TCNCYH Phg trUdng 80 (3C) - 2012
PHAN Hdi CUA SINH VIEN Vt BAI G I A N G LY T H U Y 6 T
MON DAO OLFC Y HQC TAI TRU'd'NG DAI HpC Y H A NOI
La T h u Hda, Le Thj T a i , N g u y i n Du'c Hinh Trwding D^i hgc YHi N0i
Nghiin cuu thuc hiin vin 666 luvt slnh vidn Y3 tai trwirng Dal hoc Y Hi N0I (DHYHNj. Nghiin dm nhim md ti y kiin phin hil cua slnh viin vi ndi dung, phuxmg phip day-hgc trong bit gling ly thuyit mdn Dao dire y hoc nim hoc 2011-2012. Kit qui cho thiy slnh vlin nhin thiy ndi dung day-hoc rit thich hiyp (97%), ip dung tit khi dl hgc lim sing (93.9%), vi rit cin thiit cho thi/c hinh nghi nghiip sau niy (98,7%). Phucrng phip thuyit trinh ngin cd minh hga, phin tich tlnh huing vi dit du hdi difgc cic giang viin thifc hi$n rit tit (trin 94%). Qiing vlin ndi rd, di hiiu (98.1%). slide trinh biy til (85,5%); khi ning sir dung vit li^u day hgc tit (96%). Tuy nhiin, giing viin cin ting cwdng thdi gian cho sinh vlin dit ciu hdi vi phin hit; Ihutmg xuyin Iwgng gii nhanh trong bit gling; ting kit ndi dung gling theo muc tliu hoc tip. Kit luin: ndi dung vi phuong phip dgy-hgc mdn DDYH tgi trwdng DHYHN dugic sinh viin dinh gii rit cao vi cd thi ip dgng tit trong thgc hinh nghi nghi^p.
Tu* khda: d^o dCrc y hpc, d^y/hpc tich c^c, sinh vien y.
I. DAT V A N B 6
Dgo ddc nghe y tCr xua din nay v l n ludn du'pc coi trpng khdng chi riSng d l i vdi can bp -trong nganh y ma cdn la m l i quan tam chung cua tpan xa hpi. Nam 1996, Chinh phu nude CHXHCN Vipt Nam ra Nghj quylt "Dinh hudng chiln lup'c cdng tac cham sdc va bac v$ silrc khde nhan dan din nam 2000 va 2020", nSu rd"... Tifiu chuin hda cac y6u c l u v l dgo dCrc va ve chuyen mdn del vdi nhu-ng ngudi hanh nghl Y - Du'dc"[2].
Nam 1999, H5i y hpc t h i gidi da"... khuyin nghj mgnh me Idi cSc Trudng Y trSn tdan t h i gidi rang dgy-hpc Dgo di>c y hpc va Quyin ccn ngu'di la khda hpc bat buOc trpng chuang trinh dap tgp" [13].
Dgy va hpc dgp diic y hpc tgi tn^dng Dgi hpc Y Ha Npi da dup'C tht,i'c hign ti> nhilu nam nay Chuong trinh hpc du'pc dilu chlnh theo tiJng thoi kj> de phii hpp vdi yiu cau cua nghl nghigp va si,r phat triln chung cua nin kinh te
- xa hOI. Nam hpc 2011 - 2012, chu'ang trinh COYH chd hg bac sT dupe c^p nhgl theo tai Ii0u cua T 6 chuc y t l t h i gidi nam 2010, glin cac chu d l : Ljch sir DDYH; Ly tudng dgo dl>c nghl Y; Nguyen ly ca bSn DDYH; Quan h|
chuyan mdn bac sT - b^nh nhan; Quan h§ bSc sT-dIng nghi$p; Quan hg chuyfin mdn giOa bac sT va xa hOi, cOng dong. Song song vdi vi$c c§p nh$t chi/ang trinh, cac giang viSn dgy mdn hpc nSy cOng duvc tap hu^n xay di;ng v$t li$u dgy-hpc, phu'ang phap dgy-hpc va lupng gia.
D l gdp phin nang cad chat lupng dSo tgo va chat lu'png giang vien, nghien CU'U du^c thg'c hi§n vdi myc tieu: Md ta y kiln phan hoi ciJa sinh vifen v l npi dung, phu'ang phdp dgy- hpc trpng bai giang \j thuyit mdn Dgo ai>c y hpc nam hpc 2011-2012.
