Direct patient computer interviewing.
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Biomedical subjects
Publications and source records attributed to J H Greist.
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The Lithium Information Center's experience over the past 7 years is discussed. The center is a computer-based reference service which specializes in dissemination of information about the medical uses of lithium. At the heart of the center is the Lithium Library, a bibliographic retrieval system containing references to the lithium literature. More than 5,000 requests for literature searches and patient information have been answered by Lithium Library staff members since 1977. The center has recently expanded its services, creating the Lithium Index and Lithium Consultation, computerized programs that provide immediate answers to specific questions about lithium. The center's services are directed to patient care, lithium research, and medical and patient education. Because of topical specialization and use of computers, the Lithium Information Center has been able to provide more immediate, comprehensive, relevant, integrated, and up-to-date information than other bibliographic services.
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The Lithium Information Center is described as a response to the accelerated growth of information regarding a specific health care topic. The authors describe the body of literature that is managed by the Lithium Information Center, discuss how that information is stored and retrieved, indicate the advantages of this kind of information management compared to other health care information services, and note extraordinary peripheral ways in which the Center contributes to the continued growth of useful information about lithium and its therapeutic uses. It is concluded that the Center might be used as a model for others who wish to manage literature of content areas in which interest is increasing rapidly.
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The Lithium Index, a computer consultation program, was developed at the Lithium Information Center to quickly provide up-to-date information about lithium and its side effects. Information is contained in brief summaries that are compiled from the literature, organized by clinical topic, and written and retrieved by means of an interactive computer program. Computer-stored texts are easily updated to incorporate new information. The authors present an example that deals with the use of lithium during pregnancy, the most frequently requested topic.
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Direct patient-computer interviews were among the earliest applications of computing in medicine. Yet patient interviewing and other clinical applications have lagged behind fiscal, administrative, and research uses. Several reasons for delays in the development and implementation of clinical computing programs are discussed. Patient interviewing, clinician consultation, and other applications of clinical computing in mental health are reviewed, as well as changes that will facilitate their appropriate use.
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The authors examined the effect of strenuous exercise on the serum lithium levels of four healthy, conditioned athletes who were stabilized on lithium carbonate for 7 days and who ran a 20-km race under hot, humid conditions. The subjects became substantially dehydrated during the race, and their serum lithium levels decreased, suggesting that sweat lithium loss may be substantial. (The sweat-to-serum ratio for lithium exceeded that for sodium by a factor of 4.) The authors conclude that contrary to widely held belief, heavy sweating may not increase the risk of lithium intoxication.
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The increasingly widespread use of lithium has benefited many, but the therapeutic potential of the drug will not be realized if it is used in a way that is haphazard or inattentive or adheres too rigidly to written guidelines. The authors present clinical vignettes that are representative rather than comprehensive examples of misadventures which can occur during the course of lithium therapy. They hope to stimulate a more knowledgeable, flexible, open-minded, and individualized approach to the use of this drug.
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Lithium salts are being widely used for treatment and prophylaxis of bipolar affective disorder (manic-depressive psychosis) and are under investigation in more than 30 other illnesses. The relevant literature has grown from 43 articles published between 1949 and 1964 to nearly 4,000 today. A computer-based lithium librarian program has been developed that provides an up-to-date registry of all lithium references, rapid search capability, constant availability, and easy transferability to identical computer systems located on three continents. References provided by the system are more complete, more rapidly available, and less costly than references obtained from other bibliographic services. This specific response to the rapidly expanding lithium literature provides a model for comprehensive aquisition and searching of other specialized subjects areas needed by clinicians and researchers.
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