Indigents\u27 Dissatisfaction with Assigned Counsel

The American concept of democracy embraces the principle that the basic interests of society are endangered when the rights of an individual are diminished. The indigent\u27s dissatisfaction with his assigned counsel is relevant only because Americans presuppose that a criminal prosecution unaccompanied by the panoply of the adversary process is a deprivation of the fundamental rights of the accused. This concept of justice obligates a government which institutes criminal prosecutions to provide representation for those unable to afford their own counsel. It further imposes a duty to assure effective counsel in order to preserve the element of challenge which is the very nucleus of the adversary system

Indigents\u27 Dissatisfaction with Assigned Counsel

The American concept of democracy embraces the principle that the basic interests of society are endangered when the rights of an individual are diminished. The indigent\u27s dissatisfaction with his assigned counsel is relevant only because Americans presuppose that a criminal prosecution unaccompanied by the panoply of the adversary process is a deprivation of the fundamental rights of the accused. This concept of justice obligates a government which institutes criminal prosecutions to provide representation for those unable to afford their own counsel. It further imposes a duty to assure effective counsel in order to preserve the element of challenge which is the very nucleus of the adversary system

Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration

Declining popularity increases lack of diversity: extending the discourse of the discipline

The number of young people selecting a university Information Technology (IT) course is low and has been declining alarmingly in the last few years. While young women appear to be rejecting the discipline at a greater rate than young men, the declining popularity of IT university courses is a worrying trend that is affecting the culture of the discipline and the industry nationally and internationally. The discourse of the discipline is often focused on curriculum content and industry applications with little or no attention to the type of student who is taking our courses. This paper presents senior secondary school and university enrolment statistics that emphasise a steady decline in popularity of IT courses since 2000. Results of a quantitative survey of over 700 undergraduates are presented to provide a lens into the current student experiences in IT in secondary school, the home and at university. Factors underpinning the declining popularity of the discipline as a course and career option are explored and some thoughts on the future of the discipline are offered

In a neighborhood near you: how community health workers help people obtain health insurance and primary care

Implementing the health insurance mandate of the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, will require states to reach, educate, and successfully enroll individuals and families who have had little experience with health coverage. The uninsured are likely to require considerable individualized application and enrollment support. Consumer advocates believe there is a need for ongoing support so that the newly insured retain their coverage, navigate their way effectively through the health care system, and engage in wellness and prevention activities. As many states prepare to enroll millions of low-income uninsured Americans, the experience of Community Health Workers (CHWs) in Massachusetts can inform outreach and enrollment efforts across the country

The Impact of Gender and Pedagogical Factors on Female Pass Rates

An assessment of student achievement according to gender in core units of study of a Faculty of Information and Communication Technology program tested four hypotheses. The first of these related to the role-model effect of female academics; the second related to the advantages of formal education qualifications of academics; the third to the application of contextualized curricula, and the fourth to the use of a variety of assessment modes. Correlation and regression analysis on the data set indicated that the presence of two of these factors can significantly improve the pass rate of female students while having a benign effect on the pass rate of male students. It is suggested that information systems faculties pay close attention to gender diversity of their teaching faculty, particularly if their female student cohort is less than one in five in a unit of study. It also gives substance to the need or preference for university lecturers having education qualifications. This study needs to be replicated in other information systems faculties and schools to verify this finding

Does this Feel Empowering? Using Métissage to Explore the Effects of Critical Pedagogy

The extent to which critical pedagogy disrupts the relations of dominance inside postsecondary classrooms, or empowers students to take socially just action beyond the classroom has been debated and challenged for decades. Through the use of métissage, an interpretive inquiry method that affords collaborative interrogation of individual narrative writings, we five participants in the same critical pedagogy course conducted a post-course inquiry project in order to explore what we had learned through the course. Through this inquiry project, we have come to a deeper understanding of critical pedagogy praxis. Ultimately, what we learned through the use of this inquiry method maintains important implications for postsecondary educators

Survey of preferred guideline attributes: what helps to make guidelines more useful for emergency health practitioners?

