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Barriers to Screening for Diabetic Retinopathy: A Scoping Review
Full text linkPurpose/Background
More than 34 million people in the United States have diabetes. Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of vision loss. Risk factors for diabetic retinopathy include Type 1 and Type 2 Diabetes, hypertension, smoking, and being African American or Hispanic/Latino. This scoping review seeks to analyze the current research on ways to increase vision screenings, thus reducing cases of diabetic retinopathy in adults.
Methods
Between September 2020 and November 2021, a search was conducted using PubMed, EBSCOhost, Medline, and CINAHL to identify articles using keywords such as diabetic retinopathy and ophthalmology. This extensive search led our group to twenty articles from different levels of evidence, which after undergoing rapid critical appraisal (RCA) left us with fifteen to be included in this scoping review. Our goal was to understand the barriers to receiving annual screening and strategies to enhance compliance with ophthalmology.
Results
The articles in our scoping review include systematic reviews, randomized control trials, and case-control studies. From the articles, we discovered barriers to receiving annual exams include cost, insurance, and education. We concluded that patient education along with annual referrals to ophthalmology as prevention for diabetic retinopathy is essential for reducing vision loss.
Implications for Nursing Practice
Based on our scoping review, we understand that multiple barriers exist that complicate compliance with annual vision screenings. Primary care providers play an essential role in providing patient education and referral to ophthalmology to decrease the prevalence of diabetic retinopathy. More research is needed on the effectiveness of interventions such as educational pamphlets in enhancing screening rates
Impact of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia on Time to Extubation: A Scoping Review
Full text linkPurpose/Background
Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times.
Methods
From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Center’s (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid critical appraisal (RCA). We then chose ten articles that were critically appraised and were from peer-reviewed sources. Finally, we constructed an outcome synthesis table and level of evidence table to synthesize the results of those ten articles.
Results
Ten articles were chosen for this scoping review. Nine articles show that the use of ketamine decreases the time to extubation, with five proving to be statistically significant. Four articles demonstrated a decrease in ICU length of stay in days with the ketamine-based anesthesia group. Five articles found a significant decrease in postoperative opioid consumption in the ketamine-based anesthesia group. The results demonstrate that there is evidence favoring the use of ketamine and opioid free anesthesia to decrease extubation times, decrease ICU lengths of stay, and decrease postoperative opioid consumption.
Implications for Nursing Practice
This scoping review has demonstrated that ketamine, when used as a perioperative adjunct for pain control, will reduce opioid usage and times to extubation. Implementation of routine ketamine administration should be considered in populations that may have prolonged intubation times
Impacts of Habitat, Resource Addition, and Predator Exclusion on Rodent Community Structure and Hantaviruses in the Neotropics
Full text linkUnderstanding how climate and human land use change impacts trophic interactions is essential in the face of ongoing biodiversity loss and the continued emergence of RNA viruses and zoonosis. Human land use changes such as agricultural expansion, deforestation, and habitat degradation all have been linked to zoonotic disease emergence. Despite these commonalities, our mechanistic understanding of what drives them is lacking. Moreover, genomic surveillance in wildlife populations is critical for risk assessment and mitigation. Herein, using data collected from field studies within the Reserva Natural del Bosque Mbaracayú (RNBM), a protected area of the Interior Atlantic Forest (IAF), I examined the impact of predator exclusion and habitat degradation on the rodent community and the prevalence of hantaviruses within two reservoir hosts: Akodon montensis and Oligoryzomys nigripes. These species harbor Jabora hantavirus (JABV) and Juquitiba hantavirus (JUQV) respectively. Secondly, I developed an amplicon-based, next generation sequencing approach to survey the full-length genomes of these viruses in wildlife. In the first study, predator exclusion was conducted at three grid pairs with different levels of habitat degradation: least, moderately, and most degraded. Three grids were selected for experimentation and the others as controls. On experimental grids, electric fencing and cage traps were set up at each grid. This was done to exclude the entry/re-entry of terrestrial mammals. From these studies we found that predator exclusion did not impact the structure of the rodent community, nor did it alter hantavirus prevalence. Instead, habitat degradation altered hantavirus prevalence in Akodon montensis populations. We did not observe the same effect for Oligoryzomys nigripes. Additionally, we found that prevalence is strongly associated with host biological