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.