2 Minute Medicine Rewind March 30, 2026

Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial 

1. The tailored, multidisciplinary home‑based program significantly reduced the rate of falls after stroke by about one‑third, while also improving mobility, balance, self‑efficacy, and community participation.

Evidence Rating Level: 1 (Excellent)

People recovering from stroke experience falls at more than twice the rate of the general older population, often with serious and repeated consequences for their long‑term health. Despite this high risk, previous trials have not identified an effective way to prevent falls, especially because earlier interventions relied on home modifications or exercises that were separate from daily life. This study set out to test a new approach: a multidisciplinary, home‑based program that embeds habit‑forming exercise into everyday activities while also addressing home safety and community mobility goals. To evaluate its impact, researchers conducted a large phase 3 randomized trial involving community‑dwelling adults over 50 who had experienced a stroke within the past five years and could walk at least 10 meters, recruiting participants across three Australian regions and following them for one year. Over the study period, 370 stroke survivors were enrolled. After 12 months, the intervention group showed a 33% reduction in the rate of falls compared with usual care (incidence rate ratio 0.67, 95% CI 0.48–0.94; P=0.02), although the proportion of participants who fell did not differ significantly between groups (absolute risk reduction 0.03, 95% CI −0.07 to 0.13; P=0.52). The intervention also led to meaningful improvements in community participation (3% increase, 95% CI 1%–6%; P=0.02), self‑efficacy (mean difference 0.6, 95% CI 0.2–1.0; P=0.004), mobility (fast walking speed +0.13 m/s, 95% CI 0.06–0.19; P<0.001; preferred speed +0.06 m/s, 95% CI 0.02–0.10; P=0.02), and balance (Step Test +0.06 steps/s, 95% CI 0.01–0.12; P=0.03). These findings show that a structured, individualized home‑based intervention can meaningfully reduce fall rates and enhance functional confidence and participation for community‑dwelling people recovering from stroke.

Atopic Dermatitis and Markers of Early Cardiovascular Risk in Children and Adolescents 

1. In this cohort study, more active or severe atopic dermatitis (AD) in children was not associated with a greater cardiovascular risk. 

Evidence Rating Level: 2 (Good)

Children with atopic dermatitis (AD) may be at increased risk for cardiovascular disease (CVD) later in life. Still, existing research has been inconsistent and often limited by cross‑sectional designs and inadequate adjustment for key factors like BMI. Because childhood cardiovascular risk factors, such as high blood pressure, abnormal lipids, obesity, and early signs of atherosclerosis, strongly predict adult cardiovascular disease, understanding whether AD contributes to these risks is important. This study set out to determine whether children with AD have higher rates of cardiometabolic risk factors and whether more active or severe AD across childhood is linked to early signs of atherosclerosis in young adulthood. Active atopic dermatitis was measured repeatedly from infancy through adolescence using a standardized question about itchy, dry rash in typical flexural areas, with active AD defined as at least two positive reports across assessments. Cardiovascular risk was also assessed repeatedly from early childhood through young adulthood using standardized measures, including blood pressure, BMI, and plasma lipid levels. A total of 9281 children (4612 [49.69%] female) were included in the study. AD affected 13.10% to 21.58% of participants between ages 3 and 18, with 3.52% to 6.85% reporting moderate or severe disease. Across multiple ages, multivariable models showed no consistent associations between active AD and cardiovascular risk factors. The only statistically significant findings were two inconsistent associations with LDL cholesterol at ages 3 years (−0.33 SD; 95% CI −0.58 to −0.07) and 10 years (0.14 SD; 95% CI 0.03 to 0.24). Furthermore, there was no association between children with more persistent or severe AD and increased likelihood of showing early signs of subclinical atherosclerosis as they entered adulthood. Overall, these results indicate that routine cardiovascular screening for all children with AD is unlikely to provide additional benefit in identifying those at elevated early-life cardiovascular risk.

Cardiovascular Disease in Singleton Offspring Born of Pregnancies Complicated by Placental Abruption: A Population‐Based Retrospective Cohort Study

1. In this cohort of singleton offspring, placental abruption during pregnancy was associated with significantly increased risk of cardiovascular mortality and nonfatal cardiovascular events from infancy onward. 

Evidence Rating Level: 2 (Good)

Cardiovascular disease (CVD) remains the leading global cause of death, and concerningly, early‑onset CVD is rising among children, adolescents, and young adults. Placental abruption, an obstetrical complication affecting about 1 in 100 pregnancies, has been linked to higher maternal cardiovascular risk, and growing evidence suggests that in‑utero exposures such as abruption, preeclampsia, and fetal growth restriction may also predispose offspring to later cardiovascular disease through genetic, epigenetic, and developmental pathways. Because the long‑term cardiovascular consequences for children born to pregnancies complicated by abruption are still unclear, this study examined whether these offspring face increased risks of early mortality and early‑onset CVD events. The exposure was placental abruption, defined as the premature separation of the placenta from the uterus. The study evaluated all-cause mortality, CVD mortality, and nonfatal cardiovascular events, grouping these events into heart disease and stroke. Among 2,949,992 singleton births, placental abruption occurred in 1% (n=28,641) of pregnancies. During a median follow-up time of 14.5 years (range 0-28; 41.9 million person-years), offspring exposed to abruption had markedly higher risks of both CVD mortality (4 [n=17] vs 1 [n=307] per 100,000 person years; adjusted hazard ratio [HR], 4.64 [95% CI, 2.75-7.86]) and nonfatal CVD events (627 [n=2,425] vs 190 [n=79,360] per 100,000 person years; HR, 2.86 [95% CI, 2.74-2.98]). These elevated risks were even more pronounced in infants under 1 year, and the associations persisted in sibling‑comparison analyses, suggesting shared familial factors did not explain them. Overall, these findings suggest that cardiovascular consequences of placental abruption extend beyond the mother, underscoring an impact that begins early and persists across the offspring’s lifespan.