factors including sex and age. For both species, adult males were more likely to be infected. Using samples collected from these field studies, I used empirical approaches to determine whether a multiplexed-PCR based amplicon sequencing approach could be leveraged to sequence hantaviruses from which no sequence information exists. To do so, I manually designed degenerate primers to amplify JABV and JUQV. This allowed for the recovery of near complete full-length genomes for these segmented viruses. To demonstrate the utility of this tool, I screened 98 lung O. nigripes lung tissues for the presence of S and M segment vRNA. In total, I identified 16 RNA positives, eight of which were previously confirmed as being antibody positive. From these samples, I recovered full-length S and M segment genomes at an average depth of coverage \u3e500x which facilitated the examination of the minority variant population. From all sequences collected, there were 33 synonymous, two nonsynonymous (V179I, I289T), and 20 3’ NCR mutations in the S segment sequences. There were 143 total mutations in the M segment. Of these, 137 were synonymous and six were nonsynonymous mutations: T104A, S310P, L340V, A370T, V504I, and S511L. Interestingly, nonsynonymous M segment mutations were identified in the glycoprotein, Gn, which is the spike protein involved in cellular attachment and entry. There was evidence of strong purifying selection acting on both genomic segments. There was no evidence of positive selection. Despite there being evidence of strong purifying selection, genetic diversity differed significantly by habitat type. Diversity was higher in the least degraded forests compared with the moderately or most degraded forests. Based on previous studies, there was no evidence to suggest that this level of diversity was caused by an increase in virus prevalence or host abundance. Instead, field data suggests that difference in host behavior may be mediating these responses. Altogether, this data suggests that there are tight constraints placed on the evolution of hantaviruses within their host. Long term, the sequencing approach described herein could be used for the surveillance of other segmented RNA viruses within their reservoir or non-reservoir hosts in nature. Moreover, examination of virus diversity at the population level can help elucidate mechanisms underlying virus persistence
A Design, Development, and Evaluation of Bio-Patch for Myocardial Tissue Repair
Full text linkIntroduction. Ischemic heart disease (IHD) is a major concern of human health issue. The structural repair and functional recovery of injured hearts is a major challenge in the clinical setting. Preclinical studies over last 10 years have demonstrated the potential of using stem cells to treat IHD, but the efficacy of this therapy is jeopardized by uncontrollable migration and low survival of the injected stem cells. An approach based on tissue engineering enabling target-specific stem cell delivery such as cardiac patches has emerged as an alternative solution for stem cell therapy for IHD. It employs scaffold materials to engulf various stem cells and growth factors, forming patches implantable to the injured tissue. It has been proven to be a promising method for tissue repair and regeneration, however, it remains challenging to retain a sufficient survival of the stem cells attached to the scaffold materials to fulfill the therapeutic requirement. Therefore, the purpose of this study was to develop and characterize a bio-patch combining stem cells, hydrogel, and scaffolds to improve cell survival and retention for improvement of stem cell therapy for IHD. The focus of this study was to develop an ideal bio-patch that should have suitable mechanical properties maintaining the stemness of stem cells, promoting cell adhesion, and ensuring cell proliferation and differentiation under appropriate conditions. Methods. In this study, adipose-derived stem/stromal cells (ADSC) were chosen as seed cells, and bovine type I collagen was employed to engulf ADSC to produce hydrogel spheres. To fully characterize the behavior of ADSC in the hydrogel, spheres of varying sizes (~200-1000 µm for microspheres, and ~1000-2000 µm for macrogels) were generated. To determine the optimal formulation, cell proliferation, viability, migration, and differentiation capacity of the seed cells were assessed under the conditions of varying concentrations of collagen I (2, 4, 6, 8 mg/mL) and different cell densities (1, 5, 10, 15 x 106 /mL cells). To enhance the mechanical stability of collagen spheres, an additional Poly-L-Lysis (PLL) shell material with different concentrations (0.01, 0.05, 0.1, 0.25, 0.5 mg/mL), and crosslink times (5, 10, 20, 30 minutes) were evaluated to define the best formulation for the optimal condition for cell viability. Electrospun collagen patch was fabricated to serve as flat scaffold, and an octyl-cyanoacrylate (OCA) adhesive was employed to strengthen the adhesion between ADSC microspheres and the scaffold. To define the ideal OCA concentration for ADSC survival, the cell cytotoxicity of various brands of OCA was assessed in both direct and indirect contact on a dosedependent manner. Additionally, the adipogenesis and osteogenesis of ADSC were assessed following OCA treatment to further determine the effect of OCA on ADSC. To maintain ADSC physiological performance, ADSC macrogels were immediately attached to the scaffold and immersed in