Vitreoretinal Surgical Simulator as a training tool. RETINA, 24:231-236, 2004
7, Richard P, Golden, MD, Rohit Krishna, MD, and Peter W, DeBry. MD, Resident Glaucoma Surgical Training in United States, Joumal of The Royal Society of Medicine. Volume 14, Number 3, June 2005.
8, Simon K. Law, MD, Diana A, Tamboli, BS, Yvonne Ou, MD,w JoAnn A, Giaconi, MD and Joseph Caprioli, MD, Development of a Resident Training Module for Systematic Optic Disc Evaluation in Glaucoma. Joumal of Glaucoma,vol 00; No 00, 2011.
NHU C£U OAO TAG VE CH^N DOAN VA Dl£U TRj BENH V I E M N H I I M D O A N G SINH OUC OUdl CUA CAC CAN BO Y TE THUdC TRUNG T A M GIAO OUC U O D O N G XA HOI.
THANH PRO H A N O I N A M 2011
NGUYEN MINH QUANG - B^nh vi^n Da LiSu Hi Ndi, BUI VAN NHON, N G 6 V A N TOAN - Trwdng D^i hgc YHi Wpi TOM T A T
Muc tidu: Xic (^nh nhu ciu dio tio vi chin doin vi diiu tri bdnh vidm nhiim dwdng sinh due dudi cua cin bd y ti (CBYT) hiin dang cdng tic tei Trung tim Giio due Lao ddng Xi hdi (Trii 02) nSm 2011. Ddi twgng vi phwong phip nghidn cii'u: Nghidn cuv md ti cit ngang, phdi hryp giu-a phwang phip dinh tinh vi dInhluxTng. Titci 14 CBYT cua Trai 02 nSm 2011 dwcrc chpn de nghidn ciru Kit qui: Ty 1$ CBYT du^rc dio teo ban diu vi binh vidm nhi§m dwcmg sinh di^c dwdi (VNDSDD) la rit thip (7.1%) Trong 5 nSm 2006-2010 cd 71,4% CBYTdwQC dio t^o vi bdnh VNDSDD; tit ci la cac khda ngSn han vdi ndi dung chwa tot. Trinh dd chuyen mon ciia CBYT cdn yeu, chu yeu d muc dd tnjng binh va kem (ky ning quan ly hd sa, chu'a bdnh. tw van, truyen thdng - giio dijc sire khde vd ky ning khim benh mirc trung binh vi kim (100% vi 85.7%) Cd 85,7% CBYT cd nguyin vpng dwofc dio t$o thim vi benh viem nhiim dwdng sinh due dwdi. Kit lu$n: Ty 1^
CBYT dwqrc dio t$o ban diu ve benh VNDSDD la rat thip, trinh dp chuydn mdn cdn nhieu hen che Nhu ciu dio tao vi benh viem nhiSm dwdng sinh due dwdi cao,
Tir khda: Nhu du dio tio, bdnh VNDSDD. Trung tam Clio due Lao ddng Xa hdi
TRAINING NEEDS IN DIAGNOSIS AND TREATMENT OF LOWER SEXUAL TRACT INFECTION AMONG HEALTH STAFFS IN HANOI SOCIAL EDUCATION LABOR CENTRE IN 2011
SUMMARY
Objective: To Identify the training needs in diagnosis and treatment of lower sexual tract infections among health staffs In the Hanoi Soeila Education Labor Centre (Camp 02) in 2011, Subjects and Methods: A cmss-sectional descriptive study using both qualitative and quantitative methods was carried out in all 4 health staffs in the Camp 02 in 2011. Results: The proportion of health staff trained in diagnosis and treatment of lower sexual tract infections was very low (7.1%). In the last 5 years (2006-2010), 71,4% health staffs was trained in diagnosis and treatment of lower sexual tract infections with short training course and poor quality.The qualification of health staff was weak.100% had medium and low levels of skill in terms of managerial of record.
and health education. 85.7% had examination and diagnosis skills at tow and medium levels. 85,7% health
staffs wanted to have additional training. Conclusion:
Quality of health staff in diagnosis and treatment of lower sexual tract infections was limited and a majority of health staff needs to have additional training
Keywords: Training needs, lower sexual tract infections
DAT V A N Dt
Nhu c l u ddo lao Id nhung kiln Ihirc. Ihdi dd vd k9 ndng c i n thidt md ngu'di cdn bO y t l d n c6 d l hodn thdnh du'pc nhidm vu dirpc phdn cdng sau khi dd di/gv ddo tgo, Nhu c l u ddo tao la nhCrng khoang trdng v l cdc kiln thuc, thdi dp va ky ndng c i n so vdi cdc kiln thi>c, thdi dd vd ky ndng hien cd. Xdc i^nh nhu d u ddo tgo nhdm phdt hien ra nhlj'ng gi cdn Ihilu hMt de trang bj kiln thCfc, thai dp va thi,rc hdnh c i n thiel cho ngu'di hpc Tir dp ed thd xay di/ng mOt chu'ong Irinh ddo tao hieu qud vd mang tinh ipng dung eao.
