This month

May 2012
This month
n
Spotlight
Testamentary capacity
n
Cardiology
A 65-year-old gentleman presenting
with generalized myalgia
n
Dermatology
A young lady with a warty plaque
on scalp
n
Paediatric Medicine
A 10-year-old male with a
pruritic rash
n
General Medicine
A 43-year-old male with blood
in his urine
n
HKMA Prize Winning Article
Understanding hand hygiene
HKMA CME Bulletin 持續醫學進修專訊
May 2012
3
EDITORIAL
CME COURSES
Spotlight:Testamentary capacity 5
Cardiology: A 65-year-old gentleman presenting with generalized myalgia 10
Dermatology:A young lady with a warty plaque on scalp 11
Paediatric Medicine: A 10-year-old male with a pruritic rash
12
General Medicine: A 43-year-old male with blood in his urine 14
Answer Sheet 17
HKMA Prize Winning Article: Understanding hand hygiene 19
CME NOTIFICATIONS
23
EVENT INFORMATION
27
CME Calendar The Hong Kong Medical Association is dedicated to providing a coordinated CME programme for all members of the medical profession.
Under the HKMA CME Programme, a CME registration process has been created to document the CME efforts of doctors and to provide
special CME avenues. The Association strives to foster a vibrant environment of CME throughout the medical profession. Both members
as well as non-members of the Association are welcome to join us. You may contact the HKMA Secretariat for details of the programme.
香港醫學會致力推動持續醫學進修，醫學會體察到業界有必要設立完善的持續進修計劃，為同僚建立有系統的進修記錄機制，以及為全科醫生
提供適切的進修課程。藉著這個計劃，我們期望將優良的進修傳統推展至醫學界中每一角落，同時為業界締造一個充滿活力的進修文化。我們
誠意邀請你參與醫學會持續進修計劃，不論你是否醫學會的會員，均歡迎你同來與我們一同學習，以及享用醫學會為所有醫生設立的進修記錄
機制。如欲了解香港醫學會持續醫學進修計劃的詳情，請聯絡本會秘書處查詢。
HKMA CME Bulletin – MONTHLY SELF-STUDY SERIES to help you grow!
Please read the following articles and answer the questions. Participants in the HKMA CME Programme will be awarded credit points
under the Programme for returning the completed answer sheet via fax (28650943) or by mail to the HKMA Secretariat on or before
15 June, 2012. Answers to questions will be provided in the next issue of the HKMA CME Bulletin. (Questions may also be answered
online at www.hkmacme.org)
請細閱本期文章，並利用答題紙完成自我評估測驗，於 2012 年 6 月 15 日前，將已填妥之答題紙傳真（號碼：2865 0943）或寄回本會秘書處，
您將可獲持續醫學進修的積分點 ; 至於是期自我評估測驗之答案，將刊於下一期《持續醫學進修專訊》之中。
（您亦可透過網站 www.hkmacme.org
完成自我評估測驗。）
Elsevier (Singapore) Pte. Ltd
Tel: 2965 1300
www.hkmacme.org
HKMA CME
Enquiry Hotline:
Tel: 2527 8452
2861 1979
HKMA
Hong Kong Medical
Association
May 2012
1
EDITORIAL
EDITORIAL
CME Bulletin & Online
Editorial Board
持續醫學進修專訊及網上版編輯委員會
The year of 2012 is a year of rapid change.
Chief Editor 總編輯：
Dr. WONG Bun Lap, Bernard 黃品立醫生
Board Members 委員會成員：
Dr. CHAN Hau Ngai, Kingsley
Dr. CHAN Man Kam
Dr. CHAN Yee Shing, Alvin
Dr. CHENG Chi Man
Dr. CHEUNG Hon Ming
Dr. CHIU Shing Ping, James
Dr. CHOI Kin, Gabriel
Dr. CHOW Pak Chin
Dr. CHU Kin Wah
Dr. FONG Chung Yan, Gardian
Dr. FUNG Yee Leung, Wilson
Dr. HO Chung Ping, MH
Dr. HO Hung Kwong, Duncan
Dr. KONG Kam Fu, James
Dr. KWOK Ka Ki
Dr. KWOK Tin Fook
Dr. LAM Tzit Yuen, David
Dr. LEUNG Chi Chiu
Dr. LI Siu Lung, Steven
Dr. LI Sum Wo, MH
Dr. POON Tak Lun
Dr. SHIH Tai Cho, Louis
Dr. TSANG Kin Lun
Dr. TSE Hung Hing
Dr. WONG Shou Pang, Alexander
Dr. YEUNG Chiu Fat, Henry
陳厚毅醫生
陳文岩醫生
陳以誠醫生
鄭志文醫生
張漢明醫生
趙承平醫生
蔡　堅醫生
周伯展醫生
朱建華醫生
方頌恩醫生
馮宜亮醫生
何仲平醫生
何鴻光醫生
江金富醫生
郭家麒醫生
郭天福醫生
林哲玄醫生
梁子超醫生
李少隆醫生
李深和醫生
潘德鄰醫生
史泰祖醫生
曾建倫醫生
謝鴻興醫生
王壽鵬醫生
楊超發醫生
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© Elsevier (Singapore) Pte Ltd. 2012
ISSN: 1793-5393
Notice
Medical knowledge is constantly changing. Standard
safety precautions must be followed, but as new research
and clinical experience broaden our knowledge, changes
in treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current
product information provided by the manufacturer of
each drug to be administered to verify the recommended
dose, the method and duration of administration,
and contraindications. It is the responsibility of the
practitioner, relying on experience and knowledge of the
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individual patient. Neither the Publisher nor the Authors
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Although all advertising material is expected to conform to
ethical (medical) standards, inclusion in this publication
does not constitute a guarantee or endorsement of the
quality or value of such product or of the claims made of
it by its manufacturer.
www.hkmacme.org
14th January 2012
Republic of China presidential election (Taiwan)
Ma Ying-jeou was re-elected as President with 51.6% of
the vote over Tsai Ing-wen (45.63%) and James Soong
Chu-yu (2.77%).
25th March 2012
Hong Kong SAR
Leung Chun-ying was elected as Chief Executive with
57.4% vote over Henry Tang (23.8%) and Albert Ho (6.3%).
22nd April 2012 (Date of writing)
France presidential election
President Nicolas Sarkozy is now fighting a hard battle with his major competitor
Francois Hollande.
6th November 2012
United States presidential election
President Barack Obama is going to run for his second and final term. Mitt Romney,
the former Governor of Massachusetts will probably be his major competitor.
2012–2013
In Mainland China, key leadership change is also coming. Hu Jintao, the President
and Wen Jiabao, the Premier of the State Council are going to step down for the next
generation of leadership in 2012 and 2013, respectively, after 10 years of governing
China since 15th March 2003.
My dearest HKMA fellow colleagues, you can easily see that the year 2012 will be
an important year in human history, a year of rapid changing, throughout the world.
Let us share some of my collections of words of wisdom for “Changes”.
“The world is changing very fast. Big will not beat small anymore. It will be the fast
beating the slow.”
— Rupert Murdoch (1931–), Founder, Chairman & CEO of News Corporation
“It may be hard for an egg to turn into a bird: it would be a jolly sight harder for it to
learn to fly while remaining an egg. We are like eggs at present. And you cannot go on
indefinitely being just an ordinary, decent egg. We must be hatched or go bad.”
— C.S. Lewis (1898–1963), British Writer, the Author of The Chronicles of Narnia
“Only the wisest and stupidest of men never change.”
— Confuscius (551–479 BC), Chinese Philosopher
“Change before you have to.”
— Jack Welch (1935–), Chairman & CEO of General Electric 1981–2001,
the Author of Winning
The HKMA CME Editorial Board sincerely wishes that our CME Bulletin can help
you and your patients on some day, and in some way to live healthier, simpler and
happier lives in this year 2012, a year of rapid change.
We wish you and your family a very happy Dragon Boat Festival!
Dr. WONG Bun Lap, Bernard
Chief Editor
HKMA
May 2012
3
Paediatric Medicine
SPOTLIGHT
Testamentary capacity
Complete this course
and earn
1 CME POINT
Dr. Lam Tat Chung Paul（林達聰醫生）
FRCP, FRCPsych, FHKAM(Medicine), FHKAM(Psychiatry)
Hon. Clinical Assistant Professor, The University of Hong Kong
Email: [email protected]
Testamentary capacity refers to the ability of a person to
execute (make) a Will. A male Will maker is formally referred
to as a “testator” whilst his female counterpart is referred to
as a “testatrix”. The assessment of a person’s testamentary
capacity is becoming increasingly more important because
the average age of the population as a whole is rising and
old people tend to live even longer. Many of them have no
children, and rival parties partial to the inheritance are more
prone to resolve their disputes in the court room…
In law, testamentary capacity is presumed. That is to
say, a person making a Will is normally assumed to posses
such capacity. This is the same as a person signing an
agreement to buy a flat, or when you sign on your credit
card to make a purchase. The Court takes a liberal view
in its interpretation, just like a person is presumed to be
innocent in a court of law until proven otherwise. “If the
Will is rational on the face of it and is shown to be duly
executed and no other evidence is offered, the court will
pronounce (accept) it presuming the testator to be mentally
competent” [1]. However, when a challenge is brought up
by another party, the proponent of the Will will need to
submit evidence to support the testamentary capacity of
the testator. “Those propounding the Will must satisfy the
court that the testator was of sound disposition. When the
whole of the evidence is before the court, the decision must
be against the validity of the Will unless it is affirmatively
established that the deceased was of sound mind when he
executed it. Where grave suspicion of incapacity arises in
the case of those propounding the Will, they must dispel
that suspicion by proving testamentary capacity ”[1].
Another basic concept involved is testamentary
freedom, that is, the prerogative of the testator to decide on
how he wishes to distribute his wealth. English law “leaves
everything to the unfettered discretion of the testator (on
the assumption that) the instincts, affections and common
sentiments of mankind may safely be trusted to secure, on
the whole a better disposition of the property of the dead”
[2]. This is unlike the case in some continental countries,
when landed properties can only be passed to male heirs.
The assessment of testamentary capacity is very important for a potential testator because of the following reasons:
(1) Wills are often challenged in Court;
(2) It is necessary to prevent challenge and litigation to
be brought up;
(3) To give positive evidence and dispel uncertainties of
the testator’s wish in Court;
(4) To protect any possible weakness which may be
used to challenge the Will.
In English law, there is the famous Golden Rule, which
states: “In the case of an aged testator or a testator who has
suffered a serious illness, there is one golden rule which
should always be observed, however straightforward matters
may appear, and however difficult or tactless it may be to
suggest that precautions be taken: the making of a Will
by such a testator ought to be witnessed or approved by a
(competent) medical practitioner who satisfied himself of
the capacity and understanding of the testator, and records
and preserves his examination and finding [3].”
Who is a competent medical practitioner? In Hong Kong
any registered medical doctor in current practice is allowed
to do the assessment. However, since such an assessment is
a preparation for contest to be brought up in Court, one
must foresee that the Judge will take into consideration
the training of the doctor, his specialty, his experience
and the number of cases he has performed and appeared
as an expert witness in Court. Hence, it is usually the
specialist psychiatrist with special interest and experience
in this area who is the most suitable doctor to perform
such an assessment. However one must note that whether
the testator has the requisite legal capacity to make the
contested Will is a legal issue. The doctor can only give an
opinion about the testator’s mental capacity. Only the Court
has the final authority to decide on testamentary capacity [4].
Certain principles have been used to determine capacity:
(1)By outcome, i.e., whether the person can make the
judgement that will result in the most favourable
outcome. One famous case is that of a mental patient
with an infected diabetic foot. The doctor decided
that the patient must have an amputation, or he will
die. However the Court ruled that the patient had the
Note: Where appropriate in the article, “testator” also refers to “testatrix” and “he” also refers to “she”.
www.hkmacme.org
HKMA
May 2012
5
SPOTLIGHT
capacity to refuse the operation, and in fact the patient
survived. Thus determination by outcome is not a
generally accepted principle.
(2)By status, such as elderly persons, mentally handicapped
persons, detained mental patients or people with certain
medical or psychiatric diagnosis. Again this is not found
to be a sound principle. One exception is that of minors
who are legally presumed to be incapable and do not
possess testamentary capacity.
(3)By function, depending on the testators’ ability to
understand, to possess knowledge, to make a rational
decision and to communicate choices. This is the accepted
principle used for the determination of capacity.
One erroneous concept needs to be dispelled. In a survey of
USA doctors [5],
• 72% said that a diagnosis of dementia automatically
means someone lacks capacity.
• 66% said depression.
• 71% said psychosis.
This falls into the trap of assessment by status, which, as was
previously pointed out, did not withstand the scrutiny of
the courts.
There are two types of assessment performed by the doctor.
1. Contemporaneous assessment, where the testator is
available for examination by the doctor before the Will is
executed.
2. Retrospective assessment, where the testator cannot
be examined. Usually the testator had died and his Will
was challenged in Court. At times it may be that the
testator had fallen into a coma, or he was not available
for examination.
