VIETNAM MEDICAL JOURNAL N°1 . APRIL - 2017
NGHIEN Ciru KET QUA DIEU TRI CAN THIEP NOI MACH GIAN T ! N H MACH TINH BANG icY THUAT SANDWICH
KET HOT COIL vA KEO TAI BENH VIEN BACH MAI
Le Van Khanh*, Bach Nguyin Tra My**, Nguyen Xuan Hien*
T O M TAT
Muc tieu: Danh gia ket qua di^u trj gian tTnh mach tinh bang ky thuat sandwich ket hpp coil va bOm keo. Doi tu'dng va phu'Ong phap nghien cu'u: 30 benh nhan dUpc chan doan va can thiep thanh cong gian tinh mach tinh tai Benh vien Bach Mai tff 12/2014 den 6/2016, cac benli nhan dUpc kham lam sang, lam tinh djch do, sieu am d thdi diem tru'dc nut mach va sau niit mach 6 thang. Ket qua: Do tuoi trung binh 22,6 tuoi, ly do vao vien chii yeu la dau tffe biu chiem 76,7%. Ket qua sau 6 thang dieu tn tat ca benh nhan deu giam trieu ehffng dau, ttiang diem dau Vas giam tff 6,7 diem xuong 1,2 sau 6 thang, p<0,05. MSt dp tinh trung tang len tff 10 trieu/ml len 21 tneu/ml, dp di dpng tinh triJng tang tff 27% len 55%, p<0,05.
Du'dng kinh tinh mach tinh trd ve gidi han binh thu'dng va khong con dong trao ngUOc khi lam Vaisava sau 6 thang. Khong co cac bien ehffng ldn hay nho trong qua trinh can thiep va 6 thang sau can thiep. Ket lu|n: Oieu tri can thiep npi mach vdi k9 thuat sandwidi ket hpp coil va keo trong dieu tr\ gian tTnh mach tinh la an toan va hieu qua cao.
SUMMARY
RESULTS OF INTERVENTION irTTERVErniON TREATMEffT RESULTS THE SANDWICH MECHANISM OF SANDWICH COIL AND CLEAR
COMBINATION AT BACH MAI HOSPITAL Purpose: Assessing the result of vancocele endovascular intevention by sandwich technique combining coil and hystocryl (glue). Methods and objectives: 30 patients were diagnosed and treated successfully at Baeh Mai hospital from 12/2014 to 6/2016, tiiey were examined, performed semen analysis and ultrasound at before and after 6 months of embolization. Result: The average age of 22.6 years old, the hospitalized reasons is mainly scrotal pain, with 76.7%. After 6 months of treatment, all patients have pain reduction, the pain scores decreased from 6.7 points to 1.2, p <0.05. Increasing sperm concentration from 10 million/ml to 21 million/ml, sperm mobility increased from 27% to 55%, p <0.05. Spermatic vein diameter returns to normal limits and have no reflux line after 6 months.
No major or minor complications during the
*Khoa chan doan hinh anh, Benh vien Bach Mai
** Dai hpc YHa Noi
Chju trach nhiem ehinh: Nguyen Xuan Hien Email: [email protected] Ngay nhan bai: 6.01.2017 Ngay phan bien khoa hpc: 13.3.2017 Ngay duyet bai: 22.3.2017
intervention and 6 months after intervention.
Conclusion: Embolization of spermatic vein with technique sandwich combined coil and glue to treat varicocele is safe and high effective,
I. OAT VAN OE
Gian tinh mach tinh la benh ly gay ra bdi sir trao ngu'dc dong mau tmh mach vao tTnh macli tinh, hau qua la sff gian cae tTnh maeh d biu tao thanh bui ngoan ngoeo. LTde tfnh cd 9-15% nam gidi bi gian tTnh maeh tinh,va ngay nay dffdc xem la nguyen nhan gay vo sinh hang dau d nam gidi [1][2][3]. Nguyen nhan do tTnh mach tinh trai dan lu\i mau tff tinh hoan ve tTnh mach than trai, khi eo sy suy van hoae thieu hut cac van mau mau tTnh mach cung mpt so san pham chuyen hda, protagladin se trao ngu'dc ve tinii hoan lam bien doi tinh hoan, ket qua lam bien doi so lffdng - chat Iffdng tinh triing. Mdt so nghien effu da ehi ra tam quan trpng eiia viec dieu tri gian tTnh mach tinh d tudi thieu nien de tranh vo sinh d tu6"i trffdng thanh[4]. .Phffdng phap dieu tri gian tTnh maeh tinh kinh dien la phau thuat that tTnh maeh tinh bang ndi soi hoac md md. Tuy nhien phu'dng phap nay benh nhan phai trai qua cupe gay me hoac gay te tuy song, ty le tai phat ciia phu'dng phap nay cdn cao[5].
