Electroconvulsive therapy in the long-term care setting: an overview of controversies in practice.
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Previous studies have suggested that the premotor cortex plays a role in motor preparation. We have tested this hypothesis in macaque monkeys by examining neuronal activity during an enforced, 1.5-3.0 s delay period between the presentation of an instruction for movement and the onset of that movement. Two targets for movement were available to the monkey, one on the left and one on the right. Illumination of one of the targets served as the instruction for a forelimb movement. It is known that there are cells in the premotor cortex that have directionally specific, sustained activity increases or decreases following such instructions. If the premotor cortex is involved in the preparation for movement in a particular direction, then changing the target from one to the opposite side during the delay period should lead to a pronounced change in sustained neuronal activity. Further, removing the instruction, while still requiring movement to the target, should have little or no sustained effect. Seventy cells showed the predicted activity patterns, thus supporting the view that the premotor cortex plays a role in motor preparation.
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A culture of safety is an achievable objective for perioperative management. Research in analysis, safety factors, alarms, instruction, and management can make this change rapidly. It is important to build the data and evidence for those practices that show improved patient outcomes. Those practices and the processes that develop them should be sanctioned by responsible organizations in active collaboration.
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An investigation of the differences in the perceptions of the role of physician assistant between physicians and physician assistants in the same primary care practice was conducted. A sample of six practices (one physician and one physician assistant from each practice), obtained from six Appalachian counties in New York State, was examined. Data was collected through the administration of a questionnaire, personal interviews, and on-site activity observations. Comparisons were made for two items: Number of errors between physicians' or physician assistants' perceptions and actual observations for a specified group of 23 activities, and the number of discrepancies between physicians' and physician assistants' perceptions for the same 23 activities. Study results produced significant numbers of errors and discrepancies suggesting that certain barriers to communication exist between the physicians and physician assistants and that a substantial amount of physician-physician assistant activity interaction is necessary to ensure positive conformance of standard duties and functions to practice goals and objectives.
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