30th September Research Articles

Effectiveness of Fenestration and Discectomy among Patients Presenting with Lumbar Disc Herniation

Background:Research-StackExchange47, BackgroundLumbar disc herniation (LDH) is a frequent cause of back pain and neurological dysfunction that often requires surgical treatment. There writing was another popular technique fenestration the other favorite disceyotomy, to relieve symptoms by decompressing ✓ spinal nerve roots. The study is an investigation of these existing methods and their comparison with the aim of evaluating efficacy in symptom relief as well as patient outcome. Objective: aim to compare the clinical outcomes of fenestration and discectomy in lumbar disc herniation. Study design : Descriptive case series comparative study. Place and duration of study. 6th September 2023 to 6the March, 2024 at the Department of Neurosurgery, Qazi Hussain Ahmad Medical Complex Nowshera. Methods: The patients were included in this descriptive case series study that was conducted from 6th September 2023 to 6the March, 2024 at the Department of Neurosurgery, Qazi Hussain Ahmad Medical Complex Nowshera. A sample size was determined at 46% success rate with the help of WHO software, a confidence interval of 95% and margin of error was set at 9%. Assessment of the outcomes in patients including pain and functional improvement were calculated using p-values between groups by standard deviation. Results: This retrospective study included 118 patients (34 females and 84 males) with lumbar disc herniation. Overall, the proportion of males to females was 2.47:1 In a total of 88 patients (74.58%), efficacy was reported, and the mean score for effective relief from symptoms was 3.5 ± 1.2 (SD). Statistical analysis revealed significant differences between the techniques (p < 0.05) with fenestration being marginally superior. Conclusion: Fenestration and discectomy for lumbar disc herniation: a follow-up study. As for symptomatic relief, fenestration seemed to be slightly better. Conclusions. This study provides evidence for both surgical methods as valid surgical options; however, choice of technique should be individualized based on patient characteristics. It is recommended that future studies with larger samples, to provide for more inclusive results.

The Influence of Smoking on Peri-Implantitis Treatment Outcomes: A Systematic Review and Evaluation of Adjunctive Therapies

Background: Peri-implantitis is a significant complication in implant dentistry, characterized by the progressive loss of bone support around implants, often exacerbated by heavy bacterial colonization in dental plaque. Smoking, a known risk factor for periodontal disease, may adversely affect peri-implant tissue health and treatment outcomes. Objective: This systematic review aims to analyze the impact of smoking on the clinical treatment outcomes of peri-implantitis in adult patients, focusing on key clinical parameters and the effectiveness of various treatment modalities. Methods: A systematic search was conducted across several databases including PubMed, Scopus, Web of Science, and Google Scholar using keywords related to smoking and peri-implantitis treatment to identify relevant articles published in English language without any restriction for the time of publication until 30th September 2024. Studies were included on the eligibility criteria, emphasizing adult smokers with diagnosed peri-implantitis undergoing various treatments. Data extraction focused on clinical parameters outcomes including plaque index (PI), bleeding on probing (BOP), probing depth (PD), and bone levels. Results: Seven studies met the inclusion criteria, highlighting that smokers exhibited higher PI, BOP, and PD at baseline compared to non-smokers. Adjunctive therapies, particularly antimicrobial photodynamic therapy (aPDT), significantly improved clinical parameters in smokers. However, smokers demonstrated less favorable outcomes in gingival recession and bone levels post-treatment. Conclusion: Smoking negatively impacts the treatment outcomes of peri-implantitis, with smokers showing heightened inflammatory responses and less improvement in clinical parameters. Clinicians should consider smoking status when planning treatment protocols for peri-implantitis to optimize patient outcomes. Further research is warranted to develop targeted interventions for this vulnerable population.

