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Influencing factors and processes of interprofessional professional education (IPE) implementation

Wong PS, Chen YS, Saw PS

Med Teach, 2021 Jul;43(sup1):S39-S45.
PMID: 31603016 DOI: 10.1080/0142159X.2019.1672864

BACKGROUND: Interprofessional education (IPE) is an instructional approach for equipping health professions students with essential competencies needed to provide collaborative patient-centred care. The implementation and sustainability of IPE are challenging for many institutions. This qualitative study identified barriers and facilitators in the processes of IPE implementation.
METHODS: We conducted mixed focus groups (FGs) with faculty members from medicine, dentistry, pharmacy, nutrition and dietetics, nursing, chiropractic, Chinese medicine, and other health sciences programmes; who were involved in the planning of IPE at institutional or programme level, or who participated in IPE activity. Transcripts were analysed using grounded theory.
RESULTS: We identified 25 barriers and facilitators, clustered under five major categories of commitment, faculty engagement, IPE design, support, and delivery.
CONCLUSIONS: Successful implementation of IPE may hinge on actions in 5 stages; commitment, faculty engagement, IPE design, support, and delivery. The processes will require consistent leadership to break down professional silos and enhance collaborative effort in IPE implementation.
Fulltext Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study

Win NN, Jorgensen AM, Chen YS, Haneline MT

J Chiropr Med, 2015 Mar;14(1):1-9.
PMID: 26693212 DOI: 10.1016/j.jcm.2014.12.005

OBJECTIVE: The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT).
METHODS: A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.
RESULTS: The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient's group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer' and patient' groups.
CONCLUSION: Upper cervical SMT enhances dominance of parasympathetic and lower cervical SMT enhances dominance of sympathetic activity in this young volunteer group. However, dominance of parasympathetic activity was found in patients with neck pain that received both upper and lower cervical SMT.
KEYWORDS: Blood pressure; Heart rate; Manipulation; Spinal
Fulltext Recent Advances in Learning Theory

Dai W, Duch W, Abdullah AH, Xu D, Chen YS

Comput Intell Neurosci, 2015;2015:395948.
PMID: 26649035 DOI: 10.1155/2015/395948
Fulltext In vitro anti-inflammatory activity of fractionated Euphorbia hirta aqueous extract on rabbit synovial fibroblasts

Chen J, Er HM, Mohamed SM, Chen YS

Biomed J, 2015 Jul-Aug;38(4):301-6.
PMID: 25673170 DOI: 10.4103/2319-4170.151031

BACKGROUND: Euphorbia hirta has been reported to possess anti-inflammatory activity. This study was carried out to determine the prostaglandin E 2 (PGE 2 ) inhibition activity of the fractions of the E. hirta aqueous extract on rabbit synovial fibroblast cells (HIG-82).
METHODS: E. hirta aqueous extract was fractionated into five fractions (fractions A, B, C, D, and E) by reversed phase flash chromatography. Rabbit synovial fibroblast cells (HIG-82) were activated with phorbol myristate acetate and treated with the fractions. The amount of PGE 2 released into the medium was measured by enzyme-linked immunosorbent assay.
RESULTS: Fraction A (0.1, 1, and 10 μg/ml) had the greatest PGE 2 inhibitory effect among the five fractions, and showed a greater extent of PGE 2 inhibition compared to the aqueous extract. In contrast, Fraction E had the greatest stimulatory effect on PGE 2 release.
CONCLUSIONS: Fraction A of the aqueous extract inhibited the production of PGE 2 from activated HIG-82 cells to a greater extent than the crude aqueous extract. Bioactive compounds with anti-inflammatory activity are likely to be concentrated in Fraction A of E. hirta aqueous extract.
Mutagenic and antimutagenic activities of aqueous and methanol extracts of Euphorbia hirta

Loh DS, Er HM, Chen YS

J Ethnopharmacol, 2009 Dec 10;126(3):406-14.
PMID: 19778596 DOI: 10.1016/j.jep.2009.09.025