Hidn nay, ngdnh Y t l dd ca c l u nhdn li/c y te hpp ly de kidn lodn dpi ngu edn bd y t l (CBYT) nhdm ndng cao chit Iu'png vd hieu qua cdc hoat ddng chdm sde si>c khde, dly manh viec dua cdn bO di ddo tgo ndng cao d nu'dc ngodi. khuyen khich CBYT ty tiic kinh phi di dao tgo ndng cao trinh dO chuydn mdn cua ban thdn [1]. Tuy nhidn, vdi cdc eo sd chdm sdc sCrc khde tuydn ban dau thi ddo tao lai cho CBYT cdn r l l Ihip. M^l sd nghien cCru g i n ddy cho thiy Igi 11 tinh du'pc Bd Y t l vd Quy ddn sd lidn hiep qudc hd trp cung nhu- tgi 4 bdnh vi$n Hd Ndi chi cd 1/3-2/3 CBYT du-pc ddo tgo it^nhat 1 lin k l tic luc ra tripdng, cd cdn bd cdng tdc gan 30 nam chu'a dypc ddo tgo lgi [9], [10]. Dde bidt, cdc CBYT tgi phdng y l l cua cdc Tmng tdm Gido dye Lao dpng Xd hdi cd r l l it CO hdi du'pe di ddo tgo ndng eao ndng l i ^ chuydn mdn nhu'ng hp Igi chju trdch nhidm khdm c h ^ b$nh cho nhO'ng phu nu> bdn ddm m i c nhilu b#nh nhilm InJng dudng sinh san. Nghidn ci>u ndy dupe tiin hdnh vdi mge tidu xdc d|nh "nhu du dio fgo ve viem nhiim dwdng sinh d^c dwdi cua cic cin bd y ti hi$n dang edng tic t^i Tnjng tim Giio due Lao dgng Xa hqi nim 2011'.
0 6 l TU'P'NG VA PHU'ONG P H A P NGHIEN CCFU 1. Ddi tup-ng nghien ciru: T i t ea CBYT dang cdng tdc tgi Phdng Y le Trgi 02 bao gdm: bdc sy, y s?, y td, dupe sy.
2. Phipcng phap nghien cii'u: Nghien cuu md ta c i t ngang, phoi hpp giO'a phuong phdp ^ n h tinh vd cRnh
Y HOC THUC HANH (806)-sd 2/2012
lui^ng, nhim xac i^nh nhu c l u ddo Igo cho cdc CBYT tgi Phdng Y te Trgi 02 ndm 2011, M i u nghien euu dupe chpn theo k? thugt chpn m l u todn bp- Tat ca 14 CBYT tham gia nghien cu'u deu dup'c t i l n hdnh phdng vln Iheo bp cau hdi, phdng van sdu va dupe quan sdt Iheo bang kilm ve cae ky ndng quan ly vd ehuyen mdn (dupe danh gia theo cdc muc dp lot. kha. tmng binh vd kem)
KET QUA
1. Thyc trgng ddo Igo v l quan ly va chuydn mdn cua cdc CBYT t^i Trgi 02
1.1. Dgc trung cd nhdn
CBYT tgi Trgi 02 cd tudi tir 24-48, trung binh Id 31,5 tudi, hau hit d dp ludi <40 (85,7%), Trong dP, ty le nam:
nu' Id ddng diu {1.1). CBYT Id y sy chilm ly 1$ cao nhlt (50%), tiep den la y td (21,4%) va bdc sy (14,3%). Ty 1$
duoc sy vd hp ly c6n thap (7,1%). Da sd CBYT ldm vi$c tgi Trgi 02 <5 nam, cP 3 can bp mdi nhdn cpng tdc dupe gin 1 ndm, Sd can bp lam vi$c Igi Trgi 02 trong khoang thdi gian 5-10 ndm vd 11-20 ndm luong ddi ddu nhau (lan lupl la 21,4% vd 28.6%) Khong cd cdn bd ndo Idm vi?c tgi day >20 nam, Phan ldn CBYT Trgi 02 dupe ddo tgo d cac tnj'dng trung cap (85,7%), cdn lgi dup'c ddo tgo a trudng dgi hpc (14,3%), Ba s i thdi gian ddo tgo ciia CBYT tir 2-3 nam (78,6%) Hau h i t CBYT Trgi 02 khong dupe ddo tgo ban d i u ve b§nh vi&m nhiem diFdng smh dye dudi (VNDSDD) (92,9%) Chi cd mdt CBYT cho bilt minh da dup-c ddo tgo v l b§nh VNDSDD khi cdn hoc tgi tm-dng dgi hpc (7,1%). CB'YT nay cho biet Trong qui Irlnh hoc t$p (g/ trwdng dai hoc. tdi cd dupe hoc ve mdt sd bdnh VNDSDD nhw Idu, giang mai, HIV/AIDS... trong khoang thai gian 2 tuan, Cung chi dupe tiip cin ven mdt so khU niem ca ban tren bit giang ly thuyit, viec thuc hinh tren lim sang thi rat it va khong dwf;rc true Sep tham gia diiu tri eie benh niy."
(Bic sy, nam, 16 nam cdng tic).
