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Describes and analyses the factors limiting the success of implementation of guidelines on management of heart failure using content analysis of structured interviews with nine general practitioners in Wakefield District, validated from hospital records, to generate within‐case displays. Discusses the results and conclusions.

We investigate whether information technology (IT) can help physicians more efficiently acquire new knowledge in a clinical environment characterized by information overload. We combine analysis of data from a randomized trial with a theoretical model of the influence that IT has on the acquisition of new medical knowledge. Although the theoretical framework we develop is conventionally microeconomic, the model highlights the non-market and non-pecuniary influence activities that have been emphasized in the sociological literature on technology diffusion. We report three findings. First, empirical evidence and theoretical reasoning suggests that computer-based decision support will speed the diffusion of new medical knowledge when physicians are coping with information overload. Second, spillover effects will likely lead to “underinvestment” in this decision support technology. Third, alternative financing strategies common to new IT, such as the use of marketing dollars to pay for the decision support systems, may lead to undesirable outcomes if physician information overload is sufficiently severe and if there is significant ambiguity in how best to respond to the clinical issues identified by the computer. This is the first paper to analyze empirically and theoretically how computer-based decision support influences the acquisition of new knowledge by physicians.

Describes a process of adopting a set of review criteria for use in a regional project to improve heart failure management in general practice. Published guideline review criteria were assessed using a protocol examining indicator relevance, practicality and the clinical evidence on which indicators were based. An expert panel with experience in general practice, cardiology and general internal medicine, ethics, and research methodology was used to evaluate the indicators. Good overall agreement was observed with the review criteria. Areas of disagreement related to poor wording of the criteria, the need to incorporate more up‐to‐date evidence and criteria based on weak evidence. A need exists for greater training of health practitioners about how regional indicators can be used as screening tools for quality improvement. Nationally endorsed sets of regularly updated review criteria for common and important conditions would be helpful in guiding similar quality improvement projects.

This study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses.

This is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs.

Patients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients.

Patients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.

According to Joint Commission standards, patients should be educated about drug-nutrient interactions. Because nurses are well-suited to educating patients, this paper aims to assess their knowledge of ACE inhibitor drugs, nutrient interactions and high- and low-potassium foods.

Licensed nurses from a teaching hospital in the US south eastern Atlantic region completed a self-administered questionnaire (n=83). Means, standard deviations and 95 percent confidence intervals were calculated for continuous data and frequency and percentage distribution for discrete data. Student's t-test was used to evaluate responses by ACE inhibitor patient load and nursing education.

Mean nurse knowledge of ACE inhibitors and potassium was 62±16 percent and identifying high- and low-potassium foods was 32±23 percent. Most identified five from 12 high-potassium foods and did not know the designation of six, one from 14 low-potassium foods and did not know the designation of 11. Knowledge scores and identifying high- and low-potassium foods were similar regardless of ACE inhibitor patient load and nursing education.

ACE inhibitors are the fourth most commonly used drug class in the USA. Nurses are well positioned to recognize potential drug-nutrient interactions owing to changing or adding a drug, dose delivery method, dietary change or a patient's physical or clinical status that may indicate nutrient deficiency. The findings suggest that the nurses surveyed were proficient in identifying ACE inhibitors pharmacology, but that most were unable to identify foods that increase drug-nutrient interaction risk, and thus this is an area in which additional training might be beneficial.

Case menus were used to portray real-life scenarios in which healthcare practitioners can provide patient education about ACE inhibitor drug and dietary potassium interactions.

There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary prescribing. Reports elsewhere how a modified Delphi approach, based on the RAND Health Services utilisation study method, was used to produce audit criteria for necessary prescribing for systolic heart failure in New Zealand (NZ) general practice. Reports experience of applying these criteria in late 1999 to the medical notes of a random sample of 70 patients with heart failure, as defined by a recorded diagnosis in 30 practices in central Auckland, NZ. Use of the audit criteria was feasible and appears valid, although the methods used to apply them need to be simplified to be of use as a practical means of promoting clinical governance. The small patient sample demands caution in interpreting the results. However, uncommon yet plausible findings, such as the high frequency of ACE inhibitor prescribing for heart failure, deserve further investigation.

This study aims to investigate the antihypertensive effect of camel milk hydrolysate in rats with fructose-induced hypertension.

The antihypertensive effect of fermented camel milk was determined using 6 groups comprising 36 Wistar male rats. Blood pressure of rats was altered via exposure to a 10% fructose (w/v) diet in drinking water for 3 weeks before conducting 21 days of treatment. The authors conducted the experiment for short and long term using different doses of 800 and 1,200 mg/kg body weight. Serum was used to assay total cholesterol (TC), triglyceride (TG), glucose and insulin levels using standard biochemical kits.

The group that received 1,200 mg hydrolysate camel milk (HM) has significantly (p = 0.003) reduced systolic and diastolic blood pressure after a short exposure time (4–8 h). These effects were significantly (p = 0.005) comparable to the nifedipine (NIF) drug group. Similar long-term (21 days) effects on blood pressure were observed in 1,200 mg HM and NIF groups. Angiotensin-converting enzyme (ACE) activity and levels were also reduced in a correlation with blood pressure reduction only in HM1200 and HM800 treated groups. The authors observed no significant effect on blood pressure in groups receiving the 800 mg HM or 1,200 mg unhydrolyzed camel milk (UM). Rats receiving the 10% fructose diet showed significant differences from control rats regarding their blood biochemistry, including TG, TC, blood glucose and insulin levels. Rats in groups NIF, HM1200 and HM800 showed a significant (p < 0.05) reduction in serum glucose, insulin, TG and TC levels toward the baseline level.

