Mid-Western Regional Hospital Research Articles

A randomised controlled trial of a Mediterranean Dietary Intervention for Adults with Rheumatoid Arthritis (MEDRA): Study protocol

BackgroundRheumatoid arthritis (RA) is the most common type of autoimmune arthritis affecting 0.5–1% of the adult population worldwide. While the primary line of treatment of RA includes pharmacological therapies, people living with the condition often seek non-pharmacological therapies such as diet and exercise in an attempt to attenuate their symptoms. Established, evidence-based dietary guidelines for RA are currently lacking. The MEDRA study aims to explore the effectiveness of implementing, via telehealth, a Mediterranean type diet (MedDiet) compared to a standard healthy diet as per the Healthy Eating Guidelines (HEG) in Ireland in terms of differences in physical function and quality of life in adults with RA living in Ireland. MethodsThe MEDRA study is a parallel, randomised controlled trial delivered through telehealth methods. Forty-four eligible participants who have RA will be randomly allocated to either a MedDiet or HEG group for a 12 weeks intervention period. Primary outcome measures include changes in physical function and quality of life, both of which will be measured using validated questionnaires at baseline, six and twelve weeks. Both intervention arms will attend a total five teleconsultations with a Registered Dietitian (RD). The MedDiet intervention arm focuses on recommendations from the traditional Mediterranean diet and HEG intervention arm will use the dietary recommendations as currently advised in Ireland. DiscussionThis study will provide evidence as to whether dietary treatment of RA can improve physical function and quality of life in a small cohort of participants with RA. The results of the study will be disseminated at national scientific conferences and published in peer-reviewed journals. EthicsThis protocol has been approved by the Education and Health Sciences Research Ethics Committee at the University of Limerick (2020_09_05_EHS) and by the Health Service Executive Mid-Western Regional Hospital Research Ethics Committee (REC Ref 103/19). Trial registrationClinicalTrials.gov NCT04262505. Trial registration date: April 2, 2020.

The impact of frailty Screening of Older adults with muLtidisciplinary assessment of those At Risk during emergency hospital attendance on the quality, safety and cost-effectiveness of care (SOLAR): a randomised controlled trial.

BackgroundOlder people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource-intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit.MethodsThis will be a parallel 1:1 allocation randomised control trial. All patients who are ≥ 75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥ 2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be the length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation.Ethics and disseminationEthical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer-reviewed journals and national and international conferences.Trial registrationClinicalTrials.gov NCT04629690. Registered on November 16, 2020

Predictors of Dropout in a Cohort of People Undergoing Treatment for Borderline Personality Disorder in a Public Community Mental Health Service: A Time-to-Event Analysis

Background: Dialectical Behaviour Therapy (DBT) is an effective evidence based treatment for Borderline Personality Disorder (BPD). However, irrespective of the success of the treatment, a dropout rate of approximately 30%-40% is regarded as the norm. In this analysis we aimed to investigate whether early predictors of dropout can be identified from baseline data. Methods: Between 2014 and 2017, data was collected from 196 participants at multiple timepoints as part of a coordinated multisite study of standard DBT treatment for community based service users being treated for BPD in Ireland. Dropout was strictly defined as per the standard DBT programme four-miss rule. For this analysis data were censored at 48 weeks and risk factors for dropout were identified using a Cox proportional hazards model that adjusted for age and gender. Engagement with phone coaching in the first month was examined as a time dependant covariate. Outcomes: Of the 196 participants, 12 (6%) were censored and 9 (4%) removed leaving 187 for analysis of whom, 109 (58%) completed and 66 (32%) dropped out. Results from univariable Cox proportional hazard regressions found off-label use of anti-psychotic medication was associated with an increased risk of drop-out, while full time employment status, receipt of disability support and engagement with phone coaching in the first month were associated with a reduced risk of dropout. Entering these variables in a multivariable Cox proportional hazard regression found off-label use of anti-psychotic medication (adjusted HR 2·69, 95% CI 1·50 - 4·83; p=0·001); full time employment status (adjusted HR 0.23, 95% CI 0.07-0.77; p=0.02) and disability (adjusted HR 0.20, 95% CI 0.05-0.85; p=0.03) remained significant predictors. Interpretation: Awareness of employment status and off-label prescription of anti-psychotic medication at baseline as significant risk factors for dropout may provide clinicians with valuable insight when starting treatment and could potentially inform treatment approach. Funding Information: This work, as part of the The National DBT Project, was funded by the Irish Health Service Executive (HSE) and the National Office for Suicide Prevention (NOSP). The fund is administered via the National Suicide Research Foundation (NSRF). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: All procedures were reviewed and approved by the following research ethics committees: Clinical Research Ethics Committee of the Cork University Teaching Hospitals, Galway Clinical Research Ethics Committee, HSE Mid Western Regional Hospital Research Ethics Committee, HSE North East Area Research Ethics Committee, HSE South East Area Research Ethics Committee, Linn Dara & Beechpark Ethics Committee; Naas General Hospital Ethics Committee; Saint John of God Hospitaller Ministries Research Ethics Committee and Sligo General Hospital Research Ethics Committee.