Influence of direct and staggered sowing of pelleted onion (Allium cepa) seeds on various seed yield parameters under Asian mid-hill conditions

The experiment was conducted during 2021–22 and 2022–23 at Dr. Yashwant Singh Parmar University of Horticulture and Forestry, Nauni, Solan, Himachal Pradesh to study the impact of precision planting (using pelleted seeds) and sowing dates on the numerous attributes of the onion (Allium cepa L.) variety Palam Lohit. The study was carried out with the objective to determine whether direct seed sowing would lead to successful seed production in onion under mid-hill conditions (which is not the conventional practice). Also, the staggered sowing dates would help to determine the best sowing time for higher seed production. The experiment was laid in randomized block design (Factorial) (F-RBD) with 3 replications having 19 treatments, including 3 pelleting treatments, viz. P1 (wood ash); P2 (ZnSO4 + wood ash); and P3 (H3BO3 + wood ash); 6 sowing dates, viz. D1 (15th September); D2 (1st October); D3 (15th October); D4 (1st November); D5 (15th November); and D6 (1st December); and Da (traditional bulb planting as control). The study revealed that seed pelleting with ZnSO4 + wood ash and early sowing (15th September) gave best results in terms of emergence (%), plant height, number of seeds/umbel and number of seeds/plant, seed yield and 1000-seed weight. The direct sowing treatments produced seeds in one year as opposed to two years using the conventional bulb planting method, which is traditionally being used in the Asian mid-hills.

Changes in echocardiographic parameters after hemodialysis session in a North African pediatric population with end-stage renal disease and without known heart disease.

Children undergoing long-term hemodialysis (HD) face a reduction in life expectancy mostly due to cardiovascular mortality. Effects of HD on cardiac function have not been fully elucidated in pediatric population. This study aimed to assess HD session impact on cardiac function in pediatric patients using conventional and strain echocardiography. We performed a prospective, comparative study of echocardiographic parameters before and after single HD session in a chronic HD pediatric population. We enrolled between the 1st and 30th September 2023, all consecutive patients with end-stage renal disease (ESRD) aged up to 18 years old on maintenance HD three times weekly for at least three months. All patients underwent conventional and left ventricular (LV) longitudinal strain echocardiography in a window of 30-60 minutes before and after HD. 23 patients, 14.8 ± 2.1 years old and 47.8% male, were enrolled. Reductions in body weight and blood pressure were observed after HD, whereas heart rate increased. Significant decrease in LV and left atrial diameters and volumes after HD session were observed. Mitral peak E velocity, as well as average E/e' were significantly lower after HD. Although LV ejection fraction was unchanged, global longitudinal strain for LV was significantly reduced after dialysis (-17.3 ± 3.0% vs. -14.9 ± 2.4%, p=4.10-8). Patent deterioration in LV systolic function following HD was identified by speckle tracking echocardiography (STE). STE has the potential to unmask early myocardial dysfunction even when there is no evident alteration in conventional systolic function parameters in children with ESRD.

A cluster-randomised controlled feasibility trial evaluating the Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS).

There is a high prevalence of cognitive difficulties in MS, but despite this, there are few programmes targeting cognition that focus on the ability to function well in everyday life. The Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS), an occupation-focused cognitive intervention, was developed to address this. It addresses both the functional difficulties and the wide-ranging symptoms that present in MS. Here we report on the results of a cluster-randomised controlled feasibility trial (ISRCTN11462710; registered 4th September 2019) evaluating the COB-MS in terms of feasibility and initial efficacy as a cognitive intervention for people with MS. The eight-session COB-MS intervention was delivered remotely by occupational therapists to participants with MS in the intervention group. Following the end of the trial the COB-MS was delivered to the wait-list control group. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12weeks. Data was also collected in the domains ofcognition, quality of life, and mood. One hundred and eighteen people with MS and cognitive difficulties were randomised to either usual care (n = 60) or COB-MS intervention (n = 58). Ninety-four participants were retained at 6-month follow-up. The COB-MS was found to be feasible, including trial procedures and protocol. Data indicates that the COB-MS is accepted by participants and had positive impacts on daily life. Those allocated to the COB-MS group had a significant improvement in the primary outcome compared to the control condition. Progression criteria set for the feasibility trial have been met therefore further testing of the COB-MS at a definitive trial is supported by the results. The results provide a strong basis for a pathway to a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. ISRCTN11462710 Date of registration: 4th September 2019.

Utility of diffusion weighted Magnetic Resonance Imagining to detect non-palpable undescended testis.