1.2. Thyc trang trinh dp quan 1;^ vd chuy§n mdn cua CBYT
Bang 1: Thyc trgng v l k? nang quan ly va nang lye chuydn mon ciia CBYT Trai 02 trong phdng vd dieu tri bgnh VNDSDD
Mi>cd$
K? ning quin ly h6 so si>c khoe K? ning k i i i m v i chSn d o i n
b$nh Ky n3ng chOa b^nh KJ ning t u van Ky ning TT-
GDSK T i n s6
T y l # T a n s 6
(%)
T y l §
(%)
T a n s 6 T y l 0 T a n s 6
T y l $
(%)
n n s 6 T y l e
(%)
Tot 0 0 0 0 0 0 0 0 0 0
K h i 0 0 2 14,3
0 0 0 0 0 0
Trung binh 4 28,6
7 50,0
8 57,1
11 78,6 4 28,6
Kem 10 71,4
5 35,7
6 42,9
3 21,4
10 71,4 Kj nang quan ly hd s c sire khde ciia hpc vien;
Phln Idn CBYT ed k? ndng d mire dd kdm (71,4%), cd 28,6% can bd cd ky ndng a mirc dp trung binh vd khong CO CBYT nao cd ky ndng a mirc dp khd tdt. Khi tim hilu v l vln de ndy, mpt sd CBYT cho bill: "Hd so bdnh in dupe de d phdng khim bdnh, ai dn thi Idn dd tim Ai
mudn tim hd sa thi bio mdt hoc vien tim. mdt luc la s§
liy dwpe. Vide niy cOng khdng cd ai chju trich nhiem ea' (Y sy, n(^, 11 nam cdng tic).
Ky ndng khdm vd chin dodn b?nh: 1/2 CBYT ed ky ndng d muc dp trung binh (50,0%), c^n bd cd k?
ndng d muc dd kdm chiem ty le ldn (35,7%). Chi ed 14,3% CBYT c6 ky ndng ndy d mirc dp kha, vd khong cd CBYT ndo cd k? ndng d mCre dp t i l Thyc trgng ndy dd t i n tgi nhilu ndm, mpt CBYT cho bilt: "Chung toi gip rit nhiiu khd khin trong khim vi chin doin bdnh, thiiu cic thiit bi y li thiit yiu. Xdt nghidm thi khdng diy du, chii yiu li xit nghidm soi twai vi test nhanh, cin bd xit nghidm thi chwa tuyin dwoc. Vi v$y. dung trwdc benh nhin chung tdi chu yiu chin doin di/a vio kinh nghidm li chinh, M0t khic, cic ddi twc^ng bdnh nhin & diy nhiiu khi khdng hp'p tic nen qui trinh khim chOa benh gip rit nhiiu khd khin" (Bic sy, nam, 3 nim cdng tac).
Ky ndng chua bfnh: Tat ea CB'YT deu c6 ky nang d mCre dp Irung binh, kdm (lin lupl Id 57,1% vd 42,9%).
Kh6ng cd CBYT ndo cd ky ndng d muc dp tdt, khd.
Trong qud Irinh dilu In, CBYT chu y l u dya vdo kiln thuc ty tich luy "Trong 19 nim cdng tic, toi ehO'a benh ehu yiu dwa vio kinh nghiem ciia minh, it khi co xit nghidm hd tn^. Doi khi benh nhan chi can cd biiu hidn tndu chiing cua hdnh vl du nhw ngira bd phin sinh due li tdi diiu trj khing sinh ngay. Thwdng thi trieu chiing cua bdnh nhin se giam" (Y sy, nO*, 19 ndm cong lac).
Ky nang t u v l n : Khoang 4/5 CBYT cd ky nang tu vln ve bdnh VNDSDD d mCpc dd trung binh (78,6%).
Khoang 1/5 CBYT cdn Igi ed ky nang d mue dp kem (21,4%). Khdng cd CBYT ndo eo ky ndng a muc khd, tdt, Mpt CBYT cho biet: "Trong qui trinh khim benh.
thinh thoang tdi cd tw van cho mdt vii benh nhan khi ho hoi, nhung cung it. Tdi chi khim benh, ki dan thuoc, roi sau do hp dwgc dwa xuong xwdng de hpc tap va cii tao"
(Ysy. nir, 11 nim cdng tie).
Ky nang truyin thdng - giao dye si>c khde (TT- GDSK): Phln Idn CBYT co ky nang TT-GDSK d muc dp kem (71,4%), Co 28,6% CBYT cdn Igi cd ky ndng ndy d mu'c dp trung binh. Khong eo CBYT ndo co ky ndng d mirc dp khd. tot Mpt sd CBYT cho bill: "Mac du dut^c sw hd tr<? cOa Ban giim doe Tr$i 02 nhwng ho$t ddng TT-GDSK cdn g§p rit nhiiu khd khin. Tat ci CBYT chwa timg tJupc hgc va tap huan ve eie ky nang ca ban cOa TT-GDSK. Ngay ca ban thin tdi, tuy du^fc giao phu trich mang TT-GDSK nhwng tdi khdng cd kinh nghidm cOng nhw khdng cd kien thirc trong ITnh vyc niy Cic phwang tidn vi tii lieu truyin thdng tgi diy thi rat h^n chi" (Ysy. nim, 9 nim cdng tie).
