In an era of electronics-driven healthcare, the disposability of many medical devices raises environmental concerns. Transitioning these devices towards a circular economy, involving practices like reuse, remanufacturing, and recycling, holds promise. Our paper explores this transition through desk research, literature review, and expert interviews, examining the current state of circular design in electronic medical devices. We unveil barriers, opportunities, and design recommendations for circularization. First, we highlight the circularity potential of medical devices currently on the market, implementing e.g. refuse, reuse, recycle, etc. Second, we present barriers for circular medical device design, (e.g. (perceived) safety and infection risks, (perceived) regulatory difficulties, financial constraints, and difficulties in collection and separation) and opportunities to overcome these barriers. Finally, we present 29 design-specific recommendations for creating circular medical devices. Our insights into circular healthcare practices urge design engineers to integrate sustainable principles into medical device development without compromising safety, quality, or functionality.

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Like many health devices, smart pill boxes designed to enhance medication adherence often incorporate electronic components and smart sensors. However, the production and disposal of these rising numbers of electronics contribute significantly to the global e-waste crisis, exacerbating the negative climate impact of the healthcare industry. To minimize the impact of such electronic health devices, redesign based on circular economy principles is crucial. However, currently no clear circular design methodology exists to apply those principles in the healthcare domain. This paper discusses a case study in which we propose conceptual redesigns that aim to mitigate the environmental impact of smart pill boxes and help align them with circular economy principles. We employ a research-through-design approach in which we attempt to apply the well-known '10R strategies' (i.e. refuse, rethink, reduce, reuse, repair, refurbish, remanufacture, repurpose, recycle, and recover) as a design method. While doing this, we assessed their applicability in a design process and added value in making the device circular through reflective journalling, and their estimated effectiveness on minimizing environmental impacts by comparing fast-track LCAs for each design decision. In this way, we were able to provide insights into the intricacies of designing a more sustainable and circular device in this manner, and subsequently formulate recommendations for designing similar devices in the future.

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Study objective: The three-dimensional shape of the ultrasound beam produces a thicker scan plane than most users assume. Viewed longitudinally, a needle placed lateral to a vessel just outside the central scanning plane can be displayed incorrectly in the ultrasound image as if placed intravascularly. This phenomenon is called the beam width artefact, also known as the elevation or slice thickness artefact. The goal of this study was to demonstrate the potential negative effect of the beam width artefact on the performance of in-plane ultrasound-guided vascular access procedures, and to provide a solution. Design: Randomized, double-blinded study Setting: Department of anaesthesiology and intensive care of a teaching hospital Participants: 31 experienced (anesthesiologists and intensivists) and 36 inexperienced (anesthetic nurses) ultrasound users Interventions: We developed an acoustic lens that narrows the scan plane to reduce the beam width artefact. The lens was tested in a simulated vascular access study. Measurements: The primary endpoint was first pass success. Secondary endpoints were the number of punctures and needle withdrawals, procedure time, needle visibility and operator satisfaction. Main results: First pass success was highly enhanced using the acoustic lens, with a success rate of 92.5% versus 68.7% without the lens (difference 23.8, 95% confidence interval 11.0–35.3, p < 0.001). The total number of punctures needed to obtain intravenous access was also reduced using the lens (1.10 versus 1.38, difference 0.27, 95% CI 0.11–0.43, p = 0.002). Procedure time, needle withdrawals, needle visibility and satisfaction were similar. Both inexperienced and experienced users benefited from the acoustic lens. Conclusions: The beam width artefact has a significant effect on the performance of ultrasound-guided needle-based procedures. The efficacy of in-plane superficial vascular access procedures can be enhanced by narrowing the imaging plane using an acoustic lens.

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Extremely premature babies (24 to 28 weeks) have underdeveloped bodies, resulting in a survival rate of only 50-70%. To increase this rate, researchers around the globe are developing an artificial womb (AW), a safe environment that mimics the natural uterus, allowing the fetus to develop further. To successfully transfer the fetus from the natural uterus to the AW - while avoiding the respiratory reflex and thus neonatal transition - it is important that no air enters the lungs. To improve safety and minimize animal testing, the transfer procedure is first tested and trained using a fetal manikin simulation. To this end, the intent of this study was to perform a literature analysis to understand how the breathing reflex of a premature infant can be simulated in a fetal manikin. This study resulted in an overview of triggers known to initiate the respiration at birth and ways to detect these triggers, leading to a proposal for an electromechanical system. This proposal was incorporated into a realistic-looking prototype, which was subsequently evaluated with medical end users.@en

Design fiction (DF) is gaining ground as an approach that helps designers to explore possible futures. As a method founded upon critical attitudes and creative thinking, DF may be challenging for design students. In this study, we explore how design students use DF during creative design activities. Students engaged in an individual digital brainstorm and an in-depth, semi-structured interview about their experiences with the brainstorm based on DF. The results show that DF can be challenging for students who do not have a clear appreciation of what is technologically feasible for a particular time frame in the future and do not yet have the breadth of knowledge to argue about broader topics that DF is particularly attuned to into the discussion as, for example, economics and societal norms. This study contributes insights into how DF impacts the students’ design thinking, as well as difficulties they had regarding their individual thinking process.

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