Hien nay vdi sy tien bp eua dien quang can thiep, plii/dng phap can thiep npi mach bang sLf ket hdp vat lieu coil va keo de dieu trj eho gian tTnh mach tinh cho thay nhieu ffu diem va cd ttie khac phue dffde nhffdc diem ciia phau thuat, hay nut maeh bang keo hoac coil thong thffdng, do dd ngay cang dffdc ehi dinh rong rai d cac benh vien ldn, trong dd co Benh vien Baeh Mai.
II. OOI TypWG VA PHiraNG PHAP NGHIEN CLTU 2 . 1 . 061 tu'dng nghien cihi: Tong so 30 benh nhan dffdc ehan doan gian tTnh maeh bnh ben trai, ed day du cae xet nghiem ehan doan cd ban (sieu am doppler tTnh mach tinh, xet nghiem tinh djch do), va xet nghiem danh gia tinh trang ehung. Benh nhan du'dc giai thfch va dong y ehpn phffdng phap dieu trj ean thiep.
2.2. Phu'dng phap nghien cii'u: Mo ta can thiep, hoi cffu va tien euli
Cae bien so nghien effu: dac diem dau trffdc va sau nut theo thang diem Vas, sieu am doppler
TAP CHl Y HOC VlgT NAM TAP 453 - THANG 4 - S01 - 2017 tru'dc va sau nut 6 thang, chat Iffdng tinh djch do
trffdc va sau nut 6 thang (mat dp tinh triing, dp di dpng tinh trung).
2.3. Thii thuat nut tTnh mach tinh Chup ttnh mach: Chpc tTnh mach diJi. Tien hanh diing Sonde 4-5F co dau cong chup tTnh mach than trai trong lue lam nghiem phap Valsalva vdi lieu can quang 7-15ml tdc do 5ml/s.
Muc dfch xac dmh diem xuat phat ciia tTnh mach tinh va cae bien the giai phau tTnh maeh tinh trai neu cd. Sau dd diing mieroeather 2.7F diia xuong doan thap ciia tTnh mach tinh ngang mffe lo ben sau de ehup danh them mffe dp trao ngffde va cac nhanh ben, de phan dp eac type dffa ra chien Iffdc dieu trj.
III. KET QUA 3 . 1 . Tuoi.
Gay tac tTnh mach tinh: Cd mpt so phffdng phap gay tac mach da du'dc tien hanh, tuy nhien trong nghien cuP chung tdi sff dung k^ thuat sandwich ket hdp giiJa vat lieu coil va keo hystocryl. Coil du'dc tac d ngang mffc lo ben sau, tiiy thupc mffc dp gian ciia mach de chpn kfch thffde coil, muc dfch ngan khdng eho keo di chuyen sau phfa dffdi, sau dd dimg keo hystocryl pha vdi lipiodol bdm phfa tren vdl ty le 'A (0.5 ml hystocryl/ 2ml lipiodol), sau do tien hanh tha coil phfa tren vi tri bdm keo muc dfch giff keo.
Tuan hoan sau khi niit mach: Sau khi tTnh mach tinh bi tac, cac tTnh maeh d i n lu'u mau tff dam rdi tinh maeh d biu se theo eae tTnh mach nhd dan lu'u mau ve tTnh mach chau trong.
So benh nhan/ty le ( 24/80 5/16 1/4
Mln/i4ax Tuoi trung binh (n=30)
16/52 22,6
Nhan xet: Tuoi trung binh trong nghien cffu cua chiing tdi la 22,6 tuoi. Tuoi ldn nhift la 52 tuoi, thap tudi nhat la 16 tuoi.
3.2. L'^ do v^o v i f n L^do Dau tiic biu
Vo sinh Ca hai
So benh nhan bi bien doi tinh dicli do
So benh nhan n = 3 0 ) 23
5 2 13
Tv le ( % ) 76,7 16,7 6,6 34%
bien doi tinh dieh do trong so benh nhan dffde niit maeh ehiem ty le eao 34%.
