Medical Equipment Research Articles

Adversarial robust image processing in medical digital twin

Recent advancements in state-of-the-art technologies, including Artificial Intelligence (AI), Internet of Things (IoT), and cloud computing, have led to the emergence of an innovative technology known as digital twins (DTs). A digital twin is a virtual replica of the physical entity, with data connections in between. This technology has proven highly effective in several industries by improving decision-making and operational efficiency. In critical areas like healthcare, digital twins are increasingly being used to address the limitations of conventional approaches by creating virtual simulations of hospitals, medical equipment, patients, or even individual organs. These medical digital twins (MDT) revolutionize the healthcare industry by offering advanced solutions to enhance treatment outcomes and overall patient care. However, these systems are challenging because of the security and critical issues involved. Therefore, despite their achievements, the numerous security threats make it crucial to address the security challenges of digital twin technology. Given the lack of research on attacks targeting MDT functionalities, we concentrated on a specific cyber threat called adversarial attacks. Adversarial attacks exploit the model’s performance by introducing small, carefully crafted perturbations to manipulate the input data. To assess the vulnerability of medical digital twins to such attacks, we carried out a proof-of-concept study. Using image processing techniques and an artificial neural network model, we created a digital twin to diagnose breast cancer through thermography images. Then, we employed this digital twin to initiate an adversarial attack. For this purpose, we inserted adversarial perturbation as input to the trained model. Our results demonstrated the vulnerability of the digital twin model to adversarial attacks. To tackle this problem, we implemented an innovative modification to the digital twin’s architecture to enhance its robustness against various attacks. We proposed a novel defense method that fuses wavelet denoising and adversarial training, substantially strengthening the model’s resilience to adversarial attacks. Furthermore, the proposed digital twin is evaluated using a dataset of diabetic foot ulcers. To the best of our knowledge, it is the first defense method that makes the medical digital twin significantly robust against adversarial attacks.

Urbanization factors and the vagaries of the rural health care industry in Nigeria: an analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area

This study sought to determine the effects of urbanization on access to healthcare services by older adults in Nsukka Local Government Area. The Nigerian healthcare industry is organized under the three tiers of government: Federal, State and Local governments. As such, most of the healthcare facilities are located in urban areas while majority of older adults reside in different local governments in rural communities where there are a few of the facilities. This has led to poor utilization of medical services by older adults in rural areas. This study adopted a mixed method approach. While questionnaire was used to collect quantitative data, interviews were used to collect qualitative data for the study. Questionnaire survey was used to collect data from 1180 older adults between the ages of 60 years and above from six communities in the study area. Descriptive statistics and Chi square were used to analyze the data while frequency distribution tables and percentages were used to present the results. The research showed that there are inadequate health facilities for the older adults in rural communities in Nsukka LGA. It also found that the older adults suffered challenges arising from lack of medical doctors, nurses, equipments, and drugs for effective healthcare delivery. It is recommended that more efforts should be geared towards providing adequate health facilities and health workers by government at public hospitals in rural communities to increase accessibility and adequate utilization by the older adults.

Long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic mask with a Janus-structured all-natural fiber network for personal healthcare

Conventional disposable surgical masks have become an integral part of our daily lives, however, present a limited filtration efficiency, brief operative lifespan, and inability to degrade naturally, bringing a heavy burden to the environment. Moreover, these masks cannot efficaciously eliminate bacteria, potentially causing secondary and cross infections among users, thereby failing to curb the spread of infectious diseases. Herein, a fire-new, long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic-mask is nano-engineered with a Janus-structured all-natural fiber network (SA-CPN) constructed from animal-collagen and plant-fibers. SA-CPN demonstrates exceptional filtration performance (99.9%) for PM2.5 and maintains outstanding filtration efficiency after 10 test-cycles or 32 h in high-humidity conditions. SA-CPN exhibits robust antibacterial origins for extended periods, with antibacterial rates of 98.30%, 99.36%, and 98.11% against P aeruginosa, S aureus, and E coli, respectively, and can effectively filter airborne bacterial aerosols. Moreover, SA-CPN achieves real-time detection of ammonia concentrations, effectively identifying ammonia levels in exhaled human breath and external environments, and monitoring the human respiratory rate, potentially identifying underlying health conditions. The directional water vapor transmission capability of SA-CPN improves comfort when wearing. Notably, SA-CPN can fully biodegrade within 5 h under enzyme action. The proposed multifunctional electronic mask, featuring biocompatibility, biodegradability, self-disinfection, and ammonia sensing capabilities, holds significant promise in personal medical protective equipment for health monitoring and disease prevention.

