American Speech-Language-Hearing Association Research Articles

Using case-based learning to teach evidence-based practice: A pilot study.

The American Speech-Language-Hearing Association (ASHA) promotes the use of evidence-based practice (EBP) in the provision of clinical services by speech-language pathologists (SLPs). Therefore, training in the EBP process is vital in the education of future SLPs. Case-based learning (CBL) has been found effective in facilitating transfer of knowledge and skills in various fields; however, its utilisation to teach EBP to SLP students is understudied. This phenomenological investigation explores the use of CBL, an active learning strategy that gives students the opportunity to practice application of knowledge to realistic scenarios, to teach EBP to graduate SLP students. Graduate SLP students worked in small groups to complete an article review activity centred around an assigned hypothetical clinical case. Students submitted article review papers and written reflections on their learning process. The written reflections and review papers were analysed using qualitative content analysis to understand students' approach to clinical cases and their perspectives on the CBL approach. Analysis of the papers and reflections indicated that students tended to rely heavily on scientific evidence for clinical decision making, often to the exclusion of clinical expertise or client perspectives. Students reported that the project was applicable to their future clinical practice. Further, they reported learning from multiple sources, including the instructor, class discussion and their peers. Results indicate that graduate SLP students found CBL activities beneficial for learning the principles of EBP. Students specifically indicated an appreciation for the realistic nature of the activities. Future applications are examined.

The Effects of Metformin on Cisplatin-Induced Ototoxicity in Diabetic Patients.

Ototoxicity is an important side effect of cisplatin. Recent animal and in vitro studies suggest metformin may protect hearing, though human studies are lacking. We report the first retrospective clinical study exploring the effects of metformin on cisplatin-induced ototoxicity. Retrospective case-control. Tertiary-care center. We reviewed all diabetic patients treated with cisplatin who were enrolled in an auditory monitoring program between January 1, 2000 and December 31, 2018. Patients were grouped according to their use of metformin at the time of chemotherapy. Demographics, oncologic diagnosis and treatment, and prior noise exposure were recorded. Audiometric thresholds were compared before and after chemotherapy. The primary outcome measure was a change in hearing as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). Secondary measures of ototoxicity included changes in hearing using the American Speech-Language-Hearing Association (ASHA) and TUNE criteria. Seventy-two diabetic patients met the inclusion criteria. Forty-six patients had taken metformin while on chemotherapy and 26 had not. The proportion of hearing loss as defined by both, CTCAE and ASHA criteria, was more than double in the metformin group relative to the nonmetformin group (CTCAE: 54.4% vs 19.2%, P = .004; ASHA: 62.2% vs 28.0%, P = .003). None of the potential covariates believed to be confounders were significantly associated with the outcome of multivariable analysis. Contrary to expectations from preclinical data, metformin did not reduce the incidence of hearing loss in patients receiving cisplatin and may, in fact, be associated with an increased risk.

Scholarship of Teaching and Learning Research in Communication Sciences and Disorders Journals: An Exploratory Survey of the Recent Literature.

Inspired by a preliminary survey of the Scholarship of Teaching and Learning (SoTL) literature conducted by Friberg et al. (2014), the current study aimed to expand the original study's findings-that SoTL was rarely published in the communication sciences and disorders (CSD) literature from 2009 to 2013-to the subsequent 8-year period (2014-2021). The latter period was of particular relevance considering the dissolution of one American Speech-Language-Hearing Association (ASHA)-affiliated publication and the addition of another non-ASHA-affiliated publication during that time. Ten peer-reviewed CSD journals and the articles published in them were identified via a survey of the literature that used narrowly defined criteria developed in collaboration with a librarian. Five trained CSD graduate student raters compared a definition of SoTL to article abstracts to determine whether each should have been categorized as SoTL. Part 1 of the study investigated an 8-year time span, Part 2 investigated the remaining nine journals in the subsequent 5 years, and Part 3 investigated publication rates of SoTL in Teaching and Learning in Communication Sciences & Disorders (TLCSD) alone. Part 1 of the study revealed that publication rates of SoTL were extremely low in the 10 surveyed CSD journals in the 8-year time span investigated. A similar and diminishing trend was found in Part 2. Even smaller percentages of journals were dedicated to SoTL. Part 3 confirmed that relatively large amounts of CSD-specific SoTL have been published in TLCSD since its inception in 2017. As of 2021, SoTL articles continued to be uncommonly published in CSD journals. Until recently, scholarly teachers attempting to apply SoTL in the classroom had limited resources. Beginning in 2017, TLCSD has provided an outlet for SoTL, whereas other CSD journals seem to have published less of it. Reform of publication, peer review, tenure, and promotion policies and procedures is called for so that SoTL might be included as a valid scientific endeavor.

