Population
PICO(T) Question
In patients aged 60 years and above (P), what is the effect of being administered the influenza vaccine (I) on contracting pneumonia (O) compared with not receiving the influenza vaccine (C) during the Flu season (T)?
PICO(T)
P-adults aged 60 years
I-immunization with influenza vaccines
C- group of patients not administered with the vaccine
O-vaccinated patients not as likely to develop pneumonia
T-measured twice weekly
Overview of findings
Findings from research
- Quantitative study by Vila-Corcoles et al. (2016) recommends pneumococcal vaccine as primary preventive approach for aged
- Qualitative study by Restivo et al. (2017) argued that older adults above 60 years acquire infection from other patients as well as health care workers. As per results it can be prevented by influenza vaccination
- Qualitative study by Ellen (2017) identified that nurses perceives side effects of vaccine, technology and feelings of good health as barriers to influenza immunisation. The facilitators includes recommendations from health care providers, social media networks, access to health care providers
- As per Kan and Zhang (2018) barriers to influenza vaccine among older adults are transportation cost, side effects of vaccine, ad mediating variables are recommendations from health care providers and threat perception
Strength of Evidence
Summary of the evidence
Overall strength of the study is moderate as per LoBiondo-Wood & Haber (2017)
Rationale-
- Two studies are level IV- study of Ellen (2017) and Vila-Corcoles et al., (2016)
- one is level I- study of Restive et al., (2017)
- one is level II- study of Kan and Zhang (2018)
Practice recommendations
Recommendations
- For older adults with pneumonia Pneumococcal vaccines can be considered primary preventive agent. It is recommended by CDC. PCV 13 approved by FDA protects agonist 6 more serotypes than the PCV7
Strength of evidence (review) provides rationale for older adults to uptake take pneumococcal vaccine. Evidence has relative risk of >5(<0.2) based on strong evidence of association (Assad et al., 2012)
- Influenza vaccine is recommended as evidence from randomized control trials signify the 23% effectiveness of vaccine (with 95% confidence interval)
Strength of evidence (peer reviewed journal) is moderate and the rationale for the choice is the estimate of the efficacy of the influenza vaccine (Lang et al., 2012)
Key Stakeholders
- Older patients or participants with pneumonia
-They are important to team being directly involved with the target of the effort and are beneficiaries
- Patients at risk of pneumonia
-May help in preventing proposed illness by taking benefits of the efforts and pass the health information for community awareness
- Nurse
– Important as care provider and to pass the information and aid in enforcing laws
Evaluation Plan
Intervention
- Participants will be immunized using influenza vaccine
- Periodic assessment of the study population’ level of resistance
- Monitoring subjects to demonstrate any outcomes
Plan for evaluation
- Data collection- from hospitals
- Mixed logistic regression model- statistical analysis
- Evaluation in community- Mixed method
- Surveys (Taddio et al., 2015)
- Time series of analysis (Bernal, Cummins & Gasparrini, 2017).
References
Assaad, U., El-Masri, I., Porhomayon, J., & El-Solh, A. A. (2012). Pneumonia immunization in older adults: review of vaccine effectiveness and strategies. Clinical Interventions in Aging, 7, 453–461.
Bernal, J. L., Cummins, S., & Gasparrini, A. (2017). Interrupted time series regression for the evaluation of public health interventions: a tutorial. International journal of epidemiology, 46(1), 348-355.
Ellen, M. (2017). Factors that influence influenza vaccination rates among the elderly: nurses’ perspectives. Journal of nursing management.
Kan, T., & Zhang, J. (2018). Factors influencing seasonal influenza vaccination behaviour among elderly people: a systematic review. Public Health, 156, 67-78.
Lang, P.-O., Mendes, A., Socquet, J., Assir, N., Govind, S., & Aspinall, R. (2012). Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence. Clinical Interventions in Aging, 7, 55–64.
Restivo, V., Costantino, C., Bono, S., Maniglia, M., Marchese, V., Ventura, G, Vitale, F. (2017). Influenza vaccine effectiveness among high-risk groups: A systematic literature review and meta-analysis of case-control and cohort studies. Human Vaccines & Immunotherapeutics, 1-12. doi:10.1080/21645515.2017.1321722
Taddio, A., Shah, V., McMurtry, C. M., MacDonald, N. E., Ipp, M., Riddell, R. P., … & Chambers, C. T. (2015). Procedural and physical interventions for vaccine injections: systematic review of randomized controlled trials and quasi-randomized controlled trials. The Clinical journal of pain, 31(Suppl 10), S20. DOI:
Vila-Corcoles, A., Ansa, X., Ochoa-Gondar, O., Satue, E., De Diego, C., & Rodriguez-Blanco, T. (2016). Pneumococcal pneumonia in adults 60 years or older: Incidence, mortality and prevention. Medicina Clínica, 146(5), 199-202. doi:10.1016/j.medcli.2015.09.015
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