Piperazine-Derivative MMV665917: An Effective Drug in the Diarrheic Piglet Model of Cryptosporidium hominis

BACKGROUND

Cryptosporidiosis, an enteric protozoon, causes substantial morbidity and mortality associated with diarrhea in children <2 years old in low- to middle-income countries. There is no vaccine and treatments are inadequate. A piperazine-based compound, MMV665917, has in vitro and in vivo efficacy against Cryptosporidium parvum. In this study, we evaluated the efficacy of MMV665917 in gnotobiotic piglets experimentally infected with Cryptosporidium hominis, the species responsible for >75% of diarrhea reported in these children.

METHODS

Gnotobiotic piglets were orally challenged with C hominis oocysts, and oral treatment with MMV665917 was commenced 3 days after challenge. Oocyst excretion and diarrhea severity were observed daily, and mucosal colonization and lesions were recorded after necropsy.

RESULTS

MMV665917 significantly reduced fecal oocyst excretion, parasite colonization and damage to the intestinal mucosa, and peak diarrheal symptoms, compared with infected untreated controls. A dose of 20 mg/kg twice daily for 7 days was more effective than 10 mg/kg. There were no signs of organ toxicity at either dose, but 20 mg/kg was associated with slightly elevated blood cholesterol and monocytes at euthanasia.

CONCLUSIONS

These results demonstrate the effectiveness of this drug against C hominis. Piperazine-derivative MMV665917 may potentially be used to treat human cryptosporidiosis; however, further investigations are required.

Prioritizing the Risk Factors Influencing the Success of Clinical Information System Projects

Objective: The aim of this study is to gain a better understanding of the risk factors influencing the success of clinical information system projects.

Methods: This study addresses this issue by first reviewing the extant literature on information technology project risks, and second conducting a Delphi survey among 21 experts highly involved in clinical information system projects in Québec, Canada, a region where government have invested heavily in health information technologies in recent years.

Results: Twenty-three risk factors were identified. The absence of a project champion was the factor that experts felt most deserves their attention. Lack of commitment from upper management was ranked second. Our panel of experts also confirmed the importance of a variable that has been extensively studied in information systems, namely, perceived usefulness that ranked third. Respondents ranked project ambiguity fourth. The fifth-ranked risk was associated with poor alignment between the clinical information systems’ characteristics and the organization of clinical work. The large majority of risk factors associated with the technology itself were considered less important. This finding supports the idea that technology-associated factors rarely figure among the main reasons for a project failure.

Conclusions: In addition to providing a comprehensive list of risk factors and their relative importance, the study presents a major contribution by unifying the literature on information systems and medical infor - matics. Our checklist provides a basis for further research that may help practitioners identify the effective countermeasures for mitigating risks associated with the implementation of clinical information systems.

Prioritizing the risk factors influencing the success of clinical information system projects. A Delphi study in Canada

OBJECTIVE

The aim of this study is to gain a better understanding of the risk factors influencing the success of clinical information system projects.

METHODS

This study addresses this issue by first reviewing the extant literature on information technology project risks, and second conducting a Delphi survey among 21 experts highly involved in clinical information system projects in Québec, Canada, a region where government have invested heavily in health information technologies in recent years.

RESULTS

Twenty-three risk factors were identified. The absence of a project champion was the factor that experts felt most deserves their attention. Lack of commitment from upper management was ranked second. Our panel of experts also confirmed the importance of a variable that has been extensively studied in information systems, namely, perceived usefulness that ranked third. Respondents ranked project ambiguity fourth. The fifth-ranked risk was associated with poor alignment between the clinical information systems' characteristics and the organization of clinical work. The large majority of risk factors associated with the technology itself were considered less important. This finding supports the idea that technology-associated factors rarely figure among the main reasons for a project failure.

CONCLUSIONS

In addition to providing a comprehensive list of risk factors and their relative importance, the study presents a major contribution by unifying the literature on information systems and medical informatics. Our checklist provides a basis for further research that may help practitioners identify the effective countermeasures for mitigating risks associated with the implementation of clinical information systems.

Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial

Dementia induces morbidity not only in the patients but also in the families taking care of them. Many studies described the impact of care-giving on physical and psychological health. Support groups were designed to alleviate the burden of care-givers. The objective of this study was to measure the efficacy of a support group programme for care-givers of demented patients in the community. Forty-one primary care-givers were randomly assigned to a study (n=23) or a control group (n=18). Subjects of the study group attended a structured programme of eight 2-h sessions. These weekly sessions consisted of information on the disease, role-playing on management of behavior problems, discussion on emotional impact of care-giving, and learning of stress management techniques. Subjects of the control group were referred to informal monthly meetings of the Alzheimer's Society. Subjects of both groups were evaluated at the entry (T1), after 8 weeks (T2) and after 8 months (T3). The outcome variables were the Burden Interview, the Revised Memory and Behavior Problems Checklist, the Brief Symptoms Inventory, the Alzheimer's Disease Knowledge Test and a questionnaire on health care utilization. Compared with the control group, subjects of the study group yielded only a significant increase in knowledge about the disease (p<0.0001) but no significant difference on the other outcome variables. It is concluded that this type of support group programme seems to have only a minimal impact on morbidity and on the burden of care-givers. These results are similar with two other studies examining the same issue.

The impact of a support group programme for care-givers on the institutionalisation of demented patients

Support group programmes have been proposed to alleviate the care-givers' burden and postpone institutionalisation of demented patients. Experimental studies on these programmes failed to detect any impact on care-givers' burden, but none have examined the effect on institutionalisation. The objective of this paper is to assess the impact of a support group programme for care-givers on the institutionalisation of demented patients. Forty-five care-givers of community-dwelling demented patients were allocated randomly to the study group (n = 24) and the control group (n = 21). Subjects in the study group attended a structured programme of 8 weekly sessions of 3 h each. Subjects assigned to the control group were referred to the informal monthly meetings of the Alzheimer's Society. Using survival analysis, the median length of time until institutionalisation was 30 months from the time of the entry into the study. At 24 months, the probability of being institutionalised was 0.33 in the study group and 0.45 in the control group. This difference was not statistically significant (log-rank test: chi2 = 1.02; P = 0.31). These results emphasize the lack of scientific evidence about efficacy of such programmes and the need for a large multi-centre study on this topic.