

    Abstract: Objectives: To examine the association between specialist consultation and risk of 30-day ED revisit in emergency department (ED) patients with recent-onset uncomplicated atrial fibrillation or flutter (AF/AFL).: Methods: As a secondary analysis of a ...

    Abstract Objectives: To examine the association between specialist consultation and risk of 30-day ED revisit in emergency department (ED) patients with recent-onset uncomplicated atrial fibrillation or flutter (AF/AFL).
    Methods: As a secondary analysis of a previously published trial, clinical experts identified predictors of consultation including age and sex, ED sinus conversion, thromboembolic risk, heart rate, rate control medication use, coronary artery disease and anti-platelet use, and chronic obstructive pulmonary disease. These were included in a propensity-matched hierarchical Bayesian model accounting for hospital site as a random effect, with 30-day ED revisit as the primary outcome. We also measured ED length of stay for consulted and non-consulted patients.
    Results: We analyzed data from 11 sites for 829 ED patients with AF/AFL, of whom 364 (44%) had specialist consultation. A total of 128 patients (15.4%) had an ED revisit, 78 (16.8%) from the no consult group and 50 (13.7%) from the consult group. Consultation rates ranged from 8.8 to 71% between sites. Median length of stay was 591 min (interquartile range [IQR] 359-1024) for consulted patients and 300 min (IQR 212-409) for patients without consultation. After propensity-matching, consulted patients had a 0.6% (IQR - 4 to 3%) lower risk of 30-day revisits than non-consulted patients (probability of lower risk 55%).
    Conclusions: In ED patients with uncomplicated AF/AFL, there was substantial between-site variation in specialist consultations; such consultation was unlikely to influence revisits within 30 days while ED length of stay was nearly double. ED specialist consultations may not be necessary for uncomplicated patients.
    MeSH term(s) Humans ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/therapy ; Atrial Flutter/diagnosis ; Atrial Flutter/epidemiology ; Atrial Flutter/therapy ; Bayes Theorem ; Emergency Service, Hospital ; Referral and Consultation ; Male ; Female ; Multicenter Studies as Topic ; Clinical Trials as Topic
    Language English
    Publishing date 2022-09-22
    Publishing country England
    Document type Journal Article
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1007/s43678-022-00370-5
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  2. Article ; Online: Classification versus Prediction of Mortality Risk using the SIRS and qSOFA Scores in Patients with Infection Transported by Paramedics.

    Lane, Daniel J / Lin, Steve / Scales, Damon C

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2019  Volume 24, Issue 2, Page(s) 282–289

    Abstract: ... ...

    Abstract Objective
    MeSH term(s) Aged ; Aged, 80 and over ; Cohort Studies ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Organ Dysfunction Scores ; Prognosis ; Risk Factors ; Sensitivity and Specificity ; Sepsis/diagnosis ; Sepsis/mortality ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/mortality
    Language English
    Publishing date 2019-06-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903127.2019.1624901
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  3. Article ; Online: Detoxification of wood-combustion ashes containing Cr and Cd by thermal treatment.

    Lane, Daniel J / Sippula, Olli / Peräniemi, Sirpa / Jokiniemi, Jorma

    Journal of hazardous materials

    2020  Volume 400, Page(s) 123315

    Abstract: This study assesses the potential of thermal processing for detoxification of wood-combustion ashes that contain high levels of Cr and Cd. Thermal treatment (1000 °C) of bottom ash and fly ash in an oxidising gas (air) atmosphere resulted in: low ... ...

    Abstract This study assesses the potential of thermal processing for detoxification of wood-combustion ashes that contain high levels of Cr and Cd. Thermal treatment (1000 °C) of bottom ash and fly ash in an oxidising gas (air) atmosphere resulted in: low volatilisation of Cd and most other heavy metals, oxidation of Cr in the ashes to Cr (VI), and, in the case of the fly ash, significantly increased leaching of Cr and Mo. Thermal treatment in a nitrogen atmosphere resulted in local reducing conditions due to oxidation of ash-derived carbon to CO (g). Thermal treatments in this atmosphere and in a reducing atmosphere consisting of 10 % H
    Language English
    Publishing date 2020-06-25
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1491302-1
    ISSN 1873-3336 ; 0304-3894
    ISSN (online) 1873-3336
    ISSN 0304-3894
    DOI 10.1016/j.jhazmat.2020.123315
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  4. Article ; Online: Changes in presentation, presenting severity and disposition among patients accessing emergency services during the first months of the COVID-19 pandemic in Calgary, Alberta: a descriptive study.

