Associate Professor Wilson Tam from the National University of Singapore’s Alice Lee Centre for Nursing Studies (NUS Nursing) is one of the world’s most highly cited researchers, based on the Highly Cited Researchers 2022 List published by data analytics firm Clarivate.

Associate Professor Wilson Tam from the National University of Singapore’s Alice Lee Centre for Nursing Studies (NUS Nursing) is one of the world’s most highly cited researchers. 

As the Director of Research at NUS Nursing, Assoc Prof Tam is an epidemiologist and statistician by training. He shares his thoughts of being one of the most influential researchers whose papers rank in the top 1 per cent by citations for field and publication year, in the Web of Science citation index over the past decade.

How do you feel, as one of the most cited researchers?

Of course, it is my honour to be included in the list of most cited researchers as it may be a once-in-a-lifetime opportunity. I could not believe I’d really be in the list until I received the formal notification from Clarivate on 15 Nov.

I am heartened that there are many excellent collaborators within NUS, I have worked with many of them, and they were all invaluable experiences.

What are your research interests, and why are you interested in studying these areas?

My primary research interest is the exploration of the risk factors to cardiovascular diseases –including factors such as air pollution, sleep disorders, obesity, and mental wellbeing.

I believe once we identify the risk factors, we can develop useful interventions to improve the health outcomes. For example, we recently completed a randomized controlled trial to explore the effectiveness of lifestyle modification in improving the metabolic profile of those with obesity and obstructive sleep apnea [1]. I was also involved in a project to explore the association between air quality and the risk of out-of-hospital cardiac arrest in Singapore [2]. These are projects and topics that deeply interest me, and they inspire me to keep going in my research.

Besides studies related to cardiovascular diseases, I also explore the methodological issues in conducting epidemiological studies, simply because it is essential to use appropriate methods when conducting research. One of the studies we completed recently is the evaluation of the methodological and reporting quality of the individual patient data meta-analysis [3].

What are some of your most cited works?

I was very fortunate to have been involved in some important research projects on the Severe Acute Respiratory Syndrome (SARS) and COVID-19 diseases. Two of my highly cited papers were centred on the investigation of the SARS outbreak in hospitals and the community [4, 5] and together, they garnered over 200 citations over the last two years.

I also collaborated with Prof Roger Ho from the Department of Psychological Medicine at NUS Medicine on studies about the psychological impacts of COVID-19 on healthcare workers and patients.

They are titled “Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce” [6] and “Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry” [7].

The research was conducted at the early stage of the COVID-19 outbreak, to examine the psychological impacts of COVID-19 on workers and patients, and two of those papers have received an extremely high number of citations over the last 2 years, around 350 and 570 respectively [6, 7].

How do you apply statistics and epidemiology to nursing?

I believe that both epidemiology and statistics are key to conducting any nursing or health research.

Epidemiology provides insights into the frequency and distribution of diseases in populations and its determinants. This contributes to the identification of appropriate targets for health interventions, and the evaluation of health promotion initiatives. Statistics provides various methods and tools for researchers to reveal meaning from the data in order to make conclusions.

Therefore, I think the basic knowledge of epidemiology and statistics is the prerequisite for conducting nursing research, though not limited to any specific area. I marry both disciplines and use my knowledge in epidemiology to design and implement studies to answer various research questions, and then apply appropriate statistical methods to analyse the data, in order to get a reliable conclusion. 

Relating this to your research work on the psychological impacts of COVID-19 on workers and patients, how have epidemiology and statistics been used?

These papers involved the use of different epidemiological study designs, quantitative methods, (cross-sectional e-surveys) [6, 7], qualitative methods (individual interviews) [8], and mixed methods [9].

In term of statistics, we used descriptive statistics (e.g. mean, standard deviation, median, inter-quartile range), inferential statistics (independent samples t-test, Chi-square test), and statistical modelling (e.g. Multiple Linear Regression, Logistic Regression).

These methods were paramount, as it helped us with the study of 673 workers (551 Workers and Technical staff; 122 Management and executive staff) and 185 patients (76 Psychiatric patients; 109 Healthy subjects), giving us insight into the stress conditions among the worker and patient populations, to identify appropriate intervention methods.

With these methods, we could analyse the factors that contributed to the alleviation of stress levels among workers returning to work during the pandemic, such as personal psychoneuroimmunity prevention measures like hand hygiene and wearing face masks, and organisational measures such as improving workplace hygiene and addressing employee concerns. It also allowed us to identify that people with psychiatric illnesses were significantly more likely to endorse higher levels of PTSD, depression, anxiety, stress, and insomnia scores (compared to healthy people) at the peak of the pandemic.

The results suggested the need for a new immunopsychiatry service to be implemented during the COVID-19 pandemic to disseminate management plans with psychiatric patients, via platforms like tele-psychiatry consultations. All these were done through the complex and intriguing disciplines of epidemiology and statistics.