Retraction Note: Optical medical equipment application and observing the occurrence of hypotension in elderly patients after general anesthesia induction through arteriovenous ultrasound parameters

Retraction Note: Optical medical equipment application and observing the occurrence of hypotension in elderly patients after general anesthesia induction through arteriovenous ultrasound parameters

Postprocedure protocols after intraarticular orthobiologic injections-A scoping review.

Osteoarthritis is a chronic degenerative disease affecting 500 million people throughout the world. Although orthobiologics have been proposed as a symptom and disease modifying treatment for osteoarthritis, there is significant heterogeneity in the results of the orthobiologic procedures in the literature. One possible explanation for the heterogeneity is the inconsistent reporting and description of the postorthobiologic protocols. The goal of this scoping review was to identify the current literature on the use of orthobiologics for osteoarthritis and critically evaluate the postorthobiologic protocol within these studies. A total of 200 identified studies met inclusion criteria. In 37.5% of studies, there was no mention of a postorthobiologic protocol. Of the 125 studies that did mention a postorthobiologic protocol, only 38.4% included a rehabilitation protocol, 21.6% included postprocedure weightbearing restrictions, and only 2 (1.6%) mentioned the use of durable medical equipment. Nonsteroidal anti-inflammatory drug restriction was described in 91.2% of study protocols, whereas corticosteroids and immunosuppressants were restricted in 84.8% and 19.2% of protocols, respectively. The results of this scoping review demonstrate the inconsistent reporting of postorthobiologic procedure protocols in the literature, with significant heterogeneity in those that are described. These findings highlight the need for future research and improved reporting of postorthobiologic protocols.

Test and sensitivity analysis of base‐isolated steel frame with low‐friction spherical sliding bearings

AbstractIn Japan, spherical sliding bearings with low friction coefficients are gaining popularity for base‐isolating low‐rise frames that are relatively lightweight. However, the complete dataset of isolators and a base‐isolated frame for evaluating the model sensitivity and response uncertainty are limited. This study first presents the design process, isolation unit‐ and frame‐level testing, and a blind prediction contest conducted on the occasion of full‐scale shaking table testing of a three‐story base‐isolated hospital specimen. The design process utilizes a numerical model that accounts for the velocity and contact pressure dependencies and requires soft‐ and hard‐case simulations with nominal friction coefficients plus and minus standard deviation to consider the uncertainties associated with the bearing behavior. The pre‐shipment isolation unit and frame shake table testing yielded an invaluable dataset for bearings under normal and low contact pressures, low and high velocities, and constant and varying axial loads. The accompanying blind prediction contest provided a valuable dataset for rethinking the impact of modeling uncertainty. In‐depth data analysis and sensitivity analysis were conducted. The sliding coefficient increased under low‐contact pressure and low‐velocity conditions. The static friction coefficient was 1.9 to 4.5 times higher than the dynamic coefficient, but this had little impact on the residual displacement, cumulative travel, and maximum story shear force. The axial force fluctuation, vertical motion, and two‐directional input did not significantly affect the bearing behavior in the test. The test and the following simulations confirmed that the low friction coefficient helped the building contents, that is, medical equipment in this study, remain in order under near‐fault and long‐period ground motions.

Innovative Techniques for Pharmaceutical Waste Management: Enhancing Drug Recovery and Environmental Sustainability

The pharmaceutical sector is a major component of current healthcare, manufacturing and distributing drugs, biological substances, and medical equipment. Despite its advantages, the sector creates enormous waste, including materials for packaging, production by-products, expired or unused drugs, and other residues, creating health and environmental issues. Appropriate pharmaceutical waste handling and medication recovery strategies are vital for limiting these problems. This article aims to investigate and evaluate multiple techniques for recovering pharmaceuticals from pharmaceutical waste, highlighting the significance of sustainable waste management in the pharmaceutical sector. The paper emphasizes the need to use modern methods such as liquid-liquid extraction, membrane crystallization, solid-liquid extraction, and adsorption to recover drugs from pharmaceutical waste. Liquid-liquid extraction exhibits excellent adaptability and efficiency for varied Active Pharmaceutical Ingredients (APIs), whereas membrane crystallization provides low-energy solutions for thermally sensitive compounds. Solid-liquid extraction is useful for recovering APIs from solid dosage forms, while adsorption approaches exploit substances like activated carbon for organic component recovery. Each process has particular benefits and disadvantages, with the selection of methodology based on waste properties and recovery objectives. It emphasizes the promise of these technologies for high extraction yields, purity, and environmental sustainability, supporting effective pharmaceutical waste management procedures. Additionally, difficulties such as cost-effectiveness, scalability, and regulatory compliance are addressed, pointing to opportunities for future research and development to improve the efficacy of drug recovery procedures. In conclusion, using advanced techniques to recover pharmaceuticals from pharmaceutical waste offers a viable way to implement sustainable waste recovery procedures and lessen the pharmaceutical industry's negative environmental effects.

