Promoting ‘communities of practice’ can help to better support people experiencing multiple-exclusion homelessness

How can local services be organised best to support people who have complex, overlapping needs? What are the implications for practice and governance when these needs crossover existing organisational boundaries? Michael Clark and Michelle Cornes examine these issues from the perspective of supporting people experiencing homelessness combined with other complex needs. They argue that the idea of ‘communities of practice’ can help humanise the system

Citizen science as a framework for improving the science-society interface in long-term care research

Context: Engaging with and involving the public in research has become a widespread consideration in many research fields, including long-term (social) and health care. Perspective: Citizen science (CS) is an umbrella concept that has grown rapidly in many scientific areas and has been noted as increasing in health research. Its root is the need to work at the science-society interface and its place in societal development. This interface is understood to operate in several ways, and the overarching CS goal is to strengthen it through a variety of practices. We seek to encourage a dialogue across long-term care research and CS to the benefit of both sides. Implications: We argue that using CS as an overarching concept for engaging with the public in long-term care research would provide a variety of benefits to that scientific field. These would include opportunities to examine the state of citizen involvement across the field, employing the most appropriate modes of involvement and engagement in specific contexts. It would also open opportunities to develop the methodological imagination by examining examples of CS in other research areas. CS could also benefit from the experience of public involvement in long-term care research, including its extensive consideration of power, payments, and including people with additional support needs. There is a need generally for greater dialogue about being more inclusive and addressing inequalities

Case report of unexplained hypocalcaemia in a slightly haemolysed sample

The case presented highlights a common pre-analytical problem identified in the laboratory that was initially missed. It concerns a young, generally healthy adult patient with no significant medical history and no significant family history. They presented with common flu like symptoms to their primary care clinician who considered this was most likely a viral problem that would pass with time. The clinician, however, did some routine bloods to reassure the patient despite a lack of clinical indication. When the sample was analysed the sample was haemolysed with strikingly low calcium. This led to the patient being called into hospital for urgent repeat investigations, all of which turned out to be within normal ranges. On further investigation the original sample was found to be contaminated. This result would normally have been flagged but was missed due to the complication of haemolysis

The care act, personalisation and the new eligibility regulations: a discussion paper about the future of care and support services for homeless people in England

As funding for Housing Related Support (formerly Supporting People) services continues to shrink, it is timely to revisit the question as to whether ‘homeless people’ are eligible for publically funded care and support, including personal budgets, organised through the local authority. The Care Act 2014 due to be implemented from April 2015 in England, heralds some positive changes which may serve to open the door to this funding stream which has rarely been used in support of ‘homeless people’. As the law currently stands ‘homeless people’ as a service user group are not eligible for community care assessment (though people who are homeless and who fall into one of the ‘eligible groups’ by virtue of having a mental health or drug and alcohol problem may be). The Care Act 2014 removes reference to ‘eligible’ and ‘ineligible’ groups so that any adult with any level of need will have a right to an assessment. Exploring some of the ways in which homeless people have been excluded from care and support in the past, this paper outlines how homeless organisations can work with local authorities to ensure fairer and more consistent access and in so doing, potentially secure their own futures in the face of fewer ‘block contracts’ and more individualised forms of commissioning

EFLM WG-Preanalytical phase opinion paper:local validation of blood collection tubes in clinical laboratories

The selection or procurement of blood collection devices in healthcare facilities is often an underestimated issue. This is probably due to different factors including the lack of knowledge of policymakers, hospital administrators and even laboratory managers about the importance of preanalytical quality and phlebotomy process, as well as to the absence of reliable guidelines or recommendations on how to precisely assess the quality of blood collection devices around the globe. With the awareness that a gap remains between manufacturers' and local validation of blood collection devices, the Working Group for Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has drafted a consensus document aimed to provide a set of essential requisites, technical criteria (e.g. presence of physical defects, malfunctioning, safety problems) and clinical issues for supporting laboratory professionals in organization blood collection tubes tenders and validating new devices before local routine implementation. The laboratory professionals should also make sure that the tenders accurately and strictly define the responsibilities for validation experiments and the potential consequences in the case the validation outcome shows that tubes due not fulfill the expectations

Tax evasion and exchange equity: a reference-dependent approach

The standard portfolio model of tax evasion with a public good produces the perverse conclusion that when taxpayers perceive the public good to be under-/overprovided, an increase in the tax rate increases/decreases evasion. The author treats taxpayers as thinking in terms of gains and losses relative to an endogenous reference level, which reflects perceived exchange equity between the value of taxes paid and the value of public goods supplied. With these alternative behavioral assumptions, the author overturns the aforementioned result in a direction consistent with the empirical evidence. The author also finds a role for relative income in determining individual responses to a change in the marginal rate of tax

Beyond clinical trials: extending the role of the clinical research nurse into social care and homeless research

Aim: Clinical research nurses work at the fulcrum of clinical trials with clearly defined roles and responsibilities. In England, the National Institute for Health Research (the main funder of health research) has broadened its scope to encompass social care research. The expectation is that clinical research nurses will expand their skill set to support these new studies, many of which will employ qualitative and mixed methods. This discussion paper explores the challenges of facilitating this clinical academic workforce development through a case study of a homeless health and social care research project. This was one of the first studies to engage clinical research nurses in this new and expanded role. Background: Much of what is known about the research nurse workforce has been generated through studies of clinical trials in oncology. The ‘caring-recruiting’ dichotomy has been used as a heuristic device for identifying workforce issues that can impact on study delivery such as how intense pressure to recruit study participants leads to low job satisfaction. Design: This case study reflects on the authors' experiences of employing a clinical research nurse in a social care research project concerned with the discharge of homeless people from hospital. The ‘caring-recruiting’ dichotomy is used to generate new information about the relationship between workforce development and the successful delivery of social care research. Conclusion: The case study illuminates how social care research can generate different pressures and ethical challenges for research nurses. The time and skill it took to recruit study participants identified as ‘hard to reach’ was suggestive of the need to move beyond performance measures that prioritise recruitment metrics. The need for different types of staff supervision and training was also warranted as supporting study participants who were homeless was often distressing, leading to professional boundary issues. Relevance to workforce development: This study highlights that performance management, training and supervisory arrangements must be tailored to the characteristics of each new study coming onto the portfolio to ensure research nurses are fully supported in this new and expanded role

Order of blood draw:Opinion Paper by the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE)

It has been well reported over recent years that most errors within the total testing process occur in the pre-analytical phase (46%-68.2%), an area that is usually outside of the direct control of the laboratory and which includes sample collection (phlebotomy). National and international (WHO, CLSI) guidelines recommend that the order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes that could cause erroneous results. There have been a number of studies recently looking at whether order of draw remains a problem with modern phlebotomy techniques and materials, or it is an outdated practice followed simply because of historical reasons. In the following article, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PRE) provides an overview and summary of the literature with regards to order of draw in venous blood collection. Given the evidence presented in this article, the EFLM WG-PRE herein concludes that a significant frequency of sample contamination does occur if order of draw is not followed during blood collection and when performing venipuncture under less than ideal circumstances, thus putting patient safety at risk. Moreover, given that order of draw is not difficult to follow and knowing that ideal phlebotomy conditions and protocols are not always followed or possible, EFLM WG-PRE supports the continued recommendation of ensuring a correct order of draw for venous blood collection