Articles: hospitals.
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Corporatization of health care is dramatically transforming the medical workplace and profoundly altering the everyday work of the doctor. In this article, the authors discuss recent changes in U. S. health care and their impact on doctoring, and outline the major theoretical explanations of the social transformation of medical work under advanced capitalism. ⋯ S. experience, no country or health system can be considered immune. Indeed, U. S. experience may be instructive for doctors and health care researchers in other national settings as to what they may expect.
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Recent developments that influence patterns of antibiotic prescription for obstetric-gynecologic patients include a better understanding of the multibacterial dimensions of pelvic infections, the introduction of new antibiotics, and the pressures for cost-containment in medical care. Prophylaxis has become established as effective for prevention of infection following vaginal hysterectomy and cesarean section, but its success in abdominal hysterectomy has been less uniform. For patients with pelvic infections, the poorest clinical response occurs in those whose infection is well established before initiation of therapy. ⋯ Both metronidazole and clindamycin meet these criteria. Controlled studies of infections seen early in the clinical course are few. The initial selection of agents effective against gram-negative anaerobes seems important in the treatment of endomyometritis following cesarean section, whereas curettage seems the most significant therapy for infections following abortion.
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A dominant characteristic of critical-care medicine today is the emergence of powerful institutions functioning within a framework of a noncoherent set of values and philosophical perspectives. Anyone who would assign a significant role to the philosophy of medicine for today's era must not simply account for the quandaries of critical-care medicine, but also attend to the antecedent values, conflicts, and absurdities that form the ethical issues, as well as the models of ethical response (market ethos, professional ethos, etc.) that indicate which moral principles might be relevant. These considerations form the new agenda for the philosophy of critical-care medicine. This broad philosophical task is an urgent one, for critical-care medicine is rapidly molding the moral dimensions of all of medicine.