Community based, multicenter, double-blind, randomised controlled trial comparing the effectiveness of topical ciprofloxacin and Sofradex as treatments for chronic suppurative otitis media in Aboriginal children

Many Aboriginal conmmunities in rural and remote western Australia have rates of chronic suppurative otitis media (CSOM) 10 times the rate that the World Health Organization deemed as a massive public health problem in the child population. The recognition by Aboriginal leaders that the treatment of CSOM is a priority area has led to this issue being highlighted in Australia's National Aboriginal Health Strategy. In Aboriginal children, the disease usually commences in infancy within a few weeks of birth, causes hearing loss, is recurrent, can persist into adulthood, and may impact adversely on child development. Our trial aimed to compare the effectiveness of topical ciprofloxacin (0.3%) and framycetin (0.5%), gramicidin, dexamethasone (FGD, Sofradex) as treatments for CSOM in Aboriginal children. The trial was the first conmmunity controlled, multicenter, double-blind, randomized, controlled trial in Aboriginal children across the north of Australia

Community based, multicenter, double-blind, randomised controlled trial comparing the effectiveness of topical ciprofloxacin and Sofradex as treatments for chronic suppurative otitis media in Aboriginal children

Many Aboriginal conmmunities in rural and remote western Australia have rates of chronic suppurative otitis media (CSOM) 10 times the rate that the World Health Organization deemed as a massive public health problem in the child population. The recognition by Aboriginal leaders that the treatment of CSOM is a priority area has led to this issue being highlighted in Australia's National Aboriginal Health Strategy. In Aboriginal children, the disease usually commences in infancy within a few weeks of birth, causes hearing loss, is recurrent, can persist into adulthood, and may impact adversely on child development. Our trial aimed to compare the effectiveness of topical ciprofloxacin (0.3%) and framycetin (0.5%), gramicidin, dexamethasone (FGD, Sofradex) as treatments for CSOM in Aboriginal children. The trial was the first conmmunity controlled, multicenter, double-blind, randomized, controlled trial in Aboriginal children across the north of Australia

Debakarn Koorliny Wangkiny: steady walking and talking using first nations-led participatory action research methodologies to build relationships

Aboriginal participatory action research (APAR) has an ethical focus that corrects the imbalances of colonisation through participation and shared decision-making to position people, place, and intention at the centre of research. APAR supports researchers to respond to the community's local rhythms and culture. APAR supports researchers to respond to the community's local rhythms and culture. First Nations scholars and their allies do this in a way that decolonises mainstream approaches in research to disrupt its cherished ideals and endeavours. How these knowledges are co-created and translated is also critically scrutinised. We are a team of intercultural researchers working with community and mainstream health service providers to improve service access, responsiveness, and Aboriginal client outcomes. Our article begins with an overview of the APAR literature and pays homage to the decolonising scholarship that champions Aboriginal ways of knowing, being, and doing. We present a research program where Aboriginal Elders, as cultural guides, hold the research through storying and cultural experiences that have deepened relationships between services and the local Aboriginal community. We conclude with implications of a community-led engagement framework underpinned by a relational methodology that reflects the nuances of knowledge translation through a co-creation of new knowledge and knowledge exchange

Treatment patterns for cancer in Western Australia: does being Indigenous make a difference?

Objective: To examine whether hospital patients with cancer who were identified as Indigenous were as likely to receive surgery for the cancer as non-Indigenous patients. Design, setting and patients: Epidemiological survey of all Western Australian (WA) patients who had a cancer registration in the state-based WA Record Linkage Project that mentioned cancer of the breast (1982–2000) or cancer of the lung or prostate (1982–2001). Main outcome measures: The likelihoods of receiving breast-conserving surgery or mastectomy for breast cancer, lung surgery for lung cancer, or radical or non-radical prostatectomy for prostate cancer were compared between the Indigenous and non-Indigenous populations using adjusted logistic regression analyses. Results: Indigenous people were less likely to receive surgery for their lung cancer (odds ratio [OR], 0.64; 95% CI, 0.41–0.98). Indigenous men were as likely as non- Indigenous men to receive non-radical prostatectomy (OR, 0.69; 95% CI, 0.40–1.17); only one Indigenous man out of 64 received radical prostatectomy. Indigenous women were as likely as non-Indigenous women to undergo breast-conserving surgery (OR, 0.86; 95% CI, 0.60–1.21). Conclusions: These results indicate a different pattern of surgical care for Indigenous patients in relation to lung and prostate, but not breast, cancer. Reasons for these disparities, such as treatment choice and barriers to care, require further investigation

