Urgent Requests Research Articles

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

An early assessment of the efficacy of medicines in the treatment of patients with COVID-19

Coronavirus infection 2019 is considered a modern challenge to the world community. In the absence of vaccines and antivirals, effective and safe medicines are an urgent request from the healthcare system. We have evaluated the medical technologies for COVID-19 which are being examined. The search was conducted on the СlinicalTrials.gov at the beginning of April 2020. As a result it was shown that the growth of new clinical trials in the world devoted to COVID-19 is growing by 65% per week. More often, interventional clinical trials of the II and III phases are carried out. Most studies are planned or conducted in Western Europe (n = 92), China (n = 79), and the United States (n = 51). Surrogate points are usually evaluated, such as: clinical recovery, symptom-based disease relief (fever, cough, diarrhea, myalgia, shortness of breath), lack of progression of shortness of breath, rate of artificial ventilation, rate of admission to the intensive care unit, etc. It is antimalarial drugs that are mainly studied. Currently, it is not possible to discuss the efficacy and safety of a drug in the treatment of COVID-19, as most studies have just begun. The therapeutic regimens proposed now in clinical recommendations have no evidence base, and the studies indicated in them are at best considered hypothesizing.

COVID-19 emergency responders in FDA’s Center for Drug Evaluation and Research

COVID-19 emergency responders in FDA’s Center for Drug Evaluation and Research

P73 Trends in ultrasound guided musculoskeletal injections at one tertiary care centre over 6 years

Abstract Background Ultrasound (US) has brought many benefits into rheumatologic practice, delivery of targeted injections into joints, bursae and other structures. Whilst many joints may be accurately injected in clinic, guided by clinical landmarks, US permits injections into anatomically less accessible sites. We have assessed trends in the number and type of requests for US guided joint or soft tissue injections from the rheumatology department over the last 6 years, and the impact on waiting times. Methods Details of all requests for US guided joint or soft tissue injections were obtained from the St George’s PACS system from 1 January 2013 - 31 December 2018. Review of patient records was conducted to determine whether the referral was routine or urgent, the waiting time between referral and appointment, the joint or structure to be injected, and whether an injection into the requested site was actually performed. Results Table 1 shows the total number of out-patient attendances in rheumatology per year from 2013 - 2018, the number of referrals for US-guided injection, the proportion requested urgently and waiting times for routine and urgent cases. Over 6 years requests for US guided injections have risen 2.3-fold, from <1% to nearly 2% of all out-patient attendances. Of 1834 requests, no injections were given in 420 instances (23%), due to patient preference or lack of indication at time of US. In 2018 of all joint or tendon/bursa injections initiated in rheumatology, 260 (38%) were given in routine clinic time without delay, and 420 (62%) were requested by US with a delay of over 2 months. Conclusion Over 6 years a 33% increase in out-patient clinic workload has been accompanied by a disproportionate 2.3-fold increase in requests for US guided injections, representing >50% of injections initiated by the service. One explanation may be time pressure in clinic. This trend has not been matched by increased radiology capacity, with urgent requests now waiting >6 weeks. This has implications for quality of care, staffing and effective service delivery. The trend to fewer injections in clinic will continue if clinicians become increasingly reliant on radiology colleagues. Disclosures K. Lall None. V. Ejindu None. P.D.W. Kiely None.

Use of Ipilimumab and Pembrolizumab in Metastatic Melanoma in a Combined Heart and Kidney Transplant Recipient: A Case Report

New therapeutic agents such as checkpoint inhibitors are promising strategies in the treatment of metastatic melanoma. Transplant recipients are generally at higher risk of malign diseases. Limited data are available for the use and safety of these agents in this population. We describe a patient who had a stable transplant function over years after a combined heart and kidney transplantation. Immunosuppressive medications included tacrolimus and azathioprine and were later switched to sirolimus and azathioprine. Metastatic melanoma was diagnosed; after detailed explanation of the potential risk, the patient was initially treated with the anti–cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody ipilimumab but experienced an acute kidney graft rejection and rapid progression. Rejection therapy with high-dose corticosteroids was successful, and kidney function was stabilized. Because of the urgent request of the patient for additional therapy, he received a PD-1 inhibitor. Acute kidney graft rejection resulted, with indication for acute dialysis. He developed severe candida pneumonia and died despite extensive antimicrobial therapy. Checkpoint inhibitors have become the standard in a broad entity of tumors. Organ transplant patients are at higher risk of developing malignant diseases. Limited data are available for the use of checkpoint inhibitors in this subgroup, and the use of checkpoint inhibitors is associated with a high risk of graft rejection.

