Y HOC VIET NAM THANG 7 - SO 1/2012
kien thdc chu'a tdt, thye hanh diing 88 (51,2%), thye hanh ehya dung 40 (18,3%), khoang tin cay 9 5 % OR = 4.642, x^ = 46.953, s y khac biet cd y nghTa thdng ke vdi p < 0,05 (p = 0,0001), cho thay ve thye hanh d y phdng benh ung thu' gan, ngu'di cd kien thye tdt chiTa chac ed thye hanh hoan toan diing het.
V. KET LUAN
- Ngu'di dan d thanh thi ed kien thye tdt 73,8%, thye hanh diing 58,5%, cao hdn so vdi ngydi dan d ndng thdn cd kien thdc tdt 60, 5%, thye hanh dung 51,3%. Ngydi dp tudi t y 20 - 40 cd kien thdc tdt 74, 6 % , cao hdn ngydi dd tuoi tir 4 1 - 60 cd kien thdc tdt 70,5%, nhyng thye hanh diing ed 4 4 , 2 % , thap hdn vdi ngydi dp tudi 4 1 - 60 ed thu'e hanh diing la 6 5 % .
- Kien thye ngu'di dan hieu ve yeu t d nguy eP gay ung thiT gan kha cao chiem 55,64%, nhyng hieu ve d y phdng benh ung t h y gan thi tdt hdn la 78,46%, hieu ehya diing yeu t d nguy cd va d y phdng benh ung t h y gan ehiem 46,36%
va 21,54%.
Thye hanh diing ve phat hien sdm d y phdng benh gan 83,85%
TAI U | U THAAA KHAO
1, Nguyin Chan Hung (1997), Tim hieu benh ung thu, NXBTPHCM, Trang 155 - 156.
2 Doan HCu Ngh!( 2008), Ung thUgan nguyen phat, Chan doan va dieu tn ung thU, NXB, Y Hoc, Trang 236- 137,
3. Nguyen Thi NgpcToan(2001), NhUng dieu can biet ve ung thU va each phong ngira, NXB Phu niT, Trang 74 -78.
4 Huynh Quyet Thang (2004), Danh gia tinh hinh ung thy tai Can ThO 02 nam 2002 - 2003, Y Hpc Thanh Pho HCM, Y Hoc Thanh Phd HCM, Phu ban tap 12, DHYDTPHCM, Trang 1- 18,1- 10, 5, Huynh Quyet Thang (2009), Ghi nhan ung thU
quan the tai Can Thd nam 2005 - 2007, Y Hoc Thanh Pho HCM, tap 13, Phu ban so 05, DHYDTPHCM, Trang 43- 52,
6. Nguyen Van Vy, Nguyen Lam Hoa va CS (2008), Ket qua ghi nhan ung thU quan the tai Hai Phong nam 2006 - 2007, Y Hpc Thanh Pho HCM, Phu ban tap 08, so' 04, DHYDTPHCM, Trang 1-18.
NGUON NHAN LOC Y TE TAI TINH HOA BINH VA DlTBAO NHU CAU NHAN LOC DEN NAM 2015
T O M T A T
Muc dich: Md ta thye trang nguon nhan lyc y te tai Hoa Binh nam 2010 va dy bao nhu cau ngudn nhan lyc y te giai doan 2012- 2015. PhiCrfng phap: mo ta cat ngang. Thu thap thong bn nhan lyc y te nam 2010, Ket qua: nam 2010 tinh Hda Binh co tdng so nhan vien y te cong lap la 3051 ngydi, (ehiem 88,1% nhan lyc tham gia hoat dong y te ciia ca tinh); so nhan lyc y t^ t y nhan ed giay phep hanh nghe la 412 ngudi (ehiem 11,9%). Can bo y te tai Hoa Binh con thieu:
CBYT/10000 dan la 43,7 (tfnh neng y te cong la 38,5), Ty le BS/10000 dan la 6,7; (tt'nh neng y te cong la 6,4);' ty le DSDH/10000 dan la 0,7 (tfnh neng y te cong la 0,4), Theo miTc do tang dan sd, du' bao giai doan 2012-2015 can bd sung 73-95 BS va 68-72 DSDH. Ket luan: can co cac bien phap quan ly va cac chi'nh sach dai'ngp thye te de thu hiit cae bac sT, dypc sT CO trinh dp dai hoe va cao hOn. Xay dyng ke hoach
