Maximizing purchase decision factors other than price

Assessing and acquiring technology does not have to be chaotic, driven solely by price, clinical preference, and emotion. With the tools available, it can be distilled to a process of organized common sense, which results in maximum flexibility for the user and allows materiel managers to procure the best, most cost-effective equipment for the hospital.     

Body support testing and rating

The REF, C, and score are a means to give quantitative values for product performance. Other product variables defined as humidity control factor, shear control factor, differential temperature control factor, product life factor, and cost factor were not addressed as part of this study. Additional variables include delivery, maintenance, and warranties. These components can be added to the score in some weighted manner as they become clinically founded. Interface pressures and shears were not measured for beds that are gatched. Each product tested will have characteristics pertinent to its own design that must be addressed to minimize sacral and coccyx skin breakdown when subjects are in this posture because some pneumatic pads bottom out to give excessive sacral and coccyx pressure while others wrinkle when used in this position. This is of major concern when one considers that the coccyx is more susceptible to pressure than any other bony prominence. There may be some aversion to labeling support product performance because it will allow the purchaser to know what is being bought. This initial study indicates the feasibility of quantitating what all patients require: a valid interface support surface for each specific need. The user can be adequately informed before the purchase as to a product's merits without being influenced by the results of inadequate testing, referrals, or sales media influences. Although cushions, shoes, or other prosthetic/orthotic devices were not part of this study, it is appropriate to rate all these devices in a similar manner by simply comparing pressure relief attained to that desired, expressing the result as a percentage of the worst case, and then labeling the product accordingly. Those subjects with sensation can rate comfort as part of the overall score. For cushions, ischial tuberosity pressure relief can be expressed as a percentage of the maximum attainable relief. Metatarsal head relief during gait as well as during static testing can be measured, and claims can be made for shoes and sneakers. Where impact loads and shear forces are paramount, the score must comprise appropriate parameters. Similarly, amputee distal stump relief as a percentage of worst case could be specified by the fitter. Iliac crest relief as a percentage of worst case can also be specified by the fitter. In all instances the score is not a subjective rating but one that can be measured correctly. All body support products can be given an REF, C value, and score as well as other qualifying values where appropriate instrumentation and sufficient subject sampling is used.     

U.S. Savings Bonds: the planned-gift forgotten asset

As older Americans take a close look at their assets, promote their interest in unlocking the wealth accumulation in their U.S. Saving Bond holdings. Use careful planning and advice when promoting this gift strategy.     

Couple's literacy level and acceptance of family planning methods: Lorenz curve analysis

The authors study the acceptance of family planning methods according to the level of couple's literacy in 14 states in India during 1986-87, using the Lorenz curve. The Gini Concentration Ratio and Index of Dissimilarity were calculated by level of couple's literacy for vasectomy, tubectomy, IUD, and all method combined. Firstly, analysis found literates to have accepted vasectomy and IUD more than tubectomy. Secondly, among the 3 methods, a high Gini Concentration Ratio was found for vasectomy when the wife was literate. Moreover, when the wife was literate, the Gini Concentration Ratio of IUD acceptance was higher than the acceptance of IUD by the wife whose husband was literate. Thirdly, the same trend was observed when the husband was illiterate. It is therefore clear that the level of a woman's literacy is a key factor in securing the acceptance of male or female methods of family planning. Planners should therefore concentrate on literacy programs for females independently of their age. Increasing the level of female literacy may ultimately help improve the understanding of family planning methods, while these women may also motivate their husbands to undergo vasectomy which will ultimately foster the success of the family planning program.     

Around-the-clock medical coverage

Marrying workers' compensation and health insurance plans to reduce administrative workloads and get a firm grip on expenses. Can it work?