HubMed - holistic Health
Knowing, Caring, and Telehealth Technology: "Going the Distance" in Nursing Practice.
J Holist Nurs. 2012 Nov 21;
Nagel DA, Pomerleau SG, Penner JL
The use of technology in delivery of health care services is rapidly increasing, and more nurses are using telehealth to provide care by distance to persons with complex health challenges. The rapid uptake of telehealth modalities and dynamic evolution of technologies has outpaced the generation of empirical knowledge to support nursing practice in this emerging field, specifically in relation to how nurses come to know the person and engage in holistic care in a virtual environment. Knowing the person and nursing care have historically been associated with physical presence and close proximity in the nurse-client relationship, and the use of telehealth can limit the ways in which a nurse can observe the person, potentiate perceptions of distance, and lead to a reductionist perspective in care. The purpose of this article is to illuminate the dynamic and evolving nature of nursing practice in relation to the use of telehealth and to highlight gaps in nursing knowledge specific to knowing the person in a virtual environment. Such an understanding is necessary to inform future research and generate empirical evidence to support nurses in providing ethical, safe, effective, and holistic care by distance to persons through telehealth technology.
HubMed - Alternative Health
Temporal association tracts and the breakdown of episodic memory in mild cognitive impairment.
Neurology. 2012 Nov 21;
Metzler-Baddeley C, Hunt S, Jones DK, Leemans A, Aggleton JP, O'Sullivan MJ
OBJECTIVE: To examine the pattern of association between microstructure of temporal lobe connections and the breakdown of episodic memory that is a core feature of mild cognitive impairment (MCI). METHODS: Twenty-five individuals with MCI and 20 matched controls underwent diffusion MRI and cognitive assessment. Three temporal pathways were reconstructed by tractography: fornix, parahippocampal cingulum (PHC), and uncinate fasciculus. Tissue volume fraction-a tract-specific measure of atrophy-and microstructural measures were derived for each tract. To test specificity of associations, a comparison tract (corticospinal tract) and control cognitive domains were also examined. RESULTS: In MCI, tissue volume fraction was reduced in the fornix. Axial and radial diffusivity were increased in uncinate and PHC implying more subtle microstructural change. In controls, tissue volume fraction in the fornix was the predominant correlate of free recall. In contrast, in MCI, the strongest relationship was with left PHC. Microstructure of uncinate and PHC also correlated with recognition memory, and recognition confidence, in MCI. CONCLUSIONS: Episodic memory in MCI is related to the structure of multiple temporal association pathways. These associations are not confined to the fornix, as they are in healthy young and older adults. In MCI, because of a compromised fornix, alternative pathways may contribute disproportionally to episodic memory performance.
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