The classical court
case used for over a
hundred years to test
whether a person has
testamentary capacity
is the case of Banks
a n d G o o d f e l l o w.
John Banks suffered
from delusions of
persecution and had
been confined as a
lunatic in 1841. He
made a Will disposing
of his 15 houses in Figure 1. Lord Chief Justice Sir
1863, and he died Alexander Cockburn (1802–1880).
two years later. In 1870 the Court ruled that his delusions
had no influence on his Will, which was upheld. The
judgement of Lord Chief Justice Cockburn (Figure 1) stated:
It is essential that … a testator
• Shall understand the nature of the act and its effects;
• Shall understand the extent of the property of which he
is disposing;
• Shall be able to comprehend and appreciate claims to
which he ought to give effect (and with a view to the
latter object);
• No disorder of mind shall poison his affections, pervert
his sense of right and prevent the exercise of his natural
faculties — that no insane delusion shall influence his
Will in disposing of the property and bring about a
disposal of it which, if the mind had been sound, would
not have been made.
Certain abilities are required of the testator for him to
possess capacity. He must
• Understand the information relevant to the decision he
is to make;
• Use the information rationally e.g. risk/benefit comparison;
• Appreciate the situation and its consequences i.e., that he
is being asked to make a Will to dispose of some or all of
his property after death;
• Be able to communicate choices [6].
To put this in modern language, the testator must
• Understand the nature of the act and its consequences;
• Understand the full extent of his assets affected by his
Will;
• Know the identity of the executor and each of the
beneficiaries under his Will as well as the share to be
taken by each of such beneficiaries;
• Understand and appreciate the relation and claims of
those who might expect to benefit from the Will – both
those included and excluded;
• Have no disorder of mind or insane delusion that
influences the disposition of the assets.
The UK Mental Capacity Act 2005 stated, with regard to
testamentary capacity, a person is unable to make a decision
for himself if he is unable to
• Understand the information relevant to the decision;
• Retain the information;
• Use or weigh that information as part of the process of
making the decision, or
• Communicate his decision (whether by talking, using
sign language or any other means).
However, recent cases have put additional requirements on
top of the Banks and Goodfellow judgement.
1. An 89-year-old man executed a Will a week after his wife
died, leaving his assets to his daughters. His sons made
an application to the Court claiming that the testator did
not have testamentary capacity.
The Judge ruled that the patient was devastated by the
bereavement at the time and did not have the power to
make the decision [7].
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HKMA
May 2012
www.hkmacme.org
2. A testator with multiple sclerosis who cannot speak
disinherited his daughter and left his farm to the
farm manager for no apparent good reason. The Will
was declared invalid by the Court. The Judge ruled that
“The testator need to arrive at a rational, fair and just
Will” [8].
There are certain important features about testamentary
capacity.
(1) TIME SPECIFIC
If a testator executed a Will while he is of sound
disposing mind (intact testamentary capacity), the Will
is valid even though he did not have the capacity before
the act or may lost the capacity later. So a patient may
be in a coma. When he had regained consciousness, he
may be able to make a will, even though his mental
capacity may later deteriorate due to other complicating
illnesses.
(2)TASK SPECIFIC
Depending on the complexity of the issues, a patient
may have sound capacity for one task and not possess
it for another task. So the patient may be able to testify
that he wished to give the only property he owned to
his only child, but he may not be able to give direction
about a multi-million dollar business with complicated
company structure situated in many countries to be
distributed among his many wives and children and
other relatives.
(3)SITUATION SPECIFIC
The testator may be able to understand certain simple
situations but not able to understand more complex
situations. The more complicated the situation, the
higher the level of cognition required for the testator to
be competent (Figure 2). The testator may know that he
owns a flat, but if his assets are involved in a complicated
ligation, he may not be able to appreciate the true extent
of his bounty.
(4) THE RULE OF PARKER V FELGATE (1883) is also
frequently invoked:
• A patient gave instructions for a Will. Before he could
execute (sign) it, he became confused or comatose.
• Later on the patient became conscious enough to sign
the Will.
• The Court will uphold the Will to be valid. (Example:
Perrins v Holland 2010) In the case, the Will must have
been properly and fully drawn up in the first instance.
There are no new additions or alterations.
Preparation for doing an assessment:
• Make sure that the patient agrees to be assessed;
www.hkmacme.org
Level of Cognition or Emotional Stability
Paediatric Medicine
SPOTLIGHT
High
Capable
Incapable
Low
Uncomplicated
Situation Complexity
Conflictual or Complex
Figure 2. Relationship between cognition/emotional stability and
situation complexity.
• Agree on the parties to be given the report;
• Obtain information on family background from family
members and lawyers;
• Ascertain the extent of the estate;
• Check who the potential beneficiaries are;
• You may ask to see a copy of the Will proposed to be
made by the patient to satisfy yourself that its complexity
is such that in your professional view the patient can
fully understand and give his free and independent
consent to the making of the relevant Will;
• Check previous Wills and their provisions;
• Review medical history from relatives and medical
records;
• Check relevant legal documents.
Before the assessment:
• Give optimal treatment — for example the patient may
be given blood transfusion, intense therapy for infection,
nutritional support or physiotherapy etc. to maximize
his capacity;
• Temporarily discontinue sedating medicine if applicable;
• Choose suitable period, time and environment when the
patient can perform well. The patient’s condition may
fluctuate from day to day, or may be mentally more alert
usually at a particular time of the day;
• Perform interview in a satisfactory environment (quiet,
good lighting, privacy, free from disturbance, in the
absence of people with significant interest or influence).
The assessment:
• A full medical history is taken with particular attention
to cerebrovascular accidents (CVA), dementia or other
disorders of the brain;
• Psychiatric history, past and present, should be recorded;
• General physical status, physical examination and
medical diagnosis;
• Psychiatric examination and diagnosis, paying particular
attention to recent and current symptoms like mood
disorder, confusion, hallucination or delusion;
• Cognitive tests including MMSE, Clock Drawing or
other tests are to be included;
HKMA
May 2012
7
SPOTLIGHT
• Specific confirmation of conscious level;
• Banks v Goodfellow test — the four arms of the Banks v
Goodfellow test must be applied in turn and the doctor
be satisfied that the testator has passed all parts of the test:
• Verbatim records of answers are most informative. They
are often produced in Court in support of your report or
opinion;
• Contemporaneous notes are strong evidence of proof in
Court because they are taken at the time;
• Previous Wills, reasons for change — it would greatly
help to dispel any doubt if the testator can say clearly why
his disposition has changed from a previous Will;
• Who was included, who was excluded, reasons for
disposal – as in the case of Key v Key above, the
Court will need to be certain not only that the bounty
was distributed in certain ways, but will need to be
satisfied that the testator arrived at a rational, fair, and
just will;
• Video recording in selected cases — in cases where
the situation is complicated, or the risk of a challenge
can be expected, or where large sums of money are
involved, video recording is recommended for better
documentation.
care in the preparation of this report and the opinions I
have formed;
• I have not entered into any arrangement where the
amount or payment of my fees is any way dependent
upon the outcome of this case.
The contents include:
• Family background (parents, siblings)
• Personal background (including upbringing, education
level, marriage and children)
• Medical and psychiatric history
• Current medical and psychiatric illness and disability
• Report according to finding at assessment
• Findings in regard to each limb of Banks v Goodfellow
test
• Summary of finding and your opinion
The report:
The following is a prototype, but doctors may have their
own preferences. However, the points below should generally
be included:
• State your personal identification including name,
practice address and contact telephone numbers;
• State your claim to expertise — your qualifications,
specialty, training and experience with regard to mental
state examination, cognitive testing and assessment of
testamentary capacity;
• State your instructions — the party that made the
request and what you are expected to do;
• List documents to which you made reference, including
medical reports, previous Wills, other legal documents.
Timing of assessment:
• In usual cases, when patients are not very ill and condition
not fluctuating, the Will can be executed up to a week
from the capacity assessment. Each case will turn on its
own facts.
• In more debilitated patients, or patients with fluctuation
conditions, the Will is executed immediately after
capacity assessment.
Acknowledge duties and obligations to the Court. For
example:
• I understand that my primary duty is to the Court rather
than the party that engaged me;
• I have endeavoured in my report and in my opinion to
be accurate and to cover all relevant issues;
• I will notify those instructing me immediately and
confirm in writing if, for any reason, my report requires
correction or clarification or qualification;
• I understand that my report, subject to any corrections
made before swearing as to its correctness, will form
evidence to be given by me under oath and that I may be
cross examined on my report by a cross examiner;
• I am likely to be subject of adverse criticism by the Judge
if the Court concludes that I have not taken reasonable
Retrospective assessment of testamentary capacity
• Generally, a retrospective assessment is made to
challenge a Will. In such a case the patient is dead or has
deteriorated significantly and become incapacitated since
the Will was made. He may refuse to be examined or
there may be obstruction from some family members or
care-givers. A retrospective challenge is usually based on
claims of lack of capacity, duress or undue influence.
8
HKMA
May 2012
Statement of truth: for example —
• “I declare that this report has been prepared in
accordance with information given to me. It is true and
correct to the best of my knowledge, understanding and
belief. The opinions I have expressed represent my true
and complete professional opinions on the matters to
which they refer.”
Attestation of Wills:
• Doctors may be asked to testify a Will. In this case, there
is assumption that the doctor is satisfied with the capacity
of the testator. So, do not testify a Will unless you have
assessed the testamentary capacity properly.
A retrospective assessment has to make reference to:
• Hospital and nursing home notes
• Legal records and attendance notes
• Informants, e.g. family members, care-givers, etc.
• Any other information, e.g. patient’s diary, letters, etc.
• Activity records (travel, employment, etc)
www.hkmacme.org
Paediatric Medicine
SPOTLIGHT
References
High
1.
2.
3.
4.
5.
6.
7.
8.
Level of Cognition
Not Undue
Undue
Low
Further Reading
Mild suggestion
Influence Increasing Severity
Coercion
Figure 3. Relationship between cognitive capacity and influence.
All evidences gathered are collated to form an assessment
and opinion on the patient’s capacity at the material time.
Undue influence refers to:
• One person taking advantage of the position of power
over another person;
• Free will to bargain is not possible;
• Any act of persuasion that overcomes the free will and
judgement of another, including exhortations, importuning, insinuations, flattery, trickery, and deception.
Behrens J, in Vaughan v Vaughan 2002 EWHC 699.
Sharp & Bryson v Adam and Others [2006] WTLR 1059.
Lord Templeman, Re Simpson. Sol Jo. 1977;121:224.
Otuka v Alozie 2005.
Markson LJ, Kern DC, Annas GJ, et al. J Am Geriatr Soc. 1994;42,1074–80.
Appelbaum PS, Grisso T. N Eng J Med. 1988;319,1635–8.
Key & Anor v Key & Ors [2010] EWHC 408 (Ch) (05 March 2010).
Sharp v Adam and others, Lord Justice May [2006] WTLR 1059.
Certain factors are usually present:
• susceptibility of the testator
• opportunity
• inclination and planning
• an unnatural or suspicious transaction
Warnings of undue influence:
• A confidential relationship existed between the testator
and the influencer that created an opportunity for the
latter to control the testamentary act.
• The influencer used that relationship to secure a change
in the distribution of the testator’s estate.
• There were unnatural provisions in the Will.
• The change of distribution did not reveal the true wishes
of the testator.
• The testator was vulnerable to being influenced, either
because of a neurologic or mental disorder, or because of
specific emotional circumstances.
• The beneficiary actively participated in or initiated the
procurement of the Will.
• There was undue benefit to the beneficiary (Figure 3).
Conclusion:
• Wills are very often subject to challenges.
• Care in drawing up Wills with proper assessment of
testamentary capacity is very important to avoid potential
litigations.
• The assessment should be meticulous and follow
established standards.
• Careful documentation must be done to avoid future
disputes.
• Performed by a competent doctor with appropriate
training and experience.
www.hkmacme.org
• Liptzin B, Peisah C, Shulman K, et al. Testamentary capacity and delirium. Int
Psychogeriatr. 2010;22(6):950–6.
• Peisah C, Finkel S, Shulman L, et al. The wills of older people: risk factors for
undue influence. Int Psychogeriatr. 2009;21(1):7–15.
• Shulman KI, Peisah C, Jacoby R, et al. Contemporaneous assessment of
testamentary capacity. Int Psychogeriatr. 2009;21(3):433–9.
• Roked F, Patel A. Which aspects of cognitive function are best associated
with testamentary capacity in patients with Alzheimer’s disease? Int J Geriatr
Psychiary 2008;23: 552–3.
• Shulman KI, Cohen CA, Kirsh FC, et al. Assessment of testamentary capacity
and vulnerability to undue influence. Am J Psychiatry. 2007;164(5):722–7.
• Thomas G. Gutheil. Common pitfalls in the evaluation of testamentary
capacity. J Am Acad Psychiatary Law. 2007;35:514–7.