To assess the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of non-palpable undescended testis (NPUT) and to compare DW-MRI results with surgical findings. This descriptive, cross-sectional study was carried out at Dow Institute of Radiology, Dow University of Health Sciences. Karachi on a cohort of patients who underwent DW-MRI for suspected NPUT between 15th September, 2022 to 16th March, 2023. The study included 175 boys below the age of 16 years with history of clinically non-palpable testes. MRI scans were acquired using additional DWI sequence. Two radiology faculty of more than five years of experience independently evaluated the DW-MRI images for the presence or absence of testes in its normal anatomical position, abnormal location, side and size of testes. Out of the 175 patients, DW-MRI successfully detected 128 (73.1%) non-palpable undescended testes. Statistical analysis in clinically detected cases of showed sensitivity of NPTU 0.8%, specificity of 92.5%, diagnostic accuracy 94.29%, positive predictive value 97.7%, and negative predictive value 84.1% for localizing undescended testes with Diffusion Weighted DW-MRI taking surgical findings as gold standard. DWI sequences complement the conventional MRI, increasing its sensitivity and diagnostic accuracy. By facilitating early and accurate diagnosis, DW-MRI has the potential to streamline patient management, reduce unnecessary surgical exploration, and ultimately improve the long-term reproductive health and quality of life for individuals with undescended testes.

Frequency of E-cigarette and Cigarette Smoking and Associated Health Symptoms among the Youth

Purpose: To determine the prevalence of e-cigarette and traditional cigarette use among Pakistani youth and to identify the associated health symptoms. Methodology: This cross-sectional study was conducted using a sample size of 178 respondents aged 15-25, selected through non-probability convenience and snowball sampling methods. Data were collected over five days (1st September 2023 to 6th September 2023) using a questionnaire adapted from validated studies (GATS and YUPESS) and distributed via Google Forms. Findings: The study population consisted of 178 respondents, with a gender distribution of 72.1% males and 27.9% females. Among the respondents, 41.2% had tried either e-cigarettes or traditional cigarettes. The age of first smoking experience varied, with many trying their first cigarette between ages 15 and 18. Significant health symptoms associated with smoking included respiratory issues, general malaise, and worsened asthma. Unique Contribution to Theory, Policy and Practice: The research highlights the prevalence and health impacts of e-cigarette and traditional cigarette use among Pakistani youth. It underscores the need for targeted public health interventions and stricter regulations to mitigate these health risks.

Abstracts of the 12th International Equine Infectious Diseases Conference International Conference Centre (CID), Deauville, France 30th September–4th October 2024

Abstracts of the 12th International Equine Infectious Diseases Conference International Conference Centre (CID), Deauville, France 30th September–4th October 2024

2326 Improving recording and documentation of lying standing blood pressure In patients > 65 admitted with/At high risk of fall(s)

Abstract Introduction The World Falls Guideline 2022 recommends that measurement of lying-standing blood pressure (LSBP) is an integral part of the multifactorial falls assessment (1). Pre-intervention less than half of eligible patients had a LSBP recorded and documented. The aim was to improve the recording and documentation of LSBP for adults aged 65 and over admitted with a fall or at high risk for falls. Method All patients aged 65 and over admitted with fall or identified as at high risk for falls to a care of the elderly ward were included over the period of 15th September 2023-15th November 2023. Royal College of Physicians (RCP) guidance (2017) for standard measurement of LSBP was used2. Data was collected on electronic spreadsheets from electronic observation charts. Two plan do study act (PDSA) cycles were conducted. Firstly, ward posters demonstrated how to record and document LSBP. Secondly ward-based one-to-one teaching interventions using RCP LSBP lanyard flashcards (2) were conducted. Results Following cycle one, 50% of eligible patients had LSBP documented. Following cycle two, 80% of eligible patients had LSBP documented. Following two PDSA cycles, there was a 37.1% increase in the average number of eligible patients who had LSBP correctly recorded and documented. Conclusion(s) Interventions of aide memoirs and education for nursing and medical staff improved the recording and documentation of LSBP. Indications and correct measurement guidance for LSBP should be included in future ward staff induction information and departmental teaching sessions. References 1) Montero-Odasso, M, Van der Velde N, Martin FC et al. The Task Force on Global Guidelines for Falls in Older Adults, World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing, Volume 51, Issue 9, September 2022. 2) Measurement of lying and standing blood pressure: A brief guide for clinical staff. 2017. https://www.rcplondon.ac.uk/projects/outputs/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff.

Colorado Ultraviolet Transit Experiment Near-ultraviolet Transmission Spectroscopy of the Ultrahot Jupiter KELT-9b

We present new near-ultraviolet (NUV, λ = 2479–3306 Å) transmission spectroscopy of KELT-9b, the hottest known exoplanet, obtained with the Colorado Ultraviolet Transit Experiment CubeSat. Two transits were observed on 2022 September 28th and September 29th, referred to as Visits 1 and 2 respectively. Using a combined transit and systematics model for each visit, the best-fit broadband NUV light curves are R p/R ⋆ = 0.136 −0.0146+0.0125 for Visit 1 and R p/R ⋆ = 0.111 −0.0190+0.0162 for Visit 2, appearing an average of 1.54× larger in the NUV than at optical wavelengths. While the systematics between the two visits vary considerably, the two broadband NUV light curves are consistent with each other. A transmission spectrum with 25 Å bins suggests a general trend of excess absorption in the NUV, consistent with expectations for ultrahot Jupiters. Although we see an extended atmosphere in the NUV, the reduced data lack the sensitivity to probe individual spectral lines.

Hemoadsorption therapy for myoglobin removal in rhabdomyolysis: consensus of the hemoadsorption in rhabdomyolysis task force

BackgroundRhabdomyolysis describes a syndrome characterized by muscle necrosis and the subsequent release of creatine kinase and myoglobin into the circulation. Myoglobin elimination with extracorporeal hemoadsorption has been shown to effectively remove myoglobin from the circulation. Our aim was to provide best practice consensus statements developed by the Hemoadsorption in Rhabdomyolysis Task Force (HRTF) regarding the use of hemadsorption for myoglobin elimination.MethodsA systematic literature search was performed until 11th of January 2023, after which the Rhabdomyolysis RTF was assembled comprising international experts from 6 European countries. Online conferences were held between 18th April − 4th September 2023, during which 37 consensus questions were formulated and using the Delphi process, HRTF members voted online on an anonymised platform. In cases of 75 to 90% agreement a second round of voting was performed.ResultsUsing the Delphi process on the 37 questions, strong consensus (> 90% agreement) was achieved in 12, consensus (75 to 90% agreement) in 10, majority (50 to 74%) agreement in 13 and no consensus (< 50% agreement) in 2 cases. The HRTF formulated the following recommendations: (1) Myoglobin contributes to the development of acute kidney injury; (2) Patients with myoglobin levels of > 10,000 ng/ml should be considered for extracorporeal myoglobin removal by hemoadsorption; (3) Hemoadsorption should ideally be started within 24 h of admission; (4) If myoglobin cannot be measured then hemoadsorption may be indicated based on clinical picture and creatinine kinase levels; (5) Cartridges should be replaced every 8–12 h until myoglobin levels < 10,000 ng/ml; (6) In patients with acute kidney injury, hemoadsorption can be discontinued before dialysis is terminated and should be maintained until the myoglobin concentration values are consistently < 5000 ng/ml.ConclusionsThe current consensus of the HRTF support that adjuvant hemoadsorption therapy in severe rhabdomyolysis is both feasible and safe and may be an effective method to reduce elevated circulating levels of myoglobin.

Bio-inoculant consortia modulated plantain (Musa × paradisiaca L.) growth, rhizosphere pH, acid phosphatase and urease activity

Fertilizers influence biochemical interactions in the rhizosphere that can affect crop performance. This study evaluated the interaction of plantain (Musa × paradisiaca) growth with soil pH, acid phosphatase and urease activities under different fertilizer amendments in Buea with mono-modal and Akonolinga with bi-modal rainfall patterns in Cameroon. The two experiments were setup in June 2021 following a randomized complete block design with NPK (nitrogen, phosphorus, and potassium), bio-inoculant consortia (plant growth-promoting bacteria – PGPB, Beauveria, Trichoderma, PGPB + Trichoderma), and untreated control, with four replications each. Soil samples were collected on 30th September 2021 and 30th April 2022 for analyses of soil physico-chemical and biological properties. Higher plantain performance occurred in Buea than Akonolinga across samplings, while treatments modulated plantain performance. Significant correlations occurred between plantain height or stem girth with rhizosphere pH, acid phosphatase and urease activities. The soil in Akonolinga is clayey with 38 % higher clay content than Buea, while Buea was clay-loamy with two times more silt than Akonolinga. The pre- and post-planting soil pH in Buea were strongly acidic as compared to extremely acidic soil in Akonolinga, with significant variation of post-planting pH across treatments, sampling time, and field sites. The positive correlation of soil pH, acid phosphatase and urease activities with plantain growth strongly indicate functional relationships that highlight fertilizer effects, sampling time or site-specific variations, and their interactions on plantain performance. Thereby, highlighting the role of locally formulated bio-inoculants in improving crop performance. These findings open up avenues for further studies on the role of bio-inoculants on crop nutrient uptake, and control of crop pests and diseases, in order to promote a holistic management approach that integrates bio-inoculants, crop type, and site-specific factors.

The 4th Joint ENTIS-OTIS conference abstracts September 12th–15th 2024, Nyborg, Denmark

The 4th Joint ENTIS-OTIS conference abstracts September 12th–15th 2024, Nyborg, Denmark

Indirect Tax Reform And Market Efficiency: An Empirical Study of Indian Stock Market

The biggest tax reform of the Indian Government in this present decade is the Goods and Services Tax (GST), which was passed in parliament on 8th September 2016 and was enforced from 1st July 2017. Eight years of data from the Bombay Stock Exchange Sensex and the National Stock Exchange Nifty50 index is studied. The data is divided into two sub-periods before GST was passed from parliament period - I and after GST was passed from the parliament of India period - II. The study intends to test the market efficiency in its weak form. To check the time series data for normality, stationarity, random walk, and autocorrelation function, Kolmogorov-Smirnov (KS) test, Augmented Dickey-Fuller (ADF) test, Phillips Perron (PP) test is used for the analyse of the time-series data. The study found that returns are not normally distributed and the market is inefficient in a weak form for both periods under study.

Effectiveness of Competency-Based Educational Program on Quality of Care among Post-Graduate Nurses

Background: Nursing competencies significantly impact the quality of nursing care. This care can be improved by maintaining nursing proficiency via a competency-based nursing educational program. Aim: To determine the effectiveness of the competency-based educational program on quality of care. Methods and Materials: The quasi-experimental design (pre-posttest) was used in the current study to achieve the early stated objectives. The study was carried out from the period of 4th September 2023 to 3rd April 2024. A (Purposive Sample) consisted of 80 nurses. Data collected through using of a well-designed questionnaire consists of two parts: I: socio-demographic characteristics: Which consisted of (8) items. II: The Quality Nursing Care Scale (QNCS-M) which consisted of (36) items. Results: The results of the present study indicate that there is a significant difference in the pre- and post-test periods regarding quality of care with the quality of care with the final mean of the nurses’ overall quality of care for the study group in the posttest (mean = 2.56) compared to (mean = 1.54) in the pretest for the same group. Conclusion: The results of the data analysis show that the competency education program for nurses was implemented and that the evaluation of the program in two phases (pretest and posttest), it had a positive impact on the quality of care provided by the study group. Recommendations: periodic assessment of the healthcare provider's abilities to provide, in addition to appropriate support and motivation to encourage healthcare providers to engage in activities that improve the quality of care from persons in authority.

Methane plume detection after the 2022 Nord Stream pipeline explosion in the Baltic Sea

On September 26th, 2022, the detonations at the gas pipelines Nord Stream 1 and 2 resulted in some of the largest non-natural releases of methane known. The distribution of methane in the surrounding seawater and the possible effects were not apparent. To trace the pathways of methane we recorded CH4 concentrations and the isotopic signal (δ13C-CH4) in seawater, and air. A week post-explosion, we detected methane concentrations up to 4 orders of magnitude above the natural Baltic Sea background. The released fossil methane created a distinct plume with δ13C-CH4 ratios differing from natural background values. The strong water stratification preserved the distribution pattern initiated by the explosion, shown by the laterally strong concentration gradient within the plume. Our analysis encompasses three stages of the explosion's impact; the initial sea-air methane release, measurements taken during our research expedition one week later, and a third stage triggered by the shift from summer to winter conditions as an outlook on how winter mixing and microbial activity will influence the plume.

