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Decreasing Postop Delirium with Dexmedetomidine vs Propofol
Get PDFPostoperative delirium (POD) is a common complication that contributes to increased length of hospital stay, impaired recovery, and can affect long-term outcomes. Recently, research has been conducted to determine if certain anesthetic agents decrease the likelihood of developing POD. However, no clear protocol for prevention exists. This scoping review aimed to analyze the current literature to determine the efficacy of dexmedetomidine versus propofol at preventing POD
Long-Acting Injectable Antipsychotics vs. Oral Antipsychotics in Treatment Adherence: Efficacy and Equity of Care
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Background: Compliance with oral antipsychotic medications (OAP) in the treatment of patients with schizophrenia has been a challenge. Challenges to OAP include medication side effects, lack of ability to obtain medications, and missing doses, among other factors. As a result of this non-compliance, those taking oral antipsychotic medication are at greater risk for exacerbation of their illness. The consequence of relapse carries considerable risks with each psychotic event. The study aims to compare if medication treatment adherence is greater in clients with schizophrenia using oral antipsychotics (OAPs) vs. long-acting injectable (LAI) antipsychotic medications.
Methods: In this scoping review, 15 high-quality research articles were included for review. Articles were searched using the databases PubMed, EBSCO, and Medline. The search was conducted between August 2021 and November 2022, using specific keywords relevant to the background of the scoping review. Publication dates range from 2016-2022.
Results: In this article, we examined and reviewed evidence-based research ranging in publication dates from 2016-2022. These studies revealed a wide range of benefits identifying LAIs as superior to OAPs in improving patient outcomes in clients diagnosed with schizophrenia. Evidence-based literature in this scoping review reports greater patient adherence to treatment with LAI vs. OAP.
Conclusion: Treatment of schizophrenia can be challenging. LAI can be superior to OAP in the treatment of this disease. Treatment with LAI in clients with schizophrenia can lead to increased patient adherence, decreased ER visits, decreased length of hospital stay, hospitalizations, increased prescription fills, and increased quality of life
The Long-Term Cognitive and Psychological Effects of Mild Traumatic Brain Injury (mTBI)
Get PDFMild Traumatic Brain Injury (mTBI), commonly referred to as a concussion, is a prevalent injury in the United States, with several million occurring every year. Many of these injuries take place while playing a sport, particularly in those activities that have higher rates of impact with another person, such as hockey, soccer, or football. While most recover quickly from an mTBI, some individuals may have longer term effects. Recent literature has provided some evidence for long-term dysfunction in head injured individuals, with these dysfunctions appearing as changes in cognition or psychological well-being. Some of the most frequently reported cognitive symptoms were difficulty with attention, insomnia, confusion, and memory loss. On the psychological side, depression, anxiety, insomnia, and agitation are often reported. In order to further examine such symptoms, a sample of 56 retired National Football League players participating in a medical monitoring program were assessed for their long-term cognitive and psychological functioning. In the first set of analyses, a neurocognitive battery was used to assess cognition on a set of three self-reported outcome measures: Number of Concussions, Number of Losses of Consciousness, and Number of Undiagnosed Concussions. The battery was composed of tests divided into one of five areas of cognition: Complex Attention and Processing Speed, Learning and Memory, Visual-Perceptual Processing, Language, or Executive Function. These results were assessed with descriptive statistics, linear regression, and an ANOVA for confirmation of significance (p≤0.01). The results in Complex Attention and Processing Speed, Learning and Memory were not