Health Management Resources Research Articles

Assessment of quality indicators of nursing care and clients’ satisfaction at federal medical centre Jigawa state, Nigeria

Background:The challenges in Human Resources for Health Management and Development are global. It is particularly worst in sub Saharan Africa which has been strewn with crisis. Investments in the training of the much needed professionals do not seem to match requirement and therefore does not make the expected impact. A number of other factors have also been assigned to the low level of health worker concentration in areas where their services are needed in Africa. The quality of care that nurses provide is influenced by individual nurse characteristics such as knowledge and experience, as well as human factors such as fatigue. Aims: The study aim was to Assess Quality indicators of Nursing care and clients’ satisfaction at Federal Medical Centre Jigawa State, Nigeria. Methodology: A Descriptive cross sectional design with quantitative and qualitative data collection approach was implemented in this study to Assess Quality indicators of Nursing care and clients’ satisfaction at Federal Medical Centre Jigawa State, Nigeria. The population of the study comprises nurse managers and in-patients of Federal medical Centre, Birnin kudu, Jigawa State. Probability (stratified) sampling was used for quantitative aspect and census sampling for qualitative aspect. Four main tools were used for data collection. SPSS version 24 was used for data analysis. Results: The results revealed that: In the result to assess the nursing care quality, 34% of the respondents were very comfortable of the helpfulness of nurses. 26.7% reported to be good as well as excellent by 23.3%.Significant percentages of the respondents (38.4%) were very comfortable on how nursing staffs respond to their calls, and only 5.8% reported to be poorly comfortable. Skills and competence of nursing were determined, and results show that 33.7% of the patients happen to be very good with how nurses are administering medicines and handling I.Vs. As high as 24.4% of the patients agreed that the coordination of care by the nurses as very good, while 23.3 reported to be excellent Conclusion: There is uneven distribution of nurses. Hospital infection rates and mortality rates are important indicators of quality. There are so many strategies to improve quality of care. Clients are satisfied with quality of care they receive; however, a lot improvement can be made.

Impacts of performance-based financing on health system performance: evidence from the Democratic Republic of Congo

BackgroundHealth systems’ weakness remains one of the primary obstacles towards achieving universal access to quality healthcare in low-income settings. Performance-based financing (PBF) programs have been increasingly used to increase access to quality care in LMICs. However, evidence on the impacts of these programs remains fragmented and inconclusive. We analyze the health system impacts of the PBF program in the Democratic Republic of the Congo (DRC), one of the largest such programs introduced in LMICs to date.MethodsWe used a health systems perspective to analyze the benefits of PBF relative to unconditional financing of health facilities. Fifty-eight health zones in six provinces were randomly assigned to either a control group (28 zones) in which facilities received unconditional transfers or to a PBF program (30 zones) that started at the end of 2016. Follow-up data collection took place in 2021–2022 and included health facility assessments, health worker interviews, direct observations of consultations and deliveries, patient exit interviews, and household surveys. Using multivariate regression models, we estimated the impact of the program on 55 outcomes in seven health system domains: structural quality, technical process quality, non-technical process quality, service fees, facility management, providers’ satisfaction, and service coverage. We used random-effects meta-analysis to generate pooled average estimates within each domain.ResultsThe PBF program improved the structural quality of health facilities by 4 percentage points (ppts) (95% CI 0.01–0.08), technical process quality by 5 ppts (0.03–0.07), and non-technical process by 2 ppts (0–0.04). PBF also increased coverage of priority health services by 3 ppts (0.02–0.04). Improvements were also observed for facility management (9 ppts, 0.04–0.15), service fee policies, and users’ satisfaction with service affordability (14 ppts, 0.07–0.20). Service fees and health workers’ satisfaction were not affected by the program.ConclusionsThe results suggest that well-designed PBF programs can lead to improvements in most health systems domains relative to comparable unconditional financing. However, the large persisting gaps suggest that additional changes, such as allocating more resources to the health system and reforming the human resources for health management, will be necessary in DRC to achieve the ambitious global universal health coverage and mortality goals.Trial registrationAmerican Economics Association Trial registry AEARCTR-0002880.