• James E. Spar, Andrew S. Garb. Assessing competency to make a will. Am J
Psychiatary 1992;149:169–74.
Answer these on page 17 or
make an online submission at:
www.hkmacme.org
Please indicate whether the
following statements are true or false
1. The geriatric specialist is the most competent doctor to
assess testamentary capacity.
2. Patients are presumed to have testamentary capacity.
3. Under Common Law, patients enjoy testamentary
freedom.
4. Patients suffering from dementia do not have
testamentary capacity.
5. The UK Mental Capacity Act 2005 requires that the
person should be able to retain the information relevant
to the decision he/she is to make.
6. The Banks and Goodfellow judgement required that the
testator shall understand the extent of the property of
which he/she is disposing.
7. Assessment of testamentary capacity should be done in
the presence of a close relative with significant interest
in the Will.
8. In making a Will, no reference need to be made of any
previous Wills.
9. The duty of the doctor is to the Court and not to the
party who engaged him/her.
10.Undue influence can be suspected if the beneficiary
actively participated in or initiated the procurement of
the Will.
ANSWERS TO APRIL 2012
Management of early rheumatoid arthritis: concepts in treat to target
1. False
6. False
2. True
7. False
HKMA
3. True 8. True
4. False
9. True
5. True
10. False
May 2012
9
CARDIOLOGY
A 65-year-old gentleman presenting with generalized myalgia
A 65-year-old gentleman presented to you with
generalized myalgia. He has coronary artery disease
with acute coronary syndrome 6 months ago.
He received coronary angioplasty with a drugeluting stent implanted. He has hypertension and
hypercholesterolaemia. He is currently on double
anti-platelet therapy (DAPT), amlodipine 10 mg daily
and simvastatin 80 mg daily.
Answer these on page 17 or
make an online submission at:
www.hkmacme.org
Please indicate one answer
to each question
1. What further test(s) should be done?
a. CXR
b.Blood for CK and LDH levels
c. Blood for liver function test
d.All of the above
2. What may be the underlying cause of his symptoms?
a. Simvastatin induced myopathy
b.Amlodipine induced myopathy
c. DAPT induced myopathy
The content of the Office Cardiology Series is provided by:
Dr. LI Siu Lung, Steven FHKAM (Med), FRCP (Glasg), FRCP (Edin), FRCP (Lond), Specialist in Cardiology
Dr. WONG Shou Pang, Alexander FRCP, FHKAM (Med), FHKCP, Specialist in Cardiology
3. What precautions should be taken with his current
combination of drug treatment?
a. Dose of simvastatin should be limited to 20 mg
daily when given together with amlodipine.
b.Dose of simvastatin should be limited to 20 mg
daily when given together with DAPT.
c. Dose of simvastatin should be limited to 60 mg
daily when given together with amlodipine.
臨床心臟科個案研究之內容誠蒙李少隆醫生及王壽鵬醫生提供。
Answers 1. d
APRIL ANSWERS
Questions
1. What does the ECG show?
a. Bradycardia
b. Prolonged QRS duration
c. Tall T waves
d. All of the above
2. Her blood K+ level was found to be 7.8 mmol/L.
What treatment may be considered?
a. Dextrose insulin drip
b. IV calcium carbonate
c. IV sodium bicarbonate
d. Emergency haemodialysis
e. All of the above
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HKMA
May 2012
2. e
The ECG of this lady was compatible with acute hyperkalaemia. The
features of hyperkalaemia include tall T waves, bradycardia, heart block
and prolonged QRS duration. The initial treatment of acute hyperkalaemia
includes IV dextrose-insulin drip to lower the potassium level, IV sodium
bicarbonate infusion to improve acidosis and IV calcium to protect the
myocardium. The low blood pressure was due to bradycardia. This lady
subsequently had oliguria and acute renal failure due to hypotensioninduced acute tubular necrosis. She was given IV fluid replacement and IV
furosemide infusion with subsequent return of her renal function.
Emergency haemodialysis, when available, will be another option to
achieve a faster control of hyperkalaemia, as well as to support acute
tubular necrosis. Acute hyperkalaemia is not uncommonly found in patients
with diabetes mellitus and it is sometimes related to tubular acidosis.
Regular monitoring of electrolyte level, renal function as well as cautious
use of potassium-sparing drugs such as ACEI/ARB and aldosterone are
important precautions to avoid this complication.
www.hkmacme.org
Dermatology
A young lady with a warty plaque on scalp
Complete
BOTH Dermatology and
Cardiology courses and earn
0.5 CME POINT
A young lady presented with an orange-yellow warty hairless plaque on the scalp since early
childhood. The lady was neurodevelopmentally normal and had no internal organ abnormalities of
the central nervous system, eyes and skeleton. Family history did not reveal any family members with
similar signs.
Answer these on page 17 or
make an online submission at:
www.hkmacme.org
Please answer ALL questions
1. What is the clinical diagnosis?
2. What are the differential diagnoses?
3. What are the associations?
4. What are the investigations you could consider?
5. What are the management plans?
The content of the Dermatology Series is provided by:
Dr. LEUNG Wai Yiu, Dr. TANG Yuk Ming, William,
Dr. CHAN Hau Ngai, Kingsley and Dr. KWAN Chi Keung
Specialists in Dermatology & Venereology
皮膚科病例研究之內容誠蒙梁偉耀醫生、鄧旭明醫生、陳厚毅醫生及關志強醫生提供。
APRIL ANSWERS
Questions
1. What specific question would you like
to ask this patient?
2. What is the diagnosis?
3. What is the pathogenesis?
4. What are the common causes for this
type of skin disorder?
5. What is the management plan for this
patient?
Answers
1. Drug history and history of any
specific contact: It is important
to ask the patient whether she
had taken any medication or
applied anything before the
rash occurred. She had applied
some over-the-counter pain
relief patches.
2. The patient is suffering from
acute allergic contact dermatitis
due to pain relief patches. The
differential diagnoses include
acute irritant contact dermatitis, discoid eczema, cellulitis, etc.
3. Allergic contact dermatitis is a cell-mediated type IV delayed hypersensitivity
reaction resulting from specific antigens penetrating the epidermal skin layer.
The antigen combines with a protein mediator and then travels to the dermis,
where T lymphocytes become sensitized. Allergic reaction will take place after
the subsequent exposure to the antigen.
4. Apart from topical over-the-counter pain relief patches, bone-setter’s herbs
(鐵打藥), nickel sulfate (metal alloys), fragrance mixes, paraphenylenediamine
(dyes or photographic chemicals), potassium dichromate (cements or household
cleaners), formaldehyde (dyes or medications), mercaptobenzothiazole (rubbers)
and plants are other common allergens in Hong Kong.
5. She must be asked to stop using the topical pain relief patches immediately.
Topical steroids should be given to her. Systemic steroids are reserved for severe
cases of allergic contact dermatitis with greater extent and bullae formation. She
should also be warned not to use similar pain relief patches in the future.
www.hkmacme.org
HKMA
May 2012
11
Paediatric Medicine
A 10-year-old male with a pruritic rash
Complete this course
and earn
1 CME POINT
A 10-year-old boy was brought to the clinic by his mother because of an intensely pruritic rash on his stomach
and groin. The rash began approximately 2 weeks earlier and had been getting progressively worse. The boy was
reported to be in good general health and had no history of dermatologic problems. He had not had a fever or
any upper respiratory symptoms. On examination, the boy’s vital signs were normal, and he appeared well. He
frequently scratched and was noted to have multiple excoriations. The rash was erythematous with eczematous
areas, and a few scattered papules were present. It was more severe in the groin and around his waist. He had
lesions in the antecubital fossae and between his fingers on both hands. No lesions existed on his face or head.
Eczematous lesions can be caused by excessively dry skin,
allergic dermatitis, or primary eczema. If a papular rash
is predominant, viral illnesses, drug reactions, folliculitis,
allergic reactions, and insect bites should be considered.
Chronic rashes can occur with many systemic illnesses from
metabolic diseases (e.g., hypothyroidism) to malignancies
(e.g., leukaemia), but this child has been otherwise well, so
these are less likely.
Although the classic burrows were not identified in
this patient because of the extensive excoriations, the
presentation of the rash is typical for scabies.
Scabies is caused by the mite, Sarcopte scabiei var hominis.
The female mite burrows into the skin and lays eggs. The
mite is contracted through contact with other infected
persons, including through sexual contact. The mite lays
eggs and then dies; the hatched larvae migrate to the surface
of the skin, and the cycle starts over.
The body develops a severe inflammatory response to the
mite, resulting in an intensely pruritic rash.
Since the mite can live for up to 4 days away from a
human host, it is possible to become infected (or reinfected)
by being in an area where an infected host has been.
It is also possible to acquire infestation with S. scabiei var
canis, the agent that causes mange in dogs. Close contact
with the affected dog can result in infestation, causing a
similar rash but without burrows.
Scabies is strongly suggested by a typical rash that is
pruritic and has a characteristic distribution. The rash
is concentrated in skin folds, including the axillae, the
antecubital fossae, the wrists, in the finger web spaces, groin
and gluteal folds, and about the waist. It can be papular
or nodular and may even include blisters. Burrows may be
evident, and excoriation is very common. The face, head,
and neck are usually spared in older children and adults.
Diagnosis can be confirmed with a scraping of the
skin, but the sensitivity of this test is low. The scrapings
are examined under a microscope for evidence of the mite.
Scraping the leading edge of a distinct burrow or examining
the material from under the nails of a patient who has
been scratching is more likely to yield a positive finding of a
mite.
Patients who are elderly, mentally handicapped, or
immunocompromised may present with a much more
12
HKMA
May 2012
severe infestation. They may present with wider distribution
of the rash and are more likely to have blistering and
crusting. These patients may have extensive skin thickening
and dystrophic nails, and their head and scalp may be
affected. This severe form of scabies infestation is referred
to as Norwegian scabies and is thought to be the result
of impaired host immune response. Most patients have
eosinophilia and elevated IgE levels associated with the
infestation.
In patients over the age of 5 years, a permethrin cream of
5% is applied to the body from the neck down. It is left on
for 8–14 hours (typically overnight) and then washed off.
One treatment is usually sufficient, though if new lesions
begin to develop, retreatment may be indicated.
Patients from age 2 months to 5 years can be treated
with permethrin as well, but it must be applied to the head
and neck as well as to the body.
Lindane can also be used for treatment, but it has a
greater potential for toxicity, including nausea, vomiting,
irritability, tremors, weakness, and seizures.
Crotamiton cream can be used in a similar manner in
children, but it must be left on for 24 hours, and a second
treatment is necessary.
For newborns, a 6% precipitated sulphur petrolatum
compound can be used, but its efficacy has not been proven.
It must be applied for 3 consecutive days to be effective.
If the rash is markedly crusted, topical medications will
not be as effective because of decreased absorption. A newer
treatment that may be effective for these patients is oral
ivermectin. It is effective and appears to be safe. It should be
noted this is an off-label use and is not indicated in young
children or pregnant women.
For infestations with S. scabiei var canis, no specific
treatment is necessary, as the species is not a human parasite,
and it is not able to complete the life cycle. Usually, washing
the affected skin and clothing and avoiding contact with the
affected pet is adequate. If treatment becomes necessary, the
treatment is the same as for infestation with S. scabiei var
hominis.
Drug resistance should be considered in patients who do
not respond to treatment. In these patients, it is important
first to verify the diagnosis with a skin scraping if possible
and then to attempt treatment with an alternate agent.
www.hkmacme.org
Paediatric Medicine
Itching and rash will persist for some time after the mites
have been eliminated, and medication to control the itching
is appropriate. If new lesions develop, retreatment is necessary.
The environment must also be treated, or the patient
will become reinfected. Clothing, bed linens, towels, and
other such items should be washed or dry-cleaned. Items
that cannot be cleaned should be isolated for 5 days to allow
time for the mites to die.
The main problems associated with scabies infection are
the persistent and intense itching, secondary infection from
scratching (e.g., impetigo), and the spread of the infection
to other persons.
Some patients develop chronic nodules as a result of the
infestation. The nodules are from chronic inflammation,
and histology shows infiltration of lymphohistiocytic cells.
In some cases, patients may require treatment of the nodules
with intralesional steroids.
Further reading
• Bhalla M, Thami GP. Reversible neurotoxicity after an overdose of topical
lindane in an infant. Pediatr Dermatol. 2004;21:597–9.
• Curry BJ, Harumal P, McKinnon M, Walton SF. First documentation of in
vivo and in vitro ivermectin resistance in Sarcopte scabiei. Clin Infect Dis.
2004;39:e8–12.
• Darmstadt GL. The skin: arthopod bites and infestations. In: Behrman RE,
Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed.
Philadelphia, PA: Saunders; 2000.
• Elgart GW, Meinking TL. Ivermectin. Dermatol Clin. 2003;277–82.
• Fawcett RS. Ivermectin use in scabies. Am Fam Physician. 2003;68:
1089–92.
