bhme program book-ver27 - hkma bhme_program book.pdf · 14:00 – 14:15 開幕禮 opening ceremony...

DiabetesMellitus

Cardio-metabolicDiseases

Depression

Neuro-psychiatric

Disorder

Frailty&

Fracture

Dementia&

Primary Care

Multi-disciplinaryCare with

paramedicsregarding NCD

&

程序表及論文摘要Programme and Abstracts

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會議秘書處 The Conference Secretariat第十八屆京港醫學交流會議香港醫學會香港灣仔軒尼詩道十五號溫莎公爵社會服務大廈五樓

18th Beijing/ Hong Kong Medical Exchangec/o The Hong Kong Medical Association5/F, Duke of Windsor Social Service Building15 Hennessy Road, Hong Kong

電話Tel: (852) 2527 8285 傳真Fax: (852) 2865 0943電郵地址E-mail: [email protected]會議網頁Congress website: www.hkma.org/bhme

目錄 Contents

歡迎詞 Welcome Messages⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯ 平面圖 Floor Plan⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯ 日程表 Programme Rundown⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯

醫學進修學分 Academic Accreditations⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯ 論文摘要 Abstracts⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯

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賀辭 Congratulatory Message

高永文局長Dr. KO Wing Man

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歡迎詞 Welcome Message

各位朋友，各位同仁：

首先請允許我代表中華醫學會對本次會議的召開表示熱烈的祝賀！

自1997年香港回歸祖國，中華醫學會與香港醫學會共同發起舉辦京港醫學交流會議，今年已經是第十八屆了。今年會議的主題是:慢性病的基層綜合治療。中華醫學會全科醫學分會與香港醫學會的專家共同策劃了別出心裁的學術內容，推薦了高水準的講者，使得會議的學術水準也更上一層樓。

我們希望這一傳統活動能夠秉承其理念，繼續為推進內地與香港的醫學交流與進步、為守護海峽兩岸人民的健康做出貢獻。

在此我還要特別對為此次會議舉行付出辛勤努力的各位同仁及朋友表示衷心的感謝！祝會議取得圓滿成功！

饒克勤副會長Dr. RAO Keqin

饒克勤中華醫學會副會長兼秘書長

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平面圖 Floor Plan

參展商列表 List of Exhibitors位置 Location

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Merck Sharp & Dohme (Asia) Ltd.

Novartis Pharmaceuticals (HK) Ltd.

Pfizer Corporation HK Ltd.

Nutricia Clinical (HK) Ltd.

AstraZeneca HK Ltd.

Bayer HealthCare Ltd.

公司 Organization

凡爾賽廳Versailles Ballroom

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會議日程 Programme Rundown

醫學進修學分 Academic Accreditations學院 / 組織 College / Organization 兩天會議Max. for Whole Function 19 / 11 / 2016 20 / 11 / 2016

香港麻醉科醫學院 HK College of Anaesthesiologist (Non-Ana)(Passive)

香港社會醫學學院 HK College of Community Medicine

香港牙科醫學院 HK College of Dental Surgeons

香港急症科醫學院 HK College of Emergency Medicine (PP)

香港家庭醫學學院 HK College of Family Physicians (Cat. 5.2)

香港婦產科學院 HK College of Obstetricians & Gynaecologists (Non - O&G)

香港眼科醫學院 HK College of Ophthalmologists (Passive)

香港骨科醫學院 HK College of Orthopaedic Surgeons (Cat. C)

香港耳鼻喉科醫學院 HK College of Otorhinolaryngologists (Cat. 2.2)

香港兒科醫學院 HK College of Paediatricians (Cat. A)

香港病理學專科學院 HK College of Pathologists (PP)

香港內科醫學院 HK College of Physicians

香港精神科醫學院 HK College of Psychiatrists (PP / OP)

香港放射科醫學院 HK College of Radiologists (Cat. B)

香港外科醫學院 The College of Surgeons of HK (Passive)

香港醫務委員會及香港醫學會 HK Medical Council & HK Medical Association (Passive)

CDE Points for Dietitians19 Nov – 3 Core20 Nov – 3.5 Core / 1.5 Non-Core

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3.17

Pending

Pending

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3.5

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3.25

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6.58

19 November 2016 (Saturday)14:00 – 14:15 開幕禮 Opening Ceremony

14:15 – 14:45

16:05 – 16:25 茶歇 Coffee Break

14:45 – 15:05

15:05 – 15:25

15:25 – 15:45

15:45 – 16:05

第一節 : 糖尿病 Session 1：Diabetes Mellitus

糖尿病綜合照顧模式的演變 Diabetes Care in Hong Kong - Past, Present and Future蘇詠儀醫院管理局質素及安全部總行政經理(質素及標準)2型糖尿病早期啟動胰島素治療的獲益與挑戰祝墡珠復旦大學附屬中山醫院糖尿病個人化的治療 Personalized Medicine of Diabetes Mellitus陳諾香港私人執業內分泌及糖尿科專科醫生糖尿病知信行量表的解讀與應用楊華復旦大學附屬中山醫院