Management of human resources for health: implications for health systems efficiency in Kenya

BackgroundHuman resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya.MethodsWe conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis.ResultsHuman resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency.ConclusionsHuman resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.

Disparities in Emergency Department Visits for Opioid and Stimulant Overdoses in Florida During COVID-19.

Emergency department (ED) visits for drug overdoses increased nationally during COVID-19 despite declines in all-cause ED visits. The study purpose was to compare characteristics of ED visits for opioid and stimulant overdoses before and during COVID-19 in Florida. This study tested for disparities in ED visits for opioid and stimulant overdoses by race/ethnicity, age, and insurance status. The study identified ED visits for opioid and stimulant overdose in Florida during quarters two and three of 2019 and compared them with quarters two and three of 2020. Overall, there was an increase in the number of opioid and stimulant overdoses during COVID-19. Combined with the decline in the number of all-cause ED visits, drug overdoses represented a larger share of ED visits during COVID-19 compared with before COVID-19. The study did not find evidence of disparities by race/ethnicity, as each group experienced similar increases in the likelihood of ED visits involving drug overdoses during COVID-19. Differences emerged according to age and insurance status. ED visits involving those under age 18 were more likely to involve opioid or stimulant overdose, and ED visits among those over age 65 were less likely to involve opioid overdose during COVID-19. ED visits among those with vulnerable insurance status were more likely to involve opioid overdose during COVID-19. Patterns of behavior change during periods of restricted activity due to a pandemic. These changes in behavior change the mix of risks that people face, suggesting the need for a reallocation of population health management resources during pandemics.

Online interventions aimed at reducing psychological distress in cancer patients: evidence update and suggestions for future directions.

A great proportion of people affected by cancer experience psychological distress. To reduce pressure on limited health-management resources available, evidence-based eHealth or online interventions can fill an important gap by making psychosocial care more easily accessible. However, evidence of their effectiveness is mixed. This present review provides an update on the effectiveness of online interventions in reducing psychological distress in patients with cancer by including studies published from January 2018 to September 2019. Thirty-three publications describing online interventions were included in the review, including web-based, blended care, telehealth, mHealth, and other online interventions. There was great heterogeneity across studies. The evidence of online interventions' effectiveness in reducing distress was mixed; there was partial support for reduction in psychological distress and depression, but limited evidence for reducing anxiety. Some important limitations should be taken into account when interpreting the results. Online interventions for people affected by cancer, in general, are well received and seem to be a necessary component of comprehensive cancer care. However, these interventions should be more rigorously tested to provide more conclusive evidence about their effectiveness.

Health sector decentralisation in Tanzania: Analysis of decision space in human resources for health management.

While decentralisation of health systems has dominated the political arena in the low- and middle-income countries since the 1970s, many studies on decentralisation have focused on understanding who is given more decision-making authority, but less attention is paid to understanding what that authority involves. This paper assesses the range of decision-making authority transferred from the central government to subnational levels in the area of human resources for health management in Tanzania. This analysis was guided by the decision space framework and relied on interviews, focused group discussions, and analysis of documents. Data were analysed using thematic approach. While districts had narrow decision space on recruitment and promotion of health service providers, they had wide decision space on distributing health providers within districts and providing incentives. Centrally managed recruitments resulted in frequent delays, thereby intensifying shortages of skilled health service providers. This analysis concludes that decentralisation of human resources for health planning and deployment role to lower levels of the administrative hierarchy in Tanzania is limited. This suggests the need for the central government to increase decision space to districts in the area of recruitment. In order for the Ministry of Health to perform its functions better in the area of human resources for health management, there is a need to strengthen the capacity of the department dealing with recruitment of skilled health staff at the Ministry of Health.