    Lane, Daniel J / Blanchard, Ian E / Buick, Jason E / Shaw, Marta / McRae, Andrew D

    CMAJ open

    2021  Volume 9, Issue 2, Page(s) E592–E601

    Abstract: Background: The COVID-19 pandemic has resulted in unique pressures on the emergency services system. This study describes changes in the presentation, presenting severity and disposition of patients accessing emergency services in Calgary, Alberta, ... ...

    Abstract Background: The COVID-19 pandemic has resulted in unique pressures on the emergency services system. This study describes changes in the presentation, presenting severity and disposition of patients accessing emergency services in Calgary, Alberta, during the first wave of the pandemic.
    Methods: In this descriptive study, we constructed a population cohort of all patients who accessed emergency services by calling emergency medical services (EMS) (ambulance service that provides prehospital treatment and transport to medical facilities) or presenting directly to an emergency department (4 adult and 1 pediatric) or 2 urgent care centres in Calgary during the exposure period (December 2019 to June 2020) compared to 2 historical control periods (December to June, 2017-2018 and 2018-2019) combined. Outcomes included frequency of presentation, system flow indicators, patient severity, disposition and mortality. We used a locally estimated scatterplot smoothing function to visualize trends. We described differences at the maximum and minimum point of the exposure period compared to the control period.
    Results: A total of 1 127 014 patient encounters were included. Compared to the control period, there was a 61% increase in the number of patients accessing EMS and a 35% decrease in the number of those presenting to an adult emergency department or urgent care centre in the COVID-19 period. The proportion of EMS calls for the highest-priority patients remained stable, whereas the proportion of patients presenting to an emergency department or urgent care centre with the highest-priority triage classification increased transiently by 0.9 percentage points (increase of 89%). A smaller proportion of patients were transported by EMS (decrease of 21%), and a greater proportion of emergency department patients were admitted to hospital (increase of 25%). After the first case was reported, the mortality rate among EMS patients increased by 265% (3.4 v. 12.4 per 1000 patient encounters).
    Interpretation: The first wave of the COVID-19 pandemic was associated with substantial changes in the frequency and disposition of patients accessing emergency services. Further research examining the mechanism of these observations is important for mitigating the impact of future pandemics.
    MeSH term(s) Adult ; Aged ; Alberta ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/virology ; Emergency Medical Services/statistics & numerical data ; Emergency Medical Services/trends ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pandemics/prevention & control ; Pandemics/statistics & numerical data ; SARS-CoV-2/isolation & purification ; Severity of Illness Index
    Language English
    Publishing date 2021-06-01
    Publishing country Canada
    Document type Comparative Study ; Journal Article
    ZDB-ID 2701622-5
    ISSN 2291-0026 ; 2291-0026
    ISSN (online) 2291-0026
    ISSN 2291-0026
    DOI 10.9778/cmajo.20200313
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  5. Article ; Online: Hydronephrosis severity clarifies prognosis and guides management for emergency department patients with acute ureteral colic.

    Innes, Grant D / Scheuermeyer, Frank X / McRae, Andrew D / Teichman, Joel M H / Lane, Daniel J

    CJEM

    2021  Volume 23, Issue 5, Page(s) 687–695

    Abstract: Objective: In emergency department patients with ureteral colic, the prognostic value of hydronephrosis is unclear. Our goal was to determine whether hydronephrosis can differentiate low-risk patients appropriate for trial of spontaneous passage from ... ...

    Abstract Objective: In emergency department patients with ureteral colic, the prognostic value of hydronephrosis is unclear. Our goal was to determine whether hydronephrosis can differentiate low-risk patients appropriate for trial of spontaneous passage from those with clinically important stones likely to experience passage failure.
    Methods: We used administrative data and structured chart review to evaluate a consecutive cohort of patients with ureteral stones who had a CT at nine Canadian hospitals in two cities. We used CT, the gold standard for stone imaging, to assess hydronephrosis and stone size. We described classification accuracy of hydronephrosis severity for detecting large (≥ 5 mm) stones. In patients attempting spontaneous passage we used hierarchical Bayesian regression to determine the association of hydronephrosis with passage failure, defined by the need for rescue intervention within 60 days. To illustrate prognostic utility, we reported pre-test probability of passage failure among all eligible patients (without hydronephrosis guidance) to post-test probability of passage failure in each hydronephrosis group.
    Results: Of 3251 patients, 70% male and mean age 51, 38% had a large stone, including 23%, 29%, 53% and 72% with absent, mild, moderate and severe hydronephrosis. Passage failure rates were 15%, 20%, 28% and 43% in the respective hydronephrosis categories, and 23% overall. "Absent or mild" hydronephrosis identified a large subset of patients (64%) with low passage failure rates. Moderate hydronephrosis predicted slightly higher, and severe hydronephrosis substantially higher passage failure risk.
    Conclusions: Absent and mild hydronephrosis identify low-risk patients unlikely to experience passage failure, who may be appropriate for trial of spontaneous passage without CT imaging. Moderate hydronephrosis is weakly associated with larger stones but not with significantly greater passage failure. Severe hydronephrosis is an important finding that warrants definitive imaging and referral. Differentiating "moderate-severe" from "absent-mild" hydronephrosis provides risk stratification value. More granular hydronephrosis grading is not prognostically helpful.
    MeSH term(s) Bayes Theorem ; Canada ; Emergency Service, Hospital ; Female ; Humans ; Hydronephrosis/diagnostic imaging ; Male ; Middle Aged ; Prognosis ; Renal Colic/diagnostic imaging
    Language English
    Publishing date 2021-07-25
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1007/s43678-021-00168-x
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  6. Article ; Online: Association of emergency department boarding times on hospital length of stay for patients with psychiatric illness.

    Lane, Daniel J / Roberts, Lauren / Currie, Shawn / Grimminck, Rachel / Lang, Eddy

    Emergency medicine journal : EMJ

    2021  Volume 39, Issue 7, Page(s) 494–500

    Abstract: Background: Extended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we ... ...

    Abstract Background: Extended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients.
    Methods: ED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018. The primary exposure was boarding time (admission decision to inpatient bed transfer), and primary outcome was inpatient length of stay. Confounders for this relationship, including indicators of illness severity, were selected a priori then the association was assessed using hierarchical Bayesian Poisson regression, which accounts for repeat observations of the same patient and differences between hospital sites. Changes in length of stay were measured using a rate ratio (ie, expected change in length of stay for each 1 hour increase in boarding time).
    Results: A total of 19 212 admissions (14 261 unique patients) were included in the analysis. The average boarding time was 14 hours (range: 0-186 hours). Patients who were boarded for greater than 14 hours more frequently required a high-observation bed (14% vs 3.5%), received an antipsychotic (44% vs 14%) or received sedation (55% vs 33%) while in the ED. The probability that boarding time increased hospital length of stay (rate ratio: >1) was 92%, with a median increase for a patient boarded for 24 hours of 0.01 days.
    Conclusion: Boarding in the ED was associated with a high probability of increasing the hospital length of stay for psychiatric patients; however, the absolute increase is minimal. Although slight, this signal for longer length of stay may be a sign of increased morbidity for psychiatric patients held in the ED.
    MeSH term(s) Bayes Theorem ; Emergency Service, Hospital ; Hospitals ; Humans ; Length of Stay ; Mental Disorders/epidemiology ; Patient Admission ; Retrospective Studies
    Language English
    Publishing date 2021-06-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2020-210610
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    Zs.A 1941: Show issues Location:
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  7. Article ; Online: What is the risk of returning to the emergency department within 30 days for patients diagnosed with substance-induced psychosis?

    Barbic, David / Whyte, Madelyn / Sidhu, Gurwinder / Luongo, Allesandra / Stenstrom, Robert / Chakraborty, Tapash Apu / Scheuermeyer, Frank / Honer, William G / Lane, Daniel J

    CJEM

    2022  Volume 24, Issue 7, Page(s) 702–709

    Abstract: Objectives: The primary objective of this study was to measure the risk of return Emergency Department (ED) visits in patients presenting to the ED with a diagnosis of substance-induced psychosis. Secondary objectives included: (1) describing the ... ...

    Abstract Objectives: The primary objective of this study was to measure the risk of return Emergency Department (ED) visits in patients presenting to the ED with a diagnosis of substance-induced psychosis. Secondary objectives included: (1) describing the characteristics of patients returning within 30 days to the ED with substance-induced psychosis, and (2) identifying risk factors associated with such ED return.
    Methods: At two urban sites from January 1, 2018 to December 31, 2019, we included consecutive patients presenting to the ED with substance-induced psychosis defined by their ED discharge diagnosis of psychosis and clinical evidence of substance use. We described ED resources utilized by this patient population including ED time and disposition then subsequently described return visits within 30 days and characteristics among those patients who returned.
    Results: We identified 611 unique patients presenting with substance-induced psychosis, with 813 total ED visits. The median age was 35 years (IQR 28-45), 71.4% (n = 436) were male, and 44.8% (n = 274) were homeless. The median ED length of stay was 619 min (IQR 313-898), and 48.4% (n = 296) were admitted to hospital. Forty percent of patients (n = 237) returned to the ED within 30 days of the index substance-induced psychosis visit, 116 (18.9%) returning more than once. Of these return visits, 74 (31.2%) were for recurrent substance-induced psychosis. Younger age, female gender, no opioid use, and no prior history of bipolar disorder were identified as common characteristics among those returning to the ED with substance-induced psychosis.
    Conclusions: In ED patients with substance-induced psychosis, nearly half of all patients were admitted to hospital, 40% had a 30 days return ED visit, and one-third of those were for substance-induced psychosis. We identified clinically relevant factors common to those returning with recurrent substance-induced psychosis.
    MeSH term(s) Humans ; Male ; Female ; Adult ; Patient Readmission ; Retrospective Studies ; Emergency Service, Hospital ; Hospitalization ; Psychotic Disorders/epidemiology
    Language English
    Publishing date 2022-09-15
    Publishing country England
    Document type Journal Article
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1007/s43678-022-00364-3
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  8. Article: Detoxification of wood-combustion ashes containing Cr and Cd by thermal treatment

    Lane, Daniel J / Sippula, Olli / Peräniemi, Sirpa / Jokiniemi, Jorma

    Journal of hazardous materials. 2020 Dec. 05, v. 400

    2020  

    Abstract: This study assesses the potential of thermal processing for detoxification of wood-combustion ashes that contain high levels of Cr and Cd. Thermal treatment (1000 °C) of bottom ash and fly ash in an oxidising gas (air) atmosphere resulted in: low ... ...

    Abstract This study assesses the potential of thermal processing for detoxification of wood-combustion ashes that contain high levels of Cr and Cd. Thermal treatment (1000 °C) of bottom ash and fly ash in an oxidising gas (air) atmosphere resulted in: low volatilisation of Cd and most other heavy metals, oxidation of Cr in the ashes to Cr (VI), and, in the case of the fly ash, significantly increased leaching of Cr and Mo. Thermal treatment in a nitrogen atmosphere resulted in local reducing conditions due to oxidation of ash-derived carbon to CO (g). Thermal treatments in this atmosphere and in a reducing atmosphere consisting of 10 % H₂ and the balance N₂ detoxified the ashes in at least two ways: (i) by substantially removing Cd, Pb, Bi, Tl, and, in the case of the fly ash, Zn from the ashes by volatilisation; and (ii) by thermal reduction of Cr (VI) in the ashes. There was at least a 100-fold reduction in the leaching of total Cr from both the bottom ash and the fly ash following the thermal treatments in reducing conditions. Chromium only leached from the detoxified bottom ash to a significant extent in acidic conditions (pH < 4).
    Keywords air ; bottom ash ; carbon ; chromium ; fly ash ; heat treatment ; nitrogen ; oxidation ; pH ; volatilization
    Language English
    Dates of publication 2020-1205
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ZDB-ID 1491302-1
    ISSN 1873-3336 ; 0304-3894
    ISSN (online) 1873-3336
    ISSN 0304-3894
    DOI 10.1016/j.jhazmat.2020.123315
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  9. Article: Thermal separation of zinc and other valuable elements from municipal solid waste incineration fly ash

    Lane, Daniel J / Hartikainen, Aki / Sippula, Olli / Lähde, Anna / Mesceriakovas, Arunas / Peräniemi, Sirpa / Jokiniemi, Jorma

    Journal of cleaner production. 2020 Apr. 20, v. 253

    2020  

    Abstract: Municipal solid waste incineration fly ashes can contain high concentrations of Zn and other valuable elements including Cu, Pb, Sn, and Sb. These elements can potentially be separated from fly ashes by selectively volatilising and condensing them in ... ...

