VIETNAM MEDICAL JOURNAL N'T - AKKIL - ^u^ /
V. KET LUJ^N
Dat vft neo chan la mot ky thuat khdng qua phffc tap, gia thanh villa phai, ty le thanh cdng cao (93,75%), benh nhan de dang hdp tac.
*Vit neo chan dat d viing ke chan rang mat ma 6 hai ham cung cap ngudn neo chan tuyet ddi theo chieu tru'dc sau trong dieu tri lech lac khdp can loai I. Pang ham ldn khdng bj dj^ gan, rang ciia diidc keo liii toi da vao khoang nhd. Sau ddng khoang, rang ham va rang ciia khdng bj trdi.
*Dieu tri bang vft neo chan cdn tao ra nhutig thay ddi cd gia tri ve xu'dng: TutJng quan hai ham theo chieu tnftic - sau gan ve gia tri trung binh hdn va khdng bj tang kich thiidc dffng ciia mat.
*Sff dung vft neo chan dieu tri lech lac khdp can loai I cd ehi djnh neo chan toi da mang den nhutig thay doi ldn trong md mem. Sau ddng khoang, mat het vau, mdi tren va mdi dffdi dat du'dc vj tri hdp ly.
* Vit neo chan rat hieu qua va thfch hdp trong dieu trj lech lac khdp can loai I cd yeu rau neo ehan tdi da.
TAI LIEU T H A M KHAO
1. Dao Ngoc Phong, Tdn That Bach, Nguyen Tran Hien (2006). PhUdng ph^p nghien ahi khoa hoc h-ong y hoc va su'c khoe cong dong, Nha xuat ban Y hoc.
2. Proffit W. R; Fields J R; Henry W (2000), Contemporary Orthodontics, 145-294, Mosby.
3. Madhur Upadhyay, Sumit Yadav & P, s (2008). Treatment effects of mini-implant for en- masse retraction of anterior teeth in bialveolar dental protrusion patients: A randomized controlled trial, AJODO, 134, 18-29.
4. Sameer P, Madhur U, Sumit Y & Nagaraj K (2007). Treatment effects of mini-implants for en- masse retraction of anterior teeth in bialveolar dental protrusion patients: A randomized controlled trial, American Journal of Orthodotics and Dentofacial Orthopedics, 134 No 1,18-29.
:>. Chung-Chen J. Y, Lai E. H, Chang Z. C & Ctten y. J (2008). Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveoiar protrusion, American Journal of Orthodobcs arid Dentofacial Orthopedics, 615-624.
MOI LIEN QUAN GIITA NGUON NHAN LU'C Y TE TRINH DO CAO v m THirC HIEN PHAN TUYEN CHUYEN MON KY THUAl
TAI CAC BfeNH VIEN HUYEN CUA TINH LANG SaN
Iran Bao Ng9c\ Nguyin Th^ Toan^ Nguyin Thi Hoa'
T b M T A T
Thieu hut nguon nhan li/c y t€ ca so lu'dng va ehat lu'dng va nhffng yeu to lien quan khac tai cac Benh vien (BV) huyen tinh Lang Sdn tac dpng the nao den viec thi/c hien phan tuyen chuyen mon ky thuat Muc tieu: Phan tich mot so yeu td anh hu'dng tdi thu'c hien ky thuat theo phan tuyfn tai cac benh vien huyen.
Phu'dng phap nghien cu'u: mo ta cat ngang, ket hop dinh lu'Ong vdi djnh tinh. Ket qua: Mot so yeu to anh hffdng thUc hien phan tuyen ky Oiuat la: Thieu sd luong nguon nhan \\ic trinh do cao (ke cii sau dai hoc) vdi thiTc hien phan tuyen k9 thuat. Trinh do "bac sT chu^ tdt (chii yeu tff dao tao lien thdng), chat lu'Ong djch vu chu^ cao, chu^a manh dan trien khai k9 thuat mdi. Trang thiet bj, cd sff vat chat da du'dc dau tff, nhung da xuong cap. Cniia co si/ (Kng bd giffa trang thiet bj va con ngudi. Cd hdi hgc tap, phat trien d cac BV deu thu'c hien cham do tliieu nguon Iu'c. Quy hoach Tru'dng Oai hoc Y Du'dc Thai Nguyen
^Sd Yti Lang Sdn
Chiu trach nhiem chfnh: Tran Bao Ngoe Email: [email protected] Ngay nh^n bai: 3.12.2017 Ngay phan bien khoa hoc: 01.3.2017 Ngay duyet bai: 7.3.2017
dao tao chu^ sat vdi thUc tien. Kha nang thu hiit benh nhan han che. Ket lu^n va khuyen nghj: Cac BV huyen tinh Lang Sdn deu cd diem giong nhau ve nguon nhan Iu'c trinh dd cao vdi thifc liien ky thii|L^
Lanh dao cac BV can chii trpng xay dytig de an vj tn' viec lam cu the.
