Background Chronic heart failure (CHF) is a serious, common condition associated with frequent hospitalisation. Several different disease management interventions (clinical service organisation interventions) for patients with CHF have been proposed. Objectives To assess the effectiveness of disease management interventions for patients with CHF. Search methods We searched: Cochrane CENTRAL Register of Controlled Trials (to June 2003); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to July 2003); CINAHL (January 1982 to July 2003); AMED (January 1985 to July 2003); Science Citation Index Expanded (searched January 1981 to March 2001); SIGLE (January 1980 to July 2003); DARE (July 2003); National Research Register (July 2003); NHS Economic Evaluations Database (March 2001); reference lists of articles and asked experts in the field. Selection criteria Randomised controlled trials comparing disease management interventions specifically directed at patients with CHF to usual care. Data collection and analysis At least two reviewers independently extracted data information and assessed study quality. Study authors were contacted for further information where necessary. Main results Sixteen trials involving 1,627 people were included. We classified the interventions into three models: multidisciplinary interventions (a holistic approach bridging the gap between hospital admission and discharge home delivered by a team); case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); and clinic interventions (follow up in a CHF clinic). There was considerable overlap within these categories, however the components, intensity and duration of the interventions varied. Case management interventions tended to be associated with reduced all cause mortality but these findings were not statistically significant (odds ratio 0.86, 95% confidence interval 0.67 to 1.10, P = 0.23), although the evidence was stronger when analysis was limited to the better quality studies (odds ratio 0.68, 95% confidence interval 0.46 to 0.98, P = 0.04). There was weak evidence that case management interventions may be associated with a reduction in admissions for heart failure. It is unclear what the effective components of the case management interventions are. The single RCT of a multidisciplinary intervention showed reduced heart-failure related re-admissions in the short term. At present there is little available evidence to support clinic based interventions. Authors’ conclusions The data from this review are insufficient for forming recommendations. Further research should include adequately powered, multicentre studies. Future studies should also investigate the effect of interventions on patients’ and carers’ quality of life, their satisfaction with the interventions and cost effectiveness.

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Welfare benefits advice services are increasingly being provided on primary care premises. It is assumed that the relief of financial deprivation will also relieve ill health, although there is only limited evidence to support this. This paper reports the findings of a study designed to measure changes in individual health associated with income increase as a result of such advice. It was a longitudinal observational study of advice to service users, comparing the health of those whose income increased with that of those whose income did not, using the SF-36 as an outcome measure. The study took place in 2000 and 2001 in seven sites across England, and 345 people were interviewed at base line, 245 after 6 months and 201 after 12 months. Subjects were generally in the second half of life, with one or more chronic conditions. Those who increased their income (the Income Increase group) had significantly better outcomes in mental health and emotional role functioning at 12 months than those with no income increase. There were no other significant differences between groups at 12 months, and none at 6 months. However, if all those who dropped out of the study between 6 and 12 months are excluded, then the same changes observable at 12 months are also recorded at 6 months. Although improvements in health associated with income increase are modest, they make a significant contribution to patients' quality of life. Welfare benefits advice has a role to play as part of holistic care for low-income patients with chronic conditions.

Summary This paper generalizes the results of John and Smith (1972) to multi‐factor designs.

This paper considers the problem of conducting an m» factorial experiment in blocks size mi. Designs can be constructed for all values of m, although for certain values better confounding patterns are available. Analysis of these designs is given, showingwhichcomponents of the sum of squares are confounded with blocks.