Exploring the Implications of District Splitting on the Constitution and Functionality of District Service Commissions in Uganda: A Case Study of 8 Districts in Uganda

In Uganda district splitting occurs when new districts are created out of old districts using existing boundaries which usually constitute a health sub district or county boundary. The Ugandan system of local governance is based on the district as a functional unit under which there are lower local governments and administrative units that follow the devolution system of decentralisation. The aim of this study was therefore to assess issues affecting constitution, functionality and operationalization (establishment and appointment) of District Service Commission (DSCs). This was an exploratory cross-sectional study that used qualitative methods about the implications of the phenomenon of district splitting (creation) in relation to constitution and functionality of the district service commissions and human resources for health management. We purposively collected data from 16 key informants based on their roles and responsibilities on the DSCs. Out of the eight districts in the study, only one district constituted a fully functional DSC while the remaining seven districts managed to constitute DSCs in a period between 6 and 12 months. This study shows that splitting negatively affected both the parent and child (new) districts in sense that they could not constitute a complete committee within the stipulated time of three months. Generally, all the districts have had challenges in constituting the DSCs of 5-7 commission committee members. Only one in the eight districts had managed to constitute a full committee within three months of post-splitting. After districts are split, majority of the DSCs especially in the child districts took over almost a year to be constituted and fully functional due to mainly lack of qualified members for example retired senior civil servants in these districts. All the eight districts had a challenge of political interference during the process of appointing the technical team, which delayed constitution of quorum of DSCs in the districts. Lack of resources to carry out most of the DSC functions was also mentioned in all districts as a major hindrance to the district councils which were responsible for appointing DSC members. The DSCs should be allowed to operate with no political interference and this can be enacted as a law by parliament.

Modelling the predisposition of Norway spruce to Ips typographus L. infestation by means of environmental factors in southern Finland

New measures for effective monitoring and controlling of bark beetle infestations are needed as a response to intensified outbreaks caused by the climate change. Various environmental factors affect tree health and susceptibility, as well as stand predisposition to bark beetles. European spruce bark beetle Ips typographus L. abundance and outbreak frequency in Finland has significantly increased during the last decade. The ability to identify sites under a high risk of infestation would facilitate adaptation to this new situation and help target limited forest health management resources. Accordingly, our goal was to investigate the importance of various stand, soil and topographic characteristics in the assessing predisposition of Norway spruce dominated urban forest in southern Finland to I. typographus infestations. Information on the environmental factors was assessed in the field in 2014 and derived from a digital elevation model. Ips typographus infestation intensity was classified into three infestation index classes based on tree-wise symptoms of resin flow, discoloration and defoliation. Cumulative logit link models were utilized for investigating stand-level infestation probability. The best explanatory factors were aspect, slope, site type and soil texture. Models with the highest cumulative probabilities for severe infestation were linked with eastern aspect, moderate steep slope and rich site type fertility (0.72) and eastern aspect, shallow soil and rich site type fertility (0.71). Higher soil C/N ratios with east aspect and rich site type fertility was associated with an increased risk of severe infestation in a third model. The lowest risk was associated with southern and southwestern aspects, fine soil texture, moderate site fertility and gentle slopes.

High intensity lifestyle intervention and long-term impact on weight and clinical outcomes.