Retraction Note: Application of optical medical equipment imaging detection and fire needle therapy for intestinal mucosal barrier function in patients with intestinal diseases

Retraction Note: Application of optical medical equipment imaging detection and fire needle therapy for intestinal mucosal barrier function in patients with intestinal diseases

A magnetohydrodynamic flow of a water-based hybrid nanofluid past a convectively heated rotating disk surface: A passive control of nanoparticles

Abstract One of the basic fluid mechanics problems of fluid flows over a revolving disk has both theoretical and real-world applications. The flow over a rotating disk has been the subject of numerous theoretical studies because it has many real-world applications in areas like rotating machinery, medical equipment, electronic devices, and computer storage. It is also crucial for engineering processes. Therefore, this article deals with a time-independent water-based hybrid nanofluid flow containing copper oxide and silver nanoparticles past a spinning disk. The Newtonian flow is taken into consideration in this analysis. The influence of magnetic field, thermophoresis, nonlinear thermal radiation, Brownian motion, and activation energy has been considered. The present analysis is modeled in a partial differential equation form and is then converted to ordinary differential equations using appropriate variables. A numerical solution using the bvp4c technique is accomplished using MATLAB software. The current results are matched with the previous literature and established a close relationship with previous studies. The purpose of this investigation is to numerically investigate the time-independent hybrid nanofluid flow comprising copper oxide and silver nanoparticles over a rotating disk surface. The results show that the increased magnetic parameters increase the friction force at the surface, which decreases the radial and azimuthal velocity distribution. At the sheet surface, the radial velocity of the hybrid nanofluid shows dominant performance compared to the nanofluid. On the other hand, the magnetic factor has dominant behavior on the azimuthal velocity component of the nanofluid flow compared to the hybrid nanofluid flow. The higher volume fraction and magnetic factor enhance the skin friction at the disk surface. Furthermore, greater surface drag is found for the hybrid nanofluid flow. The higher solid volume fraction, temperature ratio, and Biot number enhance the rate of heat transmission. Also, a higher rate of heat transmission is observed for the hybrid nanofluid flow.

Three Delays Model in the Context of Maternal Mortality in Longido District, Tanzania

This study dealt with the three delays model in the context of maternal mortality in Longido District, Tanzania, using the descriptive correlational design. The study selected the district due to the highest maternal mortality rates and number of women giving birth to traditional birth attendants compared to other districts in Arusha. A sample of 311 respondents from 14 health facilities participated by filling out a questionnaire. Data analysis took place through descriptive statistics and regression analysis. Based on the findings, the study concluded that although respondents possessed essential knowledge to prevent maternal mortality, they also possessed negative opinions that could delay their actions against the maternal mortality. While women’s readiness to reach the healthcare facilities prevailed, male partners’ willingness to escort their wives to the healthcare facilities did not exist. Therefore, male-female partnerships in reaching healthcare support emerged as a challenge. Furthermore, the care received from medical facilities sounds unsatisfactory due to limited medical personnel, facilities, and equipment. Social cultural practices predicted the maternal mortality. Therefore, strengthening community awareness, addressing socio-cultural barriers and positivity in accessing services will alleviate delays and reduce maternal mortality. Enhancing family and spousal support towards decision-making and financial support will overcome barriers to care, improve maternal health and reduce the maternal mortality. Strengthening the health system by sustaining resources, accountability, and improved working environment are essential steps towards enhancing the quality of care and consequently reducing maternal mortality.

