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Developing a holistic view and approach to health care. René Sand Lecture. International Hospital Federation Congress--May 2001.

One of the significant features of Hong Kong is its public healthcare system, which provides universal, easily accessible and heavily subsidized medical care for all. The governing policy has been to ensure that no one is denied adequate medical care because of insufficient means through the provision of a comprehensive range of healthcare services funded from the public purse at extremely low fees to users. Over the past decade, the public hospital sector has been able to provide efficient and quality health services comparable to those of the industrialised nations. However, the reality today is that the public hospitals are facing many challenges that must be overcome and ways must be sought to mitigate the growing strains on the healthcare system and rebalance the healthcare economics. The recently published Consultation Document on Healthcare Reform, by Dr E K Yeoh, Secretary for Health & Welfare, proposes the introduction of a comprehensive range of short-term and long-term initiatives to revitalize and transform the healthcare system into a community-focused, patient-centred and knowledge-based integrated healthcare service with improved interface between the public and private sectors.

Delivery of Health Care, Integrated↗

The 36th Harry G. Armstrong Lecture. The limits of human performance: a point of view.

The author describes his experience over the past 20 years in the Pentagon environment advocating greater understanding of the importance of human performance and its limits by military technologist. The human performance research community is a key player in the effort to reverse the present marginalization of the human in a technology-dominated world. The author suggests specific initiatives the community could take to strengthen this effort and reposition itself for a greater leadership role in science and technology of the 21st century.

Adaptation, Physiological↗

James IV Lecture: congenital deformities of the spine.

Congenital anomalies of the vertebrae producing a scoliosis, kyphoscoliosis or kyphosis are potentially serious conditions, which can, on occasion, result in an extremely severe rigid spinal deformity with possible spinal cord compression. The key to successful management depends on: (1) Early diagnosis while the curve is still small. (2) Anticipation of the likely prognosis based on the type and site of the vertebral anomaly, the degree of growth imbalance it produces and the amount of spinal growth remaining. (3) Preventing progression of the deformity and this may necessitate surgical treatment in the first few years of life. It is much better to carry out a relatively simple operation to balance the growth of the spine at an early stage than to wait and perform potentially hazardous anterior and posterior spinal surgery as a salvage procedure at a later stage.

Humans↗

Buonocore Memorial Lecture. Dentin caries: progression and clinical management.

A fundamental issue of restorative treatment is assessing the different conditions of cases not only from tooth-to-tooth but also from the activity of each caries lesion and the size of the cavity. In addition, restorative treatment is sometimes carried out for prosthetic and cosmetic purposes and involves cutting sound, unaffected dentin. These aspects are outlined in classic textbooks and are based on the principles described by Black (1908). However, each factor and its relative importance has changed over the years. Significant time has been devoted to improving the important technical aspects of performing restorative treatment. Traditionally, these aspects have primarily been related to cavity design, choice of restorative material and the clinical procedures involved. In this context, Dr Michael Buonocore's contributions must be recognized because the adhesive technique he introduced has become an integral part of modern operative dentistry. Operative dentistry today also focuses on cavity design and selecting restorative materials. Less effort has been placed on incorporating what is known about the pattern of caries progression and how it relates to caries removal or excavation. Although the reaction pattern of the pulp-dentin organ is quite different in terms of the nature of active (rapid-progressing) and arrested (slow-progressing) lesions, no widespread major distinction has been made regarding the different restorative treatment approaches in these situations. This presentation updates the progression and clinical management of dentin caries and how it relates to treating deep caries lesions.

Dental Bonding↗