Characterizing the Roles of Voice Professionals

Abstract: This article is a joint statement by the American Speech-Language- Hearing Association (ASHA), National Association of Teachers of Singing (NATS), Pan American Vocology Association (PAVA), and the Voice and Speech Trainers Association (VASTA). This statement is a revision of the previous 2005 joint statement by ASHA, NATS, and VASTA.

Spelling Facilitates Reading: A Tutorial on the Spell-to-Read Approach.

According to the American Speech-Language-Hearing Association (ASHA), prevention, identification, assessment, and intervention of children who are learning to read and write are within the scope of practice for school-based speech-language pathologists (SLPs). Furthermore, for SLPs who work in the school setting, it is not uncommon to have struggling readers and poor spellers on their caseloads. Importantly, for students who have difficulty in spelling, their spelling errors are among the early indicators of dyslexia and can provide a means for identifying readers who may benefit from early intervention. SLPs can both assess spelling skills and implement evidence-based spelling and literacy diagnosis and instruction. Spelling instruction in kindergarten through the high school grades that is heavily grounded in metalinguistic activities can provide access to mental representations of word spellings, pronunciations, and meanings; links between whole-word and phonics approaches to reading instruction; and a foundation for reading fluency and comprehension. Learning to spell is essential for learning to read. Accordingly, this tutorial aims to elucidate how to (a) assess and identify phases of spelling development and (b) teach spelling to facilitate reading through a listening-first approach.

THE FUNDAMENTAL ISSUE OF CONTINUING EDUCATION IN SPEECH THERAPY

Studies in medicine and sciences are constantly changing with the advancement of research and new discoveries. Continuing education in a field such as speech pathology is crucial for this reason. Most developed countries, like the United States of America and countries in Europe, make education after graduation mandatory and enforce restrictions on licenses in order to encourage people to renew them. Armenia, however, does not. For example, The American Speech-Language-Hearing Association (ASHA) requires all certificate holders (CCC-A and CCC-SLP) to maintain their ASHA Certificates of Clinical Competence and their CCC-SLP by taking additional courses every few years. Countries outside of the United States, such as Canada and Australia, have similar requirements of completing extra hours of practice and education in order to maintain the speech-language pathologist license. 
 Armenia also does not have a higher board or association that legally monitors and audits speech pathologists after graduation, but they should work to establish one in order to encourage and enforce speech pathologists to complete the requirements necessary to continue their practice. Armenia is trying to modernize and change the medical education system in order to advance their professional development and allow for the international mobility of healthcare workers, but they should also work to set requirements like these for the speech therapy field in Armenia. Continuing professional development allows for cardinal information that might have been forgotten over the years after graduating or receiving a license to be reviewed and recollected. With the introduction of new technologies and methods, speech pathologists need to be informed of the new ways of practice through their continuing education requirements. Speech pathologists in Armenia can use the opportunity of continuing education to learn how to use new methods such as Armav and incorporate them into their own practices.

Ethically Responsible Participant Selection in Research: A Viewpoint.

The American Speech-Language-Hearing Association (ASHA) has committed to advancing diversity, equity, and inclusion (DEI) in the profession of speech and hearing sciences. However, there exist significant discrepancies between the demographics of our members and the populations served. These discrepancies extend to the participants included within our research publications. This article addresses participant selection when conducting research investigations. First, we draw attention to standards of conduct that are present within and outside the field. Second, we highlight inequities that exist. We explore a case study as an example. Finally, we offer suggestions to help rectify the problem. Inequities at the level of participants' selection result in discrepant access to clinical services and evidence-based research for multilingual individuals; neurodiverse individuals; and Black, Indigenous, and people of color communities. ASHA and researchers alike can show commitment to DEI by addressing this problem from multiple approaches.

