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At least 793 records · Page 44Linked to original sources
PubMed2005

Comparisons of pastoralists perceptions about rangeland resource utilisation in the Middle Awash Valley of Ethiopia.

Pastoralism is the most dominant land use form in the arid rangelands of Sub-Saharan Africa, but this rangeland-based lifestyle is under threat. As a consequence a study was conducted in the Middle Awash Valley of Ethiopia with the main objectives of assessing and comparing the broad perceptions of two pastoral groups (the Oromo ethnic group living in Kereyu-Fantale and the Afar ethnic group living in Awash-Fantale) on the usage of the existing rangeland resources, and their views on constraints and possible solutions. Data were collected from 90 Oromo and 55 Afar households. Despite the difference in ethnicity both of these groups share common problems. They derive their main income from the sale of animals and animal products, but with the difference that milk products rank first in the case of the Afar and last in the case of the Oromo. Both pastoral groups depend heavily on native grasses for animal feed and to a lesser extent on woody plants as a source of browse. The majority of respondents were of the opinion that the condition of the rangelands is poor, mainly due to overgrazing, droughts and increases in the human population. Availability of water is also regarded as a problem, mainly by the Oromo. Migration is the first measure taken to solve shortages of livestock feed, but many of the pastoralists replied that migration is an undesirable practise which is mostly done out of necessity. Because of the limited resources most respondents of both groups still prefer communal land tenure where resources are shared. It is concluded that the problems facing the pastoralists in the Middle Awash Valley have been created over many years and the solutions will also require time. With the current approach of the communal grazing systems, sustainable utilisation of the rangeland ecosystem is not possible. Solutions to the poor condition of the existing rangelands will require a definite commitment and full participation not only of the pastoralists, but also of government and non-governmental organisations that are directly or indirectly involved in rangeland resources utilisation, management, conservation and other related activities.

Adult↗
PubMed2005

Coastal resource complexes of South India: options for sustainable management.

India's coastal resource complexes were traditionally characterized by a continuum of 'common property resources' or 'commons' that stretched from the shores to the seas. The continuum aided the existence of sustainable livelihood systems for local communities. Today, fragmented policy approaches and economic welfare schemes have caused the disintegration of community control over the continuum. As a consequence, livelihood systems of local communities have declined. The introduction of coastal management guidelines in the 1990s has exacerbated the situation. With reference to a coastal village located in the State of Kerala in South West India, the paper describes the trajectory of unsustainable change that has taken place in the coastal area resource complexes of the country. The paper argues for restoring the continuum of commons in the study area through community driven systems of natural resource management that are based on networks of nested institutions.

Animals↗
PubMed2006

Design principles and common pool resource management: an institutional approach to evaluating community management in semi-arid Tanzania.

This paper analyses the role of institutions in the management of common pool resources (CPRs) in semi-arid Tanzania. Common property regimes have often been considered inadequate for the management of CPRs because of the problems of excludability, but they are becoming more widely supported as the way forward to overcome the problems of resource use and degradation in developing countries. A series of design principles for long enduring common property institutions have been proposed by Ostrom, but there is concern that they are not applicable to a wide range of real life situations or that they may be specific to certain types of CPR. Here, we compare these principles to the situation prevailing in 12 villages in six districts in semi-arid Tanzania. Data on management institutions were collected through semi-structured interviews and meetings at district and village level. The combined information was used to make a qualitative assessment of the strength with which each design principle appeared to operate in the management of forest, pasture and water resources. Boundaries, conflict and negotiation in CPR management are of key importance in semi-arid regions. However, the need for flexibility in order to deal with ecological uncertainty means that many management institutions would be considered weak or absent according to the design principle approach. This supports the view that the design principles should not be used as a 'blueprint to be imposed on resource management regimes' rather that they provide a framework for investigating common property regimes with the proviso that, certainly for semi-arid regions, they may highlight where management cannot be explained by institutional theory alone.

Agriculture↗
PubMed2004

Estimation of potential impacts and natural resource damages of oil.