*Sdy te'Hoa Binh, **TrUdng Dai hgc YHa Noi Phan bien khoa hgc: PGS.TS. Ph^m Huy Hiln Hao
Bui Thj D u y e n * , Nguyen Phu'dng H o a * *
dao tao va dao tao lai, de giai quyet van de thieu hut va dap dng nhu eau den nam 2015,
Tu* khoa: nhan lu'c y te, dii bao nhu cau
SUMMARY
HUMAN RESOURCES IN HOA BINH PROVINCE IN 2010 AND FORECAST DEMAND FOR 2012-2015
Objectives: To describe the status of human resources in Hoa Binh in 2010 and forecast demand for human resources period 2012-2015, Methods: A cross-sectional study. Collect informabon of the health personnel in 2010. Results: in 2010 Hoa Binh has total public health staff is 3,051 people (at 88.1% of the staff involved in the health of the province);
number of private medical personnel licensed practice w/as 412 people (11.9%). Lack of health staff in Hoa
Y HOC VIET NAM THANG 7 - SO 1/2012
Bang3. Nhan lu'c benh vien da khoa tinh Hoa Binh nam 2010 TT
A 1 2 3 B 1 2 3 C 1 2 3
Cac chi so Chung Thonq tin chunq So qii/cinq benh So nhan vien y te Ty le ngL/di/giLtdng benh Cd cau bo phan
Ty le nhan vien bo phan lam sanq Ty le nhan vien bp phan can lam sang va ditdc
Ty le nhan vien bo phan quan ly, hanh chinh Cq cau chuyen mon
Ty ie BS/chCrc danh chuyen mon y te khac (DD, HS, CTV)
Ty ie DSOH/BS Ty ie DSDH/DSTH
Dinh mu'c theo TTLTOS
520 650-728 1,25 - 1,40
60 - 657o 22 - 15%
18 - 20%
0,33 - 0,29 0,125 ' 0,07 0,5 - 0,4
Thu'e te hien co
530 Bien che
360 0,68 69,1%
16, 7%
14,2%
0,46 0,043 0,22
Tong conq 531 1,00 64,8%
16,7%
18,5%
0,287 0,043 0,16 Benh vien da khoa tinh Hda Binh la benh
vien da khoa hang 2 trye thudc Sd y te. Nam 2010, Benh vien cd 530 giydng benh thye ke, vdi 531 nhan vien y te (360 bien che, 171 hdp dong). Trong dd ed 344 nhan vien tai cac khoa lam sang, 89 ngydi thudc cac khoa can lam sang va dyde, 98 ngydi bd phan quan ly, hanh chinh.
Ty le CBYT/giydng benh la 1,00 ehya dat yeu cau quy dinh tai TTLT 08 (1,25 - 1,40).
Ve ed cau nhan lye y te ehia cho eac bd phan: ty le nhan vien y te bp phan lam sang dat 64,8% so vdi yeu eau (60 - 6 5 % ) ; ty le nhan vien bd phan can lam sang va du'dc dat 16,7%
so vdi yeu cau (22 - 15%); ty le nhan vien bp
phan quan ly, hanh chi'nh dat 18,5% so vdi yeu cau (18 - 20%).
Ve cd cau phan theo chdc danh ehuyen mon:
ty le bac sT/chdc danh ehuyen mdn y te khac (dieu dudng, hp sinh va kT thuat vien) la 0,287 chya dat so vdi yeu eau (0,33 - 0,29); ty le dyde sT dai hpc/bac si la 0,043 chua dat so vdi yeu cau (0,125 - 0,07); ty le dyp'e sT dai hpe/dyde sT trung hoc la 0,16 thap hdn quy dmh (0,5 - 0,4).
Nam 2010, sd lu'dng can bd dang di hoc nang cao trinh dp chuyen mdn y la 47 ngydi, trong dd cd 06 ngydi hoc sau dai hoc, 30 ngu'di hpc dai hpc. Khdng ed can bp du'dc nao dang hpc nang cao trinh dp chuyen mdn.