associated with any of the three outcome measures. In Visual-Perceptual Processing, the Number of Concussions was found to be associated with the results on the Block Design test (p=0.003). The Number of Concussions was also found to be significantly associated with the Category Test, a measure of Executive Function (p=0.003). Three tests were found to be significantly associated with the Number of Losses of Consciousness (Boston Naming Test, p=0.006, Controlled Oral Word Associations: FAS Letter Fluency Test, p=0.001, and Similarities p=0.01). Of note, these reported results were all significant after the removal of any participant that failed 2 or more Performance Validity Tests, but showed a normal T-score mean and standard deviation. This may indicate that only a few participants are experiencing any long-term cognitive deficits; an increased sample size should be recruited for confirmation of these results. In the second set of analyses, two psychological tests were administered: the Minnesota Multiphasic Personality Inventory – version 2 RF (MMPI-2RF) and the Mini-International Neuropsychiatric Interview – Plus version (MINI+). The first test is made up of 9 areas of that measure a range of personality and psychological health issues. The second test conducts a brief psychological examination, looking for clinically relevant Axis I and II psychological disorders, falling into 22 diagnoses. As in the previous study, these data were analyzed with descriptive statistics and any individual with Symptom Validity Scale failures was removed from the final analysis. For the MMPI-2RF, a linear regression was conducted, as well as post hoc corrections with Tukey and ANOVA for confirmation of significance (p≤0.01). One significant outcome was found in the Somatic-Cognitive area, Head Pain Complaint (p=0.003). Two significant results were found on Internalizing scale, one in the outcome measure Number of Losses of Consciousness (BRF, p=0.01) and one in the outcome measure Number of Undiagnosed Concussions (SFD, p=0.01). A final significant result was seen on the PSY-5 scales (psychopathology), Introversion/Low Positive Emotion (p=0.01). Each of these results indicates a decreased interest in interpersonal relationships and gives an impression of lowered ability to self-regulate anxious emotions. A similar vein of significant results were found on the MINI+, with Anxiety (Dx2, p=0.001) and Panic Disorder (Dx16, p=0.007) appearing in the outcome measure Number of Concussions. Taken together, these results may indicate a relationship between anxiety and antisocial tendencies and those suffering from multiple head injuries. This work aimed to elucidate a relationship between concussions and cognitive and psychological health. The state of the science review in chapter two found several gaps in the literature and some of the issues in long-term study of concussion, such as the differences between symptoms in individuals with single versus multiple injuries. In chapters two and three, evidence was found for a small subpopulation with multiple recovery issues over time, though the overall population had normal recovery from their injuries. Of the three outcome measures studied, the Number of Concussions was most often associated with both cognitive and psychological symptoms over time. These chapters set a working model for future subjects to contribute to our growing body of knowledge. Future directions for this work include increasing the number of participants, more thoroughly studying the differences between single and multiple injury, and increasing the types of testing to include imaging work and anatomical differences in head injured individuals
Vascular Mechanisms of Rhabdomyolysis-induced Acute Kidney Injury