Co-designing health service evaluation tools that foreground first nation worldviews for better mental health and wellbeing outcomes

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.MichaelWright, Aunty Doris Getta, Aunty Oriel Green, Uncle Charles Kickett, Aunty Helen Kickett ... et al

Making a difference: Engaging both hearts and minds in research practice

This paper discusses the findings and the research process undertaken thus far for the Looking Forward Aboriginal Mental Health Project. The primary aim of the project is to engage with both the mental health service providers and the Aboriginal (Nyoongar) community living in the south-east metropolitan region of Perth to effect positive system change in terms of service provision for Aboriginal (Nyoongar) families living with mental health issues. The paper includes a background to the project and our interpretation of participatory action research in an Aboriginal (Nyoongar) context, an overview of the impact of colonisation on Nyoongar people, an account of what it means to be Nyoongar, a discussion of the methodology for the project, the research process highlighting the critical roles of advocacy and activism taken on by the project team in working with Aboriginal (Nyoongar) people, and examples of our work that we believe will assist researchers in ensuring their research practice is both respectful and responsive when working with Aboriginal (Nyoongar) people

'We are not just participants - we are in charge': the NACCHO ear trial and the process for Aboriginal community controlled health research

Objective Methodological criteria that characterise ethically sound community-based studies are often described in overviews but are rarely documented in clinical studies. Research investigating the health of Aboriginal Australians is often small-scale, descriptive and largely driven by non-Indigenous people. The 'community-controlled' model of research relating to Aboriginal peoples health is a form of 'participatory' research that shifts the balance of control towards those being researched. This paper describes the methodological issues and principles that underpin community-controlled health research; their practical application; and encourages their adoption in research involving Indigenous populations.\ud \ud Design Descriptive report of the methods used to conduct the landmark Aboriginal community-controlled multi-centre double-blind randomised controlled clinical ear trial investigating ototopical treatments for chronic suppurative otitis media.\ud \ud Results The characteristics of the community-controlled research model are illustrated under the headings of: setting the research agenda; research project planning and approval; conduct of research; and analysis, dissemination and application of findings.\ud \ud Conclusion The 22 methodological elements which defined the community-controlled design of the ear trial may assist community groups, external research bodies and funding agencies to improve the acceptability, quality and scope of research involving Indigenous peoples. Aboriginal community-controlled organisations are well placed to lead research, which can be interventional and of a high scientific standard without compromising the values and principles of those being researched. With over 120 Aboriginal community-controlled health services (ACCHSs) across Australia, the potential exists for these services to engage in multi-centre research to realise solutions to health problems faced by Indigenous Australians

Management of chronic suppurative otitis media

[Extract] In Reply: Dugdale correctly refers to the natural history of chronic suppurative otitis media (CSOM), and the spectrum of endpoints. The primary endpoint chosen in our trial after ototopical treatment was a dry ear (commonly referred to as a "clinical cure" by other trials), an outcome to be expected after short-term follow-up. Surgical closure of the tympanic membrane (TM) has also been defined as "curing" CSOM. Attaining a dry ear is essential to TM healing, and is therefore a functionally important outcome

Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial

Objectives: To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children. Design and participants: Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM. Main outcome measures: Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10–21 days after starting treatment. Results: 111 children aged 1–14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%–33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%). Conclusions: Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment