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BackgroundMechanical thrombectomy (MT) has become the standard of care for the treatment of acute ischemic stroke (AIS). The EmboTrap revascularization device (CERENOVUS, Johnson & Johnson Medical Devices, Irvine, California, USA) has an innovative, dual layer feature designed to facilitate thrombus retrieval.ObjectiveTo investigate the real-world clinical and economic outcomes among patients with AIS undergoing MT using the EmboTrap device in the United States (US).MethodsAdult patients (≥18 years) who underwent MT for AIS using the EmboTrap device between July 2018 and December 2020 were identified from the Premier Healthcare Database. Patient outcomes included discharge status (including in-hospital mortality), mean length of stay (LOS), intracranial hemorrhage (ICH), mean hospital costs, and 30-day readmissions (all-cause, cardiovascular (CV)-related, and AIS-related).ResultsA total of 318 patients (mean age 68.5±14.6 years) with AIS treated with the EmboTrap device as the only stent retriever used were identified. Approximately 25% of patients were discharged to home/home health organization, and the in-hospital mortality rate was 10.7%. The rate of ICH was 16.7%. Mean hospital LOS was 9.9±11.3 days, and the mean hospital costs were US$47 367±30 297. The 30-day readmission rate was 9.6% for all-causes, 5.9% for CV-related causes, and 2.6% for AIS-related causes.ConclusionsThis is the first study in the US to report real-world outcomes sourced by retrospective database analysis among patients with AIS undergoing MT using the EmboTrap device. Further research is needed to better understand performance of the EmboTrap device in real-world settings.

IntroductionTriage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel ‘Sheffield Paediatric Triage Tool’ (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSIs).MethodsA 10-year (2008–2017) retrospective database review of the Trauma Audit Research Network (TARN) Database for paediatric patients (15. Primary analysis was conducted on patients with complete prehospital physiological data with planned secondary analyses using first recorded data. Performance characteristics were evaluated using sensitivity, specificity, undertriage and overtriage.Results15 133 patients met TARN inclusion criteria. 4962 (32.8%) had complete prehospital physiological data and 8255 (54.5%) had complete first recorded physiological data. The majority of patients were male (69.5%), with a median age of 11.9 years. The overwhelming majority of patients (95.4%) sustained blunt trauma, yielding a median ISS of 9 and overall, 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of overtriage (75.0%). Both the Paediatric Triage Tape (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult Modified Physiological Triage Tool-24 (MPTT-24) triage tool had the second highest sensitivity (80.8%) with tolerable rates of overtriage (70.2%).ConclusionThe SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.

ObjectivesCatastrophic haemorrhage is a leading cause of morbidity and mortality in trauma, in both military and civilian settings. There are numerous studies looking at the effectiveness of different haemostatic agents in the laboratory but few in a clinical setting. This study analyses the use of haemostatic dressings used in patients injured on the battlefield and their association with survival.MethodA retrospective database review was undertaken using the UK Joint Theatre Trauma Registry from 2003 to 2014, during combat operations in Iraq and Afghanistan. Data included patient demographics, the use of haemostatic dressings, New Injury Severity Score (NISS) and patient outcome.ResultsOf 3792 cases, a haemostatic dressing was applied in 317 (either Celox, Hemcon or Quickclot). When comparing patients who had a haemostatic dressing applied versus no haemostatic agent, there was a 7% improvement in survival. Celox was the only individual haemostatic dressing that was associated with a statistically significant improvement in survival, which was most apparent in the more severely injured (NISS 36–75).ConclusionWe have shown an association between use of haemostatic agents and improved survival, mostly in those with more severe injuries, which is particularly evident in those administered Celox. This supports the continued use of haemostatic agents as part of initial haemorrhage control for patients injured in conflict and suggests that civilian organisations that may need to deal with patients with similar injury patterns should consider their use and implementation.