BackgroundObesity increases the risk for diabetes and cardiovascular events, with a corresponding growth in medical costs. High intensity lifestyle intervention (HILI) is the cornerstone for weight management. We assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of program participation and comorbid conditions.MethodsThis was a retrospective cohort study of patients who enrolled in HILI weight management programs at Health Management Resources (HMR) clinics located across the U.S. Patients completed health risk assessments (HRA) and were enrolled for up to 24 months at the time of follow-up HRA. HMR programs provide weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000 kcal/wk. A Markov model predicted avoidance of diabetes and cardiovascular events and projected cost savings due to weight loss.ResultsOf the 500 patients included in the analysis, 67% were female and mean age was 54.1 years (s.d. 11.6). The baseline weight and BMI were 243.5 lbs (range 144.0–545.0) and 38.8 kg/m2 (range 25.4–85.0), respectively. Overall, patients lost an average of 47.4 lbs (18.9% of initial body weight [IBW]); the amount of weight loss was consistent among those with diabetes/pre-diabetes (50%), high/moderate risk for dyslipidemia (60%), hypertension/pre-hypertension (86%), and severe obesity (37%). The mean IBW lost was 16.4%, 19.3%, 20.7% for ≤6 months (n = 165), 7–12 months (n = 140), 13–24 months (n = 195) of program participation, respectively. The simulation model estimated 22 diabetes and 30 cardiovascular events and $1,992,370 medical costs avoided over 5 years in the 500 patients evaluated.ConclusionPatients in the HMR clinic-based HILI program achieved substantial weight loss regardless of duration of program participation, risk profile and comorbid status. The HMR program could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high risk patients.

Mobility Outcomes From Resistance Training Delivered via Flash Drive to Overweight/obese Patients In A Clinical Setting

Elastic and isotonic resistance training can improve health and fitness. Little is known about the impact of a home-based, structured program delivered via flash drive videos to weight management patients in a clinical setting. PURPOSE: To measure functional fitness/mobility after 12 weeks of a home-based, video led resistance-training program (Mini BIRST) designed as short interval workouts using dumbbells or Theraband CLX elastic resistance bands. METHOD: Overweight/obese participants (n=21, 51.5 yrs, BMI 33.2 kg•m-2) enrolled in the Health Management Resources (HMR) weight management program, self-selected to join the study and were assessed for baseline health and mobility. They were randomized into 2 groups: 3 weeks of isotonic resistance followed by 3 weeks of elastic resistance (10-20 min/day, 2-3 days/wk, 6 wks) using a cross-over design. Participants then performed full body CLX-only circuit exercises (20 min/day, 2-3 days/wk, 6 wks). Both home-based programs were delivered via written handouts and flash drive videos. Functional fitness/mobility was assessed using standardized tests. Repeated measures ANOVA were conducted and a p-value of <0.05 was used to indicate significant changes. An opinion survey was conducted to determine attitudes about the program and delivery. RESULTS: Participants exercised 3 days/wk for 12 weeks with 83% compliance. Mobility improved for chair stand (26%), arm curl (35%), aerobic endurance (25%), and flexibility in both legs (4% right, 2% left). Participants showed no changes for weight or BMI, but successfully maintained “weight neutral” during the 12-week. Participants trended toward an increase in physical activity (9%), over baseline. ” Participant opinions revealed they “Liked” the program overall” (75%), said they “Felt good” (70%), was “Convenient to do” (85%), “Liked the flash drive delivery” (85%) and would “Continue the program” (85%). CONCLUSIONS: Participants complied to and enjoyed the home-based, dumbbell and CLX resistance band short-burst workouts delivered via flash drive videos and illustrated handouts, resulting in improved mobility and aerobic endurance. Further study is needed to determine long- term impact on adherence, weight and health. Support for this study provided by Performance Health, Akron, OH.

Constructing landscapes

The concept of therapeutic landscapes has been adopted from geography by anthropologists with a similar commitment to addressing the intersections between the construction of place and the multifaceted and symbolic dimensions of health. Drawing from health geography and medical anthropology, we take up the challenge from these fields to approach health broadly in order to understand how health decision making is connected to intersecting political, economic, social, and cultural processes that shape what options are available to people. This article presents findings from an ongoing study of the political ecology of health in northeastern South Africa. We consider how therapeutic landscapes are produced by physical infrastructure, social dynamics, and the use of natural resources for livelihoods and health management. While each of these dimensions is critical in shaping human health, we argue that it is through their interaction that therapeutic landscapes are produced. Landscapes of care are thus complicated and shifting, with rural households making strategic decisions to leverage government support, social support, and resources for health management. We conclude by emphasizing the need for further integration of anthropological and geographic frameworks in studying human health.