在社區治理高血壓 Management of Hypertension in Primary Care曾健強香港私人執業心臟科專科醫生

16:25 – 16:45

16:45 – 17:05

17:05 – 17:25

17:25 – 17:45

第二節 : 心血管代謝疾病 Session 2：Cardio-metabolic Diseases

社區高血壓的綜合管理占伊揚南京醫科大學附屬第一醫院(江蘇省人民醫院)在社區治理高血脂 Management of Hyperlipidemia in Primary Care黃煒倫香港私人執業心臟科專科醫生2015基層高血壓指南馬中富中山大學附屬第一醫院

全體會議 Plenary Session

基層綜合治療與慢性病Combating Non-Communicable Diseases through Primary Care王曼霞衞生署基層醫療統籌處處長

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20 November 2016 (Sunday)

第三節 : 抑鬱及神經精神科 Session 3：Depression and Neuro-psychiatric Disorder


16:25 – 16:35 閉幕禮 Closing Remarks


12:15 – 13:30 接種疫苗以避免帶狀皰疹神經痛及殘疾 Zoster Vaccine in Preventing Postherpetic Neuralgia and Disability

常見情緒病的診治 Managing Depression in Primary Care陳偉智香港大學李嘉誠醫學院精神醫學系ASCVD基層管理路徑的研究與初步評價王爽中國醫科大學附屬第一醫院夜食症 Night Eating Syndrome梁偉正香港私人執業精神科專科醫生如何與慢性軀體疾病患者談論他們的心理社會問題並給予心理治療湯豔清中國醫科大學附屬第一醫院

09:15 – 09:35

09:35 – 09:55

09:55 – 10:15

10:15 – 10:35

13:30 – 13:50

13:50 – 14:25

14:25 – 14:45

第五節 : 認知障礙與基層醫療 Session 5：Dementia and Primary Care

從中年預防認知障礙症 Midlife Intervention for Dementia譚鉅富香港認知障礙症協會老年性癡呆病人的症狀識別及照料管理曹雲鵬中國醫科大學附屬第一醫院認知障礙症的基層綜合治療 : 日樂計劃 Primary Care for Dementia: The Project Sunrise戴樂群香港私人執業老人科專科醫生

10:55 – 11:15

11:15 – 11:35

11:35 – 11:55

11:55 – 12:15

第四節 : 衰弱症、跌倒、骨折及肌少症 Session 4：Frailty , Falls , Fracture and Sarcopenia

零時間運動、家家齊起動 Zero-time Exercises for Families: The Hong Kong Jockey Club FAMILY Project林大慶香港大學公共衞生學院老年人衰弱綜合症方力爭浙江大學醫學院附屬邵逸夫醫院運動是良藥 Exercise is Medicine香港講者香港大學李嘉誠醫學院矯形及創傷外科學系北京市方莊社區70歲以上男性骨質疏鬆症患病率及其臨床危險因素調查吳浩北京市豐台區方莊社區衞生服務中心

15:05 – 15:25

15:25 – 15:45

15:45 – 16:05

16:05 – 16:25

第六節 : 慢性病的跨學科照顧 Session 6：Multi-disciplinary Care with Paramedics Regarding NCD

個案研習：慢性病的跨學科團隊照顧 Case Presentation on Multi-disciplinary Care of Chronic Disease林思睿及另一名香港私人執業普通科醫生

個案研習：糖尿病的跨學科團隊照顧 Case Presentation on Multi-disciplinary Care of Diabetes Mellitus馮兆璋香港大學家庭醫學及基層醫療學系楊健群及邵嘉儀醫院管理局港島西醫院聯網家庭醫學及基層醫療部

醫聯網平台的設計與應用于浩波藍卡健康集團

ASCVD基層管理路徑的實踐與教學于曉松中國醫科大學于凱中國醫科大學附屬第一醫院張陸瀋陽市和平區長白社區衞生服務中心

戴樂群香港私人執業老人科專科醫生

午餐研討會 Lunch Symposium Sponsored by Merch Sharp & Dohme (Asia) Ltd.

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全體會議 Plenary Session

基層綜合治療與慢性病Combating Non-Communicable Diseases through Primary Care

Hong Kong is facing the challenge of a rapidly ageing population. By 2044, the proportion of population aged 65 and over will have grown to 31% from 15% in year 2014. At the same time, Hong Kong is also experiencing the global epidemic of non-communicable diseases (NCD). In 2015, almost 60% of deaths were attributed to six major but preventable NCD, including cancer (30.6%), diseases of heart (13.2%), stroke (7.0%), chronic lower respiratory diseases (3.6%), injury and poisoning

(3.2%) and diabetes (1.0%). Drastic increase was also observed in hospital admission statistics related to NCD in the past decade. In 2015, these six major but preventable NCD accounted for over 468 000 episodes of in-patient discharges and deaths in all hospitals in Hong Kong, as compared to around 312 000 episodes in 2005.