T&khoa: nhan Iu'c y te trinh do cao, chuyen mon ky thuat, benh vien huyen.
SUIVIMARY
THE RELATIONSHIP BETWEEN HIGH LEVEL HEALTH HUMAN RESOURCES TO IMPLEMENT DECENTRALIZATION TECHNICAL EXPERTISE AT D I S T R i a HOSPITALS OF LANG SON PROVINCE Background: How shortage of health workers (both of quantity and aualitvl and other factors at the districts hospital of Lanq Son orovince to influence the implementation of decentralization of technical expertise. Obieetive: Analvsis factors affectina me technical imolementation of decentralization at the district hospital. Methodology: descriptive cross- sectional, combininq quantitative with aualtative.
Results: The factors affect the imolementation and technical distribution include: Lack number of Hiqw qualified human resources (including postgraduate) to
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TjaiP CHI Y HOC VIET NAM TAP 453 - THANG 4 - SO 1 - 2017 perform technical distribution. Not well qualified
doctors (mainlv from accreditation), quality of service IS not hiqh. Equipment, facilities have been invested, but has deteriorated. No synchronization Isetween the eouioment and oeoole. Opportunities for learnina and development in the hospitals are carried out slowly.
Planninq traininq is not close to reality. Ability to attract patients is 'imited. Conclusions and Recommendations: The district hospitals of Lanq Son crovince are similar between hiqhlv qualified human resources with technical imolementation.
Kevwords: highly health workforce, technical expertise, district hospitals.
L D A T V A N D E
Su'c khoe la von quy nhat cua moi con ngu'di va cua toan xa hpi. Bao ve, cham soc va nang cao su'c khoe nhan dan la hoat dgng nhan dao, triTc tiep bao dam nguon nhan Iu'c cho sii nghiep xay dutig va bao ve To quoc, la mpt trong nhijtig chfnh sach ulj tien hang dau eua Oang va Nha nu'dc [1]. De viec bao ve cham soc sire khoe nhan dan du'dc dam bao, gdp phan phat trien kinh te, xa hoi noi ehung, yeu to quan trpng nhat la phat trien nhan li/c. Nguon nhan li/c y te la yeu to then chot, mang tfnh quyet dinh cho su"
phat trien he thong cung cap cac djch vu bac ve, Cham soc va nang cao su'c khoe nhan dan. Viec chuan bj nguon nhan li/e y te vilTa dii so lu'dng, vLte dam bao chat luWng la mot yeu rau cap thiet, mang tinh lau dai doi vdi eae cd sd kham ehfe benh va can co su" quan tam, tham gia, phoi hdp nhjp nhang ciia cac cap, cae nganh [ 2 ] .
Mang lu'dl cac benh" vien huyen la tuyen y te gan dan nhat, la xu'dng song ciia he thong y te, triTc tiep cham sdc su'c khoe nhan dan (CSSKND). Cac benh vien huyen luon la mat xi'ch quan trpng trong viec tht/c hien co hieu qua cac chu'dng trinh y te quoc gia d cong dong; han che, ngan nguS va chong djch benh hieu qua;
diia cac dich vu y te den vdi ngu'di dan. Vi vay, cung CO mang lu'dl y te cd sd la dieu kien tien quyet de lam tBt cong tac CSSKND va thii'c hien cong bang xa hpi, xoa doi giam ngheo, gop phan giam su'qua tai cua cac benh vien tuyen tren.
Tru'dc tinh hinh thyc te, ngay 08/12/2014 UBND tinh Lang Sdn da ban hanh quyet djnh so 2094/QD-UBND ve viec phe duyet de an Phat trien nguon nhan Iu'c y te tfnh Lang Sdn den nam 2020 [ 7 ] , Trong npi dung d e a n da de ra cae npi Jung vdi myc tieu phat trien nhan ii/c y te dap ihg vdi SLf phat trien ciia tinh va de cd them ihifng thong tin gia tri, ehinh xae, bo sung cac iguyen nhan khach quan, chii quan ve thy'c rang nhan lyc cac benh vien tuyen huyen va dac 3ik cy the hda hdn cac giai phap ean thiep.
