Assignment: Evidence-Based Project, Part 4: Critical Appraisal of Research

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Advanced Levels of Clinical Inquiry and Systemic Review Kerri Allen Walden University NURS 6052 June 30, 2019

INTRODUCTION

There have been various debates on the effectiveness of Influenza Vaccines.

Most debated issue in primary care clinic include:

Whether the high dose flu vaccines were more effective than standard vaccine in the elderly

At the start of the 2018 to 2019 Influenza season, primary care clinics begin administering influenza vaccines to their patients. There was a recent debate between providers and the healthcare organizations about whether the standard vaccine was sufficient enough for the 65 and older population in preventing the risk of developing Influenza leading to hospitalization. The Brook Army Medical Center stated that there was no need to supply pharmacies and clinics with the high dose of influenza vaccine due to research suggesting that the standard dose was just as effective as the high dose for the 65 and older population. This is not the only issue raised against the influenza vaccines, as some people have sought to find out if the standard vaccine is efficient for the elderly population following the administration of standard vaccines to prevent them from being hospitalized from Influenza infections. This is clinical issue is what has led to the development of my PICOT question.

DEVELOPMENT OF PICOT QUESTION

PICOT Stands For:

P= Patient Population

I= Intervention

C= Comparison

O= Outcome

T= Time

How does the use of high dose vaccine compare to the standard dose vaccine prevent the risk of influenza hospitalization in the 65 and older population?

PICOT “is a mnemonic that helps you remember the key components of a well-focused question” (Walden University Library, n.d.-b). The “P” stands for patient population which is the elderly population of 65 years of age and older. The “I” stands for intervention. In this research the intervention is using higher doses of influenza vaccine. The “C” stands for comparison. The comparison is the standard dose flu vaccine. The “O” stands for the outcomes of interest. The outcomes of interest are to reduce the risks of developing influenza and to prevent hospitalizations from the complications of Influenza in the elderly population. The “T” stands for time (Walden University Library, n.d.-b). Therefore, the PICOT question is: How does the use of high dose vaccine compare to the standard dose vaccine prevent the risk of influenza hospitalization in the 65 and older population?

DATABASES

Science Direct

ProQuest Nursing & Allied Health Source

MEDLINE

Cochrane

The four research databases that were used to conduct this search include Science Direct, ProQuest Nursing & Allied Health Source, MEDLINE, and Cochrane. Science Direct has 2,500 scholarly journals and 39,000 books of life and physical sciences, medicine, and humanity to search from (Elsevier, n.d.). Search terms that were used included high dose influenza versus standard vaccine effectiveness, and prevent hospitalization. ProQuest Nursing & Allied Health Source is a nursing database that includes nursing, allied health, alternative and complementary medicine, and dissertation articles (Walden Library, n.d.-a). MEDLINE is a free database that provides exclusive texts on health and nursing. This database includes information on health sciences on about 1200 abstracts and over 13,000,000 articles with full text. Cochrane library provides the readers with high-quality information on the most efficient strategies to solve cases of health problems. The database contains reviews, clinical trials, and case studies. The database provides a combination of clinical observations and gold standard evidence ("LibGuides: Evidence-Based Practice in the Health Sciences: Databases for EBP Research," 2019).

Level of Evidence and Grade

Article 1: Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies

Level V Evidence

Strengths: 3411 unduplicated publications, of which we selected 407 for abstract review and further selected 93 for full-text review. We extracted data from 50 articles and included 30 of them in our influenza vaccine estimate meta-analysis (Rondy et al., 2017, p.381).

Article 2: Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis

Level V Evidence

Strengths: 992 studies of both randomized and observational studies were examined, nine articles were used for systematic review, seven studies were meta-analyzed, multiple databases were used to include PubMed, Medline, Embase, and Web of Science, duplicate data excluded (Lee et al., 2018).

Article 1: Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies

“The article conducted a systematic review and meta-analysis of influenza vaccine effectiveness. The article searched Pubmed (January 2009 to November 2016) for studies that used test- negative design (TND) to enroll patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18–64 and 65 years and above) using random-effects models” (Rondy et al., 2017, p.381).

Article 2: “Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis”,

“A systematic review was conducted for studies assessing the relative vaccine effectiveness of high dose inactivated trivalent influenza vaccine against confirmed influenza, hospital admissions, and death in adults ≥65” (Lee et al., 2018).

Level of Evidence

Article 3: Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis

Level II Evidence

Strengths: “Included randomized, controlled studies of adults over the age of 65, used multiple databases (Medline, EMBASE, grey literature, and Cochrane), 2955 articles were researched, included 7 unique trials with 101 to 31,803 patients (median 634; interquartile range [IQR], 300 to 6429) and one companion paper , duplicate data removed” (Wilkinson et al., 2017, p. 2775).

Article 4: Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis

Level IV Evidence

Strengths: 11 studies (6 case-control, 3 cohort, and 2 prospective case-control) met inclusion criteria, review of observational studies, case control studies, and cohort design; results of single studies were pooled, inclusion criteria clearly stated, duplicates removed (Domnich et al., 2017)

Article 3: “Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis”

Article 4: “Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis”

This article is a systematic review of “observational studies aimed at evaluating the effectiveness of MF59-TIV against influenza-related outcomes. Results of single studies were pooled whenever possible” (Domnich et al., 2017, 513).