Evidence has shown that a good primary care system is effective in improving health. Facing the ageing and NCD challenge, primary care plays a pivotal role in the healthcare system by intervening at upstream. The Government of the Hong Kong Special Administrative Region published the “Primary Care Development in Hong Kong: Strategy Document” (香港的基層醫療發展策略文件) in December 2010, setting out major strategies and pathways of action to deliver high quality primary care in Hong Kong.

With regard to the focus of NCD, the Department of Health acknowledges that there will be important health, social and economic impact on our population if the problem is left uncontrolled. A strategic framework document entitled “Promoting Health in Hong Kong: A Strategic Framework for Prevention and Control of Non-communicable Diseases” (促進健康：香港非傳染病防控策略框架) was published in 2008 to address the issue. This document sets out six strategic directions and highlights “PEOPLE” as the six key elements for implementation – Partnership, Environment, Outcome-focused, Population-based intervention, Life-course approach, and Empowerment.

This presentation will elaborate on how initiatives and efforts of the Department of Health combat NCD through primary care, with emphasis on the PEOPLE elements.

Partnership with stakeholders is a cornerstone in improving population health. We treasure the support and collaboration from primary care doctors, who provide comprehensive and continuous care to the population. At the same time, we also acknowledge that the general public is an important partner in health improvement. Hence, we strive to create a supportive environment by promulgating family doctor concept to the population, through territory-wide publicity campaigns and facilitating them to find their own family doctor by setting up the web-based Primary Care Directory (available at www.familydoctor.gov.hk).

Evidence based practice is important to population health programmes and recommendations. Drawing on global evidence of best practice, the Hong Kong Reference Frameworks (HKRFs) for Diabetes Care, Hypertension Care, Preventive Care in Children and Preventive Care in Older Adults (available at www.pco.gov.hk) were promulgated to facilitate primary care doctors to improve patients’ health outcome through their daily practice. Also, based on proven effectiveness in cancer prevention, population-based screening programmes for screening of cervical cancer and colorectal cancer at primary care settings have been implemented since 2004 and piloted since September 2016 respectively.

Through various clinical services and health promotion activities, the Department of Health adopts the life-course approach which utilizes opportunities at all life stages to combat NCDs. All in all, these programmes have an important element to empowering the public, aiming to give everyone the opportunity to gain control over their decisions and actions that influence health.

王曼霞醫生Dr. WONG Man Ha, Monica

衞生署基層醫療統籌處處長Head of Primary Care Office, Department of Health

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第一節: 糖尿病 Session 1: Diabetes Mellitus

糖尿病綜合照顧模式的演變Diabetes Care in Hong Kong - Past, Present and Future

The growing epidemic of type 2 diabetes and its complications is a major threat to the health care system. These complications are highly preventable through zealous metabolic control. Yet the rates of

adherence to treatment guidelines, and attainment of optimal risk factor control is generally low, which pose the major barrier in translating evidence into clinical effectiveness.

In Hong Kong, one-tenth of the population is having diabetes. There is increasing consensus that patient-centred care by means of empowerment of patients and protocol-driven care delivered by multidisciplinary teams forms the essence of sustainable chronic care. These allow application of interventions confirmed in clinical trials to be effective and requires organization of systems to prevent compartmentalization in delivery of service. The integration of different service sectors would support the application of evidence-based guidelines including periodic assessment with risk stratification, good record keeping and patient empowerment. In turn, the use of this form of care delivery would help to reduce both mortality and morbidity in cost-effective manner.

蘇詠儀醫生Dr. SO Wing Yee

醫院管理局質素及安全部總行政經理(質素及標準)香港中文大學威爾斯親王醫院名譽顧問醫生及名譽臨床副教授Chief Manager (Quality & Standards), Quality & Safety Division, Hospital AuthorityHonorary Consultant & Honorary Clinical Associate Professor, The Chinese University of Hong Kong, Prince of Wales Hospital

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2型糖尿病早期啟動胰島素治療的獲益與挑戰

隨著時間推移，大多數2型糖尿病患者終將使用胰島素控制血糖。早期診斷和強化血糖控制治療是降低糖尿病長期風險的關鍵因素。在新診斷的2型糖尿病患者中，強化血糖控制不僅在強化降糖治療期間有臨床獲益，還可以有遠期微血管和大血管獲益的遺留效應。早期啟動胰島素治療可能有助於預防糖尿病進展。因此，應儘早開始優化的血糖管理，並盡可能延長持續時間。但在臨床實踐中，往往無法在推薦的時機啟動進階治療。啟動胰島素治療面臨以下挑戰：在患者方，擔心發生低血糖、體重增加、對注射疼痛存在恐懼、認為胰島素治療意味著個人挫敗；在

醫生方，亦擔心發生低血糖、對患者依從性存在顧慮、缺乏足夠的時間指導患者使用胰島素。這需要醫生與患者共同克服恐懼，一方面，現今的速效和長效胰島素不太可能發生低血糖；另一方面，教導患者預防、識別和治療低血糖，避免發生嚴重事件。關鍵要制定適合患者個體情況的治療方案。醫生在診治每例2型糖尿病患者時都應時刻牢記胰島素治療的四大支柱—TIME，即Target、Insulin、Managing weight 和 Encouragement and support；同時，抓住啟動胰島素治療的4個關鍵時間點：診斷時、需要胰島素治療前、啟動胰島素和隨訪。在臨床實踐中，醫生要思考早期胰島素治療的生理學獲益，及其對患者治療的影響；思考啟動治療的障礙，以及在患者中可以有效克服這些障礙的方法；在制定個體化治療方案時，權衡早期胰島素治療的利弊。