Methods were developed to estimate the potential impacts and natural resource damages resulting from oil spills using probabilistic modeling techniques. The oil fates model uses wind data, current data, and transport and weathering algorithms to calculate mass balance of fuel components in various environmental compartments (water surface, shoreline, water column, atmosphere, sediments, etc.), oil pathway over time (trajectory), surface distribution, shoreline oiling, and concentrations of the fuel components in water and sediments. Exposure of aquatic habitats and organisms to whole oil and toxic components is estimated in the biological model, followed by estimation of resulting acute mortality and ecological losses. Natural resource damages are based on estimated costs to restore equivalent resources and/or ecological services, using Habitat Equivalency Analysis (HEA) and Resource Equivalency Analysis (REA) methods. Oil spill modeling was performed for two spill sites in central San Francisco Bay, three spill sizes (20th, 50th, and 95th percentile volumes from tankers and larger freight vessels, based on an analysis of likely spill volumes given a spill has occurred) and four oil types (gasoline, diesel, heavy fuel oil, and crude oil). The scenarios were run in stochastic mode to determine the frequency distribution, mean and standard deviation of fates, impacts, and damages. This work is significant as it demonstrates a statistically quantifiable method for estimating potential impacts and financial consequences that may be used in ecological risk assessment and cost-benefit analyses. The statistically-defined spill volumes and consequences provide an objective measure of the magnitude, range and variability of impacts to wildlife, aquatic organisms and shorelines for potential spills of four oil/fuel types, each having distinct environmental fates and effects.

Animals↗
PubMed2004

Harvesting in a resource dependent age structured Leslie type population model.

We analyse the effect of harvesting in a resource dependent age structured population model, deriving the conditions for the existence of a stable steady state as a function of fertility coefficients, harvesting mortality and carrying capacity of the resources. Under the effect of proportional harvest, we give a sufficient condition for a population to extinguish, and we show that the magnitude of proportional harvest depends on the resources available to the population. We show that the harvesting yield can be periodic, quasi-periodic or chaotic, depending on the dynamics of the harvested population. For populations with large fertility numbers, small harvesting mortality leads to abrupt extinction, but larger harvesting mortality leads to controlled population numbers by avoiding over consumption of resources. Harvesting can be a strategy in order to stabilise periodic or quasi-periodic oscillations in the number of individuals of a population.

Age Distribution↗
PubMed2006

Using economic valuation techniques to inform water resources management: a survey and critical appraisal of available techniques and an application.

The need for economic analysis for the design and implementation of efficient water resources management policies is well documented in the economics literature. This need is also emphasised in the European Union's recent Water Framework Directive (2000/60/EC), and is relevant to the objectives of Euro-limpacs, an EU funded project which inter alia, aims to provide a decision-support system for valuing the effects of future global change on Europe's freshwater ecosystems. The purpose of this paper is to define the role of economic valuation techniques in assisting in the design of efficient, equitable and sustainable policies for water resources management in the face of environmental problems such as pollution, intensive land use in agriculture and climate change. The paper begins with a discussion of the conceptual economic framework that can be used to inform water policy-making. An inventory of the available economic valuation methods is presented and the scope and suitability of each for studying various aspects of water resources are critically discussed. Recent studies that apply these methods to water resources are reviewed. Finally, an application of one of the economic valuation methods, namely the contingent valuation method, is presented using a case study of the Cheimaditida wetland in Greece.

Agriculture↗
PubMed2003

Impact of a practice guideline for patients with atrial fibrillation on medical resource utilization and costs.

Health care resource utilization is high for patients presenting with acute atrial fibrillation (AF). The potential for treatment algorithms to safely reduce resource consumption in this setting has not been prospectively evaluated. We designed and implemented a practice guideline for the management of patients presenting to the emergency department (ED) with the primary diagnosis of AF, with emphasis on appropriate cardioversion, use of oral rate-controlling medications, and expedited referral to an outpatient AF clinic. We prospectively collected clinical and resource utilization data on all such patients for 14 months before and after institution of the guideline. Institution of the guideline was associated with a decreased rate of hospital admission (from 74% to 38%), with no differences in ED return visits or hospital readmission within 30 days. No strokes or deaths were observed. This large decrease in resource utilization during the intervention phase of the study translated to an average decrease in 30-day total direct health care costs of approximately $1,400 US dollars per patient. Our clinical and cost outcomes were minimally affected after statistical adjustment for baseline differences between study groups. We conclude that the implementation of our practice guideline was feasible, safe, and effective. Widespread adoption of such practices may have large financial implications for the health care system.