2. Xac djnh nhu clu dao tgo ciia CBYT 2.1. Cong tac dao t^o v l bfnh VNDSDD trong 5 nam gin day (2006-2010)
Trong vdng 5 ndm gin day (2006-2010). da so CBYT da dupe ddo tgo ve benh VNDSDD bao gdm dao tgo CO ban vd ddo tgo bd sung (chilm 71,4%), T i t ed khda ddo Igo ve benh VNDSDD eho CBYT diu Id cdc khda ngan hgn <6 thdng. Phln Idn Id cac khoa dao Igo dudi 2 Ihdng (70,0%). ehu y l u Id lgp huln tu- 2 ngay - 7 ngdy, Khdng cd khoa ddo tgo nao ddi hgn (>6 thang), Khi phdng v l n , mpt sd CBYT cho bilt: 'Da so chiing toi chi duvc tiep c$n vai cie khoa t$p huin ngan ngay. Cdn khda dio t$o dai h^n thi rat it khi dupe tham gia. Da so vi thiiu thdng tin ve cic khda dio t$o dai hgn va (hdf
Y HOC THUC HANH (806) - S6 2/2012
gian cd nhiiu h$n chi. Ci Trii 02 cd 14 cin bd, mdi budi trpc dn 4 ngwdi vi thi chung tdi phii thay nhau tn/c. nin khdng cd thdi gian di hpc dii ngif (Bdc s?, nam, 16 ndm cPng tdc),
Trong dP, npi dung cdc khda dd duoc ddo tgo lgi ddn trdi, khdng tdp trung, Chu y l u Id cdc khda tdp huln v l HIV/AIDS (71.4%), cdc npi dung ddo tgo khde chilm ty If Idn nhu so bp truyin nhilm nhi khoa, nghidp vy su phgm, phdng vd dilu trj lao phdi ,. Npi dung ddo tgo v l bfnh VNDSDD It duoc chu trpng: chi cd 21,4% edn bd dupe di tdp huln v l v l n d l ndy,
2.2. Nhu c l u ddo Igo Ih&m
• 06
• Khdng Biiu di 1 Dinh gii nhu du dio
tao Ihim ciia CBYT Trei 02
Oa sd CBYT d i u cd nguyfn vpng dup'c ddo Igo thfim (85,7%) Cd 2 CBYT khPng cd nguydn vpng di ddo tgo thdm, trong dP eP 1 CBYT dd Idn tudi sdp nghi huu vd 1 CBYT dang cd thai, Khi phdng v l n sdu m f l sd CB'YT cho bilt 'Chung Idi rit mong muin duxTC dl dio teo thim Niu cd tdp thi tdi s6 ding ky di hpc. Nhung do sd luxTng hoc vidn ddng, cdng vide nhiiu, m$t khic ngoii chuydn mdn chOng tdi cung phii tham gia quin 1^
hoc vidn cung quin giio Vi v$y chung tdi chwa thi di hpc ngay dup'c" (Bdc sy. nam, 16 nSm edng tdc), Ddy eung Id nguypn vpng cua da sd cae CBYT tgi ddy.
Bang 2. IMhO'ng nfi dung mong mudn duoc ddo tgo them cCia CBYT Trgi 02
N$i dung mong m u i n d i o t$D th^m D i o tgo len b i c hoc cao
hon N i n g cao ky n i n g ch^n
d o i n v i di^u tn b$nh VNDSDD D i o tao ki6n thuc ca b i n
v l I u v4n v i TT-GDSK N$i dunq d i o tgo k h i c
C6 T i n s 6
9 8
8 3
T y l f {%) 64,3 57,1 57,1 21,4
Khfinq T S n s 6
5 6
6 11
T y l f
(%)
3 5 7 42,9
42,9 78,6 Npi dung mong mudn duoc ddo Igo them nhilu nhlt la ddo Igo len bfc hpc cao hon (64.3%) Tiep d^n Id ndi dung ddo tgo ndng cao ky ndng khdm, chin dodn vd dilu tn bfnh; ddo Igo kiln thire ea ban v l I u v l n vd TT- GDSK v i bfnh VNDSDD dupe nhilu CBYT d l xult (57,1%). Oa sd y sy, y td ditQC phdng v l n d i u mong muin dupe hpe Idn 'tdi rit mong muin dux^ hoc Idn OT ning cao trinh dd chuydn mdn, dwg^ tiip c$n vdi cic phwong phip chin doin vi diiu tgrndf.
"Tdi mong muin duvc dio tgo thim vi chin doin vi diiu tri vi b$nh VNDSDD. tdt nhit li duvc dio tio theo hinh thirc 'cam tay chi vi$c" Nhw v$y tdi s§ tiip thu nhanh hon, tw tin vi vOng ving han trong diiu trj binh VNDSDD" (Y sy, nO-, 11 ndm edng tdc).
BAN L U A N
T i t ca cdc CBYT d i u dupe ddo tgo chinh quy, Irong do phln Idn dupe ddo tgo tic cdc trudng tnjng d p chilm ty Id 85,7%. cdn lgi CBYT dupe ddo Igo d Inrdng dgi hpc (14.3%). Dieu ndy chua phu hpp vdi co d u
nhdn Iyc y t l theo hpc v l n cua Bd Y t l ndm 2008 vdri 19 If CBYT cd Irlnh dd cao d i n g vd Irung d p chilm khodng 55%, dai hpc ehilm 26% [4]. Cd sy khdc bi|l ndy Id do dilu kifn ldm vife tgi Trgi 02 khP khdn, eo hfi phdt triln ndng cao Irlnh dp chuydn mdn vd nghidn cuu khoa hpc edn hgn ehl; ndn mde du Ban gidm dde Trgi 02 dd h i trp v l noi d vd 1 phln kinh t l nhung v l n chua thu hCil dupe CBYT cd Irlnh dd cao nhu bdc sJ?.