祝墡珠教授

復旦大學附屬中山醫院

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糖尿病個人化的治療Personalized Medicine of Diabetes Mellitus

The cause of Type 2 diabetes is complex involving numerous patho-physiological pathways/mechanisms. Hence there are many classes of anti-diabetic drugs that are currently available. Guidelines for treating Type 2 diabetes is getting more and more complicated and have been updated regularly in recent years, and none are evidence-based. This simply reflects the need for tailor-made therapies for each patient. Newer classes of therapies have the additional benefits of weight reduction and lack of hypoglycaemic side-effects. In this synopsis, several cases will be presented to illustrate how Type 2 diabetes can be managed effectively in using “personalized medicine” approach.

陳諾醫生Dr. CHAN Nor, Norman

香港私人執業內分泌及糖尿科專科醫生Specialist in Endocrinology, Diabetes & Metabolism

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糖尿病知信行量表的解讀與應用

糖尿病知信行管理模式通過對患者進行教育，使其獲得並掌握糖尿病相關知識，引導其對血糖控制的積極態度，進而產生正確、有效的行為改變，達到良好控制血糖、減少糖尿病併發症的發生、提高生命品質的目的。糖尿病知信行量表是實施和評價知信行管理模式的有效工具，包含了知識量表、態度量表和行為量表。糖尿病知識量表是評價患者對糖尿病基本知識掌握情況的量表。通過對糖尿病患者知識錯誤率的統計，可以個體化制定針對知識薄弱點的健康教育方案，較為常用的量表包括MDKT、DKQ、DKN、PCQ等。態度和信念會影響糖尿病患者的飲食、運動、血糖監測、足部皮膚護理等行為。常用的糖尿病態度評價量表有ATT19、DQOL、DAS-3等。知信行模式最終要落實到行為上，應用較廣泛的糖尿病自我管理行為量表有SDSCA、SCI-R、D-SMART等。上述部分量表在國內外糖尿病人群中獲得了較好的信效度和臨床應用。糖尿病知信行量表是實施糖尿病自我管理的重要工具，在量表的選擇時同時也要考慮到原始量表的適用人群、文化背景、受試者的負擔等方面的限制。

楊華副主任醫師

復旦大學附屬中山醫院

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第二節: 心血管代謝疾病 Session 2: Cardio-metabolic Diseases

在社區治理高血壓Management of Hypertension in Primary Care

Hypertension is one the most important health care issue. It is the single biggest risk factor for death worldwide, including infectious causes. Reduction of blood pressure (BP) will reduce patient’s risk. The guidelines for managing hypertension are evolving with more clinical study data available. Clinical assessment with history taking, physical examination, and simple initial investigations for patient

presented with hypertensive BP>140/90mmHg. Global cardiovascular risk and target organ damage due to hypertension should be determined. Lifestyle intervention and drug treatment would be initiated. Most guidelines advocate the use of ABCD drugs. A: Angiotensin Converting Enzyme Inhibitors (ACEI) / Angiotensin II Receptor Blockers (ARB); B: Beta-Blockers (BB); C: Calcium Channel Blockers (CCB); D: Diuretics (long acting thiazide type). Combination treatment is often required to control the BP to achieve the BP goal. There is some differences among the BP goal from different guidelines. The usual BP goal is office BP

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社區高血壓的綜合管理

占伊揚教授

南京醫科大學附屬第一醫院（江蘇省人民醫院）

1.社區高血壓管理的要求

2.社區高血壓管理的方式

3.社區高血壓管理的內容

4.互聯網時代社區高血壓綜合管理系統

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在社區治理高血脂Management of Hyperlipidemia in Primary Care

Hyperlipidemia is a well established risk factor for atherosclerotic cardiovascular disease. Apart from lifestyle modifications, statins which inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase have been proven in trials to reduce cardiovascular risks, making it the current cornerstone of cholesterol management through its effectiveness in reducing low density lipoprotein (LDL). Genetic

studies have confirmed that different PCSK9 mutations can lead to hypercholestrolemia or hypocholesterolemia. These observations have resulted in the development of PCSK9 inhibitors. PCSK9 inhibitors emerges as a new treatment option for patients with severe familial hypercholesterolemia, established cardiovascular disease, statin intolerance, or failure to achieve LDL goal despite maximal therapy. Before consider using these new medications, it is essential to adopt life-style modification and to maximize statin therapy as tolerated in the high-risk patients. The PCSK9 inhibitors will be a new class of lipid-lowering medications offering effective measure for the medical management of the cardiovascular patient at high risk.

