Volume 18 Number 3 2009
The Seven Core Virtues in Medical Professionalism Low YingHui, BSc, Eunizar Omar, BSc (Hons), T Thirumoorthy, MMBS, FRCP, FAMS (Derm) Duke NUS Graduate Medical School ABSTRACT
Medicine is a moral and social enterprise. As a profession, it poses many challenges to its practitioners. Society depends on the medical community to serve the welfare of the sick, and often physicians are given much discretionary latitude in their work. Because of this, professionals must have a firm ethical foundation to avoid exploiting others, and to always serve the best interest of patients. Virtue ethics has existed since time immemorial. However, it has taken second place to principle-based ethics for a while now, where the use of logical reasoning guides ethical codes and conduct. These alone are not sufficient for a medical professional. With the peculiar stressors they may face, there are seven key virtues that are invaluable in medical practice: integrity, discernment, compassion, trustworthiness, conscientiousness, humility, courage. These virtues enable practitioners to make moral and ethical decisions when the current guidelines are incomplete, or if there are no currently available guidelines to address the problems that they face. Ultimately, these virtues enable practitioners to carry out a fulfilling and meaningful career.
Keywords: ethics, morals, principles, professionalism, virtues Full text of article Emerging Pathogen: Leuconostoc Bacteremia * Tulsidas Haresh, MMBS, MRCP (UK), Amanullah Mohammed Rizwan, MBBS Department of Internal Medicine, Singapore General Hospital, Singapore * Presented at the Best Poster (Clinical) session during the SGH 18th Annual Scientific Meeting held from 17−18 April 2009.
ABSTRACT
Leuconostoc, member of the Family Streptococcacae, is an uncommon cause of infections in humans. Previously thought to be contaminants in cultures, they are now being recognised as emerging pathogens. We describe a case of Leuconostoc bacteremia in a 76-year-old man with a history of diabetes mellitus, hepatic cirrhosis and alpha thalassemia trait. He presented with signs and symptoms of congestive cardiac failure and pneumonia. Blood culture grew Leuconostoc pseudomesenteroides. He responded to treatment with anti cardiac failure drugs and high dose penicillin. Though an uncommon cause of bacteremia,Leuconostoc sepsis should be considered in immunocompromised patients and in those with underlying chronic diseases.
Keyword: bacteremia, Leuconostoc, vancomycin
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An Integrated Approach to Learning Anatomy, Physiology and Micro-Anatomy: A Clinician-Based System at Duke-NUS Grduate Medical School Singapore Pierce Chow Kah Hoe1,2, MBBS, MMed, FRCSE, FAMS, PhD, Soh Chai Rick3, MBBS, MMed FANZCA, JFICM, Tay Sook Muay3, MBBS, FFARCSI, FAMS, MEd (Monash),Sandy Cook4, MD, PhD 1Duke-NUS Graduate Medical School 2Hepato-Pancreato-Biliary Team, Singapore General Hospital 3Department of Anaesthesiology, Singapore General Hospital 4Department of Medical Education, Research and Evaluation, Duke-NUS Graduate Medical School, Singapore
Faculty members from Duke-NUS Graduate Medical School Singapore (Duke-NUS) faced interesting challenges when developing a curriculum based on the Duke University School of Medicine’s course. Given the short time frame to get the first year basic science courses set up and the desire to enhance the learning environment required some innovative learning approaches as well as creativity. After consultation with the Normal Body course directors from Duke, Durham, North Carolina, Duke-NUS Normal Body course directors embarked on a journey to create a pioneering course for Singapore while implementing some of the curricular enhancements desired by the Duke-NUS faculty.
Keywords: anatomy, clinician-based teaching, histology, integrated learning, normal body, physiology, student-centered learning, team-based learning
Full text of article Local Intra-arterial Fibrinolysis and the Effects of Time to Treatment in Central Retinal Artery Occlusion: A Systematic Review * Elaine HZ Huang1 , MRCS, MMed, Sharon LC Tow2, FRCS, MMed, Tin Aung3, FRCS, MMed 1Singapore National Eye Centre, Singapore 2Neuro-ophthalmology Service, Singapore National Eye Centre, Singapore 3Glaucoma Service, Singapore National Eye Centre, Singapore
*Presented at the Best Systematic Review in Surgery session during the Annual Evidence-Based Medicine Seminar held in conjunction with the SGH 16th Annual Scientific Meeting, 27–28 April 2007 and awarded the 1st prize in Research at the 3rd Research Day at The Eye Institute, Tan Tock Seng Hospital, on October 2007.