Euphorbia hirta (E. hirta) is a weed commonly found in tropical countries and has been used traditionally for asthma, bronchitis and conjunctivitis. However, one of the constituents in this plant, quercetin, was previously reported to be mutagenic. This work aimed to determine the level of quercetin in the aqueous and methanol plant extracts and to investigate the mutagenic effects of quercetin and the extracts in the Ames test utilising the mutant Salmonella typhimurium TA98 and TA100 strains. The antimutagenic activity of Euphorbia hirta aqueous and methanol extracts was also studied in Salmonella typhimurium TA98. HPLC analyses showed that quercetin and rutin, a glycosidic form of quercetin, were present in the acid-hydrolysed methanol extract and non-hydrolysed methanol extract respectively. The quercetin concentration was negligible in both non-hydrolysed and acid-hydrolysed aqueous extracts. The total phenolic contents in Euphorbia hirta were determined to be 268 and 93 mg gallic acid equivalent (GAE) per gram of aqueous and methanol extracts, respectively. Quercetin (25 microg/mL) was found to be strongly mutagenic in Salmonella typhimurium TA98 in the absence and presence of S-9 metabolic activation. However, both the aqueous and methanol extracts did not demonstrate any mutagenic properties when tested with Salmonella typhimurium TA98 and TA100 strains at concentrations up to 100 microg/mL in the absence and presence of S-9 metabolic activation. In the absence of S-9 metabolic activation, both the extracts were unable to inhibit the mutagenicity of the known mutagen, 2-nitrofluorene, in Salmonella typhimurium TA98. On the other hand, the aqueous extracts at 100 microg/mL and methanol extracts at 10 and 100 microg/mL exhibited strong antimutagenic activity against the mutagenicity of 2-aminoanthracene, a known mutagen, in the presence of S-9 metabolic activating enzymes. The results indicated that these extracts could modulate the xenobiotic metabolising enzymes in the liver at the higher concentrations.
The Multiple Mini-Interview (MMI) for student selection in health professions training - a systematic review

Pau A, Jeevaratnam K, Chen YS, Fall AA, Khoo C, Nadarajah VD

Med Teach, 2013 Dec;35(12):1027-41.
PMID: 24050709 DOI: 10.3109/0142159X.2013.829912

The Multiple Mini-Interview (MMI) has been used increasingly for selection of students to health professions programmes.
Fulltext The effect of water extracts of Euphorbia hirta on cartilage degeneration in arthritic rats

Lee KH, Chen YS, Judson JP, Chakravarthi S, Sim YM, Er HM

Malays J Pathol, 2008 Dec;30(2):95-102.
PMID: 19291918 MyJurnal

The effect of water extracts of Euphorbia hirta on the histological features and expressions of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the rat articular cartilage was investigated. Arthritis was induced in rats using Freund's Complete Adjuvant containing heat-killed M. tuberculosis, and treated with water extracts of E. hirta. Paraffin tissue sections of the arthritic joints were evaluated. The extent of cartilage degeneration was found to be greatest in rats treated with the highest dosage of E. hirta, followed by rats in the untreated group. Rats treated with the intermediary and low dosages of Euphorbia hirta showed improved histology. MMP-13 levels were found to be decreased with decreasing dosages of E. hirta. TIMP-1 levels were found to increase with decreasing dosages of E. hirta. MMP-3 levels fluctuated without any appreciable pattern. Low dosages of E. hirta seem to be beneficial in reducing cartilage degeneration in cases of arthritis.
What does the multiple mini interview have to offer over the panel interview?

