Michelle Jong
Email Address
gmsmj@nus.edu.sg
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Publication Measuring the quality of care of diabetic patients at the Specialist Outpatient Clinics in Public Hospitals in Singapore(2007-12) Toh, M.P.H.S.; Bee, H.H.; Chee, F.S.; Jong, M.; Siok, B.C.; Cheah, J.T.S.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'PORE; COMMUNITY,OCCUPATIONAL & FAMILY MEDICINEIntroduction: This study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group. Materials and Methods: The cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those co-managed by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version T 3.0. Results: A total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (PPublication Multiple endocrinopathies associated with lithium therapy(Endocrine Practice, 2007) Dalan R.; Leow M.K.S.; Jong M.; MEDICINE; DUKE-NUS MEDICAL SCHOOLObjective: To illustrate a case of lithium-associated primary hyperparathyroidism, thyrotoxicosis, and nephrogenic diabetes insipidus and to discuss the potential mechanisms for these complications. Methods: We describe the clinical and laboratory findings in our current patient and review the related medical literature. Results: A 65-year-old Chinese woman with bipolar affective disorder, who had received maintenance lithium therapy for 10 years, was seen in an acute care hospital because of fever and confusion. Investigations showed that she had primary hyperparathyroidism and hyperthyroidism. She underwent a parathyroidectomy, which revealed a parathyroid adenoma. Her initial subclinical hyperthyroidism evolved into overt hyperthyroidism after use of lithium was discontinued. Therapy was initiated with carbimazole, which was up-titrated briefly; the patient was subsequently weaned off this medication. Her postoperative course was complicated by persistent polyuria in conjunction with a negative fluid balance, consistent with nephrogenic diabetes insipidus. Thus, amiloride therapy was instituted. The results of an objective causality assessment suggested that the primary hyperparathyroidism, hyperthyroidism, and nephrogenic diabetes insipidus were possibly or probably related to the lithium therapy. Conclusion: Lithium remains an intriguing drug with numerous potential endocrinologic complications. It is important that clinicians prescribing lithium are aware of its side effects and have a strategy for their detection and management. 2007 AACE.Publication Latent tuberculosis in patients with diabetes mellitus: prevalence, progression and public health implications(2014) Leow M.K.; Dalan R.; Chee C.B.; Earnest A.; Chew D.E.; Tan A.W.; Kon W.Y.; Jong M.; Barkham T.; Wang Y.T.; MEDICINE; MICROBIOLOGY AND IMMUNOLOGY; DUKE-NUS MEDICAL SCHOOLBACKGROUND: Diabetes mellitus (DM) confers a higher risk for tuberculosis (TB). Yet, TB screening and chemoprophylaxis for latent TB infection (LTBI) in DM remains controversial. We conducted a cross-sectional study to elucidate LTBI prevalence and longitudinal follow-up to ascertain LTBI to active TB progression rate in DM.METHODS: 220 DM patients without previous TB from the outpatient diabetes clinic of the hospital were enrolled. T-Spot TB, tuberculin-skin-test (TST) and chest radiography (CXR) were performed. LTBI was defined by negative CXR with reactive T-Spot TB. Progression to active TB was confirmed by cross-checking against the TB registry.RESULTS: The prevalence of LTBI was 28.2% (62/220) by reactive T-Spot. None progressed to active TB from 2007-2013. Multivariate analysis revealed that any co-morbidity (p=0.016) was positively associated while metformin (p=0.008) was negatively associated with LTBI.CONCLUSIONS: Over a quarter of DM patients harbor LTBI. While the lack of demonstrable progression to active TB within the follow-up time frame up to this point does not unequivocally support a routine TB screening policy or anti-TB chemoprophylaxis for LTBI in a diabetic population for now, this preliminary evidence needs re-evaluation with longer follow-up of this enrolled cohort over the next decade. J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart New York.Publication VIPoma in a 37-year-old man(Lancet Publishing Group, 2013) Lam S.; Liew H.; Khor H.T.; Dalan R.; Kon Y.C.; Jong M.; Chew D.E.K.; Leow M.K.-S.; MEDICINE; DUKE-NUS MEDICAL SCHOOLPublication Predictors of cardiovascular complication in patients with diabetes mellitus: A 5-year follow-up study in a multiethnic population of Singapore: CREDENCE II study(Elsevier Ireland Ltd, 2013) Dalan R.; Jong M.; Choo R.; Chew D.E.K.; Leow M.K.S.; MEDICINE; DUKE-NUS MEDICAL SCHOOL