3.4. Mii'c do dau theo thang diem Vas cua benh nhan tru'dc nut mach.
So diem So benh nhan ( n = 2 5 ) Ty le (O/o) Dau nhe (1-3)
Oau v i i ^ (4-7) 60
Oau nang (8-10)
Nhan xet: Benh nhan co dau biu chii yeu la nhdm dau viia chiem ty le 60%.
3.4. Du'dng kinh tinh mach tinh tru'dc nut mach trUdic co va khong lam valsalva.
Co vaisava S i e u a m ( n = 3 0 ) Khong vaisava
Du'dng kfnh trung binh (mm) 2,8
M\n/ Max (mm) 2,6/3,7 3,5/5,7
Nhan xet: diidng kmh tTnh mach tinh trffdc tru'dc Vaisava va sau Vaisava la 2,8mm va 3,9mm, dao dong tff tff 2,6mm va 5,7mm.
3.5. Phan dp gian tTnh mach tinh du'a vao Dubin va Amelar Mu'c do
So benh nhan (n=30) 10
Tvle(%) , i . ^Q . j . ^° I ^ . Nhan xet: trong nghien ciru ciia chiing tdi ehii yeu la nhdm benh nhan gian tTnh mach tinh d nhom i, I I chiem 90%, chi cd 2 benh nhan ehiem 10% nang hdn thude nhdm I I I .
3.5. Phan loai gian t m h mach tinh tren chup OSA theo Bahren 1983 Type
So benh nhan (N=30) 15 10
Ty le (%)
Nhan xet. Trong nghien effu chu yeu la gian type I va I I I vdi 50% va BS,*!
3,3
VIETNAM MEDICAL JOURNAL N°1 APRtL-2017
3.6. Mu'c do giam trieu Chiang dau Iu'c bui sau nut mach 6 thang. ' Thang diem dau (Vas) ( n = 2 5 )
Biem trunq binh Tv le qiam (%)
P
Tru'dc nCit mach 1 Sau nijt mach 6 thanq 6,7 [ 1,2
80
< 0 , 0 5
Nhan xet: Benh nhan co thang diem^dau trung binh tru'dc nut mach ia 6,7 diem, sau niit mach giam 80% so vdi tru'dc nut chi cdn 1,2 diem, vdi p<0,05.
3.7. Mu'c do giam trieu chu'ng dau cua tCfng nhom.
TTianq diem dau (Vas) (n=25) Nhdm dau niiieu (8-10) (1) Nhdm dau trung binh (4-7) (2)
Nhom dau it (1-3) (3)
Tru'dc nut mach 5au niit madi 6 thanq 9,2
5,3 2,1
1,3 1,6 0,9
Ty le qiam % 86 69,8
57
P P(l,3)<0,05 P(2,3)<0,05 P3<0,05 Nhan xet: CO su' Ithac biet Ichi so sanh mifc do giam dau cua nhdm dau nhieu, dau trung binh vdi nhdm dau it vdi p<b,05.
3.8. Tinh dich d6 tru'dc va sau 6 thang nut mach Cong thu'c tinh dich do ( n = 1 3 )
Mat do tinh triinq (trieu/mi) bo di donq (%)
TrUdc nut mach 10 +/- 8,2 27-1-/- 12,5
Sau nut mach 6 thang 21+/- 13,5
55-)-/-8,l ' P
<0,05
<0,05 Nhan x4t: Mai dp tinh triing, dp dj dpng tinh triing tru'dc nijt mach tu'dng u'ng la 10 trieu/ml va 27%. Sau nut mach 6 thang cd SLi tang len dang ke co <i nghTa thong l<e vdi mat dp tinh triing la 21 trieu/ml, va do di dong la 55%, p<0,05.
3.9. Sieu am doppier sau nut mach 6 thang.
Dac diem Tru'dc nut mach Sau 6 thang niit mach
DUdng l<inh ( m m ) 3-6
< 2,5
Vaisava 03 Khonq Nhan xet: Sau niit maeh sau 6 thang, tat ea benh nhan deu cd du'dng kinh tTnh mach tinh trd vfi binh thffdng va khong edn ddng trao ngu'dc khi lam nghiem phap Vaisava.
IV. BAN LUJOLN
4 . 1 . Ogc diem lam sang va can lam sang tru'dc niit mach.