Pau A, Chen YS, Lee VK, Sow CF, Alwis R

Med Educ Online, 2016 Jan;21(1):29874.
PMID: 28165931 DOI: 10.3402/meo.v21.29874

Introduction This paper compares the panel interview (PI) performance with the multiple mini interview (MMI) performance and indication of behavioural concerns of a sample of medical school applicants. The acceptability of the MMI was also assessed. Materials and methods All applicants shortlisted for a PI were invited to an MMI. Applicants attended a 30-min PI with two faculty interviewers followed by an MMI consisting of ten 8-min stations. Applicants were assessed on their performance at each MMI station by one faculty. The interviewer also indicated if they perceived the applicant to be a concern. Finally, applicants completed an acceptability questionnaire. Results From the analysis of 133 (75.1%) completed MMI scoresheets, the MMI scores correlated statistically significantly with the PI scores (r=0.438, p=0.001). Both were not statistically associated with sex, age, race, or pre-university academic ability to any significance. Applicants assessed as a concern at two or more stations performed statistically significantly less well at the MMI when compared with those who were assessed as a concern at one station or none at all. However, there was no association with PI performance. Acceptability scores were generally high, and comparison of mean scores for each of the acceptability questionnaire items did not show statistically significant differences between sex and race categories. Conclusions Although PI and MMI performances are correlated, the MMI may have the added advantage of more objectively generating multiple impressions of the applicant's interpersonal skill, thoughtfulness, and general demeanour. Results of the present study indicated that the MMI is acceptable in a multicultural context.
Twelve tips for institutional approach to outcome-based education in health professions programmes

Er HM, Nadarajah VD, Chen YS, Misra S, Perera J, Ravindranath S, et al.

Med Teach, 2021 Jul;43(sup1):S12-S17.
PMID: 31522577 DOI: 10.1080/0142159X.2019.1659942

Outcome-based education (OBE) has brought along a significant development in health professions education in the past decade. The shift from a process-driven to product-driven model of education is valuable for ensuring graduate quality and facilitating global movement of healthcare workers. Such a model can align the expectations of key stakeholders in an era of rapid knowledge expansion and technological advancement. Nevertheless, the experienced benefits of OBE depend on the effectiveness of its implementation. This article therefore provides practical tips and strategies for implementing OBE in order to maximize its potential.
Fulltext Can Malaysian Young Adults Report Dietary Intake Using a Food Diary Mobile Application? A Pilot Study on Acceptability and Compliance

Chen YS, Wong JE, Ayob AF, Othman NE, Poh BK

Nutrients, 2017 Jan 13;9(1).
PMID: 28098770 DOI: 10.3390/nu9010062

Mobile applications may improve dietary reporting among young adults due to their high accessibility and embedded camera function. This pilot study aimed to (i) evaluate users' acceptability and compliance in reporting dietary intake using a newly developed food diary mobile application (food app); and (ii) identify issues and recommendations for improving dietary assessment using this food app via quantitative and qualitative protocols. Twenty-eight university students each used a food app for seven consecutive days and attended one of five focus group interviews. A 42% decrement in reporting compliance was observed throughout the seven-day recording period. An average of 5.9 recording days were reported and 4.8 occasions of meal data were uploaded each day. Based on questionnaires, high levels of agreement were reported in terms of perceived usefulness (69.3%), perceived ease of use (77.1%), attitude (73.6%), perceived enjoyment (62.6%), and smartphone experience (91.1%), but such agreement was not reported for intention to use (38.1%) and social influence (33.4%). Four major themes emerged from the focus group interviews, namely, (i) features; (ii) potential use; (iii) utility issues of the food app; and (iv) suggestions for improvements. While the food app was well-accepted by most of the young adults, the current prototype would benefit from incorporation of a barcode scanning function, customizable reminders, in-app tutorial, an entertainment component, and enhancement in overall appearance.
Sustained Connexin43 Mimetic Peptide Release From Loaded Nanoparticles Reduces Retinal and Choroidal Photodamage

Mat Nor N, Guo CX, Rupenthal ID, Chen YS, Green CR, Acosta ML

Invest Ophthalmol Vis Sci, 2018 07 02;59(8):3682-3693.
PMID: 30029255 DOI: 10.1167/iovs.17-22829