II. B 6 | TU'P'NG V A PHU-aNG PHAP 1. Doi tirp'ng nghien cu>u
Sinh vien Y3 (hg bac sr) tru'dng DHYHN.
TCNCYH Phu trUdng 80 (3C) - 2012 2. Thiet ke nghien cu'u
Nghien cCru ngang md ta 3. C& mau
Z2 (1-0/2) X p X q 1,962 x 0,55 x 0,45
• = =78 (P X £)2 (0,55 X 0,2)2
n : cd mlu che nhdm sinh vidn
p : ty l§ sinh viSn du'pc dap tgo v l dgo due y hpc (lly kit qua tu' nghien ci>u md ta thg'c trgng cua Le Thu Hda va cOng sg' nam 2010) [4].
q = 1 - p = 0,45
a : miic y nghTa thong ke, lay d=0,05
Z2 (1-0/2) : gia trj Z thu dupe tO bang Z u'ng vdi gia tri a
£ : ty l# Sd vdi p, trdng nghien ciiu nay la 0,2
SCK dgng phu'ang phap chpn mlu chum, hp sc thilt ke la 2. C6 mau la 156 slnh vien cho mli bai giang. C& mSu chp nghien ci>u Id: 156x4 = 624 Sv
4. Cong cy nghien ciru: bp cau hdi tg' dlln cd hudng din 5. Xu' ly so ligu: SLP dgng phan mem Epidata va Stata
6. Dgo du'c trong nghien ci>u: Ddi tupng tham gia nghien cuu la tg' nguyen va dupe giai thich npi dung, phuang phap nghien ct>u... Thdng tin thu dupe se dup'c ma hda va chi su' dgng trong nghien cu'u.
III. K£T QUA
Chuang trinh mdn hpc gom 6 chd de, dup'c chia thdnh 4 bai, mdi bai 4 gid 1;^ thuyit Thdi gian ttivc hign nghien ciru tCr thang 11-12/2011.
1. Doi tuvng nghien cu'u. Cd 668 sinh vien Y3 tham gia phan hoi <j kiln Bang 1. Phan bo ty Ig phan hoi cua slnh vien cho mdi bai
Bai giang
Ljch SLP dgo due va dgo due y hpc. Ldi thi nghl nghigp Quan hg chuyen men bac sT-dong nghi#p. •
n 174 160
%
26.05 23.95 Quan hg giOa bac sT va xa hpi, cQng ding
Quan hg giua bac sT va bgnh nhan Nguyen 1^ cd ban cua dgc dire y hpc ,^Tlng
169 165 668
25.3 24.7 100
397
TCNCYH Phg truong 80 (30) - 2012
S i lupng sinh vian phan b i diu cho timg bai giang. Tit ca sinh viSn cd m|t tgi bull hpc diu tham gia phan h6i y kiln theo mlu phllu.
2. Y kiln cua slnh vlin vi n^i dung dgy-hpc
,i.,i unit. MTiir ii.n» km M B H P M H I H M M H M 98.2 Cfl,,!,. 1 1 1 ! ' Mill r llii, h l>,'|i v"t tlnh vicii I ".'j '
nr
mm mmmmmm 97.4
i I
(
' OrmtY'tLHifinty Uiijttlft'rl(IhiiilunliUlbi'iilivlvn • (>.i
mmmmmm 93,9
NviitunRb.iiB<j>)iic^i>ii>>i'i<ii"'>i<(' s n M H I H I B I B M I I W H p i 98,7 hjiih nitlii ni;ltnii llA i '
HI i'll f
Hinh 1. Nh$n xet cua sinh vien ve npi dung dgy-hpc
Nhan xet, Ty 1^ cao sinh vien dong y va ral dong y vd'i nhu'ng npi dung 6\j<yc hpc trong chu'O'ng trinh (97%); 93,9% sinh vien cho rang npi dung bai cd the ap dgng du'p-c trong thi^c hanh lam sang, va 98,7% sinh vien nhgn thay npi dung hpc DDYH la can thiet cho thyc hanh nghe nghiep trong tu'cng lai,
3. Y kien cua sinh vien ve phu-o-ng phap d^y-hpc
K -
. 5.2
77.1
H
•KhAnsdCnty
Hinh 2. PhiFong phap d^y-hpc cua giang vien. '^
Nh§n x6t: cSc gi^ng yign dS su- dgng nhOng phu-ang ph^p dgy-hgc tich eye trong mdn DDYH nhu- thuyit trinh ngan, phan tich tlnh hu6ng, d^t cdu hdi vd thao tu$n nhdm, d$c bi$t Ik sD dyng tinh huong trong cac bai giang (96,3%).