Trong nghien ciii} cixa chiing toi dp tuoi trung binh la 22,6 tuoi, thap nhat la 16 tuoi, eao nhat 52 tuoi, trong dd nhom tuoi tff 18-24 tuoi chiem ty le cao nhat 80%. Ly do benh nhan den kham chii yeu la dau tffe biu trai dtin thuan chiem ty le eao nhat vdi 76,7%,d nhdm nay chu yeu la benh nhan dau vffa ehiem ty le cao nhat vdi 60%
(15/25 so benh nhan dau tffe biu), so benh nhan bj bien ddi tinh djch dd bao gom giam mat dp tinh trimg, dp di dpng tinh trung, chiem ty le kha eao 34%, ket qua tffdng dong vdi nghien effu ciia Gandini [6]. Ket qua sieu am d cae nhdm benh nhan dffdc nut gian tmh mach tinh cho
thay dffdng kfnh trung binh tmh maeh tinh gian trffdc Vaisava la 2,8mm, sau Vaisava la 3,9mm, nhff vay dffdng kinh tinh mach tinh trffdc nut deu Idn hdn 2.5mm, va dao dpng trong khoang 3-6mm. Dffa vao lam sang va sieu am doppler co the phan loai mffc dp ciia gian tTnh mach tinh thanh 3 type theo Dubin va Amelar, theo do trong nghien effu ehiing toi gap chii yeu la type I vdi 60% va type I I vdi 30%. Trong so eae benh nhan dffdc nut mach co tdi 15 benh nhan ed bien doi ve tinh djch do chu y nhat la su" di dong cOa tinh triing, day la yeu to chi'nh de cd thai. Nhff i^y chi vdi dau hieu dau tffe biu benh nhan da eo bien dol ve tinh djch do, neu mupn hdn nhffng thay dS nay se dang ke va cd the gay vd sinh.
Anh 1 : Sieu am benh nhan tru'dc niit, thff tii la tru'dc lam Vaisava tren sieu am 2D, sau vaisava tren sieu am 2D, sau vaisava c6 trao ngffdc khi phd mau.
TAP CHl Y HOC VlgT NAM T^P 453 - THAHG 4 - SO 1 - 2017 4.2. Ket qua chup mach v^ v a t lieu sit
dung nut mach.
Hinh thai giai phau gian tTnh mach tinh d u ^ tren bang phan loai ciia Bahren 1983 chia thanh 5 type, theo do trong nghien ciiH ciia chung toi type I ehiem 50%, va type I I I ehiem 33,4%, ft gap eac type cdn lai, dac biet trong nhdm type I I I cd tdi 4 benh nhan da cd tien sff mo va tai phat.Ve vat lieu nut mach, tat ca benh nhan deu diidc ket hdp giffa tha coil va bdm keo. Dffa vao sieu am, tTnh maeh tinh gian tff 3-6mm, va ket hdp do dffdng kinh tTnh mach tinh gian tren chup tinh mach Hnh tren DSA, dffdng kinh coil dau dat
d lo ben sau cd dPdng kinh 6-8mm, coil phia tren vj trf bdm keo thffdng chpn coli 8-12mm, tiiy vao mffc dp gian tTnh maeh eiia benh nhan.
So Iffdng coil trung binh 2,2 coil/ benh nhan.
Viec ket hdp bdm keo thay vi tha coil ddn dpc se lam giam so Iffdng coil, giam chl phi cho benh nhan, thay vi sir dung coil ddn thuan, ben canh dd viec dimg coil chan dau du'di se lam cho keo Wiong di chuyen sau xuong vimg biu ben, han che cae tac dung phu sau nut mach nhff vi§m tinh hoan, tran djch tinh hoan nhff mot sd tac gia khac da cong bo khi chi sff dung chat gay xd (keo) khdng [7].
=4
Anh 2: Benh nhan gian tinh mach tmh typ I I I theo Bahren 1983 di/Oc niit tac tinh mach tinh theo ky thuat Sandwich. Tren hinh lan Iffdt la ehup goc tTnh mach than, chup chpn loe tTnh mach tinh, va
ehup kiem tra sau nut tae.
4.3. Ket qua dieu tri sau 6 thang nut mach.
Tren sieu am doppler sau 6 thang t i t ca cac benh nhan khdng con bi gian tinh mach tinh, dffdng kinh tinh maeh tinh < 2.5mm, va khong con dong trao ngffde ktii lam nghiem phap vaisava.
