Use of Emotional Intelligence to Enhance Advanced Practice Registered Nursing Competencies.

BACKGROUND: Interpersonal relationships are fundamental to competent delivery of health care. Nursing practice is grounded in interpersonal relationships, making advanced practice registered nurses (APRNs) well prepared to ensure the delivery of safe, effective care. Research demonstrates interpersonal dynamics can be enhanced. Emotional intelligence (EI) is the ability to perceive, understand, manage, and use emotions in self and others, and it comprises a key factor in interpersonal relationships. METHOD: APRN education is grounded in the Quality and Safety Education for Nurses and master's Essentials competencies. This analysis provides a framework to align APRN professional competencies with EI competencies to enhance leadership, communication, and teamwork in health care teams. RESULTS: By using the matrix of EI and APRN competencies provided, nurse educators may implement learning strategies to improve EI and support APRN competencies. CONCLUSION: Well-educated and emotionally intelligent APRNs can enhance cooperation in multidisciplinary teams, promote better communication, and demonstrate APRN leadership to improve patient outcomes. [J Nurs Educ. 2018;57(11):648-654.].

Ionic solutions of two-dimensional materials.

Strategies for forming liquid dispersions of nanomaterials typically focus on retarding reaggregation, for example via surface modification, as opposed to promoting the thermodynamically driven dissolution common for molecule-sized species. Here we demonstrate the true dissolution of a wide range of important 2D nanomaterials by forming layered material salts that spontaneously dissolve in polar solvents yielding ionic solutions. The benign dissolution advantageously maintains the morphology of the starting material, is stable against reaggregation and can achieve solutions containing exclusively individualized monolayers. Importantly, the charge on the anionic nanosheet solutes is reversible, enables targeted deposition over large areas via electroplating and can initiate novel self-assembly upon drying. Our findings thus reveal a unique solution-like behaviour for 2D materials that enables their scalable production and controlled manipulation.

Successful treatment of recurrent primary sclerosing cholangitis after orthotopic liver transplantation with oral vancomycin.

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disease of the liver that is marked by inflammation of the bile ducts and damage to the hepatic biliary tree. Approximately 60-70% of patients also have inflammatory bowel disease and progression of PSC can lead to ulcerative colitis and cirrhosis of the liver. Due to limited understanding of the etiology and mechanism of PSC, the only existing treatment option is orthotopic liver transplantation (OLT); however, recurrence of PSC, after OLT is estimated to be between 5% and 35%. We discuss the successful treatment of a pediatric patient, with recurrent PSC, after OLT with oral Vancomycin.

Commentary: Urgently needed: a safe place for self-assessment on the path to maintaining competence and improving performance.

Traditional continuing medical education (CME), necessary for keeping physicians current and competent, is insufficient in translating physician practice into better patient outcomes. CME, then, must be transformed from a system of episodic interventions to a more personalized, contextual, flexible, and targeted process within a continuing professional development framework. The core of this transformation must be a formal process of physician self-assessment. Unfortunately, health care providers tend toward inaccurate self-assessment, regardless of training, specialty, or manner of self-assessment. Therefore, the development of an external validation system conducted by credible, informal peer review in a safe environment is essential. Clinicians must be able to access practice and patient data without concerns about accuracy, timeliness, confidentiality, attribution, or unintended consequences. New analytical tools are also needed to illuminate the data compilations and present them in compelling, individualized, and comparative formats. However, such developmental work will not be possible without strong community leadership coordinating a collaboration of resources and a sharing of data. Ensuring physician competence has long been an issue for medical societies, state licensing boards, and others invested in improving patient care. Now it's time to get serious. Current efforts at massive health care reform provide the perfect opportunity to fully integrate physician self-assessment and performance improvement into the larger health care system through a continuing professional development model. Practitioners in CME have been far too complacent with the current practices. A shift to a focused and dedicated sense of urgency must occur to ensure physicians' continuous learning and change.

Long-term treatment of primary sclerosing cholangitis in children with oral vancomycin: an immunomodulating antibiotic.

BACKGROUND: Primary sclerosing cholangitis is a rare chronic cholestatic condition of unknown etiology, frequently associated with inflammatory bowel disease and characterized by diffuse fibrosing and inflammatory destruction of the intra- and/or extrahepatic biliary duct system. PATIENTS AND METHODS: The study involved 14 children with primary sclerosing cholangitis confirmed by either liver biopsy, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiogram. In each of the 14 cases, liver histology showed characteristic features consistent with primary sclerosing cholangitis. Eleven children had intrahepatic biliary beading and strictures (6 by endoscopic retrograde cholangiopancreatography; 5 by magnetic resonance cholangiogram). Biochemical tests of liver function including alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase and the erythrocyte sedimentation rate were elevated for a mean 17 +/- 22 months before vancomycin treatment was initiated. All of the patients were shown to have inflammatory bowel disease histologically; 13 of those patients had clinical evidence of colitis. Oral vancomycin was given to all 14 patients. RESULTS: All 14 patients showed improvement in their alanine aminotransferase (P = 0.007), gamma-glutamyl transpeptidase (P = 0.005), erythrocyte sedimentation rate (P = 0.008), and clinical symptoms with oral vancomycin treatment. There was less improvement noted in the patients with cirrhosis when compared with the patients without cirrhosis. CONCLUSIONS: Before this study, there has not been an effective long-term treatment for sclerosing cholangitis to prevent the usual progression of this disease to cirrhosis. This study showed that oral vancomycin could be an effective long-term treatment of sclerosing cholangitis in children, especially those without cirrhosis.