IntroductionRecent trends in Pre-Hospital Emergency Medicine (PHEM) have demonstrated the potential benefit of using fentanyl, ketamine and rocuronium for pre-hospital rapid sequence induction of anaesthesia (RSI). Isolated cases of potentially significant hypotension have been reported. This study aimed to establish a potential link between the incidence of hypotension and the dose and combination of anaesthetic induction agents used.MethodsA retrospective database review was undertaken of all cases attended by the Great North Air Ambulance Service requiring RSI during a 25-month period. The blood pressure (BP) before and after RSI and doses of drugs were recorded. Cases were divided into three groups based on changes in BP: group 1 (increase in BP post induction >20% or more), group 2 (between 20% increase and 20% fall in BP) and group 3 (fall in BP of 20% or more).Results105 cases were included in the analysis. Group 1 included 11 cases (range 23% to 106% increase in BP), group 2 included 57 cases (19% increase to 18% decrease) and group 3 included 37 cases (20% fall to 63% fall in BP).There was no statistically significant link to rocuronium (p=0.46) or ketamine (p=0.054) but the dose of fentanyl administered was highly significant (pDiscussionThis review showed a potential link between fentanyl dose and the degree of hypotension during RSI. Although this is a small study with some limitations it gives an indication that dose ratios in RSI may need to be reviewed.

ObjectiveIndividuals with immunocompromised (IC) conditions are at a higher risk of developing herpes zoster (HZ) than IC-free individuals. This study assessed the healthcare resource utilisation (HCRU) burden and costs, of HZ in IC and IC-free individuals ≥18 years of age (YOA).MethodsWe conducted an observational retrospective study in a cohort of IC (n=621 588) and IC-free (n=621 588) individuals, matched by age, gender and General Practitioner practice region, contributing to the Clinical Practice Research Datalink database from 2000 to 2012 and linked to the Hospital Episode Statistics inpatient data. HCRU (ie, primary and secondary care consultations, hospital inpatient stays and treatment prescriptions) was analysed from 7 days before to: (1) 30, (2) 365 days after the HZ diagnosis date for individuals with (1) HZ only (no postherpetic neuralgia (PHN)) and (2) individuals with HZ and PHN only. Healthcare costs were computed by multiplying the number of units of resources used by the unit costs, summed across all HCRU categories to obtain a total cost per subject. Values were expressed in 2014 UK pound sterling (£) and presented for HZ cases overall, stratified by age (ie, 18–49, 50–59, 60–69, 70–79 and ≥80 YOA) and IC status.ResultsThe percentage of HZ cases requiring hospitalisation was higher in IC individuals (2.7% vs 0.4% in IC and IC-free individuals aged 18–49 YOA, respectively and 9.5% vs 7.5% in IC and IC-free individuals aged ≥80 YOA, respectively). Similarly, HZ-related mean treatment costs per subject were higher in IC individuals (£189 vs £104 in IC and IC-free individuals aged 18–49 YOA, respectively and £557 vs £401 in IC and IC-free individuals aged ≥80 YOA, respectively). Costs varied considerably by IC condition.ConclusionsIndividuals with IC conditions, have a high burden of HZ, associated with an increased risk of HZ and high HZ-related healthcare costs.

ObjectiveHospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated changes in ‘hospital pressures’ (demand on healthcare resources and staff) following rotavirus vaccine introduction in a paediatric setting in the UK.DesignRetrospective hospital database analysis between July 2007 and June 2015.SettingA large paediatric hospital providing primary, secondary and tertiary care in Merseyside, UK.ParticipantsHospital admissions aged MethodsHospital pressures were compared before and after rotavirus vaccine introduction: these included bed occupancy, hospital-acquired infection rate, unplanned readmission rate and outlier rate (medical patients admitted to surgical wards due to lack of medical beds). Interrupted time-series analysis was used to evaluate changes in bed occupancy.ResultsThere were 116 871 admissions during the study period. Lower bed occupancy in the rotavirus season in the postvaccination period was observed for RVGE (−89%, 95% CI 73% to 95%), acute gastroenteritis (−63%, 95% CI 39% to 78%) and any infection (−23%, 95% CI 15% to 31%). No significant overall reduction in bed occupancy was observed (−4%, 95% CI −1% to 9%). No changes were observed for the other outcomes.ConclusionsRotavirus vaccine introduction was not associated with reduced hospital pressures. A reduction in RVGE hospitalisation without change in overall bed occupancy suggests that beds available were used for a different patient population, possibly reflecting a previously unmet need.Trials registration numberNCT03271593

