P5 Three year follow-up evaluation of the management of primary biliary cholangitis in Aneurin Bevan university health board
Bibliographic record
Abstract
<h3>Introduction</h3> In May 2017, a service evaluation of the management of primary biliary cholangitis in Aneurin Bevan University Health Board was performed. The evaluation identified three groups of patients: 1) non-responders to optimal ursodeoxycholic acid (UDCA), 2) patients on sub-optimal UDCA (<15 mg/kg) with persistent alkaline phosphatase (ALP) elevation and 3) patients intolerant of UDCA with persistent ALP elevation. This follow-up evaluation in January 2020 reviews how these patients have been managed since and whether their disease has progressed. <h3>Methods</h3> Of 112 patients evaluated in 2017, 30 were identified for review of their management. 11, 15, and 4 patients were in groups 1, 2, and 3 respectively. Clinical letters, weight, medications, and liver biochemistry results of these 30 patients were reviewed again in January 2020. Treatment response to UDCA was assessed using the Toronto criteria (ALP of >1.67 the upper limit of normal). Optimal UDCA therapy was considered to be ≥15 mg/kg based on most recent patient weight available. <h3>Results</h3> UDCA-non-responders (n=11) 3 did not have information available since 2017; 1 since deceased and 2 did not attend follow-up. Of the 8 reviewed 5 now have an ALP <1.67 ULN within the last 12 months. 1 is now on OCA but still has an elevated ALP. 1 has only recently been contacted and started on UDCA. 1 is on an optimal dose of UDCA with an elevated ALP, they could be eligible for OCA. Median UDCA dose was 14.6 mg/kg (12.2–19.3). Median ALP was 187 (96–283). Sub-optimal UDCA patients (n=15) 2 did not have information available since 2017, both deceased. Of the 13 reviewed, 8 had an ALP <1.67 ULN (all within the last 12 months except 1). 5 still had an elevated ALP. 2 need an increased dose of UDCA to ≥15 mg/kg. 2 have been unable to tolerate increased doses of UDCA and could be eligible for OCA. 1 is now on optimal UDCA but still has an elevated ALP and could be suitable for OCA. Median UDCA dose was 13.7 mg/kg (7.3 – 17.9). Median ALP was 200 (8–380). Patients intolerant to UDCA (n=4) 2 patients have since died, and 1 was discharged due to old age and frailty. 1 patient would be eligible for OCA if pruritus resolves. <h3>Discussion</h3> Of the 22 patients that were reviewed, 13 now have an ALP <1.67 ULN, 3 need UDCA optimisation, 1 patient is on OCA and 5 further patients could be suitable for OCA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".