Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly.

BACKGROUND: Aspirin is a well-established therapy for the secondary prevention of cardiovascular events. However, its role in the primary prevention of cardiovascular disease is unclear, especially in older persons, who have an increased risk. METHODS: From 2010 through 2014, we enrolled community-dwelling men and women in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo. The primary end point was a composite of death, dementia, or persistent physical disability; results for this end point are reported in another article in the Journal. Secondary end points included major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure). RESULTS: Of the 19,114 persons who were enrolled in the trial, 9525 were assigned to receive aspirin and 9589 to receive placebo. After a median of 4.7 years of follow-up, the rate of cardiovascular disease was 10.7 events per 1000 person-years in the aspirin group and 11.3 events per 1000 person-years in the placebo group (hazard ratio, 0.95; 95% confidence interval [CI], 0.83 to 1.08). The rate of major hemorrhage was 8.6 events per 1000 person-years and 6.2 events per 1000 person-years, respectively (hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001). CONCLUSIONS: 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 .).

Temperament and fatigue management in persons with chronic rheumatic disease.

BACKGROUND: In persons with chronic conditions, fatigue is often a disruptive symptom with a devastating impact on overall well-being. Descriptions of experiences with fatigue contribute to advancing knowledge and improving health outcomes. AIM: To describe the influence temperament has on fatigue representation, self-care strategies, and strategy success. METHOD: A secondary analysis of an existing database of personal characteristics and symptom experiences of adults with chronic rheumatic diseases was conducted. All participants who reported fatigue at least once during the first week of participation in the study were included. Relationships were examined among demographic variables, temperamental dispositions, and symptom representation. RESULTS: Significant relationships were demonstrated between perceived symptom seriousness, interference and helpfulness of selected strategies, and both demographic variables and temperamental dispositions. CONCLUSIONS: When choosing interventions for the individual experiencing fatigue, be aware of demographic data and use assessment techniques to promote positive health practices.

Temperament and satisfaction with health status among persons with rheumatoid arthritis.

PURPOSE: Health-related quality of life is a subjective phenomenon shaped by personal attributes. Research has demonstrated links between temperament and health outcomes. Because temperament is relatively stable, it could function as a moderator of quality of life. This study examined relationships among temperament disposition and satisfaction with health status. DESIGN: The model developed by Sprangers and Schwartz was used to develop a secondary analysis of data collected in a cross-sectional, correlational study with stepwise linear regression analysis. Instruments used were MPQ (dispositions) and AMIS2 (health satisfactions). SETTING: Two rheumatology private practices and 3 rheumatology clinics. SAMPLE: One hundred fifty-three persons diagnosed with rheumatoid arthritis (mean age = 55.4). FINDINGS: Scores reflecting Negative Affectivity (intrapersonal orientation and perception) demonstrated significant positive correlation (r = .26-.58) with all health domain satisfaction scores (P < .001). Negative Affectivity and Positive Affectivity (interpersonal orientation) jointly predicted 8.2%-37.8% of score variance. CONCLUSION: Temperament dispositions are associated with health-related satisfaction. IMPLICATION: 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.

Experiencing health in the context of rheumatoid arthritis.

The purpose of this study was to explicate the health experience of persons with rheumatoid arthritis who manifest a strong sense of well-being. Five women and three men participated in unstructured interviews in order to answer the research question, What are the subplots that emerge in the descriptions of health given by persons with rheumatoid arthritis? A hermeneutic method was used to analyze the transcripts. Three subplots emerged: (a) The evolving--not knowing and then knowing something, but never really knowing, (b) the reframing, and (c) the relational fugue. The findings, including creation of healing spaces and an evolving relationship with assistive devices, provide evidence of turning points in the health process and are suggestive of a strong sense of well-being as a manifestation of a reorganized pattern.

Existential caring in the family health experience: a proposed conceptualization.

Empirical realities and technological advances in the clinical practice context continuously call for ethical dialogue among healthcare providers. The nurse's voice of advocacy for humane caring grounded in an existential understanding of the complexities of the health experience remains a salient responsibility of moral agency. If nurses are to care for families, as society requires, then nurse caring, a phenomenon currently defined and understood primarily at the individual patient-nurse level, must be diligently and broadly explored in terms of its worth to guide nursing service with families. The purpose of this theoretical paper is to explore a conceptualization of care with families in the health experience that emanates from the philosophical tenets of existentialism and underpinnings of symbolic interactionism and is interpreted into action by the ethics of care. Current and classic literature, inclusive of philosophical and empirical works, provide the background for analysis of the following elements: existential caring orientation, family perspective, family-nurse interaction, construction of meaning, family meaning construction, nurse meaning construction, family-nurse co-construction of meaning and existential advocacy. Existential philosophy is understood as the basic underlying lens guiding the nurse in taking an existential caring orientation as depicted in the resultant conceptualization. Caring in the family health experience is best facilitated by a relational stance where the nurse acknowledges the family's unique perspective. Through the family-nurse interaction the nurse gains understanding of the family's perspective being constructed. Nursing practice with families confronting the empirical realities and technological advances of the new millennium will be enriched when moral agency includes ethical dialogue among healthcare providers and families. Existential advocacy with and for families grounded in the nurse's understanding of the family perspective enhances the context for moral agency.

A method for pattern recognition.

Although pattern is a dominant concept in nursing science, only Newman's method for recognizing pattern has been fully articulated and widely used in research about the human health experience. This article proposes an alternative, less costly method to facilitate research with larger numbers of participants in clinical settings. Cluster analysis, a quasi-quantitative technique, and content analysis were combined to produce a technique for recognizing patterns of person-environment interaction. Results from two studies with persons experiencing a highly variable chronic illness, rheumatoid arthritis, indicated that this new approach identifies distinct common patterns of person-environment interaction. Sufficient detail about the nature of each pattern resulted to facilitate further knowledge development about the health experience and to provide guidance in structuring nursing care.