TCNCYH Phy trUdng 80 (3C) - 2012 4. Y kien cua sinh vien ve ky nang sy pham cua giang vien
GUng virnlrlnh b.^y tllilr rlur lo, n
' ' f
Hinh 3. Ky nang su* phgm cua giang vien.
Nhgn xet: Sinh vi&n d^nh gia cao ve ky nSng su* phgm cOa cac giang vien trong mdn hpc nay, va the hi§n si^ thich thu vdi cSc phu'ang phap dgy-hpc du'g'c giang vien su- dyng trong cac bai hpc (95,9%).
IV. BAN LUAN
Phan hoi ^ kien tCc ngu'd'i hpc Id mpt trong nhOng kenh thong tin quan trpng de danh gid va gdp phan nang cao chat lu'p'ng d^y va hpc. Nam 2010, Bp Giao dye vd ddo tgo da ra cdng vdn-Hu-dng din lay y* kien phan hdi tCf ngu'd'i hpc vg hogt dpng giang dgy cua giang vien" de "...xay dyng dpi ngu giang vien cd ph^m ch^t dgo di>c, liro-ng tdm nghe nghi$p va trinh dp chuyen mdn cao, phu'ang phdp va phong cdeh giang dgy ti6n tien, hi$n dgi.=.
TSng cu'd'ng tinh thin trach nhigm cOa ngu'd'i hpc vdi quyen Ip'i, nghTa vy hpc tgp, ren luygn cua ban than..."[1]. Hogt dpng lay y kien phan hoi cua sinh vien cho cac bdi giang da du'g'c thyc hign tgi tryang DHYHN tip hpc kjf II nam hpc 2010-2011. Tru'd'ng dd "Ban hanh quy
^jnh lay y kiln phan h6i cua ngu'di hgc ve hogt
vien khdng du-gc biet tru'd'C la se chpn vao ngdy ndo (mdi bai giang du-gc giang l^i 4 Ian chd cae Idp sinh vien Y3 khde nhau). Tat ca sinh vien du-gc thdng bao ngay tD" ddu buoi hpc vd viec den cudi gid' se du-gc phan hdi y kidn vd bai giang theo mdu phieu quy dinh.
Noi dung dgy - hgc
Tat cd cac bdi giang d6u cd myc tieu hpc tap trong sdch giao khoa vd dugc giang vien gidi thigu lai vdo dau gid' hpc (98.2%). Chu-ang trinh gom 6 chCi de co ban cho sinh vi§n cdc chuyen nganh thugc h$ bdc sT. Hau het sinh vien nhgn thdy npi dung dgy-hpc rat thich hgp (97%), cd the dp dgng tot khi di hgc lam sdng (93.9%), vd rat can thiet cho thyc hdnh nghe nghiep sau nay (98.7%). Day la nhu-ng y kien rat ddng mOng, chu'ang trinh mdn DDYH da khdng cdn Id ly thuySt dan thudn, md da cd I dpng giang dgy cua giang v(en"[5]. Theo dung nhOng lien hp chgt che vai lam sdng vd mang
quy djnh cua tryd'ng, cac giang vien dgy mdn i^j i,^] ich cho sinh vien.