• Flinders DC, De Schweinitz P. Pediculosis and scabies. Am Fam Physician.
2004;69:341–8.
• Hashimoto K, Fujiwara K, Punwaney J, et al. Post-scabetic nodules:
a lymphohistiocytic reaction rich in indeterminate cells. J Dermatol.
2000;27:181–94.
• Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical
and immunological findings in seventy-eight patients and a review of the
literature. J Infect. 2005;50:375–81.
• Shahab RKA, Loo DS. Bullous scabies. J Am Acad Dermatol. 2003;49:
346–50.
• Talanin NY, Smith SS, Shelley ED, Moores WB. Cutaneous histiocytosis
with Langerhans cell features induced by scabies: a case report. Pediatr
Dermatol. 1994;11:327–30.
• Witkowski JA, Parish LC. Lindane-resistant scabies. J Am Acad Dermatol.
1992;27:648.
Current Studies
COMPLETE THIS COURSE
ONLINE AND RECEIVE
1 CME POINT
Treatment of pityriasis versicolor using
1% diclofenac gel and clotrimazole
cream (comparative therapeutic study)
Khalifa E. Sharquie, et al. / Journal of the Saudi Society of
Dermatology & Dermatologic Surgery (2011) 15, 19–23.
For full article please go to www.hkmacme.org
Answer these on page 17 or
make an online submission at:
Please indicate one answer
to each question
www.hkmacme.org
1. The mite can live for up to ____ days away from a
human host.
a. 2 b. 4
c. 6
d. 8
2. Diagnosis of this case can be confirmed with a scraping
of the skin and the sensitivity of this test is high.
a. True
b. False
3. Which of the following can be used to treat the patients
with scabies caused by mite?
a. Crotamiton cream
b.Lindane
c. Permethrin
d.All of the above
4. Itching and rash will persist for some time after the
mites have been eliminated.
a. True
b. False
OBSTETRICS & GYNAECOLOGY APRIL ANSWERS
1. d
2. c
www.hkmacme.org
3. a
4. b
HKMA
May 2012
13
General Medicine
A 43-year-old male with blood in his urine
Complete this course
and earn
1 CME POINT
A 43-year-old male came to your office because he had blood in his urine twice during the last week. He had not
felt ill and had no pain. He denied urinary frequency, urgency, or dysuria.
This patient has gross haematuria, described as visible blood
in the urine. It is helpful to know at what point during
voiding the blood has appeared. Blood that is noted at the
beginning of voiding is referred to as initial haematuria and
is more likely to be from the urethra. Blood that appears
at the end of voiding is terminal haematuria and is more
likely to be from the bladder or urethra. Blood that occurs
throughout voiding could originate anywhere in the upper
urinary tract.
A common wisdom is that painless haematuria is cancer
until proven otherwise. Painless haematuria is the most
common presenting symptom for both kidney and bladder
cancer and can occur with or without any other symptoms.
The likelihood that haematuria is due to a malignancy
increases with age and the amount of blood in the urine
(microscopic vs. gross). This patient has gross haematuria,
which must be evaluated, even if it has only happened
once.
Other aetiologies include bladder or kidney infection,
urolithiasis, glomerulonephritis, prostatic disease, vascular
anomalies, strenuous exercise, blood disorders (e.g.,
haemophilia), and trauma.
Cigarette smoking is the most notable risk factor for
both kidney and bladder cancer. It is estimated that between
30% and 45% of bladder cancers and 25–30% of renal
carcinomas are related to smoking.
Trichloroethylene, asbestos, cadmium, and petroleum
product exposures have been associated with renal
carcinoma. Exposure to aniline dyes and phenacetin are
associated with bladder cancer.
Renal cancer can also be hereditary. Patients with von
Hippel-Lindau disease, hereditary papillary renal carcinoma,
hereditary leiomyomata, Birt-Hogg-Dubé syndrome, and
familial renal oncocytoma are hereditary diseases associated
with various forms of renal cancer.
In addition, patients with pre-existing renal disease, such
as polycystic kidney disease, are more likely to develop renal
cancer.
It cannot be overstated that all patients with gross
haematuria should be evaluated to determine a cause.
Evaluating the urine itself is an easy and inexpensive
place to begin. Certain foods, such as beets and food
14
HKMA
May 2012
colouring in candy, can discolour the urine. Drugs such as
phenindione and phenolphthalein also discolour the urine.
A simple dipstick test to see whether the discolouration
is truly blood could save a lot of time and expense. Urine
sediment should be examined. If red blood cells, protein,
or hyaline casts are present, glomerular disease should be
suspected. Lastly, if white blood cells, nitrites, or other
evidence of infection is present, culture of the urine should
be done.
If no cause is determined on the initial examination,
urologic evaluation with cytoscopy is necessary. Cystoscopy
is useful in determining the location, size, and other
characteristics of any bladder lesions. Urine cytology is also
commonly done, though it may miss lower-grade lesions.
Intravenous pyelography, ultrasonography, and more
recently, 3-dimensional computed tomography are useful in
locating mass lesions.
Up to 95% of bladder malignancies are transitional cell
carcinoma. About 3% are squamous cell carcinoma, and
2–3% are adenocarcinoma.
Transitional cell carcinoma can occur anywhere along the
uroepithelium.
Clear cell carcinoma of the kidney accounts for 80% of
renal malignancies. About 10% of renal cancer is papillary
renal cell carcinoma. Chromophobic renal carcinoma,
oncocytoma, and transitional cell carcinoma make up the
remainder of the primary renal carcinomas.
Further reading
• Hassen W, Droller MJ. Current concepts in assessment and treatment of
bladder cancer. Curr Opinion in Urol. 2000;10:291–9.
• Herr HW, Shipley WU, Bajorin DF. Cancer of the bladder. In: Devita VT Jr,
Hellman S, Rosenberg SA, eds. Devita-Cancer: Principles and Practice of
Oncology. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2001.
• Hofland CA, Mariani AJ. Is cystology required for a hematuria evaluation?
J Urol. 2004;171:324–6.
• Linehan WM, Zbar B, Bates SE, Zelefsky MJ, Yang JC. Cancer of the kidney
and ureter. In: Devita VT Jr, Hellman S, Rosenberg SA, eds. Devita-Cancer:
Principles and Practice of Oncology. Philadelphia, Pa.: Lippincott Willimas
& Wilkins; 2001.
• Maranchie JK, Linehan WM. Genetic disorders and renal cell carcinomas.
Urol Clin North Am. 2003;30:433–41.
• Nadler RB, Bushman W, Wyker AW Jr. Standard diagnostic considerations.
In: Gillenwater JY, Grayhack JT, Howards SS, Mitchell ME, eds. Adult and
Pediatric Urology. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2001.
• Wai CY, Miller DS. Urinary bladder cancer. Clin Obst Gyn. 2002;45:844–54.
• Yun EJ, Meng MV, Carroll PR. Evaluation of the patient with hematuria.
Med Clin North Am. 2004;88:329–43.
www.hkmacme.org
General Medicine
Answer these on page 17 or
make an online submission at:
Please indicate one answer
to each question
www.hkmacme.org
Current Studies
COMPLETE THIS COURSE
ONLINE AND RECEIVE
1 CME POINT
Assessment of Hematuria
1.Painless haematuria is cancer until proven otherwise.
a. True
b. False
Vitaly Margulis, Arthur I. Sagalowsky / Medical Clinics of
North America 95 (2011) 153–9.
2._________________________ is the most notable risk
factor for both kidney and bladder cancer.
a. Alcoholic consumption
b.Cigarette smoking
c. Excess intake of fat
d.None of the above
Hematuria is a common clinical finding in the adult
population, with a prevalence ranging from 2.5% to
20.0%. Although gross hematuria is defined simply as
visible urine discoloration because of the presence of
blood, there is controversy regarding the exact definition
of microscopic hematuria. The American Urological
Association (AUA) guidelines define clinically significant
microscopic hematuria as more than 3 red blood cells
(RBCs) per high-power field on 2 of 3 properly collected
urine specimens over a period of 2 to 3 weeks. However,
patients at high risk for significant urologic disease (see
later discussion) should be evaluated for hematuria if
a single urinalysis demonstrates 2 or more RBCs per
high-power field. Appropriate and timely evaluation is
imperative, because any degree of hematuria can be a
sign of a serious genitourinary disease. The focus of this
article is on the logical and cost-effective evaluation of
hematuria in adults, with specific attention directed to
the indications and practice patterns for performing
laboratory tests, imaging studies, and cystoscopy.
3.If no cause is determined on the initial examination,
urologic evaluation with ________________ is necessary.
a. cytoscopy
b.intravenous pyelography
c. ultrasonography
d.None of the above
4._________ 10% of renal cancer is papillary renal cell
carcinoma.
a. Less than
b.About
c. More than
DEMATOLOGY REVIEW APRIL ANSWERS
1. d
2. b
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3. c
4. a
HKMA
May 2012
15
ANSWER SHEET
答 題 紙 May 2012
Name 姓名：____________________________________________________________
Please return completed answer sheet to the
HKMA Secretariat (Fax: 2865 0943) on or before
15 June, 2012 for documentation. However, if you
choose to do the exercises online, you do not
need to return this answer sheet by fax.
HKMA Membership No. or HKMA CME No.
香港醫學會會員編號或持續進修號碼：______________________________________
HK ID No. 香港身份証號碼：
□□-□□□ xxx (x)
Signature 簽名: ________________________________________________________
請回答所有問題，並於 2012 年 6 月 15 日前將答題紙傳
真或寄回香港醫學會（傳真號碼：2865 0943 ）。但如果
Contact Tel No. 聯絡電話：_______________________________________________
選擇在網上做練習，便不需要把答題紙傳真給秘書處。
THIS MONTH GO ONLINE
AND COMPLETE UP TO 3 OTHER
MONTHLY COURSES FOR AN EXTRA
ANSWER BOX
3 CME POINTS
www.hkmacme.org
Please answer ALL questions and write the answers in the space provided.
Both the Cardiology and Dermatology courses must be completed to earn
0.5 CME point. The other courses attract 1 CME point each.
SPOTLIGHT
1
CARDIOLOGY
2
3
4
PAEDIATRIC MEDICINE
1
2
3
4
5
6
7
8
9
10
1
2
3
GENERAL MEDICINE
1
2
3
4
DERMATOLOGY
1._____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
2._____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
✂
3._____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
4._____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
5._____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
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HKMA
May 2012
17
HKMA Prize Winning Article
Understanding hand hygiene
FONG Chui Ying
The Chinese University of Hong Kong
Class of 2012
The World Health Organization Guidelines on Hand
Hygiene in Health Care was issued in 2009, which
presented evidence for the importance of hand hygiene in
reducing healthcare-associated infections (HCAIs) and made
recommendations for the implementation of hand hygiene
in healthcare settings. In Prince of Wales Hospital (PWH),
promotional materials for hand hygiene are put up, and the
importance of hand hygiene in infection control has been
reiterated throughout the medical curriculum. However,
not many medical students really take it seriously and
some would skip the teaching sessions on hand hygiene or
infection control. It seems that gaps exist from knowing the
importance of hand hygiene, to understanding its significant
implications, to actually practising it in clinical settings.
Therefore, this article aims to explore the importance of
hand hygiene and its compliance issues, as well as to
illustrate the international guidelines for hand hygiene
and its local application.
Ample evidence has shown that good compliance to hand
hygiene can prevent HCAIs and enhance patients’ safety. For
instance, a strong negative association between hand hygiene
compliance rate and the prevalence of methicillin-resistant
Staphylococcus aureus (MRSA) was demonstrated in a French
rehabilitation hospital. Compliance rate was defined as the
number of hand hygiene procedure performed, including
washing with soap and water or rubbing with alcohol-based
product, divided by the number of opportunities observed.
Wards with hand hygiene compliance rates over 70% were
found to have significantly lower MRSA prevalence [1].
Similarly, a prospective study also demonstrated a
significant inverse association between the percentage of
nosocomial rotavirus gastroenteritis (RVGE) out of total
RVGE hospitalizations and the hand hygiene adherence
rate in an Israeli hospital. Increasing the percentage of
full compliance to hand hygiene guidelines (33.7–49%),
including hand-washing before and after treatment of
every patient and wearing of gloves or gowns as required
for contact isolation, was associated with a decreasing
percentage of nosocomial RVGE (20.3–12.7%) over a fouryear period [2]. Summarizing the results of the above two
studies, it is evident that healthcare workers’ (HCWs) hands
are good vehicles to transmit pathogens from patients or
their environment to other patients. Therefore, observation
www.hkmacme.org
of hand hygiene can effectively limit hospital-acquired
infections. This not only is beneficial to patients but also has
great cost implications to the hospital administration.
The cost of HCAIs is massive, ranging from physical to
psychological to financial aspects, such as prolonged length
of hospital stay, long-term disability, an excess of deaths,
increased antimicrobial resistance, stress to patients and
their families, as well as a substantial financial burden for
the healthcare system [3]. Hand hygiene was evaluated to
be extremely cost-saving in reducing nosocomial infections.