H l u h i t CBYT Trgi 02 khPng dupe ddo tgo ban diu v l cdc bdnh VNDSDD (92,9%). Chirng td edng tdc ddo Igo ban d i u v l d e bfnh VNOSDD cdn y l u vd chua dupe quan tdm dung mire; tgo ra khoang trlng v l kiln thirc, cOng nhu thye hdnh v l d i l u In cdc bfnh VNDSDD cho CBYT tgi ddy. Phln Idn kiln thue v l cdc bfnh VNDSDD cua CBYT dup'c lich luy tir ede khda ddo Igo ngin hgn, tdp huln, h f i thdo chuygn ngdnh vd lir qud trinh cdng tdc cua hp. Vi vdy kiln thuc cua CBYT khdng dupe h$ thdng, gdy nhilu khP khdn trong qud Irinh dilu tri bfnh VNOSDD cho bfnh nhdn tgi Trgi 02 Do dd, Irong ddo Igo ban d i u tai h f thdng cdc trudng ddo Igo nhdn lye y t l d n chu trpng han v l ddo tgo ban d i u cdc bfnh VNDSDD cho hpc vidn,
1. Thyc trgng tiinh d f quan ly vd chuydn mdn cua CBYT
K9 ndng qudn ly hd s c sire khde hpc vidn: Phln Idn CBYT cd k j ndng d muc d f kdm (71,4%) Chung td cdng tde qudn ly hd sa sue khde cdn chua dupe chii trpng. chua ddp irng dupe vdi ydu d u nhifm vy cOa CBYT CO sd, Oilu ndy luong ddi phii hpp vdi Bdo cdo Y t l Vift Nam ndm 2006: ty If CBYT dupe ddo tgo v l qudn ly cdn r i t it. anh hudng den hifu qua hogt dfng cua nhilu ea sd y t l (3] Nguyen nhdn cd t h i do chua ed sy quan Idm, cung nhy chua y IhCrc dupe l i m quan Irpng cua v l n d l ndy. H l u h i t ho sa bfnh dn cua hpc viSn khdng dupe md hda nen vif c tra cCru gfp nhilu khd khdn, thdng lin trong hd so khPng dupe cfp nhft. tinh trgng Ihit Igc hd so edn dien ra khd pho biln. Do dd d n ed sy quan Idm hon ICr nhi>ng ngudi quan ly cOng nhu tu cdc CBYT nai ddy.
Ky ndng khdm vd c h i n dodn t>fnh: >4/5 CBYTcd ky ndng d muc dd trung binh, kem (85.7%). Chung Id trinh d f chuydn mPn cua CBYT edn thap. Kit qua ndy cao han so vdi k i t qua nghi€n euu e h l l lupng ehuydn mdn cde bfnh vifn luyin dudi eua Bp Y t l ndm 2003:
trinh dd CBYT luyin dudi Ihip, kha ndng ddp irng vdi djch vy chdm sdc sue khde kdm vd ly If sai sdt trong chin dodn vd dilu In Id khd phd biln. Ndm 2003. chi c6 75% bfnh nhdn chuyin luyin tir bfnh vifn linh ho$c huyfn Idn bfnh vifn tmng uong dupe chin dodn di]ng d tuyin ea sd, Irong khi dd chi ed 59% bfnh nhdn ehuyin tuyin dupe chin dodn dung tir tuyen huyfn, 1^
If chin dodn sai d luyin dudi cdn r l l cao [2]. Da so CBYT thilu kiln thirc v l bfnh VNDSDD do khdng dup'c ddo Igo ban d i u ; ddng Ihdi qud trinh edp nhdt kiln thCpc, ndng eao k? ndng khdm chan dodn bfnh cho CBYT chua thudng xuydn, d e khda ddo tgo mdi dung d vifc t f p huln. gidi thifu ly thuyit ehir chua di sdu vao thi,rc hdnh. Mdt khdc, Igi Trgi 02 cdn thilu cdc xel nghigm h5 trp trong chin dodn. Trong khi dd. nhieu bfnh nhdn khdng hpp tdc, gilu bfnh, gia bfnh gay nhieu khd khdn.
Dilu ndy dd anh hudng trye tiep den ehat lupng khdm chin dodn bfnh tgi ddy.
Ky ndng chCra b f n h : T i t d CBYT deu cd ky ndng
62 Y HOC THUC HANH (806) - sO 2/20I^j;
a mirc dd tmng binh. kem. Chirng td, chuydn mdn cua CBYT cdn thilu vd y l u . K i t qua nay phu hap vdi nghien CCPU v l chat lupng chuydn mon cua cdc bfnh vifn tuyin dudi ndm 2003 vdi trinh do CBYT tuyin dudi thip, kha nang ddp Crng vdi djch vy cham sdc sire khde kdm, ty If sai sdt trong dieu In con phd biln [2]. Nguyen nhdn Id do kien Ihirc cua CBYT cdn hgn ehe, vifc c^p nhft kiln thdc chua thudng xuyen.
Ky ndng t u v l n : 4/5 CBYT cd ky ndng Iu v l n v l cac bfnh VNDSDD d mue dp trung binh (78,6%), cdn Igi cd ky ndng d mdc dp kdm (21,4%). Tuang ty kit qua cua tdc gid Nguyen Van Hiln: kha nang Iu v l n cua CBYT chua dip Crng dupe nhifm vy thye t l cua CBYT ca sd [8]. Tu v l n Id mpt qua Irinh quan trong trong dilu trj va phdng bfnh, luy nhiSn CBYT nai ddy khPng dupe ddo Igo ve ky nang ndy ndn vifc Ihyc hdnh gdp r i t nhilu kho khdn va con y l u k§m. Mdt khde, ddi luong bfnh nhan Id PNBD eai Igo nSn hg duac quan gido chdt che, vi vgy cP il Ihdi gian d l dupe t u v l n v l bfnh tgt cua minh. Do do c i n co k l hogeh tgp huln, ddo tgo phu hp'p cho CBYT Tr^i 02 v l ky ndng tu v l n .
