Critical Analysis and Nursing Intervention
Evidence-based practice in clinical interventions has proven effective in developing some of the best clinical approaches to treatment. The Healthcare sector has dramatically invested in research and evidence-based practices to develop some of the best nursing interventions for mitigating various infections (Horntvedt, Nordsteien, Fermann, & Severinsson, 2018). In the presented study, the primary area of focus is evidence-based practice in the treatment of coronavirus. Covid-19 was discovered in late 2019, and it has dramatically affected the healthcare sector and the entire economy. The death cases associated with Covid-19 have increased in the United States over the past two years, with 2020 being the peak period that saw a significant impact on the healthcare sectors (GÜNER, Hasanoğlu, & Aktaş, 2020). Despite the deaths and infections associated with Cold-19, healthcare professionals have developed different types of vaccines that can be used to regulate the rate of transmission of the virus. The vaccination process has seen a reduction in infection rates in the United States. Critical Analysis and Nursing Intervention
Problem Statement
The chosen topic is coronavirus, a respiratory infection caused by the SARS-CoV-2 virus—the patient infected by the virus experiences mild to moderate symptoms that get better without serious medication. The rate of asymptomatic patients increases among patients infected by the coronavirus, making it a significant problem to mitigate. The selected topic exhibits high relevancy due to the virus’s impact on the entire global economic market and healthcare sectors. The vaccination process against the virus has been a global issue, with some countries developing forced vaccination mandates to reduce the rate of spread of the virus. The practice of complete vaccination and its effectiveness is relevant due to its impact on reducing the hospitalization rate and infection among the patients. The research on full vaccination states that suppose the patient is fully vaccinated and provided with immune boosters, they are likely to exhibit a reduced chance of up to 90% of contacting coronavirus. Coronavirus infections are associated with hospitalization, whereby some patients are subjected to IC for better treatment and full patient care. Critical Analysis and Nursing Intervention
PICOT Question
Do adults with full vaccination status including boosters have lower coronavirus hospitalization rates than unvaccinated patients within a six-month time frame?
Search Summary
The study exhibited various search methods to identify some of the best articles for the research quest. Various scientific libraries proved essential in identifying some of the best articles. APU library provided a variety of essential research articles during the research. The databases utilized were PubMed, Coronavirus Research Database, CINAHL, PubMed, EBSCO, Google Scholar, Springer Link, NCBI, and Medline. Researchers used these databases to find information regarding vaccine efficacy among adults with full vaccination status and the correlation with hospitalization ns. The keywords used from the PICO question in the search process were adults, covid, vaccines, boosters, and hospitalization. The search included quantitative research and no articles with a publication date older than three years minimum. Critical Analysis and Nursing Intervention
Table of Evidence
The research resources as evidence provide a clear view of the PICOT question with an in-depth analysis of the complete vaccination on Covid-19. The table of evidence displays research articles that focus on vaccination against Covid-19, with some specifying the full vaccination and the effectiveness of boosters. The use of quantitative study, meta-analysis, systematic review, scoping review, and mixed-method approaches were all utilized during the research process. The search yielded 21 articles describing studies examining vaccination efficacy and hospitalization rates of individuals regarding vaccination status. Eight articles were obtained by researchers from Google Scholar, one from Oxford, five from Elsevier, one from Wiley online library, three from Springer, and three from EB CO. The table of content displays all the articles, topics, and research questions as indicated in appendix A in the appendix list. Critical Analysis and Nursing Intervention
Critical Analysis
The presented research articles that will facilitate and provide evidence to support the argumentative nature of the PICOT question exhibit high quality due to the content of the articles. The majority of the articles published by well-known authors will high professional research experience; thus, they provide an in-depth understanding of the PICOT question. The articles provide supportive research with data that the authors effectively analyze during the research process. The use of analytical data makes the provided evidence much more supportive due to the research study and findings (Gram et al., 2021). The primary evidence exhibited by the research articles is the effectiveness of full vaccination and administration of booster immunities to assist in reducing the rate of transmission of Covid-19. According to the papers’ findings, using the entire vaccination technique reduces the rate of patients being hospitalized due to Covid-19 infections by 80 percent if the patient receives the recommended immunization dosage. Critical Analysis and Nursing Intervention