DDYH dd dyg'c thdng bao tru'd'C vk vigc se .^^. ^ j ^ . . ^ ^^^^^^g y ^^^^ ^^^i gj^j^ gj^^ vien l^y y kiln phan h6i cua sinh vien v l bdi giang ^ ^ ^ ^ j^y_^^^^ ^ Y H vdi nhilu chCi d l bao 1)? thuyet trong chyang trinh. tuy nhien. giang ^ . ^ ^^^ ^^. ^x ^^ ^^.^ ^^^^ ^ . ^^^^ Y t l t h i 399
TCNCYH Phy trUdng 80 (30) - 2012 gidi dd khuyin cdo. Tgi Anh: Sy ding 9 vd tCr chli dilu trj; Giao tilp trong quan h$ ldm sdng; Bao m^t vd thyc hdnh ldm sdng tit; Qud trinh sinh sdn ngu'd'i; Di truyin hgc; QuyIn con ngu'di vd cdng bing trong chdm sdc sCcc khde...[7]. Tgi Canada; Bdo m$t vd quyIn md thdng tin; Chip thu$n cho thdm dd ho$c dilu trj; Thdng tin cho b$nh nhdn; Phdn b6 nguAn lye; Dgo dCfc trong nghien cu'u; Quan h$ bdc sT-b§nh nhdn; Cdl chit khdng dau...[10]. Tgi Australia vd New Zealand: LJ thuyit nIn tdng ca bdn v l dgo dCi'c y hgc; Cdc chO d l chuyfin sdu; Nguy§n lif' ca bdn cua dgo dCcc y hgc;
Thda thu§n dong y; Tdn trgng quyIn ty chu...
[6], Tgi Hoa Ky: Ljch si> y hgc vd dgo di>c y hgc; Nguydn ly dgo du'c y hgc; Lu^t phdp v l sdc khde; Sai lim y hpc; Tlnh chuySn nghi§p;
Quan hp bdc sT-b$nh nhdn; Chdm sdc sinh san; Chat lu'gng cuOc song...[8], [9]. Ngi dung dgy-hge E)DYH trong nam hpc nay khdng chl cgp nhUt vdi cac nu'dc tr§n t h i gidi md cdn djnh hu-ang cho sinh vien tam quan trpng vd nhu-ng tieu chuan dgo du'c trong thyc hdnh nghl nghigp.
Phu'ang phap dgy - hgc
Theo To chLFC y t l the gidi, dgy hpc DDYH cin kit hp'p nhilu phu'ang phdp: gidi thigu ngIn nhu-ng phan chinh; Bdi tgp ty dgc ngIn;
Nghien cdu tlnh huong: sinh vi6n thdo lu^n v l cdc vln d l trong tlnh hulng vd du-a ra nh§n xdt; ddng vai; dpng ndo; thao lu$n nhdm [12].
Nam 2002, tgi Khoa Y, Dgi hgc Sydney da khuyin nghj giang vign cin dp dyng nhilu phu-ang phdp trong dgy DDYH nhu- thuyit trinh ngdn, thdo lu$n tlnh hulng, dgy hgc dya tren vande... [11].
Din ndm 2004, tgi 91 thj-dng dgi hgc Y cua Hoa Ky vd Canada cho thiy phyo-ng phdp gidng BOYH chO ylu Id: bdi giang 1^ thuyit, thao lugn nhdm nho. ddng vai. video, phim, thdo lugn tinh huong [9].
Tgi tru-dng DHYHN, cdc gidng vi§n dd dp dyng nhilu phu'ang phdp dgy-hge. Ba phyang phdp; thuyit trinh ngIn cd minh hga, phdn tich tlnh hulng vd d$t cdu hdi du-g-c cdc gidng vien thyc hl$n rlt tit {trSn 94%). Ridng phyang phdp thdg lu$n nhdm theo tinh huong/chu de cdn cd khd khdn khdch quan do Idp hgc qud ddng (gin 200 sinh vidn) vd hgn chl v l thdi gian, khdng gian, ndn khd t l ehde thao ludn nhdm dudC d l y dO, do dd chu-a Idm hdi Idng du'vc tit cd sinh vidn (77.1%)
K^ ndng su> phgm cua giang vien Thi'dng DHYHN ludn khuyin khich cdc gidng vidn thyc hign phu'ang phdp dgy-hpc tich eye. Mil giang vidn cua tru'dng diu du'pc ddo tgo v l Phu'ang phdp su- phgm y hgc. Mpt trong nhO'ng ydu d u cua bdi gidng tot Id giang vidn phdi quan tdm din nhijng mong muon cOa ngu'di hgc nhu: bdi gidng cd MTHT; trinh bdy rd rdng. logic; hgc vien nghe rd gidng vien noi, nhin rd slide giang vidn trinh bdy; tgo ca hdi cho hgc vien tham gia tich eye trong gid giang...[4].
