P1398EFFECTS OF CONVERTING FROM CINACALCET TO ETELCALCETIDE

Abstract Background and Aims Secondary hyperparathyroidism is a common problem in patients undergoing chronic hemodialysis and its treatment includes vitamin D analogs and calcimimetics which act upon the calcium-sensing receptor. Etelcalcetide was introduced as an intravenous calcimimetic easy to administer at the end of the hemodialysis session with improved adherence. Hypocalcemic episodes have raised some concerns although this side effect is not unanimously described. As an institutional policy most patients from 2 hemodialysis units were switched from cinacalcet to etelcalcetide between July 2017 and January 2018. We aimed at evaluating the impact of this conversion upon laboratory values and ongoing medication. Method We collected data from patients in 2 hemodialysis units including monthly serum values of calcium, phosphorus, hemoglobin and albumin, quarterly parathormone (PTH) values from 3 months previous to conversion until 3 months post-conversion as well as the calcimimetic dose during the same time frame. Descriptive statistics concerning mean and median values of the previous 3 and next 3 months following conversion were used. A paired sample t-test was performed to compare values before and after conversion. Results Of the approximately 200 patients, 22 were on cinacalcet and were switched to etelcalcetide. These had a mean age of 66.9 years and included 9 women and 8 diabetics. Mean PTH value before conversion was 728±391 (range 371-1900pg/mL) and did not differ significantly from that after conversion 717±330 (p=0.9). No significant statistical difference between values before and after conversion was found for serum calcium (9.3±0.5 vs 9.2±0.6; p=0.43), phosphorus (5.4±0.8 vs 5.1±1.0; p=0.15), albumin (4.1±0.2 vs 4.1±0.2; p=0.83) and hemoglobin (11.3±0.8 vs 11.4±0.9; p=0.50). The mean number of hypocalcemic values during the 3 months before and after conversion was identical (0.6±1 vs 0.6±0.9; p=0.86). The median cinacalcet dose on the month before conversion was 30mg/day (IQR 22.5) and the median etelcalcetide dose at conversion was 2.5mg three times per week (IQR 1.9). The conversion factor was 27mg cinacalcet: 1mg etelcalcetide, because even patients on high cinacalcet doses were initially started at low etelcalcetide doses. However, at 3 months following conversion, the median etelcalcetide dose was 8.75 (IQR 7.5). The doses of erythropoiesis-stimulating agents (ESA), vitamin D analogues and phosphorus binders were not significantly affected. Conclusion Switching from cinacalcet to etelcalcetide in all patients on hemodialysis in a particular institution did not change laboratory values or increased the number of hypocalcemic measurements. The etelcalcetide dose was adjusted up for the first 3 months and the mean PTH value did not change significantly. Treatment with ESA, vitamin D analogues and phosphorus binders remained unchanged after conversion. Secondary hyperparathyroidism is a chronic condition and etelcalcetide provides a useful means to control it with an easy administration regimen.

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Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03884-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Clare Shakespeare ◽

Handsome Dube ◽

Sikhangezile Moyo ◽

Solwayo Ngwenya

Keyword(s):

Perinatal Outcomes ◽

Control Measures ◽

Central Hospital ◽

Cross Sectional ◽

Maternity Services ◽

Before And After ◽

The Mean ◽

Significant Change ◽

The Impact ◽

Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

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What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

Otolaryngology ◽

10.1177/0194599820969631 ◽

2020 ◽

pp. 019459982096963

Author(s):

Vanessa F. Torrecillas ◽

Kaden Neuberger ◽

Alexander Ramirez ◽

Paul Krakovitz ◽

Jeremy D. Meier

Keyword(s):

Elective Surgery ◽

Lag Time ◽

Cross Sectional Study ◽

Health Claims ◽

Third Party ◽

Prior Authorization ◽

Cross Sectional ◽

Before And After ◽

The Mean ◽

The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

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Tracheobronchial Foreign Bodies: The Impact of a Postgraduate Educational Program on Diagnosis, Morbidity, and Treatment

PEDIATRICS ◽

10.1542/peds.70.1.96 ◽

1982 ◽

Vol 70 (1) ◽

pp. 96-98

Author(s):

Marc Puterman ◽

Rafael Gorodischer ◽

Alberto Leiberman

Keyword(s):

Educational Program ◽

Foreign Bodies ◽

Final Diagnosis ◽

Physician Performance ◽

Postgraduate Educational ◽

Before And After ◽

History Of ◽

The Mean ◽

Hospital Days ◽

The Impact

Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.

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Impact of the Emerging COVID-19 Pandemic on the Consumption of Multivitamins (C, D and Zinc) by the Saudi Arabian Population

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i26b31476 ◽

2021 ◽

pp. 11-20

Author(s):

Duaa Mohamed Bakhshwin ◽

Abdulaziz Bakhshwin

Keyword(s):

Vitamin D ◽

Vitamin C ◽

World Health ◽

Saudi Population ◽

Viral Spread ◽

Significant Difference ◽

Before And After ◽

Zinc Supplements ◽

Vitamin D Supplements ◽

The Impact

Background: On March 11, 2020, the World Health Organization (WHO) announced the Coronavirus outbreak officially as a pandemic. This pandemic has led to new measurements to prevent viral spread. The measures included decreasing the person’s mobility outside homes with subsequent changes in the lifestyles, particularly in physical activity and eating habits. It has been noticed that consumption of some vitamins may help in preventing or reducing the symptoms of viral infection. Those vitamins include vitamin C, D and zinc. There is a common observation that the general public believes that the use of vitamins, especially vitamins C, D and zinc, reduces the chance of acquiring COVID-19. Objectives: The aim of this study was to determine the impact of COVID-19 pandemic on taking vitamins supplements by the Saudi general population in order to explore their believes regarding the protective value of these vitamins against COVID-19 infection. Subjects and Methods: This cross-sectional study was conducted using a self-administrated questionnaire that was designed, uploaded to the Google form and distributed online to the general Saudi population through the social media (Whatsapp, Twitter) as well as through email between August and December 2020. Statistical Packaged of Social Sciences program (SPSS) for Windows (version 17.0., Chicago: SPSS Inc) was used to analyze the data. A significant difference was considered when the p value is < 0.05. Student t-test and Chi-square (χ2) test were used to compare the studied variables as appropriate. Results: A total of 1043 participants were included in this study (64.9% females, 35.1% males). The mean age for them was 35.3±14.78 years. Only 9.3% (97 participants) were diagnosed to have COVID-19. About 28% of the participants were in contact with COVID-19 cases. Among participants diagnosed to have COVID-19 infection, (13% versus 29%) were taking vitamin C and (2% versus 15%) were taking zinc supplements daily during the 6 months before and after the pandemic, respectively, while (20% versus 25%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic, respectively. Among participants who were in contact with COVID-19 cases, (8% versus 20%) and (3% versus 11%) were taking vitamin C and zinc supplements daily during the 6 months before and after the pandemic, respectively, while (14% versus 16%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic Conclusion: The interest of taking multivitamin by Saudi population, such as vitamins C and D, zinc increased during and after the pandemic compared to that before it. There is no scientific evidence based on previous studies confirmed the role of dietary supplementation and multivitamins in preventing COVID-19 infection, therefore, effective education on the rationale use of vitamins during COVID-19 pandemic should be emphasized at local and/or national levels.

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The effectiveness of nutritional vitamin D supplementation and selective vitamin D receptor agonists treatment on secondary hyperparathyroidism in chronic kidney diseases patients

Osteoporosis and Bone Diseases ◽

10.14341/osteo9879 ◽

2018 ◽

Vol 21 (2) ◽

pp. 12-22 ◽

Cited By ~ 1

Author(s):

Lilit V. Egshatyan ◽

Natalya G. Mokrisheva

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Secondary Hyperparathyroidism ◽