Is Vladimir Putin a Realist with Special Attention to the Concept of a Force Monopoly and Hans Kelsen’s Principle of Effectiveness of Laws and Joe Biden’s (President of the United States of America) Speech at the United Nations General Assembly Meeting of 20th September, 2023 That There Will Be Reprisal against Russia for Starting the War with Ukraine Coincide with

Is Vladimir Putin a Realist with Special Attention to the Concept of a Force Monopoly and Hans Kelsen’s Principle of Effectiveness of Laws and Joe Biden’s (President of the United States of America) Speech at the United Nations General Assembly Meeting of 20th September, 2023 That There Will Be Reprisal against Russia for Starting the War with Ukraine Coincide with

Meeting Report for the 2023 International Scientific Conference on Complex Lymphatic Anomalies

Objectives: Complex lymphatic anomalies (CLAs) are rare diseases with variable clinical manifestations caused by the abnormal development of lymphatic vessels. The Lymphatic Malformation Institute (LMI), Lymphangiomatosis &amp; Gorham’s Disease Alliance (LGDA), and LGD Alliance Europe sponsored an international conference on CLAs so leaders in the field could discuss recent advances in research on CLAs. Methods: The conference occurred in Dallas, Texas, between September 29th and September 30th, 2023. The event had 22 distinguished speakers and 38 attendees. Additional researchers, clinicians, and patients attended the conference virtually. Results: In this article, we summarize the key takeaways from the meeting. The conference emphasized the crucial role of the patient voice in guiding research, and attendees heard stories from patients and parents of children with CLAs. The conference covered topics such as the genetic causes of CLAs, preclinical models, clinical advances, new technologies for CLA research, lymphatic imaging, and patient-centered research. Videos of all the presentations can be found on the LGDA website. Conclusions: The meeting revealed that while progress has been made, many challenges still exist surrounding the diagnosis and treatment of CLAs. Sustained research efforts are necessary to fill the gaps in knowledge and improve the care and quality of life of CLA patients.

Using a lean management approach in acute ischemic stroke management: a systematic review.

Stroke is the second leading cause of death worldwide with an annual mortality rate of 6.55 million, which accounts for 11.6% of the total number of deaths. Early diagnosis is crucial for improving treatment outcomes. Lean management is an approach originating in the car manufacturing process derived from the Toyota Production System, which healthcare providers have recently adapted. The objective is to examine the use of lean practices in managing AIS in hospital settings. A systematic literature search was performed using MEDLINE and SCOPUS databases, including publications from 1st January 2000 to 20th September 2022. A total of 13 studies fulfilled the predefined inclusion criteria. The recombinant tissue plasminogen activator (rtPA) was used in 11 studies, in 2 studies in combination with mechanical thrombectomy (MT). MT alone was used in the other 2 studies. The value stream mapping was used in all included studies to analyze workflow in acute ischemic stroke (AIS) treatment. Outcome measures include mostly door-to-needle (DTN) time for rtPA treatment and door-to-puncture (DTP) time for mechanical thrombectomy. DTN time was assessed in nine studies and reached statistically significant results in five. DTP was examined in three studies; in two, statistically significant decreases in DTP were observed. Lean management can be a useful method for achieving key performance indicators in AIS, consistent with current guidelines. The results of this systematic literature review show that value stream mapping may improve the process of AIS treatment by reducing in-hospital delays. The field of research that focuses on implementing lean management tools in healthcare is increasing, with more publications appearing in recent years.

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

BackgroundSevere overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days.MethodsBetween February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator.Results46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints.ConclusionsThis randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff.Trial registrationRegistered on clinicaltrials.gov as NCT03660215 on 4th September 2018.