Get PDFIn patients with rhabdomyolysis, the overwhelming release of myoglobin into circulation is the primary cause of kidney injury. Myoglobin causes direct kidney injury as well as severe renal vasoconstriction. An increase in renal vascular resistance (RVR) results in renal blood flow (RBF) and glomerular filtration rate (GFR) reduction, tubular injury, and acute kidney injury (AKI). The mechanisms that underlie rhabdomyolysis-induced AKI are not fully understood but may involve the local production of vasoactive mediators in the kidney. Myoglobin stimulated endothelin-1 (ET-1) production in proximal tubular cells, an effect driven by NADPH oxidase-dependent oxyradical generation. Rats subjected to glycerol-induced rhabdomyolysis also exhibited ROS-dependent ET-1 production. Vasoactive ET-1 is generated by ET converting enzyme 1 (ECE-1)-induced proteolytic processing of inactive big ET to biologically active peptides. The downstream ion channel effectors of ET-1-induced vasoconstriction are smooth muscle Ca2+ permeable transient receptor potential canonical (TRPC) channels. TRPC1, 3, 4, 5, and 6 are expressed in renal vessels, with TRPC3 predominant. TRPC3, TRPC6, and TRPC7 are highly homologous. Although the ET system is known to be associated with rhabdomyolysis-induced AKI, the function of renal vascular ion channels in the disease was unclear. Our findings demonstrate that glycerol-induced rhabdomyolysis in Wistar rats promotes ECE-1-dependent ET-1 production, RVR increase, GFR decrease, and AKI. Rhabdomyolysis-induced increases in RVR and AKI in the rats were attenuated by post-injury inhibition of ECE-1, ET receptors, and TRPC3 channels. We used TRPC3 and TRPC6 knockout (KO) rats to support the pharmacological approaches. Basal day and night arterial pressure, heart rate, GFR, plasma creatinine, and BUN were unchanged in WT vs. KO rats. Twenty-four h rhabdomyolysis led to comparable increases in urinary ET-1 production in WT and KO rats. CRISPR/Cas9-mediated knockout of TRPC3-, but not TRPC6 channels attenuated rhabdomyolysis-induced decreases in GFR, elevations in BUN, and plasma creatinine. Similarly, morphological kidney damage (tubular necrosis, casts, and dilatation) was mitigated in the TRPC3 KO with no protection offered by the KO of TRPC6 channels. Together, our data suggest that myoglobin-driven ET-1 production and downstream activation of TRPC3- but not TRPC6-dependent vasoconstriction contributes to rhabdomyolysis-induced AKI. Hence, postinjury inhibition of ET-1-mediated renal vasoregulation may provide therapeutic targets for rhabdomyolysis-induced AKI
Cytochrome P450 1B1 and 12/15 Lipoxygenase Interaction in Paraventricular Nucleus in Angiotensin II-induced Hypertension in Females
Get PDFBackground: Angiotensin (Ang) II releases arachidonic acid (AA) from tissue phospholipids that is metabolized by 12/15-lipoxygenase (ALOX15) generating 12(S)- and 15(S)-hydroxyeicosatetraenoic acid (HETE) which have been implicated in cardiovascular and renal diseases. This study was conducted to investigate a) the contribution of ALOX15 to Ang II-induced hypertension and associated pathogenesis in female mice, and b) the interaction between the cytochrome P450 (CYP)1B1-generated metabolite of 17β-estradiol (E2) (2-methoxyestradiol, 2-ME) and ALOX15 in the paraventricular nucleus (PVN) as a mechanism that protects against Ang II-induced hypertension and its associated pathogenesis in female mice. Methods: Experiments were conducted in intact and ovariectomized (OVX) wild type (WT), alox15 knockout (ALOX15KO) and CYP1B1KO female mice. Ang II (700 ng/kg/min) was infused subcutaneously by osmotic pumps for 2 weeks evaluation of hypertension and associated pathogenesis. Blood pressure (BP) was measured by tail-cuff and confirmed by radiotelemetry. Adenoviral probes including adenovirus (Ad)-green fluorescence (GFP)-ALOX15-short hairpin (sh)RNA, Ad-GFP-ALOX15-DNA, and their respective controls Ad-scrambled shRNA and Ad-GFP-DNA, 12(S)-HETE and 2-ME were injected in the brain using stereotaxic technique, either selectively in PVN or intracerebroventricularly via ICV cannula implanted in the right lateral ventricle to study their roles on Ang II-induced hypertension. Histological, immunohistochemical, and fluorescence microscopy and biochemical techniques were employed to determine the pathophysiological changes in tissues. ELISA was used for the analysis of sex steroids and eicosanoids. Results: Our results demonstrate that the effects of Ang II to increase BP, impair autonomic function and increase renal reactive oxygen species (ROS) production and plasma 12(S)-HETE but not 15(S)-HETE level without altering renal function in intact WT mice were exacerbated in OVX-WT mice. Ang II also increased renal alox15 mRNA, urine 12(S)-HETE, water intake, urine output, decreased