Automatic consultation system for patients with cardiac implantable electronic devices undergoing magnetic resonance imaging

BackgroundSafety evaluation for patients with cardiac implantable electronic devices (CIEDs) undergoing magnetic resonance imaging (MRI) scanning is often overlooked. We developed an automatic consultation system (ACS) to improve the screening rate in these patients.MethodsACS was developed by the Hospital Information System Development Department of Seoul National University Bundang Hospital. It was designed to automatically request pre-MRI cardiac evaluation in patients with CIED when MRI orders are issued. The proportion of the patients without pre-MRI cardiologic evaluation was evaluated before and after the ACS application.ResultsFrom January 2016 to June 2018, a total of 157 patients with CIEDs [pacemaker 136 (86.6%), ICD or CRT-D 21 (13.4%), MR-conditional 117 (74.5%)] visited the MRI facility. Before the ACS application, 23 out of 84 patients (27.4%) did not have adequate pre-MRI cardiologic evaluation. Despite urgent request for pre-MRI cardiac evaluation, MRI examination was postponed or cancelled in 14 (60.8%) cases. After the ACS application, all 73 patients underwent proper cardiologic evaluation before their MRI examinations (P < 0.001). The proportion of immediate request for pre-MRI evaluation at the moment of MRI order also improved with the ACS application (before ACS 57.1%, after ACS 100%, P < 0.001).ConclusionsThe newly developed ACS helped the patients with CIED receive MRI scan safely on the schedule, improving the quality of care in this population.

An investigation into the number and nature of the urgent care consultations managed and referred by community pharmacists in South-East England.

Community pharmacies are recognised as an under-utilised, accessible resource that could support the urgent care agenda. This study aimed to provide a snapshot of the number and nature of urgent care requests presented to a sample of community pharmacies in three counties in southern England, to determine how requests are managed, whether management is appropriate, as assessed by a group of experts, and whether customers receiving the care are satisfied with pharmacists' interventions. A representative sample of pharmacists across the region was invited to keep a log-book documenting all urgent care requests over a two-week period. Data were analysed to estimate frequency and type of requests and to compare consultations in core and non-core hours. Log-book entries were scrutinised blind by an expert panel to determine appropriateness of pharmacist's responses. Customers receiving pharmacists' interventions were surveyed to assess satisfaction. Seventeen pharmacies kept log-books detailing 432 urgent care consultations, equating to 13 consultations per pharmacy per week. Of these, 70% (n = 302) were dealt with by the pharmacist in-house with 30% (n = 130) resulting in referrals. Locum pharmacists were significantly more likely to refer to other NHS services than regular pharmacists. Over half the requests were for symptom management, skin problems presenting most commonly (38% of all symptoms presented). Forty-seven percent of consultations were considered to have 'averted the need for other NHS services'. Pharmacists' referral (but not assessment of urgency) was deemed appropriate by the expert panel in 90% of consultations. Ninety-five percent of customers surveyed were satisfied with the service and would use the pharmacy again. Extrapolating findings across the study population (approximately 4.4 million) suggests that community pharmacists manage over 11 500 urgent care consultations per week, with 8050 managed independently. These prevent approximately 5400 other NHS encounters, while also meeting customer expectations and expert panel endorsement.

