Tinospora Cordifolia: A review of its immunomodulatory properties.

Emergent health threats have heightened human awareness of the need for health and wellness measures that promote resilience to disease. In addition to proper nutrition and exercise, health-conscious consumers are seeking natural-based modalities, e.g. botanical preparations, that positively impact the immune system. In Ayurvedic ethnomedicine, Tinospora cordifolia (T. cordifolia), a deciduous climbing shrub indigenous to India, has been used to historically to combat acute and chronic inflammation as well as to promote a balanced immune response. As a dietary supplement, T. cordifolia has been administered most often as a decoction either alone or in compositions containing other medicinal plant extracts of the Terminalia and Phyllanthus species. Extensive phytochemical characterization of aqueous and alcoholic extracts of different Tinospora species has identified over two hundred different phytochemicals from non-overlapping chemical classes with the most abundant being diterpenoids containing the clerodane-type skeleton. Numerous pharmacology studies have demonstrated that T. cordifolia modulates key signaling pathways related to cell proliferation, inflammation, and immunomodulation. However, rigorous dereplication studies to identify active constituents in various T. cordifolia extracts and their fractions are lacking. In this review, we will summarize the current information regarding T. cordifolia's ethnomedicinal uses, phytochemistry, pharmacological activities, and safety in order to highlight its potential as an immunomodulatory dietary supplement.

Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy: A cross-sectional study.

BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. OBJECTIVE: The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. METHODS: This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. RESULTS: A total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03-1.65) and ferritin (OR = 3.91; 95% CI: 1.23-12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05-1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (ß = 0.02349; P = 0.895). CONCLUSIONS: Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.

Evaluation of doripenem utilization and susceptibilities at a large urban hospital.

BACKGROUND: Bacterial resistance presents a constant challenge in the treatment of hospitalized patients, particularly with Gram-negative infections. Carbapenems have an important role in the treatment of resistant nosocomial organisms. Doripenem, a recently approved carbapenem, has shown efficacy in clinical trials, but there is little published data on utilization in a general patient population. OBJECTIVE: The clinical utilization of doripenem in a general adult inpatient population was evaluated during a carbapenem formulary conversion. SETTING: A 706-bed acute care tertiary hospital serving an urban community. METHODS: After formulary conversion to doripenem, the first 100 patients to receive doripenem were included in the analysis. Baseline characteristics were recorded for each patient, along with indication for treatment, prescribing physician, dose and frequency of doripenem and duration of treatment. Patients were monitored for adverse reactions to doripenem. Bacterial culture results were recorded. For positive cultures, doripenem susceptibility was determined by Etest. Patients were followed until discontinuation of antibiotic therapy, discharge or death to determine treatment outcomes. Successful treatment was defined as clinical or microbiological cure, while patients with infection-related mortality or requiring subsequent antibiotics for the index infection were considered treatment failure. MAIN OUTCOME MEASURES: Clinical utilization of doripenem, including indications and doses used. RESULTS: Doripenem treatment was recorded in 102 patients. The most common indications for treatment were pneumonia and sepsis. The majority of doripenem orders were written by Infectious Disease or Pulmonology Services. Forty-nine patients were treated successfully with doripenem and six patients experienced treatment failure. The remainder of patients were not evaluable by predefined outcomes criteria. Adverse events were reported in eight patients and included acute renal failure, Clostridium difficile-associated diarrhea and seizures. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common organisms in culture results. Doripenem demonstrated in vitro activity against 81% of all organisms and susceptibility results had >90% correlation with meropenem and imipenem susceptibilities. CONCLUSION: In our limited sample size, doripenem was safe and effective against various types of infections in a general inpatient population with similar bacterial susceptibilities to other cabapenems. Doripenem was utilized for appropriate indications, but doses were frequently outside the manufacturers labeling. Adverse events were uncommon, and no serious adverse events were directly associated with doripenem treatment.

Activities of Memphis-area hospitals to meet National Patient Safety Goals for warfarin therapy.

PURPOSE: The activities of Memphis hospitals to meet National Patient Safety Goals (NPSGs) for warfarin therapy are described. SUMMARY: In March 2008, leadership from the Mid-South College of Clinical Pharmacy (MSCCP), a local chapter of the American College of Clinical Pharmacy, commissioned a task force on anticoagulation, comprising pharmacy administrators, clinical pharmacy practitioners, and pharmacy faculty from local hospitals within the greater Memphis area. The charge of the task force was to (1) identify practice variations in regard to NPSG.03.05.01, (2) develop professional collaboration among both academic and nonacademic institutions to share policy and protocol development, and (3) facilitate all institutions in meeting the deadlines set forth by the Joint Commission. The MSCCP Task Force on Anticoagulation project was successful in promoting collaboration among multiple institutions and clinical practitioners in the Memphis area. There was no one-size-fits-all approach; however, meetings and discussions were beneficial and led to idea generation. Having input from multiple institutions in different clinical settings with varying levels of experience created a rich environment from which all institutions benefited. For example, smaller institutions felt that they drew support for physician acceptance with protocol approval based on the knowledge of the policies approved or lessons learned at larger institutions. In addition, the larger institutions felt that the working group was helpful in validating their interpretation of the NPSG elements. CONCLUSION: The MSCCP Task Force on Anticoagulation project was successful in promoting collaboration among multiple institutions and clinical practitioners to offer solutions to meet NPSG.03.05.01 as it related to the needs of each institution.