Hong Kong Primary Care Conference 2013 Family …Dr. Henry Sze, Clinical Assistant Professor of the Department of Oncology, the University of Hong Kong, will talk about “New Treatment

Message from the President

Issue 111May 2013

THE HONG KONG COLLEGE OF FAMILY PHYSICIANS

Family Physicians

LinksFamilyPhysiciansLinks

1

INSIDE THIS ISSUE

FamilyPhysiciansLinks

01 MessagefromthePresident

02 CollegeNews

02CMOD,MembershipCommitteeNews,InternalAffairsCommitteeNews

03SpecialtyBoardNews,BoardofVocationalTrainingandStandardsNews,ClassifiedAdvertisements

04DiplomainFamilyMedicine

06CertificateCourseinFamilyMedicine

08 Oasis:TheTroubleTree

09 NewsCorner:AvianInfluenzaA–H7N9

10 Feature:InterviewwithProfessorJosephSung

13 LearningPointsfromBoardofEducation

15 BoardofEducationNews

20 CollegeCalendar

OurHongKongPrimaryCareConference(HKPCC),“InnovationsinPrimaryCare”willbeheldonJune16,2013attheHongKongAcademyofMedicineJockeyClubBuilding,99WongChukHangRoad,Aberdeen,HongKong.

Thisyearwewillbehavingafulldayofexcitingscientificprogramme.Followingthesuccessofourfirstclinicalcasepresentationcompetitionlastyear,wewillbeholdingthiscompetitionagainthisyear.Donotmissthiseducationalandentertainingsessionwithcompetitorteamspresentingclinicalcasesindifferentformats.Theirpresentationsareofteninteresting!

Aftertheopeningceremonywewillhavethefirstplenarysession“DrivingInnovationsinPrimaryCareResearch”byProf.DorisYoung.Prof.YoungistheChairofGeneralPractice,andAssociateDean(Academic),FacultyofMedicine,theUniversityofMelbourne.SheisalsoourHonoraryFellowandhasbeenourexternalExitExaminersince2007.Herdedicationtoandadviceonprimarycareresearchanddevelopmenthavealwaysbeeninsightfulforourdevelopment.

Oursecondplenarysessionis“PrimaryCareModels-LetaHundredFlowersBloom”byProf.GabrielLeung.Prof.LeungistheHeadoftheDepartmentofCommunityMedicine,theUniversityofHongKongafterservingasHongKong'sfirstUnderSecretaryforFoodandHealthandthefifthDirectoroftheChiefExecutive'sOffice.Hewilldiscussnotonlythevariousprimarycaremodels,butalsohowtheyshouldbeallowedtoexperiment,andbeevaluatedandimplemented.

Afterlunchwewillhaveourthirdplenarysession“e-HealthRecord(eHR)SharinginHongKong”byMr.RichardYuen,PermanentSecretary(Health)oftheFoodandHealthBureau(FHB).Mr.YuenwillsharewithustheGovernment’svisiononeHRSharingSystem,whichwillbeaveryimportanttoolforourclinicalpractice.Ms.IdaLee,DeputyHead(eHR)ofFHBwillexplainthe“RulesandPrinciplesAdoptedintheeHRSharingSystem”andDr.SummerChan,DeputySeniorHealthInformatician(eHRandSpecialClinicalProjects)oftheHospitalAuthoritywillsharehisexperiencein“CreatingUserFriendlyeHREnvironmentforFamilyPhysicians”.

Ifyouare interested in research,come join theresearch forumforhighertrainees inFamilyMedicine.Threeexperts,Prof.DorisYoung,Prof.MartinWong,AssociateProfessor,SchoolofPublicHealth&PrimaryCare, theChineseUniversityofHongKong,andDr.ChinWengYee,AssistantProfessor,DepartmentofFamilyMedicine&PrimaryCare,theUniversityofHongKongwillsharetheirviewsonsomeofthehighertrainees’researchpresentations.Besides,Dr.HenrySze,ClinicalAssistantProfessoroftheDepartmentofOncology,theUniversityofHongKong,willtalkabout“NewTreatmentinOncology”.

Iamalsoverygratefulfortheoverwhelmingresponsestoourworkshops.

Lastbutnotleast,IwouldliketothanktheOrganizingCommittee2013ledbyco-chairpersonsDr.LornaNgandDr.WilliamWong,businessmanagerandtreasurerDr.DanielChu,andcommitteemembersDr.ColmanFung,Dr.ChiangLapKin,Dr.CatherineChen,Dr.JudyCheng,Dr.DanaLo,Dr.KevinFoo,Dr.KwanYu,Dr.WendyKwan,Dr.ViennaLeung,Dr.ChongManYuk,Ms.SamanthaChon,Ms.MargaretLam,Prof. IpWanYimandourconferencesecretariatMs.EricaSo,Ms.CrystalYung,Ms.TeresaLiuandMs.AlkyYu.Theteamhasovercomealotofchallengesthisyeartobringthisconferencetous.

Pleaseregisterwith2013HKPCCifyouhavenotdoneso.Comejointhisexcitingconference,meetoldfriends,learnnewknowledge,andshareyourexpertisewithothers.

Lookforwardtoseeingyouallthere!!

Hong Kong Primary Care Conference 2013

2FamilyPhysiciansLinks

COLLEGE NEWS

"Council Member-On-Duty" (CMOD) System

DearCollegemembers,

Wearestillprovidingthisalternativechannelofcommunicationforyoutoreachus.Doletushaveyourideasandcommentssothatwecanfurtherimproveourservicestoallthemembers.

From15thMay2013to14thJune2013,Dr.AngusChanandDr.ChongManYukwillbetheCouncilMembersOnDuty.Pleasefeelfreetomakeuseofthischanneltovoiceyourdoubts,concerns,queries,andcommentsaboutanythingrelatingtoourCollegeandFamilyMedicine.YoucanreachusbycontactingourCollegeSecretariatbyphone:25286618,byfax:28660616,orbyemail:[email protected],wewillgetintouchwithyoudirectlyassoonaswecan.

Dr.TonyC.K.LeeCo-ordinator,CMODSystem

Dr.AngusChan Dr.ChongManYuk

The 26th Fellowship Conferment Ceremony and the 24th Dr. Sun Yat Sen Oration

DearColleagues,

TheCollegeisholding“The 26th Fellowship Conferment Ceremony and the 24th Dr. Sun Yat Sen Oration” on 15th June 2013 (Saturday) at the Hong Kong Academy of Medicine Jockey Club Building.

The successful candidatesofConjointExaminationwouldbeconferredFellowships,and the successfulcandidatesofDiplomainFamilyMedicineandtheExitExaminationwouldbegrantedcertificates. Inthisveryimportantoccasion,Professor Joseph J.Y. Sung, Vice-Chancellor and President of the Chinese University of Hong Kong,woulddeliverthe24thDr.SunYatSenOration.

AllFellows*,membersandtheirspousesarecordially invitedtoattendtheConfermentCeremonyandtheOration.Thedetailsare:

Events : (i)The 26th Fellowship Conferment Ceremony (ii)The 24th Dr. Sun Yat Sen Oration by Prof. Joseph J.Y. Sung Venue : 1/F,RunRunShawHall,HongKongAcademyofMedicineJockeyClubBuilding,

99WongChukHangRoad,Aberdeen,HongKong

Date : 15thJune2013(Saturday)

Time : 4:00p.m.–Receptionwithlightrefreshments 5:30p.m.–CommencementofCeremony

Remarks : 1CME(Category4.3)

ThisactivityisfreeofchargetoourCollegeFellows,membersandtheirspouses. *AllCollegeFellowsarewelcome tobring theirFellowshipgowns for the

ConfermentCeremony.

Pleasemarkyourdiariesandwelookforwardtoseeingyousoon.Thankyou!

Dr.DavidCHAOChairman,InternalAffairsCommittee

Internal Affairs Committee News

TheMembershipCommitteeapproved,onrecommendationoftheChairladyoftheMembershipCommittee,thefollowingapplicationsformembershipinApril 2013 :

Membership Committee News

Associate Membership (New Application)

Dr. CHEUNG Tsz Ki 張子祺 Dr. TSE Wan Ying 謝韻盈


COLLEGE NEWS

Specialty Board News

TheSpecialtyBoard ispleased toannounce that the followingcandidateshavesuccessfullypassed theFullExitExaminationofHKCFPin2013.

Congratulationstoyouall!

Dr.WendyTsuiChairlady,SpecialtyBoard

Dr.ChanShukYan,AngelaDr.ChanShanChingDr.CheKaSengDr.ChengChunSing,DavidDr.CheukChristinaDr.CheungWingWo

Dr.ChungSzePokDr.KwokChiMingDr.LoTszYanDr.LoWaiHonDr.PangKwokChingDr.PoonTingKong

Dr.PunLaiYinDr.SyHungPanDr.WuSzeManDr.YauKinChungDr.YeungWaiManDr.YuSzeKai,Frances

Board of Vocational Training and Standards News

Recruitment for Mentors on Research Segment,Exit Examination of Vocational Training in Family Medicine, HKCFP

DearCollegeMembers,

TheBoardofVocationalTrainingandStandards isnowrecruitingMentorsfortheResearchSegmentofExitExaminationofVocationalTrainingProgrammeinFamilyMedicine.

