The current state of ototoxicity monitoring in New Zealand.

AIM: To explore medical oncologists' and audiologists' knowledge and attitudes regarding ototoxicity monitoring, and to gain an understanding of monitoring currently being implemented at District Health Boards (DHBs) nationwide. We also aimed to identify ways in which audiological outcomes for patients receiving potentially ototoxic treatments could be improved, including examining whether the formulation and implementation of a national ototoxicity monitoring guideline is necessary. METHOD: Complementary telephonic interviews were conducted with 16 senior or charge audiologists and seven senior medical oncologists from DHBs across New Zealand, and their responses analysed. RESULTS: Responses indicate a comprehensive understanding of ototoxicity across both disciplines; however there is limited familiarity with ototoxicity monitoring protocols. Patients across New Zealand undergo significantly variable ototoxicity monitoring; local practices range from no routine monitoring to audiological assessment prior to each cycle of chemotherapy. No routine audiological follow up is conducted post completion of treatment at any DHB, in contrast with international guidelines. Twenty-two of 23 participants were in favour of development of a national ototoxicity monitoring guideline. CONCLUSION: There is significant discrepancy in how ototoxicity monitoring is conducted across New Zealand, and implementation of a national ototoxicity monitoring protocol may improve audiological outcomes for patients receiving ototoxic chemotherapy.

Wrapped in controversy: trends in fundoplication at myotomy for achalasia in Christchurch, New Zealand.

AIM: A surgical approach to the management of achalasia involves myotomy, typically with added anti-reflux procedure. The most appropriate fundoplication in this setting (total Nissen, partial anterior Dor, or partial posterior Toupet) remains controversial. We present the trends in fundoplication procedures performed at myotomy in Christchurch between 1997 and 2009, and compare this with the literature. METHODS: 34 cases of achalasia managed with myotomy and various types of fundoplication in Christchurch between 1997 and 2009 were separated into two temporal groups, and the type of surgery in each group analysed. Data was obtained from the clinical records on specific short and long-term postoperative complications. RESULTS: There is a decrease over time in myotomy without fundoplication and in total Nissen fundoplications performed. The number of posterior fundoplications remains equal over both time periods; however the proportion of anterior fundoplications is significantly increased in the later group. Three cases of mucosal perforation occurred during myotomy associated with anterior fundoplication, and reintervention rates were highest in myotomy only and anterior fundoplication patients. CONCLUSION: Trends in anti-reflux surgery in Christchurch reflect the development of the evidence base in the literature. The change in fundoplication procedure is not clearly explained by the complication rates.