An interventional cohort study concluded that the expense
of a hand hygiene promotion campaign that emphasized
alcohol-based handrubs corresponded to less than 1% of
costs associated with nosocomial infections. The direct and
indirect costs of the hand hygiene promotion campaign,
such as handrubs, promotion expenses and salaries of
participating personnel, were tiny in comparison with the
immeasurable financial cost, disability and stress caused by
nosocomial infections [4].
Despite the well-established evidence for hand hygiene in
prevention of HCAIs, the compliance to the recommended
hand hygiene regimen remains unsatisfactory. Worldwide
reported HCWs’ adherence baseline rates range from 5%
to 89%, with an overall average of 38.7% [5]. Factors
influencing hand hygiene compliance can be categorized
into environmental and individual factors. The former
included a lack of infrastructure and resources to implement
hand hygiene, belonging to a certain professional category
(such as doctor, physiotherapist and technician), working in
specific care areas, understaffing and overcrowding, as well as
wearing gowns and/or gloves. The latter included skepticism
towards the value of hand hygiene, conviction of selfefficacy in the prevention of HCAIs, skin irritation caused
by hand-washing agents, lack of role model from colleagues
or seniors, social norm barriers as well as forgetfulness [5–7].
On the contrary, Erasmus et al evaluated that the most
motivating factors for different HCWs to perform hand
hygiene procedures were self-protection from cross-infection
and the desire to clean oneself after a task perceived to be
dirty [6]. Since different groups of HCWs, such as doctors,
nurses and medical students, have different perceptions and
attitudes, Allegranzi and Pittet suggested a multi-modal
intervention programme for behavioural modification to
HKMA
May 2012
19
HKMA Prize Winning Article
enhance the compliance of hand hygiene. It consists of easy
access to hand hygiene materials, hand hygiene education
and training, posters, focus groups, performance feedback,
clear hand hygiene protocol and so on [7].
Chou et al depicted a hand hygiene improvement bundle
that substantially improved hand hygiene compliance from
below 40% to above 90% over three years. The bundle
first obtained hospital-wide support, followed by increased
availability of alcohol handrubs and enhanced educational
materials, such as culture of hand pathogens and poster
contests. In addition, hand hygiene liaisons were recruited
to review hand hygiene policy with staff as well as to observe
and collect data on hand hygiene compliance in wards.
Furthermore, feedbacks and incentives, including violation
letters and pizza parties, were given to groups and individuals
regarding their hand hygiene compliance rates. The authors
also remarked that the issue of violation letters was the most
effective means to increase and sustain adherence to hand
hygiene, provided that there was adequate administrative
support and staff coaching [8].
After reviewing the pros and cons of hand hygiene
performance and identifying common hindering/
enhancing determinants of hand hygiene compliance,
different intervention strategies can be tailor-made for
different institutions. The World Health Organization
(WHO) has also formulated consensus recommendations
for the implementation of hand hygiene on individual
and institutional levels. Regarding the indication of hand
hygiene, hand-washing with soap and water is preferred with
visible dirt or soils, after using the toilet, and when exposed
to spore-forming pathogens including C. dificile. Otherwise,
alcohol-based handrub is the preferred means for routine
hand antisepsis [3].
The choice of alcohol-based handrub over soap-andwater hand washing was supported by Boyce et al’s study
comparing the skin irritation and dryness, one of the biggest
obstacles to hand hygiene compliance, associated with the
two regimens. They showed that skin irritation and dryness
did not increased after the use of alcohol-based hand gel, but
those parameters increased significantly after hand-washing
with soap and water. Therefore, they suggested that alcoholbased hand antisepsis was better tolerated by nurses and
hence could enhance hand hygiene adherence [9].
On top of improving HCWs’ acceptance of hand
hygiene, alcohol-based handrub was also shown to improve
patients’ outcome. Ng et al compared the incidence of
late-onset (>72 hr postnatal age) infection and necrotizing
enterocolitis (NEC) in very low birthweight (VLBW)
infants between the periods of two hand hygiene protocols:
conventional handwashing (HW) and combined alcohol
handrub and gloves (HR) protocols. They retrospectively
reviewed 321 case records of VLBW infants admitted to
neonatal intensive care unit of PWH and demonstrated that
the HR group had significantly later age of onset of sepsis
20
HKMA
May 2012
and required shorter duration of oxygen supplementation. In
addition, the introduction of the HR regimen significantly
reduced the incidence of late-onset systemic infections,
including MRSA septiceamia, and NEC by 2–8 fold. They
also observed a sustained improvement in infection rate
36 months after the introduction of the HR campaign,
suggesting that the superiority of alcohol based handrub to
conventional handwashing method was long-lasting [10].
Besides evaluating the hand-cleaning agent of choice,
WHO also identified important moments when hand
hygiene should be performed. They include “the five
moments for hand hygiene in health care” (Figure 1), after
removal of sterile or non-sterile gloves, before handling
of medications and before preparing food for patients.
Furthermore, WHO provides detailed descriptions on hand
hygiene techniques, surgical hand preparation, use of gloves,
handling of hand hygiene agents and skin care. In addition
to making recommendations for individual practice, WHO
also gives strategic advice for institutions and governments
to cultivate a favourable climate to enhance HCWs’
hand hygiene adherence (Figure 2). WHO encourages
administrators to provide accessible hand hygiene facilities
and resources, to arrange infection control education and
training, as well as to have evaluation and feedback for
HCWs [3].
With reference to international guidelines and evidence,
many local institutions have adopted the recommendations
into daily practice in Hong Kong. In the Chinese University
of Hong Kong (CUHK), infection control is taught in
the pre-clinical curriculum where medical students receive
training on hand washing technique as well as the proper
use of personal protective equipment (PPE). Moreover,
the importance of hand hygiene, especially surgical hand
preparation, is reinforced throughout the clinical years as
students rotate to different departments and hospitals.
Nevertheless, Wong and Tam suggested a discrepancy
between knowledge, attitude and performance of hand
hygiene among medical students during their clinical training
Figure 1. The five moments for hand hygiene in health care [3].
www.hkmacme.org
HKMA Prize Winning Article
The five components of the WHO Multimocial
Hand Hygiene Improvement Strategy
1a. System change –
alcohol-based handrub at pont of care
1b. System change – access to safe,
continuous water supply, soap and towels
2. Training and education
3. Evaluation and feedback
4. Reminders in the workplace
5. Institutional safety climate
Figure 2. The WHO multimodal hand hygiene improvement
strategy [3].
years (year 3–5) in PWH. They conducted two crosssectional surveys in 2003 and 2004, during and after the
severe acute respiratory syndrome (SARS) outbreak in Hong
Kong respectively, which interviewed students’ attitude and
practice of hand hygiene. They reported that hand-washing
before and after physical examination of patients increased
significantly from 35.2% to 60.3%, and from 72.5% to
100% respectively. In addition, the proportion of students
wearing a mask when approaching patients also increased
dramatically from zero to 100%. Despite the improvement
in infection control measures, they still found a significant
proportion of students who failed to follow the guidelines for
proper hand hygiene even though they knew the importance
of hand hygiene and intended to perform it [11].
Eight years after the SARS outbreak, the hand hygiene
performance among HCWs in PWH remains suboptimal.
A recent hospital tally revealed hand hygiene compliance
rates during “the five moments for hand hygiene” to be
70% (before touching a patient), 83% (before clean/
aseptic procedures), 73% (after body fluid exposure risk),
87% (after touching a patient) and 65% (after touching
patient surroundings) respectively. The highest compliance
rate (after touching a patient) may reflect the intention
for self-protection to be the strongest reason for hand
hygiene. Clear protocol on clean/aseptic procedures may
also secure a satisfactory hand hygiene compliance rate.
However, the remaining three “moments” definitely have
room for improvement. Busy ward activities and heavy
patient load may hinder HCWs from abiding by all “the five
moments”, therefore they may selectively do a part of it or
unintentionally forget the steps that are perceived to be less
important.
Last week, a PWH’s infection control nurse came to my
class to give a presentation on hand hygiene, including “the
www.hkmacme.org
five moments for hand hygiene” and some statistical figures
on hand hygiene adherence. Encouragingly, different groups
of HCWs have steadily improving hand hygiene adherence
over the years. I am optimistic that the trend will continue
to rise with the multimodal education and promotion
strategy incorporated into different settings. For instance, a
lot more hand-washing sinks have been installed in the new
wards and alcohol handrubs are readily available in every
corner of PWH. In addition, posters, flyers and screensavers
not only remind HCWs and visitors about the importance
of hand hygiene, the displayed professors and senior staff
holding bottles of alcohol handrubs can also act as role
models for junior staff and medical students.
Proper hand hygiene can prevent nosocomial infections
is a fact almost instinctively ingrained in most people’s mind.
As a final year medical student having received repeated
lessons and training on infection control, I know this fact
together with the associated techniques. However, since the
consequence of suboptimal hand hygiene may not manifest
immediately during everyday clinical activities, many HCWs
may overlook the seemingly lengthy guidelines. With more
quality hand hygiene campaigns targeted at individual
and institutional levels, we can better understand the
importance of hand hygiene and be more ready to apply the
international recommendations to local settings. However,
improvement in HCWs’ hand hygiene compliance only
represents a part of the whole picture of infection control;
in the long run, we may become role models to patients and
their relatives as well as the general public to enhance the
standard of personal hygiene and public health.
References
1. Girou E, et al. Association between hand hygiene compliance and methicillinresistant Staphylococcus aureus prevalence in a French rehabilitation
hospital. Infect Control Hosp Epidemiol 2006;27:1128–30.
2. Waisbourd-Zinman O, et al. The percentage of nosocomial-related out of
total hospitalizations for rotavirus gastroenteritis and its association with
hand hygiene compliance. Am J Infect Control 2011;39:166–8.
3. World Health Organization. WHO Guidelines on Hand Hygiene in Health
Care: a Summary. Geneva, Switzerland: World Health Organization Press,
2009.
4. Pittet D et al. Cost implications of successful hand hygiene promotion. Infect
Control Hosp Epidemiol 2004;25:264–6.
5. World Health Organization. WHO Guidelines on Hand Hygiene in Health
Care. Geneva, Switzerland: World Health Organization Press, 2009.
6. Erasmus V, et al. A qualitative exploration of reasons for poor hand hygiene
among hospital workers: lack of positive role models and of convincing
evidence that hand hygiene prevents cross-infection. Infect Control Hosl
Epidemiol 2009;30:415–9.
7. Allegranzi B, Pittel D. Role of hand hygiene in healthcare-associated infection
prevention. J Hosp Infect 2009;73:305–15.
8. Chou T, et al. Changing the culture of hand hygiene compliance using a
bundle that includes a violation letter. Am J Infect Control 2010;38:575–8.
9. Boyce JM, Kelliher S, Vallande N. Skin irritation and dryness associated with
two hand-hygiene regimens: soap-and-water hand washing versus hand
antisepsis with an alcoholic hand gel. Infection Control Hosp Epidemiol
2000;21:442–8.
10.Ng PC, et al. Combined use of alcohol hand rub and gloves reduces the
incidence of late onset infection in very low birthweight infants. Arch Dis
Child Fetal Neonatal Ed 2004;89:F336–40.
11.Wong TW, Tam WW. Handwashing practice and the use of personal
protective equipment among medical students after the SARS epidemic in
Hong Kong. Am J Infect Control 2005;33:580–6.
HKMA
May 2012
21
CME NOTIFICATIONS
HKMA
HKMA CME
CME Programme Programme 香港醫學會持續進修計劃
香港醫學會持續進修計劃
CME Lecture – June 2012 進修講課 – 二零一二年六月
CME EVENT 講課簡介
VENUE & TIME 地點及時間
14 June 2012 (Thursday)
HKMA Structured CME Programme with HKS&H Session VI: The ABC of molecular pathology testing
The HKMA Dr. Li Shu Pui Professional Education Centre
Dr. MA Shiu Kwan, Edmond
Director, Clinical Pathology and Molecular Pathology, HKS&H
MB BS (HK), MD (HK), MRCP (UK), FRCP (Edin), FRCP (Glasg), FRCP RCPS (Glasg),
FRCPath, FRCPA, FHKCPath, FHKAM (Pathology), Specialist in Haematology
2/F, Chinese Club Building
21–22 Connaught Road Central, Hong Kong
Lecture: 2:00–3:00 p.m.
(Light lunch will begin at 1:15 p.m.)
香港中環干諾道中二十一至二十二號華商會所大廈二樓
香港醫學會李樹培醫生專業教育中心
講課：下午二時至三時正
(茶點於下午一時十五分開始)
This symposium is co-organized with
Hong Kong Sanatorium & Hospital
REGISTRATION:
Please fill in and return the Registration Form together with a cheque of adequate amount
made payable to “The Hong Kong Medical Association” to 5/F Duke of Windsor Social
Service Building, 15 Hennessy Road, Hong Kong. Each lecture will carry 1 CME point under
the MCHK/HKMA CME Programme (unless otherwise stated). Accreditation from other
colleges is pending. (The Secretariat fax no.: 2865 0943)
To be more eco-friendly and avoid postal delay, notification to registrants will no longer be
made through sending confirmation letters but via SMS. Please fill in your updated mobile
number so that you can be notified of your application. If you do not have a mobile phone
number, the Secretariat will issue a confirmation letter to you. If you have not received any
replies, please do not hesitate to contact us at 2527 8452.
