Pancreaticoduodenectomy after neoadjuvant therapy in a Jehovah's witness with locally advanced pancreatic cancer: case report and approach to avoid transfusion.

Although the morbidity and mortality rates associated with pancreaticoduodenectomy (PD) have been improving over the past several decades, perioperative transfusions are often needed. Here, we review the preoperative planning and overall management of a Jehovah's Witness patient with locally advanced pancreatic cancer who would not accept blood transfusion. Management of this case is reviewed, along with the relevant literature regarding major surgery in the Jehovah's Witness population. The use of neoadjuvant chemoradiation was used successfully in locally advanced disease, allowing surgical resection. In addition, we outline a cogent strategy using pre-, intra-, and postoperative techniques to minimize blood loss and maintain hemoglobin at acceptable levels thereby preventing the need for transfusion. These strategies, once in place, may be able to reduce transfusions in all patients having major resections for malignancy.

Integrating sleep medicine into a cardiology practice.

The sequelae of sleep-disordered breathing is encountered on a daily basis by the general cardiology practitioner. This includes arterial and pulmonary hypertension, congestive heart failure, atrial arrhythmias, and possibly vascular disease. Recognition, diagnosis, and treatment of sleep-disordered breathing is relatively straightforward and can be smoothly incorporated into an existing cardiology practice.

Building a cardiology practice.

This study was designed to quantify the clinical and marketing effectiveness of the Pocket EKG Clinical Based Marketing Program by measuring its impact on new patient visits, patient satisfaction, payor negotiations, and patient management at Pikes Peak Cardiology (PPC), Colorado Springs, Colorado. New patient visits were found to increase by 22% for 6.5 consecutive years. Ninety-two percent of patients surveyed found that the Pocket EKG Card promoted loyalty to the cardiology practice. The Pocket EKG Patient Satisfaction Survey was proven to satisfy Health Plan Employer Data and Information Set (HEDIS) guidelines as required in payor contracting. Finally, access to a baseline electrocardiogram contributed to a 54% reduction in unnecessary hospitalization. The Pocket EKG Clinical Based Marketing Program proved to successfully market PPC to its three customers: patients, payors, and primary care physicians.