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English summary

General Practice Research Unit in Tromsø has been a research centre at Department of Community Medicine, Faculty of Health Science, University of Tromsø since 2006. Similar research units have been established at the other three medical schools in Norway. Professor Hasse Melbye (hasse.melbye@uit.no) is head of the unit. A main research focus has been laid on diagnosis and treatment of respiratory illnesses in primary care. We also have projects on cognitive therapy and sickness certification.

 

Main international projects

Epidemiological study on lung sounds, Tromsø 7

This is a part of the 7th Tromsø study whwre lung sounds and heart sounds will be recorded. The aims are todescribe the prevalence of crackles, wheezes and other abnormal sounds over 6 different areas of the lungs in the general population of adults 40 years or older, and study the impact of age, smoking habit and self-reported diseases on the prevalence of the sounds heard. Further to study how crackles and wheezes and any abnormal sounds can predict airflow limitation (spirometry), decreased oxygen saturation (pulse oximetry) and heart failure (echocardiography).

Methods  A wireless Sennheiser microphone (Sennheiser MKE 2-EW with Sennheiser wireless system EW 112-P G3-G) placed in the tube of a Littmann Classic stethoscope will be used in the recordings.  The main study will include at least 3000 participants of the 7th Tromsø study, who also take part in spirometry and echocardiography. The primary classification of the sounds will be done by two independent observers, and quality assurance and further spwecifications of the sounds will be taken care of by expert panels.  Variables that may explain the presence of abnormal lung sounds and the predictive value of lung sounds for reduced lung function and heart failure will be evaluated by univariable and multivariable methods. Advanced analyses including subcategories of wheezes and crackles and computerized classification of sounds will also be done. Agreement between international experts and between experts and computerized classification  will be studied using kappa statistics and Intraclass correlation.

The results of the study will inform evidence based interpretation of lung sounds heard during health screening and routine health assessments. The study will also evaluate, whether sub-categories of wheezes and crackles  should be applied in the diagnosis of obstructive lung disease and heart failure and thus contribute to a strongly needed standardization of lung sound terminology.

 

 

GRACE is the largest research project ever taken place on respiratory tract infection in primary care. It is funded by EU. Our research unit was one out of 13 networks taking part in a study on treatment and clinical course of GP patients with lower respiratory tract infection. A paer on the variation in treatment across Europe was published last year (Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J et al. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ 2009; 338:b2242.). We are taking part in the preparation of several papers from this study.
Kristin Jakobsen, funded by the General Practice Research Fund (Norwegian Medical Association), is a ph.d. student in the project.


 

CHAMP is a EU-funded spin-off of GRACE. We have interviewed, together with four other GRACE networks, parents of children who had consulted a GP recently for a respiratory tract infection. Parents’ attitudes and knowledge concerning antibiotic use and resistance against antibiotics have been explored.

 

SICKRETRACT – (SICK-leave and restrictions in daily activities in patients with REspiratory TRACT infections)

We cooperate with colleagues from Medical University of Lodz, Poland, in this spin-off-project of GRACE. We have compared sickness certification for patients with acute cough in Norway and Poland, based on GRACE data. In a second study, Polish and Norwegian GPs have suggested sickness certification and restrictions in daily activities for four patients, based on paper cases, with respiratory tract infection. Peder Halvorsen is in the lead of this vignette study.

 

PEXACO - Caring for adult patients with acute exacerbations of asthma or COPD in general practice

The care of asthma and COPD exacerbations will be investigated through four studies. In Study 1, 380 general practice patients with asthma or COPD are followed for one year and examined during exacerbations by their GP with a set of tests: spirometry, pulse oximetry, and CRP test. The predictive value of the tests for medical treatment and referral to hospital will be assessed. In Study 2, in-depth interviews will be carried out with COPD patients, about access to health care, self treatment, and emotional barriers in help-seeking. In Study 3, focus groups discussions (FGD) will be done with GPs, practice nurses and pulmonologists from 6 European countries (Wales, The Netherlands, Germany, Poland, Russia, and Norway), on assessment and medical treatment of patients with asthma and COPD, with a particular focus on exacerbations. In Study 4, patients hospitalized due to asthma and COPD exacerbations will answer a questionnaire on self-treatment and contact with primary care prior to admittance. Hasse Melbye is the project leader, and Mette Bech Risør and Mark Spigt (from Maastricht) are responsible for the international FGD study.
The project is supported by a grant from the Norwegian Research Council.
 

Internet programs based on cognitive behavioural therapy as a tool in treatment of patients with mental health problems in general practice. (ICBT in GP).

ICBT in GP is a joint project between General Practice Research Unit and the Department of Psychology at the University of Tromsø and District Psychiatric Centre at Silsand.

The aim of the project is to develop a strategy whereby general practitioners will use the internet as one of the tools for treating patients with mild to moderate mental problems. The model we want to try out is to use the internet based program MoodGYM (http://moodgym.anu.edu.au/welcome) in general practice. The program is a self help program with 5 modules and rating scales for degree of symptoms. Studies show that few patients complete the program without motivational contacts. If patients have a consultation with their GP between each module the patients may be motivated to complete the program. At the same time the program gives the GP a tool which serves as a base for a better understanding of CBT and also as a tool to evaluate the severity of the symptoms. This could serve as an aid in judging if the patient should be referred to specialist health care. If the program also is used in the specialist health care, it could aid the transfer of the patient back to primary health care. Thus we hope to develop a more efficient collaboration between the primary and specialized health care services, including GPs, district psychiatric centres (DPS) and psychologists.

We are cooperating with the Australian National University, the Norwegian Institute of Public Health, and to a lesser degrees with institutions in Nederland, Denmark, UK and Sweden.

In 2009 the project received a grant from the Northern Norway Regional Health Authority (Helse Nord RHF) and from April 2010 the project is supported by a grant from the Norwegian Research Council. Project leader is Nils Kolstrup.
 

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