osmolality, increased urinary excretion of vasopressin prosegment copeptin, protein/creatinine ratio, and caused renal hypertrophy, fibrosis, and inflammation in OVX-WT mice. These effects of Ang II were attenuated in ALOX15KO mice. Moreover, the Ang II-induced hypertension that was also exaggerated in intact CYP1B1KO mice compared to WT mice was minimized by selective alox15 gene knockdown in PVN by transduction with Ad-ALOX15-shRNA and the restoration of Ang II-induced hypertension by selective reconstitution of alox15 gene in PVN by transduction with Ad-ALOX15-DNA in intact ALOX15KO mice was further exacerbated in OVX-ALOX15KO mice. Furthermore, ICV-12(S)-HETE that restored Ang II-induced increase in BP, impairment of autonomic function, neuroinflammation and renal pathogenesis in intact ALOX15KO mice, further exacerbated these effects of Ang II in OVX-ALOX15KO mice. Finally, ICV-2-ME that reduced the alox15 mRNA expression and 12(S)-HETE content in PVN minimized the hypertensive effects of Ang II, including BP, autonomic impairment, neuroinflammation and renal pathogenesis in OVX-ALOX15KO with the restoration of alox15 gene in PVN by transduction ICV with Ad-ALOX15-DNA. Conclusion: These data suggest that 17β-estradiol plays a critical role in female mice in protecting against Ang II-induced hypertension and associated pathogenesis, most likely via inhibition of ALOX15 activation and reduced production of 12(S)-HETE in the PVN. Therefore, the selective inhibitors of ALOX15 or 12(S)-HETE receptor antagonists could be useful for treating hypertension and its pathogenesis in postmenopausal, hypoestrogenic women or females with ovarian failure. These data also elucidate how drugs that inhibit CYP1B1 activity can be beneficial for treating hypertension and its pathogenesis in males but can be detrimental in females. The effect of alox15 gene polymorphism in pre-and postmenopausal females to determine its impact on the contribution of AA-ALOX15 derived 12(S)-HETE in hypertension and its pathogenesis is also warranted
A Comparative Analysis of Human Insulin versus Analog Insulin: Glycemic Control, Adherence, Utilization, and Cost-Effectiveness
Get PDFBackground: Despite being a lifesaving medicine for many patients with diabetes, insulin cost is growing out of reach for many. Of the two broad classes of insulin available in the US, analog insulin is newer, costlier, and more widely used than human insulin. The new mode of delivery with pen devices has shown promise in improving adherence and achieving glycemic control and gaining popularity. But comparing adherence to different insulins is challenging due to the lack of a validated insulin adherence method. Very little is known about the comparative benefits of different insulin types and different modes of delivery in the US. Objectives: The main goal of this project was to compare the real-world benefits of different insulin types. To accomplish this, three studies were conducted with the following aims: (1) to identify an effective method for measuring insulin adherence by its ability to predict change in hemoglobin A1c (A1c); (2) to examine the differences in 2a) improvement in a1c, 2b) adherence, and 2c) healthcare utilization between users of the analog vial, analog pen, and human insulin; and (3) to compare the cost-effectiveness of the analog vial, analog pen, and human insulin from the payer’s perspective in terms of 3a) cost per unit A1c reduction and 3b) cost per ER visit and hospitalization avoided. Methods: This project involved retrospective cohort studies using administrative claims data from Tennessee Medicaid and electronic health records from a regional diabetes registry in the Mid-South. Participants included were US adults with type 2 diabetes who filled at least 2 prescriptions for insulin between 1/1/2016 and 6/30/2018. For the first study, medication possession ratio (MPR), proportion of days covered (PDC), and medication user rate (MUR) were compared by the ability of the three measures to predict change in A1c using multiple linear regression and receiver operating characteristic curve. Each patient’s A1c records and body-mass index were extracted from the registry. All other information including insulin use was collected from the Medicaid claims data. The second study