2 Minute Medicine Rewind October 19, 2026

Clinical Decision Support for Fall Prevention in Primary Care: The eSTEPS Cluster Randomized Clinical Trial

1. In a large randomized clinical trial among 22 primary care practices, use of an electronic health record-integrated clinical decision support tool known as Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS) significantly reduced the fall rate among older adults when in comparison to the control.

Evidence Rating Level: 1 (Excellent)

Falls among older adults are a major cause of injury, disability, and increased mortality among older adults, yet practical and evidence-based exercise regimens are not implemented among primary care practices at a consistent rate. This study compared the use of a digital electronic health record tool known as Strategies for Tailored Exercise to Prevent Falls (eSTEPS) among primary care patients to a control group of patients who did not receive a regimented exercise program. These patients were aged 65 or older and were followed for 12-23 months following implementation of the exercise program, which consisted of tailored exercise recommendations, optional physical therapy referral, and patient-facing materials such as a handbook, website, or various apps. Among the 11945 participants, 52.4% were in the control group and 47.6% were in the intervention group. The rate of ICD-10-coded falls among patients in the control group was 21.2 (95% CI, 20.2-22.1) and the rate among the intervention group was 19.3 (95% CI, 18.6-20.1) within the study period. No differences were observed in mortality. Overall, the study findings suggest that implementation of an evidence-based, accessible, and regimented exercise prescription at the primary care level significantly decreased the risk of falls among older patients aged 65 and above.

Cardiovascular Risk Among Individuals With and Without a Genetic Mutation for Familial Hypercholesterolemia: A Long-Term Study

1. In a large registry-based cohort study, patients who underwent genetic testing for familial hypercholesterolemia between 1991 and 2023 were examined for cardiovascular outcomes and compared to those with negative genetic mutation status.

Evidence Rating Level: 2 (Good)

Familial Hypercholesterolemia (FH) is an inherited condition caused by pathogenic mutations of the LDL-receptor, apolipoprotein B, or PCSK9 genes, associated with elevated low-density lipoprotein cholesterol (LDL-C) and increased rates of cardiovascular disease. However, many patients experience high LDL-C levels and increased cardiovascular disease risk with negative FH mutations. This study aimed to compare the long-term cardiovascular health outcomes in patients with varying elevated LDL-C levels in both confirmed FH status and negative FH status. In this observational cohort study, all patients genetically tested for FH from January 1991 to December 2022 were analyzed for atherosclerotic cardiovascular disease, cardiovascular death, angina pectoris, or stroke. Patients with elevated LDL-C were significantly associated with the risk for future atherosclerotic cardiovascular disease, with a Hazard Ratio (HR) of 1.17 (95% CI, 1.13-1.22, P<0.001). No significant differences were found between patients with a genetic FH mutation compared to those without a genetic FH mutation. Overall, this study concluded that elevated LDL-C was a main causal risk factor for developing atherosclerotic disease and related comorbidities, irrespective of FH genetic mutation. 

Gut Microbiota Linked to Gastrointestinal Symptoms and Behavioural Changes but not Inflammation in Autism Spectrum Disorder: A Cross-Sectional analysis

1. In this cross-sectional study, stool samples from children with Autism Spectrum Disorder and increased GI symptoms yielded reduced microbiome diversity compared to stool samples from typically developing children.

Evidence Rating Level: 2 (Good)

Many children with Autism Spectrum Disorder (AS) suffer from increased gastrointestinal (GI) symptoms, with 31-84% of those with ASD suffering from severe symptoms including increased abdominal pain, food selectivity, constipation, diarrhea, stool incontinence, and vomiting. One possible mechanism to explain increased GI symptoms in patients with ASD is gut dysbiosis and subsequent overgrowth of core flora, including Bacteroides and Ruminococci. This cross-sectional study compared stool samples from children aged 4-16 with ASD to neurotypical children or siblings. It was found that children with ASD, both with or without GI symptoms, had a statistically significantly lower level of polymicrobial diversity compared to siblings (p=0.01) or neurotypical children (p=0.06). Children with ASD and GI symptoms had a higher abundance of Bacteroides and Ruminococcus flora, which was positively correlated with higher rates of flatulence, nighttime awakening, abdominal pain, and foul-smelling stool. Overall, this study demonstrates that children with ASD have less fecal microbial diversity compared to siblings and neurotypical children, correlating with a higher severity of GI symptoms. Knowing that children with ASD may struggle with food selectivity, medication adherence, and nutrition, further research is necessary to maximize positive outcomes. 

Effect of the CP@ clinic program (Community Paramedicine at Clinic Program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial

1. In this longitudinal cross-sectional RCT, 30 low-income apartment buildings in Ontario received visits from the community paramedicine clinic, resulting in significantly lower hospital admission rates and an increase in primary care visits, placing an emphasis on preventive medicine.

Evidence Rating Level: 1 (Excellent)

Evidence: 1 (Excellent)

Older adults and lower-income communities in Ontario often struggle to access primary care, resulting in increased visits to the ER, hospital admissions, and strain on emergency medical services. This study evaluates the implementation of the Community Paramedicine at Clinic Program, an evidence-based community health initiative that was implemented across five communities in Ontario, Canada. Within a 12-month study period, 30 subsidized seniors buildings were selected, where two specially trained paramedics would drop in for residents to conduct health risk assessments, provide tailored education, goal setting, and referrals to community services such as home care, wound care, or PSW support. Compared to usual care, the intervention group was associated with a 25% reduction in hospital admissions, with an adjusted incidence rate ratio (aIRR) of 0.75 (95% CI, 0.61-0.91) and an 18% reduction in hospital admissions after the study period ended (aIRR = 0.82, 95% CI, 0.70-0.96). There was no statistically significant difference in emergency department visits between the two groups, but residents within the intervention group had higher rates of primary care visits after the trial ended (aIRR=1.05, 95% CI, 1.00-1.10). Overall, this study shows the importance of emphasizing primary care and preventive health for older adults and low-income communities to reduce hospital visits and adverse health outcomes. 

Remimazolam Versus Propofol for Elderly Patients Undergoing Laparoscopic Gastrointestinal Surgery: A Randomized Trial

1. In this randomized controlled trial, elderly patients who received Remimazolam (Byfavo) prior to undergoing elective laparoscopic gastrointestinal surgery had reduced post-operative delirium compared with those induced with propofol.

Evidence Rating Level: 1 (Excellent)

Postoperative delirium is a common complication among elderly patients following surgery. Often, residual effects of anesthetic medications may alter patients’ level of consciousness and have higher rates of confusion, injury, and prolonged recovery. In this prospective trial, 186 patients aged 60-80 years were randomized to be anesthetically induced with either Remimazolam, a short-acting benzodiazepine or propofol, which is often the standard induction agent. The incidence of postoperative delirium was 12.9% in the group that received higher doses of remimazolam, 11.3% in the group that received a low dose of remimazolam, and 6.5% in the propofol control group (p=0.467). While remimazolam did not improve postoperative delirium, it did exhibit a higher mean arterial pressure following induction and intubation compared to propofol (p<0.05). In addition, remimazolam was associated with a lower rate of bradycardic events (p<0.001) and lower vasopressor requirements intraoperatively (p<0.05). Overall, this study proved that the use of short-acting benzodiazepines as an alternative to propofol for anesthetic induction prior to elective laparoscopic surgery improved intraoperative cardiovascular events; however, it did not reduce postoperative delirium in elderly patients. 

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