Modern Prospects for the Application of Mechatronics and Robotics Capabilities

This article explores the application of mechatronics and robotics capabilities. In recent years a new quickly developing scientific and technical activity was created. It is called Mechatronics and represents an innovative field of science and equipment where the high-precision mechanics connects to the same exact electronics under control of the most modern computer programs [1],[2]. As a result difficult mechanisms of computer motion control with tremendous functionality are created. Industrial robots are striking examples of such mechanisms. Besides, there are mechanisms of retracting plane flaps and the chassis, many systems of a modern car and "smart houses". Technical and technological progress is impossible without mechatronics [3],[4]. Robotics and industrial automatic equipment in various branches of economy, automation of technological processes, systems of planning and business management, automation of transport, dispatching and other systems falls within the scope of its interests. Nowadays “Mechatronics” is one of the most demanded educational majors in the world. Mechatronics specialists are demanded in different areas: in power engineering, machine-tool design and production of the equipment, automation of technological processes, robotics and automotive industry. Security systems, military equipment, the medical equipment can't be designed without mechatronics.

A numerical investigation of the polyethylene glycol‐based tetra hybrid nanofluid flow over a stretched porous rotatory disk

AbstractPolyethylene glycol (PEG) is a great heat and mass transmissive fluid that has promising applications in medical, pharmaceutical, and electronic industries. Tetra‐hybrid nanofluids (HNFs) are the most upgraded version of heat and mass transmissive nanofluids that are synthesized by dispersing four distinct nanoparticles in the carrier fluid. The study of the flow of nanofluids and their advanced classes across rotatory disks is receiving remarkable interest in research and innovation due to their considerable applications like gas turbine rotors, aeronautical, medical equipment, rotating machinery, thermal power developing systems, and so forth. Therefore, the present paper aims to inspect the magnetohydrodynamic, steady, three‐dimensional, and incompressible flow of a non‐Newtonian tetra‐HNF over a stretched porous rotating disk. The chosen tetra‐HNF consists of four distinct nanoparticles namely, molybdenum disulfide, copper oxide, magnesium oxide, and zirconium oxide with PEG as the carrier fluid. The flow model is modified with innovative impacts of variable thermal conductivity, thermal radiation, chemical reaction, variable mass diffusivity, and suction/injection to make this research more convenient. The mathematical computation is conducted via the bvp4c numerical method, and the outputs are determined via tables and graphs. Mounting values of the Deborah number amplify the axial velocity while augmentation is noticed in the fluid's radial and azimuthal velocities for rising values of the rotation parameter. Besides, the rotation parameter aids in enhancing both the heat and mass transportation rates while the chemical reaction parameter significantly aids the mass transportation rate. One of the significant results of this inspection is that tetra‐HNF exhibits better heat and mass transportation rates than the ternary‐HNF, and the HNF whereas it has lesser skin friction than the ternary‐HNF, and the HNF.

7525 Impact of Medicaid Policy Change on CGM Uptake in a Federally Qualified Health Center

Abstract Disclosure: W. Solorzano: None. L. Scarlett: None. K.P. Santiago Mangual: None. J. Borrell: None. B. Brumley: None. M. Tavares: None. C. Santana: None. T. Moin: None. E.M. Everett: None. Background: Despite the numerous benefits of CGMs in diabetes management, studies have consistently reported inequities in CGM use in racial-ethnic minorities, lower socioeconomic status, and with public insurance. In January 2022, a new California Medicaid policy switched coverage of CGMs from a Durable Medical Equipment benefit to a pharmacy benefit, creating less stringent insurance related criteria for CGM approval. We aim to evaluate the utilization of CGM use after the aforementioned policy change in an urban, multi-centered, federally qualified health center. Methods: We performed a retrospective study of patients with diabetes seen by diabetes NPs in three different clinics from January 1, 2022, through June 30, 2023. We excluded patients not managed on insulin. Patients were stratified by CGM status (current user, former user, never user). We used descriptive statistics to report patient demographics and clinical characteristics. Chi-squared test was used to evaluate differences between groups. We performed multivariate logistic regression to evaluate predictors of never using CGM. Results: We identified 239 patients who met inclusion criteria. They were primarily between the ages of 45-64 (60%), female (57%), Hispanic (84%), Spanish speaking (70%), and on Medicaid insurance (63%). Majority had a diagnosis of type 2 diabetes (93%) and managed on basal insulin plus other antidiabetic medication(s) (48%) with a mean HbA1c ≥ 10% (31%). At the end of the study period, 37% were current CGM users, 13% were former users and 51% were never users. Almost all (98%) of those who used CGMs started after January 2022.There was a statistically significant difference between CGM groups and treatment regimen (p = 0.000), insurance type (p = 0.000), type of diabetes (p = 0.000), and clinic site (p = 0.029). There was no statistically significant association between age, birth sex, race, primary language, or mean Hba1c. Most current and former users were/are on Freestyle Libre 2 (61% and 93%, respectively). Among never users, 55% had no discussion about CGM use documented in their charts. In an adjusted analysis, insurance type was the strongest predictor of never using CGM. Those without insurance on a county program, My Health LA (OR 15.5, 95% CI 3.7-65.6) or self-pay (OR 10.0, 95% CI 1.77-56.3) were more likely to be a never user. Conclusion: In an underserved population with diabetes, insurance status was the primary barrier to CGM use as demonstrated by the large uptake of CGM use after the policy change and that insurance status was the largest predictor of use. Additional studies are needed to evaluate other barriers impacting CGM uptake and adherence, clinical impact of CGM use, and patient experience. This will improve the utilization and adherence of this diabetes technology in this patient population who historically experiences more challenges with diabetes and obtaining optimal glycemic control. Presentation: 6/1/2024

