Maudrene Tan - Academia.edu (original) (raw)

Papers by Maudrene Tan

Annals of the Academy of Medicine, Singapore

Introduction: The Short Form-12 version 2 (SF-12v2) is a shorter version of the Short Form-36 ver... more Introduction: The Short Form-12 version 2 (SF-12v2) is a shorter version of the Short Form-36 version 2 (SF-36v2) for assessing health-related quality of life. As the SF-12v2 could not be resolved into the physical- and mental-component summary score (PCS and MCS, respectively) in the general population of Singapore, this study aims to determine and validate the Singapore SF-12 version 2 (SG-12v2). Materials and Methods: The SG-12v2 was generated using the same methodology as the SF-12v2. Bootstrap analysis was used to determine if the SG-12v2 were significantly different from the SF-12v2. Content validity was assessed using percentage of variance (R²) of the Singapore version of SF-36v2 PCS and MCS explained by the SG-12v2 items. Agreement between the SF-36v2 and the SG-12v2 was assessed using Bland-Altman diagrams. Criterion validity was demonstrated if effect size differences between SF-36v2 and SG-12v2 were small (Cohen’s criteria). Known-group validity of SG-12v2 was reported f...

Illustrative inpatient blood glucose datasets for QcDM project

Glucometrics is a set of measures designed to assess whether the blood glucose of patients with d... more Glucometrics is a set of measures designed to assess whether the blood glucose of patients with diabetes mellitus are effectively managed, and is useful in regular surveillance for adverse events such as hypoglycaemia and hyperglycaemia. To evaluate the quality of glycemic control using glucometrics, routinely collected blood glucose data needs to be consolidated, processed, and analysed in different units of analysis (i.e., patient-sample, patient-day, and patient-stay). Such procedure is challenging without dedicated manpower with specific professional skills. We developed an open-source tool with a user-friendly graphical interface, named the Quality care for Diabetes Mellitus (QcDM) Project (available at: https://github.com/nyilin/QcDM_Project), to facilitate the monitoring of the quality of inpatient glycemic control. To illustrate the usage of the tool, we provide two datasets: test_format1.csv to generate glucometrics for monitoring glucose readings in an inpatient setting, a...

Additional file 1 of Evaluating the effectiveness of a multi-faceted inpatient diabetes management program among hospitalised patients with diabetes mellitus

Additional file 1: Table S1. Profiles of admissions within the 3 months period prior implementati... more Additional file 1: Table S1. Profiles of admissions within the 3 months period prior implementation, the first 3 months and subsequent 3 months of post-implementation at each of the 7 phases. Table S2. Comparison of key patient-day and admission glucometrics within the 3 months period prior implementation, the first 3 months and subsequent 3 months of post-implementation at each of the 7 phases

RESEARCH ARTICLE Psychometric Properties of the Problem Areas in Diabetes (PAID) Instrument in Singapore

Background Emotional distress is an important dimension in diabetes, and several instruments have... more Background Emotional distress is an important dimension in diabetes, and several instruments have been developed to measure this aspect. The Problem Areas in Diabetes (PAID) scale is one such instrument which has demonstrated validity and reliability in Western populations, but its psychometric properties in Asian populations have not been examined. Methods This was a secondary analysis of data from patients with Type 2 diabetes mellitus recruited through convenience sampling from a diabetes specialist outpatient clinic in Singapore. The following psychometric properties were assessed: Construct validity through confirmatory factor analysis (CFA) and Rasch analysis, concurrent validity through correlation with related scales (Kessler Psychological Distress Scale, Diabetes Health Profile—psychologi-cal distress, Audit of Diabetes Dependent Quality of Life), reliability through assessment of internal consistency and floor and ceiling effects, and sensitivity by estimating effect sizes...

RESEARCH ARTICLE Open Access The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations

Background: Identification of high-risk individuals is crucial for effective implementation of ty... more Background: Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown. Methods: Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model. Results: The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. H...

Journal of the Endocrine Society, 2021

Introduction: External counter-pulsation (ECP) involves cuff inflation over the lower extremities... more Introduction: External counter-pulsation (ECP) involves cuff inflation over the lower extremities to generate sheer stress, thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. We hypothesized that 1) ECP will be associated with an improvement in endothelial function in T2DM as measured by peripheral artery tonometry, and 2) explored whether this would vary with different dose and frequency regimens. A shorter or less intensive regimen could potentially reduce cost and improve patient compliance if a similar therapeutic response is achieved. Methods: This single-center prospective study in a tertiary institute in Singapore involving 46 adults with T2DM of HbA1c between 7 to 10%, who were randomly assigned to receive 35 sessions of ECP at different regimens and duration. Subjects in arm 1 received 1-hour daily sessions 5x per week for 7 consecutive weeks, subjects in arm 2 receive...

