Clinical governance and the drive for quality improvement in the new NHS in England

Clinical governance is to be the main vehicle for continuously improving the quality of patient care and developing the capacity of the NHS in England to maintain high standards (including dealing with poor professional performance).

Abstract

Three groups (N = 8) of rats received five 10-trial sessions of one-way avoidance training in which each trial was initiated by a 10-sec tone stimulus and terminated either by a shuttle response during the tone (avoidance) or by a response during the electric shock (escape). Rats in groups treated with pimozide (0.5 or 1.0 mg/kg i.p.) failed to acquire to avoidance response although they escaped readily when shock was presented, whereas control rats consistently avoided the shock. The same rats then received several sessions of food-reinforced lever-pressing in a different apparatus; no drugs were given during these sessions. When responding had stabilized, the tone that had signalled shock in the avoidance sessions was presented for a 1-min period. A significant decrease in responding during the tone was observed in all groups when compared to unshocked controls, demonstrating that the pimozide-treated rats, although failing to acquire the avoidance response in the shuttle box, had learned the association between the tone and shock. The results suggested that the neuroleptic-treated animals failed to avoid because of a deficit in the ability to initiate responses rather than a deficit in associative learning.