Statins will continue to be the mainstay of medication for cardiovascular risk reduction. The PCSK9 inhibitors appear to have a key role to play due to abundant evidence for ‘lower LDL is better’ approach in high-risk cardiovascular patients. New and effective drugs will offer people maximum hope for the prevention, control of atherosclerosis and its devastating secondary effects. Long term safety and outcome studies would be needed to know the real value of these drug.

黃煒倫醫生Dr. WONG Wai Lun

香港私人執業心臟科專科醫生Specialist in Cardiology

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1. 高血壓危害大；降壓治療效果好

2. 提高人群高血壓的知曉率、治療率、控制率是當前的主要任務

3. 測量血壓，利用各種機會把高血壓檢測出來

4. 診斷評估：根據現有資源進行評估；簡化危險分層

5. 治療：堅持非藥物和藥物療法，降壓治療要達標

6. 管理：科學分級管理，重點管理高危患者

7. 預防教育：易患高血壓人群每3個月測血壓一次

8. 雙向轉診：維護患者利益，互利合作

9. 考核評估：因地制宜，促進工作


2015 基層高血壓指南

馬中富教授

中山大學附屬第一醫院

16

第三節: 抑鬱及神經精神科 Session 3: Depression and Neuro-psychiatric Disorder

常見情緒病的診治Managing Depression in Primary Care

Depression is one of the commonest health conditions worldwide. According to the Hong Kong Mental Morbidity Survey, a recent territory-wide psychiatric epidemiological study interviewing 5,719 randomly selected residents in Hong Kong, the 1-week prevalence of mixed anxiety and depressive disorder and depressive episode are 6.9% and 2.9% respec-

tively. It is now recognised that depression not only results in significant morbidity, but also increases suicidal as well as non-suicidal mortality.

Primary care physicians play an important role in the management of persons with depression, especially those with mild to moderate depression. In a cross-sectional study surveying more than 10,000 patients attending 59 local primary care clinics, one in ten were screened positive for depression. However, only 23.1% of them were diagnosed. Among those who were diagnosed, 43% were prescribed with antidepressants, 11% with benzodiazepines, 42% with counseling and 9% were referred to counsellors or other healthcare professionals.

Detection and management of depression is complex. The present talk will cover the barriers and facilitators to depression management at primary care, comprehensive assessment, safety evaluation, and an update of evidence-based pharmacological and non-pharmacological treatment for depression.

陳偉智副教授Dr. CHAN Wai Chi

香港大學李嘉誠醫學院精神醫學系副教授Associate Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong

17


ASCVD 基層管理路徑的研究與初步評價

1. ASCVD基層管理概述

2. 基層管理路徑的研究思路

3. 基層管理路徑《專家共識草案》

4. 初步試點與驗證

5. 局限性與展望

王爽教授

中國醫科大學附屬第一醫院

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夜食症 Night Eating Syndrome

早於六十多年前 (1955), 美國醫生斯坦科德 (Stunkard) 首先描繪並確診了夜食症 (Night Eating Syndrome) 的存在。夜食症的患者在白天吸收的卡路里較正常人少，但在晚上九時至翌日清晨的時段裏，他們所攝取的卡路里至少是一天總量的四分之一，並且每星期至少有兩次夜食行為。在講座裏，我們會探討夜食症的特徵及診斷標準，它的成因及治療方式。 More than 60 years ago (1955), American doctor Stunkard first described Night Eating Disorder. Night Eating Disorder is defined by morning anorexia, evening hyperphagia (consuming 25% of daily food intake after 9 p.m.) and at least two nocturne eating per week. In the lecture, we will discuss the characteristic, diagnostic criteria, causes and treatment of the Night Eating Disorder.

梁偉正醫生Dr. LEUNG Wai Ching

香港私人執業精神科專科醫生Specialist in Psychiatry

19


如何與慢性軀體疾病患者談論他們的心理社會問題並給予心理治療

隨著慢性軀體疾病伴發心理疾病和軀體形式障礙患者的增加，綜合科醫生需要更多的專業知識來說明患者意識到心理問題對軀體疾病的影響，並引導其尋求專業幫助。在與軀體疾病患者談論心理社會問題時需要秉承接納患者、循序漸進的基本理念，建立良好的醫患關係，逐步識別患者的問題，給予回應，表現共情，適當提問，並引導患者自我意識到心理問題的影響及情緒改善對各方面的裨益，進而推動患者自我調整及尋求精神心理專業幫助。

湯豔清教授


20

第四節: 衰弱症、跌倒、骨折及肌少症 Session 4: Frailty , Falls , Fracture and Sarcopenia

零時間運動、家家齊起動Zero-time Exercises for Families: The Hong Kong Jockey Club FAMILY Project

Physical activity and reducing sedentary behavior have significant health benefits. Successful interventions are scarce and physical inactivity remains a major problem worldwide. We propose “Zero-time Exercise” (ZTEx) as a new approach to promote physical activity, family exercise and well-being in Phase Two of The Hong Kong Jockey Club FAMILY project which aims to

promote FAMILY Health, Happiness and Harmony (3Hs). We use a public health approach and positive psychology to promote FAMILY Holistic Health, and collaborate with government and many NGOs to design, implement and evaluate many simple and low-cost community based projects which are evidence-based and evidence-generating, for thousands of participants across ages. (See www.family.org.hk, or YouTube for details).

