ABSTRACT
Background: During the first quarter of 2021, several European countries suspended the use of the Oxford-AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person. This was followed by several reports of fatalities related to pulmonary embolism and other thrombotic events including thrombocytopenia which has been referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). Aim(s): This study investigated the occurrence of thrombotic adverse events and their clinical outcomes of the three approved and most used COVID-19 vaccines namely Moderna, Pfizer and Oxford-AstraZeneca, using one of the largest spontaneous adverse events databases, namely EudraVigilance. Method(s): A retrospective descriptive analysis was conducted of spontaneous reports for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines submitted to the EudraVigilance database in the period from 17 February to 14 June 2021. Result(s): There were 729,496 adverse events for the three vaccines, of which 3420 were thrombotic, mainly Oxford-AstraZeneca (n = 1988, 58 1%) followed by Pfizer (n = 1096, 32 0%) and Moderna (n = 336, 9 8%). As serious adverse events, there were 705 reports of pulmonary embolism for the three vaccines, of which 130 reports (18 4%) were for Moderna, 226 reports (32 1%) for Pfizer and 349 (49 5%) for Oxford-AstraZeneca vaccines. The occurrence of pulmonary embolism is significantly associated with a fatal outcome (p = < 0 001). Sixty-three fatalities were recorded (63/3420, 1.8%), of which Moderna (n = 6), Pfizer (n = 25) and Oxford-AstraZeneca (n = 32). Conclusion(s): Thrombotic adverse events reported for the three vaccines remains extremely rare with multiple causative factors reported elsewhere as precipitating these events. Practicing vigilance and proper clinical management for the affected vaccines, as well as continuing to report adverse events, are essential. More than 4 89 billion doses of different COVID-19 vaccines have been administered across the globe. On the basis of scientific evidence showing that benefit outweighs risk, people continue to be urged to accept the vaccination when offered.
ABSTRACT
Purpose Domestic abuse or intimate partner violence is a term that describes a pattern of abusive behaviours, often experienced concurrently and linked to gender-based violence. This study aims to explore through the literature the potential to design effective digital services that work for victims, survivors and those who provide domestic abuse support services. Design/methodology/approach This study is based on a systems or service design thinking methodology which was adopted during a Scottish Government-funded Technology Enabled Care (TEC) pathfinder project on domestic abuse. This methodology is the basis for the Scottish Approach to Service Design which is based on the Design Council Double Diamond. During the first phase, known as the discovery phase, desk-based research is conducted by the service design team to inform their approach to the later phases (the second half of the first diamond is define whilst design and deliver form the second diamond). Time is spent during discovery to unpack the complexity whilst the approach takes a pragmatic worldview. Findings Technology has yet to be shown to provide an effective solution to any aspect of the victim or survivors' experience or support services albeit these are often over-stretched and under-funded even without the Covid-19 pandemic. Digital abuse is increasing with perpetrators adapting new technologies. Digital developments should be grounded on ethical design principles. Research limitations/implications This study is the result of the desk-based research during a TEC project considering the potential role of technology in tackling domestic abuse. Limitations include only including evidence from the literature;interviews were conducted but are not reported here. Another limitation is the pragmatic rather than academic nature of the approach;it was to be a foundation for service re-design. So hopefully useful for new practitioners to immerse themselves in the topic area but with no claims to be reproducible as would be the case in a formal review. Practical implications All the evidence shows the authors need to keep trying different approaches, different forms of engagement and ways to empower survivors. Could technology support health-care practitioners to consistently use sensitive routine enquiry? Perhaps enable independent domestic violence advisors to attend more multidisciplinary team meetings in local community settings? Meanwhile, digital abuse is increasing with perpetrators adapting new technologies. Technology has not yet provided a digital solution which is practical and meets the needs of the broad intersectional population affected by domestic abuse nor those who provide support. If the future is to be based on digital developments it must be grounded on ethical design principles. Originality/value This desk-based review collates the current national and international policy and research literature whilst focusing on digital developments which support those affected by domestic abuse.
ABSTRACT
The development of safe, effective, affordable vaccines against COVID-19 remains the cornerstone to mitigating this pandemic. Early in December 2020, multiple research groups had designed potential vaccines. From 11 March 2021, several European countries temporarily suspended the use of the Oxford-AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person, despite the European Medicines Agency (EMA) and the World Health Organization's assurance that there was no indication that vaccination was linked. This study aimed to identify and analyse the thrombotic adverse reactions associated with the Oxford-AstraZeneca vaccine. This was a retrospective descriptive study using spontaneous reports submitted to the EudraVigilance database in the period from 17 February to 12 March 2021. There were 54,571 adverse reaction reports, of which 28 were associated with thrombotic adverse reactions. Three fatalities were related to pulmonary embolism;one fatality to thrombosis. With 17 million people having had the AstraZeneca vaccine, these are extremely rare events The EMA's Pharmacovigilance Risk Assessment Committee (18 March 2021) concluded that the vaccine was safe, effective and the benefits outweighed the risks. Conducting further analyses based on more detailed thrombotic adverse event reports, including patients' characteristics and comorbidities, may enable assessment of the causality with higher specificity.