RATIONALE FOR DEVELOPING A UNIVERSAL PLATFORM OF DATA MINING USING SCALABLE COMPUTING RESOURCES FOR HEALTH MANAGEMENT IN THE NAVY

The article explains the issues of implementation, upgrade and support of algorithms for analysis of large data sets, which are hidden from the end user. It is shown that, to create a universal platform of data mining using scalable computing resources for health management in the Navy requires the development of information-analytical core of intelligent system of high-performance analysis of large amounts of data that will successfully work as a developer of services for the creation of the health management system in the Navy (providing the environment and processing power for debugging and research of parallel and distributed versions of the algorithm, as well as a framework and a development tool for local development and debugging of algorithms) and analysts (providing services of data mining by various methods, data processing (conversion, cleaning, etc. etc.) to «unlimited» computing resources.

Efficacy of commercial weight-loss programs: an updated systematic review.

Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear. To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults. MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff. Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only). Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias. We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs. Many trials were short (<12 months), had high attrition, and lacked blinding. Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed. None. ( CRD4201-4007155).

Turnover Intention and Associated Factors Among Health Professionals in University of Gondar Referral Hospital, Northwest Ethiopia

Background: Health workers turnover is an increasing problem that threatens the functioning of the health care sector worldwide, especially in developing countries. There are very few studies on turnover intention in low-income countries, especially in Ethiopia. This study aimed to assess turnover intention of health workers and its determinants in University of Gondar Referral Hospital, Ethiopia. Methods: Institutional based cross sectional study was conducted from March to April, 2014 at University of Gondar Referral Hospital on 394 health professionals using stratified random sampling techniques. The data were cleaned, coded, entered into EPI INFO version 3.5.3, and transferred and analyzed using SPSS version 20. Bi-variable and multivariable logistic regression analyses were carried out to identify factors associated with turnover intention. Results: overall, 52.5% of the health professionals reported to have turnover intentions. Respondents who have degree and above academic rank [AOR=2.717(95%CI:1.192,6.190)]; nursing profession [AOR= 7.668(95%CI: 2.913,20.188)], laboratory profession[AOR 9.153,(95% CI: 2.925,28.636)], work experience of 2.1 to 5 years [AOR=1.937,(95% CI: 1.142,3.288)] and income level of 2100 to 2259 [AOR =0.431(95% CI: 0.213,0.871)] were significantly associated with turnover intention of the health professionals. Conclusions: In this study, turn over intention of health professionals was found to be high. Educational level, profession, work experience, income are significantly associated with intent to turnover. Hence, it is worth strengthening human resources for health management at hospital level through implementing retention strategies.

Role of Civil Society in Human Resources for Health Management in Nepal

Role of Civil Society in Human Resources for Health Management in Nepal

A Systematic Review of Literature on the Effectiveness of Behavioral Weight Loss Programs to Achieve Weight Reduction

The goal of this systematic review of literature is to determine the efficacy of behavioral weight loss programs at reducing weight and maintaining weight loss. The review of literature consists of articles focusing on the Health Management Resources (HMR) behavioral weight loss program focusing on specific aspects within the weight loss program and how they contribute to overall weight loss and weight maintenance

Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States

Each year millions of Americans enroll in commercial and self-help weight loss programs. Health care providers and their obese patients know little about these programs because of the absence of systematic reviews. To describe the components, costs, and efficacy of the major commercial and organized self-help weight loss programs in the United States that provide structured in-person or online counseling. Review of company Web sites, telephone discussion with company representatives, and search of the MEDLINE database. Randomized trials at least 12 weeks in duration that enrolled only adults and assessed interventions as they are usually provided to the public, or case series that met these criteria, stated the number of enrollees, and included a follow-up evaluation that lasted 1 year or longer. Data were extracted on study design, attrition, weight loss, duration of follow-up, and maintenance of weight loss. We found studies of eDiets.com, Health Management Resources, Take Off Pounds Sensibly, OPTIFAST, and Weight Watchers. Of 3 randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at 2 years. One randomized trial and several case series of medically supervised very-low-calorie diet programs found that patients who completed treatment lost approximately 15% to 25% of initial weight. These programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss. Because many studies did not control for high attrition rates, the reported results are probably a best-case scenario. With the exception of 1 trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal. Controlled trials are needed to assess the efficacy and cost-effectiveness of these interventions.