ZTEx are easy, enjoyable and effective (3Es) that can be done with zero time, zero money and zero equipment (3 Zeros) by anybody, anytime and anywhere (3As). ZTEx are simple movements and stretches that can be done while sitting, standing and walking. We have done many presentations and workshops, and found most of the participants admit that they do not have enough physical activity and exercise, although they understand the harms of physical inactivity, and want to be healthier and fitter. We use ZTEx as “a foot-in-the-door approach” to motivate people with sedentary behaviour, and those who do not exercise regularly to start exercising and integrate ZTEx into daily life with their family members.

We have conducted different simple and brief workshops on ZTEx in collaboration with several NGOs in different community settings. In June 2015, we were invited by Hong Kong Department of Health to add ZTEx to its series of health talks to older people in all 18 districts for the local Estate Management Advisory Committees of public housing estates. The total duration of the talk was 60 minutes and we were given about 15 minutes in the middle. During June 2015 to Feb 2016, we conducted 18 "mini-workshops", which were the shortest of all our workshops on ZTEx, for 556 residents in public housing estates. During the presentations, we briefly introduced ZTEx to the participants, and invited them to act immediately (such as raising both legs above ground, and do foot pedaling while sitting, and standing on one leg). We encouraged the participants to share what they have learnt and do ZTEx with their family members. We assessed the responses and behavior changes of the participants during and after the workshops, and at two-week follow up by telephone interview.

Results (preliminary): Most of the participants were actively involved, enjoyed the session and showed great appreciation. 228 participants (88% female, 66% age ≥ 60 years old, 56% with primary education) completed the interview before the workshops. The evaluation after the workshops (n=150) showed significant improvements in the mean scores of knowledge (4.9 to 5.3, p=0.001, scores ranged from 1 to 6) of and self-efficacy (4.8 to 5.3, p

21


老年人衰弱綜合症

衰弱是由於老年人身體多系統生理儲備減少和失調使機體脆弱性增加，維持自穩能力降低的一種可識別的臨床狀態或綜合症。65歲以上的老年人約有10%患有衰弱，85歲以上老年人約25%-50%。其特點是生理儲備下降，伴隨著發病率和死亡率方面的風險增加。衰弱定義有很多種，目前國際上採用比較多的標準是美國的一項標準。此標準共有5項指標，包括：1.不明原因體重下降，一年體重下降超過4.5公斤(在沒有主動節食的情況下)；2.疲勞感增加，即使是做掃地這樣簡單的家務也會感到吃力；3.手握力下降；4.步速下降，步速每秒鐘不超過0.8米；5.低體能狀

態。如老年人看似健康，但符合5項標準中的3項，即可判定為衰弱綜合症；如只符合1到2項，則屬於衰弱綜合症前期。衰弱老年人發生多種不良健康事件的風險高，包括失能、跌倒、急性疾病、恢復緩慢甚至死亡等。衰弱老年人會因較小的應激如感染、服用新藥、跌倒、便秘或尿瀦留等而使身體健康較前惡化。衰弱也可能表現症狀不明顯，除非積極主動的識別診斷。許多老年人常由於將注意力放在特定疾病如糖尿病或心力衰竭而忽視了衰弱。也有些衰弱老年人，並沒有意識到要去尋求基本的醫療或當地權威機構的治療，直到行動不便、臥床不起或由於很微小的刺激而出現譫妄。對於衰弱的老年人，以個體為中心的，目標驅動的綜合治療途徑可減少不良後果，減少住院率，改善衰弱的老年人提高生活品質。

方力爭教授

浙江大學醫學院附屬邵逸夫醫院

22

Physical inactivity is a leading cause of death worldwide and is a major risk factor for chronic diseases, such as coronary heart disease, type II diabetes, and several cancers.

Physical activity can reduce medical expenses and improve quality of life. Exercise is considered a treatment for many chronic diseases. Promotion of proper exercise will be at doctors’ level by prescribing exercise and at public level by enrolling to exercise.

How to integrate physical activity in healthcare is an issue to improve general health of the population. ‘Exercise is Medicine’ is a platform to promote exercise and align multi-disciplinary health workers to achieve the target.


運動是良藥Exercise is Medicine

香港講者Hong Kong Speaker

香港大學李嘉誠醫學院矯形及創傷外科學系副教授Associate Professor, Department of Orthopaedics and Traumatology,Li Ka Shing Faculty of Medicine, The University of Hong Kong

23


北京市方莊社區70 歲以上男性骨質疏鬆症患病率及其臨床危險因素調查

目的：調查北京市豐台區方莊社區70歲以上老年男性原發性骨質疏鬆症(OP)患病率及其相關的臨床危險因素。

方法：根據入選和排除標準於2014年1-10月在北京市豐台區方莊社區採用廣告招募的抽樣方法，收集接受雙能X線骨密度儀骨密度檢查並完成《北京市老年男性原發性骨質疏鬆症高危人群臨床危險因素調查問卷》調查