Amentoractsasan“anchor”andpersonaladvisorforthetrainee’sresearchprojectthroughouttheir2-yearhigher training.Thementor is theexpertwhoprovides the traineewithgeneralandoverallguideline inconductingresearchanddataanalysis,andhelpsthetraineeidentifyhis/herowncompetenceanddeficiencies.Thementorhastogivefeedbacktothetraineeperiodically,monitortheprogressofthetrainee’sprojectandensurethathe/sheisreachingthestandardsoftheExitExamination.

Actingasamentor,youwouldbeawardedupto5pointsofContinuousProfessionalDevelopment (underQA&ARegulationCategory3.2).Pleaseindicateyourinterestfortheappointmentbyfillingtheapplicationformavailableonwww.hkcfp.org.hk.YouarewelcometocontactourSecretariatat25286618orbvts@hkcfp.org.hkshouldyouhaveanyenquiries.

Yourssincerely,

Dr.ChiuChiFai,BillyChairman,HigherTrainingSubcommittee

BVTS

FT/PT/Locum Family Physician (min. 3 years’ experience)forpracticesofUnitedChristianNethersoleCHS inTaiPo&Kowloon.Flexiblehours.Pleasee-mail resumewithexpectedsalary-Ms. Law:[email protected].

Accredited Private FM Centre invites full time / part time Doctors forexpandingservices (TuenMun/KwaiFong).FMTrainee,specialistswelcomed.Basic+ProfitSharing±[email protected](AmyCHAN)92126654

Part-timeLocumWantedbyaclinic inShamShuiPo,6:30pm-8:30pm,5daysaweek,$1,200persection.InterestedpleasecallMissHo54168313.

Classified Advertisements

PositionsVacant


COLLEGE NEWSDiploma in Family Medicine (HKCFP) Third Announcement

TheBoardispleasedtoannouncethattheDiplomaCourseinFamilyMedicine(DFM)organizedbytheHongKongCollegeofFamilyPhysicianswillcommenceinJune2013.

ThecourseconsistsofFIVEmodules.ModulesI&IIwillbedeliveredbyLocalDistanceLearning.ModulesIII,IV&Vconsistoflectures,seminars,tutorials,workshopsandclinicalattachments.ThewholecourserequiresONEyearofpart-timestudies.

Detailsofthecourseareasfollows:

1. Objectives:

i) Toprovideknowledgeable,pragmaticandstructuredteachinginFamilyMedicineformedicalpractitioners ii) Toencourageprofessionaldevelopmentofpractisingmedicalpractitionersand toprovidean intermediate step to fellowship

qualificationsinFamilyMedicine iii) ToimprovestandardsandqualityinthepracticeofFamilyMedicine

2. *Syllabus:

ThecourseconsistsofFIVEcompulsorymodules.Doctorsgraduatedfromthecourseareexpectedtohaveacquired: i) CurrentconceptsaboutthenatureofFamilyMedicine ii) Knowledgeandskillsinconsultation,counsellingandproblemsolving iii) Knowledgeandskillsincommonpracticeproceduresandemergencycarerequiredforgoodqualityfamilypractice iv) UnderstandingtowardstheroleofFamilyDoctorsasgatekeepersofthehealth-caresystemandinprovidingcost-effectiveprimarycare

tothecommunity

Module I – Principles of Family Medicine (Distance Learning)

Aims: 1.LearntheconceptsofFamilyMedicine 2.UnderstandtheroleandscopeofaFamilyDoctor

Contents: DefinitionofFamilyPhysicians,FamilyPhysicians’Functions,CoreValuesofFamilyMedicine,Consultation,FutureofFamilyMedicine

Module II – Common Problems in Family Medicine (Distance Learning)

Aims: 1.Enhanceconsultation,communicationandproblemsolvingskills 2.GainknowledgeincommonandchronicdiseasesinFamilyMedicine

Contents: SelectedtopicsfromClinicalPsychology,DiabetesMellitus,LowBackPain,COPD,AtopicEczema,ElbowMass,FacialRashes,HealthPsychology,AllergicRhinitis,Urethritis,UrineIncontinence,etc

Module III - Essentials of Family Medicine (Structured Seminars and Tutorials)

Aims: 1.StrengthenknowledgeinFamilyMedicine 2.UnderstandthepotentialgrowthofFamilyMedicine 3.DevelopresearchandteachingskillsinFamilyMedicine

Contents: PracticeManagement,CareofElderly&ChronicIllnesses,AnticipatoryCare,ClinicalAudit&QualityAssurance,IntroductiontoFamilyTherapy,Research&TeachinginFamilyMedicine,EvidenceBasedMedicineandCriticalAppraisal

Module IV - Clinical Updates (Updates and Clinical Attachment)

Aims: Acquire in-depthknowledgeandpracticalskills inselectedspecializedareas includingMedicine,Surgery,Geriatrics,ENT,Orthopaedics&Traumatology,Accident&EmergencyMedicine,InfectiousDiseasesandDermatology

Contents: FIVEUpdateseminarsandONEclinicalattachmentonselectedspecialties includingMedicine,Surgery,Geriatrics,ENT,Orthopaedics&Traumatology,Accident&EmergencyMedicine,InfectiousDiseasesandDermatology(subjecttoavailability)

Module V - Practical Family Medicine (Practical Workshops)

Aims: Enhancepracticalandcommunicationskills inFamilyMedicinebyPracticalWorkshops inselectedareas includingCPR,ConsultationSkills,CounsellingSkills,Women’sHealth,OrthopaedicInjectionandMusculo-SkeletalMedicine

Contents: 5compulsoryand1electivePracticalWorkshops inselectedareas includingCPR,ConsultationSkills,CounsellingSkills,Women’sHealth,OrthopaedicInjectionandMusculo-SkeletalMedicine

Module III & V will be scheduled in Saturday and Sunday afternoons

3. Articulations:

TheCourseallows(uptoafixedmaximumpercentageoftheCourseunits)articulationsorcrossrecognitionofpreviousFamilyMedicinetrainingprogrammesthatprovidelearningunitsequivalenttothatoftheabovesyllabus.Participantswhowishtoapplyforsucharticulationshavetosubmitevidenceofrelevanttrainingtogetherwiththeirapplication.Thegrantingofarticulations ishowever,completelyatthediscretionanddecisionoftheBoardofDFM.

4. *Schedule:

The whole course requires ONE year of part-time studies.

JunetoSeptember2013 ModuleINovember2013toJanuary2014 ModuleIIJuly2013toMay2014 ModuleIII,IV&VMay2014 FinalExamination


COLLEGE NEWS5. Admission Requirements:

MedicalPractitionerwithBachelor’sdegreeinMedicine.

6. Teaching Staff:

ApanelofexperiencedacademicmedicalprofessionalsinFamilyMedicine,hospitalspecialistsandexperiencedFellowsorTrainersofHKCFPwillbeinvitedtoteachintheprogramme.

7. Teaching Medium:

#English(Cantonesemaybeusedinsomeseminars,workshopsandclinicalattachments)

8. Course Fees:

Wholecourse:

HK$28,000formembersofHKCFP

HK$56,000fornon-members

(A discount of HK$3,000 for early birds who apply on or before May 17, 2013)

IndividualModules: Members Non-members

ModuleI(DistanceLearning–PrinciplesofFamilyMedicine) $3,600 $7,200

ModuleII(DistanceLearning–CommonProblemsinFamilyMedicine) $3,600 $7,200

ModuleIII(StructuredLectures&Seminars) $2,600 $5,200

ModuleIV(Updates&ClinicalAttachment) $3,200 $6,400

ModuleV(PracticalWorkshops) $4,200 $8,400

Examination $8,000 $16,000

AdministrationFee $3,000 $6,000

All fees must be paid upon application and before commencement of the course. Fees paid are NON-TRANSFERABLE and NON-REFUNDABLE.

9. Awards/Credits:

i) ADiplomainFamilyMedicineissuedbyHKCFPwillbeawardedtocandidateswhohavesatisfiedalltherequirementsandhavepassedalltherequiredassessmentandtheFinalExamination.

ii)TheDiplomaisaQuotable QualificationofTheMedicalCouncilofHongKong.iii) 50CMEand10CPDcreditpointswillalsobeawardedtocandidatesonsatisfactorycompletionoftheCoursebytheQA&ACommitteeof

HKCFP.

10. Application Procedures:Application is now open

AcompletedapplicationformmustbereturnedtoTheHongKongCollegeofFamilyPhysicianswiththefollowing:

i) PhotocopyofthecurrentAnnualPracticingCertificate.ii) Arecentphotooftheapplicant(passportsize).iii) Asigned“DisclaimerofLiability”.iv) AnapplicationfeeofHK$200bycrossedchequepayableto“HKCFPHoldingsandDevelopmentLimited”.Thisfeeisnon-refundable.v) ACourseFeeofHK$28,000(orHK$56,000fornon-members)bycrossedchequepayableto“HKCFPHoldingsandDevelopmentLimited”.

Thisfeeisnon-refundableunlesstheapplicationisunsuccessful.

Everysuccessfulapplicantwillbenotifiedbyanofficialletterofadmission.

