[The system of criteria and indicators of accessibility of laboratory diagnostic in the Subject of The Russian Federation].

The modern health care is characterized by constant increasing need in laboratory tests. The quality and accessibility of laboratory diagnostics becomes one of key determinants of social well-being in aspect of maintaining population health. The purpose of the study is in developing system of criteria and indicators of accessibility of laboratory diagnostics applicable in organization of health care at the level of the Subject of the Russian Federation. The methods. The study was carried out based on principles of system approach. The methodological approach developed by Professor O. Yu. Alexandrova was applied. The analytical research methods (analysis, synthesis) were implemented. The results and discussion. The set of criteria, including three groups of measurable indicators, applicable in the field of laboratory diagnostics was developed. The original approach to determine time indicators of laboratory tests accessibility was proposed. The system can be applied as organizational technology permitting to establish specific requirements for laboratory diagnostics accessibility at the level of the Subject of the Russian Federation. These requirements can be included in local normative legal acts. The conclusions. The developed system of criteria and indicators of laboratory diagnostics accessibility can be used in development of medical care system that meets the best of characteristics and needs of particular Subject of the Russian Federation.

[The strategic management of laboratory diagnostic service: analysis of organization models].

The modern trends in health care (strategies of optimizing costs, value-oriented medical care) require systematic development of laboratory services for administrative territories. The study was carried out to provide support for decision-making by systematizing models of laboratory services on the basis of principles of systematic approach. Four basic models (centralization, outsourcing, horizontal integration, point-of-care) were analyzed. The study applied such research methods as analytical and strategic SWOT-analysis. The SWOT-analysis was implemented using list of standard characteristics for each model of laboratory service organization. Each model is distinguished by complex combination of strengths, weaknesses, lines of functioning and development. The availability of implementing particular model depends on delicate balance of opportunities and risks against the background of local characteristics of administrative subject. The dynamics of the social economic and infrastructural development of administrative subject can significantly affect effectiveness of model implementation. The objective set of characteristics was obtained for each model of laboratory service organization. Actually it is impossible to select particular model for specific administrative subject. Hence, scientific substantiation of "flexible" model is needed to implement.

A statistical approach for assessment of bronchodilator responsiveness in pulmonary function testing.

OBJECTIVE: Because published criteria for bronchodilator responsiveness are based on population variability and compare only the single best measures before and after intervention, we hypothesized that the variability of the FEV1 and FEV3 of each patient would better determine that patient's responsiveness. DESIGN AND INTERVENTIONS: Five 3-s forced expiratory maneuvers were used for each of 3 sequential portions of the study: baseline, after nebulized saline solution, and after nebulized albuterol. SETTING: Clinical pulmonary function laboratory in a county/university teaching hospital. PATIENTS: Fifty consecutive adult patients with obstruction referred for routine testing and thought to be able to complete the study. (The primary diagnoses were found to be equally divided between asthma, bronchitis, and emphysema; equal numbers had very severe, severe, moderate, mild, or minimal obstruction.) MEASUREMENTS AND RESULTS: The primary finding was that 36 patients were found to be responders (consistent and statistically significant FEV1 and FEV3 improvement after albuterol). The 14 identified as nonresponders would have been so categorized by all other published criteria. For assessing responsiveness, we found FEV3 measures preferable to vital capacity measures, because the latter depends on the duration of the maneuver. CONCLUSIONS: The percentage of responders identified is higher than recognized by any other published criteria. Most criteria would not have identified the responders with very severe or minimal airways obstruction.

Distribution and chemical composition of the toxic skin secretions from trunkfish (family Ostraciidae).

The components of the mucus skin secretions from eight species of trunkfish found in the coastal waters of Australia were analyzed by combined chemical ionization-gas chromatography mass spectrometry. The species investigated were Anoplacapros lenticularis, Aracana aurita, Aracana ornata, Lactoria fornasini, Ostracion cubicus, Rhinesomas reipublicae, Strophiurichthys inermis and Strophiurichthys robustus. The beta-substituted choline chloride esters (mainly acetoxy, but with some species having butyryloxy, valeryloxy and one species with caproyloxy) of palmitic acid were the predominant components in almost all cases. High concentrations of monounsaturated palmitic acid were present in S. inermis and S. robustus. Trace quantities of C14, C17 and C18 choline chloride esters were also detected as were compounds where the choline moiety was modified by addition of one extra carbon.

Isolation and structural elucidation of an ichthyocrinotoxin from the smooth trunkfish (Lactophrys triqueter Linnaeus).

An ichthyocrinotoxin has been isolated from the skin secretion of the smooth trunkfish, Lactophrys triqueter Linnaeus (family Ostraciidae). A crystalline toxin was isolated and identified as the choline chloride ester of palmitic acid. The toxin has a minimum lethal concentration of 2 ppm and an LC50 of 3.5 ppm using mosquito fish as the test organism. A trace quantity of the choline ester chloride of heptadecanoic acid was identified as a minor component of the toxin.

The utility for audit of manual and computerized problem-oriented medical record systems.

Objective assessment of the delivery of care requires an unambiguous record of all related events and decisions in the care process. Both the handwritten Problem-Oriented Medical Record (POMR) and its computerized successor, the Problem Oriented Medical Information System (PROMIS) have been designed to facilitate audit of care delivery. In this study, a national sample of physicians was asked to determine which of these two record systems best serves the function of audit. The study involves assessment of a sample of 69 matched pairs of patient records drawn from two different ward settings, one of which used the manual POMR, the other, PROMIS. No difference was perceived between the two records with respect to the reliability of information or the analytical reasoning of providers. Information in PROMIS records was judged to be slightly more thorough. The format of the manual record was judged better on the basis of conciseness, accessibility, and organization of record information.

Cerebrospinal fluid IgE and the diagnosis of cerebral cysticercosis.

Cerebral cysticercosis (CC) is a common cause of seizures and other central nervous system disorders in the Mexican-American population. The elevation of serum IgE in many parasitic diseases led us to study CSF and serum IgE in patients with CC diagnosed by pathologic, radiologic or clinical criteria. A paper disc radioimmunoassay, sensitive to 0.01 IU/ml, was used to measure CSF and serum IgE in 69 patients. The mean CSF IgE level in Mexicans with CC was 0.44 IU/ml compared to 0.28 IU/ml in Mexicans without CC and 0.07 IU/ml in non-Mexicans without CC.