Across Time and Place: A Focused Review of Telepractice in ASHA Journals

With advances in technology and the COVID-19 Public Health Emergency (2020–2023), telepractice has become a prominent service delivery model. This study explores the evolution of telepractice service delivery research published by the American Speech-Language-Hearing Association (ASHA) and the impact of the COVID-19 Public Health Emergency on ASHA publications through searches of the ASHAWire database using “telepractice OR telehealth OR virtual OR teletherapy” in February 2021, 2022, 2023 and April 2023. In February 2023, 1,683 records were identified and hand searched for relevance to the evolution of telepractice. In April 2023, 471 records published from 2020 to 2023 were systematically screened for relevance to reveal 148 articles that met inclusion criteria. ASHAWire is a reputable resource for articles on telepractice service delivery, especially after the COVID-19 Public Health Emergency. It is important, however, for researchers and clinicians to carefully examine methodology of studies as the use of technology may conflate search results.

Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study.

The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. A retrospective study. The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: -1.24, 95% CI: -1.55--0.92; P < 0.001). Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

Continuing Education Needs of Speech-Language Pathologists for Assessing and Treating Children With Cleft Palate: A National Analysis Across Areas of Varying Population Density.

The purpose of this study was to identify training gaps and continuing education (CE) needs for speech-language pathologists (SLPs) in evaluating and treating children with cleft palate across and among areas of varying population density. An anonymous 35-question survey lasting approximately 10-15 min was created in Qualtrics based on a previously published study. The survey information and link were electronically distributed to American Speech-Language-Hearing Association (ASHA)-certified SLPs through ASHA listservs, social media, individual-state SLP organizations, and an e-mail list of publicly listed SLPs. A total of 359 survey responses were collected. Respondents varied in terms of age, type of certification, practice location, and clinical experience with cleft palate, with the largest percentage (46.7%) of respondents in a school-based setting. Only 28.5% reported currently feeling comfortable treating children with cleft palate. Respondents reported conventions/conferences (25.4%) and webinars (23.2%) were the most helpful resources, but DVDs were frequently not used for CE. Information from the child's cleft team (84.4%) and mentors/colleagues (70%) were considered high-quality resources. Respondents indicated information on treatment of articulation (79.2%) and resonance (78.4%) disorders as well as specific therapy techniques (76.9%) would be very helpful for clinical practice. Population density significantly influenced how respondents ranked the perceived helpfulness and quality of different resources as well as desired topics for future resources. There is a continued need for adequate training and CE opportunities for SLPs, particularly related to assessing and treating children with cleft palate. Increased access to high-quality CE resources will be key to filling educational gaps present for SLPs, especially in areas of low-population density. https://doi.org/10.23641/asha.24891423.

Reported Barriers to Augmentative and Alternative Communication Service Delivery and Learning Preferences Among Speech-Language Pathologists.

Speech-language pathologists (SLPs) report extensive barriers to delivering augmentative and alternative communication (AAC) services, including the knowledge and skills necessary for AAC service delivery. Although nearly all graduate programs report the inclusion of preservice training for SLPs to provide AAC services, existing research on SLPs' characteristics of AAC service provision does not reflect these changes. This study aimed to identify current AAC service delivery characteristics, barriers, and learning preferences reported by SLPs. A survey invitation was distributed to SLPs with American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence through social media and the ASHA Community discussion groups. Participants were 530 SLPs who predominantly identified as general practice SLPs. Participants reported 1%-25% of their weekly patient caseload has AAC needs for communication or receives AAC intervention. SLPs reported feeling at least "knowledgeable" in more than half of the targeted competency areas. The reported primary barriers to AAC service provision are knowledge, caseload, and time. Preferences for topic, format, and frequency and duration for AAC-related continuing education were highly variable among SLPs. SLPs' barriers to AAC service delivery are consistent with research from the last 15 years, revealing a lack of systematic, organizational, and informational mechanisms to support SLPs as vital members of the AAC team. Those involved in post-service instruction and training must consider the training needs of SLPs with varying competence and their experience with AAC modalities, clinical practice backgrounds, and learning preferences. AAC-related training and continuing education must reflect SLP's daily practice, learning needs, and preferences. https://doi.org/10.23641/asha.23503809.

School-Based Speech-Language Pathologists' Engagement With Evidence-Based Practice: An Update With Implications for Implementation Research.