Индия: от “реформы М. Сингха” к экономической политике Н. Моди

In consequence of the 1991 economic reform, India has become one of the world&rsquo;s fastest growing economies and evolved into a new center of attraction regionally and globally. Meanwhile, the postreform development model has accumulated a lot of constraints, particularly a high percentage of the people living below poverty line and exacerbation of regional disparities. These unresolved problems hamper geopolitical and geoeconomic aspirations of the country. The architects of reforms have ever emphasized the need to accompany high economic growth by more equitable distribution of income among the general population. This means that economic reforms must be provided with appropriate changes of political institutions reflecting cooperative nature of &ldquo;centre&ndash;state relations&rdquo;. In 2014, Bharatiya Janata Party was able to perceive an urgent request of the Indian society for changes. The government primary tasks emanated from progressive trends of socio-economic and political development were as follows: firstly, to strength the infrastructure; secondly, to attract the foreign direct investments; thirdly, to attain the financial inclusion of the people; fourthly, to create an enabling business environment; and fifthly, to encourage the manufacturing sector. Despite the ongoing efforts improvement in the agricultural sector, some Indian states continue to be shaken by farmers&rsquo; protests. In that way the farmers appeal to the authorities to intensify the implementation of a comprehensive problem solution in the farm sector. It was suggested that this theme will be one of the key issues of the BJP&rsquo;s strategy plan in a pre-election phase. The article points out that under present-day conditions, transformation development model includes the continuation of economic reforms initiated in the early 1990s. The author reveals that the main intention of the transformative development strategy after the 1991 reform was to engage the most vulnerable (in economic and social regard) population groups and sections as well as backward states in economic growth. The article also examines the initiatives of Narendra Modi&rsquo;s government and their results attained in terms of strengthening the socio-economic integration.

현대중국어 부가의문문의 화행 기능과 의사소통 효과

This paper aims to study the function of speech acts and communicative effects carried by means of attaching a tag question to the end of such a sentence as declarative sentence, imperative sentence, exclamatory sentence, and rhetorical question. The paper discusses the presupposition that the hearer needs to know the background information about the information delivered by the speaker. It also discuses four types of Chinese tag questions, such as ‘X嗎?’, ‘X吧?’, ‘X不X?’, ‘不X嗎?’. The ‘declaration’ of the speaker’s views or opinion expressed in a declarative sentence is changed to the speaker’s ‘request’, ‘blame’, ‘excuse’, ‘assertion’ etc by means of attaching a tag question to the end of the declarative sentence. The attachment of a tag question to the end of an imperative sentence with a soft tone changes the speaker’s ‘order’ to ‘advice’, ‘refusal’ to ‘persuasion’, ‘request’ to ‘urgent request’, which may easily get the hearer to cooperate for the conversation. However, the tag question with a strong tone attached to the end of an imperative sentence tends to change the speaker’s ‘order’ to ‘threat’, which may force the hearer to satisfy the speaker’s requirement without complaining. The speaker’s ‘compliment’ expressed in an exclamatory sentence tends to be changed to ‘request’ for the hearer’s approval by means of attaching a tag question to the end of the exclamatory sentence, which have naturally the hearer participate in the conversation. The speaker’s ‘statement’ expressed in a rhetorical question tends to be changed to ‘assertion’, ‘tease’ to ‘blame’, ‘cynicism’ to ‘suggestion’ by means of attaching a tag question to the end of the rhetorical question. These changes of speech act through attaching a tag question have a great influence on the effects of communication in an either affirmative or negative way.

Redes de suministro: evaluación del desempeño logístico de los miembros clave en la distribución física de productos acabados

En el presente artículo se analiza la relación entre los tres actores principales presentes en la distribución física de los productos finales desde la perspectiva de las redes de suministro: operadores logísticos, empresas de transporte y embarcadores. Por medio de una encuesta realizada a tales agentes, informaciones sobre cómo valoran los criterios de desempeño de los servicios ofrecidos y contratados, como el cumplimiento de las entregas sin errores, atención de solicitudes urgentes, averías y pérdida de mercancía fueron recolectadas. Estos criterios fueron analizados desde el punto de vista de cada miembro de la red que contrata o presta el servicio. Se encontró que los criterios más importantes para embarcadores y los transportadores fueron los relacionados a la atención de pedidos urgentes y cumplimiento del programa de entrega, en tanto que para los operadores logísticos la disponibilidad de vehículos y atendimiento en periodo de alta demanda representaron los criterios más significativos.