Implementing an allied health team intervention to improve the care of older adults in the emergency department: protocol for a process evaluation

IntroductionHealth and social care professionals (HSCPs) have increasingly contributed to enhance the care of patients in emergency departments (EDs), particularly for older adults who are frequent ED attendees with significant...

Exploring the perspectives of stroke survivors and healthcare professionals on the use of mobile health to promote physical activity: A qualitative study protocol

Background: Physical inactivity is both the second-highest population attributable risk factor for and a common consequence of stroke. Despite well-documented health benefits associated with physical activity, its levels typically remain below recommended guidelines in stroke survivors. Consequently, calls have been made for novel interventions targeting the promotion of physical activity in stroke survivors. Mobile health is an emerging field which can offer personalised health interventions through mobile and wireless technology. However, a paucity of research has focused on mobile health to promote physical activity in stroke survivors and, more broadly, this field has been criticised for not incorporating the views of stakeholders. This study aims to explore the perspectives of stroke survivors and healthcare professionals on the development of a mobile health intervention for the promotion of physical activity. Methods: The current study will employ a qualitative descriptive approach using separate, semi-structured focus groups for two key stakeholder groups. Community-dwelling stroke survivors will be recruited through an early supported discharge service for acute stroke and stroke support groups. Healthcare professionals will be recruited through the same early supported discharge service, relevant professional bodies and Twitter. The final number of focus groups will depend on data saturation. Thematic analysis will be conducted using NVivo 12 and findings will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. Conclusion: This study was granted ethical approval from the HSE Mid-Western Regional Hospital Research Ethics Committee and the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Output will consist of recommendations for the development of a mobile health intervention aimed at the promotion of physical activity in stroke survivors. Findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals.

Induction of labor in Mid-Western Hospital in Nepal: Practice and Solution

IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery.

Acute hospital reconfiguration and self-harm presentations: a before-and-after study.

The evidence for improved patient outcomes following acute hospital reconfiguration is limited. We assessed the impact of the reconfiguration of acute services within a hospital group in terms of the number and clinical management of self-harm presentations. The study was conducted across the three Mid-Western regional hospitals in Ireland during 2004-2014. Reconfiguration in April 2009 involved two hospitals reducing the operation of their emergency departments (EDs) from 24 to 12h. We used Poisson regression analysis of data from the National Self-Harm Registry Ireland to assess change in the hospital burden and clinical management of self-harm associated with the reconfiguration. We observed that the cumulative decrease in self-harm presentations at the two reconfigured hospitals was of a similar magnitude to the increase observed at the larger hospital. Despite this large increase in presentations, there was only a small increase in admissions. Reconfiguration of hospital services was also associated with changes in the provision of assessments for self-harm patients. There is evidence to suggest that acute hospital reconfiguration of hospital services impacts on patterns of patient flow. Findings have implications for those implementing reconfiguration of acute services.

Profile of Caesarean Section in Mid-Western Regional Hospital in Nepal

Rising rate of caesarean section since few decades has been a global public health issue.This study is aimed to determine the rate of caesarean section plus examine the indications and complications of caesarean section. A retrospective cross-sectional study was conducted using secondary data sources at Mid-Western Regional Hospital in Surkhet, Nepal. Data were collected from patients'records ofthe hospital dating from 16 July 2016 to 15 July 2017. All patients who had delivered their baby by caesarean section were included in this study. Data were analyzed by help of SPSS version 21.Ethical approval was obtained from the hospital authority prior to the study. During the study, out of total 3,694 deliveries, 695 (18.8%) were caesarean section. Most of the caesarean section were emergency than elective (83.0% vs 17.0%). Among all women who underwent caesarean section, majority were from 37 to 42 weeks pregnancy (88.5%), age group between 20 and 24 (42.9%) and multiparous (53.5%).Fetal distress (20.1%) was most common among all major indications of caesarean section.Maternal complications due to caesarean section was low (3.7%). Among all complications, Post-partum hemorrhage (30.5%) was the major maternal complication of caesarean section. Most of newborn babies had APGAR score six or more at one minute (94.5%) and five minutes (97.9%). In our study, caesarean section rate was 18.8%, which is higher than WHO recommendation (10 - 15%). Main indication for caesarean section was fetal distress. Maternal and fetal complications were low.

Profile of Caesarean Section in Mid-Western Regional Hospital in Nepal

Profile of Caesarean Section in Mid-Western Regional Hospital in Nepal

P216 Mesenteric disease is directly related to mucosal disease in Crohn's disease

Background: Crohn's disease (CD) displays mesenteric disease manifestations such as fat wrapping and mesenteric thickening. The frequency at which these occur in CD point to a pathobiological relevance. Fat wrapping in particular has been suggested to play a role in disease progression [1]. This study aimed to evaluate the relationship between mesenteric disease and other manifestations of CD and to examine the significance of advanced mesenteric disease. Methods: Ethical approval and informed consent were obtained from the HSE Mid-Western Regional Hospital Research Ethics Committee. All patients undergoing resection for ileocolic CD in University Hospital Limerick since 2010 have undergone a resection which included the mesentery. Novel disease activity indices were generated to quantify mesenteric and mucosal disease. Mesenteric disease was graded based on the presence and extent of mesenteric thickening and fat wrapping (Table 1A). Mucosal disease was graded based on the presence of different intestinal features of CD (Table 1B). Pre-operative Crohn's disease activity index (CDAI) was recorded for all patients. The effect of smoking on all disease activity indices was investigated. The relationship between histologic fat wrapping and surgical recurrence was determined in all intestinal forms of CD (n=94). Table 1A. Mesenteric disease activity index in Crohn's disease Key: FW = fat wrapping, MT = mesenteric thickening. Table 1B. Mucosal disease activity index in Crohn's disease Results: Mucosal and mesenteric disease were topographically coupled in all resection specimens examined. There was a direct association between mesenteric and mucosal disease when investigated using the novel disease activity indices (r=0.78, p<0.0001). Higher CDAI scores were associated with higher mesenteric and mucosal disease scores (r=0.72; r=0.70, respectively, p<0.0001). Patients who smoked had more severe mesenteric disease (p<0.05) but there was no effect on mucosal disease or CDAI. Fat wrapping was observed histologically in 13 (41.9%) index resection specimens and 18 (72%) recurrence specimens. Fat wrapping was an independent predictor of increased risk of surgical recurrence (HR 4.7, 95% CI: 1.71–13.01, p=0.003) and was also associated with a shortened time to recurrence (p<0.001). Conclusions: There was a direct association between mesenteric disease and mucosal disease manifestations. Fat wrapping independently predicted surgical recurrence and was associated with a shortened time to recurrence.

Miller's Pyramid and Core Competency Assessment: A Study in Relationship Construct Validity.

Continuous professional development relies on the link between performance and an educational process aimed at improving knowledge and skill. One of the most broadly used frameworks for assessing skills is Miller's Pyramid. This Pyramid has a series of levels of achievement beginning with knowledge (at the base) and ending with routine application in the clinical setting. The purpose of this study was to determine the degree of convergence of two measurement methods, one based on Miller's framework, the second using the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties (ACGME/ABMS) Core Competency framework. The data were gathered from the faculty of a large, Midwestern regional health care provider and hospital system. Data from 264 respondents were studied. The 360° data were from raters of physicians holding supervisory roles in the organization. The scale items were taken from an instrument that has been validated for both structure and known group prediction. The Miller scale was purposely built for this application. The questions were designed to describe each level of the model. The Miller scale was reduced to a single dimension. This result was then regressed on the items from the 360° item ratings. Results of a multivariate analysis of variance isolated a significant relationship between the Miller's Pyramid score and the competency items (P < 0.001). These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.

Soothing Rooms Reduce the Need for Restraints for Inpatient Mental Health Patients

Implementation of soothing rooms for adults and adolescents in an acute mental health unit in a Midwestern regional hospital resulted in a 35% reduction in the use of restraints among the adult patients, demonstrating a benefit to both patients and mental health nurses by reducing restraint usage and suggesting a new standard of care. The effectiveness of soothing rooms was evaluated in an acute 32-bed mental health care unit at the SwedishAmerican Center for Mental Health, Rockford, Illinois, USA, and is discussed in this article.

The Diagnostic Yield of Double Contrast Barium Enema

Introduction: The disease of colon and rectum impose a major diagnostic challenge to the clinician. Although double contrast barium enema (DCBE) has been overshadowed by the advent of colonoscopy and the sophisticated investigations, its role in failed colonoscopies can not be disputed. Aim: Aim of this study was to evaluate the diagnostic accuracy of DCBE. Methods: Patients attending the Mid-Western Regional Hospital, Ennis for DCBE from January 2003 to December 2007 were identified from computerised database of radiology department and were studied retrospectively. The accuracy / effectiveness of the procedure were examined in terms of its completeness. The diagnostic yield for benign and malignant pathologies was determined along with primary and secondary diagnosis. Results: A total of 278 patients (159 Females and 119 Males) with mean age of 64.44 +/- 12.99 (range 25-92) attended the Hospital for DCBE. Colonic cancer were diagnosed in 15 (5.39 %) whereas diverticular disease was reported in 137 (49.28 %) patients. There were no missed pathologies and a failure rate of less than 2% was achieved in this study. Conclusion: Double contrast barium enema is a sensitive diagnostic tool in the investigation of colorectal pathologies. In view of its low failure rate, it may be used as an adjunct to commonly practiced endoscopic investigation to further increase the accuracy

P233 Early measurement of fecal calprotectin after intestinal resection is useful to predict postoperative recurrence in patients with Crohn's disease

Background: Serological Inflammatory markers can be used for assisting in the diagnoses of inflammatory bowel disease but are neither particularly sensitive nor specific. Aim of this study is to investigate the role of fecal Calprotectin in the diagnosis of inflammatory bowel disease along with the serological markers ESR, CRP and endoscopic and radiological means. Methods: Retrospective data of Fecal Calprotectin was collected from the online portal of Kings College Pathology Laboratory London, along with blood and colonoscopy reports from the iLab and Unisoft software of the Mid Western Regional Hospital Limerick respectively over period of 18 months. Statistical analysis was performed using Chi square and Student’s T test on SPSS. A P-value of 0.05 was taken as significant. Results: In the 18 months 97 patients had their faecal Calprotectin checked. Fifty-two (53.6%) of them subsequently had the diagnosis of inflammatory bowel disease made on the basis of colonoscopy, CT scan abdomen or small bowel follow through. We divided patients into 2 groups on the basis of faecal Calprotectin values. Patients in group 1 faecal Calprotectin values less than 60 (n = 27) group 2 had values above 60 to 2009 (70). Of those with normal faecal Calprotectin 21 did not have a diagnosis of IBD, whilst 6 had, of those with elevated faecal Calprotectin 23 did not have a diagnosis of IBD, whilst 47 did (Chi square test, p = 0.001). Six (22%) of group 1 had colitis while nineteen (27%) of group 2 were normal. Mean ESR in group 1 was 11.38 VS 17.65 in group 2 (P= 0.159 Student T Test) while mean CRP in group 1 was 10.6 VS 6.4 in group 2 (P= 0.226 Student T test). Those patients with subsequent diagnosis of IBD (52) had a mean faecal Calprotectin of 335.89 VS non IBD patients (45) mean faecal Calprotectin value was 138 (P= 0.0059 Student T test). Conclusions: This study shows that the use of faecal Calprotectin is a reliable indicator of IBD in the Irish population studied. It also shows that ESR and CRP levels do not correlate with or assist in the diagnosis of IBD in this population.

P232 Evaluation of the use of fecal calprotectin as a diagnostic aid for IBD in an Irish population

Background: Serological Inflammatory markers can be used for assisting in the diagnoses of inflammatory bowel disease but are neither particularly sensitive nor specific. Aim of this study is to investigate the role of fecal Calprotectin in the diagnosis of inflammatory bowel disease along with the serological markers ESR, CRP and endoscopic and radiological means. Methods: Retrospective data of Fecal Calprotectin was collected from the online portal of Kings College Pathology Laboratory London, along with blood and colonoscopy reports from the iLab and Unisoft software of the Mid Western Regional Hospital Limerick respectively over period of 18 months. Statistical analysis was performed using Chi square and Student’s T test on SPSS. A P-value of 0.05 was taken as significant. Results: In the 18 months 97 patients had their faecal Calprotectin checked. Fifty-two (53.6%) of them subsequently had the diagnosis of inflammatory bowel disease made on the basis of colonoscopy, CT scan abdomen or small bowel follow through. We divided patients into 2 groups on the basis of faecal Calprotectin values. Patients in group 1 faecal Calprotectin values less than 60 (n = 27) group 2 had values above 60 to 2009 (70). Of those with normal faecal Calprotectin 21 did not have a diagnosis of IBD, whilst 6 had, of those with elevated faecal Calprotectin 23 did not have a diagnosis of IBD, whilst 47 did (Chi square test, p = 0.001). Six (22%) of group 1 had colitis while nineteen (27%) of group 2 were normal. Mean ESR in group 1 was 11.38 VS 17.65 in group 2 (P= 0.159 Student T Test) while mean CRP in group 1 was 10.6 VS 6.4 in group 2 (P= 0.226 Student T test). Those patients with subsequent diagnosis of IBD (52) had a mean faecal Calprotectin of 335.89 VS non IBD patients (45) mean faecal Calprotectin value was 138 (P= 0.0059 Student T test). Conclusions: This study shows that the use of faecal Calprotectin is a reliable indicator of IBD in the Irish population studied. It also shows that ESR and CRP levels do not correlate with or assist in the diagnosis of IBD in this population.

