Young Clinicians Research Articles

A high-fidelity personalised 3d printed simulator for the left atrial appendage occlusion procedure

Purpose This study aims to develop a realistic 3D printing-based simulator for the training and planning of the left atrial appendage occlusion (LAAO) to be used in the cath lab. Design/methodology/approach Starting from a pre-operative computed tomography dataset of a patient already treated with LAAO, the model was obtained, consisting in the right and left heart, opportunely assembled to replicate the position and orientation of the patient's anatomy while lying on the cath lab table. Different 3D printing techniques and materials were used to mimic the interaction between the cardiac tissue and the clinical instrumentation. The simulator was tested in the cath lab under proper image guidance by three LAAO expert operators. The clinicians were required to assign a score in terms of realism to each material used to fabricate the fossa ovalis and the LAA. Findings The simulated interventions were successfully performed by the operators, who were able to navigate in the system and release the occluder device as during a real procedure. The intraoperative images acquired during the simulations were highly comparable with data from a real intervention, with a mean percentage difference below 10%. Originality/value This study demonstrated the feasibility of the proposed simulator to faithfully replicate the LAAO procedure and its potentiality to be used for multiple purposes, including the training of the young clinicians, the evaluation of the most complicated cases and the design of novel occluder devices, in a fully realistic setting.

Building a community-academic partnership to expand services for childhood cancer survivors in a rural, low-income region in California.

360 Background: Community-engaged research is an effective approach to address health disparities that is well-established in the public health domain and has not been widely applied in childhood cancer survivorship. We present our multi-year experience building a community-academic partnership and community-engaged childhood cancer survivorship research portfolio. Methods: We have developed a partnership between Jacob’s Heart Children’s Cancer Support Services, a nonprofit community-based organization (CBO) and an academic pediatric cancer survivorship team, with the goal of improving health outcomes for childhood cancer survivors and their families in the Salinas Valley, a rural, low-income region in California with majority Hispanic/Latino/a/e residents. Our partnership process is guided by principles of community-based participatory research, prioritizing trust and involving community members as equal partners in all phases of research. Results: In year 1 (2021-2022), we held successive meetings which identified common goals and shared values, established the collaboration, and sought funding to advance our goals. In year 2 (2022-2023), with internal grant funding, we conducted a qualitative needs assessment interviewing childhood cancer survivors, parents, and CBO staff. Teamwork enriched the data analysis and allowed us to identify problems in communication as an area of need, which directly informed subsequent grant proposals. In year 3 (2023-2024), with external funding we began a multi-year study to understand and improve survivorship-related communication among Hispanic/Latino/a/e young adult childhood cancer survivors, their parents, and clinicians. Current and future projects include collaborative design and pilot testing of a novel communication intervention, formation of a dedicated community advisory board, and a CBO-driven program evaluation. Findings from our community-engaged studies have prompted new sets of research questions and illustrate opportunities for institutional change in the clinic setting. In parallel, the CBO has leveraged research findings in real-time to identify barriers to seeking support among childhood cancer survivors and families, and adapted and improved programming for families in response. Through our joint research portfolio, we have incorporated training and mentorship for staff at the CBO and medical trainees at the academic center. Conclusions: A community-academic partnership in a rural, low-income region has the potential to reduce health disparities and improve childhood cancer survivors’ health outcomes through collaborative program development and community-engaged research. Fueled by mutual investment and strong momentum, our partnership facilitates an interconnected cycle of research and practice change that is grounded in community needs.

Service users perspectives on psychosis-risk terminology: An Italian study on labeling terms preferences and stigma

AimsThe current range of labeling terms—at-risk mental state (ARMS), ultra-high risk for psychosis (UHR), and attenuated psychotic syndrome (APS)—used to refer to the psychosis-risk concept is varied, and their acceptability and potential stigma are not well understood. By involving Italian youth with lived experience of mental ill-health, we aimed to generate new labeling terms for psychosis-risk, and to evaluate literacy, attitudes, and preferences regarding these and the existing terms. Additionally, we investigated opinions of disclosure of the at-risk concept in clinical practice. MethodsThrough a dual-moderator focus group, novel diagnostic terms were coined for the at-risk concept: psychosis proneness (PP), change of personal reality (CPR), and hints of subjectivity dysregulation (HSD). A specifically designed questionnaire was then completed by 47 help-seeking youths, 60 relatives, and 61 clinicians to test newly generated and already established at-risk terms. ResultsLiteracy on already established terms was significantly lower among youth (mean= 42 %) and relatives (mean= 38 %). ARMS was the preferred and least stigmatizing term among young people and clinicians. UHR was considered the most stigmatizing label. Among newly generated terms, CPR was the least stigmatizing and most informative. Disclosure of at-risk terminology was generally preferred after establishing a trusting clinician-patient relationship. ConclusionsFindings support ARMS as a useful and acceptable term in clinical practice with young people, while UHR is associated with the highest stigma. CPR is promising and should be tested in cross-cultural studies. In Italy, there is an urgent need for improving literacy on prevention in mental health.

