The purpose of this report is to describe the scope of clinical services provided by emergency medicine (EM) pharmacists in a tertiary academic medical center. The primary objective is to describe and categorize pharmacist interventions and clinical activities. Secondary objectives are to categorize drug therapy recommendations based on therapeutic class of medication and to determine the percentage of emergency department (ED) patients for whom an intervention was documented. This was a retrospective, single-center, chart review conducted in the emergency department of an urban tertiary care center with approximately 65,000 patient visits per year. EM pharmacists provided dedicated support daily within two shift assignments from 0700 to 2300 and documented interventions and clinical activities in the electronic health record (EHR). As part of the usual care process and departmental procedures, all interventions and clinical activities by EM pharmacists are documented electronically within discrete fields in the EHR. All interventions and clinical activities from January 1, 2015 through March 31, 2015 were abstracted via electronic data pull for further analysis by a trained reviewer. All data were analyzed descriptively. A total of 3739 interventions and clinical activities were documented by EM pharmacists, with a mean of 41.5 ± 13.3 (mean ± standard deviation) documented per day. Categorization of interventions and clinical activities is summarized in Table 1. Of the 1165 drug therapy recommendations, a total of 986 were linked within the EHR to a therapeutic class of medication. For these 986 drug therapy recommendations, the most frequently implicated therapeutic classes were antimicrobial agents (31.9%), cardiovascular agents (16.2%), analgesic agents (12.6%), central nervous system agents (8.1%), and antihyperglycemic agents (6.2%). EM pharmacists documented interventions for 11.7% of emergency department patients during the study period. EM pharmacists documented multiple types of interventions and clinical activities in a tertiary medical center with 66% of documentation relating to drug therapy recommendations and medication histories. These documented interventions demonstrate the role of EM pharmacists in optimizing medication therapy to improve patient safety.

A number of fuel cell systems have been recently developed to meet the U.S. Army's soldier power requirements. The operation and performance of these systems are discussed based on laboratory results and limited soldier evaluation. The systems reviewed are primarily intended for soldier use in an austere environment with minimum access to resupply and vehicular transportation. These applications require high power and energy density sources that are portable (300 W) and wearable (20 W) to minimize the soldier's load burden. Based on soldier field evaluations of portable fuel cell systems, improvements in power density and compatibility with logistical fuels are required to be successfully deployed. For soldier worn applications, a novel chemical hydride system has shown significant advances in power and energy density while maintaining a small form factor. The use of a high energy dense fuel cartridge (800 Wh kg (-1)) based on AlH3 (Alane) thermolysis, allows a power density of (28 W kg(-1)) which offers promising weight savings compared to the standard military batteries. Published by Elsevier B.V.

Communications-Electronics Research, Development, and Engineering Center (CERDEC) has been developing fuel cell power sources for the US military, including soldier borne applications in an austere environment with minimum access to resupply and vehicular transportation. These dismounted soldier applications require systems that are power and energy dense to minimize the load burden. A number of fuel cell products have been developed for these applications, and the performance of these systems are discussed. Significant advancements in power density and energy density have been made, resulting in increased relevance to users. Based on recent advances, it is anticipated that these fuel cells will be transitioned as a viable alternative to the incumbent power solutions upon successfully meeting cost, reliability and ergonomic targets.

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Radio-labeled red cell perfusion scan of the non-donorydonor forearmyhand was undertaken, 1- and 5-years post operation, in 12 patients who had received a radial artery graft during myocardial revascularisation. Results were analysed using a Wilcoxon Signed Rank test (P- value -0.05 was taken as statistically significant). Mean tissue perfusion (in millilitersy100 ml tissueymin) declined in the non-donor (y10.06%, Ps0.07) and donor (y6.65%, Ps0.15) forearm, respectively, compared to 1 year post radial artery harvest. The statistically significant observed difference in tissue perfusion between the non-donor (21.9"5.1) and donor (17.5"3.7) forearm (Ps0.0007) at 1 year was maintained at 5 years, non-donor and donor, 19.5"3.7 and 16.2"3.4 (Ps0.001), respectively. The same pattern in tissue perfusion was observed in the non-donorydonor hand. This study demonstrates that, over time, there is little recovery in perfusion in the donor forearmyhand from ulnar artery collateral circulation. There is a significant and persistent difference in tissue perfusion between the non- donorydonor forearmyhand at 5 years post radial artery harvest. Although no functional deficit or overt ischaemic events were recorded, these findings may influence the choice of conduit and the information given when obtaining consent in patients undergoing myocardial revascularisation.

1098 Background: MBC (metastatic breast cancer) is among the leading causes of cancer deaths in women worldwide and in Egypt. Gemcitabine has shown synergy with vinorelbine in preclinical models, and has a toxicity profile that is different from vinorelbine. Methods: This was an open-label, single-arm, non-randomised phase II study in patients with locally advanced or MBC who have been previously treated with one anthracycline with/without taxane, based regimen in the adjuvant/neoadjuvant setting. The primary objective of this study was to assess the efficacy of this combination by determining overall response rate. Secondary endpoints were the assessment of the toxicity of gemcitabine in combination with vinorelbine, as well as the time to disease progression, one-year survival. Results: Of the 74 patients enrolled, 72 patients were evaluable for primary treatment outcome (tumor response rates). Overall response rate was 42%. Four patients (6%) had complete response and 26 patients (36%) had partial response. Nineteen patients (26%) had stable disease. Among the 30 patients who had a response to treatment during the study period, the median time to disease progression was 37 weeks (range 1 -60). Median duration of response was 43 weeks (95% CI 31- unestimated). The probability of surviving one year from the Kaplan-Meier estimate for 12 months is 77% (95% CI 64%-86%). Mean percentage of dose intensity of gemcitabine and vinorelbine received was 86% (SD 13%). Mean number of cycles received was 4.4 (SD 1.8). Grade III-IV neutropenia was reported to be 10%, thrombocytopenia was 1.4%, and febrile neutropenia (with documented infection) was 1.4%. As for the clinical toxicities, the most common grade III-IV toxicities were nausea (24%) and diarrhea and stomatitis (11%). Serious clinical adverse events; 5 (7%) hospitalizations for adverse events mainly due to anemia, febrile neutropenia, septic shock and hepatic failure. There were 2 platelet transfusions and 14 RBC transfusions. Conclusions: With a disease control rate of 68%, gemcitabine/vinorelbine demonstrated to have a promising efficacy and at the same time good tolerability in metastatic breast cancer patients. [Table: see text]

12021 Background: Myoepithelial carcinoma of the breast is a rare condition. Here, are 2 cases of malignant myoepithelial documented. Both were 51 year-old Kuwaiti women, presenting with abnormal breast masses. Methods: The first patient underwent mastectomy while the second patient underwent lumpectomy followed by mastectomy for narrow margins. The tumours were clinically, radiologically and macroscopically demarcated. Diagnosis was made based on histological and immunohistochemical studies. Results: Both cases were positive for α-smooth muscle actin, S-100ptn and one case was positive for Vimentin and the other case was positive for Epithelial Membranous Antigen (EMA). From these findings the cases were diagnosed with malignant Myoepithelioma. One case consisted microscopically of tumour cells with clear cytoplasm, possibly making it one of 3 reported cases of clear cell myoepithelial carcinoma. One case locally recurred and metastasized, while the other is still newly diagnosed and under follow-up. Conclusion: Myoepithelial tumours are generally considered benign but do have a spectrum of behaviour with a potential for local recurrence and rarely distant metastases. No significant financial relationships to disclose.