Purpose: To evaluate the long-term effect on inflammation and inflammasome activation of intravitreally delivered connexin43 mimetic peptide (Cx43MP) in saline or incorporated within nanoparticles (NPs) for the treatment of the light-damaged rat eye.
Methods: Light-induced damage to the retina was created by exposure of adult albino Sprague-Dawley rats to intense light for 24 hours. A single dose of Cx43MP, Cx43MP-NPs, or saline was injected intravitreally at 2 hours after onset of light damage. Fluorescein isothiocyanate (FITC)-labelled Cx43MP-NPs were intravitreally injected to confirm delivery into the retina. Electroretinogram (ERG) recordings were performed at 24 hours, 1 week, and 2 weeks post cessation of light damage. The retinal and choroidal layers were analyzed in vivo using optical coherence tomography (OCT) and immunohistochemistry was performed on harvested tissues using glial fibrillary acidic protein (GFAP), leukocyte common antigen (CD45), and Cx43 antibodies.
Results: FITC was visualized 30 minutes after injection in the ganglion cell layer and in the choroid. Cx43MP and Cx43MP-NP treatments improved a-wave and b-wave function of the ERG compared with saline-injected eyes at 1 week and 2 weeks post treatment, and prevented photoreceptor loss by 2 weeks post treatment. Inflammation was also reduced and this was in parallel with downregulation of Cx43 expression.
Conclusions: The slow release of Cx43MP incorporated into NPs is more effective at treating retinal injury than a single dose of native Cx43MP in solution by reducing inflammation and maintaining both retinal structure and function. This NP preparation has clinical relevance as it reduces possible ocular complications associated with repeated intravitreal injections.
Randomized comparison of the Baska FESS mask and the LMA Supreme in different head and neck positions

Foo LL, Shariffuddin II, Chaw SH, Lee PK, Lee CE, Chen YS, et al.

Expert Rev Med Devices, 2018 Aug;15(8):597-603.
PMID: 30095289 DOI: 10.1080/17434440.2018.1506329

BACKGROUND: The Baska functional endoscopic sinus surgery (FESS) mask is a new supraglottic airway designed for head and neck procedures. This prospective, randomized controlled trial compared the oropharyngeal leak pressure (OLP) of the Baska FESS mask with the laryngeal mask airway (LMA) Supreme in different head and neck positions.
METHODS: One hundred patients undergoing elective surgery were recruited. OLP was compared in supine position, 45° lateral rotation, 45° neck extension, and 30° neck flexion. Glottic view, insertion time, ease of insertion, number of attempts, ease and time of insertion of gastric tube, and complications were also compared.
RESULTS: The OLP of the Baska FESS was higher than the LMA Supreme in all head and neck positions studied (p
Tumor regression and modulation of gene expression via tumor-targeted tocotrienol niosomes

Tan DM, Fu JY, Wong FS, Er HM, Chen YS, Nesaretnam K

Nanomedicine (Lond), 2017 Oct;12(20):2487-2502.
PMID: 28972460 DOI: 10.2217/nnm-2017-0182

AIM: To develop 6-O-palmitoyl-ascorbic acid-based niosomes targeted to transferrin receptor for intravenous administration of tocotrienols (T3) in breast cancer.
MATERIALS & METHODS: Niosomes were prepared using film hydration and ultrasonication methods. Transferrin was coupled to the surface of niosomes via chemical linker. Nanovesicles were characterized for size, zeta potential, morphology, stability and biological efficacy.
RESULTS: When evaluated in MDA-MB-231 cells, entrapment of T3 in niosomes caused 1.5-fold reduction in IC50 value compared with nonformulated T3. In vivo, the average tumor volume of mice treated with tumor-targeted niosomes was 12-fold lower than that of untreated group, accompanied by marked downregulation of three genes involved in metastasis.
CONCLUSION: Findings suggested that tumor-targeted niosomes served as promising delivery system for T3 in cancer therapy.
The effects of Euphorbia hirta on the ultrastructure of the murine liver, kidney and aorta