Ky nfing truyin thong - gido dye sire khde: Phan Ion CBYT cd ky ndng TT-GDSK d mCrc dg kdm (71,4%) va chua dugc dao tgo v l v l n d l ndy. Kit qua Ihu dugc cao hon so vdi kit qua nghidn cCru eua tde gia Nguyen Van Hiln vdi ty if 44,9% CBYT chua duac ddo tgo kiln thiic vd ky ndng [8]. Chung td cong tde TT-GDSK ve bfnh VNOSDD (X>n y l u kdm. Hogt dgng TT-GDSK Igi Trgi 02 thyc hifn ehua deu, ehua xdy dyng dupe k l hogch cy thi. Tai lifu tmyen thong rit nghdo ndn, ngi dOng cdn hgn c h l chua di sdu v l bgnh VNDSDD.
Pliuang tifn laiyln thong, kmh phi cho hogt dgng truyin
^ n g tgi Trgi 02 cung rai Ihilu. Hifn nay tgi Trgi 02 Ihi loa
^ ^ Ihanh Id phuang tifn duy nhlt d l TT-GDSK, luong W ^ t qua nghien cCru cua tac gia Nguyen Van Hiln [8].
WK2. Xac dinh nhu c l u dao tao ciia CBYT
^ . 1 . Cdiig tdc ddo tgo v l ' b f n h VNDSDD trong 5
• " n a m g i n day (2006-2010)
Trong vong 5 ndm gin day (2006-2010), da s l CBYT da dupe dao tgo v l bfnh VNDSDD bao gdm dao Igo co ban vd ddo tao bd sung (71,4%). T i t ca khoa dao tgo v l bfnh VNDSDD eho CBYT d i u Id cae khoa ngin hgn <6 thing. Phln Idn Id cdc khoa dao tgo dudi 2 Ihdng (70,0%), tap huln lir 2-7 ngay Khdng cd khoa ddo tgo ndo dai hgn (>6 thdng). Kit qua nay luong l y kit qua nghign ciru cua tdc gia Nguyen Th| Ngpe Chi v l "Nhu cau ddo tgo cho khoi can bg xg tn bfnh vifn K" nam 2010 [7].
Chirng Id, cPng tac ddo tao Igi cho can bg hifn dang cdng tac tai Trgi 02 da duoc chu y vd de eao, tuy nhien thdi gian dao Igo lgi rat ngin. chua ddp irng dupe nhu c l u ciia nguPi hgc. Nguyen nhdn ehu y l u Id do kho khdn trong vifc tilp cgn vdi thong tin eua khpa hgc ddi hgn cua CBYT vi do dilu kif n cdng tac khd khdn: so lugng cdn bO y te il, thdi gian ldm vifc lien tyc, nhilu can bg tre Idm vifc xa gia dinh... Dilu nay da anh hudng Iryc tilp den tiogt ddng chuydn mon eiia CBYT tgi Trgi 02.
i Npi dung cdc khda ddo tgo lgi ddn trai, khong tdp tfurig. Chu y l u Id tfp huln ve HIV/AIDS (71,4%). Cdc nfi dung ddo Igo khdc chiem ty If Idn nhu so bg truyen i ^ m nhi khoa, nghif p vy su phgm, phdng vd dieu trj
^ ^ p i i o i . . . nhung chua phu hpp vdi thye t l cdng vifc cua CBYT lgi day. Trong khi dd. npt dung ddo Igo v l 2 S " ^ N e S D D II dupe ehCi Irpng. chi cd 21,4% edn bf
duoc dl Ifp huln v l v l n d l ndy, chua dap ung dupe nhu eau eua CBYT vd Ihyc le cdng vifc tgi Trgi 02 Tuong ty bdo cdo Ting quan chung nganh Y t l nam 2007: nhilu Idp ddo tgo ngin hgn thudng ed chu de trung Ifp nhilu, khdng ddp ung dugc nhu c l u thyc l l ; chit lupng ddo tgo chua cao, chu y l u giang dgy v l ly Ihuyll, it cd dilu kifn thye hdnh [5], {6] Nguyen nhan chu y i u do vifc xde d|nh nfi dung ddo tgo th6m cho CBYT chua duoc quan Idm vd chua phu hyp vdi Ihyc t l cdng vifc eua hg.
2.2. Nhu cdu dao tgo Ihem
Nhu c l u ddo tgo cua CBYT Id r l l ldn. Da sd CBYT diu cd nguyfn vpng dupe dao tgo thdm (85,7%). Ngi dung mong mudn dupe ddo tgo them nhilu nhil Id ddo tgo len bfc hge eao hon (64,3%), nhlt Id vdi dli tuang y sy, y td Dilu ndy phu hop vdi chu Inrang ddo tgo ciia Bf Y t l trong nhCrng ndm gan ddy. Nhdm tdng cudng bdc sy, dupe sy ldm vifc d luyin ca sd, Bg Y le chu Iruang luyen sinh hf lgp trung 4 ndm dudi cac hinh thdc thi tuyin, cu tuyin, ddo tgo dja ehi, tgo dilu kifn Ihuf n lyi cho y sy. duac sy dang cdng ldc Igi tuyen xa, huyfn dupe hpe len bfc dgi hgc d l sau khi tdt nghifp trd v l dja phuang nai dd eCr di hpe tilp tyc cdng tdc lot ban Bg Y te cho ph6p tiep luc ddo tgo y sy cho cac dja phuong ePn g§p kho khan v l nhdn Iyc y te. Tilp den Id nfi dung ddo Igo ndng cao ky ndng khdm, chin dodn va dilu tn bfnh; ddo tgo kiln thuc ea ban v l tu vln vd TT- GDSK ve cae bfnh VNOSDD dirvc nhilu CBYT d l xult (57,1%). Ody Id nhung ngi dung thiet thyc thyc t l vdi cong vif e hdng ngdy cua cdc CBYT tgi Trgi 02, cung la nhiing kiln thuc vd thyc hdnh con thilu vd can duyc bd sung cua CBYT. Vi vgy can eo nhij-ng bifn phdp ean Ihif p phu hyp tir eo quan quan ly d l dap ung duyc nhu eau ddo Igc cua eac CBYT tgi day.