FRI0592-HPR Relationship between energy expenditure and inflammatory markers linked to cardiovascular disease (CVD) in rheumatoid arthritis (RA)

BackgroundIt has recently come to light that the increased mortality risk in the RA population is related to increased CVD risk. The key feature explaining the increased CVD risk in...

AB1451-HPR Correlation between sensewear armband (SWA) and international physical activity questionnaire (IPAQ) in rheumatoid arthritis (RA)

BackgroundIt is well recognised that many health benefits, in particular cardiovascular benefits, are associated with an active lifestyle (Bauman, 2004). Those with RA are at an increased risk of mortality...

FRI0591-HPR Correlates of energy expenditure in the rheumatoid arthritis (RA) population

BackgroundFew research studies have been conducted designed specifically to examine the correlates of physical activity behaviour for people with RA. Most of this work has been conducted assessing the psychosocial...

Study to Determine the Criterion Validity of the SenseWear Armband as a Measure of Physical Activity in People With Rheumatoid Arthritis

Measuring physical activity in people with rheumatoid arthritis (RA) is of great importance in light of the increased mortality in this population due to cardiovascular disease. Validation of activity monitors in specific populations is recommended to ensure the accuracy of physical activity measurement. Thus, the purpose of this study was to determine the validity of the SenseWear Pro3 Armband (SWA) as a measure of physical activity during activities of daily living (ADL) in people with RA. Fourteen subjects (8 men and 6 women) with a diagnosis of RA were recruited from rheumatology clinics at the Mid-Western Regional Hospitals, Limerick, Ireland. Participants undertook a series of ADL of varying intensities. The SWA was compared to the criterion measures of the Oxycon Mobile indirect calorimetry system (energy expenditure in kJ) and of manual video observation (step count). Bland and Altman, intraclass correlation coefficient (ICC), and correlation analyses were done using SPSS, version 19.0. The SWA showed substantial agreement (ICC 0.717, P < 0.001) and a strong relationship (Pearson's correlation coefficient = 0.852) compared with the criterion measure when estimating energy expenditure during ADL. However, it was found that the SWA overestimated energy expenditure, particularly at higher intensity levels. The ability of the SWA to estimate step counts during ADL was poor (ICC 0.304, P = 0.038). The SWA can be considered a valid tool to estimate energy expenditure during ADL in the RA population; however, attention should be paid to its tendency to overestimate energy expenditure.

The Advanced Paramedic Clinical Activity Study (APCAS): an insight into the work of advanced paramedics in the mid-west of Ireland

The Advanced Paramedic (AP) is a relatively recent role in Ireland and refers to a prehospital practitioner with Advanced Life Support (ALS) skills and training. The Advanced Paramedic Clinical Activity Study (APCAS) was initiated to provide an evaluation of the impact of the AP programme on patient care in Ireland. The aim of this study is to provide an insight into the clinical activity of APs over a 6-month period in the mid-west region of Ireland. A prospective study was initiated whereby all ambulance calls dispatched by the regional Ambulance Control Centre were recorded by the attending AP, including calls received via the statutory 999/112 system. Participating APs were asked to complete a separate call log data sheet recording all demographic and clinical information for every call attended during the study period. A total of 17 APs participated and 1,969 ambulance calls were recorded in APCAS. The Mid-Western Regional Hospital, Limerick was the busiest receiving facility. Activity peaked at weekends and was lowest on Tuesdays. Crew response, on-scene times and transport times agree with previous reports. Most common emergencies include medical (12 %), cardiovascular (10%) and altered level of consciousness and seizures (10%). Least common calls include airway and ventilation and environmental emergencies (<1%). This study provides an insight into the work of APs in the mid-west region of Ireland. It would appear that despite the relative recency of the Irish AP programme, the findings of this study are in line with previous international studies.