` The research design adopted by the authors of the articles are modern approaches that focus on addressing essential issues necessary during the research process. The articles adopt different design methods, such as qualitative, mixed-method, and meta-analysis, which provide varying views on the findings. For instance, the use of meta-analysis involves statistical computation to analyze the research findings, thus providing a statistical view of the use of the vaccination approach towards reducing the rate of hospitalization as a result of Covid-19 infections (Lopez Bernal et al., 2021). The authors of different research articles adopted different sample sizes based on the research design applied by the researchers. The sample sizes prove effective in the research despite the varying difference. The randomized sampling approach seems to be dominant among the research articles due to its authenticity to the research. The use of random sampling seems to increase the authentic nature of research due to the increased level of uncertainties. Critical Analysis and Nursing Intervention
` The research articles exhibit a unique way of identifying their subject for the study. For instance, one article focuses on a patient who had been vaccinated seven months before the research. The subject involved both males and females, increasing the authenticity of the research. The study’s choice of subjects proves to be effective in exhibiting outstanding findings regarding the research question ns. For instance, the subjects with full vaccination make an essential part of the research study, given that they fit the exact profile of the research quest. The instruments utilized by the researchers in data analysis are effective in providing a precise analysis of the findings (Mattiuzzi, & Lippi, 2022). Using statistical instruments such as statistical software proves essential in providing an in-depth understanding of the data being analyzed. For instance, one of the articles utilized SPSS statistical software to facilitate an effective data analysis process during the research. Critical Analysis and Nursing Intervention
The articles exhibited varying findings with major linking points that developed effective relationships between the articles. Some of the significant findings of the articles include a reduction in the hospitalization rate among patients who had received complete vaccination against Covid-19. One of the articles clearly outlines the effectiveness of full vaccination, indicating a reduced hospitalization rate among the patients (Tenforde et al., 2021). Most of the articles utilized in the study focus on addressing the importance of the vaccination process towards reducing the rate of spread of Covid-19 that might lead to hospitalization or subjection of the patients to ICU patient care. The findings prove that the use of vaccination as an intervention process assists in creating an effective environment for reducing the spread of Covid-19. The researchers linked their findings with the research questions, thus providing a clear view of the presented problems statement in the study. Critical Analysis and Nursing Intervention
The research exhibited certain limitations that tend to alter the nature of the research findings. Some of the significant limitations included a lack of an adequate sample size. The majority of the articles provided exhibited a smaller sample size which does not have apparent variation in the research findings. The practice alters the concept of a broader view that the researchers can attain through a larger sample size. The research also lacked verification of the findings because there was no direct link to the research to help shed further light on the research findings. The above-presented limitation tends to alter the nature of the study due to an increased level of ambiguity that can be associated with the entire process of research and approaches adopted by the researchers in analyzing most of the collected data during the findings. The use of evidence-based research articles in the analysis assisted in providing more insight into the PICOT question. The studies answered the presented PICOT question by providing an in-depth understanding of the effectiveness of complete vaccination and boosters in reducing the transmission rate of Covid-19. The use of data findings exhibited by the selected articles assists in supporting the PICOT question through analysis of the findings of various articles. The discussion presented by the authors of every article utilized in the study proved to be essential in supporting the PICOT question by drawing a link between the practice of full vaccination and the spread of Covid-19. Critical Analysis and Nursing Intervention
Nursing Implications
The finding of the study and synthesis review could impact the nursing practice by providing some practical and reliable intervention approaches toward the treatment of Covid-19. The practice of full facilitation seems to reduce the possible rate of infection an individual by Covid-19; thus, the government should facilitate a mandatory facilitation policy to reduce the rate of spread of Covid-19. The healthcare sector should invest more resources in acquiring vaccines to facilitate an effective process, thus reducing the rate of Covid-19 transmission (Collie, Champion, Moultrie, Bekker, & Gray, 2022). The vaccination process exhibits certain risks that can cause adverse effects on the patients, thus significantly altering their hormonal function. There are various advantages to the immunization process, including a reduction in the spread of Covid-19 and a lower hospitalization rate due to the virus’s low transmission rate. Critical Analysis and Nursing Intervention