Informationandapplication formsareobtainableat theCollegeorcanbedownloadedat theCollegewebsite (http://www.hkcfp.org.hk).Memberswhowerenotadmittedinthecoursein2012havetosendintheirapplicationagainiftheywanttostudythecoursethisyear.PleasecontacttheCollegesecretariat,Mr.JohnLeeat28610220foranyqueries.

11. Application Deadline: June 21, 2013

Comments From Former DFM Graduates

- Thecontent isuseful indailypractice. Icanhavehands-onpracticalskills. Icanpolishmycommunicationskillsduringthelectures&workshops.

- IcanunderstandtheroleofFamilyPhysiciansasgatekeepersofhealth-caresystemandbetterknowabouttheirrole inthesociety.Ialsoacquiretheskillsoncriticalappraisal.

- Therearesessionsofclinicalupdatesforrefreshingourknowledgeonclinicalmedicine.ModulesI,II&IIIcouldhelpimprovemyknowledgeandmyunderstandingofFamilyMedicine.Sessionsinconsultationareinvaluableinimprovingmycommunicationskills.

Dr.AuChiLapChairmanTheBoardofDFM

*Coursesyllabus,scheduleandavailabilitymaybesubjecttochangewithoutpriornotification.

#CantoneseandEnglishwillbeusedasthelanguageforteachingandexamination.

CPRTrainingWorkshop Women’sHealthWorkshop OrthopaedicInjectionWorkshop MusculoskeletalWorkshop


COLLEGE NEWSCertificate Course in Family Medicine (HKCFP) Third Announcement

TheBoardispleasedtoannouncethattheCertificateCourseinFamilyMedicine(CFM)organizedbyTheHongKongCollegeofFamilyPhysicianswillcommenceinJune2013.

ThecourseconsistsofTHREESegments.SegmentIandSegmentIIwillbedeliveredbyLocalDistanceLearning.SegmentIIIconsistsofworkshops.ThewholecourserequiresFIVEmonthsofpart-timestudies.

Detailsofthecourseareasfollows:

1. Objectives:i) Toprovideknowledgeable,pragmaticandstructuredteachinginFamilyMedicineformedicalpractitionersii) Toencourageprofessionaldevelopmentofpracticingmedicalpractitionersandtoprovideanintermediatesteptoattaindiploma

qualificationsinFamilyMedicineiii) ToimprovestandardsandqualityinthepracticeofFamilyMedicine

2. *Syllabus: ThecourseconsistsofTHREEcompulsorysegments.Doctorsgraduatedfromthecourseareexpectedtohaveacquired:i) CurrentconceptsaboutnatureofFamilyMedicineii) Knowledgeandskillsinconsultationiii) Knowledgeandskillsinsomecommonpracticeproceduresrequiredinfamilypracticeiv) UnderstandingtowardstheroleofFamilyDoctorsasgatekeepersofthehealth-caresystemandinprovidingcost-effectiveprimary

caretothecommunity

Segment I – Principles of Family Medicine (Distance Learning)

Aims: 1.LearnconceptsofFamilyMedicine 2.UnderstandtheroleandscopeofaFamilyDoctorContents: DefinitionofFamilyPhysicians,FamilyPhysicians’Functions,CoreValuesofFamilyMedicine,Consultation,FutureofFamilyMedicine

Segment II- Common Problems in Family Medicine (Distance Learning)

Aims: 1.Enhanceconsultation,communicationandproblemsolvingskills 2.GainknowledgeincommonandchronicdiseasesinFamilyMedicineContents: SelectedtopicsfromClinicalPsychology,DiabetesMellitus,LowBackPain,COPD,AtopicEczema,ElbowMass,FacialRashes,

HealthPsychology,AllergicRhinitis,Urethritis,UrineIncontinenceetc.(Subjecttofurtherselection)

Segment III - Practical Family Medicine (Practical Workshops)

Aims: EnhancepracticalskillsandconsultationskillsinFamilyMedicinebyPracticalWorkshopsinsomeselectedareasContents: OrthopaedicInjectionandConsultationSkills

3. *Schedule:ThewholecourserequiresFOURmonthsofpart-timestudies.JulytoOctober2013 SegmentI&II1-dayworkshopinOctober2013 SegmentIII

4. Admission Requirements:MedicalPractitionerwithBachelor’sdegreeinMedicine.

5. Teaching Staff:ApanelofexperiencedacademicmedicalprofessionalsinFamilyMedicine,hospitalspecialistsandexperiencedFellowsorTrainersofHKCFPwillbeinvitedtoteachintheprogramme.

6. Teaching Medium:#English

7. Course Fees:HK$9,000formembersofHKCFPHK$18,000fornon-membersAll fees must be paid upon application and before commencement of the course. Fees paid are NON-TRANSFERABLE and NON-REFUNDABLE.

8. Awards/ Credits:i) ACertificateinFamilyMedicineissuedbyHKCFPwillbeawardedtocandidateswhohavesatisfiedalltherequirements.ii) 10CMEcreditpointswillalsobeawardedtocandidatesatsatisfactorycompletionoftheCoursebytheQA&ACommitteeofHKCFP.

9. Application Procedures:Application is now open

AcompletedapplicationformmustbereturnedtoTheHongKongCollegeofFamilyPhysicianswiththefollowing:i) PhotocopyofthecurrentAnnualPracticingCertificateii) Arecentphotooftheapplicant(passportsize)iii) AnapplicationfeeofHK$200bycrossedchequepayableto“HKCFPHoldingsandDevelopmentLimited”.Thisfeeisnon-refundableiv) ACourseFeeofHK$9,000 (orHK$18,000 ifnon-member)bycrossedchequepayableto“HKCFPHoldingsandDevelopment

Limited”.Thisfeeisnon-refundableunlesstheapplicationisunsuccessful.

Everysuccessfulapplicantwillbenotifiedbyanofficialletterofadmission.

InformationandapplicationformsareobtainableattheCollegeorcanbedownloadedattheCollegeWebsite(http://www.hkcfp.org.hk).PleasecontacttheCollegesecretariat,Mr.JohnLeeat28610220foranyqueries.

10. Application Deadline: June 21, 2013

Dr.AuChiLapChairman,TheBoardofDFM

*Coursesyllabus,scheduleandavailabilitymaybesubjecttochangewithoutpriornotification.#CantoneseandEnglishwillbeusedasthelanguages,forteachingandexamination.


OASIS

The carpenter I hired to help me restore an old farmhouse had just finished a

rough day on the job. A flat tire made him lose an hour of work. His electric saw

quit, and now his ancient pickup truck refused to start.

He sat in stony silence while I drove him home.

On arriving, he invited me in to meet his family. As we walked towards the front

door, he paused briefly at a tall tree, touching the tips of the branches with both

hands. Upon opening the door, he underwent an amazing transformation. His

tanned face was wreathed with smiles as he hugged his two small children and

gave his wife a kiss.

He walked me to the car after introducing his family to me. We passed the tree and

my curiosity got the better of me. I asked him about what I had seen him do earlier.

"Oh, that's my trouble tree." He replied.

"I know that I can't help having troubles on the job but there’s one thing for sure.

Troubles don't belong in the house with my wife and children. Hence, I just hang

them up on the tree every night when I get home. I pick them up again in the morn-

ing. Funny thing is…" he said with a smile,

"…when I come out in the morning to pick them up, there are not nearly as many

as I remember hanging up the night before."

http://www.inspirationallane.com/ThanksgivingInspirationalStories6.htm

The Trouble Tree


NEWS CORNER

"Submissions of articles to News Corner with up to 500 words are always welcome. Gift vouchers will be given as a token of appreciation for good works if the articles are selected for publication. Email: [email protected]"

Avian Influenza A – H7N9

TenyearssincetheSARSepidemic,anotherdeadlyemergingdisease,theavianinfluenzaAH7N9isfuellingconcernsinourcommunity.

Theinfluenza(flu)virushaseightgenesincludingtwothatcarrycodesforthehaemagglutinin(H)andneuraminidase(N)proteinsandsixgenesthatcodeforinternalproteins.ThegenefortheHproteinisthemostimportantasitistheHproteinwhichallowsthevirustobindtohostcells.Inthenewhumancasesofavianinfluenza,thegenescodingfortheinternalproteinsappeartocomefromH9N2viruses–aclassthatisendemicinbirdsincludingpoultry.ThegenefortheNproteinappearssimilartoavianH11N9virusesthatwererecentlyfoundinSouthKoreain2011.ThegenefortheHprotein,themostcriticalgene,seemstobelongtoaEurasiangroupofH7avianfluviruswhichdoesnotcauseseveresicknessinbirds.Thisisavitallinkasvirusesthatdon’tsickenbirdscan,however,causeseverediseaseinhumansaswelackimmunitytothemandtheymaybemorelethalinhumansdependingonhowtheybindtoourairwayreceptors.

Clinicalpresentationofavianinfluenzainhumansincludeseyeinfection(conjunctivitis),flu-likesymptoms(e.g.fever,cough,sorethroat,muscleaches)orsevererespiratoryillness(e.g.chestinfection).Themorevirulentforms[e.g.infectionbyavianinfluenzaA(H5N1orH7N9)viruses]canresultinrespiratoryfailure,multi-organfailureandevendeath.

