Self-assessment of residents in breaking bad news; skills and barriers.

INTRODUCTION: Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difficult professional tasks of physicians. The main aims of this study are to evaluate residents' practice of BBN and identify perceived barriers to its implementation. METHODS: In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. RESULTS: 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient's emotions during BBN as good or very good, respectively. The most difficult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient's emotions (61%) and the aggressiveness of the patient or companions (52.6%). A significant proportion of participants identified lack of training (28%) and insufficient skills (21.9%) as significant barriers to BBN. CONCLUSIONS: The skill of residents in BBN is insufficient in some aspects and points to the need for BBN training courses during residency. BBN is difficult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents' confidence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended.

Electrochemical detection of kynurenic acid in the presence of tryptophan with the carbon paste electrode modified with the flower-like nanostructures of zinc oxide doped with terbium.

With the help of a hydrothermal approach in this study, we could provide flower-like nanostructures (NSs) of zinc oxide (ZnO) doped with Tb (FL-NS Tb3+/ZnO). Then, FL-NS Tb3+/ZnO morphology was investigated by energy-dispersive X-ray spectroscopy (EDX), scanning electron microscopy (SEM), X-ray powder diffraction (XRD), and map analysis. The results revealed higher activity centers and porosity of this nanocomposite, which were followed by acceptable electrochemical function. Hence, it can be utilized for fabricating an electrochemical sensor with an appropriate response for the simultaneous determination of kynurenic acid (KYN) and tryptophan (TRP). However, as compared with the modified carbon paste electrode (FL-NS Tb3+/ZnO/CPE), the bare carbon paste electrode (BCPE) exhibited a weak response toward KYN and TRP but the modified electrode was followed by a high current response for KYN and TRP at a potential 0.35 and 0.809 V. Therefore, cyclic voltammetry (CV) was applied in optimal experimental conditions to study the electrochemical behaviors of KYN and TRP over the surface of the proposed modified electrode. Moreover, we used differential pulse voltammetry (DPV) for quantitative measurements. It was found that this new modified electrode linearly ranged from 0.001 to 700.0 µM, with detection limits of 0.34 nM and 0.22 nM for KYN and TRP, respectively. In addition, KYN and TRP in real samples can be analyzed by this sensor, with a recovery of 97.75%-103.6% for the spiked KYN and TRP in real samples.

A study on synergistic effect of chloride and sulfate ions on copper corrosion by using electrochemical noise in asymmetric cells.

The current study includes a systematic examination of copper corrosion initially in each of NaCl and Na2SO4 solutions separately and then in the mixture solution of Cl- and SO42- ions as aggressive ions. Electrochemical current noise (ECN) signals resulting from asymmetric (Asy) as well as symmetric (Sym) cells have been interpreted using wavelet transform (WT) along with statistical procedures. The signals have been detrended and the decomposition of every signal has been carried out into 8 crystals. Then the standard deviation of every crystal has been illustrated with the standard deviation of partial signal (SDPS) plots. The Asy electrodes increased the pitting detection on copper compared with the Sym ones, indicating higher efficiency of the Asy electrodes. Asymmetric-copper electrodes have been studied using SDPS plots at different temperatures (40, 60, as well as 80 °C). Finally, in order to partly understand the effect of Cl- and SO42- ions on the corrosion of copper, the stabilization of Cu2+ cations by Cl- and SO42- ions in aqueous solutions have been modeled by DFT calculations. The derived results are in accordance with the experimental data.

Synthesis of La2O3/MWCNT nanocomposite as the sensing element for electrochemical determination of theophylline.

In this study, an electrochemical sensor was applied for the determination of theophylline, a bronchodilator drug, using differential pulse voltammetry (DPV). A glassy carbon electrode (GCE) surface was modified with the La2O3/MWCNT nanocomposite. The design is simplistic, efficient, greener and solvent-free microwave procedure for synthesizing La2O3/MWCNT nanocomposites. Fourier transform infrared (FT-IR) spectroscopy, field emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDX), and X-ray diffraction (XRD) techniques are used to characterize the features of the La2O3/MWCNT nanocomposite morphology and structure. The use of the modified sensor remarkably enhanced the current density and displayed a linear response ranging between 0.1 and 400.0 µM, with a limit of detection of 0.01 µM (S/N = 3). Using optimized conditions, the modified sensor demonstrated very good stability, selectivity and improved accuracy. Acceptable outputs were achieved in the analysis of real specimens, indicating that it is possible to use the modified sensor for practical analyses.