The EAO Junior Committee—History, present and future activities

AbstractObjectiveTo describe the evolution and aims of the European Association for Osseointegration (EAO) Junior Committee (JC).Materials and MethodsFormer members of the EAO JC and members of the board were interviewed, and current projects and initiatives were summarized.ResultsThe EAO JC was launched in 2007 as the first young committee in Europe. Despite initial skepticism, it became a famous initiative, and the concept was copied by other dental and medical associations and societies. Since 2010, the committee organizes summer camps allowing young talents to discuss, network and interact beyond traditional boundaries.ConclusionsThe EAO JC is giving fresh energy to the entire society and provides education and network opportunities for young clinicians and scientists.

A relational approach to youth healthcare: Examining young people's, parents' and clinicians' experiences in the context of variations in sex characteristics

According to popular understandings, children grow from a state of dependence to eventually become independent adults. Interdependence helps to disrupt the in/dependence binary and is a useful concept for making sense of the experiences young people with variations in sex characteristics in relation to healthcare. This study used semi-structured interviews with 32 health professionals, 33 caregivers and 12 young people recruited in the UK and Sweden. The analysis is guided by the questions: (1) how do young people, carers and health professionals position themselves in the adult/young person relationship in the context of healthcare? (2) how is the (in/ter)dependence of young people imagined when young people, carers and health professionals talk about healthcare? Our analysis shows how carers and health professionals might support dominant understandings about young people growing towards independence while providing little opportunity for young people's agency and voice. Interviews with young people gave clear examples of their negotiating relational ways of being, seeking agency in the context of healthcare and not simply becoming independent of adults. This analysis also draws attention to the ways young people might be silenced within healthcare contexts. The present paper is based on secondary analysis of data from the SENS. It works with concepts of relationality and interdependence to draw out the possibilities of voice and agency for young people with variations in sex characteristics in healthcare contexts.

Assessments from the first year of an underrepresented undergraduate internship program

To enhance our service to a diverse student population our faculty created the INtegrative biology and Physiology Undergraduate Training (INPUT) program. This research focused initiative solicited applications from first- and second-year students undergraduates of our large, urban, land-grant university. Selection criteria included academic aptitude, self-reported socioeconomic and cultural challenges, interest in physiological research and letters of support. Six students were selected from our initial cadre of applicants. The students were matched with faculty research mentors and provided a paid research opportunity for the spring semester of 2023. At the end of the term, an assessment of the experience by both each student and mentor determined whether a second semester experience was offered by the department. All of our faculty mentors were favorably impressed by the progress made by their INPUT scholars and five of the six students requested and were granted a second semester research opportunity. The five INPUT students continued their mentored research in the areas of neurophysiology, skeletal muscle physiology, and adipose biology. The one outlier stated that while she enjoyed the experience and that it encouraged her to continue in research. She also found that her scientific passion was in chemistry rather than physiology and moved to a different program. Based on the overall positive outcomes a second semester opportunity was offered to the five students who expressed an interest in continuing their physiology-focused projects. The second term experiences were completed either during the summer or fall of 2023. We will encourage our initial group of INPUT scholars to serve as ambassadors for other underrepresented students who are interested in physiology research and use their end of experience assessments to help shape the future of our INPUT program. We will report on the opportunities discovered and the challenges faced in launching the INPUT program as well as the prospects for continued outreach. Our hope is that our experiences with INPUT will encourage others to attract, encourage and prepare a robust and representative group of young scientists and clinicians to enter the 21st century biomedical community. Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, MN 55455. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Opportunities of digital health technologies for rheumatology: from clinics to quality and research