The European health psychologist, 2016

This study uses the results from the baseline of a prospective study that was conducted at the ou... more This study uses the results from the baseline of a prospective study that was conducted at the outpatient Endocrinology clinic of the National University Hospital. All adult patients aged 21-64 years, diagnosed with T2DM for at least 1 year, literate in English and able to consent and comply with the study protocol were included. Patients with active cardiovascular disease such as unstable angina or recent coronary artery bypass, liver

JAMIA Open, 2021

Objectives The objective of this study is to facilitate monitoring of the quality of inpatient gl... more Objectives The objective of this study is to facilitate monitoring of the quality of inpatient glycemic control by providing an open-source tool to compute glucometrics. To allay regulatory and privacy concerns, the tool is usable locally; no data are uploaded to the internet. Materials and Methods We extended code, initially developed for healthcare analytics research, to serve the clinical need for quality monitoring of diabetes. We built an application, with a graphical interface, which can be run locally without any internet connection. Results We verified that our code produced results identical to prior work in glucometrics. We extended the prior work by including additional metrics and by providing user customizability. The software has been used at an academic healthcare institution. Conclusion We successfully translated code used for research methods into an open source, user-friendly tool which hospitals may use to expedite quality measure computation for the management of...

848-P: Assessing Impact of Proactive Interventions in Patients with Near-Hypoglycemia

Diabetes, 2021

Effects of external counter-pulsation on endothelial function assessed by peripheral artery tonometry, levels of glycaemia and metabolic markers in individuals with type 2 diabetes mellitus

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020

BACKGROUND AND AIMS External counter-pulsation (ECP) generates sheer stress thereby improving end... more BACKGROUND AND AIMS External counter-pulsation (ECP) generates sheer stress thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. The aim of this pilot study was to investigate the use of ECP at different doses in improving endothelial function and glycaemic markers in T2DM. METHODS This prospective study involved 46 subjects with T2DM randomly assigned to receive 35 sessions of ECP at different regimens (0.5 h versus 1 h) and duration (7 versus 12 weeks). Endothelial function was evaluated by reactive hyperaemia index (RHI) via peripheral arterial tonometry at the start, midpoint and end of study. Other secondary outcomes included fasting glucose, HOMA-IR, HbA1c, blood pressure, lipid profile, weight and vibration sense. RESULTS There was no change in RHI across all 3 regimens of ECP individually or collectively at the end of the study (ΔRHI +0.01%, p = 0.458). Glycaemic markers also remained unchanged at endpoint. Subgroup analysis showed an improvement in RHI (ΔRHI +20.6%, p = 0.0178) in subjects with more severe endothelial dysfunction at baseline. CONCLUSION ECP did not show a beneficial effect on endothelial function or glycemic control in this South-East Asian population with T2DM at any of the three regimens. This may partly be explained by less severe endothelial dysfunction and less insulin resistance in our population at baseline.

Clinical Diabetes and Endocrinology, 2020

Background Diabetes mellitus (DM) is one of the most common chronic diseases. Individuals with DM... more Background Diabetes mellitus (DM) is one of the most common chronic diseases. Individuals with DM are more likely to be hospitalised and stay longer than those without DM. Inpatient hypoglycemia and hyperglycemia, which are associated with adverse outcomes, are common, but can be prevented through hospital quality improvement programs. Methods We designed a multi-faceted intervention program with the aim of reducing inpatient hypoglycemia and hyperglycemia. This was implemented over seven phases between September 2013 to January 2016, and covered all the non-critical care wards in a tertiary hospital. The program represented a pragmatic approach that leveraged on existing resources and infrastructure within the hospital. We calculated glucometric outcomes in June to August 2016 and compared them with those in June to August 2013 to assess the overall effectiveness of the program. We used regression models with generalised estimating equations to adjust for potential confounders and ...