Synthesis of bifunctional cabbage flower-like Ho3+/NiO nanostructures as a modifier for simultaneous determination of methotrexate and carbamazepine.

Cabbage flower-like Ho3+/NiO nanostructure (CFL-Ho3+/NiO NSs) with significant electrocatalytic oxidation has been published for the first time. First, structure and morphology of CFL-Ho3+/NiO-NSs have been described by XRD, SEM, and EDX methods. Then, CFL-Ho3+/NiO-NSs have been applied as a modifier for simultaneous electrochemical detection of methotrexate (MTX) and carbamazepine (CBZ). Functions of the modified electrode have been dealt with through electrochemical impedance spectroscopy (EIS). It has been demonstrated that the electrode response has been linear from 0.001-310.0 µM with a limit of detection of 5.2 nM and 4.5 nM (3 s/m) through DPV for MTX and CBZ. Diffusion coefficient (D) and heterogeneous rate constant (kh) have been detected for MTX and CBZ oxidation at the surface of the modified electrode. Moreover, CFL-Ho3+/NiO-NS/GCE has been employed for determining MTX and CBZ in urine and drug specimens. Outputs showed the analyte acceptable recovery. Therefore, the electrode could be applied to analyze both analytes in drug prescription and clinical laboratories. Graphical abstract Electrochemical sensor based on bifunctional cabbage flower-like Ho3+/NiO nanostructures modified glassy carbon electrode for simultaneous detecting methotrexate and carbamazepine was fabricated.

Metoprolol: New and Efficient Corrosion Inhibitor for Mild Steel in Hydrochloric and Sulfuric Acid Solutions.

The inhibition behavior of metoprolol tablet on steel alloy (st37) in 1 M hydrochloric acid and 0.5 M sulfuric acid solutions were studied by three methods (potentiodynamic polarization, electrochemical impedance spectroscopy, and scanning electronic microscopy, SEM). The obtained parameters revealed that different amounts of metoprolol drug inhibited the corrosion of mild steel in the acid solutions of HCl and H2SO4. The corrosion resistance of the alloy increased with the increase in the concentration of metoprolol up to 300 ppm but was reduced by increasing the temperature. The derived parameters from polarization curves indicated that the drug is a mixed type inhibitor. The results obtained from the different methods are consistent with each other. The adsorption of metoprolol was found to be physical, exothermic, and spontaneous, and also fitted the Langmuir adsorption model. SEM micrographs are in accordance with the adsorption performance of the tablet.

Green and facile microwave solvent-free synthesis of CeO2 nanoparticle-decorated CNTs as a quadruplet electrochemical platform for ultrasensitive and simultaneous detection of ascorbic acid, dopamine, uric acid and acetaminophen.

This study designed a simplistic, efficient, and greener procedure to synthesize CeO2-CNTs. The analysis of structural and morphological characteristics of nano-composites has been done with regard to different procedures (e.g., EDX, XRD, & FESEM). In addition, simultaneous detection of ascorbic acid (AA), dopamine (DA), uric acid (UA) and acetaminophen (AC) has been examined at the modified glassy carbon electrode with CeO2-CNTs nano-composites. The surface area and electron transfer speed of the interplay between neuro-transmitters and electrode may be efficiently enhanced due to the existence of CeO2 nano-particles on CNTs surfaces. Moreover, electro-chemical behavior of electrodes has been dealt with by differential pulse voltammetry (DPV), impedance analysis (EIS), and cyclic voltammetry (CV). Acceptable linear response of AA, DA, UA and AC respectively have been ranged 0.01-900.0 µM, 0.01-700.0 µM, 0.01-900.0 µM, and 0.01-900.0 µM with determination limits (S/N = 3) of 3.1 nM, 2.6 nM, 2.4 nM and 4.4 nM. Ultimately, this procedure was used with successful results for determining AA, DA, UA and AC in real specimens, which suggested probable uses in other sensing studies.