ObjectivesTo investigate if there is a significant difference between the LOS for patients admitted as waiting list initiative patients to a private hospital versus standard care in an NHS hospital.DesignRetrospective analysis between 2015 and 2017 of all ACD procedures at the two hospitals.Subjects674 elective NHS patients were included, 340 were admitted to the NHS hospital and 334 as waiting list initiative patients to the private hospital. Acute patients were excluded.MethodsRetrospective database search of electronic hospital records for all ACD procedures carried out between 2015 and 2017. The student standard t test analysis was used to compare the difference in LOS.ResultsIn both groups 100% were admitted on the day of surgery. The mean NHS LOS was 3.3 (SD=6.34) days and the private hospital was 1.1 (SD=0.97) days. (pConclusionsWe found that length of stay is significantly shorter in the private hospital than in the NHS hospital. This could be due to patient selection, a swifter patient pathway or a combination of the two and these factors will be explored.

ObjectivesSubdural haematoma (SDH) is a recognised complication of forceps-assisted delivery (FAD). There are no guidelines regarding its management. This study aims to provide a better insight into the management and outcomes of neonatal SDH post FAD.DesignRetrospective review of our neonatal database and systematic review of the literature.SubjectsNeonatal cases presented with SDH after FAD.MethodsRetrospective database search of cases managed in our unit between January 20 111 and January 2018. Systematic review of the literature was performed using PRISMA guidelines. Inclusion criteria: (i) neonates, (ii) forceps-assisted delivery, (iii) evidence of SDH on imaging, with or without other traumatic lesions.ResultsA literature search yielded 9 studies with 30 patients meeting our inclusion criteria, In addition three cases were identified from our institutional database. 42% (n=14) had their SDH managed surgically, with subsequent full neurological recovery in 57%. In comparison, 95% (n=18) of the conservatively managed patients made a full recovery. Hydrocephalus was present in 1 and 11 of the conservatively managed and surgically managed patients, respectively.ConclusionsConservative management can lead to a full neurological recovery in SDH following FAD in neonates. However, a significant number may still need neurosurgical intervention for the SDH or subsequent hydrocephalus, therefore we advocate early transfer to a specialist neuroscience centre.

Dear editor The recently published original research by Winstanley et al [1][1] titled ‘Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield’ addresses a timely and important topic as it relates to civilian

Introduction This paper describes the first 16-months experience of prehospital rapid sequence intubation (RSI) in a rural and suburban helicopter-based doctor-paramedic service after the introduction of a standard operating procedure (SOP) already proven in an urban trauma environment. Method A retrospective database review of all missions between October 2010 and January 2012 was carried out. Any RSI or intubation carried out was included, regardless of age or indication. Patients who were intubated by Ambulance Service personnel prior to the arrival of the East Anglian Air Ambulance (EAAA) team were excluded. Results The team was activated 1156 times and attended 763 cases. A total of 88 RSIs occurring within the study period were identified as having been carried out by the EAAA team and meeting inclusion criteria for review. There were no failed intubations that required a rescue surgical airway or the placement of a supraglottic airway device. For road traffic collisions (RTCs), the overall on-scene time for patients who required an RSI was 40 min (range 15–72 min). For all other trauma, the average on-scene time was 48 min (range 25–77 min), and for medical patients, the average time spent at scene was 41 min (range 15–94 min). Conclusions We have demonstrated the successful introduction of a prehospital care SOP, already tested in the urban trauma environment, to a rural and suburban air ambulance service operating a fulltime doctor-paramedic model. We have shown a zero failed intubation rate over 16 months of practice during which time over 750 missions were flown, with 11.5% of these resulting in an RSI.