Bang 4. Nhan lu'c thuoc he diT phong tuyen TT
A 1 2 3 B 1 2 3 C 1 2
Cac chi so chunq Ten dqn vi TT phong chong HIV/AIDS TT phong chong BXH TT CSSKSS CO cau bo phan Chuyen mon Xet nghiem Ouan iy, hanh chinh CO cau chuven mon Bac SI
Kv thuat vien xet nqhiem
tinh
Dinh mu'c theo TTLTOS
30 40 30 72-78%
24%
18-24%
> 36%
> 24%
Thu'e te hien co
29 33 30 60,9%
13%
26,1%
31,5%
5,4%
(So lieu tinh trung binh cho 3 trung tam)
Cd eau ngudn nhan lyc theo ed cau chuyen mdn edn nhieu bat cap, thieu hdp ly. Ty le bac sT chi la 31,5% chu'a dat so vdi quy djnh ( > 36%); ty le KTV xet nghiem la 5,4% thieu so vdi quy djnh (>
24%),
Y HOC VIET NAM THANG 7 - SO 1/2012 DiT bao nhu cau nhan lu'c y, du'dc tai tinh
Hoa Binh den nam 2 0 1 5
De dam bao nhiem vu eham sdc sdc khde cho nhan dan trong tinh thi viec d y bao nhu eau ngudn lyc y, dyde eua tinh Hda Binh la can thiet.
Nhu cau ve sd Iddng: Ket qua nghien cdu thye trang nhan lye y te eua Hda Binh nam 2010 cho thay cd sy thieu hut nhan lye ed trinh dp ehuyen mdn nhy bae sT, dyde sT dai hpc (DSDH), ty le BS/10000 dan la 6,7; ty le DSOH/10000 dan la 0,7.
Theo d y bao dan sd nam 2015 tinh Hda Binh se ed khoang 829.000 ngu'di [6],
Sd lu'dng BS, DSDH can bd sung theo mdc do tang dan sd tfnh ehung (bao gdm ca y te cdng va t y nhan) den nam 2015. s y dung cdng thdc:
N - (AxB)/10.000 - (C-D)
+ sd lu'dng BS can bo sung la: 73 -95 BS (vdi A= 7,57; B2on= 800.000; B2015 = 829.000;
C= 533; D = 0).
-^ Sd lydng DSDH can bo sung la; 68 -72 DSDH (vdi 'A= 1,5; 82011= 800.000; 82015=
829.000; C= 52; D= 0).
IV. BAN LUic^N
1. Sd Iddng nhan lu'c y tenoi chung:
Ty le CBYT/10000 dan cua tinh Hda Binh la 43,7; trong dd trong dd ty le BS/10000 dan la 6,7; DSDH/10000 dan la 0,7. Ty CBYT/IOOOO dan va BS/IOOOO dan chu'a dat chi tieu chien \\icic ciia nganh de ra la cd 7 BS va 1 DSDH/10000 dan vao nam 2010. Ty le CBYT/IOOOO dan va BS/10000 dan deu cao hdn ty le CBrT/lOOOO dan va BS/lOOOO dan cua tinh Phu Tho (33,98 va 5,96), nhyng ty le DSDH/10000 dan lai thap hdn tinh Phil Tho (0,79) [ 4 ] .
Neu tinh rieng khdi y te cdng thi ty le CBYT/10000 la 38,5; ty le BS/10000 dan la 6,4;
ty le DSDH/10000 dan la 0,4 cao hdn ty le DSOH/10000 dan ciia Ha Ndi (0,021). Ty Ie CBYT/10000 cao hdn ty le chung ciia ca nyde (34,7). Tuy nhien, ty le BS/10000 dan va DSDH/10000 dan lai thap hdn b/ le chung ciia ca nydc (6,5 va 1,2) [ 2 ] .
Nam 2010, benh vien da khoa tinh Hda Binh vdi 530 giu'dng benh, de dam bad cdng viee ciia benh vien, theo quy dinh cua nha nyde tai Thong tu' 08 thii nhan lyc benh vien can phai dat t y 663 - 742 ngu'di. Nhtf vay, hien tai nhan lyc BVOK tinh Hda Binh thieu 132 - 211 ngydi (dat 71,5% - 80,1%). Benh vien da khoa tinh Quang Ninh vdi
quy md 764 giydng benh nam 2009 cdn thieu 368 - 487 ngydi (dat 54,9% - 61,5%) [ 5 ] .