Background: Enhancing CPG acceptance and implementation can play a major role in the development and establishment of emergency medicine as a specialty in many parts of the world. A Guideline International Network special interest group established to support collaboration to improve uptake of clinical practice guidelines (CPGs) across the emergency care sector conducted an international survey to identify attributes of guideline likely to enhance their use. Methods: A Web-based survey was undertaken to determine how CPGs were accessed, the preferred formats and attributes of guidelines, and familiarity with GRADE. The criteria used to identify preferred attributes of guidelines were adapted from the AGREE II Tool. Results: Two hundred six responses were received from 31 countries, 74/206 (36%) from the US, 28/206 (16%) from Canada, 17/206 (8%) from Australia and 15/206 (7%) from the UK. The majority of responses were from physicians (176/206, 85%) with 15/206 (7%) of responses from nurses and 9/206 (4%) from pre-hospital emergency services personnel. The preferred format for guidelines was clinical protocols that incorporated recommendations into workflow, and the most preferred attribute of guidelines was the clear identification of key recommendations. The results also identified that within the group that responded to the question related to GRADE, 66% were unfamiliar with this system for summarizing evidence in relationship to recommendations. Conclusions: The findings provide the basis for further research to explore the most appropriate formats for guidelines or guidelines resources tailored to the needs of the emergency care providers

A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom.

OBJECTIVE To evaluate the microbiologic effectiveness of the World Health Organization's 6-step and the Centers for Disease Control and Prevention's 3-step hand hygiene techniques using alcohol-based handrub. DESIGN A parallel group randomized controlled trial. SETTING An acute care inner-city teaching hospital (Glasgow). PARTICIPANTS Doctors (n=42) and nurses (n=78) undertaking direct patient care. INTERVENTION Random 1:1 allocation of the 6-step (n=60) or the 3-step (n=60) technique. RESULTS The 6-step technique was microbiologically more effective at reducing the median log10 bacterial count. The 6-step technique reduced the count from 3.28 CFU/mL (95% CI, 3.11-3.38 CFU/mL) to 2.58 CFU/mL (2.08-2.93 CFU/mL), whereas the 3-step reduced it from 3.08 CFU/mL (2.977-3.27 CFU/mL) to 2.88 CFU/mL (-2.58 to 3.15 CFU/mL) (P=.02). However, the 6-step technique did not increase the total hand coverage area (98.8% vs 99.0%, P=.15) and required 15% (95% CI, 6%-24%) more time (42.50 seconds vs 35.0 seconds, P=.002). Total hand coverage was not related to the reduction in bacterial count. CONCLUSIONS Two techniques for hand hygiene using alcohol-based handrub are promoted in international guidance, the 6-step by the World Health Organization and 3-step by the Centers for Disease Control and Prevention. The study provides the first evidence in a randomized controlled trial that the 6-step technique is superior, thus these international guidance documents should consider this evidence, as should healthcare organizations using the 3-step technique in practice. Infect Control Hosp Epidemiol 2016;37:661-666

Comparing apples with apples: hierarchical task analysis as a simple systems framework to improve patient safety.

Changing healthcare culture to improve patient safety is the goal of healthcare systems across the world. However the proliferation of Human Factors/Ergonomics (HFE) systems methods may be limiting the embedding of improvements as well-established methods from other safety critical industries are modified. This paper explores how the basic HFE method of Hierarchical Task Analysis (HTA) could be used to compare ‘apples with apples’ by looking at national guidance and local hospital guidance for the care of women and their babies during labour and child birth. It is concluded that HTA could offer a simple framework to visualize operational systems as shared mental models which are accessible within and between multi-disciplinary teams, as part of process improvement projects (including Plan-Do-Study-Act; PDSA) and as the foundation for HFE in healthcare education to ensure the consistency of messages throughout the patient journey