Strengths of Systematic Reviews

Exclusion Criteria Stated

Usage of Multiple Databases

Duplicate Reports Excluded from research

Inclusion Criteria Stated

Meta-analyses were conducted

Systematic reviews and meta-analysis have many strengths to conduct clinical research. Two strengths are that the exclusion criteria are clearly stated, multiple databases were searched, and duplicated reports were not included. For example, in the article “Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies”, the exclusions were “duplicate reports, studies reporting secondary analyses of previously-published IVE data, interim reports superseded by a final report, and reports that were calculated using all ages (children and adults)” (Rondy et al., 2017, p.383).

ARTICLE CITATIONS

These are the four systematic articles used in this clinical issue research.

References

Rondy, M., Omeiri, N. E., Thompson, M. G., Levêque, A., Moren, A., & Sullivan, S. G. (2017). Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. Journal of Infection,75(5), 381-394. doi:10.1016/j.jinf.2017.09.010

Lee, J. K. H., Lam, G. K. L., Shin, T., Kim, J., Krishnan, A., Greenberg, D. P., & Chit, A. (2018). Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis, Expert Review of Vaccines, 17:5, 435-443, DOI: 10.1080/14760584.2018.1471989

Wilkinson, K., Wei, Y., Szwajcer, A., Rabbani, R., Zarychanski, R., Abou-Setta, A. M., & Mahmud, S. M. (2017). Efficacy and safety of high-dose influenza vaccine in elderly

adults: A systematic review and meta-analysis. Vaccine,35(21), 2775-2780. doi:10.1016/j.vaccine.2017.03.092

Domnich, A., Arata, L., Amicizia, D., Puig-Barberà, J., Gasparini, R., & Panatto, D. (2017). Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine, 35(4), 513-520. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.vaccine.2016.12.011

Rondy, M., Omeiri, N. E., Thompson, M. G., Levêque, A., Moren, A., & Sullivan, S. G. (2017).

Effectiveness of influenza vaccines in preventing severe influenza illness among adults:

A systematic review and meta-analysis of test-negative design case-control

studies. Journal of Infection,75(5), 381-394. doi:10.1016/j.jinf.2017.09.010

Lee, J. K. H., Lam, G. K. L., Shin, T., Kim, J., Krishnan, A., Greenberg, D. P., &

Chit, A. (2018). Efficacy and effectiveness of high-dose versus standard-dose

influenza vaccination for older adults: a systematic review and meta-analysis, Expert

Review of Vaccines, 17:5, 435-443, DOI: 10.1080/14760584.2018.1471989

Wilkinson, K., Wei, Y., Szwajcer, A., Rabbani, R., Zarychanski, R., Abou-Setta, A. M., &

Mahmud, S. M. (2017). Efficacy and safety of high-dose influenza vaccine in elderly

adults: A systematic review and meta-analysis. Vaccine,35(21), 2775-2780.

doi:10.1016/j.vaccine.2017.03.092

Domnich, A., Arata, L., Amicizia, D., Puig-Barberà, J., Gasparini, R., & Panatto, D. (2017).

Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A

systematic review and meta-analysis. Vaccine, 35(4), 513-520.

doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.vaccine.2016.12.011

Rondy, M., Omeiri, N. E., Thompson, M. G., Levêque, A., Moren, A., & Sullivan, S. G. (2017).

Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. Journal of Infection,75(5), 381-394. doi:10.1016/j.jinf.2017.09.010

Lee, J. K. H., Lam, G. K. L., Shin, T., Kim, J., Krishnan, A., Greenberg, D. P., &

Chit, A. (2018). Efficacy and effectiveness of high-dose versus standard-dose

influenza vaccination for older adults: a systematic review and meta-analysis, Expert Review of Vaccines, 17:5, 435-443, DOI: 10.1080/14760584.2018.1471989

Wilkinson, K., Wei, Y., Szwajcer, A., Rabbani, R., Zarychanski, R., Abou-Setta, A. M., & Mahmud, S. M. (2017). Efficacy and safety of high-dose influenza vaccine in elderly

adults: A systematic review and meta-analysis. Vaccine,35(21), 2775-2780. doi:10.1016/j.vaccine.2017.03.092

Domnich, A., Arata, L., Amicizia, D., Puig-Barberà, J., Gasparini, R., & Panatto, D. (2017).

Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A

systematic review and meta-analysis. Vaccine, 35(4), 513-520.

doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.vaccine.2016.12.011

Elsevier. (n.d.). ScienceDirect: Elsevier's leading information solution. Retrieved June 19, 2019, from https://www.elsevier.com/solutions/sciencedirect

Walden University Library. (n.d.-a). Databases A-Z: P: Find the best library databases for your research. Retrieved June 19, 2019 from https://academicguides.waldenu.edu/az.php?a=p

Walden University Library. (n.d.-b). Evidence-Based practice research: Clinical question Anatomy. Retrieved June 29, 2019 from https://academicguides.waldenu.edu/library/healthevidence/clinicalquestion

LibGuides: Evidence-Based practice in the health sciences: Databases for EBP research. (2019). Retrieved from https://spcollege.libguides.com/c.php?g=254423&p=1695554

Elsevier. (n.d.). ScienceDirect: Elsevier's leading information solution. Retrieved June 19, 2019,

from https://www.elsevier.com/solutions/sciencedirect

Walden University Library. (n.d.-a). Databases A-Z: P: Find the best library databases for your

research. Retrieved June 19, 2019 from https://academicguides.waldenu.edu/az.php?a=p

Walden University Library. (n.d.-b). Evidence-Based practice research: Clinical question

Anatomy. Retrieved June 29, 2019 from

https://academicguides.waldenu.edu/library/healthevidence/clinicalquestion

LibGuides: Evidence-Based practice in the health sciences: Databases for EBP research.

(2019). Retrieved from https://spcollege.libguides.com/c.php?g=254423&p=1695554