employed multivariate logistic regression to compare the improvement in A1c and adherence, and negative binomial regression to compare the rates of emergency room (ER) visits and hospitalizations between analog vial, analog pen, and human insulin users. Cost-effectiveness was analyzed for the third study using the claims and registry data. Adjusted mean cost, mean A1c reduction, and mean ER visit and hospitalization were determined using generalized linear models with gamma distribution, multiple linear regression, and negative binomial regression. Cost-effectiveness was computed by the incremental cost-effectiveness ratio (ICER). Results: The cohort for studies 1, 2a, and 3a consisted of 533 patients and was a subset of the cohort for studies 2b, 2c, and 3b with 2,763 patients. In both cohorts and all insulin groups, the majority were female and African Americans and resided in health-professional-shortage areas. Adherence to insulin was poor across all insulin groups ranging between 53\% to 60\%. We found MPR and PDC to be strong predictors of change in A1c and identified both as effective methods for measuring insulin adherence. The second study used MPR and PDC to compare adherence between insulin groups. Analog vial users were less likely to be adherent compared to human insulin users (OR: 0.686; 95\% CI: 0.531 – 0.885). No difference in adherence was observed between analog pen and human insulin. No significant association between insulin type and A1c improvement was detected, indicating neither type of insulin was more likely than another to show improvement in A1c. Analog vial users were more likely to visit the ER compared to human insulin users (OR: 1.275; 95\% 1.027 – 1.582) and analog pen users (OR: 1.528; 95\% CI: 1.289 – 1.812) and be hospitalized compared to analog pen users (OR: 1.820; 95\% CI: 1.315 – 20519). Analog pen users were less likely to be hospitalized compared with human insulin users (OR: 0.637; 95\% CI: 0.407 – 0.997). In the third study, human insulin was dominant over analog vial in cost per unit A1c reduction and cost per ER visit and hospitalization. Analog pen was more cost-effective than analog vial with small ICER values. Conclusion: Our study demonstrated that analog insulin when delivered in a vial, had worse adherence, higher rates of ER visits and hospitalizations, and less cost-effectiveness in comparison with human insulin. Users of analog insulin via pen devices had better adherence and this type of insulin was more cost-effective. Physicians, payers, and policymakers should consider the real-world benefits of analog vs. human insulin when choosing or prioritizing insulin for patients. Future research is warranted to compare the benefits of all insulin types and modes of delivery in other populations
Investigation of Clinically Relevant Fluconazole Resistance Mechanisms in the Fungal Pathogen Candida parapsilosis
Get PDFInvasive candidiasis is a severe fungal infection associated with significant morbidity and mortality, particularly among the critically ill and immunocompromised. Candida parapsilosis is the most common non-albicans species causing invasive Candida infections in pediatric and neonatal populations worldwide and is particularly common in the countries of South America, Western Asia, Mediterranean Europe, and Southern Africa. For many of these countries, fluconazole and other triazoles are the first line antifungal agents used for effective treatment of invasive Candida infection. Until recently, rates of fluconazole resistance among C. parapsilosis isolates were relatively low, therefore the determination of clinically relevant resistance mechanisms in C. parapsilosis isolates were primarily presumed from the observations of Candida albicans. Gain-of-function polymorphisms in MRR1 and TAC1 have been shown to elevate the expression of MDR1 and CDR1/CDR2 respectively and directly contribute to fluconazole resistance in Candida albicans. Our lab previously identified three resistant isolates with upregulated CpMDR1 expression that contained CpMRR1 mutations, while CpTAC1 mutations were found in three isolates with upregulated CpCDR1 expression. Deletion of CpMDR1 or CpCDR1 from strains containing the nonsynonymous CpMRR1 or CpTAC1 polymorphisms had little to no impact on fluconazole