the growth medium. After bio-patch produced, the cells were released by 0.1% type I collagenase after different days of culturing (1, 3, 5 days), and cell proliferation, adipogenesis, osteogenesis ability were evaluated to check the properties of ADSC. The growth factors released situation (VEGF) under hypoxia conditions were evaluated by RT-PCR. Finally, in the in vivo study, a rat model of IHD was employed to assess the effect of the bio-patch on the injured heart by examining changes in infarcted area and cardiac contractile function after bio-patch implantation. v Results. The ADSC exhibited reduced migration, adhesion, viability, and proliferation ability with high concentrations of collagen, specifically, cell viability decreased when collagen concentration higher than 4 mg/mL. Furthermore, cell viability decreased with high cell density engulfed in macrogel. The author found that 5x106 cells/mL in collagen solution was the optimal concentration for cell survival. The ADSC’s viability decreased with high concentrations as well as prolonged assembly time of PLL; The author found the concentration at 0.05 mg/mL and the assembling time of 10 min was the best formulation for cell survival and structure integrity. Characterizations of ADSC released from macrogels by flow cytometry showed good preservation of stem cell surface marker expression. Trilineage differentiation analyses further confirmed the preservation of ADSC released from microspheres. The author found OCA affects ADSC in a dosedependent manner, OCA at concentrations below 14 µM did not affect the morphology, proliferation, and viability of the tested cells (50000 cells). OCA from different sources displayed variable adverse effects on the cells but overall, the concentration over 23 µM showed a significant cytotoxic effect. Furthermore, the author also observed that OCA at its concentration of 5 µM did not alter the trilineage differentiation of ADSC. Under this condition, the adhesive capacity of OCA for the bio-patch was well maintained. The expression of VEGF was significantly increased under hypoxic conditions that was regulated by increased expression of Hif-1α. Finally, the bio-patch’s function in a rat model of IHD was validated. Improved heart function was observed in the ischemic heart after treatment with the bio-patch for 7 days. Histological observation exhibited a decreased TNF- expression and improved IL10 expression, with less fibrosis and collagen deposition. Conclusion. An implantable bio-patch as an effective delivery system for ADSC was developed in this study. Specifically, the author worked out the formulation of each component: the optimal collagen/PLL concentrations, cell density in different spheroid size, and the best OCA to ADSC ratio under different conditions. Animal studies using a rat model of IHD validated the potential of the bio-patch in prevention of acute ischemic cardiac injury. This protection by ADSC patch most likely resulted from a paracrine mechanism and anti-inflammatory effect
Modified vs. Standard Sternal Precautions
Full text linkThe poster examines standard and modified sternal precautions in pediatrics following a median sternotomy and the impact on developmental outcomes. The question our poster aims to answer includes, do modified sternal precautions improve developmental outcomes in children who underwent (median) sternotomy in a hospital setting compared to those with traditional sternal precautions? Through searching databases, the authors were able to gather articles providing evidence and information regarding modified vs. standard sternal precautions. Through the research, the authors concluded that there is further research needed on this topic in pediatric populations with the recommendation to proceed using caution due to no adverse effects mentioned
Occupational Therapy Strategies for Postural Orthostatic Tachycardia Syndrome
Full text linkEffectiveness of occupational therapy strategies with adults with postural orthostatic tachycardia syndrome
Development of Novel, Brain Permeable, mPGES-1 Inhibitors for Inflammatory Conditions
Full text linkProstaglandin E2 (PGE2) is a potent proinflammatory lipid signaling molecule produced downstream of the cyclooxygenase (COX) cascade. The COX pathway has long been implicated for its role in inflammation, with drugs like aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) non-selectively targeting the upstream COX enzymes to suppress inflammation. However, despite displaying potent anti-inflammatory effects it has been demonstrated that when taken chronically, NSAIDs can cause gastrointestinal bleeding. COX-2 selective inhibitors (COXIBs) were then developed to combat the gastrointestinal bleeding induced by nonselective NSAIDs by specifically inhibiting the COX enzyme most infamous for its role in inflammation. Yet, soon after entering the market it became apparent that COXIBs provoked even more deleterious cardiovascular side effects. Thus, there is a critical and urgent need for novel anti-inflammatory therapeutics targeting the COX cascade that circumvent the adverse effects of chronically targeting COX. Microsomal prostaglandin E synthase-1 (mPGES-1) is the major producer of PGE2 during inflammation and therefore represents a more specific therapeutic target to combat inflammation. Although a promising target, mPGES-1 inhibitors have been difficult to develop due to the interspecies differences that exist between the human