We replicated a prior survey study (Hoffman et al., 2013) to document current evidence-based practice (EBP) patterns as reported by school-based speech-language pathologists (SLPs) during the 2021-2022 school year. Via an online survey, SLPs reported their training experiences and needs, workplace resources, and frequency of engagement in EBP activities. A total of 889 SLPs in 50 states participated in the survey. Results revealed that 19% of seasoned SLPs (with more than 10 years since last degree) had no formal training in EBP, 22% of SLPs worked in school districts with official EBP procedural guidelines, and 36% had scheduled time in their work week to support EBP activities. Early career (EC) professionals were more likely than seasoned career (SC) professionals to pose and research one or more EBP questions per year and to read journal articles about assessment and treatment. The gap in article use by experience groups was larger than a decade ago. Like prior survey results, the majority of SLPs read zero to four American Speech-Language-Hearing Association (ASHA) journal articles on assessment or intervention per year, with similar results for reading non-ASHA journal articles. Although the past decade has fostered some positive increases in the use of EBP resources and engagement in EBP activities, there continues to be a need for additional training and support for school-based SLPs to fully implement EBP. Training and implementation support should account for differences in training preferences and workplace resources and address differentiation of reported practices by EC versus SC professionals. Further implications for implementation science in schools are provided. https://doi.org/10.23641/asha.23152817.

The Effect of Open Access on Scholarly and Societal Metrics of Impact in the ASHA Journals.

This study examined the effect of open access (OA) status on scholarly and societal metrics of impact (citation counts and altmetric scores, respectively) across manuscripts published in the American Speech-Language-Hearing Association (ASHA) Journals. Three thousand four hundred nineteen manuscripts published in four active ASHA Journals were grouped across three access statuses based on their availability to the public: Gold OA, Green OA, and Closed Access. Two linear mixed-effects models tested the effects of OA status on citation counts and altmetric scores of the manuscripts. Both Green OA and Gold OA significantly predicted a 2.70 and 5.21 respective increase in citation counts compared with Closed Access manuscripts (p < .001). Gold OA was estimated to predict a 25.7-point significant increase in altmetric scores (p < .001), but Green OA was only marginally significant (p = .68) in predicting a 1.44 increase in altmetric scores relative to Closed Access manuscripts. Communication sciences and disorders (CSD) research that is fully open receives more online attention and, overall, more scientific attention than research that is paywalled or available through Green OA methods. Additional research is needed to understand secondary variables affecting these and other scholarly and societal metrics of impact across studies in CSD. Ongoing support and incentives to reduce the inequities of OA publishing are critical for continued scientific advancement. Open Science Form: https://doi.org/10.23641/asha.21766919.

American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss.

Hearing loss poses a significant public health challenge as a common chronic condition with many known side effects that are often worse when left untreated. Aural rehabilitation (AR) is an umbrella term that encompasses a range of interventions (e.g., informational counseling and perceptual training) designed to reduce deficits related to hearing loss that may stand alone or be used in combination as part of a holistic plan. This evidence-based clinical practice guideline is intended to inform the implementation of person-centered AR to adults with hearing loss. Given the well-known benefits of sensory management, it was not included within the scope of this guideline. The recommendations aim to help clinicians, individuals with hearing loss, and other stakeholders make evidence-informed treatment decisions and improve clinical outcomes, as well as provide payers and policymakers with information detailing a comprehensive approach to AR. The American Speech-Language-Hearing Association (ASHA) and a multidisciplinary panel of subject matter experts prioritized key clinical questions and outcomes that served as the foundation of the guideline. The clinical recommendations were based on a comprehensive systematic review and a meta-analysis of 85 studies published between 1978 and 2021. Given the current state of the evidence, resource considerations, patient acceptability, clinical feasibility, and the overall balance of benefits and harms, ASHA developed several evidence-based recommendations for the provision of AR to adults with hearing loss. Each recommendation is accompanied by a series of key practice points to support its implementation within a person-centered framework.

The effect of pyridostigmine on post-stroke dysphagia: A randomized clinical trial.