Asof22April2013,104casesofhumaninfectioncausedbytheavianinfluenzaA(H7N9)virushavebeenreportedwithatotalof21deathsasfollows:

Region No. of cases

AnhuiProvince 3

BeijingMunicipality 1

HenanProvince 3

JiangsuProvince 23

ShanghaiMunicipality 33

ZhejiangProvince 41

TherearenoconfirmedcasesofH7N9inHongKongatthetimeofwriting.

Investigations intothepossiblesourcesof infectionandreservoirsof thevirusareongoingbytheWorldHealthOrganization (WHO)andtheMainlandhealthauthorities.AccordingtotheNationalHealthandFamilyPlanningCommission,theH7N9virusisofavianoriginandpeoplearemainlyinfectedthroughexposuretoinfectedpoultryoritscontaminatedenvironment.Acaseinvolvingthedeathsoftwoclosefamilymembers,involvingthefirstH7N9case,an87-yearoldmanandhis55-yearoldsonhasraisedconsiderableconcernonhuman-to-humantransmissionbyclosecontact,althoughthereisnodirectevidenceofsuchtransmissioninasustainedmanner.

H7N9isnowastatutorynotifiablediseaseinHongKong.Asgatekeepers,familyphysiciansshouldbewellawareofthereportingcriteria.Apartfromclinicalfeaturesofacuterespiratoryillness,feverandunexplainedseverepneumonia,epidemiologicalcriteriaforreportingincludescontactwithaconfirmedcase,contactwithinfectedpoultryorvisitingwetmarketswithlivepoultryinaffectedcountries,consumptionofraw/undercookedpoultryinaffectedareas,andclosecontactwithinfectedanimalsorlaboratorysamples.Inthisconnection,visitingwetmarketswithlivepoultrypersewithoutactualcontactwiththepoultryinanaffectedareaisalsoconsideredasanepidemiologicalreportingcriteriaforinfluenzaA(H7N9).

AccordingtotheChinesehealthauthorities,antigenicandgenomesequenceanalysesindicatethattheavianinfluenzaAvirus(H7N9)issensitivetotheneuraminidaseinhibitors.Theusageofneuraminidaseinhibitorsintheearlystageoftheinfectionhasbeenproveneffective,butwhetheritistheonlyspecifictreatmentforH7N9virusneedsfurtherinvestigation.Recommendedantiviralagentsincludeoseltamivir(Tamiflu®)andZanamivir(Relenza®).

References:

1. CentreforHealthProtection.UpdateonnumberofsuspectedhumancasesofavianinfluenzaA(H7)notified.Availablefrom:http://www.chp.gov.hk/en/view_content/28948.html.Accessedon23April2013.

2. WorldHealthOrganization.NumberofconfirmedhumancasesforinfluenzaA(H7N9)reportedtoWHOasof22April2013.Availablefrom: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/02_ReportWebH7N9Number.pdfAssessedon23April2013.

3. WorkGrouponClinicalManagementforAvianInfluenzaA(H7N9)andNovelCoronavirus(NCoV).InterimRecommendationonAntiviralTherapyforHumanInfectionduetoAvainInfluenzaA(H7N9).HospitalAuthorityCentralCommitteeonInfectiousDiseaseandEmergencyResponses.Version1:11April2013.

Complied by Dr. Cheng Ghar Yee, Judy


FEATURE

Dr. Cheng Ghar Yee, Judy, Specialist in Family Medicine, Hospital Authority

An Interview with the Headmaster - Professor J Y Sung

Beingcalledintotheheadmaster’sroomalwaysmakesyoufeelasifyou’reatwelve-year-oldwho’sjusthadafightwithyourclassmate.DuringaninterviewwiththeChineseUniversityofHongKong’sViceChancellor,IwasinitiallyquiteinaweuntilProf.Sungmesmerizeduswithinterestinganecdotesabouthischildhoodandchallengesinthemedicalprofession.Thisyear,ourCollegeismosthonoredtoinviteProf.JosephSungtobeour24thSunYatSenOrator.Prof.SunghasalsokindlyagreedtobeinterviewedbyFPLinkstosharehisviewsonFamilyMedicine,thecurrenthealthcaresystem,hisplansforCUHKasViceChancellor,andhissecretsofsuccess.

“Submissions of articles to Feature with up to 1200 words are always welcome. Gift vouchers will be given as a token of appreciation if the articles are selected for publication. Email: [email protected]”

As the 24th Sun Yat Sen Orator, how do you perceive Family Medicine?Prof. Sung: I thinkFamilyMedicine isavery importantspecialtywithanirreplaceablehumanisticnature.ButIthinkitsimportancemightnothavebeenappreciatedbymanymedicalgraduates. Iremembermychildhoodfamilydoctortakingcareofme,mybrother,myparentsandalsomygrandparents.ChineseNewYeargreetinghasincludedpayingavisittomyfamilydoctorathishome.Myfamilydoctor’shousecallswerenotonlylimitedto“homes”.Irememberonetimeasachild,Iwasrunningahighfeverandwastakingtheelevatordowntoseemydoctor.UnfortunatelytheelevatormalfunctionedandIwastrappedinside.Iremembermyfamilydoctorprisingopentheliftdoorandpeeringdownaskingif Iwasalright.Familydoctorsare inaprivilegedpositiontoofferholistic

ProfessorJosephJ.Y.SungreceivedhisMBBSdegreefromtheUniversityofHongKongin1983,andwasconferredaPhDinbiomedicalsciencesbytheUniversityofCalgaryin1992,andaMDbyCUHKin1997.ProfessorSungholdsfellowshipsfromtheRoyalCollegesofPhysiciansofEdinburgh,Glasgow,London,ThailandandfromtheAmericanCollegeofGastroenterology,theRoyalAustralianCollegeofPhysicians,theAmericanGastroenterologicalAssociation, theHongKongCollegeofPhysiciansandtheHongKongAcademyofMedicine.ProfessorJosephJ.Y.SungisconcurrentlyMokHingYiuProfessorofMedicineofCUHK,andanAcademicianoftheChineseAcademyofEngineeringofthePeople’sRepublicofChina.

HewastheChairmanoftheDepartmentofMedicineandTherapeutics,CUHKin1999-2010,AssociateDean(Clinical)oftheFacultyofMedicinein2002-04andAssociateDean(GeneralAffairs)in2004-09,HeadofShawCollegeofCUHKin2008-10andVice-Chancellor/PresidentofCUHKsince2010.ProfessorSungisaworldleaderinresearchongastroenterology.Heledagroupofexpertsfrom15Asia-Pacificcountriestolaunchcolorectalcancerscreeningresearchin2004,andhaslaiddownclearguidelinesandpromotedcolorectalscreeningintheregion.Becauseofhisworkincancerscreeningandprevention,ProfessorSungwashonouredbytheLaurelAwardconferredbythePreventCancerFoundationoftheUnitedStatesin2008.

In2003,ProfessorSungledhismedicalteamtofightagainstSARSandwasnamedan“AsianHero”bytheTimemagazineinrecognitionofhisoutstandingcontributions.HiscontributionstothesocietyandsciencehasbeenrecognizedwithmanyawardssuchasEminentScientistoftheYear2003(TheInternationalResearchPromotionCouncil,2003),theVice-Chancellor’sExemplaryTeachingAward(CUHK,2003),SilverBauhiniaStar(HKSARGovernment,2004),aJusticeofPeace(HKSARGovernment,2012),andmanyothers.

careastheyknowthewholepersonandhis/herfamily.Ourcurrenthealthcarelacksthisimportantfactor.Insidehospitals,ouroperationsarerunlikeafactorywithvariousspecialtiestreatingoroperatingontheir“own”bodypartsbutnooneistakingcareofthepatientasawhole.Familyphysiciansholdthekeytothisveryimportantroleandthispointcannotbemorereemphasized.Familyphysicianshaveanimmensejobsatisfactionastheyarecaringforthewholepatientinsteadofjustcuringacertainorgan.

ThedisciplineofFMisalreadyquicklydevelopingandthesystemisitselfheadingtowardsarightdirection.OneofthemostimportantchallengesisthelowpublicawarenessofFamilyMedicineasadisciplineandhencemorepubliceducationabouttheproperconceptionoffamilydoctorsandthecurrentundesirablehealthseekingbehaviorsuchasdoctorshoppingshouldbecorrected.

ProfessorJosephSung


FEATURE

Do you have any suggestions for the future development of Family Medicine in Hong Kong with respect to its vocational training and implementation in Hong Kong?Prof. Sung: Recentreportsondoubtfulunprofessionalconductinaestheticmedicinehasgiventhepublic impressionthatdoctorsareonlyinthejobformoney.Themedicalprofessionasawholeisunderrisk.Thequote“whilewehavethemeans,wehave lost themeaningofpracticingmedicine”hasatremendousimpressiononme.Ithinkweshouldemphasizewholepersoncareandnotonlydisease-orientatedcare.Weshouldeducatethepublicthatfamilydoctors“care”forthewholepersonandnotjust“cure”withtechnology.Holisticcareandcontinuityofcarearestrengthstobehighlighted.MoreprospectivetraineeswillbeattractedintoFamilyMedicinebysharingthesatisfactionofbeingafamilydoctor.