and murine enzyme, creating a hurdle in the preclinical drug development of mPGES-1 inhibitors. Utilizing the well-known dual species mPGES-1 inhibitor C3 as our parent compound, we developed a series of 20 novel mPGES-1 inhibitors by employing a scaffold hopping design approach. We selected the benzothiazole and phenyl-thiazole scaffolds to replace the benzimidazole scaffold within C3, to increase lipophilicity with the notion of increasing blood brain barrier penetration. From our primary screen at 10 µM we identified two inhibitors namely compound 11 (UT-11) and compound 19, representing our novel scaffolds that were able to significantly suppress PGE2 production in both human (SK-N-AS) and murine (BV2) cells better than their parent compound (C3). To follow up on our initial screen IC¬¬50 values of UT-11 and compound 19 were calculated. We obtained 0.10 and 2.00 μM for UT-11 and 0.43 and 1.55 μM for compound 19 against human and murine cells, respectively. These results, coupled with in vitro anti-inflammatory effects and pharmacokinetic data of UT-11 lead us to select UT-11 for in vivo evaluation. Using an lipopolysaccharide (LPS)-induced inflammation model we found that treatment with UT-11 following exposure to LPS (3mg/kg) was able to significantly suppress pro-inflammatory mediators in the hippocampus, but not in the kidney. It is important to note that the anti-inflammatory effects of UT-11 were dependent on mPGES-1 expression, thus underscoring the specificity of UT-11. Taken together these results demonstrate the potential utility of UT-11 in treating other neuroinflammatory diseases such as epilepsy and stroke, which should be investigated in future studies
Targeting Prostaglandin E2 Receptor EP2 for Treatment of High-Risk Neuroblastoma
Full text linkProstaglandin E2 (PGE2) is a predominant proinflammatory regulator that plays pivotal roles in regulating tumor cell proliferation, migration, and invasion. It fosters an inflammation-enriched microenvironment that facilitates angiogenesis and immune evasion. Neuroblastoma (NB) is a lethal pediatric malignancy. PGE2 has been reported to promote high-risk NB proliferation and progression. However, the PGE2 receptor subtype (EP1-EP4) which potentially contributed to NB growth remained elusive. In this research, at first, we demonstrated that EP2 receptor was highly correlated with NB aggressiveness, and acted as a predominant Gαs-coupled receptor mediating PGE2-initiated cyclic AMP (cAMP) signaling in NB cells with high-risk factors, including chromosome 11q deletion and MYCN amplification. CRISPR/Cas9 induced EP2 knockout blocked the development of NB xenografts in athymic nude mice. Additionally, EP2 conditional knockdown prevented established tumors from progressing in vivo. Pharmacological inhibition of EP2 by our recently developed antagonist TG6-129 substantially suppressed the NB tumor growth in both nude mice and syngeneic immunocompetent hosts, with the observable anti-inflammatory, anti-angiogenic, and apoptotic effects. Next, based on the scaffold of TG6-129, we developed, and identified a novel robust EP2 antagonizing compound GLL-618. GLL-618 demonstrated enhanced EP2 binding potency. Meanwhile, it also showed advanced pharmacokinetic features such as prolonged plasma half-life and im-proved bioavailability. Applied as a single treatment reagent, GLL-618 could significantly inhibited high-risk NB neuro-spheres development and suppressed high-risk NB xenograft tumors growth by 50%. Subsequently, we combined GLL-618 with vincristine, a prevalently used chemotherapy drug for the treatment of high-risk NB. GLL-618 could synergistically increase the anti-tumor effect of vincristine, which was evidenced by an overall 70% tumor weight reduction at the treatment endpoint in an immunocompetent allograft model, accompanied with quenched proinflammatory signaling within the tumor microenvironment and elevated expression of apoptotic markers. In conclusion, this study suggested that the PGE2/EP2 signaling pathway might contribute to NB development and progression. EP2 inhibition with our drug-like compounds could be potentially applied as an alternative, and adjunctive treatment strategy for this deadly pediatric cancer
The Effects of Synovial Fluid and Inflammatory Cells on Orthopaedic Implant Alloys
Full text linkIntroduction. Total knee arthroplasty (TKA) is a common surgical procedure used to treat end-stage osteoarthritis. The implants used in TKA typically consist of a Cobalt Chromium Molybdenum (CoCrMo) femoral component and a Titanium Aluminum Vanadium (TiAlV) alloy baseplate. These metal alloys are chosen for their mechanical properties, corrosion resistance, high affinity for bone, and biocompatibility. However, they can be susceptible to mechanical and electrochemical wear, leading to the release of metal ions. Osteoarthritis and inflammation can alter the composition of Synovial Fluid (SF), potentially causing implant corrosion and the release of metal ions into the surrounding tissue. These metal ions can trigger innate and adaptive responses, further enhancing implant corrosion. As the number of primary TKA (PTKA) procedures increases, the incidence of revision surgeries due to implant failure is also expected to rise. Approximately 20% of TKA recipients report dissatisfaction after surgery. To reduce this number, it is crucial to investigate the modes of failure in TKA and their correlation with patient quality of life.