Ve tdng the thi BVDK tfnh Hda Binh cdn thieu bien che can bd y te. Cd cau NNL theo chuyen mdn ty le BS/chdc danh chuyen mdn y te khac la 0,287, thieu so vdi yeu cau (0,29 - 0,33) nhyng cao hdn chi so nay dat dyde tai BVDK Quang Ninh (0,27) [ 5 ] . Sd lydng nhan lyc BVOK tinh Hda Binh cdn thieu, ddi ngQ BS, DS ehya dii theo quy dmh. Sd lypng BS cd trinh do sau dai hoc tai BV ehiem 41,5%. Viec dao tao nang cao trinh dp cho can bd da dyde chu trong. Nam 2010, sd lu'dng can bd dang di hpc nang cao trinh dp chuyen mdn y la 47 ngydi. Benh vien mdi chi cd 03 DSCKI va 01 DSOH, tuy nhien khdng ed can bd dyde nao dang hoc nang cao trinh do ehuyen mdn trong nhffng nam vda qua.
2. Nhu cau nhan lu'c y t e tai Hoa Binh den nam 2 0 1 5
Nhu eau ve sd lydng BS (73-95 BS) mdi chi tfnh dya tren mdc dp tang dan sd chung ciia toan tinh. Chya nghien cyu sau hdn de xac dinh nhu cau cy the eua tdng ddn vi y te.
Nhu eau ve sd lypng DSOH ngoai viec tinh nhu cau dya tren myc dp tang dan so (68-72 DSOH).
Theo quan diem ehi dao eua Oang va Nha nyde ta tai Nghi quyet 46-NQ/TW ciia Bd Chfnh tri ve edng tac bao ve, eham sdc va nang cao sdc khoe nhan dan trong tinh hinh mdi da neu ro;
"Nghe y la mdt nghe dae biet, can dyde tuyen chpn, dao tao, sd dung va dai ngo dae biet. Moi can bd, nhan vien y te phai khdng ngdng nang cao dao ddc nghe nghiep va nang lyc chuyen mdn, xyng dang vdi sy tdn vinh eiia xa hdi, thye hien Idi day eua Chii tich Hd Chf Minh "Ngu'di thay thudc gidi ddng thdi phai la ngydi me hien".
Tuy nhien, viec thu hiit va s d dung lao ddng lai chu'a cd nhu'ng chinh sach "dae biet". Cac che dd dai ngd ddi vdi nganh y te ve cd ban cung chu'a cd gi khae biet hdn so vdi cac nganh khae, van theo quy dinh ciia nha nyde ve thu nhap, ve ngach, bae lu'dng trong cac ddn vi sy nghiep.
Trong khi dd, nhieu benh vien dan lap, phdng kham tu' nhan, eac cdng ty du'dc d eac thanh phd Idn ludn rpng md de ddn chao cac BS, DSDH vdi myc thu nhap thda dang.
V. KET LUAN
Ty le can bd y te tai Hda Binh cdn thieu:
CBYT/10000 dan la 43,7 (tfnh rieng y te cdng la 38,5). Ty le BS/10000 dan la 6,7; (tinh rieng y te
65
Y HOC VIET NAM THANG 7 - SO 1/2012
edng la 6,4); ty le DSOH/10000 dan la 0,7 (tfnh rieng y te edng la 0,4).
Theo mdc dd tang dan so, giai doan 2012- 2015 can bd sung 73-95 BS va 68-72 DSOH.
Hoa Binh can ed cac bien phap quan ly va cae chfnh sach dai ngd thye te de thu hiit eac bae sT, dyde sT cd trinh do, chat lypng ve cdng tae tai eac ddn vi y te cdng. Xay dyng ke hoaeh dao tao va dao tao lai, dao tao nang cao can bd hien CO de giai quyet van de thieu hut va dap dng nhu cau den nam 2015.
TAI UEU THAM KHAO
1. Bo Noi vu - Bo Y te (2005), Thong tUlien tich so O8/2607/TTLT-BYT-BNV HUdng dan dmh mdc bien che sU nghiep trong cac cdsdy te nha nude
Bg Y te & nhom dol tac y te (2009), Nhan lUcy ted Viet Nam, Bao cao chung tong quan nganh y te nam 2009.