With your experience in SARS, what do you think about the role of family physicians in facing public health crises?Prof. Sung: Familyphysiciansactonthefrontiertoguardagainst infectiousdiseasesbyearlydetection, infectiousdiseaseprecautionandeducatingthepatientsbyprovidinginformationonoutbreaks.IholdaprofoundrespectforfamilydoctorsespeciallyafterSARSwheremore thanenoughdoctorshavesacrificed themselves suchasDr.ThomasCheungwhodiedofSARSafterescortingoneofhispatientstotheAED.

What do you perceive are the major areas of improvement required for the current healthcare system?Prof. Sung: Therearealotofnoveltechnologiesincurrenthealthcareandwehaveadvancedintheareaoftreatmentandcure.Butwestillhavemuchtoachieveintheareaofpreventionforcommunicableandnoncommunicablediseases.Anexampleiscancerprevention,whichiswhyIhaveestablishedthecolorectalscreeningprogramme.Preventionofmetabolicdiseasessuchashypertension,diabetesandobesitywillhavetorelyontheexpertiseofFamilyPhysicians.EarlydetectionofcommunicablediseasessuchasSARSisanotherexamplewherefamilyphysiciansactasimportantgatekeepersandplaycrucialsurveillanceroles.Appropriaterestructuringofthehealthcaresystemshouldbemadebyproperutilizationofprimarycarefortheearlydetectionandtimelypreventionofdiseases,and

hencereducingtheirburdentothehealthcaresystematthesecondaryandtertiarylevels.Thepublicshouldbeeducatedontheimportanceofprimarycarethroughamultidisciplinaryapproachviathemedia,storiesandvideos.Onthecontrary,thedevelopmentofnewtechnologyshouldnotbeover-stressed.

As the Vice-Chancellor of the CUHK, what do you think are the major challenges of undergraduate education?Prof. Sung: Ithinktherearetwomainchallengesthatwehavetoovercome.Oneistheshortsightednessofouryoungpeople.

DinnerPartywithCUStudents

VisittoSichuan

AlotofyoungpeopleItalktoaimtohaveahighearningcapacitywithintheirfirstfewyearsofcareertopayforthefirstinstallmentofaflatinsteadoffocusingontheirowncareerplan.Someyoungpeopleareinterestedinbecominginvestmentbankersandstudyingbusinesswithlittleinterestinmedicineandscience,artsandhistory.ButIthinkthereismuchmoretolifeandaperson’sachievementthanmakingmoney.Ihopestudentscanhaveabroaderacademicexperienceoutsidetheirmajorfieldandaholisticnon-academiclearningtoguidetheminlifeandnotjusttheircareers.

AnotheraspectI’mconcernedaboutistheresilienceofouryoungsters.Thisisaglobalproblemandevenmoreprominentinanaffluentsocietysuchasours inHongKong.Withthefinancialgrowthandprivilegedcircumstancesofthe80sand90s,studentsfindithardertocopewhenfacingadversities.Weseealotofmoodproblemsandsadlyevensuicideswhenourstudentsfeeltheycan’tcopewiththeirstudies.ExchangestudentsfrommainlandChinawhoarethecreamofthecropintheirownprovinceshaveanespeciallyhardtimewhentheydon’tgetsatisfactoryresultsintests.Aspartofanadmissionhealthcheck,weperformedquestionnairesonourfreshmenandfound30%of themhavingsymptomsofanxietyanddepressionalbeitnottothedegreeofhavingapathologicaldiagnosis.So themessageof“notgivingup”has tobefostered.Withthenew3-3-4educationsystemandyoungstershavingafour-yearundergraduateuniversitycurriculum,oneofourchallengesistodevelopthemasawholeperson.Thismightbeanopportunityforstudentstotakeupmorechallengesatayoungeragewithanearlierexposuretocampuslifeanddeveloptheirmoralcharacter.ResiliencetrainingshouldbeginatanearlierdevelopmentalstageandtheUniversityprovidesauniqueplatformforouryoungsterstobeincontactwithacomprehensiverangeofpersonsandcultures.


FEATURE

What are the mottos and secret of your success?“You must be the change you want to see in the world.” Gandhi

Ihavealwayscarriedthismottoinmylifeandbelieveonemustchangeoneselffirsttobringaboutchangesinothers.DuringtheSARSepidemic,oneofmymedicalstudentswasunfortunatelybroughtdownwithSARSandwasextremelydejectedwithhisillfortuneinitially.Afterhisrecovery,hewrotemealettertellingmeitwasthemostremarkableexperienceinhislifeashelearntmoreduringhishospitalizationthanhisfiveyearsofmedicalschool,whenheexperiencedfirsthandprofessionalandcompassionatecarefromthemedicalstaff.

“You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. Because believing that the dots will connect down the road will give you the confidence to follow your heart even when it leads you off the well worn path; and that will make all the difference.” Steve Jobs

SteveJobs’quoteringsabellveryclosetomyheart.Ialwaysfirmlybelieve thatoneshouldavoidnarrowingyourownspectrumandpigeon-holingyourselfespeciallyinthemedicalprofession.AsayoungmanIthoughtIwasveryknowledgeableinmyownfield.ButthatwasuntilmyPhDwhichopenedmeuptoawholenewarenaofexperiencesandpeople.Eversince,Ihavebelievedoneshouldenrichone’slifewithwhateverexperiencefateand lifethrowsatyoubecauseyouneverknowwhereyoucouldendupwithallthelittledotsyouhaveaccumulatedalongtheway–toimpactmankindandmakingasplashinyourlife.

One of Prof. Sung’s Favourite Poems

滾滾長江東逝水，

浪花淘盡英雄。

是非成敗轉頭空。

青山依舊在，幾度夕陽紅。

白髮漁樵江渚上，慣看秋月春風。

一壺濁酒喜相逢。

古今多少事，都付笑談中。《臨江仙》

Afterwords:IthasbeenanimmensehonourfortheFPLinksreporterstotalkwithProf.Sung.OneofthemoststrongnotionsIhadofProf.Sungwashisfirmbeliefinmoralvalues.Anotherimpressionwashisubiquitouspresence-IsuspectI’llalwaysfeelliketwelveyearsoldintheheadmaster’sroom!

(fromlefttoright)ProfessorJosephSung,Dr.JudyChengandProfessorMartinWong

Seventy-secondCongregationfortheConfermentofDegrees

What are your future p lans on the development of CUHK?Prof. Sung: CUHKisacomprehensiveuniversityconsistingofscienceandartwithmedicineinbetweenthesetwospectrums.AsIhavementioned,theUniversityhasanimperativeobligationtoguideandprepareouryoungpeopleforthesocietyandtheirfuturelives.Ihopetocultivateahumanisticculturetogroomtheirmoralcharacterandtobroadentheirhorizoninethicsandlifevaluesinsteadofjustdevelopingtechnology.Noprofessioncouldthrivewithoutethics.Couldyouimaginetheunethicalpracticeofmedicineandlaw?Experiencehasshownuswhatcouldhappentounethicalpracticesinbankingandinvestmentinrecentyears.

Asforconcreteplans,asajointventurewiththeShenzhenUniversitytheShenzhencampusoftheChineseUniversityofHongKong(CUHK)isexpectedtobeginin2014,initallystartingfromasmallerscale.ApartfromintroducingoureducationresourcesintotheMainland,wealsohopetoinstillourmoralvaluesintothenewcampus.


LEARNING POINTS FROM BOARD OF EDUCATION

(Disclaimer:Alladviceandsharinginthemeetingarepersonalopinionsandbearnolegalresponsibility.Allpatients’identitiesarekeptconfidential.)

Interest Group in Mental Health & Psychiatry in Primary CareThe 35th Meeting on 6th April 2013Dr. Mark S. H. Chan (Co-ordinator) - Board of Education

Theme : What are the current mental health topics of interest to family physicians?

Speaker : Dr.ChanSuenHo,Mark Coordinator,BoardofEducation

Dr.ChanSuenHo,MarkgraduatedwithMBBS(UNSW),andMasterinPainMedicine(Newcastle).HewasaVocationalScholarattheSchoolofImmunology,JohnCurtinSchoolofMedicalResearch,ANUandwastrainedatthe InstituteofNationalHeartLungTransplantatStVincentHospital.Dr.Chanhas20publicationsinAnesthesiaandFamilyMedicine.Heisafamilyphysicianinprivatepractice.Apartfromteaching,healsowritesfornewspapers.

Dr.Chanreviewedandpresented25papersinthefieldofmentalhealthandpsychiatrypublished inthepreceding12monthstocolleagues.Theselectioncriteriaare:ofrelevancetoFamilyMedicine, interesting,makingonefeel in touchwithcurrentthinkingandimportantinconceptualapproach.

Learning points

The following is a summary of questions answered in the paper discussed.

1. What happened to personality disorder in the new DSM V?

InthefirstdraftofChapterP(Personalitydisorders),DSM-5,February2010proposed to removeparanoid, schizoid,histrionic,dependentandnarcissisticpersonalitydisordersfromtheclassification.ItwasrevisedinJune2011,reinstatingnarcissisticpersonalitydisorderbutnottheotherfour.It isbeinghotlydebated.

Reference:TooFeworTooMany?ReactionstoRemovingversusRetainingSpecificPersonalityDisorders inDSM-5.CharlesB.PullCurrOpinPsychiatry.2013;26(1):73-78.