minimum inhibitory concentrations (MIC), suggesting the presence of uncharacterized resistance effectors. This dissertation reviews the emergence of resistance, presents investigations of three major mediators of fluconazole resistance, and characterizes a collection of clinical isolates to better identify and understand how fluconazole resistance in C. parapsilosis. A recently developed CRISPR-Cas9 system was used to edit CpMRR1 alleles in the clinical isolate backgrounds and allowed for characterization of the single nucleotide polymorphisms (SNPs) leading to the substitutions A854V, I283R, and R479K and gain-of-function in CpMrr1. Antifungal susceptibility testing demonstrated that gain-of-functions (GOF) in CpMrr1 increased fluconazole MIC 128-fold when placed into a susceptible background while correction of CpMRR1 SNPs to the wildtype nucleotides decreased fluconazole MICs 32-fold. Transcriptional profiling revealed the previously identified CpMDR1, the novel major facilitator superfamily (MFS) transporter, herein named CpMDR1B, and an ATP-binding cassette (ABC) transporter, herein designated CpCDR1B, were all upregulated by CpMrr1 GOF. Our development of a promotor replacement method for C. parapsilosis and implementation of a barcoded gene disruption system, demonstrated the direct contribution of CpCDR1B and CpMDR1B expression on fluconazole susceptibility and confirmed expression of CpMDR1 was not a primary driver of CpMrr1-mediated resistance. Subsequent investigation of putative GOF mutations in CpTAC1 showed correction of a SNP leading to the G650E substitution in a resistant clinical isolate decreased fluconazole MICs by 32-fold. Transcriptional profiling showed elevated expression for three ABC transporters, CpCDR1, CpCDR1B, and a gene identified here as CpCDR1C. Utilizing the overexpression and disruption systems, we demonstrated the direct effects of CpCDR1, CpCDR1B and CpCDR1C on triazole MICs. The single base editing system was also used to place the SNP leading to the Y132F substitution into the triazole drug target CpErg11 of susceptible isolates. Antifungal susceptibility testing demonstrated this frequently cited driver of resistance was insufficient in-and-of itself to elicit high-level fluconazole resistance in C. parapsilosis. Finally, next generation sequencing was used to genotypically and phenotypically characterize the entire clinical isolate collection to identify key and potentially novel markers of fluconazole resistance in C. parapsilosis. Phylogenic analysis revealed distinctive clusters of isolates with similar resistance mechanisms while implying fluconazole resistant C. parapsilosis both with and without the CpErg11 substitution, Y132F were capable of persisting in healthcare facilities. Additionally, eight isolates with clinical fluconazole resistance demonstrated distinct patterns of upregulated MFS and ABC transporters compared to the susceptible isolates while the presence of wildtype CpMRR1, CpTAC1, CpERG11, CpUPC2 and CpERG3 suggests novel mediators of fluconazole resistance within C. parapsilosis. The absence of meaningful CpERG11 upregulation among resistant clinical isolates alongside distinct expression patterns for both of MFS and ABC transporters emphasizes the importance of looking beyond CpErg11 when investigating clinical resistance in C. parapsilosis. Understanding how resistance is regulated, develops, and even persists among clinical isolates is fundamental to the preservation of triazoles as effective treatments for invasive C. parapsilosis infection
The Efficacy of Constraint-Induced Movement Therapy or Modified Constraint-Induced Movement Therapy in Improving Upper Extremity Motor Function in Adults with Hemiplegia After a Traumatic Brain Injury
Get PDFThe final portfolio contains 11 research articles from both national and international journals. Study designs include two randomized control trials, one systematic review, four quasi-experimental studies, one case study, two case series, and one pilot case study. All studies relate directly to components of the evidence-based practice question and will be used to draft new practice guidelines for using constraint-induced movement therapy (CIMT) or modified constraint-induced movement therapy (mCIMT) in occupational therapy practice.