M^t s6 ky ndng su" phgm md cdc giang vien dd the hign trong bdi gidng nhu": giang vign ndi rd, d l hilu (98.1%), slide trinh bdy tit (85.5%); khd ndng si> dyng vdt li$u dgy hpc tit (96%). Tuy nhidn, cdc gidng vien cin tdng cydng thdi gian cho sinh vidn ddtcdu hdi vd phdn hii; ttiydng xuyen Iwgng gid nhanh trong bdi gidng; ting k i t nOi dung bdi giang theo myc tidu hgc t ^ .
Cdc phu-ang phdp dgy-hge trong chu-ang trinh du'g'c sinh vien danh gid r l t cao (95.9%) chdng td cdc gidng vidn dd cd khd rang su phgm tit, t l chdc buoi hpc higu qua va khuyin khich du-p'c sinh vidn tham gia tIch eye vdg bdi gidng.
V. K^T LUAN
N$i dung vd phu-ang phdp dgy-tigc m6n DDYH du-g-c ddnh gia cao. Cin tdng cwdng thdi gian cho sinh vien thao ludn nhdm vd dgt c3u
TCNCYH Phu trUdng 80 (3C) - 2012
hdi, cDng nhu ting kit bSi thee mgc tidu hpc t|p.
Cac chu de trong ndi dung dgy-hpc r l t thich hpp vdi sinh vien (97%), dp dgng t i t khi di hpc lam sang (93.g%), va r l t c i n thilt cho thg'c hanh nghe nghigp (98.7%).
Ba phuong phdp: thuyit trinh ngln cd minh hpa, phan tich tlnh hulng vi djit oSu hdi dupe cSc giang viSn thg'c hign r l t t i t (trdn 94%). Cin tdng cudng thap lu^n nhdm thep tinh hulng.
Ky nang su' phgm cua giang vien r l t tit.
Giang vien c i n ddnh them thdi gian d l sinh vien dgt cau hdi v^ ph^n hli; thudng xuyen lupng gid nhanh trang bdi gidng; ting kit n^i dung bai gidng thed MTHT.
TAI LIEU THAM K H A O 1. Bp Giao dgc va dao tgo. 2010. Cdng van so 2754/BGDDT-NGCBQLGD v l vigc hyang ddn lay y kiln phdn hoi ti> ngudi hpc v l hogt d|ng gidng dgy cOa giang vien. Ngay 20/5/2010.
2. Chinh phij Nu'O'c Cpng hda xa hpi chii nghta Vigt Nam, Nghj quyet. Djnh hudng chiln lupc cdng tac chdm sdc vd bao v$ si>c khde nhan dan tu nay den nam 2000 va 2020.
So 37-CP, ngdy 20/6/1996. Chinh phu. 32 3. Le Thu H6a, Nguyen OLPC Hinh, Le Thi Tai, 2010. Khdo sat y kiln sinh vien ve hogt dpng dgy-hpc mdn Dgp due y hpc tgi 8 tnrdng Dgi hpc Y cua Viet Nam. Tgp chi Nghien cuu y hpc. 71(6); 122 -127.
4. Nguyin Van Hien, Le Thu Hoa, Dinh H&u Dung va CS (2011). Phupng phdp dgy- hpc tich cgc (Danh cho hpc vien sau dgi hpc).
Nha xuat ban y hpc. 278 trang.
I t s . Tru'wng Dgi hpc Y Ha Npi. 2011.
^ k | djnh s6 3126/QD-DHYHN v l vl$c ban TdnTquy dinh lly )? kiln phan h i l cua ngudl
hpc v l hpgt aOng gidng dgy cua gidng vidn.
6. Asscclation of teachers of Ethics and Laur in Australia and New Zealand Medical schools (ATEAM), 2001. An ethics core curriculum for Australlaslan medical schools. ATEAM, The Medical Journal of Australia, 175; 205-210.
7. Teachers of medical ethics and law In UK medical schools (1998), Teaching and assessing ethics and law within medical educatlcn; a model fdrthe UK core curriculum.
Journal of Medical Ethics. 24.188-192.
8. DuBois M.J., and Burkemper J., 2002. Ethics education in US. Medical Schools;
A Study of Syllabi. Academic Medicine. 77 (5);
432 - 437.
9. Lehmann S.L., Kasoff D.W., Koch P., and Federman D.D., 2004. A Survey of Medical Ethics Education at U.S and Canadian Medical Schools. Academic Medicine. 79 (7)
;682 - 689.