報名方法：
請填妥表格連同支票寄交香港灣仔軒尼詩道十五號溫莎公爵社會服務大廈五樓，支票抬頭請書
明支付「香港醫學會」。參加者可獲醫務委員會/香港醫學會持續醫學進修計劃積分一分（除特
別註明外）。其他專科學院之學分尚在申請中。(秘書處傳真號碼:2865 0943)
為響應環保及為免郵遞延誤，秘書處將以手機短訊通知講課報名結果。因此，請準確填上 閣下
之手機號碼以便接收通知，倘若 閣下沒有手提電話，秘書處仍會以郵寄方式把講課確認通知書
寄上。參加者如沒有收到任何通知，請致電2527 8452查詢。
Please register for participation. First come, first served. 名額有限 請早登記
Typhoon/Black Rainstorm Policy
When Tropical Storm Warning Signal No. 8 (or above) or
the Black Rainstorm Warning Signal is hoisted within 3
hours of the commencement time, the relevant CME
function will be cancelled. (i.e. CME starting at 2:00 pm
will be cancelled if the warning signal is hoisted or in force
any time between 11:00 am and 2:00 pm).
The function will proceed as scheduled if the signal is
lowered three hours before the commencement time. (i.e.
CME starting at 2:00 pm will proceed if the warning signal
is lowered at 11:00 am, but will be cancelled even if it is
lowered at 11:01 am).
When Tropical Storm Warning Signal No. 8 (or above) or
the Black Rainstorm Warning Signal is hoisted after CME
commencement, announcement will be made depending
on the conditions as to whether the CME will be terminated
earlier or be conducted until the end of the session.
The above are general guidelines only. Individuals should
decide on their CME attendance according to their own
transportation and work/home location considerations to
ensure personal safety.
Reply Slip 回條
I would like to register for the following CME lecture(s) 本人欲報名參加以下講課:
HKMA Structured CME Programme with HKS&H
14 June 2012
HKMA Member CME Participants
HKMA Structured CME Programme with HKS&H Year 2012
Session VI – The ABC of molecular pathology testing
I enclose herewith a cheque of
HK$50
□
HK$80
□
Please “✔” as appropriate. 請在適用處加上 ✔ 號
現隨表格附上支票一張作為講課之報名費用：HK$港幣 ___________________
Name 姓名：____________________________________________________
HKMA Membership No. 會員編號
or HKMA CME No. 或進修號碼：_ ___________________________________
Mobile No. 手機號碼 ：____________________________________________
Fax No.傳真 : ___________________________________________________
(Mandatory for emergency contact or SMS 必須填寫用以緊急聯絡或接收短訊)
Signature 簽名： _ _______________________________________________
Date 日期 : _____________________________________________________
Data collected will be used and processed for the purposes related to the MCHK/HKMA CME Programme only. All registration fees are not refundable or transferable.
個人資料將用於有關香港醫學會持續醫學進修計劃之事宜。所有報名費用將不給予退還或轉授予其他會員。
www.hkmacme.org
HKMA
May 2012
23
CME NOTIFICATIONS
THE HONG KONG
MEDICAL ASSOCIATION
Newer Trends in Management of
Acute Diarrhoea in Children
Organized by
Dr. CHENG Yan Wah, Vinson
Speaker
Consultant Paediatrician, Union Hospital
Date
Tuesday, 12 June 2012
Time
1:00 – 2:00 p.m. Registration & Lunch
2:00 – 2:45 p.m. Lecture
2:45 – 3:00 p.m. Q & A Session
Venue
Crystal Room I–III, 30/F, Panda Hotel, 3 Tsuen Wah Street, Tsuen Wan, N.T.
Moderator
Dr. LEUNG Gin Pang
Honorary Treasurer, HKMA Kowloon West Community Network
Fee
Free-of-charge
Capacity
50
Registration is strictly required on a first-come, first-served basis. Priority will be given to doctors
practising in Kowloon West till 28 May 2012.
Enquiry
Miss Candice TONG, Tel: 2527 8285
*Please call and confirm that your facsimile has been successfully transmitted to the HKMA Secretariat to avoid any misunderstanding
that might arise thereafter.
CME Accreditation: Pending
This lecture is sponsored by
Abbott Laboratories Limited
REPLY SLIP
HKMA Kowloon West Community Network
Newer Trends in Management of Acute
Diarrhoea in Children
I would like to register for the above lecture. Fax: 2865 0943
Please “✔” as appropriate
Name: _________________________________________________________ HKMA No.:_ __________________________________________________
Mobile No.*: ____________________________________________________
Fax No.: _____________________________________________________
*Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone, the Secretariat will still issue you a confirmation letter.
Practising
location:
In Kowloon West (Please specify*: ______________________________________________________)
Others (Please specify: _______________________________________________________________________________)
* Null entry will be treated as non-Kowloon West member registration.
Signature:______________________________________________________
Date:_ ______________________________________________________
Data collected will be used and processed for the purposes related to this event only.
24
HKMA
May 2012
www.hkmacme.org
CME NOTIFICATIONS
THE HONG KONG
MEDICAL ASSOCIATION
Speaker
Recent Advance in
Osteoporosis Management
Organized by
New Territories West Community Network
Dr. HO Yiu Yan, Andrew
Specialist in Endocrinology, Diabetes & Metabolism
Date
Thursday, 7 June 2012
Time
1:00 – 2:00 p.m. Registration & Lunch • 2:00 – 2:45 p.m. Lecture • 2:45 – 3:00 p.m. Q & A Session
Venue
Maxim’s Palace Chinese Restaurant (美心皇宮), Tuen Mun Town Hall, 3 Tuen Hi Road, Tuen Mun
Moderator
Dr. CHUNG Siu Kwan, Ivan
Committee Member, HKMA New Territories West Community Network
Fee
Free-of-charge
Capacity
48
Registration is strictly required on a first-come, first-served basis*.
Priority will be given to doctors practising in the New Territories West district till 28 May 2012.
Enquiry
Mr. Alan LAW, Tel: 2527 8285 (HKMA Secretariat)
*Please call and confirm that your facsimile has been successfully transmitted to the HKMA Secretariat to avoid any misunderstanding
that may arise thereafter.
CME Accreditation: Pending
This lecture is sponsored by
GlaxoSmithKline Limited
HKMA New Territories West Community Network
REPLY SLIP
Recent Advance in Osteoporosis Management
I would like to register for the above event.
Fax: 2865 0943
Please “✔” as appropriate
Name: _________________________________________________________ HKMA No.:_ __________________________________________________
Mobile No.*: ____________________________________________________
Fax No.: _____________________________________________________
*Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone, the Secretariat will still issue a confirmation letter to you.
Practising
location:
In the New Territories West (Please specify *: _______________________________________________________________)
Others (Please specify: _______________________________________________________________________________)
* Null entry will be treated as a non-New Territories West member registration.
Signature:______________________________________________________
Date:_ ______________________________________________________
Data collected will be used and processed for the purposes related to this event only.
www.hkmacme.org
HKMA
May 2012
25
CME NOTIFICATIONS
THE HONG KONG
MEDICAL ASSOCIATION
Speaker
Gender Neutral HPV Vaccination:
The Real World Impact
Dr. LO Kuen Kong
Capacity
48
Registration is strictly required on a firstcome, first-served basis.
Priority will be given to doctors practising
in Kowloon East district till 4 June 2012.
Registration
Interested members please complete the
reply slip below and FAX it back to HKMA
Secretariat at 2865 0943.
Enquiry
Mr. Alan LAW, Tel: 2527 8285
Specialist in Dermatology & Vernerology
Date
Thursday, 14 June 2012
Time
1:00 – 1:45 p.m.
1:45 – 2:30 p.m.
2:30 – 3:00 p.m.
Venue
Registration & Lunch
Lecture
Q & A Session
Lei Garden Restaurant（利苑酒家）,
Shop no. L5–8, apm, Kwun Tong,
No. 418 Kwun Tong Road, Kwun Tong,
Kowloon
Organized by
*Please call and confirm that your facsimile has
been successfully transmitted to the HKMA
Secretariat to avoid any misunderstanding that
might arise thereafter.
Moderator Dr. AU Ka Kui, Gary
Chairman, HKMA Kowloon East Community Network
Fee
CME
Accreditation
Free-of-charge
This lecture is sponsored by
Merck, Sharp & Dohme (Asia) Limited
REPLY SLIP
HKMA Kowloon East Community Network
Fax: 2865 0943
Gender Neutral HPV Vaccination:
The Real World Impact
I would like to register for the above event.
Pending
Please “✔” as appropriate
Name:_________________________________________________________ HKMA No.:______________________________________________________
Mobile No.*: ____________________________________________________ Fax No.:_________________________________________________________
*Please fill in your updated mobile number so that you can be notified of your application via SMS. If you do not have a mobile phone, the Secretariat will still issue a confirmation letter to you.
Practising location:
In Kowloon East (Please specify*: ___________________________________________________________________)
Others (Please specify: _________________________________________________________________________)
* Null entry will be treated as non-Kowloon East member registration.
Signature:______________________________________________________ Date:___________________________________________________________
Data collected will be used and processed for the purposes related to this event only.
26
HKMA
May 2012
www.hkmacme.org
CME CALENDAR
持續進修日程
Note: For each issue of the CME Bulletin, we shall try our best to include all the CME activities for the month, which are made known to the Association Secretariat. Members interested in any of
these functions are encouraged to check with the individual Colleges for credit points awarded by the Colleges and with respective organizers for confirmation of the details. Pharmaceutical advertisements are welcome. For advertising rates and placement details, please contact Barbara Lam at Tel: 2965 1313, Fax: 3764 0374 or email: [email protected]
Your comments to the HKMA CME Bulletin are most welcome. Please send your opinion to Dr. Wong Bun Lap, Bernard, Editor of HKMA CME Bulletin, by fax at 2865 0943 or via e-mail at [email protected]
May 2012
16 (Wed)
2:00–4:00 pm
Hong Kong Academy of Medicine
2
20 (Sun)
1:00–4:00 pm
Hong Kong Medical Association
Medical Protection Society
Mastering Your Risk
Hong Kong Doctors Union: Wan Chai Study Group
20 (Sun)
3:30–6:00 pm
Hong Kong Medical Association: Hong Kong East Community Network
21 (Mon)
12:00–1:00 pm
1
Optimal Treatment for BPH in Primary Care Practice
Hong Kong Medical Association
Hospital Authority: United Christian Hospital
Hong Kong College of Family Physicians
21 (Mon)
12:45–1:45 pm
21 (Mon)
1:00–2:00 pm
1
Review Meeting in areas related to Public Health Medicine
CHP —Room 311, Centre for Health Protection;
WCH—Room 2115 of Wu Chung House
Ms. Yandy Ho – Tel: 2871 8745
18 (Fri)
10:00 am–
12:00 pm
The University of Hong Kong: Carol Yu Centre for Infection
18 (Fri)
1:00–2:00 pm
The University of Hong Kong: Family Medicine and Primary Care
22 (Tue)
9:30 am–
5:30 pm
2
Infectious Diseases Rounds for Year 2012
22 (Tue)
1:00–3:00 pm
1
Family Medicine Clinical Management Meeting—
Management Guidelines for Common Problems
22 (Tue)
1:00–3:00 pm
1
Innovative Treatment on BPH
Hong Kong Medical Association: Shatin Doctors Network
1
Acne and Acne Scar Management
Jasmine Room, Level 2, Royal Park Hotel
Ms. Wendy Cheng – Tel: 2824 0333
18 (Fri)
7:00–8:30 pm
Federation of Medical Societies of Hong Kong
Hong Kong College of Psychiatrists
22 (Tue)
3:00–5:30 pm
Certificate Course on Management of Common Psychiatric
Disorders 2012
The University of Hong Kong: Dept of Surgery
Case Presentations and Journal Presentations in Areas
Related to Administrative Medicine
Hong Kong Medical Association
Medical Protection Society
Mastering Adverse Outcomes
Hong Kong Medical Association Dr. Li Shu Pui Professional Education Centre, 2/F,
Chinese Club Building, 21–22 Connaught Road Central
HKMA Cme Dept. – Tel: 2527 8452
1
HKW Geriatric Grand Round
The University of Hong Kong: Centre on Behavioral Health
5
1-day Workshop on “Guided Relational Viewing:
Art Exhibits, Art Workshops and Art Therapy for Social Change”
Hong Kong Medical Association: Kowloon West Community Network
1
Clinical Consideration of the Long-term Treatment of Osteoporosis
Hong Kong Medical Association
1
Reducing the Burden of Acute Otitis Media: Current &
Future Strategies
Hong Kong College of Psychiatrists
3
Junior CAC Module F—Lecture 25 & Q&A on MCQ
Exam Paper / Feedback
Asia Medical Specialists
1
Prevention and Treatment of Stroke
1) How to vascular neurosurgeons prevent stroke?