Seven articles specifically describe the effectiveness of CIMT or mCIMT for adults with hemiplegia following a traumatic brain injury. The other four articles describe the effectiveness of CIMT or mCIMT for adults with hemiplegia following a cerebrovascular accident or an acquired brain injury. These themes will be discussed in detail
The Utilization of Depression Screening Tools in Patients with Diabetes Type 2
Get PDFPurpose/Background
Diabetes and depression are highly prevalent and concerning conditions impacting millions worldwide. Evidence-based guidelines recommend regular depression screening of individuals with type II diabetes (DM2) to appropriately diagnose and treat depression and proactively enhance clinical outcomes. The gold standard for determining depression in patients with chronic disease is the diagnostic clinical interview; however, many clinicians have turned to brief, self-reported screening tools such as the PHQ-2 and the PHQ-9 whose use are recommended by evidence-based guidelines. This study aims to assess the utilization of the PHQ-2 and PHQ-9 versus no screening on DM2 patients in a primary care setting.
Methods
In this retrospective chart review, 29 charts of patients ages 18 and older diagnosed with DM2 were assessed to determine if a depression screening was completed. For subjects who met the study’s inclusion criteria, we obtained the sex, age, whether the patient was screened for depression at the office visit, and if they were screened, which depression screening tool was utilized.
Results
Between November 15, 2018, and November 8, 2021, 29 patients met the inclusion criteria for our retrospective chart review. In total, the patients were seen for a total of 102 visits, with 68% of patients screened for depression using either the PHQ-2 or the PHQ-9 screening tool. The average number of visits per patient was 3.5 visits. The average age of the patients was 52.8, with a median age of 51. Twenty-one of the subjects were female, while eight were male.
Implications for Nursing Practice
Based on the data collected, more research is needed to determine if the utilization of a screening tool such as the PHQ-2 and PHQ-9 would indeed be beneficial in treating depression in patients with chronic diseases such as diabetes. Confounding variables that hindered obtaining sufficient data include clinic participation in screening, readily available screening forms, and time constraints. Additionally, variables that could have resulted in a more robust study include a larger sample size, the collection of the patient’s ethnicity, hemoglobin A1c, PHQ-2, and PHQ-9 scores, and the initiation or referral for psychiatric treatment. Further areas of research are needed to determine the benefits of screening for depression in patients with chronic diseases such as diabetes
Telehealth by Certified Psychiatric Providers Compared to Emergency Department Healthcare Providers on Psychiatric Patient Outcomes: A Scoping Review
Get PDFBackground: Emergency department visits for mental health disorders have increased over the years due to insufficient mental health resources. The number of ED visits for mental health disorders rose from 1.4 to 2.5 million per year in the US. Therefore, mental health patients being seen by ED physicians are more likely to have longer lengths of stay, an increase in hospital admission, and high recidivism rates. Purpose: In this scoping review, we wanted to determine the role of telehealth on ED mental health patients. outcomes regarding how telehealth can reduce the number of admissions, length of stay in the ED, dispositions of patients with mental illness complaints, the cost-effectiveness of telehealth, and patient and staff satisfaction were reviewed. Method: We collected data using The University of Tennessee Health Science Center (UTHSC) online Library, and we obtained articles using CINAHL Complete, Medline, and PubMed. The eligibility criteria were studies conducted in English, subjects greater than 18 years of age, meet DSM criteria for mental health diagnosis, and no limit on gender, race, and ethnicity. Participants must be able to consent. Result: Data from 11 articles published from 2012 to 2020 was collected. Decreased length of stay, improved patient outcomes, decreased healthcare cost, and reduction in readmission/revisit rates were the most frequently reported findings. Implications for Nursing Practice: Results of this scoping review showed improved patient outcomes and decreased readmission/revisit rates when patients with psychiatric illness were seen by a psychiatric physician via telehealth in the Emergency Department. This practice can be standardized and utilized to yield similar results to the literature review. Additional research is necessary to assist in the development of healthcare resources that will provide patients who suffer from mental illness with the care they deserve