Recent developments in digital health technologies are overwhelming, and their use in routine work is still difficult to anticipate. This narrative review summarizes the concept of consecutive cohorts in the literature, together with local research experiences in consecutive rheumatic outpatients. Digital health techniques have to reflect the clinicians’ needs, support real-life care of patients, and allow for the specific assessment of quality parameters fulfilling the Donabedian aspect of qualified health care, using quality indicators to improve health care and research. Rapidly growing observational cohorts will perform best to provide follow-up data as the basis for further development of healthcare approaches for rheumatic patients. The challenges of a selection bias, patients with limited disease expression, and chances of early detection of patients with rare diseases are addressed. For research purposes, sequential analyses with growing cohort size, comparative cross-sectional studies with sequential hypothesis testing and other prognostic, diagnostic, and therapeutic aspects of patient management can be performed. With the support of new technologies, young clinicians can easily approach such clinical topics, and learn about clinical data analyses. The use of quality standards as proposed in international recommendations for diagnostic issues and classification criteria, management recommendations, monitoring, and training issues can be supported by digital technologies. In conclusion, collaborative projects allow detailed clinical analyses of large cohorts, but local initiatives can prepare these co-operations, provide first local logistics and research experiences, and teach clinicians how to perform clinical research. Digital health technologies will strongly support these local initiatives.

A pioneer Turkish urologist-medical historian (Saim Erkun 1901-1949) and his one-century-old review about prostate.

Saim Erkun (1901-1949) was born in Manisa at Aegean region of Anatolia as an Ottoman citizen. While his early life was spent in late Ottoman times at military actions including military prison camp in British colony; India, his active professional productive period was in early Turkish republic period (Est. 1923, centenary). He had a good education period for medicine with the help of his good level of all main World scientific languages such as French, German, and English. Besides his main profession, he was also interested in Ottoman urological medicine around the conquer of Istanbul and allocated them a space in his books in 1930s. He was one of the earliest urology resident (1929-1933, Istanbul) of modern medicine in Turkey. He performed many urological procedures and published the outcomes following modern scientific algorithms, furthermore, there have been urological books including "history" partly referring to antique Ottoman literature among his publications. In this manuscript we focused on the magic word of Urology forever; "Prostate," among his essays. Turkish medicine, particularly urology, renewed itself by some intelligent hard working young clinicians such as Saim Erkun, immediately after the short struggling by means of establishment process of modern Turkiye after World War I by the collapsing of old Ottoman Empire. Furthermore, we think that the stunning special word of urology, "prostate," should especially be mentioned to emphasize the importance of this beginning.

Critical appraisal of YouTube videos regarding peri-implant diseases and conditions: A cross-sectional analysis.

To critically appraise the quality and reliability of YouTube videos regarding peri-implant diseases and conditions as a source of information for patients, students, and young clinicians. In March 2023, electronic searches were performed on YouTube website to identify videos related to peri-implant diseases and conditions. We considered only the relevant 250 English-language videos with durations between 3 and 30 min for final analyses. Following the eligibility criteria videos were evaluated for their demographic data, including number of views; number of likes, dislikes, and comments; days since upload; duration; and number of subscribers. Moreover, two assessors independently evaluated the quality and reliability of the included videos using the DISCERN and Video Information and Quality Index (VIQI) tools. Statistical analyses were performed using the Kruskal-Wallis test and Spearman correlation analysis (∝ = 0.05). A total of 69 videos were included for profound analyses. The average DISCERN and VIQI scores were 35.04 ± 6.3 and 14.18 ± 2.46, with 53 videos categorized as "poor" quality using the DISCERN tool. A Spearman rank correlation analysis presented a strong agreement between the DISCERN and VIQI scores (r = .753; p < .001). Nevertheless, based on different sources of upload, no statistically significant differences were reported for video demographics, interaction index, and DISCERN and VIQI scores. Although YouTube videos on peri-implant diseases and conditions present accurate preliminary information, their reliability still remains uncertain. Hence, we urge respective policymakers to recognize, endorse and produce high-quality videos for accurate information dissemination.

Evaluation of arteriovenous fistula for hemodialysis with a new generation digital stethoscope: a pilot study.