的北京地區70歲以上老年男性人群150例。測量並記錄所有患者的腰椎總(L1-4)、左側股骨頸和左側髖部總的骨密度值。根據WHO診斷標準診斷OP患者，將研究物件分為OP組和非OP組，分析各臨床危險因素與OP發生的相關性。結果：150例老年男性OP患病率為20.7%(31/150)，骨量減少者佔55.3%(83/150)，骨量正常者佔24.0%(36/150)。150例老年男性腰椎總骨密度、左側股骨頸骨密度、左側髖部總骨密度比較，差異有統計學意義(F=96.106，P

24

午餐研討會 Lunch Symposium

接種疫苗以避免帶狀皰疹神經痛及殘疾Zoster Vaccine in Preventing Postherpetic Neuralgia and Disability

Herpes Zoster in elders may be misdiagnosed in the pre-vesicular stage. The neuropathic pain can persist after the healing of the acute dermatological lesions, and is known as post-herpetic neuralgia (PHN). The incidence of PHN rises in persons after 50 years old, and pain management can be problematic. In elders this may lead to falls and depression. The Zoster Vaccine demonstrates efficacy in reduction of incidence of zoster, PHN and burden of illness by 51%, 67% and 61% respectively. The Zoster Vaccine is therefore recommended for persons aged 50 and above, especially for at risk groups including diabetes, hypertension, COPD, and CKD.

戴樂群醫生Dr. DAI Lok Kwan, David

香港私人執業老人科專科醫生Specialist in Geriatric Medicine

Sponsored by Merck Sharp & Dohme (Asia) Ltd.

25

第五節: 認知障礙與基層醫療 Session 5: Dementia and Primary Care

從中年預防認知障礙症Midlife Intervention for Dementia

1. Early symptoms of Dementia

2. Early diagnosis of Dementia

3. Early intervention for Dementia

譚鉅富醫生Dr. TAM Kui Fu, Stanley

香港認知障礙症協會副主席老人科顧問醫生Vice-Chairman, Hong Kong Alzheimer's Disease AssociationConsultant, Geriatric Medicine

26


老年性癡呆病人的症狀識別及照料管理

癡呆的種類很多，發病率最高的是阿爾茨海默病(Alzheimer Disease即AD)，正確識別AD對疾病的預後及治療具重要意義。AD理論上分為三個階段即AD的臨床前階段(Preclinical states of AD)；AD源性MCI(MCI due to AD)和AD。AD的臨床前階段有兩種情況即AD的無症狀危險階段(Asymptomatic at-risk state for AD)和AD症狀前期(Presymptomatic AD)，兩者均無臨床症狀，前者有AD危險因素即CSFAβ1-42降低及T-tau 或P-tau 升高或Aβ-PET示腦內Aβ蓄積，但不一定發病；後者攜帶了致病突變基因即AD常染色體顯性基因突變(PSEN1,PSEN2,APP)

或其他基因(including Down’s syndrome trisomy 21)，將來幾乎均發病。AD源性MCI有臨床特徵性表現但尚不夠癡呆診斷，但有反映病理改變的生物學標誌即腦脊液低Aβ含量，高tau、p-tau蛋白，更特異性指標是tau蛋白和Aβ比率增高和PiB-PET示腦內Aβ沉積。第三階段是AD，其確定診斷依賴於臨床符合癡呆標準，有前述反映病理改變的生物學標誌並排出引起癡呆的其他疾病。 AD的治療常用的藥物是膽鹼酯酶抑制劑和NMDA受體阻斷劑以改善認知，但該類病人的照料更為重要，根據中國老年醫學學會認知障礙分會制定的指南，主要圍繞MCI的照料與管理、認知維持與訓練、日常生活照料、精神行為的照料與管理、居住環境設置、文娛活動安排、癡呆終末期照料與管理、照料者壓力調適建議等領域開展。

曹雲鵬教授


27


認知障礙症的基層綜合治療：日樂計劃Primary Care for Dementia: The Project Sunrise

A high prevalence of dementia in elder persons marks a socio-economically advanced society like Hong Kong. However, the diagnostic rate in HK is low at 10%. Early detection and diagnosis is proven to benefit the patient by early appropriate medical treatment in optimization of symptoms and allow the family to plan care in the longer term. Capacity building for family doctors is thus important, and training of community social workers in dementia care planning will help the family navigate through the disease process in reducing catastrophic occurrences.

Medical social collaboration in primary care will be the key to address the increasing needs of dementia in our aging society. The Project Sunrise is a 3 year project in actualizing the above.

