BIOSOFT HELP FILES

Mx :

Laryngospasm treatment depends on the underlying cause. For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. If laryngospasms are due to anxiety, then anti-anxiety meds can help ease your spasms.

Unfortunately, laryngospasms usually happen quickly. So, treatment often involves finding ways to stay calm during the episode. If you or someone you’re with is having a laryngospasm, you should:

Try not to panic or gasp for air. Remaining calm can help you relax more through the laryngospasm.
Take small sips of water. This will help wash away any irritants that may have come in contact with your vocal cords.
Apply pressure behind your earlobes. The soft spot behind your earlobes and just above your jaw is known as the laryngospasm notch. When you apply forceful pressure down and inward on this pressure point, it can help your vocal cords relax.

Very Frequent Attacks can be managed by treating :

But it can be a symptom of other conditions, including:

Asthma. People with asthma may experience laryngospasm after coming in contact with air pollution or breathing vigorously after exercise.
GERD (chronic acid reflux). Gastroesophageal reflux disease (GERD) causes stomach acid or undigested food to come back up into your esophagus (throat). Sometimes, this acid or debris also comes in contact with your larynx and triggers a laryngospasm.
Stress or anxiety disorders. Emotional responses like stress and anxiety can trigger laryngospasm. It’s your body’s physical response to an intense emotion that you’re feeling.
Sleep-related laryngospasm. Some people experience laryngospasm in their sleep and wake up gasping for air. Often, this is related to vocal cord dysfunction or acid reflux.
Anesthesia. In some cases, laryngospasm occurs during general anesthesia. This happens when the anesthesia or extubation (removal of the nose or throat tube) irritates your vocal cords. This type of laryngospasm is more common in certain individuals, including children, people undergoing surgery on their larynx or pharynx, and those with chronic obstructive pulmonary disease (COPD).
Laryngeal hypersensitivity (irritable larynx syndrome). If the mucosa of your upper airway is too sensitive, anything that stimulates it may cause a laryngospasm, such as cold air, talking loudly, coughing or eating certain foods.

https://my.clevelandclinic.org/health/diseases/22406-laryngospasm Accessed 6:55 PM 7/10/2024

REF - Rotenstein LS, Melnick ER, Sinsky CA. A Learning Health System Agenda for Organizational Approaches to Enhancing Occupational Well-being Among Clinicians. JAMA. 2022;327(21):2079–2080. doi:10.1001/jama.2022.7461

the last decade has deepened the understanding of clinicians’ occupational well-being, including
having characterized the prevalence of burnout (traditionally defined as Emotional Exhaustion,
Depersonalization, and a Reduced sense of personal accomplishment OR DEER) and the variation in
burnout across specialties and professions. Accordingly, addressing clinicians’ occupational well-being (hereafter referred to solely as well-being) has become a national priority, as evidenced by the focus of the National Academy of Medicine1 and the US surgeon general. The importance of this topic has been amplified by the effects of the COVID-19 pandemic, including clinicians experiencing deep exhaustion and concerns about their own safety, a proliferation of message- and technology-based care, and some clinicians reevaluating their desire to remain in the health care workforce. Evidence from before the pandemic has increased understanding of how well-being relates to quality of care2 and factors that might influence well-being, such as time spent using electronic health records, cognitive load, and team and leadership structures. THIS ARTICLE IS SEEN IN THIE REFERENCE
D://LIBRARY/eHealth-LearningHealthSysetms.pdf

These potential interventions could be considered
in 4 maincategories.

The first category,
new and adapted workflows, includes
ways of working that enhance the clinician experience whil ealso improving efficiency.
These could range from team-based workflow interventions, such as office visits with
substantial involvement of other team members, to optimized medication refill workflows.7

The second category, technologies,
could include artificial intelligence–powered documentation support,
which has the potential to significantly reduce documentation burdens, or
innovative information displays that enhance the processing of information necessary for
clinical care or population health interventions.

The third category, enhanced clinical supports,
might involve documentation assistance (whether in-person or remote) and other
administrative supports that facilitate clinician focus on clinical care and patient relationships.

The fourth category, clinician training, has the potential to support clinicians in managing change
and systems improvement, leading teams, and building strong organizational cultures

IN OTHER WORDS :
1. NEW WORFLOWS - TRADITIONAL WORKFLOWS ARE NOT GOING TO REAP HIT BENEFITS
2. HIT
3. CDSS
4. TRAINING

EMR-PHR-EHR
SHOULD FOCUS ON
1. DATA ENTRY
2. DATA CURATION
3. DOCUMENTATION SUPPORT
4. CDSS

MORE ON LEARNING HEALTH SYSTEMS

Learning health systems
Learning health systems are healthcare systems in which knowledge generation processes are
embedded in daily practice to produce continual improvement in care. Wikipedia

What does health learning system means?
AHRQ defines a learning health system as a health system in which internal data and
experience are systematically integrated with external evidence, and that knowledge is put into
practice. ... Employ IT methods to share new evidence with clinicians to improve decision-making.