Further mechanistic investigation on the HM antihypertensive activity is highly recommended before suggesting HM as a product to reduce blood pressure. While drug–food interaction between HM and antihypertensive drugs, especially ACE inhibitors, is probable, UM seems not to affect blood pressure or ACE activity and therefore is expected to have no or minimal effects on the activity of other antihypertensive drugs. Investigation of ACE expression from various organs including lungs and leukocytes is highly recommended in future works using sodium dodecyl-sulfate polyacrylamide gel electrophoresis and western blot analysis or reverse transcription polymerase chain reaction.

No previous studies have measured the antihypertensive activity of milk hydrolysate mediated by the reduction of ACE activity and levels in plasma. Mechanisms involved in attenuating the levels of ACE warrant further investigation.

Salak (Salacca zalacca) is an underutilised fruit. The bioactivities of this fruit have rarely been studied scientifically. Thus, the present study aimed to determine the antioxidant activity of extracts derived from the peel, fruit and kernel of the Salak fruit, as well as the hypoglycemic and anti-hypertensive properties of Salak peel extracts.

The peel, fruit and kernel of the Salak were extracted using distilled water, methanol and ethanol. Antioxidant activities, angiotensin-converting enzyme (ACE) and alpha-amylase inhibition properties of the extracts were estimated via in vitro standard methods. Besides, the total phenolic content (TPC) and total flavonoid content (TFC) of the extracts were also determined in the present study. The antioxidant activities of different parts of Salak extracts were determined by ferric-reducing antioxidant power (FRAP) and Trolox equivalent antioxidant capacity (TEAC) methods. Percent of radical scavenging properties were calculated via DPPH assay. The hypoglycemic and anti-hypertensive properties of Salak peel were evaluated using alpha-amylase inhibition and ACE assays, respectively.

Fruit extracts of Salak in methanol were found to exhibit the highest TPC (10.27 ± 0.12 mg GAE/g), TFC (11.04 ± 0.89 mg CE/g) and antioxidant properties amongst all samples whereby the TPC and TFC were strongly correlated with antioxidant activities. On the other hand, distilled water extracted Salak kernel showed to have the lowest TPC (0.53 ± 0.05 mg GAE/g), TFC (0.37 ± 0.01 mg CE/g) and antioxidant properties amongst all the Salak extracts. Peel extracts exhibit comparable antioxidant activities with fruit extracts in the current findings. In addition, peel extracts indicated some extend of ACE and alpha-amylase inhibition activities regardless of the solvents used. Methanol and ethanol peel extracts indicated no significant difference (p < 0.05) ACE (98%) and alpha-amylase (90%) inhibition activities. However, distilled water extracted Salak peel showed significantly lower ACE and alpha-amylase inhibition in comparison to methanol and ethanol peel extracts.

The present findings suggested that the fruit of Salak exhibits the highest antioxidant properties, followed by the peel and lastly, the kernel, which shows the lowest antioxidant properties amongst all the samples. The results also indicated that the peel extracts have ACE and alpha-amylase inhibition activities.

The purpose of this paper is to understand the effect of hydrolysis by pepsin and pancreatin on the angiotensin-I-converting enzyme (ACE) inhibitory activity of bioactive peptide from pigeon pea tempe and the absorption of pigeon pea tempe peptide by using the everted gut sac method.

The tempe was prepared by inoculating Raprima (Rhizopus oligosporus) on hulled-cooked pigeon pea for 48 h. The extraction was performed using the ultrasonic method at 40 kHz frequency and 100% ultrasonic power for 10 min. The extracted protein was placed in simulated gastrointestinal digestion using consecutive pepsin–pancreatin for 240 min. The hydrolysates were fractionated using a dialysis tube, and its absorption was assessed using the everted Sprague–Dawley rat gut sac.

The tempe protein from the hydrolyzed pigeon pea exhibited higher ACE inhibitory (71.53%) activity than that from the boiled pigeon pea (53.04%) (p = 0.028). The bioactive peptide of the digested pigeon pea tempe consisted of low-molecular-weight peptides (<1 kDa). The fraction also showed the highest ACE inhibition activity among the others (IC50 = 0.61 mg/mL, p = 0.021). Bioactive peptides from pigeon pea tempe were absorbed well in the small intestine, mainly in the jejunum. The activity of the absorbed peptides did not change considerably.

The activity of bioactive peptide of pigeon pea tempe was comparatively stable during digestion. It exhibited activity even after absorption in the small intestine. Thus, pigeon pea tempe can serve as an antihypertensive peptide source and alternative food for maintaining/reducing blood pressure.

The purpose of this paper is to focus on some of the reported natural advanced glycation end‐products (AGE) inhibitors providing an outline of AGE‐breakers and the potential anti‐glycation properties of some foodstuffs.

Literature searches were conducted to find a link between common household spices, medicinal herbs, AGE and diabetes which could lead to practical home‐based recommendations for changes in a person's diet.

Findings tend to indicate the potential of some dietary components to prevent and/or inhibit AGE formation. Thus, these dietary agents may be exploited for controlling AGE‐mediated diabetic pathological conditions and as possible natural protector of AGE formation in vivo. Consequently, the quest for new AGE inhibitors is considered of paramount importance which can be of therapeutic potential in patients with diabetes or age‐related diseases.

Studies on the inhibition of AGE formation have received increasing recognition from both a nutritional and medical research standpoint. Inhibition of the formation of AGE is believed to play a key role in the prevention of diabetic and cardiovascular complications. Investigation of nutritional bioactive compounds with anti‐glycation properties provides future perspectives for prevention or intervention related to AGEs complications.

This paper adds on to the evidence of the use of dietary agents as natural inhibitors of AGE and hence the prevention of diabetic complications and age‐related diseases.