Background: Inappropriate use of proton pump inhibitors (PPI) is common in patients with cirrhosis. PPIs are associated with deleterious effects in cirrhosis including increased risk for hepatic encephalopathy, spontaneous bacterial peritonitis, and liver-related mortality. Objectives: The aim was to decrease the incidence of low-value, non-guideline supported prescription of PPIs in the inpatient setting with a PPI Clinician Update education and a PPI stewardship by Hepatology. Methods: The study was implemented in a single inpatient transplant center. Key medical staff were identified to receive a PPI Clinician Update educational session, including Hospitalist, Gastroenterology fellows, Hepatology and Liver transplant advanced practice provider (APP). Patient data providing incidence of inappropriate PPI prescription was evaluated under a non-equivalent group pre-posttest design. The study used a one group pre-posttest design for assessing change in provider knowledge levels. A designated hepatology APP steward reviewed all PPI prescription appropriateness. Inappropriate PPI prescription was discontinued by the Hepatology APP who provided constructive feedback to the providers. The primary outcome measure was the incidence of inappropriate PPI prescription before and after the education session which were compared using a chi square test. Secondary outcome was percentage of correct responses (from a total of 10 questions), with before- and after-education measures compared using a paired t-test. Results: Twenty-six providers completed the educational session and pre-posttest. Lack of knowledge regarding outpatient PPI indication was reported as the main barrier to verifying PPI prescription. There was a statistically significant 20% increase in knowledge (p < .001) one month after receiving the educational intervention. There was a decrease in the incidence of inappropriate PPI use from 52% (23/44) to 25% (11/44) (p = .009) one month after receiving the educational intervention. The most common reason for inappropriate PPI prescription was continuation of the patient’s home medication without verifying the indication. The posttest survey showed that 46% of clinicians strongly agreed that their practice changed after the educational intervention and constructive feedback. Conclusion: The most common reason for inappropriate PPI prescription was due to a continuation of a home medication without verifying the indication. A multifaceted approach including an educational intervention and hepatology stewardship was effective in increasing knowledge and decreasing the inappropriate PPI prescriptions in the inpatient setting.

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Background: Depression is a major public health problem worldwide. It is estimated that 350 million individuals around the world are affected by depression. Depression is known to be more prevalent in women than men. Several social, economic, biological, behavioral, psychosocial, and health-related factors have been identified as predictors of depression in women worldwide. However, whether or not these factors have similar effects on Omani Arab women, and the mechanism of their effects on depression among adult Omani women have not been well examined.

Aims: This study focuses on assessing predictors of depression among adult Omani women, including socioeconomic status (SES), material circumstances, bio-behavioral, psychosocial, and health care system factors, as well as age. Moreover, this study examined the utility of the revised Social Determinant of Health (rSDH) conceptual model in assessing the predictors of depression in the targeted population.

Method: A cross-sectional study was conducted involving 240 adult women, 18-72 years old from urban and rural areas of Wilayat (province) of Rustaq. An Arabic version of the Beck Depression Inventory (BDI-II) scale was used to assess depression scores. A bivariate analytical model was used to identify correlations between each independent variable and depression in adult Omani women. Path analysis using Partial Least Square Structural Equation Modeling (PLS-SEM) was used to test the effects of factors within the conceptual model (rSDH), the mediator effects of latent variables between SES and depression, and the effect of age as a moderator of the association between SES and depression.

Results: Fifty-two of the participants (21.7%) were found to be depressed. Of all participants, 12.5% were mildly depressed, 6.7% were moderately depressed, and 2.5% were severely depressed. Depression scores were significantly correlated with education level, employment, place of residence, number of children, domestic violence, social support, coping strategies, seeking professional help, comfort level regarding talking to a health care professional, perceived stigma, and age. Path analysis results showed that the examined factors explained a variance of 62% on the dependent variable (depression scores). Moreover, path analysis through PLS-SEM indicated that the bio-behavioral latent variable is the significant mediator of the association between SES and depression. Age was not a significant moderator of the association between SES and depression.

