The first decade of the American Board of Internal Medicine certification in critical care medicine: an overview of examinees and certificate holders from 1987 through 1996.

OVERVIEW: This study reviews the first decade of critical care medicine (CCM) certification by the American Board of Internal Medicine (1987-1996). Included are the characteristics of examinee and certificate-holder groups; examination performances from different underlying disciplines of internal medicine, with or without formal CCM training; and the influence of background and a training program as correlates of examination performance. DATA SOURCES: The CCM certification examination has been offered biennially since November 1987. Performance data on the American Board of Internal Medicine examinations in internal medicine and its subspecialties and added qualifications were available for candidates taking the CCM examinations. For examinees with formal CCM training, residency program director ratings, and information regarding the program characteristics of size and percentage of United States and Canadian medical graduates were also available. STUDY SELECTION: All examinees who ever attempted certification were included in this study. The study cohort for each of the five examination administrations consists of all first-time takers. CONCLUSIONS: Cohort sizes have decreased since formal training became an admission requirement in 1993. Percentages of International Medical Graduates and women attempting and achieving certification have increased steadily. Examination performance was positively associated with formal training, internal medicine examination performance, recent medical training, and pulmonary disease certification. For those with formal training, performance was also positively associated with training program director ratings of overall clinical competence and completion of a training program with a higher proportion of United States and Canadian medical graduates.

Yoga-based intervention for carpal tunnel syndrome: a randomized trial.

CONTEXT: Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity. OBJECTIVE: To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome. DESIGN: Randomized, single-blind, controlled trial. SETTING: A geriatric center and an industrial site in 1994-1995. PATIENTS: Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years). INTERVENTION: Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment. MAIN OUTCOME MEASURES: Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time. RESULTS: Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time. CONCLUSION: In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.

The answer key as a source of error in performance assessment.

OBJECTIVE: To determine the impact of variability in answer key construction (i.e., option weighting) on total errors of measurement and to compare several designs for reducing this effect. METHODS: A video-based format that assesses ability to interpret arteriograms is studied because it reproduces with high fidelity an important task faced by cardiologists. Responses given by highly qualified examinees are used to develop answer keys by the aggregate scoring method, and generalizability theory is applied to estimate the error variance in answer key construction. SAMPLE: Two hundred and two examinees who volunteered to participate in the study after taking their certifying examination in cardiovascular diseases. RESULTS: RESULTS show less scorer variability than case variability; however, several scorers make a sizeable reduction in measurement error. CONCLUSION: Although there is some error in the answer key construction process, its size is relatively small and it should not be a major impediment to the use of performance-based item formats.

Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands.

OBJECTIVE: Yoga and relaxation techniques have traditionally been used by nonmedical practitioners to help alleviate musculoskeletal symptoms. The objective of this study was to collect controlled observations of the effect of yoga on the hands of patients with osteoarthritis (OA). METHODS: Patients with OA of the hands were randomly assigned to receive either the yoga program or no therapy. Yoga techniques were supervised by one instructor once/week for 8 weeks. Variables assessed were pain, strength, motion, joint circumference, tenderness, and hand function using the Stanford Hand Assessment questionnaire. RESULTS: The yoga treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. Other trends also favored the yoga program. CONCLUSION: This yoga derived program was effective in providing relief in hand OA. Further studies are needed to compare this with other treatments and to examine longterm effects.