KtJ LUAN
CBYT duoc dao tgo ban ddu v l bfnh VNDSDD la rat thap (7,1%). Trong 5 nam gan day (2006-2010), so CBYT dupe ddo tgo ve bfnh VNDSDD g i p 2,5 lin sd CBYT khong dupe ddo tgo. Tuy nhien, tat ea khoa ddo tgo diu Id cae khoa ngdn hgn (<6 Ihdng). Ngi dung dao tgo ngheo ndn, chu yeu ve HIV/AIDS (71,4%), trong khi ede bfnh VNDSDD khac ehua dupe ehCi Irgng.Trinh dg quan ly, chuyen mon eua CBYT cdn yeu, ehu y l u d mdc dg trung binh vd kem: ky nang quan iy hd so, ky ndng chu'a bfnh, ky ndng tu v l n , ky ndng TT-GDSK diu Id 100%; ky nang khdm chin doan bfnh Id 85,7%. Nhu c l u dao Igo cua CBYT la r l l Idn. Oa s l CBYT deu co nguyfn vgng dupe ddo tgo them (85.7%). Ngi dung duyc mong mudn dao tgo nhilu nhlt Id dao tgo len bgc hgc eao han, tilp den Id ddo tgo kiln thuc co ban ve tu v l n va TT-GDSK; dag tgo ndng eao ky ndng chin doan dilu tri bfnh VNDSDD.
TAI LI$U THAM K H A O
1. Chinh phii (2006). Quyit djnh cda Chinh phu sd 153/2006/QD-TTg: "Phe duy$t quy ho^ch tong the phit tnin hd thdng y ti Viet Nam giai do?n din nam 2010 va tim nhin den nam 2020". Hd Ngi.
2 Bd Y l l (2003). Cic kit qua nghiin cOv vi chit iuvng chuyen mdn a cic bdnh vi^n tuyin dwdi a Vidt Nam. Hgi thao v l Hudng dan chuyen mdn cua bfnh vifn tuyen trdn eho tuyin dudi ndm 2003, Ha Nfi.
3 Bg Y l l (2007). Bio cao Y te Vidt Nam 2006:
Cong bang, hieu qua, phit trien trong finh hlnh mdi.
^ V HOC THUC HANH (806) - S6 2/2012
NXB Y hgc, Hd Npi.
4 Bg Y t l (2009). Niin giim thing k§ y ti 2008, NXB Y hpc, Hd Ndi.
5. Bg Y te vd nhdm ddi tdc y t l (12/2009). Bio do Chung Tdng quan nginh y ti nSm 2009 vi Nhin Iwc y ti d Vidt Nam. Hd nfi, trang 114-115
6 Fields B, Due NX (2008). Health wori<foree training. Situation Analysis and Initial Identification of Opporiunities forProgram Support ADB. Vietnam.
7, Nguyin Thj Nggc Chl (2010), Nghidn cOv vi nhu ciu dio tao cho khoi cin bd xg trj bdnh vi$n K Lufn vdn tdt nghifp BSDK, Dgi hpc Y Hd Nfi, trang 32-33.
8. Nguyin Vdn Hiln (2004). Nghidn cuu ho$t ddng giio due stic khde tai mdt sd xa & mdt so huydn ding bing Bie Bd vi thif nghidm md hinh can thiep gi^o due siic khde, Lufn dn Tien s? y hge, Dgi hgc Y Hd Nfi, trang 108-110, 129.
9. LS Thj Kim Trang (2006). Nghidn ciru kiin thirc, thu'C hinh phwang phip da ki da vi nudi con bing sira me sdm til cic bi me t^i 4 b$nh vidn Hi Ndi nim 2005, Ludn vdn Thgc s? YTCC, Hd Nfi.
10.Save the Children/US (2005). Diiu tra cabin vi chim sdc sire khde bi me vi trd so sinh. Bio do dw in SC/US. Hd Nfi.
NGHIEN cuu CAC DAC TRUNG TR^N XA HINH CUA 0 T U Y £ N G I A P TRANG L A N H TINH VA AC TINH
T 6 M T A T :
Af(/c tidu: So sinh hlnh inh trdn xa hlnh vi dd tip tmng 1-131 trin tuyin giip cd u linh tinh vdi u ung thw tuyin giip treng nguydn phit. Ooi twgng, phwong phip- Nhdm U giip tr^ng linh tinh gdm 52 b^nh nhin (U tuyin. tuyin nang, U nang) Nhdm ung thw tuyin giip tring gdm 62 bdnh nhin.ghi hinh Scanner.SPECT. Kit qui vi kit lu$n: - Nhin lanh gip nhiiu nhit & ci 2 nhdm UTGTvi UGTIinh tinh (UTGT 92,5%, U GTlinh tinh 88%) - Nhin ndng Khdng g$p d d hai nhdm - Nhan im a ca hai nhdm vdi ty 1$ thip vi xip xi nhw nhau (16.9% vi 12%) - UTGT cd ho$t tinh phdng xe khdng deu (39,6%) Idn han UGT linh tinh (24%) UTGT phin lan khong dong diu d cic loai nhan.- Dp t$p trung 1-131 sau 2 gid d nhdm UTGT thap hon nhdm UGT linh tinh (TB: 12,7% UTGT, 15,4% UGTIinh tinh). tuy nhiin s y khic biet niy khong cd y nghTa thong ke vdi p>0,05.- Dg tip tmng 1-131 tai tuyin giip sau 24 gid a nhdm UTGT thap han nhdm UGT lanh tinh (Gii tq TBcCia UTGT la 28.53%, UGT lanh tinh la 40,02%), sw khic biet nay cd y nghTa thong ke vdi p<0,05.
