The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo. (Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number, NCT01038583 .).

Background and Purpose Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a Phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment, and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95%CI) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes), and 115 major vascular events (stroke, myocardial infarction, vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95%CI 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR 2.32, 95%CI 1.15–4.68). HsCRP predicted increased risk of major vascular events (top quartile adjusted HR 2.04, 95%CI 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions Among recent lacunar stroke patients, hsCRP levels predict risk of recurrent strokes and other vascular events. HsCRP did not predict response to dual antiplatelets.

Although lay referrals are known to be important as factors affecting the use of professional services, less is known about how individuals use lay consultation in evaluating symptoms. The amount and type of advice given by persons in the social network is especially important with respect to self care of symptoms that never reach the attention of professional caregivers. This article provides information on how often and from whom elderly citizens seek and receive consultation, such as family and friends, when they experience common symptoms. Findings suggest that female relatives are important sources of advice but that neither gender nor living arrangements are closely related to the tendency to seek lay advice for common symptoms. Subjects who consulted lay advisers about arthritic symptoms also were more likely to seek professional consultation.

This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.

Assessment of temperament can facilitate early identification of potential problems in the 3 quality of life domains (meaningfulness, manageability), and comprehensibility, and is useful for selecting or designing tailored interventions.

We read with considerable interest the report of the Order of St Francis (OSF) Stroke Network in Peoria, 1 discussing their early experience promoting the use of intravenous tissue plasminogen activator (IV tPA) in central Illinois. Since 1996 we have been somewhat differently organized in Minnesota for a similar phase IV assessment of this important therapy. Our initial report in 1998 2 presented 60 patients collected over 14 months, a quantity similar to the current OSF report. It was our judgment then, and our main criticism now of the OSF report, that such a limited number of patients precludes any meaningful statistical analysis of data and conclusions must be viewed with great reservation. Our most recent report 3 of 151 patients accumulated over 34 months-now 252 patients over 43 months, as presented at the recent American Stroke Association 25th Annual Stroke Conference-still is limited by marginally adequate numbers. It has, however, provided us with sufficient data to apply multivariate analysis to questions about size, rural/urban location and academic affiliation of treating hospitals, specialty expertise of supervising physicians, pretreatment patient risk factors, accuracy of pretreatment CT interpretation, incidence and predictors of poor outcomes including symptomatic intracerebral hemorrhage (ICH) and ICH-related death. Our steering committee of volunteer stroke neurologists has reviewed CT images on every patient with a poor outcome; we obtained posttreatment CT scans on approximately 70% of patients and so know much about asymptomatic ICH. All CT images, regardless of clinical outcome, have been reviewed by a neuroradiologist blinded to all clinical details. This process has given us confidence that IV tPA in Minnesota has been reasonably safe over the last 3 years and not detectably different from the statistically robust National Institute of Neurological Diseases and Stroke study. 4 Our initial and motivating concerns of 1996 have gradually been lightened, though we realize that our conclusions are yet tentative and can't completely counter the skeptical concerns of many of our local colleagues. We will publish our data in full when we have accumulated 300 patients, later this year.Our process has been different from the OSF effort. The OSF Network appears to be centrally directed, while our IV tPA treating hospitals have been independent after the initial orientation and nominal "training." Our observation tools evolved over the first 2 years of our organization, and on behalf of those now organizing or implementing such clinical programs, we have some questions for the OSF authors: How were the widely distributed medical facilities recruited and organized, for this and other stroke projects? Were/are there CME education-presentations only, or more specific arrangements? Was a specific Stroke/tPA Champion named at each site? How is communication maintained between the various facilities? How are peripheral sites encouraged and given feedback about their performance in following the protoc...

This study's purpose was to identify and describe common patterns of person-environment interaction in persons with rheumatoid arthritis. Newman's propositions about pattern provided the theoretical foundation, and a combination of quantitative and qualitative techniques were used to recognize pattern. Sixty-six adults diagnosed with rheumatoid arthritis completed questionnaires that assessed characteristic ways of functioning. Iterative cluster analysis of the data identified five distinct groups of individuals with similar response profiles. Content analysis of each group's characteristics produced a core theme representing the nature of the common pattern. The finding of multiple, distinct common patterns of person-environment interaction within the population of persons with RA is consistent with findings in other populations. Further study of the common patterns, in relation to health outcomes, has potential for increasing knowledge about the sources of different health experiences among persons with the same chronic illness.

When choosing interventions for the individual experiencing fatigue, be aware of demographic data and use assessment techniques to promote positive health practices.