Trong nghien ciili eiia chung toi cd 15 benh nhan cd thay dol tinh dich do. Va sau 6 thang sff eai thien ve tinh dich do la kha dang ke, eu the mat dp tinh triing tang tff 10 trieu len 21 trieu tinh tri!ing/ml, ydi p <0,05, dp dj dpng tinh trimg tang len tff 27% len 55%, vdi p<0,05. Ket qua nay cung kha tffdng dong vdi mpt sd tae gia khac [3, 5]. Nhff vay cd the thay rang nut mach eho nhiipg benh nhan gian tTnh mach tinh cd the giiip cai thien ve so Iffdng, sff dl dong eung nhff so Iffdng tinh trung song.Tuy nhien do thdi gian theo doi con ngan nen chiing toi chu^ danti gia ve kha nang co con cua nhffng benh nhan den kham vi vo sinh hay cd thay doi tinh dieh do.
4.4. Ty le tai phSt, tac dung phy va bien chu'ng: Tren the gldl da co mot so bao cao ve ty Ie tai phat sau dieu trj gian tTnh maeh tinh bang can thiep tff a-8%[6], tuy nhien trong nghien euP CLia Chung toi hien tai chffa ^ a p benh nhan cd tai phat sau dieu trj ed the do thdi gian nghien cffu ciia chung toi edn ngan, va so lu'dng benh nhan chffa nhieu. Cac tac dung php thffdng gap da dffdc mot so tae gia bao cao thffdng gap la viem dam roi tTnh mach tinh hay tran djch mang tinh hoan, nhffng bien ehffng nay do chat
gay xd trao vao doan xa eiia tTnh maeh tinh. Tuy nhien trong nghien ciiu cua chiing toi ehffa phat hien bien ehffng nao, cd the do ehiing tdi diing coll ehan dau nen keo khong trao dffde den doan xa ciia tTnh mach tinh.
V. KET L U A N
Oleu tn gian tTnh maeh tinh bang phffdng phap nut mach sff dung ky thuat sandwich ket hdp tha coil va bdm keo la phffdng phap an toan, hieu qua, giam - het trieu ehimg dau tffe biu cimg nhff tang mat dp eung nhu' dp di dpng tinh trimg tff do lam giam ty le vo sinh d ngffdi trffdng thanh.
TAI LIEU THAIVl KHAO
1. Berger OG, Varicocele in adolescence. ClinPediatr (Phiia), 1998.19:(810-811).
z. Aziz N, Agarwal A, Nallella KP, et al.
Relationship "Between epidemiological features and aetiology of male infertility as diagnosed by a comprehensive infertility service provider. Reprod Biomed Online, 2006.12: p. 209-2014.
J . Bigot JM and et al. Trait ment endovasculaire des varicoceles. Radiodiagnosis - Urologie- Gynecologie, 2003(34-450-0).
4. Kurgan A, Nunnelee 3., Zilberman M. The importance of the early detection of varicocele in adolescent males 1994. 19: p. 36-37.
3. Homonnai ZT, Engelhard Y, Rudberg Z, David HP, Paz G. Varicocelectomy and male fertility:
comparison of semen quality and recurrence of varicocele following varleoceledomy by bvo techniques. Int J Androl 1997. 3: p. 447-458.
VIETNAM MEDICAL JOURNAL N°1 • APRIL . 2017 . Roberto Gandini and et al. Transi^thelsr kiam
sderodierapy with sodium tetradecyi sulfate-- outcome in 244padents. Radiology, 2008. 246: p. 2.
. Kian-Hiong Tay and et al. Selective Spermatic Venography and Varicocele Embolization in Men with Circumaodc Left Renal Veins. Joumal vascular interventional radiology 2002. 13: p. 739-742.
DANH GIA HIEU QUA KHOA DAO TAO KY NANG GIAO TIEP QUA Y KIEN COA DIEU DU'CJNG
Le Thu Hoa*
T O M TAT
Nghien cffu duHc thUc hien vdi 199 dieu dUSng ciia B^nh vien Dai hgc Y Ha Npi sau khi hoan thanh khoa 1 "Ky nang giao bep cho nhan vien y te". Myc tieu: Nghien cdu phan hSi cua dieu dudng ve khda hoc "Ky nang giao tiep cho nhan vien y te". Ket qua:
Khoa hoc da dao tao kien thffc cap nhat ve KNGT (99%), vdl nhffng noi dung thu vj (98%) va ap dung du'dc vao thi/c te lam viec tai benh vien (100%); IHoc phan thi/c hanh Ky n3ng giao tiep rift can thiet de dieu duSng ren luyen ky nang ngay trong khoa hpc (98.5%). Khoa hoc da giup tang cu'dng KNGT ciia dieu du9ng (99,5%). Giang vien khoa hoc co phu'cfng phap su" pham tdt (99.5%), ky nang giao tiep v6i hpc viSn va ky nang tich eye hoa hpc vien tot (99.5%)%).
