Biomedical subjects
F D Moore
Publications and source records attributed to F D Moore.
"Catastrophic" health insurance--a misguided prescription?
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"Catastrophic" health insurance: a misguided prescription?
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Effect of cytotoxic agents on protein kinetics in patients with metastatic cancer.
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IgG on mouse erythrocytes augments activation of the human alternative complement pathway by enhancing deposition of C3b.
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In celebration of dialysis and kidney transplantation.
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High-cost users of medical care.
Cost characteristics of hospital patients were analyzed in 2238 medical records randomly selected from 42,880 dicharges in six contrasting hospital populations in the year 1976. Total hospital billings were concentrated on a few patients. On average, the high-cost 13% of patients consumed as many resources as the low-cost 87%. Repeated hospitalizations for the same disease were more characteristic of the expensive patients than were single cost-intensive stays, "intensive care," or prolonged single hospitalizations. Potentially harmful personal habits (e.g., drinking and smoking) were indicated in the records of high-cost patients substantially more often than in those of low-cost patients. Unexpected complications during treatment were five times more frequent in the high-cost group. Public policy programs for health insurance or cost control should include provisions based on the special characteristics of high-cost patients.
Regionalization of surgical services.
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Repeated hospitalization for the same disease: a multiplier of national health costs.
In five typical hospitals, and a specialized treatment center, more than half of all patients--and 60 percent of all costs--were attributable to repeated admissions for the same disease. The fiscal and clinical nature of repeated hospitalization suggests changes for national health policy. These will require more sensitive identification of patients "at risk" of recidivism, and insurance mechanisms that relate more rationally and equitably to long-term needs.
Lister Oration, 1979. Science and service.
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Transplantation--a perspective.
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The Wangensteen's history of surgery.
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Primary treatment of breast cancer by modified radical mastectomy, radiotherapy, and chemotherapy.
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The study of trauma. Can we encourage new federal directions?
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Glucose promotes whole-body protein synthesis from infused aminoacids in fasting man. Isotopic demonstration.
15N-glycine constant infusion, with plateau urea enrichment as the endpoint, demonstrated a clear increase in whole-body protein synthesis when glucose was added to aminoacid infusion in fasting men. Whole-body protein-breakdown rates remained unchanged. There was an unexpected fall in whole-body nitrogen turnover when the subjects were changed from an oral intake to either of the intravenous programmes: this finding, not previously reported, may be due to the decrease in gastrointestinal enzyme synthesis and intestinal-lining cell-turnover when oral intake is replaced by total parenteral nutrition.
The effects of glucagon on protein metabolism in normal man.
Plasma glucagon rises after major injury and could act to increase gluconeogenesis and ureagenesis in the post-traumatic state. This study documents the effect of prolonged glucagon infusion on ureagenesis and nitrogen excretion, as well as possible sources of the increased ureagenesis, in normal man. Four healthy men fasted for 6 days during intravenous infusion of glucose (750 gmday), establishing a steady state of minimal ureagenesis. Glucagon (1 mg/day) then was added to the infusion for 5 days. Glucose alone was given for the final 2 days. Forearm muscle flux of metabolites was determined by standard arterial-deep venous sampling and capacitance plethysmography. Glucagon concentration was suppressed during glucose infusion (11 +/- 13 pg/ml) and rose to levels seen in subjects with major trauma during glucagon infusion (669 +/- 138 pg/ml). Glucose infusion stabilized urine nitrogen excretion at 1.54 +/- 0.42 gm of N/sq m/day. Nitrogen excretion increased to 2.40 +/- 0.53 gm of N/sq m/day with glucagon infusion, with urea accounting for the increased excretion. Excretion of 3-methylhistidine was unchanged. Plasma amino acid concentration was strikingly reduced on the first day of glucagon infusion, where it stabilized. Forearm flux showed a slight net release of amino acid nitrogen during glucose infusion. Addition of glucagon to the glucose infusion resulted in a net uptake of nitrogen by forearm skeletal muscle. These evidences strong suggest that glucagon infusion in normal man increases ureagenesis, not only at the expense of the free amino acid pool, but by the hydrolysis of visceral protein as well, with muscle protein being maintained.
CAGS lecture. Scientific salients in surgery.
Surgery, as a field of clinical skill and scientific knowledge, advances by Discovery, Development and Delivery. While the basic biosciences have been more productive in Discovery than have the clinical fields, surgery has participated in several important areas of Discovery. Developmental science is often called biomedical engineering. In this activity, surgery has been pre-eminent, while it is the study and perfection of Delivery that holds such promise for the future of surgery. Distribution and regionalization of operations, bidirectional referral flow, manpower norms and analysis of adverse outcomes are important horizons for study in surgical care delivery.