Justification of Urgent Brain CT Examinations at Medium Size Hospital, Jerusalem

We studied requested urgent Brain CT Scan procedures justification. In addition, we addressed referrer’s (physician’s) awareness of radiation risks. In doing so, we considered two aspects to the issue. First, we reviewed the records of the requested urgent CT scan procedures for a sample of 339 patients at Al-Maqassed Hospital, a major hospital in Palestine. Secondly, we surveyed a sample of forty-two referrer’s from the same hospital to test their awareness of radiation risks. Our study shows that out of the 339 urgent brain CT requests, 69.6% were justified requests and 30.4% were unjustified. On the other hand, our survey on referrers shows that 42% of respondents knew the effective dose of a brain CT scan, 24% of respondents knew the radiation risks and 14% of respondents knew about radiation protection. Although the study is limited, yet it shows the need to reduce the number of brain CT examinations and the need to improve their justification. Consequently, the need for regular education and guideline implementation at least in this country is of paramount importance

An Urgent Request for Evidence-Based Mental Health Intervention Research in Low-Income and Middle-Income Countries

An Urgent Request for Evidence-Based Mental Health Intervention Research in Low-Income and Middle-Income Countries

The role of vascular ultrasound in managing giant cell arteritis in ophthalmology

Giant cell arteritis is the most common systemic vasculitis in the elderly and is a potentially life-threatening ophthalmic emergency that can result in irreversible blindness. Blindness is most commonly associated with acute onset, irreversible arteritic ischemic optic neuropathy. Without treatment, second eye involvement may occur, resulting in bilateral blindness. Patients with established visual loss are treated with high-dose steroids and generally undergo a temporal artery biopsy to confirm their diagnosis. A significant number of patients are, however, referred for urgent ophthalmology assessment from concerns about “incipient” arteritic ischemic optic neuropathy. Before visual loss, patients may experience a range of ocular symptoms related to ischemia. This generally leads to treatment with high-dose systemic steroid and an urgent request for a temporal artery biopsy. Temporal artery biopsy is considered as the standard investigation for confirmatory diagnosis. It is generally arranged as soon as possible, although it is often not carried out for several days, and there may also be delays in histopathological reporting. It is often perceived that the patient is “safe” while on corticosteroids, in that they are being treated to avoid visual loss. What is not acknowledged, however, is that, if patients do not have giant cell arteritis and are being treated “just in case,” they will often require a tapering of oral steroids over several weeks, exposing them to unnecessary and significant side effects. In the rheumatology setting, vascular ultrasound has emerged as a safe and reliable alternative to temporal artery biopsy as a point of care diagnostic tool in the management of giant cell arteritis. Given an experienced sonographer and optimal equipment, a rapid diagnosis can be established in a fast-track clinic setting, taking into consideration clinical assessment, scoring, and ultrasound findings. A huge advantage of ultrasound is that it provides immediate information that can be used to inform treatment decisions. We explore the evidence that supports the incorporation of vascular ultrasound into the ophthalmology repertoire to make a more efficient diagnosis that is cost-effective and associated with better patient outcomes, including a potential reduction in loss of sight and avoidance of unnecessary long-term steroid treatment by early exclusion of mimics.

Electrospun cellulose acetate nanofiber incorporated with hydroxyapatite for removal of heavy metals

Due to the negative impact of the heavy metal ions in water, the rejection of these toxic materials is one of the urgent requests for wastewater treatment. This work aims to facile fabrication and characterization of new organic/inorganic hybrid nanofiber membrane composites for removal of Fe (III) and Pb (II) ions using a batch technique. The manufacturing of pure cellulose acetate nanofibers (CA NFs) and its impregnated with hydroxyapatite (CA/HAp) nanocomposite fibers is explored by an electrospinning process. A production process of uniform and bead-free nanofiber is developed by adjusting various electrospinning conditions. The experiments prove that the slight changes in operating parameters may result in significant variations in the fiber morphology. The influence of various adsorption conditions and its effect on the removal efficiency is investigated. High separation efficiency of about 99.7 and 95.46% within 35 and 40 min. for adsorption Pb (II) and Fe (III) ions using hybrid nanofiber composite, respectively are obtained. The adsorption process was found to obey a pseudo-second-order and Freundlich models. The adsorption mechanism on the CA/HAp composite can be established via ion exchange and surface complexation.