Aged↗
PubMed2000

Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons.

PURPOSE: Previous studies have suggested that specialists may achieve better clinical outcomes for patients, albeit often at greater cost. We sought to compare outcomes of care and resource utilization among patients with shoulder or knee problems who were treated by general internists, rheumatologists, and orthopedic surgeons. SUBJECTS AND METHODS: Outpatients with knee or shoulder complaints who were seen by general internists, rheumatologists, or orthopedic surgeons at an academic medical center were administered questionnaires at enrollment in the study and again 3 months later. The questionnaires included validated measures of satisfaction, functional status, and pain severity, as well as resource utilization. We compared baseline clinical characteristics, satisfaction with care, resource utilization, and changes in function and symptoms during 3 months of follow-up among patients who were cared for by the three different types of providers. RESULTS: A total of 534 patients responded to the baseline survey and 436 (82%) to the 3-month follow-up survey. About 60% (n = 323) had knee pain. Orthopedists cared for 40% (n = 211) of the patients, with the remainder treated in approximately equal numbers by general internists or rheumatologists. At baseline, patients of internists had less severe pain (differences of 0.3 to 0.6 points on a 1 to 5 scale, P <0.05) and functional limitations (differences of 0.4 to 0.6 points on a 1 to 5 scale, P <0.0006) than patients of rheumatologists and orthopedic surgeons. Adjusting for baseline differences, there were no significant differences among provider groups in pain relief or functional improvement during follow-up. However, in adjusted analyses, patients with shoulder pain who were cared for by orthopedic surgeons were least satisfied with the office environment [adjusted mean (+/- SD) satisfaction score of 1.6 +/- 0.8 on a 1 to 4 scale for orthopedic surgeons vs 1.3 +/- 0.8 for rheumatologists and 1.4 +/- 0.8 for internists, P = 0.004]. Among patients with knee pain, those treated by rheumatologists and orthopedic surgeons were more satisfied with the doctor-patient interaction (adjusted mean satisfaction scores of 1.1 +/- 0.9 for rheumatologists and 1.2 +/- 0.7 for orthopedic surgeons on a 1 to 4 scale vs 1.4 +/- 0.8 for general internists, P = 0.003). Orthopedic surgeons obtained significantly more radiographs of the knee or shoulder and more magnetic resonance imaging scans of the knee. Rheumatologists performed significantly more aspirations or injection procedures. Among all patients, those treated by rheumatologists were most satisfied with the physician interaction, and those treated by orthopedic surgeons were most satisfied with treatment results. CONCLUSION: The relative benefits of specialist compared with generalist care for patients with knee or shoulder pain depend on the importance attached to resource utilization, patient satisfaction, and health outcomes.

Academic Medical Centers↗
PubMed2002

Animal genetic resources in Brazil: result of five centuries of natural selection.

Brazil has various species of domestic animals, which developed from breeds brought by the Portuguese settlers soon after their discovery. For five centuries, these breeds have been subjected to natural selection in specific environments. Today, they present characteristics adapted to the specific Brazilian environmental conditions. These breeds developed in Brazil are known as "Crioulo," "local," or naturalized. From the beginning of the 20th century, some exotic breeds, selected in temperate regions, have begun to be imported. Although more productive, these breeds do not have adaptive traits, such as resistance to disease and parasites found in breeds considered to be "native." Even so, little by little, they replaced the native breeds, to such an extent that the latter are in danger of extinction. In 1983, to avoid the loss of this important genetic material, the National Research Center for Genetic Resources and Biotechnology (Cenargen) of the Brazilian Agricultural Research Corporation (Embrapa) decided to include conservation of animal genetic resources in its research program Conservation and Utilization of Genetic Resources. Until this time, they were only concerned with conservation of native plants. Conservation has been carried out by various research centers of Embrapa, universities, state research corporations, and private farmers, with a single coordinator at the national level, Cenargen. Specifically, conservation is being carried out by conservation nuclei, which are specific herds in which the animals are being conserved, situated in the habitats where the animals have been subjected to natural selection. This involves storage of semen and embryos from cattle, horses, buffaloes, donkeys, goats, sheep, and pigs. The Brazilian Animal Germplasm Bank is kept at Cenargen, which is responsible for the storage of semen and embryos of various breeds of domestic animals threatened with extinction, where almost 45,000 doses of semen and more than 200 embryos exist presently. An important challenge for this program is to make the different segments of society realize the importance of the conservation of animal genetic resources.