Wong JY, Chen YS, Chakravarthi S, Judson JP, L SR, Er HM

Exp Ther Med, 2013 Nov;6(5):1247-1250.
PMID: 24223653

Euphorbia hirta is widely used in traditional remedies and has been used cross-culturally for generations against maladies such as asthma, skin ailments and hypertension. Previous studies have demonstrated that Euphorbia hirta has antibacterial activity, and have also indicated certain antimolluscidal, antimalarial and anti-inflammatory properties, the latter of which have been suggested to be more pronounced than those of the rheumatological drug, etanercept. To date, no studies have identified the anatomical effects of this herb on the organs of test animals. This study aimed to identify the effects of Euphorbia hirta on the ultrastructure of the murine liver, kidney and aorta. A total of 32 adult male Sprague-Dawley rats were divided into four groups; three groups were fed with aqueous extracts of Euphorbia hirta at doses of 1, 10 and 50 mg/kg, respectively, every alternate day for 50 days, while one group served as a control. The animals were later sacrificed and the liver, kidney and aorta harvested for examination by electron microscopy. The aorta showed no ultrastructural changes across the groups. Renal and hepatic tissue from the treated groups demonstrated dose-dependent injuries, which showed architectural damage beginning in the nuclei and spreading outwards. Taking into consideration the properties of Euphorbia hirta that have been described in previous studies, in addition to the results from the present study, it appears that the herb may exhibit similar effects to those of the quinolone group of antibiotics. Further in-depth investigations are required into the potential effects of Euphorbia hirta, deleterious and otherwise.
Fulltext Removal of Ionic Dyes by Nanofiber Membrane Functionalized with Chitosan and Egg White Proteins: Membrane Preparation and Adsorption Efficiency

Chen YS, Ooi CW, Show PL, Hoe BC, Chai WS, Chiu CY, et al.

Membranes (Basel), 2022 Jan 01;12(1).
PMID: 35054589 DOI: 10.3390/membranes12010063

Electrospun polyacrylonitrile (PAN) nanofiber membrane was functionalized with chitosan and proteins for use in the treatment of dye-containing wastewater. The PAN nanofiber membrane was subjected to alkaline hydrolysis, before being grafted with chitosan and subsequently the proteins from chicken egg white. The resultant nanofiber membrane (P-COOH-CS-CEW) was comprehensively characterized using thermogravimetric analysis, Fourier-transform infrared spectroscopy, and scanning electron microscopy. The efficiency of P-COOH-CS-CEW in removing cationic dye toluidine blue O (TBO) and anionic dye acid orange 7 (AO7) in aqueous solution was evaluated. Based on the performance of model fitting, Langmuir and pseudo-second-order kinetic model could be used to describe the performance of P-COOH-CS-CEW in the removal of TBO (pH 10) and AO7 (pH 2) from the dye solutions. The adsorbed TBO and AO7 dyes can be completely desorbed by an elution solution made of 50% (v/v) ethanol and 1 M sodium chloride. After five consecutive adsorption-desorption cycles, the efficiency of dye removal by P-COOH-CS-CEW was maintained above 97%.
Fulltext Rosmarinic acid exhibits broad anti-enterovirus A71 activity by inhibiting the interaction between the five-fold axis of capsid VP1 and cognate sulfated receptors

Hsieh CF, Jheng JR, Lin GH, Chen YL, Ho JY, Liu CJ, et al.

Emerg Microbes Infect, 2020 Dec;9(1):1194-1205.
PMID: 32397909 DOI: 10.1080/22221751.2020.1767512

Enterovirus A71 (EV-A71), a positive-stranded RNA virus of the Picornaviridae family, may cause neurological complications or fatality in children. We examined specific factors responsible for this virulence using a chemical genetics approach. Known compounds from an anti-EV-A71 herbal medicine, Salvia miltiorrhiza (Danshen), were screened for anti-EV-A71. We identified a natural product, rosmarinic acid (RA), as a potential inhibitor of EV-A71 by cell-based antiviral assay and in vivo mouse model. Results also show that RA may affect the early stage of viral infection and may target viral particles directly, thereby interfering with virus-P-selectin glycoprotein ligand-1 (PSGL1) and virus-heparan sulfate interactions without abolishing the interaction between the virus and scavenger receptor B2 (SCARB2). Sequencing of the plaque-purified RA-resistant viruses revealed a N104K mutation in the five-fold axis of the structural protein VP1, which contains positively charged amino acids reportedly associated with virus-PSGL1 and virus-heparan sulfate interactions via electrostatic attraction. The plasmid-derived recombinant virus harbouring this mutation was confirmed to be refractory to RA inhibition. Receptor pull-down showed that this non-positively charged VP1-N104 is critical for virus binding to heparan sulfate. As the VP1-N104 residue is conserved among different EV-A71 strains, RA may be useful for inhibiting EV-A71 infection, even for emergent virus variants. Our study provides insight into the molecular mechanism of virus-host interactions and identifies a promising new class of inhibitors based on its antiviral activity and broad spectrum effects against a range of EV-A71.

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