Giang vien thu'c hien bai giang dat hieu qua cao (100%). Ket lu|n: Khda 1 "Ky nSng giao tiep cho nhan vien y te" d l dudc phat trien vdi nhffng npi dung va phu'cfng ph^p day-hoc thfch hdp de dao tao giao tiep, ffng xff eho dieu dffSng tcii benh vien.
SUMMARY
EFFECnVENESS OF T R A I N I N G COURSE ON COMMUNICATION SKILLS THROUGHT
NURSES' OPINIONS The study was conducted with 199 nurses at Hanoi Medical University Hospital after completing the 1^
training course of "Communication skills for health workere". Objective: To study feedback fmm nurses on training course of 'Communication skills for health woikers". Results: The course has provided an update knowledge of communicabon skills (99%), with interesting contents (98%) as well as had the ability to apply in practice in hospital (100%); Module practice of communication skills was essentia! for nurses to pracbce skills wiSiin courses (98.5%). The course has helped strengthen communication skills for nursers (99.5%). Lecturers have good teaching methods (99.5%). They communicated and encouraged learners very well (99.5%)%). Lecturers implemented lectures quite well (100%). Conclusion:
The 1^ course of "Communication skills for health workers" were developed with appropriate contents
* Trddng Dai hoc Y Ha Ngi Chiu trach nhi^m chinh: Le Thu Hoa Email: [email protected] Ngay nhan bai: 7.01.2017 Ngay phan bien khoa hoc: 8.3.2017 Ngay duyet bai: 13.3.2017
and teaching-learning methods in order to train communication skills for nurses in hospital.
I. OAT VAN OE
Chu'dng trinh tong the cai each hanh chfnh nha nffdc giai doan 2011-2020 da neu rd "sy hai Idng ciia ca nhan doi vdi djch vu do ddn vj sff nghiep cong cung cap trong ITnh vffc y te du'dc ky vpng se dat tdi mffc tren 60% vao nam 2015 va tren 80% vao nam 2020 [1], Trong cham soc sffc khde, sff hai Idng cua ngu'di benh khong chi phu thupc vao hieu qua chan doan, dieu trj benh, ma edn lien quan den thai dp giao tiep, ffng xff eiia nhan vien y te.
Oao tao lien tuc de nang cao nang \iic chuyen mdn la mpt nhiem vu doi vdi mpi bac sT, dieu dffdng. Ky nang giao tiep la mpt mon hgc frong chu'dng trinh dao tao bac sT va dieu dffdng chinh quy tai tru'dng Dai hpc Y Ha Npi. Khoa "Ky nang giao tiep eho nhan vien y te" da d\idc bp mon Giao due y hpe va Ky nang tien lam sang ciia tru'dng Dai hpc Y Ha Npl phat trien de thiTc hien dao tao lien tuc cho bac sT, dieu dffdng tai cae ctf sd y tie. Nghien cffu nay dffde thffc hien vdi muc tieu: Nghien e&u phan hoi cua dieu dddng ve khda hpc Ky nang giao tiep nham cung cap bang ehffng de dieu ehinh ehffdng trinh dao tao 1^
nang giao tiep ngay cang dat hieu qua tdt hdn.
II. OOI TU'ONG VA PHU'aNG PHAP NGHIEN CLTU 2.1.D6i t&dng nghien c&u: Toan bp dieu dffdng tham gia khda 1 "Ky nang giao tiep cho nhan vien y te" nam 2016.
2.2.Thietke nghien c&u: mo ta cat ngang 2.4.Cdng cy: Bp cau hdi tii dien 2.5.X&ly sd lieu: sff dyng phan mem Epidata va Stata.
2.6.Dao d&c trong nghien cdV: Ooi tudng tham gia dffcfc giai thfch ve npi dung, phffdng phap nghien cffu... Thong tin se dffdc ma hoa.
Ooi tffdng tff nguyen va ky vao ban cam ket trffdc khi tham gia nghien cu\i.
III. K ^ QUA
Nghien cffu da cd 199 dieu dffdng tham gia- Sd nam cong tae trung binh ciia dieu duSng
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