Conclusion: Depression scores are high among adult Omani women and different factors were linked to higher levels of depression among those women. It will be important to consider socioeconomic, bio-behavioral, psychosocial, and health care system factors, as well as material circumstances, that may all impact the mental and emotional health of Omani women. This study is a step towards exploring predictors of an important mental disease as well as developing cost-effective prevention, promotion, and management programs to address the mental and emotional needs of adult Omani women.

Educating College Students About Human Papillomavirus

Background: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in the US affecting almost 60% of college women ages 20 to 24 years. At one west coast community college, two thirds of males and half of females were unaware of HPV vaccine recommendation through age 26 years. Objectives: This aim of this project is to determine if an evidence-based online educational video about HPV and HPV vaccine would increase knowledge of HPV and intent to receive the vaccine among community college students enrolled in urban and suburban community colleges in Southern California. Measured outcomes of interest included HPV knowledge and intent to receive HPV vaccine. Methods: A quasi-experimental, one-group pre-posttest design was used to determine the effect of the HPV educational video on a sample of 24 gender and ethnically diverse community college students ages 18 through 26 years. Knowledge changes were measured using an online Student HPV-Knowledge Assessment immediately before and after video education. Statistical analysis included descriptive statistics, paired t-test, and the McNemar chi-square test for paired dichotomous variables. Results: Study results revealed all participants were aware of HPV and a majority was aware of the vaccine. Findings confirmed increased knowledge of HPV, perception of risk, and increased intent to get HPV vaccine in participants who were previously aware of disease following the intervention. These results support the utility of an online educational intervention to increase knowledge of HPV and intent of HPV vaccine uptake. Conclusion: HPV infection is common. Awareness of vaccines as protection from disease is increased during the pandemic, providing opportunity for influence of increased HPV vaccine uptake. The impact of HPV vaccine education through an educational video may be an effective method to reach young college students to heighten awareness and increase knowledge of HPV leading to increased HPV vaccine uptake. Future studies may examine if widespread education on vaccination as disease prevention during pandemic conditions could have impact on other vaccine uptake, specifically HPV vaccine, or if perception of risk from HPV infection might be overshadowed by perception of risk for COVID-19 and thus affect vaccine interest.

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Trial registration

Background. Neurological disorders, such as Parkinson’s disease (PD) and Essential Tremors (ET) are among the leading sources of disability. Several studies have demonstrated the efficacy of Deep Brain Stimulation (DBS) therapy for motor symptom control in a selected group of patients with PD or ET. However, patient education materials are not consistently available for DBS candidates or caregivers. The purpose of this quality improvement project was to examine the effects of an Advanced Practice Registered Nurse-led comprehensive DBS Education-Based Intervention program (DBS-EBI) on DBS knowledge and satisfaction in patients with PD or ET and their caregivers immediately after, and two weeks after DBS-EBI.

Methods. A single group design with three time-points was used to examine knowledge and satisfaction after DBS-EBI in patients with PD and/or ET and caregivers. Knowledge was measured using the Knowledge Evaluation Form before (T1), immediately after (T2), and two weeks after (T3) The Program Evaluation Form was used to measure satisfaction (T3).

Results. Patients (n=7 PD; 2 ET; 1 PD + ET, 58.8 ± 17.28 years) had a significant change in knowledge (χ2 df=2, 13.2, p = 0.001), with scores at T2 > T1 (p = 0.007) and T3 > T2 (p = .01).

Caregivers (n = 12; 58.0 ± 15.33 years) also had significant change over the three time-points (χ2 df=2, = 10.82, p = .004) with scores at T3 > T2 > T1 (p = 0.05). Patients found the DBS-EBI was helpful (33%), educational (33%), and had good information (33%). Caregivers thought that the most important information were related to before and after surgery (66.7%) and precautions to minimize risk for infection (50%). Both patient and caregivers (60%) had positive comments on the DBS-EBI PowerPoint presentation and the Pamphlet that was given for reference at home.

Conclusion. The DBS-EBI showed a significant increase in knowledge and the majority of participants were satisfied with the DBS-EBI. A nurse-lead DBS-EBI program can improve DBS knowledge, and may be a useful practice across many DBS centers, given that DBS knowledge is associated with improved health outcomes and quality of care for DBS patients and caregivers.