About Learning Health Systems - AHRQ

What is the learning health system approach?
Learning health systems are organizations or networks that continuously self-study and adapt using
data and analytics to generate knowledge, engage stakeholders and implement behavior change
to transform practice.

Learning Health Systems - Michigan Medicine

What are the goals of a learning health system?
“A learning healthcare system is one that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care” [1].

The Learning Healthcare System: Where are we now? A ...

What is a learning system and how can healthcare benefit from it?
A learning health care system, that collects, analyzes, and reports on quality data in real-time, is
essential for achieving this goal. It would facilitate the capture of clinical and patient-reported data
in EHRs, allowing researchers to measure both the proficiency of care and patients' experiences
with care.

6, A Learning Health Care Information Technology System for Cancer - NCBIhttps://www.ncbi.nlm.nih.gov › books › NBK202143

What does the healthcare system do?
Image result
A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

MORE ON LEARNING HEALTH SYSTEMS LHS :
1. Connect LHS with AUDIT, BENCHMARKING
2. Connect LHS with ACTION RESEARCH - https://en.wikipedia.org/wiki/Action_research 8:12 AM 6/22/2022
3. Connect LHS with Kolb's Learning Cycle - https://www.simplypsychology.org/learning-kolb.html 8:14 AM 6/22/2022
Kolb's Learning Cycle - Remeber ERECT
Experience => REflection => Conceptualization => Testing => Experience

In LHS who learning what from whom ?
LHS the system must learn - this is not yet realizable ?
The system can cause the User to engage meaningfully in Learning

Abstract
Leg cramps are a common problem, especially in the elderly. The differential diagnosis is extensive and includes the following conditions: true cramps, such as those related to heat, hemodialysis, and electrolyte disturbances, as well as idiopathic cramps (the most common type); contractures occurring in conditions such as metabolic myopathies and thyroid disease; tetany, which is usually related to electrolyte disturbances, and dystonias, such as occupational cramps and those related to antipsychotic medications. Other leg problems that are not cramps, such as restless legs syndrome and periodic leg movements, also must be distinguished. The etiology of idiopathic leg cramps is not clear. Treatments for leg cramps include stretching exercises, quinine sulfate, and vitamin E, but no treatment is conclusively effective. Nonetheless, in many patients relief of symptoms is achieved with one or more of these treatments.

Riley JD, Antony SJ. Leg cramps: differential diagnosis and management. Am Fam Physician. 1995 Nov 1;52(6):1794-8. PMID: 7484689.

LEG CRAMPS FOR CMEOS ADULT
"Nocturnal Leg Cramps",
"age above 60 yrs",
"cramps sleep related",
"cramps at calf",
"cramps relieved by stretches",
"Attend to the risk factors - prolonged standing, walking, electrolyte imbalances, neurological disorders, hormonal and metabolic disturbances, nerve compressions, arterial compressions, diuretics, statins, and beta-blockers. Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/2024",

Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/2024

Exercise Associated Muscle Cramps, cramps during exercise, cramps after exercise,
Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/2024",

Writer Cramp, cramp in the writing hand, cramps between 30-50 yrs,
Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/202,

Cramp Fasciculation Syndrome, cramps in legs, cramps in upper limbs, cramps and fasciculation, cramps and numbness, cramps and burning sensation,
Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/202",

Secondary Cramps,
cramps,
chronic kidney disease,
diabetes,
amyotrophic lateral sclerosis,
cirrhosis,
drug-induced,
iron deficiency anemia,
Ref - Bordoni B, Sugumar K, Varacallo M. Muscle Cramps. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499895/ Accessed 12:18 PM 3/9/2024,

Myopathic Cramps,
cramps after prolonged exercise,
cramps during exercise,
cramps after exercise,
cramps with myoglobinuria,
cramps with muscle pain,
EMG studies diagnostic,
Ref - https://practicalneurology.com/articles/2019-aug-july/muscle-cramps Accessed 5:10 PM 3/9/2024,

1)      Shin splints – medial tibial stress syndrome – mid tibial or distal 1/3^rd tibial pain, pain is present even before the start of the activity like running, diffuser tenderness over a wider area over tibia and tibialis muscle, risk factors are poor flexibility, over-pronation (pes planus), internal tibial rotation (look for tibial rotation in a seated patient with both legs dangling over the edge of the bed, both eyes focusing along the longitudinal axis of both tibia from above), worn shoes, running on hard surfaces,

2)      Shin contusion – direct blow over the shin, ecchymosis, swelling,

3)      Tibial Stress Fracture – commonest stress fracture, runners, dancers, and jumpers, very localized area of pain in the tibia, usually at the junction of middle and distal 1/3^rd of the tibia, night pain, patient hopping on the affected leg severe pain  at the site (this test is also positive with femoral shaft/pelvic stress fractures), Ix – Xray with cone down view, MRI tibia,

