Minerals and Trace Elements in 990 Beverages and Their Contribution to Dietary Reference Values for German Consumers.

Beverages are an integral part of human nutrition, yet little is known about their contribution to daily intakes of minerals and trace elements in German consumers. Using inductively coupled plasma-mass spectrometry, we determined the concentration of five minerals and six trace elements in beverage samples (n = 990, assigned to different beverage groups) collected throughout Germany. For a calculation of their relative contribution to the mineral supply, available beverage consumption data was combined with our quantitative analysis to calculate the average contribution of beverage groups to meet the respective dietary reference values currently used in Germany, Austria and Switzerland (D-A-CH region). Based on their presence in beverages and their consumption, the top three minerals are phosphorous, calcium and magnesium, and they, therefore, may reasonably contribute to the reference values. Among the trace elements, beverages mostly contributed to the manganese supply, whereas at the same time, concentrations of iron, cobalt and copper were low across all tested groups. Our study provides an overview of the assumed mineral and trace element intake via beverages in Germany and may, thus, serve as a foundation for a mineral and trace element database of beverages that needs to be expanded in the future.

Comparison of Resident Self-Evaluation to Standardized Patient Evaluators in a Multi-Institutional Objective Structured Clinical Examination: Objectively Measuring Residents' Communication and Counseling Skills.

BACKGROUND: For the past 30 years, there has been a growing emphasis on communication and self-evaluation skills training in graduate medical education. This is reflected in the Next Accreditation System. The Objective Structured Clinical Examination (OSCE) is widely used in graduate medical education for assessing dimensions of interpersonal communication and counseling skills. The OSCEs may be developed to target challenging clinical scenarios difficult to capture in clinical practice and can be used as a medium for resident self-evaluation. OBJECTIVES: The aims of the study were to evaluate residents' interpersonal, communication, and counseling skills using Kalamazoo Essential Elements Communication Checklist in 4 clinically challenging scenarios and to compare standardized patient (SP) evaluations to residents' self-evaluation by category of medical school. METHODS: South East Michigan Center for Medical Education is a consortium of teaching hospitals. Member residents participate in 4 OSCEs as part of their postgraduate 1 curriculum. The OSCEs were developed to evaluate clinically relevant but difficult to capture scenarios including: (a) error disclosure/counseling an angry patient; (b) delivering bad news/end of life; (c) domestic violence; and (d) counseling a patient with colon cancer requesting alternative treatments. At the conclusion of each OSCE, SPs evaluated and residents self-evaluated their performance. Once evaluations were completed, SPs provided residents with feedback. RESULTS: Six member institutions and 344 residents participated during the 2014, 2015, and 2016 academic years. There were more international medical graduates (59%) than graduates of Liaison Committee for Medical Education-accredited medical schools. There were more males (62.2%) than females. Standardized patients rated residents higher than residents rated themselves in 2014 (<0.001), but not in 2015 or 2016. When combining all years and all residents, there was no correlation of SP and resident scores. Standardized patients rated female residents higher than female residents rated themselves (P < 0.0001). Male residents scored themselves similarly to the SPs, but male residents rated themselves higher than female residents rated themselves (P < 0.001). Standardized patient scores for male and female residents were not significantly different. CONCLUSIONS: Targeted OSCEs provide an objective format to evaluate residents in challenging clinical scenarios. Resident self-evaluations did not correlate with SPs. In addition, female residents rated themselves lower than male residents and lower than SPs. There is need to develop interventions and curricula to improve resident's self-evaluation skills and in particular address lower self-evaluation by female trainees.

Assessment of Vascular Disease Prevention Practices in Urban Women.

BACKGROUND: Women suffer higher rates of death due to stroke compared to men. In addition, previous studies suggest that women are treated less aggressively for vascular risk factors compared to men. We assessed the quality of primary and secondary vascular prevention at multiple primary care sites within a single region. METHODS: Women more than age of 40 years were eligible for the study. Data from the electronic medical record at multiple primary care locations (internal medicine, family medicine, and geriatrics) were analyzed to assess quality of vascular preventative care. Specific attention was devoted to use of antithrombotic agents, statins, and estrogen. RESULTS: 1,815 women with a mean age of 61 years were reviewed. Seventy-five percent were African American. Patients in the urban practices had higher rates of vascular risk factors and existing vascular disease (heart disease or stroke) compared to the suburban locations. Seventy-one percent of patients with diabetes were receiving statins. For patients with previous stroke/transient ischemic attack (TIA), the use of antiplatelet agents or statins was <70%. Patients >70 years were more likely to receive antiplatelet agents (51% vs. 30%, p < 0.0001) and statins (p < 0.001). CONCLUSIONS: Urban women have higher rates of vascular risk factors and overt vascular disease compared to suburban women. The use of proven secondary prevention medications for patients with prior stroke/TIA was suboptimal. Both primary and secondary prevention should be intensified for urban women.