Adaptation, Physiological↗
PubMed2003

The institutional design of forest certification standards initiatives and its influence on the role of science: the case of forest genetic resources.

In the 1990s a wide array of non-governmental certification initiatives emerged as a way to promote the sustainable management of resources in sectors such as fisheries and forestry. In this paper, we examine two related questions about these initiatives: how does the institutional design of certification initiatives affect the way science is used in the development of certification standards and in whose interest is science employed? Using the empirical case of forest certification and the specific standards various initiatives have created to address the management of forest genetic resources, we show how structural aspects of decision-making processes affects the standards adopted and the rationalization for their appropriateness. Two basic models of decision-making-stakeholder participation and technical expertise-are discussed in relation to three certification initiatives active in North America-the Canadian Standards Association, the Sustainable Forestry Initiative and the Forest Stewardship Council. By examining the standards these initiatives set for the management of forest genetic resources, we illustrate how two dimensions of science-uncertainty and the logic of cause and effect-are used to rationalize cautious and rigid versus flexible and discretionary standards for the management of forest genetic resources. Our findings indicate that the design or structure of certification decision-making processes, and their embedded balance of authority, mediate the form of standards initiatives will justify on the basis of science.

Certification↗
PubMed1996

A retrospective study of resource utilisation in the treatment of advanced colorectal cancer in Europe.

An estimation of resource utilisation in the treatment of advanced colorectal cancer has been carried out by the European Organization for Research and Treatment of Cancer. Data on resource utilisation were collected retrospectively from 10 European centres, examining 20 consecutive patient files in each centre. Data from eight centres are reported in this paper. 160 patients were included in the sample, followed up for a median of 530 days. All patients were hospitalised and almost all underwent surgery. Fifty-four per cent received chemotherapy, and most visited the hospital as an outpatient. Including hospital stay and outpatient visits, patients spent almost 10% of their time in hospital or associated travelling. The most common diagnostic tests were chest X-ray, electrocardiogram and abdomen ultrasound. There was considerable variation between hospitals in resource utilisation, both within and between countries. Surgical procedures, chemotherapy, hospitalisation, diagnostic tests and outpatient visits are major cost determinants in the treatment of colorectal cancer. The variation in resource utilisation suggests that efficiency could be improved.

Aged↗
PubMed2004

[The Spanish registry of organization, resources and activities in pediatric cardiology].

INTRODUCTION: We present the findings of the registry of activities and resources of the Spanish Society of Pediatric Cardiology in 2002, with the objective of providing a national reference for professionals and entities involved in the study and treatment of congenital heart defects. METHODS: Data were retrospectively collected through questionnaires sent from the Spanish Society of Pediatric Cardiology to the heads of pediatric cardiology units with medical and surgical activities, as well as to all the members of the Society and those of the Pediatric Cardiology Section of the Spanish Society of Cardiology. RESULTS: Thirty-eight centers, including 17 national centers with medical and surgical activities, completed the questionnaire. Human resources consisted of 110 cardiologists, 43 surgeons and 12 residents in training. All the centers had the elementary tools for diagnosis and all except one had Echo-2D-Doppler. There were eight catheterization laboratories exclusively used for pediatric activities and nine further laboratories that combined adult and pediatric activities. A total of 83,061 patients were attended in outpatient clinics and there were 6,938 hospital admissions in 22 centres. A total of 279 ablation procedures were performed in 12 electrophysiology laboratories. The seventeen centres with surgical activities performed 2,498 cardiac catheterisms (968 interventional) and 2,292 cardiac surgical interventions. CONCLUSIONS: Given the large number of participating centers, the present report provides exhaustive information on the organization, resources and activities of pediatric cardiology in Spain. Pediatric cardiology should be granted official recognition of its work so that teaching hospitals, organization, resources and activities can be regulated.

Cardiac Care Facilities↗
PubMed2006

An improved calculation of the exergy of natural resources for exergetic life cycle assessment (ELCA).