4)       Chronic exertional compartment syndrome – leg pain, slow onset, usually bilateral, swelling of the affected limbs, predictable response for exercise – pain onset after the exercise, offset with 20 minutes of rest, pain recurs with exercise, risk factors are uneven exercise surface, worn out shoes, unacceptable training intensity, hindfoot pronation, Mx- Treat or modify the risk factors

5)      Varicose veins – leg pain worse with prolonged standing and relieved by leg elevation, heaviness of legs, mild nakle edema, skin ulceration, hyperpigmentation, recurrent episodes of superficial venous thrombosis, dilated tortuous leg veins, Mx – periodic elevation of legs, avoid prolonged standing,  elastic support hose, external compression stockings, sclerotherapy, surgical referral for intractable symptoms, recurrent superficial vein thrombosis, skin ulceration, cosmetic reasons.

6)      Superficial vein thrombosis – leg pain along the course of a superficial vein, the red, warm, tender, palpable cord of a vein, surrounding redness and swelling, Mx – NSAIDs and antibiotics.

7)      Recurrent bacterial lymphangitis – a patchy area of redness, warmth, swelling and tenderness, migrating proximally, with associated proximal site lymphadenopathy, distal leg swelling, and pain, maybe a precursor of lymphedema, Tx – NSAIDS, anti-streptococcal antibiotics

8)      Chronic venous insufficiency – leg pain worsens on standing and relieved by leg elevation, increased leg girth, edemas, superficial varicose veins, erythema, dermatitis, skin ulcers (can occur near both medial and lateral malleoli), hyperpigmentation of skin, recurrent cellulitis,  Mx – avoid prolonged standing, frequent leg elevations, graduated compression stockings, management of ulcers with wet/dry dressings with topical antibiotic solutions, and cellulitis with antibiotics.

9)      Deep venous thrombosis – iliac, femoral, popliteal veins – unilateral painful leg swelling, warmth, redness, tenderness along the vein, palpable vein like a cord, increased tissue turgor, distended superficial veins, prominent venous collaterals, dark blue discoloration of the leg, Ix and Mx see below.

10)    Deep venous thrombosis – calf veins – calf pain, swelling, posterior calf tenderness, warmth, increased tissue turgor, Homan’s sign positive (increased resistance or pain on ankle dorsiflexion), Ix – duplex venous ultrasonography, Doppler ultrasound, MRI, Mx – high risk for pulmonary embolism, chronic venous insufficiency, medical referral for further management.

1)      Growing pain

2)      Patellofemoral arthalgia

1)      Severe extremity pain disproportionate to the injury, paresthesiae or anesthesia to light touch, passive stretching of involved muscles very painful,  later pallor, pulseless limb, and muscle weakness appear (Acute exertional compartment syndrome) 

2)      Recent onset unilateral leg swelling in the presence of DVT risk factors

3)      Migrating superficial vein thrombosis (marker of carcinoma, vasculitis)

4)      Acute onset severe leg pain in a patient with Diabetes or peripheral vascular disease, paresthesiae, pallor, pulselessness (acute limb ischemia – within 6 hrs irreversible damage to muscles and nerves)

1)      Pain at a point just above the ankle after a minimal trauma, lower leg Xray AP may be almost normal but the lateral view may show the spiral fracture of the lower tibia (Toddler’s fracture or minimally displaced spiral fracture of lower tibia) 

(Leet and Skaggs 2000)

(Martinez 2008)

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
Advertising & Sponsorship

Statement of Intent
The Practice Guidelines and the Quick Reference Guides are not intended to be
construed or to serve as a standard of medical care. Standards of medical care are
determined on the basis of all clinical data available for an individual patient and
are subject to change as scientific knowledge and technology advance and practice
patterns evolve. These parameters of practice should be considered guidelines only.
Adherence to them will not ensure a successful outcome for every individual, nor
should they be interpreted as including all proper methods of care or excluding
other acceptable methods of care aimed at the same results. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by
the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available.
The development of the APA Practice Guidelines and Quick Reference Guides
has not been financially supported by any commercial organization. For more
detail, see APA’s “Practice Guideline Development Process,” available as an appendix to the compendium of APA practice guidelines, published by APPI, and online
at http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.

Severity scales
none, mild, moderate, severe, catastrophic,

Agreement
Strongly Agree, Agree, Undecided, Disagree. Strongly disagree

Frequency
Always, Often, Sometimes, Rarely, Never

Importance
Very important, Important, Moderately Important, Slightly Important, Unimportant

Quality
Excellent, Good, Fair, Poor, Very poor

Likelihood
Almost always true, Usually true, Occasionally True, Usually not True, Almost never true

Likelihood
Definitely, Probably, Possibly, Probably not (improbable), Definitely not (impossible)

Very Independent
Fairly Independent
Fairly Dependent
Very Dependent