International Journal of Medical Informatics, 2018

Background: Measuring adherence to processes is one of the established ways to quantify the quali... more Background: Measuring adherence to processes is one of the established ways to quantify the quality of healthcare. Providing timely feedback to healthcare workers on the level of adherence can improve process measures. However, it is challenging to present data on adherence to repetitive time-sensitive tasks in a clear manner. Objectives: We used inpatient glucose monitoring as a test case to explore the feasibility of using visualizations to communicate adherence to repetitive scheduled tasks to healthcare workers. Methods: We selected four candidate plots that represented distribution across time: histogram, probability density function plot (pdf plot), violin plot and cumulative density function plot (cdf plot). Doctors and nurses involved in inpatient diabetes care in a tertiary hospital were invited to complete a self-administered questionnaire that measured self-reported baseline knowledge, performance, and perception towards the visualizations. Performance was assessed by determining if a participant was Conclusions: Adherence to repetitive time-sensitive tasks can be presented in the form of visualizations. However, nurses' and doctors' knowledge and understanding of these visualizations are generally poor. This may influence their perception of usability of these plots. Therefore, these visualizations need to be implemented in tandem with training on their interpretation, to enhance the usefulness of these plots in motivating quality improvement.

Problem Areas in Diabetes Scale--Abridged Version

PsycTESTS Dataset, 2015

PloS one, 2015

Emotional distress is an important dimension in diabetes, and several instruments have been devel... more Emotional distress is an important dimension in diabetes, and several instruments have been developed to measure this aspect. The Problem Areas in Diabetes (PAID) scale is one such instrument which has demonstrated validity and reliability in Western populations, but its psychometric properties in Asian populations have not been examined. This was a secondary analysis of data from patients with Type 2 diabetes mellitus recruited through convenience sampling from a diabetes specialist outpatient clinic in Singapore. The following psychometric properties were assessed: Construct validity through confirmatory factor analysis (CFA) and Rasch analysis, concurrent validity through correlation with related scales (Kessler Psychological Distress Scale, Diabetes Health Profile-psychological distress, Audit of Diabetes Dependent Quality of Life), reliability through assessment of internal consistency and floor and ceiling effects, and sensitivity by estimating effect sizes for known clinical ...

Annals of the Academy of Medicine, Singapore, 2013

Few studies in Asia have assessed the burden of hypercholesterolaemia based on the global cardiov... more Few studies in Asia have assessed the burden of hypercholesterolaemia based on the global cardiovascular risk assessment. This study determines the burden of hypercholesterolaemia in an Asian population based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) guidelines, and examines predictors of low-density lipoprotein cholesterol (LDL-C) goal attainment. Five thousand and eighty-three Chinese, Malays and Asian-Indians living in Singapore were assigned to coronary heart disease (CHD)-risk category based on the NCEP-ATPIII guidelines. Awareness, treatment and control of hypercholesterolaemia based on risk- specific LDL-C goal were determined, including the use of lipid-lowering therapy (LLT). Cox-regression models were used to identify predictors of LDL-C above goal among those who were aware and unaware of hypercholesterolaemia. One thousand five hundred and sixty-eight (30.8%) participants were aware of hypercholesterolaemia and 877 (17.3%) were...

Nutrition & diabetes, 2011

Statin therapy reduces coronary heart disease (CHD) and mortality in individuals with elevated C-... more Statin therapy reduces coronary heart disease (CHD) and mortality in individuals with elevated C-reactive protein (CRP) but low-density lipoprotein cholesterol below the threshold at which statin therapy is recommended. We determined the proportion of individuals with elevated CRP in whom statin therapy was not indicated, and examined predictors for elevated CRP in a multi-ethnic Asian population. We studied 3404 participants (Chinese, Malays and Asian-Indians) without a history of hypercholesterolemia living in Singapore (mean age±s.d.: 48.9±11.2 years). Eligibility for statin therapy was determined based on the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III (ATPIII)) guideline. CRP was measured by high-sensitivity enzyme-linked immunosorbent assay method. CRP level greater than 2 mg l(-1) was considered as elevated. Elevated CRP was found in 29.3% participants who were...

