Individual Placement and Support for persons with alcohol and drug addiction in a Swedish context (IPS-ADAS): study protocol for a randomised controlled trial.

BACKGROUND: Employment is a vital source for experiencing well-being and lowering the risk of long-term social marginalisation and poverty. For persons with alcohol and drug addiction, it may also improve sobriety. However, the unemployment situation for this group reflects the knowledge gap in effective interventions to support employment. While Individual Placement and Support (IPS) is recognised as evidence-based supported employment for those with serious mental health problems, no scientific evidence for the target group of addiction exists to date. The aim of the present IPS for Alcohol and Drug Addiction in Sweden (IPS-ADAS) trial is to study whether IPS has an effect on gaining employment for this group. METHODS: The IPS-ADAS trial is a multisite, pragmatic, parallel, and single-blinded, superiority randomised controlled trial (RCT). Participants (N = 330) will be randomly assigned (1:1) and participate in IPS plus treatment as usual within Addiction Services (IPS + TAU) or Traditional Vocational Rehabilitation (TVR) available plus TAU (TVR + TAU) for 12 months. The principle of intention-to-treat (ITT) will be applied. The hypothesis is that a significantly larger proportion of IPS + TAU participants will be employed for > 1 day (primary outcome), reach employment sooner, work more hours and longer periods of time, and have a higher income as compared to TVR + TAU participants at 18-month follow-up. We further anticipate that those who benefit from IPS + TAU will use less alcohol and drugs, experience better health, and use less care and support, including support from the justice system, in comparison to TVR + TAU participants, at 6, 12, and 18 months. A supplementary process evaluation, using the IPS Fidelity Scale (25 items) and adhered interviews will address delivery and receipt of the IPS as well as contextual hinders and barriers for coproduction and implementation. Working age (18-65), willingness to work, unemployment, participation in an information meeting about the RCT, treatment for addiction diagnosis, and being financially supported by welfare, constitute eligible criteria. DISCUSSION: A primary study on the effectiveness of IPS on employment for the new target group of addictions will add to the international IPS knowledge base and inform national policy to include the underrepresented group in working life. TRIAL REGISTRATION: WHO International Clinical Trials Registry Platform ISRCTN10492363. Registered on 14 August 2023.

Supporting education with ips: Advancing a career-oriented model for integrating work and study support for young adults in sweden.

OBJECTIVE: Supported education (SEd) provides individualized support to people with mental health problems to achieve their educational goals. Individual placement and support (IPS) has emerged as a model through which SEd may be efficiently delivered. However, the components and characteristics of educational support for these employment-focused services have not been fully explored. Building on earlier studies, we constructed a preliminary model of SEd components that integrated with the IPS model. The SEd model included the eight original principles of IPS, developed to reflect the SEd component, and two new principles were suggested. The aim of the study is to investigate these adapted principles by exploring the feasibility of applying them within established IPS programs providing both employment and educational services. METHODS: An organizational learning approach was taken, involving five IPS programs providing both employment and educational services to young adults with mental health problems. Data were collected through focus groups, interviews, and workshops with 19 IPS specialists. RESULTS: The results suggest that while the IPS principles provide a feasible and relevant structure for the development and provision of integrated services, adaptations that reflect the educational context were considered valuable when supporting young adults in pursuing their career-related goals. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The respondents confirmed that the SEd principles and the focus on support in educational contexts helped them to further develop their knowledge and strategies. While challenging, integrating SEd in IPS models shows good potential for supporting young adults as they struggle to reach longer term career-oriented goals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Capillary and venous lactate measurements with a handheld device compared to venous blood-gas analysis for emergency patients.

BACKGROUND/AIM: Early identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method. METHODS: Patients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study. Capillary (CAP) and venous (VEN) blood were analyzed with Accutrend Plus (AP). Venous blood samples were analyzed at the local hospital laboratory (GEM premier 4000) within 20 min from sampling. All sampling was conducted by two registered nurses specially trained in prehospital care. RESULTS: 480 lactate measurements were performed in 160 patients. The mean difference between measurements in capillary blood compared with the reference method was 0.7 mmol/L and for venous blood 0.9 mmol/L. The limits of agreement from the Bland-Altman plot was - 0.9 to + 2.5 mmol/L and and - 0.1 to + 1.9 mmol/L, for CAP and VEN compared with GEM. CONCLUSION: Our results shows low accuracy and low precision with VEN / CAP measurements of lactate compared to reference GEM.

Evolving techniques in text-based medical consultation - Physicians' long-term experiences at an Ask the doctor service.

INTRODUCTION: Both the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text. OBJECTIVE: To improve text-based medical consultation by learning from long-term experiences. MATERIALS AND METHODS: Physicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach. RESULTS: Over time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients. CONCLUSION: Text-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation.

Professionals' perceptions of and views about vocational rehabilitation for people with psychiatric disabilities.

OBJECTIVE: One of the challenges agencies and professionals face is to enable people on sick leave to be successful in their vocational rehabilitation. The objective of this study was to explore and analyze some professionals' perceptions of and views about vocational rehabilitation among people with psychiatric disabilities. PARTICIPANTS: Eight professionals from four different agencies (social services, the employment service, the social insurance office, and a psychiatric outpatient setting) working in the area of vocational rehabilitation for people with psychiatric disabilities. METHODS: Eight in-depth interviews were conducted. The data collected was analyzed using qualitative content analysis together with an interpretive approach. RESULTS: The results suggested the respondents were in consensus regarding that which they considered to facilitate or enable successful vocational rehabilitation. Intensive support over a long period of time and a holistic view that takes into account the habits and routines of daily life outside of work as well as the social and psychological aspects of individuals during their rehabilitation processes were considered to be just as crucial to the vocational rehabilitation process as training in the workplace. CONCLUSIONS: These professionals dealt with a complex vocational rehabilitation system; they felt that their organizations' directives and inability to collaborate successfully with other authorities restricted their scope of action and hindered their exercise of good practice.

Towards a working life? Experiences in a rehabilitation process for people with psychiatric disabilities.

The aim of this study was to reveal the meaning some people with psychiatric disabilities assigned to important personal experiences in relation to an ongoing rehabilitation process. The data comprises open-ended interviews of eight participants. A hermeneutic approach together with a content analysis was used to analyse the data. The results indicated the importance of not relying on simplified prognoses early in a rehabilitation process when assessing rehabilitation measures and/or work capacity. The phenomenon of rehabilitation seemed to be very complex, diverse, and changed over time depending on different circumstances that arose during the rehabilitation process. These circumstances arose on individual, contextual as well as structural levels and all had an impact on the outcomes. The results also indicated that it seemed to be possible to achieve success, change attitudes, and create a positive image of a future related to a working life if the support was perceived as relevant and the activities undertaken were perceived as contributing to achievement of the individual's goals. Regardless of which path the informants later chose these factors were seen to support an empowerment process and active participation in their own rehabilitation.