Pilot Study: Behavioral and Medical Clinical Partnership for Optimization of Positive Airway Pressure Therapy in Pediatric Patients

BackgroundTo assess the effectiveness of a structured algorithm for pediatric positive airway pressure (PAP) initiation for the treatment of obstructive sleep apnea (OSA). MethodsAn algorithm was created to support pediatric PAP use and identify patients who could benefit from early behavioral consultation and education. Sleep providers implemented a unified introduction to PAP therapy with the PAP therapy toolkit. Through a collaborative approach with the medical equipment companies, pediatric patients were provided with PAP equipment before PAP titration studies and were allowed a gradual initiation of PAP therapy. PAP downloads were reviewed to determine improvements in compliance measured by percent of average days used and average minutes per night used. ResultsThirty-eight pediatric patients completed the PAP therapy algorithm. There was significant improvement in PAP compliance in percentage of days used (paired t test P value = 0.04), as well as an improvement (although not statistically significant) in average nightly use. Patients benefitted from close follow-up visits with the sleep advanced practice providers. Patients seen for the consultation with the pediatric behavioral psychologist showed statistically significant improvement in both percentage of days and average nightly use. ConclusionsOur pilot study shows that a behavioral and medical partnership using a structured algorithm was feasible and resulted in improved PAP compliance for our pediatric patients.

Background and Effects of Creative Accounting Practices in the Health Sector in Latin America During the Pandemic Era

The COVID-19 pandemic marked a before and after for the global economy, and one of the most affected sectors was the health sector, where rising costs in medical care, protective equipment and infrastructure, coupled with a decrease in income from other regular services, led a large part of health centers such as public and private hospitals to resort to unethical accounting practices for the manipulation of their financial information (creative accounting). These events of financial depression and relaxation of controls during the health emergency allowed the creation of a "favorable" environment to distort financial statements through techniques such as premature recording of income, undervaluation of expenses, among others, to evade taxes and take advantage of the benefits imposed by governments to promote humanitarian aid and prioritize health care. The purpose of this article is to highlight the most common creative accounting practices that were applied in the health sector in Latin America during the COVID-19 pandemic and the consequent effects it had on the economy and on the governmental control of the countries in the region for the detection of these practices.

Research Progress on Preparation of Superhydrophobic Surface and Its Application in the Field of Marine Engineering

Inspired by the “Lotus Leaf Effect” in nature, the phenomenon of superhydrophobia has attracted tremendous attention from researchers. Due to their special surface wettability, the superhydrophobic surfaces have been found to have broad potential applications in the fields of marine engineering, medical equipment, and aerospace. Based on the introduction of the principles of wettability, the advantages and disadvantages of various preparation methods for superhydrophobic surfaces were studied and summarized in this paper. The research progress on superhydrophobic surfaces in marine engineering applications was analyzed according to their self-cleaning, anti-corrosion, heat transfer, drag reduction, anti-fouling, ant-icing, and oil/water separation properties. Finally, to advance practical applications, the current challenges associated with superhydrophobic surfaces are highlighted, and potential future development directions are proposed.