To determine whether the Glasgow-Blatchford bleeding score (GBS) or pre-endoscopy Rockall score was better at accurately identifying patients with acute upper gastrointestinal bleeding (AUGIB) who were at low risk of the need for clinical intervention and death and therefore suitable for outpatient management.Retrospective database and case note review of all patients admitted to the emergency departments with AUGIB from 1 January 2008 to 31 December 2009.Two tertiary centre teaching hospitals.432 patients met the inclusion criteria.None.Clinical interventions (blood transfusion, endoscopic therapy and surgery) and death.Of 432 patients, 40 (9.3%) had a GBS of 0 and none required intervention or died. In contrast, 13/104 patients (12.5%) who had a pre-endoscopy Rockall score of 0 and 23/125 patients (18.4%) who had a complete Rockall score3, required clinical intervention. The performance of the scores at these cut-offs were: GBS (sensitivity 100%, specificity 16.1%, positive predictive value (PPV) 37.8%, negative predictive value (NPV) 100%, accuracy 82.3%), pre-endoscopy Rockall (sensitivity 91.2%, specificity 32.0%, PPV 41.2%, NPV 87.5%, accuracy 70.9%) and complete Rockall (sensitivity 84.5%, specificity 50.7%, PPV 55.8%, NPV 81.6%, accuracy 76.2%). For prediction of the need for intervention or death, the accuracy of the GBS (0.82; 95% CI 0.78 to 0.86) was superior to the pre-endoscopy Rockall score (0.71; 95% CI 0.67 to 0.76).The GBS but not the pre-endoscopy Rockall score identifies patients with upper gastrointestinal bleeding who may be suitable for outpatient management, therefore potentially allowing for more efficient use of hospital resources.

Retrospective prescribing data were obtained from 46 general practice surgeries in NHS Scotland. Patients with asthma who were naïve to previous long-acting β agonist therapy and initiated combination inhaler therapy in 2008-2009 were classified according to the inhaled corticosteroid (ICS) dose in their combination inhaler compared with the highest dose of ICS they received before initiation. Among the 685 patients (541 (79.0%) who had been prescribed an ICS previously), those originally on low-, medium- or high-dose ICS were changed to high-dose combination therapy in 122/250 (48.8%), 94/151 (62.3%) or 85/113 (75.2%) cases in each ICS dose category, respectively. These results suggest that evaluation of appropriate high-dose ICS prescribing in general practice is needed.

Background Despite routine use of pre-hospital identification instruments, approximately 30% of suspected stroke admissions are stroke mimics (SM). Early identification may allow “false positive” SM patients to be directed to appropriate care and improve healthcare resource utilisation. Methods A retrospective database of ambulance records containing a paramedic impression of stroke was linked to hospital specialist diagnosis data from 01/06/13 to 31/05/16. Logistic regression identified clinical features predictive of SM. An assessment score was constructed prioritising specificity over sensitivity. Results 1650 patients (mean age 75.3, 47% male, 40% SM) were included. 1520 (92%) were Face Arm Speech Test (FAST) positive. Table 1 describes the characteristics in the SM assessment. Each characteristic scores 1 point if present. 86% (66/77) of suspected stroke patients scoring 1 were SM. 100% (6/6) of patients scoring >1 characteristic were SM. A score ≥1 identified SM with 11% (95% CI, 8–13) sensitivity, 99% (95% CI, 98–99) specificity, positive predictive value of 87% (95% CI, 79–94), negative predictive value of 62% (95% CI, 60–64) and a diagnostic odds ratio of 11 (95% CI, 6–20, p Conclusions Amongst ambulance patients with suspected stroke, a small number of SM can be identified with a high degree of certainty. This simple tool needs further validation, prospective testing in the pre-hospital environment with characteristics systematically recorded and consideration of potential clinical impact.