2. We ask patients to tell us more, what is the concept of Wisdom Environment in Narrative openness?

“Wisdomenvironment”meansanycontextoroccasion—reminiscence, lifereview,orsimplysoulfulconversation—wheredeep storytellingiselicitedbydeep storylistening,wherenarrativereflectionisinvited,andwhere wisdom (as awareness of alternative stories) is evoked.

We empower patients to be strong, what is resilience?

Resilienceistheabilitytotransformadversityintoagrowthexperienceandmoveforward,isthecapacitytoseesomethinghopeful,humorous,orotherwise“redemptive”amidthenegativesofourlives.Thisisaninsightfulpaper.

Reference: The Importance of Being Ironic, NarrativeOpennessandPersonalResilienceinLaterLife;WilliamL.Randall.Gerontologist.2013;53(1):9-16.

3. A new and renew approaches to the old body-mind, body-brain discussion.

A reviewonbrainfulness.Thisarticlehasan in-depthdiscussionontheeverlastingbody-minddebateinmedicine.Needpatiencetodigesttheauthor’spersonalview.

Reference:Brainfulness, JohnLaunerPostgradMedJ.2013;89(1047):60.

4. What is new in ADHD?

ANorwegianstudyshowedvideosandfilmstochildren

withADHDandrecordedthebrainactivitiesbyEEG.ItwasshownthattherewerepossibilitiestoshiftBetaactivities.Implicationsforfuturemanagement?

Reference:NeurofeedbackfortheTreatmentofChildrenandAdolescentsWithADHD.ARandomizedandControlledClinicalTrialUsingParentalReports.NezlaSDuric,JørgAssmus,DorisGundersen;BMCPsychiatry.2012;12(107).

5. How much do we know about faecal incontinence?

ThereisaROMEIIIclassificationbyretentionoffaecalmatters.Some15%ofdiagnosedchildrenstillhavetheproblematage18.

Reference:ReviewArticle:FaecalIncontinenceinChildren:Epidemiology,Pathophysiology,ClinicalEvaluationandManagement.S.Rajindrajith,N.M.DevanarayanaAlimentPharmacolTher.2013;37(1):37-48.

6. What is the Third Wave?

ApartfromtheThirdWavesbyAlvinToffler,thethirdwaveinPsychotherapy refers toaheterogeneousgroupoftreatments,including:

1. acceptanceandcommitmenttreatment, 2. behaviouralactivation, 3. cognitivebehaviouralanalysissystemofpsychotherapy, 4. dialecticalbehaviouraltherapy, 5. metacognitivetherapy, 6. mindfulness-basedcognitivetherapyand 7. schematherapy.

Thisreviewlookedattherandomizedcontrolledtrialsandcaseseriesduringthepast5years,showingtheeffectivenessof‘thirdwavepsychotherapies’.

Reference: The Third Wave of Cognitive BehaviouralTherapiesWhatIsNewandWhatIsEffective?KaiG.Kahl,LottaWinter.CurrOpinPsychiatry.2012;25(6):522-528.

7. We advocate empathy, is there a neural basis? Can we share joy as well? What are the empathy-related neural structures?

Themedialprefrontalcortex(MPFC),theinsula,thesuperiortemporalsulcus(STS)andtheinferiorfrontalgyrus(IFG)werediscussed.

Reference:CanWeSharetheJoyofOthers?EmpathicNeuralResponsestoDistressvsJoy.DaniellaPerry,TalmaHendler,SimoneG.SocCognAffectNeurosci.2012;7(8):909-916.

8. Will power make a difference? What is the easiest way to stay alive?

SimplybystatingI’dliketo.AstudyshowedthatMortalitywasthehighest(68.0%)amongthosewishingtolive<5yearscomparedtothosewishingtolive5–10years(45.6%)orover10years(33.3%)(P<0.001).

Reference:Will-to-LiveandSurvival ina10-yearFollow-upAmongOlderPeople.HelenaKarppinen,etal.AgeAgeing.2012;41(6):789-794.

9. What are the models of Insomnia ?

Theoldmodel is the3Pmodel, theothersarestimuluscontrolmodelandcognitivemodel.

Reference:ThePathophysiologyofInsomniaFromModelstoMolecules(andBack)WilfredR.Pigeon,MatthewR.CurrOpinPulmMed.2012;18(6):546-553.


LEARNING POINTS FROM BOARD OF EDUCATION

10. What are the five major psychiatric disorders that share common genetic risk ?

Fivemajorpsychiatricdisorders—autism,attention-deficit/hyperactivitydisorder (ADHD),bipolardisorder,majordepressivedisorder,andschizophrenia—shareseveralcommongeneticriskfactors.4riskloci–onchromosomes3p21and10q24,in2genesregulatetheflowofcalciuminbraincells(CACNA1CandCACNB2).

Reference:Lancet,2013Feb27.

11. Memory loss and drugs in MCI / Dementia.

Thereisnoevidencethatdrugswillbenefitpeoplewithmildcognitiveimpairment.

1. Cholinesterase inhibitorormemantine (anN-methyl-D-aspartatereceptorantagonist) inAlzheimer’sdiseasemayprovidesymptomaticrelief,butdoesnotappeartoalterprogressionoftheillness.

2. Atypicalantipsychoticshavemodestbenefitinreducingagitationandpsychoticsymptomsbutincreasetheriskofcardiovascularevents.

3. The roleofantidepressants inmanagingdepressivesymptomsinpatientswithmildcognitiveimpairmentisuncertainandtheymayincreasetheriskofdeliriumandfalls.

Reference:MemoryLoss.FlickerLA,FordAH,BeerCD,AlmeidaOP;MedicalJournalofAustralia196114-7 (Feb2012).

12. Two simple tests may help predict dementia and stroke in middle-aged people.

1. Peoplewithaslowerwalkingspeedinmiddleagewere1.5timesmorelikelytodevelopdementiawhencomparedwithpeoplewithfasterwalkingspeed.

2. Strongerhandgripstrength-associatedwith42%lowerriskofstrokeortransientischaemicattackinpeopleagedolderthan65yearscomparedwiththosehavingweakerhandgripstrength.

Reference:AmericanAcademyofNeurology:2012Dec27.

13. Donepezil and memantine for moderate-to-severe Alzheimer’s disease.

InpatientswithmoderateorsevereAlzheimer’sdisease,continuedtreatmentwithdonepezilwasassociatedwithcognitivebenefits thatexceededtheminimumclinicallyimportantdifferenceandwithsignificantfunctionalbenefitsoverthecourseof12months.

Reference:HowardR,McShaneR.NewEnglandJournalofMedicine(NEJM)366(10),893-903(Mar2012)Source:ExpertOpinPharmacother.

14. New approaches to the pharmacological management of generalized anxiety disorder.

QuetiapinehasthemostrobustevidenceofefficacyinGAD.

ValproicacidandagomelatineappeartobeeffectiveinGADpatients,butdataarepreliminary.Quetiapineispromisingbutitsuseiscomplicatedbymetabolicsideeffects.

Reference:BuoliM,CaldiroliA,CalettiE,PaoliRA,AltamuraAC;ExpertOpiniononPharmacotherapy(Jan2013).

15. Clinically significant drug interactions with newer antidepressants.

ImportantpharmacokineticinteractionsthroughinhibitingspecificCYPs.egduloxetineandbupropionaremoderateinhibitorsofCYP2D6.

Reference:SpinaE,TrifiròG,CaraciF;CNSDrugs26(1),39-67(Jan2012).

16. Ketamine for Treatment-Resistant Unipolar Depression.

Thispaperreviewedtheuseofsubanestheticdoseof IVKetamineforresistantdepressivepatients.

Reference:CurrentEvidence.MathewSJ.;CNSDrugsFeb2012.BrJPsychiatry.

17. Vitamin D deficiency and depression in adults.

SystematicreviewshowedthatlowvitaminDconcentrationisassociatedwithdepression,needforrandomisedcontrolledtrialsoftherolevitaminDforthepreventionandtreatmentofdepression.

Reference:AnglinRE,etal.BritishJournalofPsychiatry202100-7(Feb2013).

18. Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder.

In thepresent8-week trial, thevitaminD+ fluoxetinecombinationwassuperiortofluoxetinealoneincontrollingdepressivesymptoms.

Reference:KhoraminyaNetal;AustralianandNewZealandJournalofPsychiatry(Oct2012).

19. Obsessive-compulsive disorder, a new model of basal ganglia dysfunction?

Elementsfromdeepbrainstimulationstudies.

Reference:HaynesWI,MilletB,MalletL;RevueNeurologique(Aug2012).

20. Some practical advice regarding autism.

Autismisprevalent.ThelinkleadtoanexcellentsourcefordoctorscaringforAutistickids.Listentoparents.

1. Earlysignsofautismareoftenpresentbefore18months.

2. ParentsusuallyDOhaveconcernsthatsomethingiswrong.

3. ParentsgenerallyDOgiveaccurateandqualityinformation.

4. Whenparentsdonotspontaneouslyraiseconcerns,askiftheyhaveany.

Reference:www.cdc.gov/autismandwww.aap.org/autism.