Optimized substrate temperature for high-quality CdZnTe epitaxial film in X-ray flat panel detectors

Cadmium zinc telluride (CdZnTe or CZT) materials, favored for their physical superiority in optoelectronic applications, can be efficiently produced as large-area epitaxial film via close space sublimation (CSS), enhancing potential in flat-panel detector imaging. However, the application of CdZnTe epitaxial film in medical imaging equipment is limited by their lower resistivity, prolonged response times, and diminished sensitivity. By elevating the substrate temperature, we enhanced the number and depth of reverse sublimation pits on the surface of the CdZnTe epitaxial film, established an approximately 100 nm Zn-rich layer, broadened the bandwidth, and minimized electrode injection. Additionally, we observed an aggregation of dislocations at the edges of the reverse sublimation pits, which promoted surface recombination and reduced leakage current. These modifications significantly increased the film's resistivity to 1011 Ω cm. Further, they notably decreased the rise and drop times to 2 m s and 4 m s, respectively. Integrated with thin-film transistors (TFTs), the optimized CdZnTe epitaxial film now distinctly differentiate between air, plastics, and metals under X-ray examination. This improved performance of X-ray flat panel detectors (FPDs) based on CdZnTe epitaxial film is promising for the development of next-generation X-ray detection systems.

Practice changes and infant health risks during the 2022 infant formula shortage: Results of a US healthcare provider survey.

In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and healthcare providers across the US. A 19-item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected. Two hundred forty-one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended. Providers made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.

Use of and spending on medical equipment among cancer survivors.

210 Background: Cancer survivors are increasingly older, with rising rates of functional impairment, comorbidity burden, and needs. Patients often require medical equipment, but administrative barriers and lack of payer coverage can limit access and increase cost sharing for patients. Prior work on financial burdens has largely focused on direct medical costs and costs of prescription drugs. We sought to characterize patterns of use and costs associated with medical equipment use among US cancer survivors. Methods: We used the US National Health Interview Survey (NHIS)—a nationally representative survey of the US population— to identify self-reported use of medical equipment (‘’such as a cane, a wheelchair, a special bed etc.’’) among cancer survivors from 1997-2018. We then used the Medical Expenditure Panel Survey (MEPS) — which includes additional data on health care costs and spending among people sampled from the NHIS— to evaluate out-of-pocket (OOP) and total spending on equipment (e.g., orthopedic items, prosthesis, bathroom aids, disposable supplies etc.) among cancer survivors from 2016-2020. We describe trends in prevalence of use, and compared OOP costs and percentage of cost sharing responsibility (OOP cost/total spending) for equipment relative to other medical care, such as prescription drugs. Results: We identified 55,625 cancer survivors in the NHIS, representing 19.1 million weighted individuals from 1997-2018. The weighted number of cancer survivors using medical equipment increased during the study period from 0.9 million in 1997 to 2.3 million 2018, a 2.4-fold increase. The number of survivors not requiring equipment increased by 1.7-fold during the same period. The adjusted prevalence of equipment use among survivors increased from 5.1% in 1999 to 7.9% in 2018, a 2.8 percentage-point increase (P < .001 for trend). We identified 32,106 cancer survivors (56.6% women, 55.9% ≥65 years) in MEPS from 2016-2020. Among users, mean annual total spending on equipment was 1,205, and mean OOP costs for equipment were 672. For comparison, mean annual OOP costs for prescription drugs was $541. The cost sharing responsibility for equipment (56%) was higher than that for all other comparison groups: prescription drugs (10%), outpatient visits (11%), occupational/physical therapy (18%), emergency room visits (20%), and hospitalization (3%). Conclusions: The number of US cancer survivors who use medical equipment has more than doubled during the past 20 years. For these patients, OOP costs for equipment are greater than that for prescription drugs, with patients responsible for over half the total spending. These data are particularly notable given that patterns of use and spending reported here do not capture survivors unable to access necessary equipment due to administrative, financial, and/or other barriers. Interventions to assess need, ensure access, and decrease associated financial burden are urgently needed.

Medical Equipment Aging: Part III—An Aging Model for Maintenance and Replacement Plannings

The first article of this series demonstrated that some medical equipment exhibits clear, progressive deterioration with age, whereas some others do not. The second article showed that although most equipment remains safely and reliably deployed well over its respective depreciation period and the end-of-life or end-of-support dates declared by the respective manufacturers, some equipment needs to be replaced sooner. Because it is not practical to wait for the collection and analysis of large amounts of data to better plan for maintenance and replacement, a simple, quantitative model for equipment aging is introduced in this article to help improve both types of planning. The model was tested on professionals not directly involved in its formulation and applied to 34 equipment types. The results show this aging model can be used by professionals experienced in medical equipment maintenance and management, with only some basic instructions. Furthermore, it can be used to update the traditional “risk-based criteria” for planned maintenance and turning it into a risk management method fully compliant with the ISO 14971 standard.