Title Best current evidence on chest physiotherapy in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis: a systematic review. Purpose To determine the current scientific evidence for using three chest physiotherapy modalities namely percussion, postural drainage and suctioning in paediatric patients (0 to 24 months). Relevance The field of cardiopulmonary physiotherapy seems to be a neglected area in physiotherapy, with a subsequently limited evidence base. The author observed that in various clinical settings physiotherapists tend to administer routine chest physiotherapy to paediatric patients with bronchiolitis. Findings from this study may assist physiotherapists in their choice of effective treatment options. Sources The following databases were searched for evidence: African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP E-theses/dissertations, PEDro, Medline Ovid, Sabinet, Science Direct, Up To Date. Methodology This was a systematic review. The databases were reviewed by making use of a specified search strategy customised for each database. Keywords were: physiotherapy/physical therapy, bronchiolitis and paediatric/pediatric in combination with percussion, postural drainage and suction. The search yielded 10,016 study titles. Studies were chosen from the population of studies using pre-set inclusion and exclusion criteria. These criteria were applied to the titles, abstracts and full-text articles as appropriate. Five full text-articles were appraised and based on the scores from the appraisal three were included in the final sample. Data analysis Appraisal instruments from the National Health System Critical Appraisal Skills Programme (NHS CASP) and the PEDro scale (for randomised controlled trials) were used to evaluate and score the sample. Scoring was done independently by two researchers, and agreement reached through negotiation. The evidence was synthesised and graded according to the Sackett hierarchy of evidence. Results Owing to the heterogeneity of the sample, and the nature of results reported, a meta-analysis was not possible. Results from this study reveal that there is no evidence to support routine chest physiotherapy in uncomplicated viral bronchiolitis amongst the paediatric population. Chest physiotherapy does not decrease length of hospital stay, oxygen requirements or clinical scores indicating distress/morbidity. However, with secondary bacterial respiratory infections, chest physiotherapy may be indicated, depending on the assessment of each individual patient. Conclusion Percussion, postural drainage and suctioning are not effective in the management of bronchiolitis in children, newborn to 24 months old, except in individually assessed cases with secondary bacterial infection. In this subset, physiotherapy must be customised to the patient. Therefore routine physiotherapy is not indicated. Implications Chest physiotherapy should be based on a complete evaluation and on clinical merit, as well as on evidence and patient preference. Education of physiotherapy students at universities as well as doctors regarding the current evidence for chest physiotherapy in paediatric bronchiolitis is essential. Doctors and clinicians need to be made aware that routine chest physiotherapy for paediatric patients with bronchiolitis should not be prescribed. AFRIKAANS : Titel Die beste huidige bewyse aangaande longfistioterapie vir non geventileerde pediatriese pasiënte (0 tot 24 maande) met brongiolitis: 'n sistematiese oorsig. Doel Om huidige wetenskaplike bewyse vir die gebruik van drie long fisioterapietegnieke naamlik beklopping, posturale dreinasie en suiging in pediatriese pasiënte (0 tot 24 maande) te bepaal. Toepaslikheid Die veld van pediatriese fisioterapie blyk 'n verwaarloosde area van navorsing te wees, met gevolglik beperkte bewysbasis. Die navorser het ondervind dat fisioterapeute dikwels in kliniese praktyk roetine longfisioterapie in pediatriese pasiënte met brongiolitis toepas. Bewyslewering vanuit hierdie studie kan fisioterapeute help met die keuse van effektiewe behandelingsprosedures. Bronne Die volgende databasisse is deursoek vir bewyse: African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP e-theses and dissertations, PEDro, Medline, Sabinet, Science Direct en Up To Date. Die soektog het 10,016 titels gelewer. Metode 'n Sistematiese oorsig van die data is uitgevoer deur 'n gespesifiseerde soekstrategie, aangepas vir elke databasis, te volg. Sleutelwoorde was: “physiotherapy/physical therapy”, “bronchiolitis” and “paediatric/pediatric” in kombinasie met “percussion”, “postural drainage” and “suction”. Voorafbepaalde insluitings- en uitsluitingskriteria is toegepas op titels, abstrakte en artikels soos toepaslik. Data analise Evalueringsinstrumente van die “National Health System Critical Appraisal Skills programme” (NHS CASP) asook die PEDro skaal (ewekansige gekontroleerde eksperiment) is gebruik vir evaluasie van en puntetoedeling vir die verkose studies. Die puntetoekenning is onafhanklik deur twee navorsers gedoen en konsensus is bereik deur onderhandeling. Die inligting verkry is gesintetiseer en gegradeer aan die hand van die Sackett hiërargie van bewyse. As gevolg van die heterogeniteit van die ingeslote studies en die aard van die resultate was 'n meta-analise nie moontlik nie. Resultate Die studie het bevind dat daar geen bewyse is vir roetine borskasfisioterapie van ongekompliseerde akute virale pediatriese brongiolitis nie. Borskasfisioterapie verminder nie die duur van hospitaalverblyf, suurstofbehoeftes of die kliniese respiratoriese aanduiding van stres in die pasiënte nie. In die geval van sekondêre bakteriële respiratoriese infeksies mag borskasfisoterapie egter geindikeerd wees, afhangend van die evaluasie van elke individuele pasiënt. Gevolgtrekking Beklopping, posturale dreinasie, en suiging as roetine behandeling is nie effektief in die behandeling van brongiolitis in pasgebore tot 24 maand oue pasiënte nie, behalwe individuele gevalle met sekondêre bakteriële infeksies. In hierdie spesifieke subgroep moet borskasfisioterapie aangepas word vir pasiënt. Roetine fisioterapie is dus nie aangedui nie. Implikasies Borskasfisioterapie moet gebasseer wees op 'n volledige evaluasie en kliniese meriete, asook bewyslewering en die pasiënt se voorkeure. Opleiding van fisioterapie studente by universiteite, asook dokters aangaande die huidige bewyslewering vir borskasfisioterapie in pediatriese brongiolitis is belangrik. Dokters en klinici moet bewus gemaak word dat roetine borskasfisioterapie vir pediatriese brongiolitis pasiënte nie voorgeskryf moet word nie. Additional information available on a CD stored at the Merensky Library. / Dissertation (MPhysT)--University of Pretoria, 2011. / Physiotherapy / unrestricted

Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.