Feeding Bottles With Different Venting Methods and Gastrointestinal Discomfort in Infants: A Randomized Clinical Trial

1. In this randomized controlled trial, bottom‑vented bottles did not reduce mild gastrointestinal discomfort overall in infants aged 0–90 days.

Evidence Rating Level: 1 (Excellent) 

Bottle feeding infants in the first 6 months has become more common, with over 60% reported, which may be due to low lactation, infection, or a busy work schedule. Bottle feeding can affect how a baby eats, which can impact a variety of health and growth factors. A vent must be designed into the bottle to ensure smooth milk flow and generally falls under 1 of 2 categories: teat-vented and bottom-vented, with air holes on the teat and bottom sides, respectively. Bottom-vented bottles theoretically have benefits for the infants; avoiding milk oxidation and lower air intake, which can cause colic and gas in the infant. This randomized control trial aimed to determine if mild gastrointestinal discomfort (MGD) was reduced in infants using bottom-vented compared to teat-vented bottles. A total of 1041 (mean [SD] age, 25.4 [24.9] days, 575 males [55.2%], 107 [10.3%] premature) infants were included in the final study, among which 36.6% had prior MGD. At week 2, the difference in MGD prevalence was slight but not significant (185 infants [35.5%] vs 197 infants [37.9%]; RR, 0.94; 95% CI, 0.80-1.10; P = .44), not varying with premature status (full-term birth, RR, 0.89; 95% CI, 0.75-1.06; preterm birth, RR, 1.39; 95% CI, 0.89-2.19; P = .07 for interaction), or feeding frequency (<6 times, RR, 1.08; 95% CI, 0.87-1.34; ≥6 times, RR, 0.77; 95% CI, 0.61 to 0.98; P = .06 for interaction). However, infants aged over 60 days showed 55% lower (15 infants [21.1%] vs 24 infants [47.1%]; RR, 0.45; 95% CI, 0.26-0.77) MGD prevalence. While previous studies had noticed a link between bottom venting and MGD, this larger study did not. This may be owed to very few high-frequency feedings of over 6 times a day, giving fewer effects overall, and younger and premature infants not generating the necessary suction pressure. While MGD was not seen, crying was much less prevalent among bottom-vented bottles, showing potential for greater comfort while feeding. These findings suggest that while bottom‑vented bottles do not broadly reduce gastrointestinal discomfort in young infants, their potential benefits in older infants and in reducing feeding‑related crying merit further investigation.

Two Perioperative Ketorolac Dosing Regimens After Cesarean Delivery and Opioid Use: A Randomized Controlled Trial 

1. In this randomized controlled trial, a 60‑mg IV ketorolac loading dose after cesarean delivery modestly reduced postoperative opioid use and delayed the need for first opioid administration compared with a 30‑mg dose.

Evidence Rating Level: 1 (Excellent) 

Cesarean delivery accounts for nearly one‑third of births in the United States, making effective postoperative pain control essential to improve recovery, support early mobility, and reduce opioid exposure. Although multimodal analgesia, including NSAIDs like ketorolac, is standard, the optimal ketorolac dose after cesarean delivery remains uncertain. Pregnancy has associated changes in drug metabolism that may increase ketorolac clearance and distribution. These physiologic differences suggest that a higher loading dose could provide better analgesia, prompting this study to compare 60 mg versus the standard 30 mg dose on postoperative opioid use and pain control. In this randomized controlled trial, pregnant individuals undergoing cesarean section were included, and randomization occurred in the operating room once surgery was complete. These 92 participants were randomized to receive either a 60 mg (n=46) or 30 mg (n=46) intravenous ketorolac loading dose after cesarean delivery. Median opioid use in the first 24 hours was similar in both groups at 7.5 morphine miligram equivalents (MMEs), though the distribution differed significantly (P=.02). Across the full delivery admission, patients receiving 60 mg required fewer opioids overall (15 MMEs, IQR 0–37.5) compared with those receiving 30 mg (30 MMEs, IQR 7.5–54.5; P=.043). The 60‑mg group also experienced a markedly longer interval before first opioid administration (15 hours vs 2.75 hours; P=.002) and reported lower pain scores on arrival to the postpartum unit (3 vs 5; P<.001). No treatment‑related adverse events occurred in either group, and no difference in pain scores. Overall, a 60 mg loading dose of IV ketorolac after cesarean delivery modestly reduced postoperative opioid use and delayed the need for first opioid administration compared with the standard 30 mg dose; however, the effect was modest, suggesting further research is needed to clarify its clinical value.

Image: PD

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