Background: Swallowing is one of the most complex functions of the central nervous system (CNS), which is controlled by different parts of the brain. Oropharyngeal dysphagia (OD) is one of the most common complications after stroke. Despite a variety of behavioral, compensatory, and rehabilitative methods, many stroke patients still suffer from swallowing disorders that adversely affect their quality of life (QOL). The aim of this study was to evaluate the effect of pyridostigmine on patients with post-stroke dysphagia. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out on 40 patients suffering from post-stroke dysphagia. Patients were assigned randomly into two groups: intervention and control groups (20 in each group). The intervention group was treated with pyridostigmine (60 mg, three times a day, 30 minutes before each meal for three weeks), and the control group received placebo treatment in the same way. All patients (intervention and control) were evaluated according to National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Functional Communication Measures (FCM)/American Speech-Language-Hearing Association (ASHA) criteria at baseline and after three weeks of intervention. Values of P < 0.05 were considered statistically significant. Results: In the intervention group, the mean values of NIHSS, mRS, and ASHA/FCM were significantly reduced following three weeks of treatment with pyridostigmine (P = 0.002, P = 0.003, and P < 0.001, respectively), but no significant differences were found in the mean NIHSS, mRS, and ASHA/FCM in the placebo group. Conclusion: Although pyridogestamine is somewhat effective in post-stroke dysphagia, it has not been shown to be more important in preventing aspiration pneumonia and length of hospital stay.

Hearing Impairment in French Merchant Seafarers: Retrospective Study on Data from 8308 Audiometric Tests.

Background: A high level of occupational noise exposure has been noted in the fishing sector. Yet, less is known regarding other navigation groups, such as merchant seafarers, since a French study in the 1980s. This study assesses hearing impairment (HI) in a French merchant seafarers’ population. Methods: We collected data of all audiograms performed in 2018 and 2019 for French merchant seafarers. For each seafarer, hearing ability was measured in both ears using pure-tone audiometry at the following frequencies: 0.5, 1, 2, 3, 4, 6, and 8 kHz. Hearing threshold levels (HTLs), or the intensity of sound below which no sound is detected, were measured in decibels Sound Pressure Level (dB SPL) at each frequency and recorded in 5 dB increments. For HI, we used the validated definition of the American Speech–Language–Hearing Association (ASHA). Results: We were able to include statistical analysis results of 8308 audiograms. In a multiple logistic regression adjusted for age, experience, and class of navigation, we found that experience of more than 14 years Odds Ratio OR 1.28 (CI 95% 1.07–1.53), age 31–40 OR 2.2 (CI 95% 1.4–3.4), and >40 years OR 14, 3 (IC 95% 9.7–21) and marine engineers OR 1.26 (IC 95% 1.01–1.57) were still risk factors for HI. Conclusion: In 2018, Marine engineers were still the workers’ group with a higher risk of HI in merchant seafarers but, notch at 4 Hz, specific of noise-induced hearing loss, has improved. They have an HI close to the definition of socioacousis and mean deficit differences with deck and services’ merchant seafarers improved. Our results could be interpreted as a limitation of occupational noise exposure impact in a merchant seafarers’ population, needing an improvement in prevention measures and also encouraged to continue to improve onboard working conditions.

Relationship between self-reported hearing impairment and occupational exposure to aggressive agents in workers

The goal of this study was to estimate the relationship between self-reported hearing impairment and occupational exposure to too aggressive agents in Mosul workers. This is an analytical cross-sectional study was conducted in out-patient of Ibn Sina Teaching Hospital in City of Mosul, Iraq. Data collection: data were categorized into two parts; part one included information related to workers' socio-demographic characteristics like (age, gender, duration of working, work Environment, and specific diseases like hypertension). Part two included a hearing assessment. A Self-reported questionnaire (HHIE) which was developed by Ventry and Weinstein and its scores were classified based on American Speech-Language-Hearing Association (ASHA) draft guidelines, was used in the present study. A total of 500 workers participated in this study. The largest proportion of the sample was composed of men (63.7%). Regarding the occupational environment, 62 % of workers had between 0 and 4 years of work, followed by individuals with ten years or more (28%). In addition, there was a higher prevalence of closed work environments (50.5%). Among the most prevalent occupational exposures, 30.5% were exposed to noise, followed by chemical substances (17.3%) and industrial dust (8.2%). Difficulty hearing was reported by 8.2 % of participants.