    Abstract Municipal solid waste incineration fly ashes can contain high concentrations of Zn and other valuable elements including Cu, Pb, Sn, and Sb. These elements can potentially be separated from fly ashes by selectively volatilising and condensing them in thermal processes. This study presents a thermal process for production of zinc concentrates from fly ashes and assesses the impact of the reducing gas atmosphere used in the process on the volatility of Zn, Pb, and Cu. Concentrates were produced by heating samples of municipal solid waste incineration fly ash in a reducing atmosphere, consisting of 10% H2 and 90% N2, and selectively condensing elements which volatilised from the ash at 900 and 1100 °C. Thermodynamic equilibrium calculations were used to predict the volatile behaviour of Zn, Pb, and Cu in the reducing atmosphere and in an oxidising atmosphere (air). The extent of volatilisation of these elements was also determined experimentally for both the reducing atmosphere and the oxidising atmosphere by means of mass balances based on elemental analyses of untreated and heat-treated ashes. The concentrate produced at 900 °C contained high concentrations of Zn (55.9 ± 12.5% w/w) and Pb (4.7 ± 1.1% w/w). These metals and other higher value elements, specifically, Sn, Sb, and Bi, were greatly enriched in the concentrates when compared with the untreated fly ash, showing a high potential for the developed process to separate multiple valuable elements from ashes. However, several deleterious impurities, particularly K, Na, and Cd, also reported to the concentrates in significant concentrations. Further refinements to the process are needed to separate these elements from Zn. The reducing gas atmosphere substantially increased the volatility of Zn, but suppressed the volatility of Cu and, to a lesser extent, the volatility of Pb. The equilibrium calculations overestimated the release of Cu in oxidising conditions and the release of Zn and Pb in both oxidising and reducing conditions.
    Keywords antimony ; bismuth ; cadmium ; copper ; fly ash ; heat treatment ; hydrogen ; lead ; municipal solid waste ; nitrogen ; potassium ; sodium ; tin ; volatilization ; waste incineration ; zinc
    Language English
    Dates of publication 2020-0420
    Publishing place Elsevier Ltd
    Document type Article
    ISSN 0959-6526
    DOI 10.1016/j.jclepro.2020.120014
    Database NAL-Catalogue (AGRICOLA)

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  10. Article ; Online: Bayesian analysis of amiodarone or lidocaine versus placebo for out-of-hospital cardiac arrest.

    Lane, Daniel J / Grunau, Brian / Kudenchuk, Peter / Dorian, Paul / Wang, Henry E / Daya, Mohamud R / Lupton, Joshua / Vaillancourt, Christian / Okubo, Masashi / Davis, Daniel / Rea, Thomas / Yannopoulos, Demetris / Christenson, Jim / Scheuermeyer, Frank

    Heart (British Cardiac Society)

    2022  Volume 108, Issue 22, Page(s) 1777–1783

    Abstract: Objective: Clinical trials for patients with shock-refractory out-of-hospital cardiac arrest (OHCA), including the Amiodarone, Lidocaine or Placebo (ALPS) trial, have been unable to demonstrate definitive benefit after treatment with antiarrhythmic ... ...

    Abstract Objective: Clinical trials for patients with shock-refractory out-of-hospital cardiac arrest (OHCA), including the Amiodarone, Lidocaine or Placebo (ALPS) trial, have been unable to demonstrate definitive benefit after treatment with antiarrhythmic drugs. A Bayesian approach, combining the available evidence, may yield additional insights.
    Methods: We conducted a reanalysis of the ALPS trial comparing treatment with amiodarone or lidocaine with placebo in patients with OHCA following shock-refractory ventricular fibrillation or ventricular tachycardia (VF/VT). We used Bayesian regression to assess the probability of improved survival or improved neurological outcome on the 7-point modified Rankin Scale. We derived weak, moderate and strong priors from a previous clinical trial.
    Results: The original ALPS trial randomised 3026 adult patients with OHCA to amiodarone (n=974, survival to hospital discharge 24.4%), lidocaine, (n=993, survival 23.7%) or placebo (n=1059, survival 21.0%). In our reanalysis the probability of improved survival from amiodarone ranged from 83% (strong prior) to 95% (weak prior) compared with placebo and from 78% (strong) to 90% (weak) for lidocaine-an estimated improvement in survival of 2.9% (IQR 1.4%-3.8%) for amiodarone and 1.7% (IQR 0.84%-3.2%) for lidocaine over placebo (moderate prior). The probability of improved neurological outcome from amiodarone ranged from 96% (weak) to 99% (strong) compared with placebo and from 88% (weak) to 96% (strong) for lidocaine.
    Conclusions: In a Bayesian reanalysis of patients with shock-resistant VF/VT OHCA, treatment with amiodarone had high probabilities of improved survival and neurological outcome, while treatment with lidocaine had a more modest benefit.
    MeSH term(s) Adult ; Humans ; Amiodarone/therapeutic use ; Anti-Arrhythmia Agents/therapeutic use ; Bayes Theorem ; Lidocaine/therapeutic use ; Out-of-Hospital Cardiac Arrest/drug therapy ; Ventricular Fibrillation/therapy ; Randomized Controlled Trials as Topic
    Chemical Substances Amiodarone (N3RQ532IUT) ; Anti-Arrhythmia Agents ; Lidocaine (98PI200987)
    Language English
    Publishing date 2022-10-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2021-320513
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