In the past decade, 3D printing technologies were widely applied to the medical services by the medical service providers. The technologies provide more details and accurate information to the surgical team in order to prepare the pre-operative planning before surgery. In addition, 3D printing technologies allow the team to design and make the patient specific instrument (PSI) and the anatomical models by using the patient’s imaging files --- DICOM files which are acquired through CT or MRI. The well prepared surgical plan, the PSI and anatomical models can lead to more accurate surgical result and reduce patient’s health risk during surgery, such as reduce the invasive imaging exposure, reduce the analgesic time and blood lost, etc. It is expected that the time needs for rehabilitation can be shorten and patient’s physical function after surgery could be improved earlier. P&O colleagues paid an important role to assist the surgeon to design the pre-operative planning and patient specific instruments by applying our knowledge in 3D printing as well as in biomedical engineering. For the last few years, some surgeries acquired an amazing results by using the 3D printing techniques. On the other hand, Prosthetist and Orthotist also apply the 3D printing technologies in P&O service. The services include to design and 3D print the tailor-made functional partial hand prosthesis and different kinds of orthoses. In this opportunity, I would like to share our experiences in 3D printing to different specialists and other healthcare professions.

Technology is a common element in our everyday lives. The goal of occupational therapy is to enhance or enable meaningful participation in the occupations (activities) important to the clients served. Occupational Therapist prescribes assistive technology device to increase, maintain, or improve the functional capabilities of individuals with disabilities.
Ultra-bag Connecting Device (UC Device) was first invented and developed in 2006 through the conjoint effort of the Occupational Therapy Department and the Renal Team of United Christian Hospital (UCH). The device helps renal patients with impairment in eye hand function to perform Self-continuous ambulatory peritoneal dialysis (CAPD) in a safe and independent way. With the guidance of UC device, patients with hand tremor and visual impairment can perform continuous ambulatory peritoneal dialysis (CAPD) with lower risk of contamination. It also promotes the better quality of life, increase the independency of patient and hence reduce caregiver stress and burden. Until now, there were over 200 patients in Hong Kong benefit from UC Device and the device was widely recognized among health care professionals. UC Device was awarded Excellent Award in Asia Hospital Management Awards 2013 and the device was widely reported by press on 4/2013.
Since 2017, UCH Occupational Therapy Department has applied 3D printing technology in renal device fabrication. The digital model of the UC device is created with computer aided design (CAD) software. Different parts of subsets were then 3D printed with dual extruder and 100-micron layer resolution using Polylactic acid (PLA) filaments. With the assistance of 3D technologies, the renal devices can be fabricated more accurate and precise, also less expensive and less manpower required. In the future, more new renal devices can be invented to apply in different dialysis systems and benefit more patients. With the rapid development of 3D printing technology, it can promote more new creative assistive device invention to serve our patient needs.

The steady increase in the incidence of geriatric hip fracture places an increasing burden on health care service in Hong Kong. Post fracture limitations are prominent and restrain many of the elderly from returning to community, rehabilitation is therefore important for reducing their long-term disability.
By integrating the results from pilot application of video guided training and tele-physiotherapy program in different phases of rehabilitation, a Mobile Application (app) is developed aiming to improve hip fracture patients’ and their carers’ experience throughout the healthcare journey and empower them to manage their own health. A steering group comprised of physiotherapists, informatics and university research expert is formed to co-design the app, compose education content and formulate the promulgation and evaluation strategies. Meetings are also held with all involved clinicians to refine the app before implementation.
This app provides features for hip fracture rehabilitation including "Understanding Hip Fracture", "Hip Fracture Care", "Training" and "Companion". Patients and their carers can obtain hip fracture care related information through the app anywhere, anytime, instead of coming to the clinics in person or reading the information on pamphlets. Physiotherapists can use the app to set training program for discharged patients with “Push Reminder” function and training record can be saved in “Progress Summary”, which facilitates them and carers to get a grip on the patients’ rehabilitation progress.
Besides monitoring the download rate, a cohort study will be conducted to evaluate the effectiveness of the app from different perspectives, including the users’ acceptance and satisfaction, patients’ program compliance and functional recovery. The process and findings learnt from this project may also provide additional information for the development of the corporate “Rehab” app, which is going to be launched in late 2019.

Radioactive iodine therapy (RAI) using a high dose of I-131 (3 or 5.5 GBq) is an effective regime to eradicate or ablate any remnant cancerous thyroid tissues after surgery or thyroid cancer which has metastasized. Hong Kong radiation regulations mandate that a patient with radioactivity of higher than 0.4 GBq of I-131 has to be hospitalized. In practice, these radioactive patients are isolated individually in radiation-shielded isolation rooms in a cancer ward until their remaining radioactivity falls below 0.4 GBq. Normally, for a dose of say, 3 GBq, it may take a couple of days for the body to excrete the excess iodine to below the quarantine level. A physicist is usually called to the ward and perform an external dose rate measurement to try to ensure the residual radioactivity to be below discharge level using a handheld radiation monitor, measuring at 1 meter from the patient. This procedure may need to be repeated if the current measured radiation level exceeded the patient discharge threshold. In this project, the cumbersome manual approach was replaced with an in-house developed automated method by mounting a wireless radiation monitor on a wall and ask the patient to stand on a footmark on the floor at 1 meter and radiation data acquired automatically with a WiFi-connected mobile phone (with an in-house app installed). A print-to-discharge button will only be enabled when the measured radioactivity is below 20 micro-sieverts per hour, which approximately equates to 0.4 GBq of I-131 in an average patient. Radiation exposure to the physicist is minimized since he/she no longer needs to enter the isolation room when the measurement can be obtained outside through Wi-Fi. This system started to go clinical in Queen Mary Hospital??s clinical oncology ward in September 2015. The advantages of this new system of radioactive patient discharge can be enhanced if ward nurses use it to discharge patients in non-office hours including weekends and bank holidays when physicists are not available on site.

Rapid multiplex real-time polymerase chain reaction (PCR) is an all-in-one real-time pathogen detection method that integrates sample preparation, amplification, detection and analysis. It can simultaneously detect multiple targeted pathogens in a run. The system requires shorter laboratory processing time in comparing to the routine real-time PCR method and it has significantly shorter turn-a-round time than the traditional culturing method. In Queen Mary Hospital, two rapid multiplex PCR systems (Cepheid GeneXpert and BioFire FilmArray) have been installed in 2017 for rapid detection of pathogens causing emerging infectious diseases (e.g. Mycobacterium tuberculosis, respiratory viruses including MERS Coronavirus) and multi-drug resistant bacteria (e.g. MRSA, CPE, VRE) causing nosocomial infections in hospitals. During the recent influenza surge periods, the systems were also extensively used for rapid seasonal flu detection. By comparing the rapid multiplex PCR system with the routine real-time PCR method, the laboratory processing time in the laboratory can be significantly shortened from 5 hours to 1 hour for seasonal influenza virus and MERS coronavirus detection. Recent studies have shown that the introduction of rapid PCR can significantly reduce 21.5 hours of hospital stay in median among patients with positive rapid viral PCR testing results and significantly reduce the airborne infection isolation (AII) duration from 68.0 to 20.8 hours in comparing to the use of conventional smear microscopy for mycobacteria infection. This method can have positive effect to the control of medical inpatient bed occupancy rate. It can also improve the hospital infection control by reducing the risk of pathogen transmission. The rapid multiplex PCR is quick and simple to handle. Although the use of rapid multiplex PCR system will increase the laboratory running cost, the shortened turn-a-round time can significantly improve patient care. In conclusion, the introduction of rapid multiplex real-time PCR for diagnosis of emerging infectious diseases is highly recommended in public hospitals in Hong Kong.