[The adaptation of methodology of expert selection of indicators for integral evaluation of effectiveness and efficiency of organization of medical care support at the level of subject of the Russian Federation at the "pediatrics" profile].

The adaptation of methodology of expert selection of indicators for integral evaluation of efficiency of organization of medical care on profile "pediatrics" at the level of the Subject of the Russian Federation. The study was organized as expert survey using structured interview technique. At the first stage, primary selection of indicators carried out. At the second stage, selection of experts in accordance with inclusion criteria and assessment of level of expert competence was organized. Then, criteria of expert evaluation of significance of selected indicators in accordance with international principles applied in of bench-marking systems construction were formulated. The Kendall's concordance coefficient (W) was calculated for quantitative assessment of degree of agreement between the experts answers. The non-parametric Friedman test was applied to evaluate significance of differences. The indicators with high degree of agreement between opinions of experts and availability of statistical significance according concordance coefficient are recommended as indicators for assessment of efficiency of organization of medical care of children at the level of the Subject of the Russian Federation. The following indicators satisfy these requirements: mortality of children aged 0-17 years (per 100 000 of population of corresponding age), mortality of children aged 0-1 year (per 1000 live births), mortality of children aged 0-4 years (per 1000 live births), support of population with beds for children, percentage of children aged 0-17 years under dispensary observation with diagnosis established for the first time. The study permitted to select indices (indicators) that can be applied both for integral rating of the Subjects of the Russian Federation and in formation of Federal projects or departmental target programs in pediatrics. The study results can also be applied in development of system of monitoring efficiency of implementation of these projects and programs.

[METHODOLOGICAL APPROACHES TO THE FORMATION OF THE RATING OF THE CONSTITUENT ENTITIES OF THE RUSSIAN FEDERATION, REFLECTING THE EFFICIENCY AND QUALITY OF MEDICAL CARE BY PROFILE].

Aim of the study - determination of approaches to the formation of the rating of the constituent entities of the Russian Federation, reflecting the state of medical care in various profiles (the effectiveness and quality of medical care in various profiles). The study included a comprehensive analysis of the structure and content of the reports based on the results of national medical research centers field events using classification and grouping methods. Assessment of the advantages and disadvantages of the used variants of the methodology for forming the subject rating of the Russian Federation used the method of selective SWOT analysis of methodologies published in the form of scientific articles. Further, based on the results obtained, the main requirements for building a rating system for subjects of the Russian Federation based on the indicators of efficiency (performance) and the quality of medical care were formulated. The possibility of applying international experience in building benchmarking systems in the Russian Federation is analyzed and requirements are formulated for building a subject rating system of the Russian Federation, taking into account the peculiarities of the domestic healthcare system. There are 3 main methodological approaches to the formation of the subject rating of the Russian Federation: a quantitative score rating assessment of quantitative indicators without weight coefficients, a qualitative rating assessment of the effectiveness of medical care in a profile without weight coefficients, and a mixed score-rating assessment of quantitative and qualitative indicators using weight coefficients determined only by an expert method. It has been established that many of the existing approaches to the formation of the subject rating of the Russian Federation are based on a combination of a point rating and weight coefficients established by an expert method. Since different indicators have different contributions to the final integral value of the subject rating of the Russian Federation, it is advisable to conduct another study to establish weight coefficients for indicators.

[A case of seronegative systemic lupus erythematosus (an immunopathological study)]. / Sluchai seronegativnoi sistemnoi krasnoi volchanki (immunopatologicheskoe issledovanie).

A case of systemic lupus erythematosus (SLE) in a 37-year-old female is described which was primarily diagnosed as epilepsy. Immunopathologically, an immunoglobulin in the nuclei of the majority of cells in the skin biopsy and blood cells was found against the background of the lack of SLE manifestations (antinuclear factor in the circulating blood, skin lesions, etc.). Antibodies against the antigen of vascular intima are revealed in the blood by means of the indirect immunofluorescence. The epilepsy diagnosis was established due to the prevalence of the brain vessels affection (frequent loss of consciousness). The progression of the disease with the involvement of joints, heart, lungs and other organs, high indexes of the rheumatoid factor made it necessary to differentiate between rheumatoid arthritis and SLE. The immunopathological examination confirmed the SLE diagnosis. Hemosorption combined with a standard therapy was followed by the decrease of the immunopathological manifestations.

[Use of germ-free mice in experimental transplantation]. / Ispol'zovanie myshei, svobodnykh ot patogennoi flory, v éksperimental'noi transplantologii.

A comparative study of skin allografts was performed in germ-free A/Ola mice kept in boxes and in A/Ola and BALB mice raised in ordinary conditions. Skin graft (of C57B1/6 mice) in A/Ola and BALB mice raised in ordinary conditions was shown to reject 16-21 and 12-18 days after the transplantation, respectively without cyclophosphamide (CP) use. CP application in BALB mice, grown in ordinary conditions, prolonged the lifespan of grafts to 12-29 days. The use of CP in germ-free A/Ola mice prolonged the lifespan of grafts to 19-39 days. In germ-free mice kept in boxes the use of an immunodepressant was not accompanied by infectious complications, while the animals kept in the vivarium often died of infectious diseases.