Objectives The main objective of this study was to assess the impact of changes in care commissioning policies on National Health Service (NHS)-funded cosmetic procedures over an 11-year period at our centre. Setting The setting was a tertiary care hospital in London regulated by the North Central London Hospitals NHS Trust care commissioning group. Participants We included all patients logged on to our database at the time of the study which was 2087 but later excluded 61 from analysis due to insufficient information. Primary and secondary outcome measures The main outcome measures were the results of tribunal assessment for different cosmetic surgeries which were either accepted, rejected or inconclusive based on the panel meeting. Results There were a total of 2087 patient requests considered between 2004 and 2015, of which 715 (34%) were accepted, 1311 (63%) were declined and 61 (3%) had inconclusive results. The implementation of local care commissioning guidelines has reduced access to cosmetic surgeries. Within this period, the proportion of procedures accepted has fallen from 36% in 2004 to 21% in 2015 (χ2; p

Background Inadequate control of hyperuricaemia in gout patients can lead to loss of work productivity, activity limitations [1] and higher gout-related treatment costs [2]. Some patients treated with conventional urate-lowering therapy (ULT) are inadequately controlled [3]. Objectives To evaluate the impact of inadequate control on work productivity and activity limitations in gout patients. Methods A retrospective database analysis of gout patients currently receiving conventional ULT for at least 3 months. Data were drawn from the Adelphi Disease Specific Programme (DSP)™, a cross-sectional survey of patients with gout in France, Germany, UK and US. Participating physicians submitted extensive clinical data for each patient including most recent serum uric acid (sUA) level and number of flares in last 12 mos. Patients were invited to complete a patient self-completion questionnaire, containing the Work Productivity and Activity Impairment (WPAI) questionnaire. Inadequate control was defined as sUA level >6 mg/dL or ≥2 flares. Adequate control was defined as sUA level ≤6 mg/dL and 0 flares. Mann-Whitney tests investigated differences between inadequately and adequately controlled patients in productivity measured by WPAI. Results Of 1204 gout patients in this analysis, 836 (69%) were inadequately controlled; 82% of patients were male, mean age was 61 yrs, and mean duration on current ULT was 32 mos. 368 (31%) patients were adequately controlled with a mean age of 63 yrs and mean duration on current ULT of 57 mos. There were no significant differences between patients deemed adequately controlled vs inadequately controlled on number of renal, autoimmune, GI or CV comorbidities. Inadequately controlled patients were significantly more impaired by gout compared to adequately controlled patients (Work time missed: 4.50% vs 1.34%, p=0.0003; Impairment while working: 19.08% vs 5.17%, p Conclusions Only 31% of gout patients currently treated with a ULT were adequately controlled. Inadequately controlled patients reported greater impairment in productivity. Gout treatment strategies to improve control of hyperuricaemia may lead to improvement in productivity. References Perry M. Rheumatology (Oxford) 2010;49:2233-4. Saseen JJ. Rheumatology (Oxford) 2012;51:2004-12. Perez-Ruiz F. Adv Ther 2012;29:935-46. Acknowledgements Research sponsored by Ardea Biosciences/AstraZeneca. Disclosure of Interest R. Wood Employee of: Adelphi Real World, J. Johnson Employee of: Adelphi Real World, R. Morlock Employee of: Ardea Biosciences, Inc, S. Baumgartner Employee of: Ardea Biosciences, Inc, S. Ramachandran Employee of: AstraZeneca DOI 10.1136/annrheumdis-2014-eular.4482

Objectives Hospital discharge data (HDD) in many health systems do not capture the date of injury (DOI); the absence of this date hinders researchers’ ability to distinguish repeat from incident injury admissions. Various approaches using somewhat arbitrary criteria have been explored to increase the accuracy of incident injury identification. However, these approaches have not been validated against a data source which contains DOI. The aim of this study was to determine the accuracy of evidence-based criteria for identifying fall-related incident hip fractures in the absence of DOI using HDD containing DOI as the reference standard. Design Retrospective database study. Setting New Zealand. Participants 8761 patients aged 65+ years admitted for fall-related hip fracture between 1 July 2005 and 30 June 2008, inclusive. Outcome measures We defined person-identifying HDD containing DOI as the reference standard and calculated measures of the accuracy of evidence-based criteria for identifying fall-related incident hip fractures from HDD not containing DOI. The criteria were principal diagnosis of hip fracture, mechanism of injury indicating a fall, admission type emergency, admission source other than a transfer and presence of hip operation code(s). For a subsequent fall-related hip fracture, additional criteria were time between successive hip fractures ≥120 days, and all external cause-of-injury codes being different to those for the previous hip fracture. Results The sensitivity and specificity of the criteria for identifying fall-related incident hip fractures from data not containing DOI were 96.7% and 99.3%, respectively, compared with the reference standard. The application of these criteria resulted in a slight underestimation of the percentage of patients with multiple hip fractures. Conclusions Although it is preferable to have DOI; this study demonstrates that evidence-based criteria can be used to reliably identify fall-related incident hip fractures from the person-identifying HDD when DOI is unavailable.