The cost of implementing the intervention might be high though the focus should be on the benefits associated with the intervention process. The practice of complete vaccination exhibits a reduction in the rate of transmission of Covid-19; thus, upon investing in the practice by the government, the community will experience reduced hospitalization process. Nurses should respond positively by adjusting to the new intervention changes to create an effective environment for patient care. Nurses are expected to receive education on the effectiveness of the intervention towards reducing the hospitalization rates, thus enabling effective implementation of the practice in other healthcare facilities (Wang, Yang, Jin, & Lin, 2021). Evidence-based practice intervention provides nurses with a more in-depth understanding of various practical approaches they can adopt toward creating an effective environment for patient care. Nurses should be provided with equipment and mandated to practice the exercise of complete vaccination to effectively reduce the spread of Covid-19 hence during the hospitalization rate associated with Covid-19 infections. Critical Analysis and Nursing Intervention
The presented research on the PICOT question might exhibit a certain level of flops; thus, more research can be conducted to provide an in-depth understanding of the PICOT question. The research gap in the study provides a window for further research whereby the researcher can utilize more future data to support the PICOT question. Covid-19 infection is still in existence, and there are new traits of the virus that are emerging; thus, the research gap can assist in providing a view on which research can improve the use of vaccination approaches. For instance, the Chinese government has implemented new Covid-19 regulations to assist in sustaining the emerging new rate of infections of the virus in the country. Critical Analysis and Nursing Intervention
Reference APA
Bosch, W., Cowart, J. B., Bhakta, S., Carter, R. E., Wadei, H. M., Shah, S. Z., Sanghavi, D. K., Pollock, B. D., Neville, M. R., Oman, S. P., Speicher, L., Scindia, A. D., Matson, M. W., & Moreno Franco, P. (2021). COVID-19 Vaccine-Breakthrough Infections Requiring Hospitalization in Mayo Clinic Florida through August 2021. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciab932
Collie, S., Champion, J., Moultrie, H., Bekker, L. G., & Gray, G. (2022). Effectiveness of BNT162b2 vaccine against omicron variant in South Africa. New England Journal of Medicine, 386(5), 494-496.
Gram, M. A., Nielsen, J., Schelde, A. B., Nielsen, K. F., Moustsen-Helms, I. R., Sørensen, A., Valentiner-Branth, P., & Emborg, H. D. (2021). Vaccine effectiveness against SARS-CoV-2 infection, hospitalization, and death when combining a first dose ChAdOx1 vaccine with a subsequent mRNA vaccine in Denmark: A nationwide population-based cohort study. PLoS medicine, 18(12), 1-13. https://doi.org/10.1371/journal.pmed.1003874
GÜNER, H. R., Hasanoğlu, İ., & Aktaş, F. (2020). COVID-19: Prevention and control measures in community. Turkish Journal of medical sciences, 50(SI-1), 571-577.
Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), 1-11.
Kalligeros, M., Shehadeh, F., Mylona, E. K., Kaczynski, M., Kalagara, S., Atalla, E., Vafea, M. T., & Mylonakis, E. (2021). Clinical Outcomes of Adult Patients Hospitalized with COVID-19 after Vaccination. Tropical Medicine & Infectious Disease, 6(4), 1–6. http://dx.doi.org/10.3390/tropicalmed6040175
Lopez Bernal, J., Andrews, N., Gower, C., Robertson, C., Stowe, J., Tessier, E., Simmons, R., Cottrell, S., Roberts, R., O’Doherty, M., Brown, K., Cameron, C., Stockton, D., McMenamin, J., & Ramsay, M. (2021). Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study. BMJ: British Medical Journal, 373(8292), n1088-11. https://doi.org/10.1136/bmj.n1088
Mattiuzzi, C., & Lippi, G. (2022). Efficacy of COVID-19 vaccine booster doses in older people. EUROPEAN GERIATRIC MEDICINE. https://doi.org/10.1007/s41999-022-00615-7
Rosenberg, E. S., Dorabawila, V., Easton, D., Bauer, U. E., Kumar, J., Hoefer, R. H., Wu, M., Lutterloh, E., D., M., Conroy, M. B., Greene, D., Zucker, H. A., Hoen, R., & Hoefer, D. (2021). Covid-19 Vaccine Effectiveness in New York State. New England Journal of Medicine, 386(2), 116–127. https://doi.org/10.1056/NEJMoa2116063
Sadoff, J., Gray, G., Vandebosch, A., Cárdenas, V., Shukarev, G., Grinsztejn, B., Goepfert, P. A., Truyers, C., Fennema, H., Spiessens, B., Offergeld, K., Scheper, G., Taylor, K. L., Robb, M. L., Treanor, J., Barouch, D. H., Stoddard, J., Ryser, M. F., Marovich, M. A., & Neuzil, K. M. (2021). Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. New England Journal of Medicine, 384(23), 2187–2201. https://doi.org/10.1056/NEJMoa2101544
Tenforde, M. W., Self, W. H., Adams, K., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., & Exline, M. C. (2021). Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA: Journal of the American Medical Association, 326(20), 2043–2054. https://doi.org/10.1001/jama.2021.19499
Thompson, M. G., Stenehjem, E., Grannis, S., Ball, S. W., Naleway, A. L., Ong, T. C., DeSilva, M. B., Natarajan, K., Bozio, C. H., Lewis, N., Dascomb, K., Dixon, B. E., Birch, R. J., Irving, S. A., Rao, S., Kharbanda, E., Han, J., Reynolds, S., Goddard, K., & Grisel, N. (2021). Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings. New England Journal of Medicine, 385(15), 1355–1371. https://doi.org/10.1056/NEJMoa2110362
Uzun, O., Akpolat, T., Varol, A., Turan, S., Bektas, S. G., Cetinkaya, P. D., Dursun, M., Bakan, N., Ketencioglu, B. B., Bayrak, M., Baris, S. A., Guner, R., Gunal, O., Nural, S., Deniz, P. P., Toprak, O. B., Ozkan, G., Gumus, A., Kerget, F., … Itil, O. (2022). COVID-19: vaccination vs. hospitalization. INFECTION. https://doi.org/10.1007/s15010-021-01751-1
Wang, Q., Yang, L., Jin, H., & Lin, L. (2021). Vaccination against COVID-19: A systematic review and meta-analysis of acceptability and its predictors. Preventive medicine, 150, 106694.