2) Endovascular Treatment of Stroke
Hong Kong Medical Association: Central, Western & Southern Community Network
1
Diagnosis & Management of Major Depressive Disorder
Hong Kong Medical Association Central Premises, 2/F. Chinese Club Building,
21–22 Connaught Road Central
Mr. Alan Law – Tel: 2527 8285
bk
23 (Wed)
2:00–3:00 pm
Hong Kong Doctors Union: Tsuen Wan Study Group
1
Evidence Based Preventive Care Activities in Elderly
Lecture Theatre, Nursing School, 3/F, Block A, Yan Chai Hospital
Tel: 2388 2728
2
23 (Wed)
2:00–4:00 pm
Room 524N, 5/F, Hospital Authority Building
Ms. Yandy Ho – Tel: 2871 8745
19 (Sat)
2:30–5:30 pm
The University of Hong Kong: Dept of Medicine
8/F, Aon China Building, 29 Queen’s Road Central, Hong Kong
Ms. Hilda Poon – Tel: 3420 6685
#
Advanced Trauma Life Support (ATLS) Student Course
Hospital Authority
Hong Kong College of Community Medicine
22 (Tue)
7:30–8:30 pm
23 (Wed)
1:00–3:00 pm
Surgical Skills Centre, Room 1006, 10/F, Laboratory Block, L
i Ka Shing Faculty of Medicine
Program Manager – Tel: 2819 9691
19 (Sat)
9:30–11:30 am
1
Clinical Genetics Round, CTG Round, Journal Club,
High Risk Team Meeting
Lecture Theatre, LG/F, Block J, Kwai Chung Hospital
Ms. Elaine Tse – Tel: 2255 3066
bk#
Lecture Hall, 4/F, Duke of Windsor Social Service Building
Ms. Erica Hung – Tel: 2527 8898
18–20
(Fri–Sun)
Hospital Authority: Queen Mary Hospital–Dept of Obstetrics & Gynaecology
Star Room, 42/F, Langham Place
HKMA CME Dept – Tel: 2527 8452
Crystal BallRoom, 30/F, Panda Hotel
Tel: 2388 2728
18 (Fri)
1:00–3:15 pm
1
HKW Geriatric Grand Round
Crystal Room I–III, 30/F, Panda Hotel
Ms. Candice Tong – Tel 2527 8285
Conference Room, Room 405, Clinical Pathology Building, Queen Mary Hospital
Ms. Karis Lam – Tel: 2255 3243
Hong Kong Doctors Union: Tsuen Wan Study Group
The University of Hong Kong: Dept of Medicine
2/F, 5 Sassoon Road, Pokfulam, Hong Kong
Tel: 2831 5168
Department of Family Medicine and Primary Care 3/F, Ap Lei Chau Clinic
Ms. April Fung – Tel: 2553 4817
18 (Fri)
1:00–3:00 pm
2
The 231st HKDU Sunday Afternoon Symposium
6/F, KTSH Centre, Grantham Hospital
Ms. Joanne Hui – Tel: 2255 3315
East Ocean Seafood Restaurant, Shop 137, 1/F, Metro City Plaza III
Ms. Gary Wong – Tel: 3513 4821
Hong Kong College of Community Medicine
Hong Kong Doctors Union
Room 415, K Block; Room 120A, New Clinical Building; Lecture Theatre, 6/F,
Professorial Block, Queen Mary Hospital
Ms. Heung – Tel: 2255 4647
1
Certificate Course for GPs 2012—Allergic Rhinitis
17 (Thu)
6:00–7:00 pm
The 230th HKU Sunday Afternoon Symposium
6F, KTSH Centre, Grantham Hospital
Ms. Joanne Hui – Tel: 2255 3315
Hong Kong Medical Association Wanchai Premises, 5/F,
Duke of Windsor Social Service Building
Ms. Candice Tong – Tel: 2527 8285
17 (Thu)
1:00–3:00 pm
Hong Kong Doctors Union
Lecture Hall, 8/F, Block G, Princess Margaret Hospital
Tel: 2388 2728
1
The Smart Way of Managing Osteoarthritis Pain—
Oral or Topical Analgesic?
Sportful Garden Restaurant, 2/F, Tai Tung Building, 8 Fleming Road, Wanchai
Tel: 2388 2728
17 (Thu)
1:00–3:00 pm
bk#
Pre-Hospital Trauma Life Support (PHTLS) Provider Course
Lecture Hall, 8/F, Block G, Princess Margaret Hospital
Tel: 2388 2728
Eaton Hotel
HKMA Cme Dept. – Tel: 2527 8452
17 (Thu)
1:00–2:45 pm
The University of Hong Kong: Dept of Surgery
St. John Tower, 2 MacDonnell Road
Senior Training Officer – Tel: 2530 8020
Elderly Depression and the Elderly Suicide Prevention Program
Lecture Theatre, G/F, Block M, Queen Elizabeth Hospital
Ms. Joanne Ho – Tel: 2871 8747
16 (Wed)
6:30–9:30 pm
19 & 27
(Sat & Sun)
Hong Kong Academy of Medicine
2
1) Common Spinal Disorder
2) Degenerative Arthritis of Lower Limb
Lecture Theatre, G/F, Block M, Queen Elizabeth Hospital
Ms. Joanne Ho – Tel: 2871 8747
23 (Wed)
6:30–9:30 pm
Hong Kong Medical Association
Medical Protection Society
Mastering Difficult Interactions with Patients
HKMA Dr. Li Shu Pui Professional Education Centre, 2/F, Chinese Club Building,
21–22 Connaught Road Central
HKMA Cme Dept. – Tel: 2527 8452
# for whole function
www.hkmacme.org
HKMA
May 2012
27
CME CALENDAR
24 (Thu)
1:00–3:00 pm
Hong Kong Doctors Union: Hong Kong East Study Group
1
Management of Difficult Situation in Patients with Acute
Chest Pain
30 (Wed)
2:00–4:00 pm
Pier 88 – Shop 203-204, 2/F, Paradise Mall
Tel: 2388 2728
24 (Thu)
1:00–3:00 pm
Hong Kong Medical Association: New Territories West Community Network
1
New Development of Anticoagulants in Prevention of Stroke
in Atrial Fibrillation
Hong Kong Medical Association: Kowloon East Community Network
30 (Wed)
5:00–8:00 pm
31 (Thu)
1:00–3:00 pm
Hong Kong Medical Association
Medical Protection Society
Eaton Hotel
HKMA Cme Dept. – Tel: 2527 8452
25 (Fri)
1:00–2:00 pm
Hospital Authority: Tuen Mun Hospital–Dept of Obstetrics & Gynaecology
2
Infectious Diseases Rounds for Year 2012
1
Role of Lymphadenectomy in Endometrial Cancer
Hong Kong Community Psychological Medicine Association
2
Review Meeting on Occupational Health Service in 2012
The University of Hong Kong: The University of Hong Kong Family Institute
31 (Thu)
8:30–10:00 pm
Expressed Emotion: Theory, Measurement, and Application—
Training Workshop on the Camberwell Family Interview
(3-day workshop)
1 (Fri)
1:00–2:00 pm
The University of Hong Kong: Family Medicine and Primary Care
1 (Fri)
3:00–6:00 pm
Mastering Your Risk
2 (Sat)
12:45–3:15 pm
2 (Sat)
2:00–5:00 pm
The 9th HK International Orthopaedic Forum:
Orthopaedics and Pain
The University of Hong Kong: Dept of Medicine
3 (Sun)
2:30–5:30 pm
HKW Geriatric Grand Round
The University of Hong Kong: Dept of Medicine
1
4 (Mon)
12:00–1:00 pm
Hong Kong Medical Association
1
4 (Mon)
12:45–1:45 pm
An Update in Osteoporosis Management with Bisphosphonates
Hong Kong Medical Association: Central, Western & Southern Community Network
Practical Tips on Male LUTS & BPH Management
Hong Kong Medical Association Central Premises, 2/F. Chinese Club Building,
21–22 Connaught Road Central
Mr. Alan Law – Tel: 2527 8285
Hong Kong Medical Association
Kowloon Hospital Alumni Society
2
1) Recent Advances in Medical Imaging
2) Recent Advances in Cardiothoracic Surgery
Hong Kong Medical Association
Medical Protection Society
Mastering Difficult Interactions with Patients
Hong Kong Medical Association
Medical Protection Society
Mastering Adverse Outcomes
The University of Hong Kong: Dept of Medicine
1
HKW Geriatric Grand Round
Hospital Authority: Queen Mary Hospital–Dept of Obstetrics & Gynaecology
1
Clinical Genetics Round, CTG Round, Journal Club,
High Risk Team Meeting
Room 415, K Block; Room 120A, New Clinical Building; Lecture Theatre, 6/F,
Professorial Block, Queen Mary Hospital
Ms. Heung – Tel: 2255 4647
Jade BallRoom, 2/F, Eaton Smart
HKMA Cme Dept – Tel: 2527 8452
30 (Wed)
1:00–3:00 pm
Higher CAC—
1) Update on Positive Psychology 2012 (including Q&A)
2) Introduction to Behavioural Investing (including Q&A)
K2, Queen Mary Hospital
Ms. Joanne Hui – Tel: 2255 3315
HKW Geriatric Grand Round
5/F, Fung Yiu King Hospital
Ms. Joanne Hui – Tel: 2255 3315
29 (Tue)
1:00–3:00 pm
3
Hong Kong Medical Association Dr. Li Shu Pui Professional Education Centre, 2/F,
Chinese Club Building, 21–22 Connaught Road Central
HKMA Cme Dept. – Tel: 2527 8452
1
5/F, Fung Yiu King Hospital
Ms. Joanne Hui – Tel: 2255 3315
28 (Mon)
1:00–2:00 pm
Hong Kong College of Psychiatrists
Hospital Authority: Kwai Chung Hospital
Holiday Inn Golden Mile Hong Kong
HKMA Cme Dept. – Tel: 2527 8452
bk#
William MW Mong Block, Faculty of Medicine Building
Ms. YN Chang – Tel: 2255 4257
28 (Mon)
12:00–1:00 pm
1
Family Medicine Clinical Management Meeting—
Management Guidelines for Common Problems
Conference Rooms 1&2, 2/F, Main Building, Kowloon Hospital
Mrs. Bianca Lee – Tel: 3129 6167
8#
The 13th Regional Osteoporosis Conference 2012
The University of Hong Kong: Dept of Orthopaedics & Traumatology
Conference Room, Room 405, Clinical Pathology Building, Queen Mary Hospital
Ms. Karis Lam – Tel: 2255 3243
Lecture Theatre, LG/F, Block J, Kwai Chung Hospital
Ms. Connie Lo – Tel: 2959 8020
Room S421, 4/F, Phase 1, Hong Kong Convention & Exhibition Centre
Ms. Zita Bai – Tel: 2852 2311
26–27
(Sat–Sun)
2
Infectious Diseases Rounds for Year 2012
Department of Family Medicine and Primary Care 3/F, Ap Lei Chau Clinic
Ms. April Fung – Tel: 2553 4817
Hong Kong Medical Association
Medical Protection Society
Osteoporosis Society of Hong Kong
Hong Kong Doctors Union
Management of Atopic Dermatitis
The University of Hong Kong: Carol Yu Centre for Infection
bk#
Hong Kong Medical Association Dr. Li Shu Pui Professional Education Centre, 2/F,
Chinese Club Building, 21–22 Connaught Road Central
HKMA Cme Dept. – Tel: 2527 8452
26–27
(Sat–Sun)
China-Hong Kong Society for Medical and Health Care
1 (Fri)
10:00 am–
12:00 pm
HKU Family Institute, 2/F, The Hong Kong Jockey Club Building for
Interdisciplinary Research
Ms. Rachel Lam – Tel: 2831 5181
26 (Sat)
2:30–5:30 pm
1
Early Nutrition & Subsequent Manifestation of Allergies
June 2012
2
25/F, Harbour Building, Central
Ms. Yandy Ho – Tel: 2871 8745
25–27
(Fri–Sun)
Hong Kong Medical Association
Chuen Cheung Kui Restaurant, 8/F, Causeway Bay Plaza One
Tel: 2475 2212
HKCPMA Certificate Course 2011: Clinical Management of
Common Mood Disorder in Primary Care
Labour Dept
Hong Kong College of Community Medicine
1
Management of Allergies—Allergic Rhinitis and Airway
Hyper-responsiveness
Hong Kong Medical Association Central Premises, 2/F, Chinese Club Building,
21–22 Connaught Road Central
HKMA CME Dept – Tel: 2527 8452
Eaton Hotel Hong Kong
Ms. Sharon Ng – Tel: 9867 7251
25 (Fri)
2:15–3:45 pm
31 (Thu)
7:00–9:00 pm
Conference Room, Room 405, Clinical Pathology Building, Queen Mary Hospital