The application of data analytics to healthcare is pivotal and yet overlooked by many. Could you share about the importance of its application to nursing?

It is really an interesting question. Did you know that Florence Nightingale (known as “The Lady With the Lamp”), was deemed as one of the pioneer statisticians who used data visualization and analysis, through simple graphs or numbers, to improve healthcare for patients during the Crimean war? This shows that the use of data analytics is not a novel concept, and has been pivotal to healthcare since eons ago.

Nowadays, with the advancement of computer and internet, the volume of the data can be tremendous and complex. Hence, it is all the more essential to have robust data analytic methods on hand, to analyze the data for meaningful conclusions. I do believe that data analytics will soon become an indispensable component in healthcare.

What would you like to say to the research community in NUS Nursing?

I would like to thank my Head of Department, Prof Emily Ang, and my academic and administrative colleagues for their support over the years. They have been providing me with a very good environment to conduct research projects.

Although NUS Nursing is still very young, it is energetic. We are one of the top Nursing institutions in Asia. With many young talents joining us as research fellows and assistant professors, we’ll undoubtedly be able to achieve more in the near future.

References

[1] Ng, S. S. S., Tam, W. W. S., Lee, R. W. W., Chan, T. O., Yiu, K., Yuen, B. T. Y., Wong, K. T., Woo, J., Ma, R. C. W., Chan, K. K. P., Ko, F. W. S., Cistulli, P. A., & Hui, D. S. (2022). Effect of Weight Loss and Continuous Positive Airway Pressure on Obstructive Sleep Apnea and Metabolic Profile Stratified by Craniofacial Phenotype: A Randomized Clinical Trial. American journal of respiratory and critical care medicine, 205(6), 711–720. https://doi.org/10.1164/rccm.202106-1401OC

[2] Ho, A. F. W., Ho, J. S. Y., Tan, B. Y., Saffari, S. E., Yeo, J. W., Sia, C. H., Wang, M., Aik, J., Zheng, H., Morgan, G., Tam, W. W. S., Seow, W. J., Ong, M. E. H., & PAROS Singapore Investigators (2022). Air quality and the risk of out-of-hospital cardiac arrest in Singapore (PAROS): a time series analysis. The Lancet. Public health, 7(11), e932–e941. https://doi.org/10.1016/S2468-2667(22)00234-1

[3] Wang, H., Chen, Y., Lin, Y., Abesig, J., Wu, I. X., & Tam, W. (2021). The methodological quality of individual participant data meta-analysis on intervention effects: systematic review. BMJ (Clinical research ed.), 373, n736. https://doi.org/10.1136/bmj.n736

[4] Yu, I. T., Li, Y., Wong, T. W., Tam, W., Chan, A. T., Lee, J. H., Leung, D. Y., & Ho, T. (2004). Evidence of airborne transmission of the severe acute respiratory syndrome virus. The New England journal of medicine, 350(17), 1731–1739. https://doi.org/10.1056/NEJMoa032867

[5] Wong, T. W., Lee, C. K., Tam, W., Lau, J. T., Yu, T. S., Lui, S. F., Chan, P. K., Li, Y., Bresee, J. S., Sung, J. J., Parashar, U. D., & Outbreak Study Group (2004). Cluster of SARS among medical students exposed to single patient, Hong Kong. Emerging infectious diseases, 10(2), 269–276. https://doi.org/10.3201/eid1002.030452

[6] Tan, W., Hao, F., McIntyre, R. S., Jiang, L., Jiang, X., Zhang, L., Zhao, X., Zou, Y., Hu, Y., Luo, X., Zhang, Z., Lai, A., Ho, R., Tran, B., Ho, C., & Tam, W. (2020). Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce. Brain, behavior, and immunity, 87, 84–92. https://doi.org/10.1016/j.bbi.2020.04.055

[7] Hao, F., Tan, W., Jiang, L., Zhang, L., Zhao, X., Zou, Y., Hu, Y., Luo, X., Jiang, X., McIntyre, R. S., Tran, B., Sun, J., Zhang, Z., Ho, R., Ho, C., & Tam, W. (2020). Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain, behavior, and immunity, 87, 100–106. https://doi.org/10.1016/j.bbi.2020.04.069

[8] Woo, B. F. Y., Poon, S. N., Tam, W. W. S., & Zhou, W. (2022). The impact of COVID19 on advanced practice nursing education and practice: A qualitative study. International nursing review, 69(3), 330–339. https://doi.org/10.1111/inr.12732

[9] Hao, F., Tam, W., Hu, X., Tan, W., Jiang, L., Jiang, X., Zhang, L., Zhao, X., Zou, Y., Hu, Y., Luo, X., McIntyre, R. S., Quek, T., Tran, B. X., Zhang, Z., Pham, H. Q., Ho, C. S. H., & Ho, R. C. M. (2020). A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities. Translational psychiatry, 10(1), 355. https://doi.org/10.1038/s41398-020-01039-2