Vitamin D Receptor ◽

Vitamin D Supplementation ◽

Target Range ◽

Receptor Agonists ◽

Stage 4 ◽

Calcium Phosphorus ◽

Phosphorus Levels

Background: secondary hyperparathyroidism (SHPT) is an early complication of chronic kidney disease (CKD). Maintaining the level of 25(OH)D and parathyroid hormone concentrations in the target range reduce its associated complications (fractures and cardiovascular calcification). Aims: to examine the effectiveness of vitamin D supplementation and selective vitamin D receptor agonists treatment on SHPT in CKD. Material and methods: prospective observational study to evaluate the efficacy and safety of vitamin D therapy SHPT in 54 in patients with CKD. The first phase (24 weeks) – treatment of suboptimal 25-hydroxycalciferol (25(OH)D) levels. The second (16 weeks) – treatment colecalciferol-resistant SHPT by combination of cholecalciferol with paricalcitol. Blood samples were taken to assess parathyroid hormone (PTH), 25(OH)D, creatinine, calcium, phosphorus levels and calcium excretion. Results: After 8 weeks of cholecalciferol treatment all patients achieved 25(OH)D levels above 20 ng/ml, however 78% of patients still had SHPT. After 16 weeks, the decrease of PTH was achieved in all patients, but significantly only in patients with CKD 2 (19.2%, p< 0.01) and 3 (31%, p <0.05), compared with CKD 4 (17%, p >0.05). After 24 weeks of therapy, PTH normalized in all patients with CKD 2, in 15 (79%) with CKD 3 and in 9 (50%) patients with CKD 4. Cholecalciferol treatment resulted in a substantial increase in 25(OH)D levels with minimal or no impact on calcium, phosphorus levels and kidney function. After 24 weeks we initiated combination therapy (cholecalciferol and paricalcitol) for patients with colecalciferol-resistant SHPT (n=13). PTH levels decreased from 149.1±13.4 to 118.2±14.1 pg/ml at 8 weeks, and to 93.1±9.7 pg/ml (p <0.05) at 16 weeks of treatment. No significant differences in serum calcium, phosphorus or urinary calcium levels. Normalization of PTH was achieved in all patients with CKD 3 and in 8 patients with stage 4. One patient with CKD 4 needed an increase in paricalcitol dose. Conclusion: Cholecalciferol can be used in correcting vitamin D deficiency in patients with all stages of CKD, however, its effectiveness in reducing PTH in stage 4 is limited. Selective analogs, such as paricalcitol, were well-tolerated and effectively decreased PTH levels.

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Microfracture: State of the Art in Cartilage Surgery?

Cartilage ◽

10.1177/1947603517700956 ◽

2017 ◽

Vol 9 (4) ◽

pp. 339-345 ◽

Cited By ~ 5

Author(s):

Florian Frehner ◽

Jan P. Benthien

Keyword(s):

Clinical Trials ◽

Impact Factor ◽

Sports Medicine ◽

Time Frame ◽

Evidence Based ◽

Yearly Average ◽

The Mean ◽

Based Medicine ◽

Number Of Citations ◽

The Impact

Objective This study is a literature review from 2010 to 2014 concerning the quality of evidence in clinical trials about microfracture in attempt to repair articular cartilage. We have decided to focus on microfracturing, since this seems to be the best documented technique. Interest in evaluation of publication quality has risen in orthopaedic sports medicine recently. Therefore, we think it is necessary to evaluate recent clinical trials being rated for their evidence-based medicine (EBM) quality. We also compared the mean impact factor of the journals publishing the different studies as an indicator of the study’s citation and evaluated for a change over the studied time frame. Design To measure the EBM level, we applied the modified Coleman Methodology Score (CMS) introduced by Jakobsen. The impact factor, which is a measurement of the yearly average number of citations of articles recently published in that journal, was evaluated according to self-reported values on the corresponding journal’s website. Results We found that the mean CMS has not changed between 2010 and 2014. The mean impact factor has also not changed between 2010 and 2014. The CMS variance was high, pointing to different qualities in the evaluated studies. There is no evidence that microfracturing is superior compared to other cartilage repair procedures. Conclusion Microfracture cannot be seen as an evidence based procedure. Further research needs to be done and a standardization of the operating method is desirable. There need to be more substantial studies on microfracturing alone without additional therapies.

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Effect of Narrow- band UVB on serum and tissue vitamin D level in vitiligo

QJM ◽

10.1093/qjmed/hcab093.009 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ali Abdulkareem Al-Shabkhon ◽

Adel Ahmed Halim Emam ◽

Ahmed Abd Elfattah Afify

Keyword(s):

Vitamin D ◽

Case Control Study ◽

Narrow Band ◽

Tissue Level ◽

Before And After ◽

Duration Of Disease ◽

The Mean ◽

Tissue Vitamin ◽

Control Study

Abstract Background Immunologic background of vitiligo, role of vitamin D on its pathogenesis, role of NB-UVB on its treatment and its stimulatory effect NB-UVB on VDR expression are challenging area of research. The current study will focus on evaluating the effect of NB-UVB on serum and tissue level of vitamin D in vitiligo patients and correlating it with the degree of improvement. Aim of the study The aim of the present study is to evaluate and compare the serum and tissue vitamin D level in vitiligo patients before and after NB- UVB therapy and correlate them together and with the degree of improvement. Patients and methods A case-control study included 16 vitiligo patients and 16 age and sex matched healthy controls. All patients will be examined by one dermatologist (demonstrating the extent of depigmentation according to rule of nines), and photographs will be taken before and after phototherapy to be evaluated by two different dermatologists to document the extent of repigmentation. Estimation of serum level of vitamin D by ELISA Results Five of the 15 patients achieved more than 55% repigmentation; the mean duration of disease was 13 months. The remaining 10 patients had 30% - 40% repigmentation.