21. Parkinson’s disease, insulin resistance and novel agents of neuroprotection.

Therearecommoncellularpathwaysrelatingneurodegenerativeprocesses with abnormal mitochondrial function andabnormalglucosemetabolism.Egperoxisomeproliferatoractivatedreceptorgammacoactivator1-α,akeyregulatorofmitochondrialrespirationandinsulinresistance,ispivotalinthepathogenesisofneuro-degenerationinParkinson’s.

Reference:Aviles-OlmosI,LimousinP,LeesA,FoltynieT;Brain(Feb2012).

Next meeting

Thenext(36th)meetingfortheInterestgroupwillbeon1stJune2013,attheCollegemeetingroom.Dr.DickyChung,ConsultantPsychiatristofTaiPoHospital,willsharehisexperienceonSuicidalAssessment.

AllmembersoftheCollegearewelcomeandencouragedtopresenttheircasesandproblemsfordiscussionsorroleplay.(Pleasedoso2weeksbeforehandforspeakerstoreview;andcontactoursecretaryat28610220.)Again,thosewhoareexperiencedcanshare,lessexperiencedonescanbenefitfromparticipation.Ourgoalistoenhanceourpracticalskills,promoteearlyawarenessandbettermanagementofmentalhealthproblemsinourcommunity.


BOARD OF EDUCATION NEWS Please wear a surgical mask if you have respiratory tract infection and confirm that you are afebrile before coming to the meeting. Please wear an appropriate dress code to the hospital for the clinical attachment. Private Video Recording is not allowed. Members, who wish to review the lecture, please contact our secretariat.

ASSESSMENT ENHANCEMENT COURSE (AEC) FOR FAMILY PHYSICIANS 2013

Organizer : AssessmentEnhancementSub-committee,BoardofEducation,HKCFP

Tutors : FamilyMedicineSpecialists,FellowsofHKCFPandRACGP

Supervisors : Dr. Wong Ka Wah and Dr. Chan Chi Wai

Co-ordinator : Dr. Tam Chung Yin, Janet

Objectives : 1. Toimproveclinicalknowledge,problemsolvingandconsultationskillsthroughdifferentworkshops

2. Toimprovephysicalexaminationtechniqueandclinicproceduralskillsthroughhands-onexperience

3. Toprovideopportunity for inter-professional communicationand social networkexpansionthroughself-helpgroups

4. Toimprovetimemanagementthroughsimulatedexamination

Venue : DukeofWindsorSocialServiceBuildingandHKAMJockeyClubBuilding

Date : 7months’coursestartingfromApril2013

Course Structure : Thecoursewillconsistof4maincomponents: 1. Seminars

2. Workshops

3. Self-helpGroupSupport

4. MockExam

SeminarsandWorkshopswillbearrangedonSaturdayafternoons(2:30p.m.to5:30p.m.)

Accreditation : Upto15CMEpoints(Category4.4)&5CPDpoints(Category3.15)forthewholecourse

Course Fee : Members : HK$3,200(Wholecourse) HK$900(Spotadmissionforeachseminarorworkshoponly) Allchequespayableto“HKCFP Education Ltd” Allfeesreceivedarenon-refundableandnon-transferable.

Capacity : 50doctorsmaximum

Enrolment : Enrolmentisnowopen.PleasecalltheCollegeSecretariat,Ms.YvonneLam,at28610220fordetails.Successfulapplicationswillbeinformedlater.

Disclaimer : Allcasesandanswersaresuggestedbyourtutorsonly.Theyarenotstandardanswersforexamination.

Remarks : Post-AEC training coursewillbeorganizedforcategory2candidateswhohaveenrolledinAEC.

Assessment Enhancement Course 2013Timetable for Workshops

Date Topics Venue

Apr20,2013(Sat)2:30–5:30p.m.

Introduction Duke of Windsor Social Service Building, Wanchai

May11,2013(Sat)2:30–5:30p.m.

Approach to Physical Complaints Duke of Windsor Social Service Building, Wanchai

Jun8,2013(Sat)2:30–5:30p.m.

Proper Physical Examination & Common Clinic Procedures

Duke of Windsor Social Service Building, Wanchai

Jul13,2013(Sat)2:30–5:30p.m.

Viva Practice: Enhance Interprofessional Communication

Duke of Windsor Social Service Building, Wanchai

Sept14,2013(Sat)2:30–5:30p.m.

Problem Solving Skills Duke of Windsor Social Service Building, Wanchai

Oct19,2013(Sat)2:30–6:00p.m.

Mock Exam HKAM Jockey Club Building, 99 Wong Chuk Hang Road

28 June 2013 Friday

Latest Update on COPD ManagementProf. Peter Calverley

Professor, Medicine in the Pulmonary and Rehabilitation Research Group,

University of Liverpool

Chairman Dr. Chan Sze Luen, DavidTheHongKongCollegeofFamilyPhysicians

Time 6:00p.m.–7:00p.m.Registration7:00p.m.–7:40p.m.Lecture&Discussion7:40p.m.Dinner

Venue JordanBallroom,2/F,EatonHotel,380NathanRoad,Kowloon

AdmissionFee

CollegeFellow,FullorAssociateMembersOtherCategoriesofMembersNon-Members

Free

HK$350.00HK$450.00

Allfeesreceivedarenon-refundableandnon-transferable.

Accreditation 2CMEpointsHKCFP(Cat.4.3)2CMEpointsMCHKUpto2CPDpoints(SubjecttosubmissionofsatisfactoryreportofProfessionalDevelopmentLog)

Language LecturewillbeconductedinEnglish.

Registration Registration will be first come first served.Please reserve your seat as soon as possible.

SponsoredbyGlaxoSmithKline Ltd.

TheCPRSubcommitteeof theBoardofEducation ispleasedtoannounce that followingcandidateshavepassedtheCPRExaminationon23March2013:

Congratulationstoyouall.

Dr.ChanSiuChung,BruceDr.ChooKwongYinDr.KeungManFung

Dr.KiChiWing,SamuelDr.LiLaiMing,HelenDr.SiuChiMing

Dr.TamWingYi,CherryDr.TseTungWing,George

1 June 2013 Saturday

Board of Education Interest Group in Mental Health

Aim Toformaregularplatformforsharinganddevelopingknowledgeandskillinthemanagementofmentalhealth

Topic Assessing Suicidal Patient: Psychiatric Considerations

Speaker Dr. Chung Wai Sau, Dicky

Co-ordinator&Chairman

Dr. Chan Suen Ho, MarkTheHongKongCollegeofFamilyPhysicians

Time 1:00p.m.–2:00p.m.LightLunch2:00p.m.–4:00p.m.ThemePresentation&Discussion

Venue 8/F,DukeofWindsorSocialServiceBuilding,15HennessyRoad,Wanchai,HongKong

AdmissionFee


Free

HK$350.00HK$450.00


Accreditation 2CMEpointsHKCFP(Cat.4.3)2CPDpointsHKCFP(Cat.3.15)2CMEpointsMCHK

Language LecturewillbeconductedinCantoneseandEnglish.


Note Participants are encouraged to present own cases for discussion. Please forward your cases to the Co-ordinator via the College secretariat 2 weeks prior to meeting.

22 June 2013 Saturday

Board of Education Interest Group in Counseling

Aim (1)Toformaregularplatformforinteractivesharinganddiscussionofvariouscounselingcasescommonlyseeninourdailypractice;

(2)Toboosterthecompetenciesincounselingoffamilypractitionersthroughcasediscussionandpractisingselfawareness

Topic The Anxious Patient

Speakers Dr. Lau Ka Fai, Tony and Dr. Lau Wai Yee, Aster

Co-ordinator&Chairman

Dr. Lau Wai Yee, AsterTheHongKongCollegeofFamilyPhysicians

Time 2:30p.m.–3:30p.m.Lecture3:30p.m.–4:30p.m.SmallGroupInteractive CaseDiscussion(max.10 participants)

Venue 8/F,DukeofWindsorSocialServiceBuilding,15HennessyRoad,Wanchai,HongKong

AdmissionFee


Free

HK$350.00HK$450.00


Accreditation 2CMEpointsHKCFP(Cat.4.3)2CPDpointsHKCFP(Cat.3.15)2CMEpointsMCHK

Language LecturewillbeconductedinCantoneseandEnglish.


Note Participants are encouraged to present own cases for discussion. Please forward your cases to the Co-ordinator via the College secretariat 2 weeks prior to meeting.

On-Going Events organized by Board of EducationPleaseberemindedthattherewillbeonelectureorganizedbytheBoardofEducationon19May2013.KindlyrefertoFPLinksAprilIssue(page21)fordetails.