ABSTRACT Objective: Conventional regimens in central retinal artery occlusion have been ineffective in reversing visual loss. Local intra-aterial fibrinolysis(LIF) has shown promising results. The aim of this study was to review data on LIF with directed emphasis on the effect of time interval to treatment on visual outcome to obtain an idea on the time frame within which fibrinolysis would yield worthwhile results.
Methods: We systematically reviewed studies published after year 2000 on LIF. After correction for data duplication, the results of LIF in 44 patients with complete data are reported.
Results: Mean interval to LIF was 18.7 hours (SD 37.2), range 4–240 hours. 43.2% of patients had an improvement of 2-Snellen lines or more with 25% achieving 6/15 or better and 34.1% attaining 6/60 or better 48 hours postintervention. Treatment instituted within 6 hours from symptom onset resulted in a mean improvement of 5.4 lines compared to 2 lines in patients treated beyond 6 hours. When presenting acuity was light perception or worse, only 1 in 10 eyes attained a 2-line improvement even with intervention within 10 hours. Complications were seen in 5 patients (11.4%) and included intracerebral haemorrhage (1), ischaemic cerebrovascular accident (2), transient ischaemic attack (1) and vitreous haemorrhage (1).
Conclusion: Retrospective studies show potential benefits of LIF especially if administered within 6 hours from symptom onset. The studies had methodological limitations and in the absence of randomised controlled trials, there is insufficient evidence to justify its routine use in view of notable systemic events.
Keywords: CRAO, fibrinolytic therapy, systematic review Full text of article
Identification of a Novel Class of Allosteric Modulators of the NMDA Receptor * Nian-Lin Reena Han1, MD, PhD, Hendrika MA Vandongen1, BSc, Antonius MJ Vandogen1,2, PhD 1Program in Neuroscience & Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore 2Pharmacology and Cancer Biology, Neurobiology, Duke University Medical Centre, Durham, NC, USA *Presented at the SGH Scientist Award session during the SGH 18th Annual Scientific Meeting held from 17 - 18 April 2009. ABSTRACT Introduction: N-methyl-D-aspartate (NMDA) receptors are glutamate-gated ion channels that play key roles in processes underlying learning and memory. NMDA receptor dysfunction is thought to contribute to virtually every major neurological disorder, including Alzheimer’s, Parkinson’s, and Huntington’s disease, stroke, epilepsy, neuropathic pain, schizophrenia, ADHD, chronic depression and ageing-related memory deficits. Despite the enormous potential of NMDA receptorbased therapeutics, drugs targeting this receptor have been mostly disappointing in clinical trials, due to a combination of intolerable side effects and poor efficacy. The aim of our present work is to develop a new class of NMDA receptor drugs for treating neurological disorders, which are expected to be efficacious, selective and safe.
Methods: The approach is based on our recent observation suggesting that allosteric modulators bind to the heteromeric dimer interface formed by the NMDA receptor subunit NR1 and NR2 ligand binding domains. The 3D structures for 7,000 compounds from a virtual library were docked into the NR1-NR2A dimer interface and the binding affinity was estimated for each optimal pose, using the eHiTS software (www.simbiosys.com). The top-ranking compounds were characterized electro-physiologically using 2-electrode voltage clamp in Xenopus oocytes.
Results & Conclusion: Out of 10 top-ranking compounds tested, 3 were negative allosteric modulators, decreasing NMDA current by 17–25%. Six compounds enhanced NMDA receptor function by 17–73%, while 1 drug was ineffective. Our preliminary data suggest that this approach is feasible. Because only 0.1% of the available compounds have been screened in silico, we expect to identify a wide range of positive and negative allosteric modulators for the NMDA receptor. Keywords: drug screening, modulators, neurological disorders, NMDA receptor Full text of article page updated Dec 2009