Appendix A:
Table of Evidence (TOE)
| Citation Last name and year of publication
| Purpose State the purpose of the study using exact words from the article if possible and (p. XX).
Research Question and/or Hypothesis State actual or implied research question.
If hypothesis present, state. If no hypothesis states “none” and write one that would apply to this study. | Sample/Setting State the sample size.
Describe the sample
State the sampling method and the method used to assign subjects to groups (if applicable).
Describe the setting in which the study was conducted.
| Research Design & Treatment State research design (e.g. quantitative quasi-experimental)
Identify the Level of Evidence (see below)
Describe treatment (if appropriate).
Discuss what controls were put in place to strengthen the design?
Variables & Their Definitions State independent (IV) and dependent (DV) variables.
Abbreviate as: (for example) IV1 IV2
DV1 DV2 | Measurement Measurement of major variables refers to the DV. Include the scales used to measure the outcome variable.
Discuss reliability and validity information of scales used.
List name of statistics used to answer the clinical question (e.g. chi square, ANOVA)
State level of significance accepted top guide the analysis of data. | Findings For every statistical test you have in the previous column, you should have a finding.
Conclusions Present conclusions based on findings (include interpretation of the results here). |
| (Uzun et al., 2022)
[Francisco] | This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols (p. 1).
What is the comparison of two different vaccine protocols to the vaccination status of the hospitalized patient?
| Data sample size of 1401 patients from 25 hospitals in 16 cities.
The samples were made up of patients hospitalized between august 1 and 10 2021.
A government vaccine tracking system was used to determine patient’s vaccination status and vaccination dates (p. 2).
They used a non-probable, purposive sampling method.
Research carried out in a hospital setting in Turkey. | The research uses quasi- experimental research where the samples are further divided into groups depending on their vaccination statuses.
The level III evidence is the most applicable since the evidence is obtained from a well-designed control trial without randomization.
Age, sex, vaccination status, comorbidities (such as diabetes mellitus, hypertention, cardiovascular disease, chronic lung disease, cerebrovascular disease, chronic kidney disease), and the reason for the patients not being vaccinated (if avaliable) were collected (p. 2). | Student t and chi-square tests were used for statistical analysis, and a p value <0.05 was considered significant (p. 2). | Approximately half (47.8%) of the patients were unvaccinated, and the next largest group comprised those who received two doses of Sinovac (32.9%) (p. 2).
The results presented in Tables 1 and 2 should be evaluated and compared cautiously, because vaccine types and their accessibility were dependent on age group, comorbidities, and previous infection; therefore, only appropriate data are presented (p. 3).
Results showed reasons people were not vaccinated due to hesitancy and negligence.
In conclusion, effective vaccinations decrease COVID-19-related hospitalizations. Protection after two doses of Sinovac may not provide long-lasting immunity; however, a booster dose increases the immunity response of patients who received two doses of Sinovac (p. 4). |
| (Thompson t al., 2021)
[Francisco] | Purpose of the research study is to evaluate the effectiveness of covid19 vaccines in the ambulatory and inpatient care setting.
Implied research question: How well do these vaccines protect against more severe illness due to severe acute respiratory syndrome coronavirus 2 resulting in hospitalization?