The focus in environmental research is shifting from emission abatement to critical process analysis, including assessment of resource consumption. The exergy theory offers a thermodynamic methodology to account for the consumption of natural resources. However, exergy data on mineral resources available in the literature are inadequate to apply to exergetic life cycle analysis, due to incompleteness, inconsistencies, and a dated thermochemical basis. An uncertainty assessment of the data has to be performed as well. In this work, three recent thermochemical databases were applied to evaluate the chemical exergy of 85 elements and 73 minerals, 21 of which had not yet been quantified in the literature. The process required the choice of a new reference species for aluminum. Muscovite was selected, giving rise to a chemical exergy of 809.4 kJ/mol for aluminum. The theory proved to be robust for the exergy of chemical elements, as exergy values differing by 1.2% on average from most recent literature were found. On the contrary, the exergy values for minerals differed by factors up to 14 from literature values, due to the application of recent thermochemical values and consistently selected reference species. The consistent dataset of this work will enable straightforward resource intake evaluation through an exergetic life cycle assessment.

Aluminum↗
PubMed1999

Resources revisited: salutogenesis from a lay perspective.

Health visitors are being pressured to move away from their traditional role in health promotion and public health to focus more closely on people with established clinical disorders. This is partly because of a paucity of theoretical explanations against which to assess interventions directed explicitly at promoting health rather than only preventing disease. However, there are growing public health concerns about increasing inequalities and rising numbers of disadvantaged groups in the UK as well. This paper revisits a grounded theory study that revealed how, in the absence of a need for clinical intervention, health visitors appear to assess needs by treating health as a process fuelled by the accumulation and use of 'resources for health'. Wider theories about salutogenesis ('health creation') and research showing the importance of health and social capital demonstrate the potential of this idea, and were combined with the health visiting study to create a theoretical framework for analytical purposes. Semi-structured interviews with the main carer in 50 families with resident children were analysed using this framework, to provide a lay perspective on how people consider they maintain their health. The analysis demonstrated the usefulness of treating health as a process and of focusing on the development of health-related resources rather than only on presenting problems. The processes of developing capacity were shown to be more important than the presence or absence of specific resources. Links with personal empowerment were apparent; cultural patterns that evolved across generations and neighbourhoods revealed possible pathways to social cohesion. Practice approaches that enhance or inhibit the development of these health-creating resources were identified, and considered in the light of emerging public health needs.

Attitude to Health↗
PubMedDate not supplied

Early detection of breast cancer in countries with limited resources.

Breast cancer is commonly diagnosed at late stages in countries with limited resources. Efforts aimed at early detection can reduce the stage at diagnosis, potentially improving the odds of survival and cure, and enabling simpler and more cost-effective treatment. Early detection of breast cancer entails both early diagnosis in symptomatic women and screening in asymptomatic women. Key prerequisites for early detection are ensuring that women are supported in seeking care and that they have access to appropriate, affordable diagnostic tests and treatment. We therefore propose the following sequential action plan: 1) promote the empowerment of women to obtain health care, 2) develop infrastructure for the diagnosis and treatment of breast cancer, 3) begin early detection efforts through breast cancer education and awareness, and 4) when resources permit, expand early detection efforts to include mammographic screening. Public education and awareness can promote earlier diagnosis, and these goals can be achieved in simple and cost-effective ways, such as dissemination of messages through mass media. All women have the right to education about breast cancer, but it must be culturally appropriate and targeted and tailored to the specific population. When resources become available for screening, they should be invested in screening mammography, as it is the only modality that has thus far been shown to reduce breast cancer mortality. Clinical breast examination (CBE) and breast self-examination (BSE) are important components of routine breast care in countries with access to mammography and are important for general breast health education in all countries. However, the evidence does not support the use of CBE and BSE as lifesaving screening methods at this time, recognizing that data from countries with very limited resource are lacking. When widespread screening is not possible, screening can begin in an institution, city, or region, or by targeting screening to women at highest risk. A pilot program can be an ideal way to define the best approach to screening. To succeed, early detection efforts must include the health care providers with whom women have contact; these providers may be physicians, nurses, midwives, traditional healers, or others. There are tremendous differences among and within countries, and a program to promote early detection must be tailored to each country's unique situation.

Breast Neoplasms↗
PubMedDate not supplied

Treatment of breast cancer in countries with limited resources.

