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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 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) | 0.000 | 0.000 |
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 teacher head, 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".