“none”, Vaccine effectiveness has been limited in populations that have been disproportionately affected by Covid-19, including older adults, persons with chronic medical conditions, and Black or Hispanic populations (p. 1356). | hospitalizations and ICU visits from a total of 187 hospitals; three partners also contributed data on visits to a total of 167 emergency departments and a total of 54 urgent care clinics
The demographic characteristics of the patients and their underlying medical conditions (defined according to the ICD codes that were assigned at the visit) were extracted from medical records (p.1356).
Our analytic sample included 41,552 hospitalizations and 21,522 emergency department or urgent care visits; 3% of the hospitalizations and 14% of the emergency department or urgent care clinic visits were repeat medical visits by the same patient (Table 2) (p. 1360).
Systematic sampling method. | Quasi experimental research design
Level III
Systematic identification of the hospitals throughout the region was ideal in strengthening the design. | Nominal measurement method would be the most ideal in this case. | Findings indicate that; The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit (p.1355).
It can be concluded that Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARs-CoV-2 infection (p. 1355). |
| (Tenforde et al., 2021)
Drucilla Garcia | Evaluate the association between vaccination with mRNA COVID-19 vaccines—mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)—and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease | 4513 adults
Random sampling method used. Research in a hospital setting. | a test-negative case-control design to assess the association between hospitalization for COVID-19 and prior vaccination with an mRNA COVID-19 vaccine. I | Ordinal measurement applied | The findings indicate that Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19hospitalizations. In conclusion, Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. |
| (Sadoff et al, 2021)
Drucilla Garcia | This research purposes on evaluating the issue of efficacy and safety relationship of a single dose vaccine against covid19 | 19630 vaccinated population.
An international, randomized, double-blind, placebo-controlled sampling of phase 3 trial, were randomly assigned. | Quasi experimental research design
Level III
Systematic identification of the hospitals throughout | Ratio variable measurement technique was applied. The single dose was given in ratio 1:1 | The findings shows that The incidence of serious adverse events was balanced between the two groups.
In conclusion, A single dose of Ad26.COV2.S protected against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death. Safety appeared to be like that in other phase 3 trials of Covid-19 vaccines. |
| (Rosenberg et al., 2021)
(Anna K) | The research purposes on identifying the effectiveness of Covid19 vaccine in New York State. (p.117)
Implied question: Is there changes in vaccine effectiveness across outcomes, products, and population subgroups ? | 8,690,825 adults in New York State of which 5,638,142 persons (64.9%) were fully vaccinated (p.118)
Systematic sampling method was applied. Four databases were linked to construct a surveillance-based cohort of adults 18 years of age or older residing in New York State. (p.117) | Experimental research design was used in the research
Level VI evidence from single descriptive or qualitative study. | The DV in this research was measured using the ordinal technique “The Covid-19 data from the NYSIIS and the CIR were combined and deduplicated on the basis of first name, last name, date of birth, and ZIP Code. The data were then matched to the ECLRS with the use of a deterministic algorithm on the basis of first name, last name, and date of birth and matched to HERDS on the basis of initials, sex, date of birth, and ZIP Code.” (p.117) | The findings state that There were 150,865 cases of Covid-19 and 14,477 hospitalizations with Covid-19. During the week of May 1, 2021, when the delta variant made up 1.8% of the circulating variants, the median vaccine effectiveness against Covid-19 was 91.3% (range, 84.1 to 97.0) for BNT162b2, 96.9% (range, 93.7 to 98.0) for mRNA-1273, and 86.6% (range, 77.8 to 89.7) for Ad26.COV2.
In conclusion, the effectiveness of the three vaccines against Covid-19 declined after the delta variant became predominant.
|
| (Mattiuzzi & Lippi, 2022) (Anna K) | provide here an updated analysis on efficacy of COVID-19 vaccine booster doses in older people based on ongoing Italian nationwide COVID-19 vaccination campaign. “We provide here an updated analysis on efcacy of COVID-19 vaccine booster doses in older people (i.e., aged≥80 years) based on ongoing Italian nationwide COVID-19 vaccination campaign.” (p. 275) | 2,385,897 people purposed to receive booster shots of the vaccine
Random sampling method applied | Quasi- experimental research.
Level III, evidence obtained from well designed controlled trials without randomization | Nominal measurement is applied where the measurement is presented in percentages. “ Data were obtained from the COVID-19 national integrated surveillance program, made available and regularly updated by the Italian National Institute of Health.” (p. 275) | Findings indicate that compared to those who completed the COVID-19 vaccination cycle for≥5 months (n=2,385,897), those receiving booster doses (n=1,549,747) had 75% lower risk of SARS-CoV-2 infection, 82–83% lower risk of COVID-19 hospitalization and ICU admission, and 81% lower risk of death.
In conclusion, The administration of COVID-19 vaccine booster doses is advisable for reducing the risk of morbidity and mortality in older people. |
| (Bernal et al., 2021)
(Sommer) | To estimate the real-world effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S vaccines against confirmed covid-19 symptoms (including the UK variant of concern B.1.1.7), admissions to hospital, and deaths. | 156930 adults aged 70 years and older who reported symptoms of covid-19 between 8 December 2020 and 19 February 2021 and were successfully linked to vaccination data in the National Immunization Management System.
| Test negative case-control study.
Level IV evidence from well designed cohort studies | Primary outcomes were polymerase chain reaction confirmed symptomatic SARS-CoV-2 infections, admissions to hospital for covid-19, and deaths with covid-19 | The findings indicate that Participants aged 80 years and older vaccinated with BNT162b2 before 4 January 2021 had a higher odd of testing positive for covid-19 in the first nine days after vaccination (odds ratio up to 1.48, 95% confidence interval 1.23 to 1.77), indicating that those initially targeted had a higher underlying risk of infection.
In conclusion, Vaccination with either one dose of BNT162b2 or ChAdOx1-S was associated with a significant reduction in symptomatic covid-19 in older adults, and with further protection against severe disease. Both vaccines showed similar effects. Protection was maintained for the duration of follow-up (>6 weeks). |
| (Kalligeros et al., 2021)
(Sommer) | to identify breakthrough cases of COVID-19 and to assess the impact of previous vaccination on hospitalization outcomes. | identified 915 consecutive patients hospitalized with a primary diagnosis of COVID-19 from 1 January to 4 April 2021.
Systematic sampling method applied
The research carried out in hospital setting | Experimental research design.
Level IV evidence from well designed case control | continuous measurements as medians (IQRs), and we compared them with the Mann–Whitney-Wilcoxon test. | The study finds out that 16 patients were hospitalized after receiving either both doses of the BNT162b2 Pfizer-BioNTech or the Moderna mRNA-1273 COVID-19 mRNA-based vaccine or a single dose of the Ad26.COV2. S Janssen Biotech Inc. adenoviral vector vaccine. Most of these individuals (14/16, 88%) tested positive within the first 2 weeks after vaccination
In conclusion, Despite the presence of vaccine breakthrough COVID-19 cases, the present brief report underlines the importance of vaccination against COVID-19. In our study, even a single dose of vaccination was associated with decreased risk of death. |
| (Gram et al., 2021)
(Crystal) | The study proposes on establishing the effectiveness of combining ChAdOx1 vaccine and subsequent mRNA vaccine. | The analyses included 5,542,079 individuals (97.6% of the total Danish population).
Random sampling method applied | Experimental research design was applied
Level IV evidence was applied and it implied a cohort study. | Nominal DV measurement was applied
Chi- square statistics applied | The findings indicate that A statistically significant adjusted VE of 93% (95% CI: 80; 98) against COVID-19–related hospitalization was observed from 14 days after the first dose ChAdOx1 and until receiving a second dose of an mRNA vaccine.
In conclusion, In this study, we observed a large reduction in the risk of SARS-CoV-2 infection when combining the ChAdOx1 and an mRNA vaccine, compared with unvaccinated individuals. |
| (Bosch et al., 2021)
(Crystal) | The research purposes Tests for differences between breakthrough and no breakthrough admissions were 2-sample t tests for continuous variables and Pearson χ2 tests for categorical variables. | 6161 patients
Random sampling method applied. | Quasi experimental design
Level III evidence from a well designed control platform.
| a Pearson χ2 test was used
Descriptive statistics were used to summarize the clinical data | The findings of this research shows that the 126 vaccine breakthrough admissions, the manufacturer was known in 105 cases: Pfizer, Inc (n = 59), Moderna US, Inc (n = 36), and Janssen (n = 10). The percentage of hospitalized breakthrough infections was 2.1% before 2 May 2021 and later rose to 19.1%.
In conclusion, our study describes an increased number of vaccine breakthrough COVID-19 infections requiring hospitalization at a single center in Florida after May 2021. This coincided with the more-infectious delta variant, with more high-risk vaccinated individuals, with changes to preventive recommendations, and with the potential for waning immunity from early vaccinations. |