Nien giam thong ke tinh Hoa Binh (2010), Nha xuat ban thong ke,
Nguyen Hong Stfn (2008), Nghien cub thUc trang nguon nhan luc y, dUdc va dU bao nhu cau nhan iuc y, dUdc tai tinh Phu Tho giai doan 2010- 2015, Luan van thac sT du'dc hoc, TrUcJng Dai hoc duoc Ha N61.
Vo Van Tai (2009), ThUc trang nguon nhan lUc va mot sdyeu td lien quan den dong lUc iam viec cua bac si binh vien da khoa tinh Quang Ninh, nam 2009 - 2010, Luan van thac si quan ly benh vien, TrUdng Oat hoc Y te cong cong.
Tong cue thong ke (2011), DU bao dan so Viet Nam 2009-2049, Nha xuat ban Ha Noi, tr. 52.
DANH GIA MUfC DO DE KHANG KHANG SINH CUA CAC TAG NHAN GAY N H I I M TRUNG M A U TAI BENH VIEN BACH IVIAI - NAM 2011
Boan Mar Phu'dng*, Nguyen Quoc Anh*
TOM TAT
Nhiem trung mau la mot trong nhu'ng nguyen nhan chu yeu gay benh tat va iii vong. Xac dinh mire do de khang khang smh ciia vi khuan gay nhiem triing mau giup cac bac sy lam sang co hUcing dieu tn dung dan, han che ty le tir vong cho benh nhan. Muc tieu nghien cii'u: Oanh gia mire dp de khang khang sinh ciia cac VI khuan gay nhiem trung mau benh vien Bach Mai. DOI tu'dng va phu'dng phap nghien cii'u: 957 chiing vi khuan phan lap 6 benh nhan nhiem triing mau, ty 01/01/2011 den 31/12/2011, tai benh vien Bach Mai. Xac dinh mdc do de khang khang smh ciia vi khuan bang phu'dng phap khoanh giay khang smh khuech tan Kirby - Bauer. Ket qua dyde xir ly theo chUdng trinh WHONET 5.4. Ket qua va ket luan: Ty le E. coll de khang amoxicillin-Facid clavunalic la 28,6%; ceftazidime 48,4%; gentamicin 41,0%;
ciprofloxacin 46,6%; nhay cam v6i cac khang sinh earbapenem 100%; sinh ESBL [+]38,3%. Ty le K.
pneumoniae sinh ESBL [+] 13,7%. Ty le A, baumannii de khang ceftazidime 72,7%; earbapenem la 60,6%;
amikacin 65,6%; ciprofloxacin 66,7%; minocycline 9,1%; colisbn 6,7%; ty le toan khang (PDAB) 57,1%.
Ty le S. aureus khang methicilline (MRSA) 28,1%.
•* Benh vien Bach Mai
Phan bien khoa hgc: PGS.TS. Nguyen Gia Binh
ABSTRACTS
ANTIBIOTIC RESISTANCE IN BACTEREMIA AGENTS AT BACH MAI HOSPITAL, IN 2011 Bacteremia is one of the main reasons causing disease and death. Determine the rate of antibiotic resistance help doctors with the nght treatments, limit mortality for patients. The objectives: Assessing the antibiotic resistance of bacteria causing bacteremia at Baeh Mai hospital. Subjects and methods: 957 bactena strains isolated of sepbcemia patients, from 01/01/2011 to 31/12/2011, at Bach Mai hospital.
Determination of the antibiotic resistance by disk diffusion Kirby Bauer method. Results and conclusions: The rate of £ coll resistant to amoxicillin -i- clavunalic acid was 28.6%; to ceftazidime was 48.4%; to gentamicin was 41.0%; to ciprofloxadn was 46.6%; the rate of B. coli sensitive to carbapenems were 100%; ESBL [+] producing was 38.3%. The rate of K pneumoniae ESBL produced [-I-]
was 13.7%. The rate of A. baumannii resistant to ceftazidime was 72.7%, earbapenem was 60.6%;
amikacin was 65.6%, ciprofloxacin was 66.7%, minocycline was 9.1%, colistin was 6.7%. The rate of pan drug resistance A. baumannii (PDAQ) was 57.1%.
The rate of methicilline resistance 5. aureus (MRSA) was 28.1%.