CAUSAL EVALUATIONS OF THE FORENSIC OBJECTS IN THE TRAUMATIC PROCESS

Expert diagnostics of forensic causal determinations should be based on a dialectical-materialistic approach, provided with a modern level of specially applied theoretical knowledge of pathology, etiology and pathogenesis of traumatic processes, as well as stimulated by urgent requests of the theory and practice of forensic medical expertise (FME). The aim of this work is to determine causal estimates of the components of forensic objects: natural and causal – through retrospective causal modelling. Materials and methods. The research material was archival documents of the Vinnytsia Regional Bureau of Forensics (Ukraine) for 2009–2012 with cases of violent death from injuries. 27 deterministic models were constructed by modelling the regular relationships in traumatic processes. Result. The qualitative unity of the forensic object is simulated: empirical (natural) and causal (determinant). The existence of an object determinant in concordance of the determinant object with the deterministic object is stated. The method of investigation of the determinants of expertise was proposed – logical retrospective modelling of object determinants dependencies. An assumed model of the dependency model is a multi-link time-chain of forensic medical determination. The adequacy of the proposed method of logical modelling of determinants in forensic examination is confirmed with the help of known scientific knowledge about dual, causal determination, causal diagnostics of determinants and forensic cause and effect relationships. It is proved that forensic expertise is a multidisciplinary branch of science and reflects the realized integration of different scientific knowledge. However, diagnosis of "causes of violent and non-violent death" requires the development of an applied methodology for FME from the standpoint of modern philosophical concepts of causality and general theory of systems, the achievements of which must be used in the construction of the methodology of FME. Conclusions. From the results of this study, it follows that causation is only a moment of determination, and purely causal modelling as an exploration of a particular type of determination cannot give a complete explanation for the deterministic relationship. The property of necessity of a specific reason determines the tendency, the orientation of development in the form of possibility, which is actualized only by the complete set of determinants - causal and noncausal, conditional.

Referral Patterns in Neuro-Ophthalmology.

Neuro-ophthalmologists specialize in complex, urgent, vision- and life-threatening problems, diagnostic dilemmas, and management of complex work-ups. Access is currently limited by the relatively small number of neuro-ophthalmologists, and consequently, patients may be affected by incorrect or delayed diagnosis. The objective of this study is to analyze referral patterns to neuro-ophthalmologists, characterize rates of misdiagnoses and delayed diagnoses in patients ultimately referred, and delineate outcomes after neuro-ophthalmologic evaluation. Retrospective chart review of 300 new patients seen over 45 randomly chosen days between June 2011 and June 2015 in one tertiary care neuro-ophthalmology clinic. Demographics, distance traveled, time between onset and neuro-ophthalmology consultation (NOC), time between appointment request and NOC, number and types of providers seen before referral, unnecessary tests before referral, referral diagnoses, final diagnoses, and impact of the NOC on outcome were collected. Patients traveled a median of 36.5 miles (interquartile range [IQR]: 20-85). Median time from symptom onset was 210 days (IQR: 70-1,100). Median time from referral to NOC was 34 days (IQR: 7-86), with peaks at one week (urgent requests) and 13 weeks (routine requests). Median number of previous providers seen was 2 (IQR: 2-4; range:0-10), and 102 patients (34%) had seen multiple providers within the same specialty before referral. Patients were most commonly referred for NOC by ophthalmologists (41% of referrals). Eighty-one percent (242/300) of referrals to neuro-ophthalmology were appropriate referrals. Of the 300 patients referred, 247 (82%) were complex or very complex; 119 (40%) were misdiagnosed; 147 (49%) were at least partially misdiagnosed; and 22 (7%) had unknown diagnoses. Women were more likely to be at least partially misdiagnosed-108 of 188 (57%) vs 39 of 112 (35%) of men (P < 0.001). Mismanagement or delay in care occurred in 85 (28%), unnecessary tests in 56 (19%), unnecessary consultations in 64 (22%), and imaging misinterpretation in 16 (5%). Neuro-ophthalmologists played a major role in directing treatment, such as preserving vision, preventing life-threatening complications, or avoiding harmful treatment in 62 (21%) patients. Most referrals to neuro-ophthalmologists are appropriate, but many are delayed. Misdiagnosis before referral is common. Neuro-ophthalmologists often prevent vision- and life-threatening complications.