Tw khda: Xa hinh tuyin giip, UTGT. UGT- SPECT.
SUMMARY:
Objective: Comparison of the radiation image and the 1-131 concentration in benign thyroid tumors with thyroid cancer primary. Subjective, method Benign tumor group: 52 Pt.Canceriumor62Pt Scanner,SPECT imaging. Results,conclusions: Cold nodules were inmost of two groups malign and benign tumor (malign 92 5%, benign, 88%).- Hot tumor were not seen in both gn}ups -Warm tumor in two groups with low and approximately the same (16.9% and 12%).- Thyroid tumors in the cancer group with irregular radioactive, pn}portion(39 6%) greater than benign tumor (24%).
Thyroid eaneer were mostly irregular in nodules types. - The concentration of 1-131 in the thyroid gland afterZ hours in group thynd cancer lower tumor benign groups (Thyroid cancer is 12.7%, benign tumor 15,4%), but this difference is not statistically significant with p> 0.05. 1- 131 concentration in the thynd gland after 24 hous in thyroid cancer group lower than benign tumor (Average of cancer group: 28 53 %, benign tumor 40 02 %) this difference is statistically significant with p <0.05.
Keywords: Radiationthe thyroid, UTGT, UGT- SPECT
PHAN SY AN, T R A N GIANG C H A U vi CS.
OAT VAN D^
D l chin dodn ung Ihu tuyin gidp trgng nguyen phdt,tr6n t h i gidi dd ed nhilu phuang phdp cfn Idm sdng dupe ung dyng d l nhu xdl nghif m t l bdo hpe, mfl bfnh hpe, d|nh lugng cdc hooc mdn tryc ydn gidp, cdc chit chi dilm khdi u (Tumor marker). Bdn cgnh dd cdn ed cdc phuang phdp sidu dm luyin gidp, ghi hinh tuyin gidp nhu chyp X quang ed ngyc, chyp elt Idp vi tinhi,epng hudng tii' hgt nhdn, dde bift ede phuang phap y hgc hgt nhdn ghi hinh (Ghi hlnh nhip nhdy phdng xg'Radio-Scintigraphy) nhu Scanner. Gamma-camera, SPECT, PET cho cde hinh anh cd dg nhgy. dg phan giai.df dfc hifu eao. Do dP dd phdt hifn dupe chinh xdc v| tri, kich thudckhdi lugng vd chuc nang cua cac khoi u trong tuyin giap. Dong thdi cdn linh dugc dg tgp tmng 1-131 d tuyin gidp.
O Vift Nam, m f l sd phuang phdp ghi hinh tuyen gidp bing nhip nhdy phdng xg cOng da dupe Phan Van Duyft ung dyng tir nhCrng nam 1980. Sau nay da ed nhieu phuang phdp hifn dgi duye nghien euu ung dyng rfng rdi vd hifu qua han.Tuy nhien cde edng trinh nghien cuu v l dde dilm Irdn nhip nhdy do (Scintigramme) cua u ldnh tinh (ULT) vd u de tinh (UAT) trong tuyin gidp trgng ehua nhilu.Trong nghien cCru ndy chung tdi tfp trung vdo mye tidu ehinh Id:
So sdnh hinh anh trgn xg hinh (Hay Scintigramme) vd d f If p trung 1-131 trdn tuyen gidp ed u Idnh tinh vdi u ung thu tuyin gidp trgng nguydn phdt.
D 6 | TU'Q'NG, PHUaNG PHAP NGHIEN CLFU Ddi t u v n g nghien ciru
Bao gdm 114 bfnh nhdn dupe chia thdnh 2 nhdm:
- Nhdm 1: Nhdm U gidp trgng(UGT) Idnh linh gom 52 bfnh nhdn, Cdc bfnh nhan dupe chin dodn vdi kit qua md bfnh hgc xac djnh la U gidp trgng lanh tinh (U tuyen, tuyin nang, U nang) tgi bfnh vifn K Hd Nfi.
- Nhdm 2 Nhdm ung thu tuyin gidp trgng(UTTGT) gdm 62 bfnh nhdn. Cdc bfnh nhan dupe chin dodn mo bfnh hge xdc djnh Id ung thu giap trgng tgi bfnh vien K Hd N$i.
Phuang phdp nghien CCFU.
Ghi hinh tuyin giap bing Rectilinear Scanner va SPECT vdi dupe ehat phdng xg tgp trung dge hifu vdo t l bao tuyin giap Id Nal-131 hogcOpc k i t qua tren xg hinh dya vdo s y phan bd cua mft dp hogt tinh phdng xg d l phdn logi nhan lm,ndng,lgnh,3g ding d i u . Odng thfli
Y HOC THirC HANH (806) - s6 2/2012