Relationship between self-reported hearing impairment and occupational exposure to aggressive agents in workers

The goal of this study was to estimate the relationship between self-reported hearing impairment and occupational exposure to too aggressive agents in Mosul workers. This is an analytical cross-sectional study was conducted in out-patient of Ibn Sina Teaching Hospital in City of Mosul, Iraq. Data collection: data were categorized into two parts; part one included information related to workers' socio-demographic characteristics like (age, gender, duration of working, work Environment, and specific diseases like hypertension). Part two included a hearing assessment. A Self-reported questionnaire (HHIE) which was developed by Ventry and Weinstein and its scores were classified based on American Speech-Language-Hearing Association (ASHA) draft guidelines, was used in the present study. A total of 500 workers participated in this study. The largest proportion of the sample was composed of men (63.7%). Regarding the occupational environment, 62 % of workers had between 0 and 4 years of work, followed by individuals with ten years or more (28%). In addition, there was a higher prevalence of closed work environments (50.5%). Among the most prevalent occupational exposures, 30.5% were exposed to noise, followed by chemical substances (17.3%) and industrial dust (8.2%). Difficulty hearing was reported by 8.2 % of participants.

Inequity in Peer Review in Communication Sciences and Disorders.

The American Speech-Language-Hearing Association (ASHA) has committed to advancing diversity, equity, and inclusion (DEI) by retaining and advancing Black, Indigenous, and people of color (BIPOC) individuals in the discipline of communication sciences and disorders (CSD), amid critical shortages of faculty to train the next generation of practitioners and researchers. Publishing research is central to the recruitment, retention, and advancement of faculty. However, inequity in peer review may systematically target BIPOC scholars, adding yet another barrier to their success as faculty. This viewpoint article addresses the challenge of inequity in peer review and provides some practical strategies for developing equitable peer-review practices. First, we describe the demographics of ASHA constituents, including those holding research doctorates, who would typically be involved in peer review. Next, we explore the peer-review process, describing how inequity in peer review may adversely impact BIPOC authors or research with BIPOC communities. Finally, we offer real-world examples of and a framework for equitable peer review. Inequity at the individual and systemic levels in peer review can harm BIPOC CSD authors. Such inequity has effects not limited to peer review itself and exerts long-term adverse effects on the recruitment, retention, and advancement of BIPOC faculty in CSD. To uphold ASHA's commitment to DEI and to move the discipline of CSD forward, it is imperative to build equity into the editorial structure for publishing, the composition of editorial boards, and journals content. While we focus on inequity in CSD, these issues are relevant to other disciplines.

Cisplatin-associated ototoxicity: perspectives from a single institution cervical cancer cohort and implications for developing a locally responsive monitoring programme in a public healthcare setting

BackgroundOtotoxicity monitoring is uncommon in South Africa, despite the increased use of ototoxic medication to manage the burden of disease in the country. The successful implementation of such a protocol requires cognisance of contextual realities and multiple dimensions for consideration from both patients and service providers. As part of an ongoing cohort study on cisplatin-associated ototoxicity and efforts to better inform the implementation of such programmes, the perspectives of cervical cancer patients and healthcare workers towards ototoxicity monitoring were assessed.MethodsThis concurrent-triangulation mixed-methods study was conducted at a tertiary hospital in South Africa. Self-reported questionnaires from patients (n = 80) and healthcare personnel comprising clinicians, oncology nurses, pharmacists, and radiotherapists (n = 32), results of audiological evaluations, researcher field notes, and estimated patient and service provider costs contributed to data for this study. Data analysis included descriptive statistics, comparison of test characteristics and deductive thematic analysis.ResultsThe ototoxicity monitoring programme was positively received by the participants, with 90.6% of healthcare personnel and 89% of patients reporting it to be beneficial. The clinicians (76.6%) were identified as the main providers of information on the effects of chemotherapy medication and made the necessary referrals for audiological evaluation. The approximate cost of setting up such a programme included purchase of equipment (US56 700) and the appointment of an audiologist (US 26 250). The approximate costs to patients included transport costs (US$ 38) and the loss of income for the day (US 60), calculated at the minimum wage per hour, if employed. Creative appointment scheduling, easy facility access and detailed locally comprehensible couselling improved patient compliance to the programme. Whilst the sequential use of American Speech-Language-Hearing Association (ASHA) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) criteria aided in an evidence-informed approach to aural rehabilitation, DPOAEs and speech discrimination displayed low sensitivity (range 1.45% – 22.39%) but high specificity (range 77.78% – 100%) when identifying ototoxic change.ConclusionThis novel study, through a ‘real-world’ experience, has revealed that an ototoxicity monitoring programme is feasible in South Africa, through meaningful engagements with- and considerations from- patients and service providers regarding planning, delineation of responsibilities and cost implications. The findings can potentially serve as a roadmap for other limited resource environments.