Background Golimumab is a once-monthly, subcutaneously-administered, anti-TNF agent indicated for treatment of active psoriatic arthritis (PsA). Real-world dosing and refill compliance patterns of golimumab use in PsA patients have not been reported previously. Objectives This study reports golimumab (GLM) dosing and refill compliance observed in psoriatic arthritis (PsA) patients. Methods This retrospective database analysis assessed GLM use in adult PsA patients with ≥2 GLM prescriptions between 4/24/2009 and 12/31/2010; ≥1 PsA diagnosis during the study period; continuous activity in the Source® LX database (≥6 months before; ≥6 months after the index GLM prescription; and a 28-31 day GLM supply. Refill compliance was defined as refills occurring ± 1 week of the expected 28-31 day (d) interval. The percent of compliant GLM refill intervals and the percent of patients demonstrating refill compliance at the 6th GLM dose were assessed in the overall population and in bio-naive/bio-experienced subgroups. Descriptive statistics were used to characterize the study population (mean ± SD, median, n and %). Results A total of 262 PsA patients and 1,489 GLM refill intervals were observed. The sample was 59% female; mean age of 50 years with 72% bio-experienced. A 50 mg GLM dose was found in 97% of all fills. The mean±SD refill interval for the overall population was 35.6±19.8 d with a median of 31 d. Bio-experienced patients had slightly more frequent refill intervals (34.9±18.4 d) as compared to bio-naive patients (37.4±23.2 d), but the median was 31 d in both subgroups. Refill compliance was observed in 80% of all intervals for the overall population. Refill compliance at the 6th GLM dose was achieved by 84% of patients overall; (87% of bio-naive and 82% of bio-experienced patients). Conclusions In this retrospective analysis of a large national administrative claims database, 97% of GLM doses were 50 mg with approximately once monthly refill intervals. Overall refill compliance was observed in approximately 80% of all GLM refills and in greater than 80% of PsA patients at the sixth GLM dose. Median refill interval and refill compliance appeared similar in bio-experienced and bio-naive subgroups. Further study of these trends using additional data sources are desired to substantiate these preliminary findings. Disclosure of Interest L. Ellis Employee of: Janssen Scientific Affairs, LLC, S. Haas Consultant for: Janssen Scientific Affairs, LLC, S. Bolge Employee of: Janssen Scientific Affairs, LLC, N. Tandon Employee of: Janssen Scientific Affairs, LLC