Early and accurate diagnosis of breast cancer is important for optimizing treatment. Local treatment of early stage breast cancer involves either mastectomy or breast-conserving surgery followed by whole-breast irradiation. The pathologic and biologic properties of a woman's breast cancer may be used to estimate her probability for recurrence of and death from breast cancer, as well as the magnitude of benefit she is likely to receive from adjuvant endocrine therapy or cytotoxic chemotherapy. Ovarian ablation or suppression with or without tamoxifen is an effective endocrine therapy in the adjuvant treatment of breast cancer in premenopausal women with estrogen receptor (ER)-positive or ER-unknown breast cancer. In postmenopausal women with ER- and/or progesterone receptor (PR)-positive or PR-unknown breast cancer, the use of tamoxifen or anastrozole is effective adjuvant endocrine therapy. The benefit of tamoxifen is additive to that of chemotherapy. Cytotoxic chemotherapy also improves recurrence rates and survival, with the magnitude of benefit decreasing with increasing age. Substantial support systems are required to optimally and safely use breast-conserving approaches to local therapy or cytotoxic chemotherapy as systemic therapy. Locally advanced breast cancer (LABC) accounts for at least half of all breast cancers in countries with limited resources and has a poor prognosis. Initial treatment of LABC with anthracycline-based chemotherapy is standard and effective. Addition of a sequential, neoadjuvant taxane thereafter increases the rate of pathologic complete responses. Neoadjuvant endocrine therapy may benefit postmenopausal women with hormone receptor-positive LABC. After an initial response to neoadjuvant chemotherapy, the use of local-regional surgery is appropriate. Most women will require a radical or modified radical mastectomy. In those women in whom mastectomy is not possible after neoadjuvant chemotherapy, the use of whole-breast and regional lymph node irradiation alone is appropriate. In those women who cannot receive neoadjuvant chemotherapy because of resource constraints, mastectomy with node dissection, when feasible, may still be considered in an attempt to achieve local-regional control. After local-regional therapy, most women should receive additional systemic chemotherapy. Women with LABC that has a positive or unknown hormone receptor status benefit from endocrine therapy with tamoxifen. The treatment of LABC requires multiple disciplines and is resource intensive. Efforts to reduce the number of breast cancers diagnosed at an advanced stage thus have the potential to improve rates of survival while decreasing the use of limited resources.

Antibiotics, Antineoplastic↗
PubMed2003

Migraine preventive medication reduces resource utilization.

OBJECTIVE: To determine if long-term resource utilization is reduced by adding a preventive medication to a migraine management regimen that already includes acute medication. BACKGROUND: In 2000, new evidence-based guidelines for the treatment of migraine were released by the US Headache Consortium and the American Academy of Neurology. Although these guidelines emphasize the role of preventive medication in achieving significant clinical improvement, little yet is known concerning the impact of such management on medical and pharmaceutical resources. Methods.-Resource utilization information in a large claims database was analyzed retrospectively. RESULTS: Adding a preventive medication to migraine management reduced the use of other migraine medications, as well as visits to physician offices and emergency departments. In addition, both acute and preventive medications were associated with lower utilization of computed tomography and magnetic resonance imaging scans. CONCLUSION: Migraine preventive drug therapy is effective in reducing resource consumption when added to therapy consisting only of an acute medication.

Amitriptyline↗
PubMed1999

Effects of education and support on self-care and resource utilization in patients with heart failure.

AIMS: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure. METHODS: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'. The supportive educative intervention consisted of intensive, systematic and planned education by a study nurse about the consequences of heart failure in daily life, using a standard nursing care plan developed by the researchers for older patients with heart failure. Education and support took place during the hospital stay and at a home visit within a week of discharge. Data were collected on self-care abilities, self-care behaviour, readmissions, visits to the emergency heart centre and use of other health care resources. RESULTS: Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure. Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge, but the increase in the intervention group was significantly more after 1 month. Although self-care behaviour in both groups decreased during the following 8 months, the increase from baseline remained statistically significant in the intervention group, but not in the control group. No significant effects on resource utilization were found. CONCLUSIONS: Intensive, systematic, tailored and planned education and support by a nurse results in an increase in patients' self-care behaviour. No significant effects were found on use of health care resources. Additional organisational changes, such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support.

Aged↗