Physical Activity Survey Among Participants in a Weight Management Program

Although physical activity is widely accepted as an important variable in weight management, there are few large-scale surveys that report on the amount and type of activity people in community programs are actually doing. This was a prospective study of 2005 participants (77.1% women, 22.8% men) from 39 different clinics all participating in the Health Management Resources® Weight Management Program. Fifty-seven percent of the participants responding to the survey were in the weight loss phase and 43% were in the maintenance phase. All patients in each clinic were asked to complete the survey using their physical activity records for the week of Oct. 19, 1998. Eighty-three percent of patients reported having physical activity records for that week. The average number of total activity calories reported by all patients was 2063kcal/wk. The average number of weekly physical activity calories reported by weight loss patients was 2012; the average number of exercise calories reported by maintenance patients was 2139kcal/wk. Fifty-eight percent of exercise calories were reported as walking. Other popular activities included using a treadmill, aerobics or step aerobics, using a stair machine, yard work or outside work, housework, weights, exercise bike and bike riding. The average amount of reported weight loss being maintained was 43 Ibs and the average amount of weight lost in the program was 52 Ibs. Maintenance patients reported an average weight loss of 50 Ibs as being maintained. Sixty-six percent of patients reported doing one long bout of activity per day as compared to 27% who reported doing several short bouts of activity per day. This survey shows that patients in a weight management program can leam to track exercise calories, incorporate exercise into their daily lives in numerous ways and do substantial amounts of physical activity.

Assessing Long Term Weight Maintenance Results

A retrospective analysis was performed on all patients active in the maintenance phase (n=82) of the weight management/behavior change education program at the Springfield Diabetes & Endocrine Center in November 1998, to evaluate success in losing weight and maintaining weight loss. Three methods for weight loss were used: very low calorie diets (520kcal/day) (HMR™500) for morbidly obese, low calorie diets (800kcal/day)(HMR™800) for patients at minimal health risk, and moderate calorie deficit diets. Patients attended weekly group classes conducted by registered dietitians, which emphasized physical activity, calories, low rat cooking, environmental control, Failure Syndrome™ issues, and self-management of weight. All staff are trained and skilled in teaching the Health Management Resources (HMR™) behavioral change education program. All patients attended a minimum of 6 months of weekly one hour maintenance classes, while high risk morbidly obese patients attended a minimum of 18 months of classes. 59% patients had voluntarily chosen to extend their initial maintenance contract period of service. 57% patients were at least 2 years in maintenance, while 26% were beyond 5 years. Average weight loss of all patients (n=82) was 64lbs. & 27% of initial body weight. Average % initial body weight being kept off is 21%. Patients beyond 2 years in maintenance (n=40) lost an average of 75lb., equal to 13% initial body wt Patients beyond 5 years in maintenance (n=21) lost an average of 80 lbs. and are maintaining wt. loss equal to 15% initial body wt. Authors conclude it is possible to get patients to attend behavior change education classes regularly even after 5 years in maintenance. Participation in the HMR™ maintenance program enables patients to keep off significant amounts of weight. It appears mat periods of non-participation in maintenance affect weigjht maintenance adversely.

Designing a Marketing Plan That Works

As healthcare organizations incorporate marketing strategies into daily operations, nurse executives find themselves involved in the process with varying degrees of comfort and success. The authors discuss the nurse executive's role and responsibilities for the success of a marketing plan and describe the importance of recognizing how far marketing has evolved within an organization in order to design a suitable plan successfully.