Potential impact of a bedside procedure service on training procedurally competent hospitalists in a community-based residency program.

BACKGROUND: The Society of Hospital Medicine has delineated procedures as one of the core competencies for hospitalists. Little is known about whether exposure to a medical procedure service (MPS) impacts the procedural certification rate in internal medicine trainees in a community hospital training program. OBJECTIVE: To determine whether or not exposure to an MPS would impact both the number of procedures performed and the rate of resultant certifications in a community hospital internal medicine training program. DESIGN: Retrospective review. METHODS: Five cohorts of resident physicians and their procedure data were analyzed comparing months where residents were unexposed to the intervention (pre-MPS) to months where residents were exposed to the intervention (post-MPS). We calculated the average number of procedures performed per month for pre- versus post-MPS periods. For procedural certification, we compared two proportions: the number of certifications over the number of 6-month pre-MPS periods and the number of certifications over the number of 6-month post-MPS periods. SETTING/SUBJECTS: The study was conducted at a community-based academic medical center. Subjects included all internal medicine residents. RESULTS: We found a statistically significant difference between the groups, with pre-MPS groups performing 4.3 procedures per month compared with post-MPS groups performing 6.7 procedures per month (p=0.0010). For certification rates, we found statistically significant differences in several categories - overall, paracentesis, femoral central lines, and jugular central lines. CONCLUSIONS: This study demonstrated that resident exposure to an MPS statistically significantly increased the total number of procedures performed. This study also showed that overall certification rates were statistically significantly different between the pre- and post-MPS groups for several procedures.

Cytotoxic cardenolide and sterols from Calotropis gigantea.

The dichloromethane extract from the leaves of Calotropis gigantea Linn. was strongly cytotoxic against non-small cell lung carcinoma (A549), colon carcinoma (HCT 116) and hepatocellular carcinoma (Hep G2), and non toxic to Chinese hamster ovary (AA8). The extract afforded uscharin (1), 3,5,8-trihydroxy-24-methylcholest-6,22-diene (2), a mixture of (24R)-3beta-hydroxy-24-ethylcholest-5-en-7-one (3a) and 6beta-hydroxy-24-ethylcholest-4,22-dien-3-one (3b), and another mixture of (24R)-24-ethylcholest-4-en-3-one (4a) and (24S)-24-ethylcholest-4,22-dien-3-one (4b). Cardenolide 1 exhibited extreme toxicity to A549, HCT 116 and Hep G2 with IC50 values of 0.003 microg/mL, 0.013 microg/mL, and 0.018 microg/mL, respectively, while sample 3 exhibited an IC50 of 1.35 microg/mL, 4.46 microg/mL, and 3.83 microg/mL, respectively.