Background Golimumab is a once-monthly, subcutaneously-administered, anti-TNF agent indicated for treatment of patients with ankylosing spondylitis (AS). Real-world dosing and refill compliance patterns of golimumab use in AS patients have not been reported previously. Objectives This study reports golimumab (GLM) dosing and refill compliance observed in ankylosing spondylitis (AS) patients. Methods This retrospective database analysis assessed GLM use in adult AS patients with ≥2 GLM prescriptions between 4/24/2009 and 12/31/2010; ≥1 AS diagnosis during the study period; continuous activity in the Source® LX database (≥6 months before; ≥6 months after the index GLM prescription); and a 28-31 day GLM supply. Refill compliance was defined as refills occurring ± 1 week of the expected 28-31 day (d) interval. The percent of compliant GLM refill intervals and the percent of patients demonstrating refill compliance at the 6th GLM dose were assessed in the overall population and in bio-naive/bio-experienced subgroups. Descriptive statistics were used to characterize the study population (mean±SD, median, n and %). Results A total of 99 AS patients and 559 GLM refill intervals were studied. The sample was 53% male; mean age of 44 years with 72% bio-experienced. A 50 mg GLM dose was found in 99% of all fills. The mean ± SD refill interval for the overall population was 35.1±21.0 d with a median of 30 d. The refill interval of bio-experienced patients (34.8±18.7 d; median 30 d) was similar to bio-naive patients (35.8±25.8 d; median 31 d). Refill compliance was observed in 79% of all intervals for the overall population. Refill compliance at the 6th GLM dose was achieved by 83% of patients overall. Conclusions In this retrospective analysis of a large national administrative claims database, 99% of GLM doses were 50 mg with approximately once monthly refill intervals. Overall refill compliance was observed in nearly 80% of all GLM refills and in greater than 80% of AS patients at the sixth GLM dose. Median refill interval and refill compliance appeared similar in bio-experienced and bio-naive subgroups. Further study of these trends using additional data sources are desired to substantiate these preliminary findings. Disclosure of Interest L. Ellis Employee of: Janssen Scientific Affairs, LLC, S. Haas Consultant for: Janssen Scientific Affairs, LLC, S. Bolge Employee of: Janssen Scientific Affairs, LLC, N. Tandon Employee of: Janssen Scientific Affairs, LLC

Commentary on: Dormuth CR, Hemmelgarn BR, Paterson JM, et al. Canadian Network for Observational Drug Effect Studies (CNODES). Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases. BMJ 2013;346:f880.[OpenUrl][1][Abstract/FREE Full Text][2] Statins are commonly used medications for the reduction of low-density lipoprotein cholesterol resulting in markedly improved cardiovascular disease outcomes.1 Prior studies with regard to acute kidney injury (AKI) risk in statin users versus non-statin users show mixed results. Dormuth and colleagues address the question of whether high-potency statin therapy is associated with increased hospitalisation for AKI compared to low-potency statin therapy, thereby decreasing indication bias for statin use as a confounder. The Canadian Network for Observational Drug Effect Studies (CNODES) are an observational retrospective database meta-analysis of 2 008 003 patients without chronic kidney disease … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.f880%26rft_id%253Dinfo%253Apmid%252F23511950%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=346/mar18_3/f880&atom=%2Febmed%2F19%2F1%2F28.atom

Background BASHH guidelines recommend all patients diagnosed with Chlamydia trachomatis (CT) should be given a detailed explanation of the condition, managed with appropriate antibiotics and have effective partner notification (PN). Patients tested in non-GUM settings may receive sub-optimal management. Following a 2008 audit highlighting several untreated CT cases in the Gynaecology Department (GD) we introduced a bespoke IT lab-link allowing daily downloads of results to GUM health advisers (HA). Objectives To re-audit the management of females tested for CT in GD. Methods We performed a retrospective database analysis of all CT tests requested by any of the 11 Gynaecology consultants from June 11 to January 12. Demographic and clinical details were extracted from a prospectively collected lab. database and clinic records. Results were compared with the 2008 audit. Fisher9s exact test was used to compare differences between proportions. Results 889 tests {864 (97.2%) negative, 16 (1.8%) positive, 9 (1%) not tested—incorrect swab} were requested by GD over 29 weeks. HAs were notified of 100% of results in real time. Median time from notification of positive results to patient contact was 1 day (range 1–60). Median time from positive result to treatment was 7 days (range 1–70). This compares to an upper limit of 168 days in the 2008 audit. Recommended antibiotics were used in all cases. PN outcomes improved from 31% to 75% (p=0.02) and untreated cases decreased from 38% to 18.7% (p=0.2) (see abstract P68 table 1). Discussion Since the introduction of a referral pathway and automated IT lab-link, management of CT positive patients from GD has improved, in particular PN and proportion left untreated. GUM departments should have a clear pathway for the management of patients diagnosed with STIs in non-GUM settings.