Cisplatin-induced ototoxicity: the current state of ototoxicity monitoring in New Zealand.

Background: Many well-known pharmacologic agents have been shown to have toxic effects to the cochleo-vestibular system. Examples of such ototoxic agents include cisplatin and aminoglycoside antibiotics. Ototoxicity monitoring consists of a comprehensive pattern of audiological assessments designed to detect the onset of any hearing loss. Three main methods have emerged over the past decade, and include the basic audiological assessment, extended high frequency (EHF) audiometry, and otoacoustic emission (OAE) measurement. These measures can be used separately or in combination, depending on clinical purpose and patient considerations. It is suggested by the American Academy of Audiology Position Statement and Clinical Practice Guidelines: Ototoxicity Monitoring, that baseline testing be done in a fairly comprehensive manner, including pure-tone thresholds in both the conventional- and extended high frequency ranges, tympanometry, speech audiometry, and the testing of OAEs (AAA, 2009). Anecdotal evidence suggests that New Zealand Audiologists do not currently follow a national ototoxicity monitoring protocol. Therefore the main aim of this study was to explore the current status of ototoxicity monitoring within New Zealand. Hypothesis: It was hypothesized that hospital based Audiology departments across New Zealand each followed their own internal ototoxicity monitoring protocol based, to a large extent, on the guidelines proposed by the American Academy of Audiology and by the American Speech-Language-Hearing Association. Method: Through the use of a Telephone Interview Questionnaire, 16 charge Audiologists were interviewed to establish their current state of knowledge regarding ototoxicity monitoring at 16 out of 20 district health boards in New Zealand. Enquiries about the current systems and procedures in place at their departments together with any suggestions and recommendations to improve on these systems were made. Results: This study found that only 9 of the 16 DHBs interviewed currently follow an ototoxicity monitoring protocol. Furthermore, other than initially hypothesized the origin of the protocols followed by the remaining 7 departments were reported to have ranged from independently developed protocols to historically adopted protocols. One department implemented an adapted version of a protocol by Fausti et al. (Ear and Hearing 1999; 20(6):497-505). This diversity in origin however, does confirm our initial suspicion that no universal and standardized monitoring protocol is currently being followed by Audiologists working in the public health sector of New Zealand

Umweltschutz, Strukturwandel und Wirtschaftswachstum

SIGLEAvailable from FIZ Karlsruhe / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Grundlagen eines mittelfristigen umweltpolitischen Aktionsplans

The most pressing issues of environment protection today are global climatic changes, pollution of groundwaters and surface waters, increased waste accumulation, impairment of soil functions, and, from another aspect, environmentally relevant trends of development in some polluter groups (in particular farming, forestry, the traffic sector, and the area of hazardous substances and chemical products). Working from this point, the study inquires into the immediate and probable medium-term ecopolitical tasks in the areas named and points out ways of avoiding undesirable developments. Due consideration is given to the growing pressure to find efficient solutions of environment protection. One can assume a priori that this will require with less compromise than hitherto the creation of economic instruments and of more efficient institutional arrangements. The study attempts to solve these problems with an interdisciplinary approach on as broad a basis as possible. It was initiated as a research project commissioned by the Federal Minister of the Environment, Nature Conservation and Reactor Safety. (orig./HSCH)Vordringliche Problemfelder des Umweltschutzes sind aus heutiger Sicht die globalen Klimaveraenderungen, die Belastung des Grund- und Oberflaechenwassers, die Zunahme des Abfallaufkommens sowie Beeintraechtigungen der Bodenfunktionen, aber auch umweltrelevante Entwicklungstendenzen in einigen Verursachergruppen (insbesondere in der Land- und Forstwirtschaft, im Verkehrssektor und im Bereich Gefahrstoffe und Chemieprodukte). Vor diesem Hintergrund prueft die Studie den aktuell gegebenen bzw. sich mittelfristig abzeichnenden umweltpolitischen Handlungsbedarf in den genannten Bereichen und zeigt konkrete Ansatzpunkte fuer die Vermeidung von Fehlentwicklungen auf. Dabei wird dem wachsenden Zwang zu effizienten Loesungen im Umweltschutz Rechnung getragen; dies wird - so ist a priori zu vermuten - staerker als bisher flexible, oekonomische Anreize schaffende Instrumente und sachgerechtere institutionelle Arrangements erfordern. Die Studie versucht, diese Aufgaben durch einen moeglichst breiten, interdisziplinaeren Ansatz zu loesen. Sie ist als Forschungsvorhaben des Bundesministers fuer Umwelt, Naturschutz und Reaktorsicherheit entstanden. (orig./HSCH)Available from TIB Hannover: RR 2401(10) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman