Increased family history documentation in internal medicine resident continuity clinic at a community hospital through resident-led structured genetic education program.

We aim to assess residents' perspectives and clinical utility of obtaining family history (FH) as well as to improve the rate of FH documentation in electronic medical record (EMR) at an internal medicine resident continuity clinic at a community hospital. The residents' perspectives were assessed with questionnaires. The study period was divided into the first 10-week Phase 1 in which genetic education interventions were delivered by residents, and the second 10-week Phase 2 with minimal intervention. FH documentation in EMR was reviewed and compared to a 4-week baseline (Phase 0). We found that time constraint was the most reported barrier. We reviewed 1197 patient visits; FH was recorded in 34% (67/200), 52% (272/522), and 50% (239/475) during Phase 0, Phase1, and Phase 2, respectively. Genetic education significantly increased the rate of FH documentation in Phase 1 from baseline, which was maintained in Phase 2 despite removal of interventions. The mean age of patients with documented FH was younger than those without documentation (48 years vs 51 years; p < 0.001). Documented FH of cancers and coronary artery disease lacked important details, such as age at diagnosis, in 62% (86/138) and 51% (41/81) of them, respectively. Out of 511 patients that had documented FH, we identified 66 patients (13%) where positive family history could alter medical management. In conclusion, resident-led structured genetic education effectively increased family history documentation in EMR in internal medicine resident continuity clinic and showed clinical utility.

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion.

El Síndrome de Takotsubo es una disfunción ventricular aguda reversible en ausencia de obstrucción coronaria. Una mujer de 85 años de edad con antecedentes de reemplazo valvular aórtico transcatéter, ingresó por dos semanas de dolor severo por una cadera desplazada por osteosíntesis fallida. Mientras se programaba para cirugía, se documentó hiponatremia severa secundaria a secreción inapropiada de hormona antidiurética. Súbitamente desarrolló edema agudo pulmonar. El ecocardiograma confirmó una válvula protésica funcional y aquinesia medial y apical de las paredes del ventrículo izquierdo. Recibió tratamiento con ventilación mecánica no invasiva, restricción de líquidos y diuréticos. La hiponatremia y la cardiomiopatía resolvieron.Takotsubo syndrome is a form of acute reversible left ventricular dysfunction in the absence of coronary obstruction. An 85-year-old lady with a medical history of transcatheter aortic valve replacement was readmitted complaining of 2 weeks of severe pain by a displaced hip and failed osteosynthesis. While she was scheduled for hip surgery, severe hyponatremia secondary to inappropriate antidiuretic hormone secretion was documented, and sudden-onset pulmonary edema ensued. Echocardiography confirmed normally functioning aortic prosthetic valve and classical features of Takotsubo. She was treated with non-invasive mechanical ventilation, water restriction, and diuretics. Hyponatremia and the cardiomyopathy resolved and the patient recovered completely.