PLoS ONE, 2014

Aims: To establish a thematic framework for a Diabetes Mellitus (DM)-specific health-related qual... more Aims: To establish a thematic framework for a Diabetes Mellitus (DM)-specific health-related quality of life (HRQoL) item bank by identifying important HRQoL themes and content gaps in existing DM-specific HRQoL measures and determining whether Patient-Reported Outcomes Measurement Information System (PROMIS) item banks are useful as a starting point. Methodology: English-speaking Type 2 DM patients were recruited from an outpatient specialist clinic in Singapore. Thematic analysis was performed through open coding and axial coding. Items from four existing DM-specific measures and PROMIS Version 1.0 and 2.0 item banks were compared with identified themes and sub-themes. Results: 42 patients participated (25 men and 17 women; 28 Chinese, 4 Malay, 8 Indians, 2 other ethnicities). Median age was 53.70 years (IQR45.82-56.97) and the median disease duration was 11.13 (SD9.77) years. 10 subthemes (neutral emotions, coping emotions, empowered to help others, support from family, spend more time with family, relationships, financial burden on family, improved relationship, social support and religion/spirituality) were not covered by existing

Diabetes Research and Clinical Practice, 2008

Aim: To evaluate family history (FH) of type 2 diabetes (T2DM) as a risk factor for impaired fast... more Aim: To evaluate family history (FH) of type 2 diabetes (T2DM) as a risk factor for impaired fasting glucose (IFG), impaired glucose tolerance (IGT), T2DM and related metabolic traits in South East Asia and to compare the effects of a paternal versus maternal history. Methods: We studied 4717 men and women (68% Chinese, 18% Malays and 14% Asian Indians) living in Singapore. FH was considered positive if at least one first degree relative had T2DM. Obesity, fasting lipids, glucose and insulin levels were measured for all subjects. Insulin resistance (IR) was estimated by homeostasis model assessment (HOMA). An oral glucose tolerance test was carried for all subjects except those on diabetes medication. Results: A positive FH was associated with increased risk of IFG/IGT (OR = 1.67, 95% CI = 1.42-1.97) and T2DM (OR = 2.95, 95% CI = 2.36-3.70) as well as higher levels of obesity, HOMA-IR, fasting triglyceride (TG), and lower levels of high density lipoprotein (HDL) cholesterol and HOMA-b. A maternal history of T2DM appeared to have a greater impact on obesity-related traits than a paternal history of T2DM. Compared to individuals with no FH of T2DM, a maternal history was associated with (i) greater body mass index (BMI) (24.15 kg/m 2 vs. 23.42 kg/m 2 , p = 0.016) and waist-to-hip ratio (WHR) (0.874 vs. 0.865, p = 0.037) in men; and (ii) greater WHR (0.788 vs. 0.779, p = 0.004), fasting triglyceride (1.23 mmol/L vs. 1.09 mmol/L, p < 0.001), HOMA-IR (2.02 vs. 1.75, p < 0.001), fasting plasma glucose (5.25 mmol/L vs.

BMC Medical Research Methodology, 2012

Background Identification of high-risk individuals is crucial for effective implementation of typ... more Background Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown. Methods Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model. Results The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. Howe...

Quality of Life Research, 2012

Purpose Obesity adversely affects health-related quality of life (HRQoL). Most studies have used ... more Purpose Obesity adversely affects health-related quality of life (HRQoL). Most studies have used body mass index (BMI) to measure obesity. Other measures of obesity, such as waist circumference (WC) or waist-to-hip ratio (WHR), may be better predictors of cardiovascular disease and mortality. We, therefore, examined the associations between other anthropometric measures and HRQoL in a multi-ethnic Asian population. Methods In this follow-up study from four previous crosssectional surveys, HRQoL was measured, at follow-up, using the Short-Form 36 version 2 (SF-36v2) questionnaire. Linear regression was used to assess the relationship between anthropometric measures [BMI, WC, waist residuals (WR) (generated by regressing WC on BMI), WHR, waist-toheight ratio (WHtR) and height (Ht)] and HRQoL. We compared the models' R 2 , Akaike's information criteria (AIC), and Schwarz Bayesian information criteria (BIC) from the different models. Results Among 4,981 subjects, 47.6 % were men aged 50.6 ± 12.2 and women aged 49.3 ± 11.6 years. All gender-specific anthropometric measures were significantly correlated with BMI, except WR. After adjusting for known determinants of HRQoL, we found significant associations between BMI, WC and WHtR with SF-36v2 Physical Component Summary (PCS) scores in women but not men. In contrast, after adjusting for known determinants of HRQoL, WR and WHR were significantly associated with SF-36v2 Mental Component Summary (MCS) scores in men, but not women. R 2 , AIC and BIC were similar for all anthropometric measures in the final model. Conclusions The associations between measures of central obesity and HRQoL differed between men and women. In women, associations were seen with SF-36v2 PCS, but measures of central obesity did not have significant associations with HRQoL after controlling for BMI. In men, an association between WC and SF-36v2 MCS was statistically significant independent of BMI. These gender differences require further investigation.