Literature Collection

BACKGROUND: In January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency; by March 11, a pandemic was declared. To date in Ireland, over 3300 patients have been admitted to acute hospitals as a result of infection with COVID-19. AIMS: This article aims to describe the establishment of a COVID Recovery Service, a multidisciplinary service for comprehensive follow-up of patients with a hospital diagnosis of COVID-19 pneumonia. METHODS: A hybrid model of virtual and in-person clinics was established, supported by a multidisciplinary team consisting of respiratory, critical care, infectious diseases, psychiatry, and psychology services. This model identifies patients who need enhanced follow-up following COVID-19 pneumonia and aims to support patients with complications of COVID-19 and those who require integrated community care. RESULTS: We describe a post-COVID-19 service structure together with detailed protocols for multidisciplinary follow-up. One hundred seventy-four patients were discharged from Beaumont Hospital after COVID-19 pneumonia. Sixty-seven percent were male with a median age (IQR) of 66.5 (51-97). Twenty-two percent were admitted to the ICU for mechanical ventilation, 11% had non-invasive ventilation or high flow oxygen, and 67% did not have specialist respiratory support. Early data suggests that 48% of these patients will require medium to long-term specialist follow-up. CONCLUSIONS: We demonstrate the implementation of an integrated multidisciplinary approach to patients with COVID-19, identifying those with increased physical and mental healthcare needs. Our initial experience suggests that significant physical, psychological, and cognitive impairments may persist despite clinical resolution of the infection.

Men's health, particularly in the domain of urology, faces significant challenges in access to care, patient outcomes, and cost efficiency. Despite advances in medical treatment, conditions such as prostate cancer remain a leading cause of cancer-related death among men, with African American men disproportionately affected at twice the mortality rate of other groups. Compounding these challenges is a critical shortage of urologists, with 62% of US counties lacking a practicing urologist and only 1 new urologist entering the field for every 10 retiring. This shortage results in delayed diagnoses, increased rates of advanced-stage conditions, and significant health disparities. To address these pressing issues, telehealth and technology-based integrated care models present a promising solution. Telehealth expands access to specialized urological care by overcoming geographical barriers and offering virtual consultations, at-home diagnostics, and continuous patient engagement. Artificial intelligence-driven tools further enhance the efficiency and accuracy of care delivery, improving provider experience by automating administrative tasks and facilitating early intervention through predictive analytics. Furthermore, remote patient monitoring devices provide accurate, cost-effective, and highly accessible alternatives. These innovations reduce provider burnout, lower health care costs, and, critically, improve patient outcomes. This paper explores the potential of telehealth and integrated care in men's health urology as a practical pathway to bridging access gaps, enhancing care quality, and achieving cost savings. By leveraging digital health solutions, health care systems and employers can promote health equity, increase engagement, and ensure that all men receive timely and effective urological care.

PURPOSE AND APPROACH: Women in recovery describe stigma, negative treatment, and limited support as barriers to achieving their health and parenting goals. Mobile health technologies carefully tailored to support the unique needs of recovery communities can provide less burdensome alternatives to in-person services for women transitioning out of substance use treatment. An iterative design process integrated women's interests into the structure, content, and interaction flow of a mobile health (mHealth) app. SETTING AND PARTICIPANTS: Participants included women in recovery from opioid, alcohol, and polysubstance use disorders in a comprehensive housing program in urban Arizona. METHODS: Five focus groups with 3-7 participants each (n = 27 total) informed creation of the mHealth app. Informed by theoretical models of usability and person-centered design, development involved an iterative series of focus groups in which we asked women to comment on interest in using each feature. This provided a qualitative priority framework for feature development. We then modified the app and repeated the process to gauge consensus and continually refine our prototype. RESULTS: Women were interested in access to resources, such as housing, counseling, and parenting advice in settings known to treat women in recovery with respect. They also asked for positive messages, chatting with peers, and access to expert answers. They were less interested in points-based learning modules and "scored" activities, leading us to develop a "daily challenges" concept that builds good habits, but does not feel like "classwork". Women's recommendations shaped an mHealth app tailored to maximize utility, access, and safety for this at-risk population. CONCLUSION: Integration of user-centered design with applied ethnographic techniques guided the development of a custom-tailored mHealth app responsive to lived experiences and needs of women in recovery. Future research should evaluate the potential for user-centered apps to increase self-efficacy, perceived social support, and to reduce risk of relapse.

The integration of Artificial Intelligence (AI) in to the field of medicine is offering a new-age of updated diagnostics, prediction and treatment across multiple fields, addressing systemic disease including viral infections and cancer. The fields of Oral Pathology, Dermatology, Psychiatry and Cardiology are shifting towards integrating these algorithms to improve health outcomes. AI trained on biomarkers (e.g. salivary cf DNA) has shown to uncover the genetic linkage to disease and symptom susceptibility. AI-enhanced imaging has increased sensitivity in cancer and lesion detection, as well as detecting functional abnormalities not clinically identified. The integration of AI across fields enables a systemic approach to understanding chronic inflammation, a central driver in conditions like cardiovascular disease, diabetes and neuropsychiatric disorders. We propose that through the use of imaging data with biomarkers like cytokines and genetic variants, AI models can better trace the effects of inflammation on immune and metabolic disruptions. This can be applied to the pandemic response, where AI can model the cascading effects of systemic dysfunctions, refine predictions of severe outcomes and guide targeted interventions to mitigate the multi-systemic impacts of pathogenic diseases.

BACKGROUND: Same-day access to mental health services is associated with better patient outcomes (e.g., diagnosis, treatment). Telehealth appointments via video or phone can improve timely access to care but may complicate in-person care transfers ("warm handoffs") between primary care and mental health teams. OBJECTIVE: To examine associations between receiving telehealth services and same-day access to integrated mental health services within primary care (PCMHI). DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 1,220,902 Veterans who newly initiated PCMHI services between 10/01/18 and 09/30/23. MAIN MEASURE(S): Our primary outcome of interest was whether "same-day access" occurred, defined as a PCMHI visit that took place on the same day as a primary care visit. Our exposure of interest was whether a patient's initial PCMHI visit took place through in-person versus telehealth, defined as either video or phone. Using multi-level regression models, we examined the association between same-day access and PCMHI visit modality (in-person/phone/video), adjusting for time, region, patient (e.g., demographics, physical and mental health diagnoses), and clinic (e.g., rurality, staffing). Models were stratified by pre-/early-pandemic (FY19-21) versus late-pandemic (FY22-23) periods. RESULTS: Patients with an initial PCMHI visit conducted through telehealth (video/phone) had 86% lower odds of receiving same-day access than those with an in-person PCMHI visit (95% CI = 0.1444-0.1448). Lower odds of same-day access with PCMHI providers were found for both video (OR = 0.0912; 95% CI = 0.0909-0.0915) and phone (OR = 0.1604, 95% CI = 0.1602-0.1606) visits. Odds of same-day access from primary care to telehealth-based PCMHI care improved with time (OR(FY19-21) = 0.10, 95% CI = 0.09-0.12; OR(FY22-23) = 0.18, 95% CI = 0.16-0.20). CONCLUSIONS AND RELEVANCE: Results suggest that primary care patients who receive integrated mental health services via telehealth may be less likely to access primary care services on the same day. Further research should consider how traditional primary care workflows (e.g., warm handoffs) may need to adapt to better integrate tele-mental health services.