戴樂群醫生Dr. DAI Lok Kwan, David

香港私人執業老人科專科醫生Specialist in Geriatric Medicine

28

第六節: 慢性病的跨學科照顧 Session 6: Multi-disciplinary Care with Paramedics Regarding NCD

個案研習：糖尿病的跨學科團隊照顧Case Presentation on Multi-disciplinary Care of Diabetes Mellitus

楊健群女士Ms. YEUNG Kin Kwan

邵嘉儀女士Ms. SU Ka Yi

With the aging population in Hong Kong, more and more people are diagnosed with chronic diseases. Type 2 Diabetes Mellitus (T2DM) is one of the local major health burdens, and many diabetic patients are receiving care under the public primary care. Because of the association of T2DM with various complications including coronary heart diseases, strokes, chronic kidney diseases, diabetic retinopathy, and diabetic neuropathy, etc., early screening and detection of associated risk factors and health problems facilitate early intervention and multi-disciplinary care in order to prevent or delay such complications. In this session, we will illustrate through patient scenarios how a multi-disciplinary approach of care can be implemented in a programme on diabetic patients under public primary care.

馮兆璋醫生Dr. FUNG Siu Cheung, Colman

醫院管理局港島西醫院聯網家庭醫學及基層醫療部資深護師Advanced Practice Nurse, Department of Family Medicine and Primary Healthcare, Hong Kong West cluster, Hospital Authority

醫院管理局港島西醫院聯網家庭醫學及基層醫療部資深護師Advanced Practice Nurse, Department of Family Medicine and Primary Healthcare, Hong Kong West cluster, Hospital Authority

香港大學家庭醫學及基層醫療學系臨床助理教授Clinical Assistant Professor, Department of Family Medicine and Primary Care, The University of Hong Kong

29


個案研習：慢性病的跨學科團隊照顧Case Presentation on Multi-disciplinary Care of Chronic Disease

In Hong Kong, diabetes mellites (DM) patients are taken care of in the Government and private sectors.

In the private sectors, DM patients have the choice of going to specialist physicians or primary care physicians. Specialists such as the diabetologists or endocrinologists may be partnered with DM nurses, dietitians, podiatrists, physiotherapists to provide comprehensive care to their patients.

Primary care doctors in private sector (GP) are less equipped with resources in their clinics. Many primary care doctors would like to collaborate with non-government organizations to provide comprehensive services to their patients. It will be illustrated in our presentation with two case examples.

Doctors should provide comprehensive management of their DM patients with patient empowerment, providing dietary advice, life style modification including exercise prescription. Private doctors in Hong Kong have full range of diabetes drug armory at their full disposal, ranging from traditional metformin, sulphonylurea, glucosidase inhibitor, thiazolidinedione (TZD), to newer agents such as GPD4, GLP1, SGLPT1, insulin injection etc. Primary care doctors also have the privilege of easy availability in terms of consultation time and clinic place and usually a long trusting relationship with their patients. As primary care doctors we also provide comprehensive care in terms of physical, psycho-social and family for patients.

With the advent of eHRSS (Electronic Health Record Sharing System), primary care doctors can assess patient records in Hospital Authority and share the patient data effectively. This platform provide comprehensive multidisciplinary care for patient and hence efficient use of medical resources.

香港私人執業普通科醫生General Practice

林思睿醫生Dr. LAM See Yui, Joseph

香港私人執業普通科醫生General Practice

香港講者Hong Kong Speaker

30


ASCVD 基層管理路徑的實踐與教學

于曉松副校長中國醫科大學附屬第一醫院

于凱講師中國醫科大學附屬第一醫院

張陸副主任醫師瀋陽市和平區長白社區衞生服務中心

1. 社區衞生服務中心對慢性病患者的管理2. 全科醫生問診3. 轉診及綜合醫院醫生遠端會診4. 患者下轉後的管理

31


醫聯網平台的設計與應用

1. 目前智慧醫療和資訊系統遇到的問題

2. 問題的解決方案

3. 分級診療中遇到的最大問題

4. 如何解決基層醫療能力弱的問題

5. 如何利用互聯網+

6.“藍卡健康”的模式和系統介紹

于浩波董事長

藍卡健康集團

34

鳴謝 Acknowledgement

AstraZeneca Hong Kong Limited

Bayer HealthCare Limited

Boehringer Ingelheim (HK) Limited

Janssen, Johnson & Johnson (HK) Limited

MERCK Pharmaceutical (HK) Limited

Merck Sharp & Dohme (Asia) Limited

Novartis Pharmaceuticals (HK) Limited

Novo Nordisk Hong Kong Limited

Nutricia Clinical (Hong Kong) Limited

Pfizer Corporation Hong Kong Limited

Sanofi Hong Kong

香港醫學會第十八屆京港醫學交流會議 HKMA 18th Beijing/Hong Kong Medical Exhange

籌備委員會 Organizing Committee

學術委員會 Scientific Committee

贊助機構 Sponsors：

聯席主席：陳重娥教授Co-Chairpersons 祝墡珠教授于曉松教授

委員：陳諾醫生Members 戴樂群醫生馮兆璋醫生馬珮珊醫生

Prof. CHAN Chung Ngor, JulianaProf. ZHU Shan ZhuProf. YU Xiao Song

Dr. CHAN Nor, NormanDr. DAI Lok Kwan, DavidDr. FUNG Siu Cheung, ColmanDr. MA Pui Shan

bhme program book-ver27 - hkma bhme_program book.pdf · 14:00 – 14:15 開幕禮 opening ceremony...

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