J Y Lukoff | PubMed Health

PubMed1999

Validation of an XML-based process to automatically web-enable clinical practice guidelines: experience with the smoking cessation guideline.

OBJECTIVES: To validate the ease by which a Clinical Practice Guideline (CPG) can be web-enabled using an XML-based semi-automated process. DESIGN AND IMPLEMENTATION: An XML DTD for Clinical Practice Guidelines and an MS Word authoring template were created in an earlier project. We took an existing guideline, Bedside Smoking Cessation Intervention, placed it into the MS Word template, converted it into XML, and then to HTML for deployment over the Kaiser Permanent intranet. CONCLUSIONS: We were able to use the MS Word authoring template and automatically generate both an XML representation of our guideline, and an HTML representation, which we have deployed on our intranet. The Bedside Smoking Cessation Intervention guideline was automatically merged into the online guidelines collection. Placing it on our intranet allowed for rapid and easy access by physicians and other health care providers throughout the Kaiser Permanente Medical Care Program.

Humans↗

PubMed1979

Munchausen syndrome by proxy: definition of factitious bleeding in an infant by 51Cr labeling of erythrocytes.

The Munchausen syndrome by proxy is a phenomenon in which symptoms of a disease are fabricated by some person other than the patient. This report describes and 8-week-old infant with repetitive bleeding episodes, presumably originating from the upper respiratory tract. Extensive investigations, including angiography, several endoscopies under general anesthesia, and reinfusion of the infant's red cells labeled with 51Cr followed by pulmonary and upper airway scanning, failed to reveal the source of bleeding. Within two weeks after initiation of the 51Cr studies, radioactivity of facial blood from two separate bleeding episodes did not exceed background counts. Simultaneous examination of the infant's capillary blood, however, showed moderate to marked radioactivity. The Rh subtype of the facial blood was cc, whereas the infant's type was Cc. These findings indicated that the facial blood was factitious in origin. No further "bleeding" occurred after this information was presented to the parents. This case represents an unusual example of the Munchausen syndrome by proxy. Awareness of this entity can prevent potentially harmful investigations. Documenting its occurrence and sharing the information with parents in a nonaccusatory manner may prevent future harm to the patient.

Diagnosis, Differential↗