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Maths Sparks engagement programme: investigating the impact on under-privileged pupils’ attitudes towards mathematics

Teaching Mathematics and its Applications An International Journal of the IMA ◽

10.1093/teamat/hraa009 ◽

2020 ◽

Author(s):

Aoibhinn Ni Shuilleabhain ◽

Anthony Cronin ◽

Mark Prendergast

Keyword(s):

Social Research ◽

Time Frame ◽

Mathematics Students ◽

Undergraduate Mathematics ◽

High Stakes ◽

Mathematical Concepts ◽

Attitudes Towards Mathematics ◽

Before And After ◽

The Subject ◽

The Impact

Abstract In this paper we explore the attitudes of under-privileged secondary school pupils in Ireland towards mathematics and investigate the impact of attending a 4-week engagement programme on these attitudes. The pupils involved in this research attended schools recognized by the Department of Education & Skills as socio-economically deprived. Pupils attending these schools, known as Delivering Equality of Opportunity in Schools (DEIS), are 40% less likely than their counterparts in non-DEIS schools to pursue mathematics at a higher level in state examinations (Smyth, E., Mccoy, S. & Kingston, G., 2015, Learning From the Evaluation of DEIS. Dublin: Economic and Social Research Institute). However, little research has reported on these pupils’ experiences of and attitudes towards mathematics at senior secondary level. An engagement programme entitled ‘Maths Sparks’ was purposefully designed for secondary pupils from DEIS schools, with the aim of positively influencing their attitudes towards and confidence in mathematics. The programme consisted of weekly out-of-school workshops exploring extra-curricular mathematics topics, designed and delivered by undergraduate mathematics students. Questionnaires were utilized to evaluate pupils’ attitudes towards mathematics before and after their participation in the programme. Despite its relatively short time frame, qualitative and quantitative analysis suggests an increase in participating pupils’ attitudes towards, enjoyment of and self-confidence in mathematics due to their participation in the programme. Findings also suggest that while these pupils liked the subject of mathematics, their experience of learning the subject in school was not always positive and was sometimes hindered by the absence of higher-level mathematics as an option in school. The high-stakes examination content and teachers’ beliefs in the ability of their students also sometimes negatively impacted learners’ intentions to pursue mathematics at a higher level. Findings suggest that longitudinal mathematics engagement programmes, which focus on problem solving, involve extra-curricular mathematical concepts and are presented by undergraduate mathematics students, may provide a valuable way of positively impacting pupils’ intentions to pursue the subject.

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A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1703961 ◽

2020 ◽

Vol 11 (02) ◽

pp. 250-255

Author(s):

Vasantmeghna S. Murthy ◽

Vedant S. Shukla

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Statistical Tests ◽

T Test ◽

Emotional States ◽

Single Session ◽

Dialysis Unit ◽

Before And After ◽

The Mean ◽

The Impact

Abstract Background Executive functions (EFs) are critical to daily life and sensitive to our physiological functioning and emotional states. The number of people living with chronic kidney disease (CKD) on hemodialysis (HD) globally is increasing steadily. We aimed to determine the impact of a single session of HD on EFs in patients with CKD receiving maintenance HD (MHD). Methods This was a quasi-experimental study conducted at the department of psychiatry and dialysis unit of a tertiary hospital. Patients undergoing MHD underwent screening to rule out delirium, using the Confusion Assessment Method prior to EF testing. The tests of EF used were the Trail-Making Test—Part B (TMT-B) and Frontal Assessment Battery (FAB), both of which were administered before and after a session of HD. Statistical tests used were Wilcoxon matched pairs signed ranks test, paired t-test, single sample t-test, and correlation analyses. Results The mean time taken on TMT-B before HD was 195.36 seconds and after HD, 171.1 seconds; difference is significant (p = 0.0001). The mean FAB score was 13.19 before HD and 14.83 after HD; the difference is significant (p < 0.0001). Significant differences were observed on similarities (p = 0.003), lexical fluency (p = 0.02), and go–no go (p = 0.003) subtests of FAB. Mean TMT-B scores before and after HD differed significantly from that of a reference study (reference TMT-B 150.69 seconds), p = 0.0002 and 0.04, respectively. Conclusion We conclude that patients with CKD on MHD, in general, have worse executive cognitive functioning compared with healthy populations. A session of HD results in significant improvement in these functions.

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P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽

10.1017/cem.2020.343 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S114-S115

Author(s):

A. Albina ◽

F. Kegel ◽

F. Dankoff ◽

G. Clark

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Tertiary Care ◽

Physician Satisfaction ◽

Academic Hospital ◽

Before And After ◽

Potential Applicability ◽

The Mean ◽

Algorithm Implementation ◽

The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

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