Methodology.The study employed a methodology to examine the effects of SF on orthopedic implant alloys. SF samples were collected from patients before their TKA surgery (IRB approval number: 16-04802-XP and 21-08403-XP) and transferred to an electrochemical cell (Bioanalytical Systems, Inc.), in which the metal alloy electrodes served as working electrodes. To obtain the corrosion rates of TiAlV and CoCrMo alloys in each patient SF, passivated rods of ASTM F1537 CoCrMo and ASTM F136 TiAlV alloys were used. The volumes and pH of the collected SF samples were recorded with the electrochemical potential of the metal alloy electrodes in the SF samples against an Ag|AgCl|3M NaCl reference electrode. Patients were contacted 3 months post-op to answer the KOOSJR (Knee injury and Osteoarthritis Outcome Score, Joint Replacement) survey to assess their knee pain, stiffness, and function. After electrochemical testing, samples were stored at -80 °C until the metal ion content in the individual SF samples was determined. To determine the effects of the innate and adaptive responses in vitro on orthopaedic implant metal, IC-21 murine macrophages and D10.G4.1 murine lymphocytes were cultured. Select groups of macrophages were activated using Interferon Gamma (IFNγ) and Lipopolysaccharide (LPS). CoCrMo and TiAlV alloy disks were cut, polished, passivated, and placed into 24 well plates. After seeding the cells, the culture medium was replaced every 24 hours, and the supernatant fluid was collected every day starting on the second day of the experiment. After 30 days, cells were removed from the surface of the alloy specimens, counted, tested for viability, and digested. The metal concentrations found in the supernatant and digested cell mixture were assessed using inductively coupled plasma spectrometry (ICP-MS), conducted at Brooks Applied Labs (Bothwell, WA). The oxygen (oxide) levels on the metal alloy specimen surfaces were determined as percent weight using Scanning Electron Microscopy and Energy Dispersion X-ray Spectroscopy (SEM-EDS). Statistical analysis was conducted using Microsoft Excel (Microsoft, Redmond, WA) and IBM SPSS (Armonk, NY).
Results. The open circuit potential (OCP) values ranged from -0.274 to 0.123 V and -0.322 to 0.027 V for CoCrMo and TiAlV respectively. However, no significant association was found between the electrochemical parameters and the KOOSJR scores, indicating no direct correlation between corrosion rates and patient-reported outcomes. The SF volume was found to be a significant factor, with patients having greater SF volumes exhibiting higher KOOSJR scores. Patients with greater than 2 mL SF volumes had significantly higher KOOSJR scores than those who had less than 2 mL SF (p = 0.004). All patients with higher SF pH values (pH values ranged from 7.09 to 8.5) had smaller SF volumes (p \u3c 0.05). Patients with CoCrMo implants and higher pH values had lower OCP (p = 0.002), Rp (p = 0.013), and Ecorr (p = 0.012) values but higher corrosion rates (p = 0.03). No similar relationships were found for patients\u27 SFs with TiAlV alloy implants. No differences in cell counts were found. The macrophages and supernatant were sent for ICPMS (Inductively Coupled Plasma Spectrometry) testing to determine their metal ion concentration. Activated MO + Disks in both alloy groups had elevated metal content compared to non-activated MO + Disk groups. The Activated MO + lymphocytes + Disks had lower metal ion levels compared to Nonactivated MO + lymphocytes + Disks groups for CoCrMo groups and TiAlV groups. Ti, Al, Cr, and Mo metal concentration in the supernatants of the compared groups were the same but Co metal ion levels were significantly higher in Activated + MO + TiAlV disks (p = 0.004) and Nonactivated + MO + TiAlV disks (p = 0.007) groups compared to their control groups (Activated + MO + no disks and Nonactivated + MO + no disks respectively). V metal ion levels were significantly higher in Activated + MO + TiAlV disks (p = 0.007) and Nonactivated + MO + TiAlV disks (p = 0.026) groups compared to their control groups (Activated + MO + no disks and Nonactivated + MO + no disks respectively). SEM (Scanning Electron Microscopy) imaging was used to analyze the surface of the CoCrMo and TiAlV disks. Features with the size of inflammatory cells were identified as valleys. The possibility that these features were the result of the sanding process could be excluded, as the “streaks” crossed in a different direction. Oxide levels were analyzed to detect corrosion for CoCrMo and TiAlV groups with EDS (Energy Dispersive X-ray Spectrometry) SE (Secondary Electron). The Disks + Non-Activated Medium groups for both CoCrMo and TiAlV had significantly higher oxide levels compared to all other groups (p\u3c 0.001). The Activated MO + Lymphocytes + CoCrMo disks group had significantly higher oxide levels than the Nonactivated MO + CoCrMo disks and Activated MO + CoCrMo groups.