10.Medical Council of Canda, 1999.
CLEO. Objective of the Cosideration of the Legal Ethical and Organization Aspects of the Practice of Medicine. Medical Coucii of Canada.
42 pages. http;//www.mcc.ca/objectives_
online/objectives.pl?lang=engllsh&loc=cleo.
11. University of Sydney IMedical Program, 2002. Integrated Clinical Attachments (ICAs). Tutor Handbook. Faculty of Medicine, The University of Sydney; 50 pages.
12. World Health Organization. Regional office for the Western Pacific, 2010.
Facilitators' guide for teaching medical ethics td undergraduate students In medical college in the South-East Asia region. World Health Organization, India, 38 pages.
IS.Worid IVIedical Association, 1999.
Resolution on the Inclusion of Medical Ethics and Human Rights in the Curriculum of Medical Schools World-Wide. 15st World Medical Assembly. 2 pages.
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TCNCYH Phy trUdng 80 (3C) - 2012
Summary
STUDENTS' FEEDBACK OF LECTURES OF MEDICAL ETHICS IN HANOI MEDICAL UNIVERSITY
The investigators have conducted interviews with 668 students in year 3 in HMU. Objective of the study was to find feedbacks from students of contents and teaching-learning methods in lectures of Medical Ethics in a academic year 2011-2012. The results showed that students commented: learning contents are very suitable (97%). can be applied in clinical wards (93.9%). and very useful to practice in a furture (98.7%,). Short presentations with illustration, cases analysis and making questions were done very well by teachers (over 94%). Lecturers' voice were clearly easy understanding (98.1%>), good presentaUons (85.5%); good using teaching materials (96%). So, teachers should set more time for students to make questions and fyedbacks; quick assessing in lessons and summary contents fit in learning otyjectives. In conclusion, contents and teaching-leeming methods of medical ethics In HMU were appreciated highly by students and could be good using In professional practice In a furture.
Key words: medical ethics, active teaching-learning, medical student.
BI^N CHLCNG HO H A P SAU P H A U T H U A T 6 BMNG
PULMONARY COMPLICATIONS AFTER ABDOMINAL SURGERY
Ph^m Quang Minh, Bui My H^nh, Nguyen HihJ Tu Trwdng D^i hQC Y Ha N$;
I. DAT V A N B^
Bien chu-ng hd hip td nguyen nhdn hdng d^u dan den tu- vong vd tdn t$t sau phSu thudt ndi chung vd phSu thudt 6 byng trdn ndi ridng.
M$c du (t du-gc ok c$p d^n han so vdi bi4n chu-ng tim mgch nhu-ng mu-c dO n$ng, thdi gian nim vi$n cOng nhu chi phi di^u tq lidn quan d^n biln ehdng hd hAp th§m chl cdn Idn han nhieu [1]. Ty 10 bien chu-ng hd hap sau mo rk thay d6i dao d$ng td 10-60% tCiy thuOc vdo tu-ng nghidn cdu, tdng tieu chuin chin dodn [3]. Chdc ndng hd hip sau mo bj anh hu-dng rlt nhieu bdi phu'ang phdp gdy md h6i sdc.
vj tri vd thdi gian phau thu|t, cdc b$nh cd sin cua b$nh nhan. M0t trong nhu-ng khd khdn nhIt khi nghidn cdu v^ biln chdng hd hip sau
md td tieu chuin chin dodn, h l u nhir chira cd tdc gid ndo du-a ra dipg^c tidu chuin chinh xdc vd du'g'c cdc nhd chuydn mdn chip thu^n.
Cho din nay vai ti^ cua cdc test ddnh gid chCrc ndng hd hip trong vi$c tien lug-ng bien chu-ng hd hip vd mdc dO ndng cua nd vSn cdn nhieu tranh lu$n tren the gidi. Myc tieu cua bdi ndy nh^m phdn tich. anh hu-dng cua gdy md va phlu thudt din chdc ndng hd hip; Bdn lu$n mOt s6 tidu chuIn chin dodn vd cdc khuy4n cdo dy phdng vd di4u trj biln chdng hd lilp sau m6.
II. sg* THAY 0 6 l CHU'C NANG H 6 HAP GAY LIEN QUAN D£N GAY ME
Gdy md gdy ra nh&ng thay doi Idn trdn