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National Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a ‘traffic light’ system for risk and a clinical management pathway.
To evaluate this care pathway.
The care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained.
The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (<50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC>250 mcg/g and were diagnosed by ‘straight to test’ colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%).
A care pathway for the use of FC that incorporates a higher cut-off value, a ‘traffic light’ system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.
In the United Kingdom, successful completion of the examinations for both the Primary and Final Fellowship of the Faculty of Intensive Care Medicine (FFICM) is now an integral part of the assessment for a Certificate of Completion of Training (CCT) in Intensive Care Medicine (ICM). Currently, a pass in the Primary examination of one of the relevant UK medical colleges – MRCP (UK), MCEM or FRCA Primary - allows candidates to sit the Final FFICM exam. Discussions are under way on the introduction of a FFICM Primary examination in its own right.
The Final FFICM exam comprises three sections: a multiple choice question examination (MCQ), an objective structured oral examination (OSCE) and a structured oral examination (SOE). From July 2014, the MCQ part of the exam has consisted of 90 questions, 60 of the multiple true false (MTF) type and 30 of the single best answer (SBA) type. While this book will be useful for all three components of the exam, it is best placed as a revision aid for the MTF part of theMCQ exam. The three 90-question papers contained in the book have been designed to encompass the 13 sections that make up the current syllabus for a CCT in ICM. This syllabus is broadly similar to the CoBaTrICE syllabus developed under the auspices of the European Society of Intensive Care Medicine, so the questions will be of direct relevance to those candidates undertaking this exam as well.
Following the introduction in 2013 of the FFICM exam for trainees in intensive care, this book provides candidates with practice materials for the MCQ section. Written by a team of specialists in intensive care medicine, including senior trainees who have recently passed the new exam and authors of the popular FRCAQ website, the book contains 270 multiple true-false questions that cover the breadth of the current Faculty of Intensive Care Medicine curriculum. These are presented as three 90-question practice papers, providing candidates with a faithful simulation of the style, standard and format of the questions they will encounter. With short and long explanations for each question, presented with up-to-date references for extended reading, this book is both an ideal tool for in-depth exam preparation, and an excellent resource for practising consultants in intensive care medicine. It is also suitable for candidates taking the EDIC and other intensive care exams worldwide.