Conclusions. In conclusion, this study aimed to investigate the electrochemical properties of SF in relation to CoCrMo and TiAlV orthopedic alloy implants and their impact on patient-reported outcomes. The findings contribute to understanding the processes that lead to patient pain and TKA failure. Further research is ongoing to enroll more patients and assess their outcomes up to a year after surgery, aiming to identify protocols that can improve patient satisfaction. The study also explored the effects of macrophages and lymphocytes on the corrosion mechanisms of the implant surfaces, which is essential for reducing the burden on patients and preventing complications such as ALVAL
The Exploration of Perceptions of Patient-Clinician Communication in Black Mothers Diagnosed with an Acute Post-Partum Hypertensive Crisis
Full text linkFor Black American mothers, postpartum stressors are magnified as about half of this population are single mothers, and many suffer from inadequate social and healthcare needs. Expected postpartum stressors, coupled with social stressors that Black American mothers face, can mask or influence patient reporting of early postpartum hypertensive crisis symptoms. Patients diagnosed with preeclampsia risk developing even more severe complications, such as cardiovascular disease, which is the leading cause of pregnancy-related deaths in the United States. Black American women face the challenge of inadequate communication with their healthcare providers, medical mistrust, and perceived discrimination when accessing health care. Pregnant women, in general, report informational needs and relationships as highlighted factors when exploring patient-clinician communication. Therefore, this dissertation research aimed to understand Black American mothers\u27 perceptions of care and communication with their clinicians after being diagnosed with an acute hypertensive crisis and the findings will provide knowledge that will improve maternal outcomes for this population. Three projects were conducted: a manuscript consisting of a literature review, a methods manuscript, and a convergent mixed-methods study. The first manuscript consisting of the literature review revealed that early detection of acute hypertensive crisis among the postpartum mother’s interdisciplinary care team improves maternal neonatal outcomes. This manuscript proposes an example protocol for facilitating emergency care to those. symptomatic postpartum mothers who are visiting their neonate in the neonatal intensive care unit (NICU). Also in this manuscript, a literature review was conducted on the etiology, pathophysiology and treatment recommendations for acute hypertensive crisis. The findings of this review led to the importance of investigating those diagnosed with acute hypertensive crisis, specifically those who were most at risk- Black Postpartum Mothers. The next project, a methods paper on qualitative interview techniques, was written to inform qualitative researchers on how to amplify the voices of Black postpartum mothers diagnosed with an acute hypertensive crisis during qualitative interviews. Techniques were shared based on lessons learned during qualitative data collection. The third project, a convergent mixed-methods study, was conducted to explore the perceptions of care and patient-clinician communication from Black postpartum mothers diagnosed with an acute hypertensive crisis in the Mississippi Delta region of the United States. Findings from this study revealed that most participants rated higher satisfaction with their doctor-patient communication during their outpatient prenatal visits and hospital stay, but still voiced repeated experiences of being dismissed and their symptoms being minimized by their obstetric clinicians. To meet the needs of Black postpartum mothers who experience high risk disorders such as acute hypertensive crises, obstetric clinicians must understand their experiences with patient-clinician communication and the adjustive communicative behaviors they adopt to navigate healthcare spaces. Obstetric clinicians must be intentional about providing detailed information early in pregnancy and establish a trusting relationship in order to improve their perceptions of care and patient-clinician communication