BOARD OF EDUCATION NEWS

Community Education Programme

OpenandfreetoallmembersHKCFPCMEpointsaccreditation(Cat5.2)

Date/Time/CME Venue Topic/Speaker/Co-organizer Registration

8 June 20132:30–4:30p.m.2CMEpoints

TrainingRoomII,1/F,OPDBlock,OurLadyofMaryknollHospital,118ShatinPassRoad,WongTaiSin,Kowloon

Elderly Health in Primary CareDr.LoKwokManAC,Geriatrics,DepartmentofM&G,OLMH

Ms.ClaraTsangTel:23542440Fax:23276852

18 July 20131:00–3:00p.m.1CMEpoints

EastOceanSeafoodRestaurantShop137,1/F,MetroCityPlaza3,8MauYipRoad,TseungKwanO,Kowloon

Management of Primary Headache Disorders in Clinics: From Diagnosis to TreatmentDr.ChanChunKongRS,DepartmentofM&G,UCH

Ms.CordyWongTel:35133087Fax:35135505

15 June 20131:30–3:45p.m.2CMEpoints

LectureTheatre,G/F,BlockP,UnitedChristianHospital,130HipWoStreet,KwunTong,Kowloon

Management of Degenerative Joint Diseases in Primary Care SettingDr.HoHonShuenAC,DepartmentofO&T,UCH

Ms.CordyWongTel:35133087Fax:35135505

Structured Education Programmes

FreetomembersHKCFPCMEpointsaccreditation(Cat4.3)

Date/Time/CME Venue Topic/Speaker(s) Registration

5 June 13 (Wed)

2:15–4:45p.m.3CMEpoints

E1034AB,1/F,MainBlock,TuenMunHospital

Health Care Delivery Model in ChinaDr.TongKaHung

Ms.ElizaChanTel:24686813


MeetingRoom2,1/F,BlockF,UnitedChristianHospital

Shared Care and Referral SystemDr.HoPuiGiandDr.ChanFuLeung

Ms.CordyWongTel:35133087


SeminarRoom,3/F,LiKaShingSpecialistClinic,PrinceofWalesHospital

Health Care Insurance Proposal in Hong KongDr.LeungWingKit

Ms.CrystalLawTel:26323480


LectureHall,5/F,TsanYukHospital Dermatological EmergenciesDr.GeorgeTse

Ms.ManChanTel:25892337

6 June 13 (Thur)


LectureTheatre,8/F,AmbulatoryCareBlock,TseungKwanOHospital

Shared Care and Referral SystemDr.LeeHungFaiandDr.CheungYanKit


Monthly Video Viewing Session

MonthlyvideoviewingsessionswillbescheduledonthelastFridayofeachmonthat2:30–3:30p.m.at8/F,DukeofWindsorSocialServiceBuilding,15HennessyRoad,Wanchai,HongKong.

June’s session:

Date 28June2013(Friday)

Time 2:30p.m.-3:30p.m.

Topics 1. Glycemic Index – Non-alcoholic Fatty Liver Disease – Dr. Leong In Son2. Statin Benefit Beyond Lipid Lowering – Dr. Ko Wai Chin

Admission FreeforMembers

Accreditation 1CMEpointHKCFP(Cat.4.2)1CMEpointMCHKUpto2CPDpoints(SubjecttosubmissionofsatisfactoryreportofProfessionalDevelopmentLog)

Language LectureswillbeconductedinEnglish.

May’s session:

Date 31May2013(Friday)

Time 2:30p.m.-3:30p.m.

Topics 1. Traditional Chinese Therapy & Dermatosis – Dr. Lee Tze Yuen2. Treatment of Sputum. Old is New – Dr. Edwin Poon

Admission FreeforMembers

Accreditation 1CMEpointHKCFP(Cat.4.2)1CMEpointMCHKUpto2CPDpoints(SubjecttosubmissionofsatisfactoryreportofProfessionalDevelopmentLog)

Language LectureswillbeconductedinEnglish.




Room614,AmbulatoryCareCentre,TuenMunHospital

Teenage PregnancyDr.LeungHorYee



Room041,2/F,PamelaYoudeNethersoleEasternHospital

Journal ClubDr.LeeHoMing

Ms.KwongTel:25956941

13 June 13 (Thur)



Common Symptoms in Orthopaedics (LBP, Neck Pain, Shoulder Pain)Dr.YuenMingWaiandDr.MokKaYee




Community Resources for Patients with Substance AbuseDr.LeeSikKwanandDr.CheukTatSang




Use of Clinic Tests in Daily Consultations – Urea Breath Test and DyspepsiaDr.YioShing


19 June 13 (Wed)


E1034AB,1/F,MainBlock,TuenMunHospital

Knee PainDr.ChanKaHo



Multi-mediaConferenceRoom,2/F,BlockS,UnitedChristianHospital

Principle of Professional Ethics, Red BookDr.TsuiHiuFaandDr.KwokYeeMing



SeminarRoom,3/F,LiKaShingSpecialistClinic,PrinceofWalesHospital

Menopause and OsteoporosisDr.ChowTzeLing,Sylvia

Ms.CrystalLawTel:26323480


LectureHall,5/F,TsanYukHospital Journal ClubDr.LeePuiWai


20 June 13 (Thur)



Principle of Professional Ethics, Red BookDr.KwongKokSeeandDr.LeeWingMei




Approach to Numbness in Primary Care ClinicDr.HongSzeNga




Disgnosis and Management of Shoulder PainDr.LeeHoMing


26 June 13 (Wed)


E1034AB,1/F,MainBlock,TuenMunHospital Emergency Infectious DiseasesDr.LiuChungWo



Multi-mediaConferenceRoom,2/F,BlockS,UnitedChristianHospital

Eating DisorderDr.YuenChingYiandDr.LamWingSze



LectureHall,5/F,TsanYukHospital Care of Patient with Chronic Pain / Analgesic Ladder in GOPC SettingDr.TseungKwanHang


27 June 13 (Thur)



Case Presentation (Ethical Dilemma, Confidentiality Issue, Medical-Legal Cases)Dr.LeungYuenKinJournal Club (Infectious Disease/Infection Control Related) Dr.TsuiWingHang




Burn Out and Sick DoctorsDr.TangHoiYan




End of Life Decision and Palliative CareDr.YanKaShing,Quentin




Sunday Monday Tuesday Wednesday Thursday Friday Saturday

19 20

7:00 p.m.CSAStandardizationWorkshop

21 22

2:15 – 7:30 p.m. StructuredEducationProgramme

23

2:15 – 7:00 p.m. StructuredEducationProgramme9:00 p.m.CouncilMeeting

24 25

26 27 28 292:15 – 7:15 p.m. StructuredEducationProgramme


312:30 – 3:30 p.m.BoardofEducation-VideoSession

11:00 - 4:00 p.m.InterestGroupinMentalHealth

2 3 4 5


6


7 82:30 - 5:30 p.m.AssessmentEnhancementCourses2013

9 10 11 12 132:15 – 7:00 p.m. StructuredEducationProgramme7:00 - 9:30 p.m.StandardizationWorkshoponResearchSegment

14 15

5:30 - 7:30 p.m.ConfermentCeremony

16

9:00 a.m. - 5:30 p.m.HongKongPrimaryCareConference2013

17 18

9:00 p.m.CouncilMeeting

19


20

2:15 – 7:00 p.m. StructuredEducationProgramme9:00 p.m.BoardofConjointExaminationMeeting

21 22

2:30 - 4:30 p.m.InterestGroupinCounseling

23

2:30 - 5:30 p.m.Conjoint2013InformationSeminaronOSCESegmentforCandidates

24 25 26


27


282:30 – 3:30 p.m.BoardofEducation-VideoSession6:00 - 7:40 p.m. LatestUpdateonCOPDManagement

29

Red : Education Programmes by Board of EducationGreen : Community & Structured Education ProgrammesPurple : College Activities

“RestrictedtomembersofHKCFP.TheviewsexpressedintheFamilyPhysiciansLinksrepresentpersonalviewonlyandarenotnecessarilysharedbytheCollegeorthepublishers.Copyrightsreserved.”Contact and Advertisement EnquiryMs. Carmen Cheng Tel: 2528 6618 Fax: 2866 0616 E-mail: [email protected] Hong Kong College of Family Physicians7th Floor, HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Hong Kong

BackRow(lefttoright):Miss.WindyLau,Miss.CarmenCheng,Dr.FungHoiTik,Dr.WendyTsui,Dr.CatherineNg,Dr.MariaLeung,Dr.JudyCheng,Dr.NatalieSiuFrontRow(lefttoright):Dr.HoKaMing,Dr.FokPeterAnthony,Dr.ChanManLi,Dr.SinMingChuen,Dr.AnitaFan,Dr.AlfredKwong,Dr.SzeHonHo

Dr.AlvinChanDr.ChanManLiDr.JudyChengDr.ChungChakCheongDr.AnitaFanDr.FokPeterAnthonyDr.FungHoiTik,HeidiDr.HoKaMingDr.AlfredKwongDr.DorothyLawDr.MariaLeungDr.NgaiKaHoDr.SinMingChuenDr.SiuPuiYi,NatalieDr.SzeHonHoDr.WongYuFai

Chief Editor :Dr.CatherineNg

Deputy Editors: Prof.MartinWong

Dr.NatalieYuen

Board Advisor :Dr.WendyTsui

Board Members :

FP LINKS EDITORIAL BOARD 2013

Section Coordinator (Oasis)Section Coordinator (Feature)Section Coordinator (After Hours)

Section Coordinator (WONCA Express)

Section Coordinator (Photo Gallery)

Section Coordinator (News Corner)


COLLEGE CALENDAR

Documents

Hong Kong Primary Care Conference 2013 Family …Dr. Henry Sze, Clinical Assistant Professor of the Department of Oncology, the University of Hong Kong, will talk about “New Treatment