Ms. Karis Lam – Tel: 2255 3243
Room E1034 A&B, 1/F, Special Block, Tuen Mun Hospital
Tel: 2468 5404
25 (Fri)
1:30–3:30 pm
Hong Kong Medical Association: Hong Kong East Community Network
Hong Kong Medical Association Wanchai Premises, 5/F,
Duke of Windsor Social Service Building
Ms. Candice Tong – Tel: 2527 8285
Mastering Adverse Outcomes
The University of Hong Kong: Carol Yu Centre for Infection
3
Queen Elizabeth Hospital; Pamela Youde Nethersole Eastern Hospital;
Queen Mary Hospital; Tuen Mun Hospital
Ms. Jenny Cho – Tel: 2958 6437
1
Lecture on “Atopic Dermatitis”
25 (Fri)
10:00 am–
12:00 pm
Hong Kong Society of Nuclear Medicine
Hospital Authority: Queen Elizabeth Hospital–Dept of Nuclear Medicine/
Pamela Youde Nethersole Eastern Hospital/Queen Mary Hospital
Hospital Authority: Tuen Mun Hospital
Clinical Nuclear Medicine Conference
East Ocean Seafood Restaurant, Shop 137, 1/F, Metro City Plaza III
Mr. Alan Law – Tel: 2527 8285
24 (Thu)
6:30–9:30 pm
2
Common Psychiatric Disorders Encountered in General
Practice
Lecture Theatre, G/F, Block M, Queen Elizabeth Hospital, Kowloon
Ms. Joanne Ho – Tel: 2871 8747
Maxim’s Palace Chinese Restaurant, Tuen Mun Town Hall
Mr. Alan Law – Tel: 2527 8285
24 (Thu)
1:00–3:15 pm
Hong Kong Academy of Medicine
1
4 (Mon)
1:00–2:00 pm
The University of Hong Kong: Dept of Medicine
1
HKW Geriatric Grand Round
K2, Queen Mary Hospital
Ms. Joanne Hui – Tel: 2255 3315
# for whole function
www.hkmacme.org
HKMA
May 2012
29
CME CALENDAR
6 (Wed)
2:00–4:00 pm
Hong Kong Academy of Medicine
2
1) Diagnoses and Management of Anxiety Disorders
2) Diagnoses and Management of Depressive Disorders
Seminar Room 3, LG1, Ruttonjee Hospital
Ms. Joanne Ho – Tel: 2871 8747
6 (Wed)
5:00–7:30 pm
Hong Kong College of Emergency Medicine
3
8 (Fri)
1:00–2:00 pm
Hospital Authority: Tuen Mun Hospital–Dept of Obstetrics & Gynaecology
Hospital Authority: Queen Elizabeth Hospital–Dept of Nuclear Medicine
1
Hong Kong Doctors Union: Wan Chai Study Group
1
8 (Fri)
1:30–3:30 pm
Shifting the Paradigm for Stroke Prevention in Atrial Fibrillation
Hong Kong Medical Association: New Territories West Community Network
1
Recent Advance in Osteoporosis Management
Hong Kong Community Psychological Medicine Association
8 (Fri)
4:00–6:00 pm
9 (Sat)
2:30–4:30 pm
A New Approach of Managing Mood Problems in Clinics
1
Family Medicine Clinical Management Meeting—
Management Guidelines for Common Problems
Hong Kong Community Psychological Medicine Association
2
HKCPMA Certificate Course 2011: Clinical Management of
Common Mood Disorder in Primary Care
Hospital Authority
Hong Kong College of Community Medicine
2
Review Meeting on Occupational Health Service in 2012 (HA)
Hong Kong Medical Association
Hong Kong College of Family Physicians
Hospital Authority: Our Lady of Maryknoll Hospital
2
Refresher Course for Health Care Providers 2011/2012
Hong Kong College of Community Medicine
Training Room II, 1/F, OPD Block, Our Lady of Maryknoll Hospital
Ms. Clara Tsang – Tel: 2354 2440
1
Review Meeting in Areas Related to Public Health Medicine
CHP—Rm 311, Centre for Health Protection;
WCH—Room 2115 of Wu Chung House
Ms. Yandy Ho – Tel: 2871 8745
7–8
(Thu–Fri)
The University of Hong Kong: Family Medicine and Primary Care
Queen Elizabeth Hospital / Prince of Wales Hospital
Ms. Yandy Ho – Tel: 2871 8745
Star Room, Level 42, Langham Place Hotel
Ms. Cherry Cheung – Tel: 2235 3283
7 (Thu)
6:00–7:00 pm
1
Contemporary Prediction of Pre-eclampsia
Eaton Hotel Hong Kong
Ms. Sharon Ng – Tel: 9867 7251
Maxim’s Palace Chinese Restaurant, Tuen Mun Town Hall
Mr. Alan Law – Tel: 2527 8285
7 (Thu)
1:00–3:30 pm
Conference Room, Room 405, Clinical Pathology Building, Queen Mary Hospital
Ms. Karis Lam – Tel: 2255 3243
Department of Family Medicine and Primary Care 3/F, Ap Lei Chau Clinic
Ms. April Fung – Tel: 2553 4817
PET & Nuclear Medicine Clinical Meeting
Sportful Garden Restaurant, 2/F, Tai Tung Building
Tel: 2388 2728
7 (Thu)
1:00–3:00 pm
2
Infectious Diseases Rounds for Year 2012
Room E1034 A&B, 1/F, Special Block, Tuen Mun Hospital
Tel: 2468 5404
8 (Fri)
1:00–2:00 pm
PET Centre, Block P, LG Floor, Queen Elizabeth Hospital
Ms. Jenny Cho – Tel: 2958 6437
7 (Thu)
1:00–2:45 pm
The University of Hong Kong: Carol Yu Centre for Infection
Joint Clinical Meeting & Didactic Lectures (JCM)
PMH—Lecture Theatre, 7/F, Block H, Princess Margaret Hospital
QEH—Block D, G/F, Queen Elizabeth Hospital
Ms. Cherry Kwok – Tel: 2871 8877
7 (Thu)
1:00–2:00 pm
8 (Fri)
10:00 am–
12:00 pm
9 (Sat)
2:30–4:30 pm
The University of Hong Kong: Dept of Surgery
11 (Mon)
12:00–1:00 pm
Underground Lecture Theatre, New Clinical Building, Queen Mary Hospital
Tel: 2819 9692
2
Training Course on Counseling in Family Medicine
8/F, Duke of Windsor Social Service Building
Ms. Yvonne Lam – Tel: 2861 0220
bk#
Head and Neck Course 2012—Cancer of the Larynx and
Hypopharynx
Hong Kong College of Family Physicians
The University of Hong Kong: Dept of Medicine
1
HKW Geriatric Grand Round
C9, Tung Wah Hospital
Ms. Joanne Hui – Tel: 2255 3315
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HKMA
May 2012
31
CME CALENDAR
11 (Mon)
1:00–2:00 pm
The University of Hong Kong: Dept of Medicine
1
HKW Geriatric Grand Round
14 (Thu)
1:15–3:00 pm
C9, Tung Wah Hospital
Ms. Joanne Hui – Tel: 2255 3315
12 (Tue)
9:30–5:30 pm
The University of Hong Kong: Centre on Behavioral Health
12 (Tue)
1:00–3:00 pm
Hong Kong Medical Association: Kowloon West Community Network
1
12 (Tue)
5:30–7:30 pm
Hospital Authority: Kwong Wah Hospital
13 (Wed)
8:30–9:30 am
15 (Fri)
1:00–2:00 pm
Hospital Authority: Tuen Mun Hospital–Dept of Obstetrics & Gynaecology
Union Hospital
15 (Fri)
1:00–2:00 pm
1
Mortality and Morbidity Meeting
Hong Kong Doctors Union: Tsuen Wan Study Group
1
The Role of Basal Insulin in the Management of Type 2 Diabetes
Hong Kong Academy of Medicine
15 (Fri)
7:15–8:45 pm
2
1
Clinical Pathological Conference
The University of Hong Kong: Family Medicine and Primary Care
1
Family Medicine Clinical Management Meeting—
Management Guidelines for Common Problems
Hong Kong Society of Paediatrics Gastroenterology, Hepatology & Nutrition/
Obstetrical & Gynaecological Society of Hong Kong
Symposium on Infant Feeding 2012
Topics: 1. Breast is still the best; 2. Mimicking the effects of
mother’s milk: an infant formula with a partial whey
hydrolysate and probiotics
Regency Ballroom, Hyatt Regency Hong Kong
Mr. Dickson Lau – Tel: 2859 6324
1) Disorders of Blood Coagulation
2) Imaging of Back Pain
Seminar Room 3, LG1, Ruttonjee Hospital
Ms. Joanne Ho – Tel: 2871 8747
14 (Thu)
1:00–3:00 pm
Conference Room, Room 405, Clinical Pathology Building, Queen Mary Hospital
Ms. Karis Lam – Tel: 2255 3243
Department of Family Medicine and Primary Care 3/F, Ap Lei Chau Clinic
Ms. April Fung – Tel: 2553 4817
Crystal Room, 30/F, Panda Hotel
Tel: 2388 2728
13 (Wed)
2:00–4:00 pm
2
Infectious Diseases Rounds for Year 2012
Room E1034 A&B, 1/F, Special Block, Tuen Mun Hospital
Tel: 2468 5404
2
Training Room, MIC, 8/F Hospital Building, Union Hospital
Ms. Penny Fok – Tel: 2608 3287
13 (Wed)
1:00–3:00 pm
The University of Hong Kong: Carol Yu Centre for Infection
KWC Joint Endocrine & Chemical Pathology Meeting
Meeting Room 615, Block G, Princess Margaret Hospital
Tel: 6123 6913
Hong Kong Medical Association Structured CME Programme
with HKS&H Session 6: The ABC of molecular pathology testing
15 (Fri)
10:00 am–
12:00 pm
Newer Trends in Management of Acute Diarrhoea in Children
Crystal Room I–III, 30/F, Panda Hotel
Ms. Candice Tong – Tel: 2527 8285
1
The Hong Kong Medical Association Dr. Li Shu Pui Professional Education Centre,
2/F, Chinese Club Building, 21–22 Connaught Road Central
HKMA CME Dept – Tel: 2527 8452
5
1-day Workshop on “Guided Relational Viewing: Art
Exhibits, Art Workshops and Art Therapy for Social Change”
2/F, 5 Sassoon Road, Pokfulam, Hong Kong
Tel: 2831 5168
Hong Kong Medical Association
Hong Kong Sanatorium & Hospital
15–16
(Fri–Sat)
Hong Kong Medical Association: Kowloon East Community Network
1
Gender Neutral HPV Vaccination: The Real World Impact
bk#
Alzheimer’s Disease Conference 2012: From Public Health,
Basic and Clinical Sciences to Therapeutic Insights
Cheung Kung Hai Lecture Theatre 1, G/F, William MW Mong Block, Li Ka Shing
Faculty of Medicine
Ms. Joyce Ha – Tel: 2255 4689
Lei Garden Restaurant, Shop No. L5–8 on Level 5, APM Millennium City V
Mr. Alan Law – Tel: 2527 8285
The Hong Kong Medical Association
The University of Hong Kong: Department of Medicine
Kowloon Hospital Alumni Society
Date
: 2 June, 2012 (Saturday)
Venue
: Conference Rooms 1&2, 2/F., Main Building, Kowloon Hospital, 147A Argyle Street, Kowloon
Time
: 12:45–12:50 p.m. Welcome Remarks by Prof. LEE Shiu Hung, Founding President, KH Alumni Society
12:50–12:55 p.m. Speech by Dr. CHOI Kin, President, The Hong Kong Medical Association
12:55–1:00 p.m. Presentation of Souvenirs
1:00–2:00 p.m.
Recent Advances in Medical Imaging
Dr. FAN Tsz Wo
Consultant Radiologist of Kowloon Central Cluster of Hospital Authority
Recent Advances in Cardiothoracic Surgery
Dr. MA Chan Chung
2:00–3:00 p.m.
COS, Cardiothoracic Surgery Department, Queen Elizabeth Hospital
3:00–3:10 p.m.
3:10–3:15 p.m.
Capacity: 100
Q&A
Vote of Thanks by Dr. CHOY Yuen Chung, President, Kowloon Hospital Alumni Society
All medical professions are welcome. Registration not required. Light lunch would be provided by courtesy of KH Alumni Society. First come, first served.
MCHK/HKMA CME Accreditation: 2 points
Please make reservation on or before 30 May 2012 by sending a fax with your name, telephone number and
EVENT NAME and EVENT DATE to 2760 7608 or contact Mrs. Bianca LEE on 3129 6167 for enquiries.
32
HKMA
May 2012
www.hkmacme.org