Flood Management in Aqala through an Agent-Based Solution and Crowdsourcing Services in an Enterprise Geospatial Information System

Propagating crowdsourcing services via a wireless network can be an appropriate solution to using the potential of crowds in crisis management processes. The present study aimed to deploy crowdsourcing services properly to spatial urgent requests. Composing such atomic services can conquer sophisticated crisis management. In addition, the conducted propagated services guide people through crisis fields and allow managers to use crowd potential appropriately. The use of such services requires a suitable automated allocation method, along with a proper approach to arranging the sequence of propagating services. The solution uses a mathematical framework in the context of a GIS (Geospatial Information System) in order to construct an allocation approach. Solution elements are set out in a multi-agent environment structure, which simulate disaster field objects. Agents which are dynamically linked to objects in a crisis field, interact with each other in a competitive environment, and the results in forming crowdsourcing services are used to guide crowds in the crisis field via the crowdsourcing services. The present solution was implemented through a proper data schema in a powerful geodatabase, along with various users with specialized interfaces. Finally, a solution and crowdsourcing service was tested in the context of a GIS in the 2019 Aqala flood disaster in Iran and other complement scenarios. The allocating performance and operation of other system elements were acceptable and reduced indicators, such as rescuer fatigue and delay time. Crowdsourcing service was positioned well in the solution and provided good performance among the elements of the Geospatial Information System.

Joint inventory and distribution strategy for online sales with a flexible delivery option

This paper develops a strategy to jointly optimize the inventory and distribution for an online sales firm. The firm has to decide how to distribute the products from its warehouse to customers: this can either be done by using a company-owned vehicle, or by outsourcing to a third-party transportation company. The online sales environment includes a flexible delivery option that gives a discount to customers in return. This option is offered when the inventory level in the warehouse is lower than a threshold level. Customers accepting flexible delivery pay a deposit at the time they place the order and pay the remaining reduced price at the time of delivery. By offering the flexible delivery option, the firm aims to reduce the cost of distribution to the customers as well as postpone the timing of paying an outside supplier for stock replenishment. Additionally, this allows the firm to use on hand stock effectively to respond to more urgent customer requests. As the timing of cash-flows are dependent on the customer behaviour and the inventory and distribution strategy, the profit function is the Net Present Value of future cash-flows. We analyze the benefit of flexible delivery to the firm and perform sensitivity analysis with respect to various parameters. The profitability of flexible delivery depends on price setting and customer behaviour. Flexible delivery, in this model, has great potential to reduce transport distances and emissions when firms use their own vehicles.

A fast building demand response method based on supply–demand coordination for urgent responses to smart grids

Many demand response (DR) measures are available for building air-conditioning systems, which can be categorized as demand-side-based controls and supply-side-based controls. However, due to the limitations of response speed and/or thermal comfort control, existing methods cannot economically and effectively meet the urgent DR requests from grids in emergency situations. This paper proposes a fast building demand response method based on supply-demand-side coordination for urgent responses to smart grids. It combines both the demand-side-based and supply-side-based control measures simultaneously. On the supply side, direct load control actions are employed to provide immediate power reductions. On the demand side, indoor air temperature set-points are adjusted stepwise according to an “incremental schedule” to achieve a uniform indoor temperature rise in different zones. In addition, two performance indexes are newly proposed to evaluate the sacrifice degree of thermal comfort. Measures for avoiding power rebound in post-DR periods are also considered. The proposed DR method is tested as a case study in a virtual building. The results show that through the coordinated control of the supply and demand side, a fast and effective DR (e.g., 18.3% of power reduction) is achieved with a uniform sacrifice of thermal comfort.

ARRIVE: Ambulance paramedics Responding to urgent patient Requests In general practice for home Visits — Evaluation development

BackgroundIn response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have been introduced over the past few years, with various configuration, employment, and governance arrangements, but we do not know the risks and benefits of Paramedics working in Primary Care (PPC), or which model works best. There is an urgent need to better understand the PPC innovation.AimTo describe the evidence base, theoretical underpinning and current initiatives; and determine the feasibility of undertaking a definitive evaluation of PPC in order to produce generalisable evidence to inform policy and practice.MethodA survey of Welsh Health Boards has been undertaken to identify sites and stakeholders to take part in qualitative interviews. A feasibility study will be conducted with three GP practice sites: one with a directly-employed paramedic; one with a Welsh Ambulance Service-employed paramedic; and a control site. Data will be collected for the following outcomes: 1) number of home visits requested; 2) home visit outcomes (the proportion resolved, further home visit required, emergency admission, 999 call placed); 3) prescribing patterns; 4) subsequent healthcare contacts; 5) patient satisfaction; 6) serious adverse events; and 7) cost profile.ResultsWelsh Health Board survey and qualitative findings will be available at the time of the conference.ConclusionWe will submit an application for a fully powered application to NIHR HS&amp;DR if indicated by our progression criteria.