Although fortunately rare, the serious and potentially fatal complication of air embolism continues to occur following open-heart surgery. Its reliable prevention is dependent on the avoidance of specific procedural hazards and the exercise of various maneuvers to evacuate residual air from the heart before it is allowed to eject. Specifically, the beating heart should not be opened without ventricular fibrillation, cardioplegia, or aortic cross-clamping unless special precautions are exercised.

Cardiac Surgical Procedures↗

PubMed1985

Rational remuneration.

Physicians face the end of a phase of unrealistic and unprecedented prosperity fostered by unrestrained third-party remuneration policies. The cost of that phase, along with inflation and the use of expensive technology, has created an economic crisis. I urge my colleagues to take the initiative to address this crisis with other affected groups in the private sector by working to develop guidelines to restrain abuses, promote cost effectiveness, simplify administration, and increase fairness in the remuneration system. Remuneration scales should reflect variations among specialties in terms of skill, stress, and time involved, but should avoid unmeasurable and unverifiable differences within each category of service. Slowness and ineptitude should no longer be rewarded under the guise of "complexity." In the long run, standardized fees will be fair and will simplify the payment process greatly. Reasonable remuneration for agency-subsidized services can be derived in several ways, and once the median remuneration for various services has been established in each specialty, existing relative-value scales can be applied for other cases in that specialty. These measures would effect substantial savings in health care costs without incurring bureaucratic interference or impairing the quality of service. Moreover, they would allow distribution deficiencies to be remedied by permitting a response to market forces--i.e., higher payments would be made in underserved areas.

Economic Competition↗

PubMed1985