The management of complications of arteriovenous fistula (AVF) for hemodialysis, principally stenosis, remains a major challenge for clinicians with a substantial impact on health resources. Stenosis not infrequently preludes to thrombotic events with the loss of AVF functionality. A functioning AVF, when listened by a stethoscope, has a continuous systolic-diastolic low-frequency murmur, while with stenosis, the frequency of the murmur increases and the duration of diastolic component decreases, disappearing in severe stenosis. These evidences are strictly subjective and dependent from operator skill and experience. New generation digital stethoscopes are able to record sound and subsequently dedicated software allows to extract quantitative variables that characterize the sound in an absolutely objective and repeatable way. The aim of our study was to analyze with an appropriate software sounds from AVFs taken by a commercial digital stethoscope and to investigate the potentiality to develop an objective way to detect stenosis. Between September 2022 and January 2023, 64 chronic hemodialysis (HD) patients were screened by two blinded experienced examiners for recognized criteria for stenosis by Doppler ultrasound (DUS) and, consequently, the sound coming from the AVFs using a 3M™ Littmann® CORE Digital Stethoscope 8570 in standardized sites was recorded. The sound waves were transformed into quantitative variables (amplitude and frequency) using a sound analysis software. The practical usefulness of the core digital stethoscope for a quick identification of an AVF stenosis was further evaluated through a pragmatic trial. Eight young nephrologist trainees underwent a simple auscultatory training consisting of two sessions of sound auscultation focusing two times on a "normal" AVF sound by placing the digital stethoscope on a convenience site of a functional AVF. In 48 patients eligible, all sound components displayed, alone, a remarkable diagnostic capacity. More in detail, the AUC of the average power was 0.872 [95% CI 0.729-0.951], while that of the mean normalized frequency was 0.822 [95% 0.656-0.930]. From a total of 32 auscultations (eight different block sequences, each one comprising four auscultations), the young clinicians were able to identify the correct sound (stenosis/normal AVF) in 25 cases, corresponding to an overall accuracy of 78.12% (95% CI 60.03-90.72%). The analysis of sound waves by a digital stethoscope permitted us to distinguish between stenotic and no stenotic AVFs. The standardization of this technique and the introducing of data in a deep learning algorithm could allow an objective and fast method for a frequent monitoring of AVF.

Clinicians’ knowledge and understanding regarding multidisciplinary treatment implementation: a study in municipal public class III grade A hospitals in Southwest China

BackgroundPrevious studies have highlighted several problems in the implementation of multidisciplinary treatment (MDT) from a managerial perspective. However, no study has addressed these issues from clinicians’ perspective. Therefore, this study aimed to identify and address the existing problems in MDT by investigating what clinicians know and think about the implementation of MDT.MethodsA self-designed questionnaire was used to evaluate clinicians’ understanding of MDT in municipal public Class III Grade A hospitals in Western China using a cross-sectional questionnaire study.ResultsOverall, 70.56% of clinicians knew the scope of MDT, and 63.41% knew the process of MDT. Professional title (P = 0.001; OR: 2.984; 95% CI: 1.590–5.603), participated in MDT (P = 0.017; OR: 1.748; 95% CI: 1.103–2.770), and application for MDT (P = 0.000; OR: 2.442; 95% CI: 1.557–3.830) had an impact on clinicians’ understanding of the scope of MDT. Professional title (P = 0.002; OR:2.446; 95% CI: 1.399–4.277) and participation in MDT (P = 0.000; OR: 2.414; 95% CI: 1.581–3.684) influenced clinicians’ understanding of the scope of MDT. More than 70% of the respondents thought that MDT was important in medical care. However, less than half of the clinicians who had attended MDT were currently satisfied with the results of MDT. ConclusionMost clinicians agreed that MDT was crucial in clinical care. However, more than a third of clinicians did not fully understand the scope and process of MDT. Appropriate measures are necessary to improve the quality of MDT. Our study suggests that healthcare administration should strengthen MDT education, especially for new and young clinicians.

Osseointegration Foundation Charity Overdenture Program Study: Part 2.

This assessment evaluated the clinical feasibility of using narrow-diameter implants to support a mandibular overdenture. Twelve patients presenting with an edentulous mandible were recruited from nine dental offices. Each patient received two to four implants in the mandible. The implants were placed without additional bone augmentation, and a total of 36 implants were placed. All sites achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after the final prosthetic restoration. This investigation was supported by the Osseointegration Foundation, working in conjunction with the Zest Anchors implant company. There are three basic valuable activities that emerge from a professional foundation, which were reflected in this case study. They include disseminating information to practitioners, persuading young clinicians to become research investigators, and reaching out to patients in need of treatment who cannot afford it without a charitable opportunity.

Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders.

Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) "progress" is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.

The experiences of young people, parents and professionals of using the attend anywhere video consultation system in a child and adolescent mental health service: a mixed-methods approach

BackgroundIn 2020, Attend Anywhere video consultation service was introduced across the Irish public health service to facilitate the provision of health interventions remotely in light of COVID-19-related restrictions. This study aims to explore the experiences of young people, their parents and their clinicians, of using the newly introduced Attend Anywhere video consultation as part of their Child and Adolescent Mental Health Service (CAMHS).MethodA cross-section of twenty-nine young people, their parents and clinicians working in CAMHS Clare completed a survey pertaining to their experiences of using Attend Anywhere as part of their service. A cross-disciplinary research steering group of CAMHS clinicians adapted the NHS Scotland evaluation of Attend Anywhere / Near Me survey to better capture experiences in a CAMHS setting. The survey included both quantitative and qualitative items. Descriptive statistics were used to examine quantitative data. Qualitative data was analysed using Thematic Analysis.Results/FindingsResults demonstrated a decrease in the number of barriers reported by clients and professionals in accessing the CAMH service following the introduction of Attend Anywhere video consultation. Overall, the majority of professionals reported that they would use Attend Anywhere again, whereas almost a quarter of clients reported that they did not wish to use it again. Clients indicated a preference for receiving face-to-face services over other service provision options and this finding was associated with not having to rely on technology or manage connectivity issues and finding it easier to build the therapeutic relationship in-person.ConclusionFindings suggest that both professionals and clients value face-to-face service provision while also acknowledging the benefits of Video Enabled Care in overcoming access barriers. We conclude that VEC be offered as an option in a blended service model, in conjunction with rather than as a replacement of face-to-face service provision.

26th Annual Meeting of the German Society for Travel Medicine (DFR) Leipzig, Germany, 7–9 September 2023

This year the meeting included again a wide variety of topics. Beside of ‘typical’ ones like malaria (Rothe) or actual aspects concerning vaccinations (Burchard, Kling) other lecturers reported about international aid in the case of catastrophies (Schad), polar regions (Kohlberg), volcano tourism (Heggie), diving medicine (Koonen and Schröder), rare diseases like naegleria (Heggie), and even work in space (Ewald). A session focused tricky cases from daily routine travel medicine. There was also a special invitation to young scientists, students and clinicians with a specific event. Poster presentations added topics for discussions.The presented abstracts include lectures and posters and are listed in alphabetical order of the first author. The presented abstracts include lectures and posters and are listed in alphabetical order of the first author.

What do rural young people want from their mental health service.

Rural young people have high rates of mental illness and low rates of help-seeking making it crucial to extend research about service improvement in rural and remote Australia. To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide. This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes. Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth-focus, and evidence-based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring. The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified. Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes.

Young-GRAPPA (Y-GRAPPA) at the GRAPPA 2022 Annual Meeting: One Year in Y-GRAPPA. Where Do We Stand, Where Do We Go?

Young-GRAPPA (Y-GRAPPA) was introduced at the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting. Here we present the 1-year progress of Y-GRAPPA and future plans of this enthusiastic group of young clinicians and early career researchers interested in psoriasis and psoriatic arthritis.

Developing a Pipeline of African Global Surgery Scholars.

Global surgery is developing as new discipline in many countries. Global surgery primarily aims to improve access to quality surgery in low-and-middle Income countries (LMICs). Thus, ensuring appropriate LMIC representation and leadership in global surgery research, projects, and innovations, is essential. There is a paucity of pathways for students and young clinicians in LMICs to attain training in and exposure to global surgery research and projects. If equity in global surgery leadership and scholarship is truly desired, steps need to be taken to ensure that more students and young clinicians in LMICs are exposed to global surgery as an academic discipline and are offered pathways to practice and leadership. This paper explores ways of ensuring this through increased exposure, increased training and increased funding.

A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study.

Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care. This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services.

In Memoriam: Soldano Ferrone MD, PhD (1940–2023)

In Memoriam: Soldano Ferrone MD, PhD (1940–2023)