Chung toi tien hanh nghien cu'u de tai vdi mue tieu: Phan tich mil Hen quan gi&a ngudn nhan l&c y t i trinh do eao vdi viee th&c hien phan tuyin ehuyen mdn ky thuat tai 10 binh vien huyen cua tinh Lang Sdn.
II. OOI TU'QIMG VA PHLTONG PHAP NGHIEN COU Oja d i e m n g h i e n cuXi: l^u'di benh vien huyen cua tinh Lang Sdn.
Thdi gian: T\S thang 01 nam 2016 den thang 6 nam 2016.
Thiet ki nghien cuXi: Mo ta cat ngang, ket hdp dinh lu'dng vdi dinh tfnh.
Ooi tu'dng nghien cii'u djnh lu'dng la toan bo ho sd can bp vien chu'c trinh dp dai hpc trd leii trong bien che ciia cac benh vien, cac bao cao thu' cap nam 2015, thu thap thong tin theo mau phieu thong nhat can cu" theo tieu chuan quy djnh t?i thong tu' 43 cua Bp Y te, tii do cd cac so lieu de so sanh, phan tich.
Ooi tu'dng nghien cu'u djnh tfnh tien hanh thao luan nhdm va phdng van sau (100% can bp vien chifc trinh dp dai hpc trd len (279 ngu'di)) tien hanh 10 buoi thao luan nhdm (moi benh vien 1 buoi), 10 cuoc phdng van sau (cac lanh dao cap khoa trd len d moi benh vien). Npi dung thao luan/phong van tap trung vao 04 van de:
Chat lu'dng/so lu'dng nguon nhan Iu'c; Cd sd vat chat, trang thiet bi; Cd hpi hpc tap, phat trien;
Kha nang thu hut ngu'di benh.
Cac dieu tra vien la cae can bp ciia Phong To chu'c ciia Sd Y te va Benh vien deu du'dc tap huan thu thap so lieu, eae doi tu'dng nghien ciJu du'dc quan triet nhan manh ti'nh t y giae, hdp tac, thang than tren tinh than xay dyng. Cac giam sat vien du'dc Sd va Benh vien chi djnh thu'dng xuyen giam sat, ghi am qua trinh thu thap sd lien va kiem tra thong tin tru'dc khi nhap so lieu de dam bao chat lu'dng sd lieu.
Soli$ud&dc\iiii trUtren ban ciinq, file mem va du'dc xii ly tren phan mem excel 2010.
III. KETQUA NGHIEN CU'U
Vdl 279 can bp y te trinh dp rao (trong dd 179 bac sT, 17 du'dc sT, 83 dai hoc khae). Ty le bae sT, du'dc s?/l van dan thap hdn so vdl quy dinh, lan lu'dt la 2,7 va 0,95, tu'dng yng. Ty le sau dai hpc chung cua 10 BV la 26,2% (con hai huyen Van Quan va Bac Sdn mdi cd 2-3 BS chuyen khoa I, thap hdn so vdi quy dinh-5 BSCKI/BV huyen).
Ty le thyc hien phan tuyen ky thuat theo cac chuyen nganh du'dc Sd Y te phe duyet dat trung binh 43% {tii 7,7 den 81,1%). Cdn'04'chuyen
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VIETNAM MEDICAL JOURNAL N"1 - APRIL - 2017 khoa chu'a trien khai ky thuat (Y hpc hat nhan; Vi
phau; Giai phau benh-Te bao va Phau thuat npi soi). Ty le thu'c hiin ky thuat trung binh eiia 10 BV huyen dat 39,7% ( t y 28,8 den 50,3%), thap nhift d Oinh Lap, rao nhat d Trang Ojnh. Ty le thyc hien ky thuat vu-pt tuyen thap (trung binh 2,9%). Con hai ddn vi'Cao Loe va Lpc Binh eong suat sir dung giu'dng benh k§ hoach du'di 90%.
Ket qua eu the cua thyc trang nguon nhan lyc du'dc dang tai Tap chf Y hpc thye hanh thang 10/2016.
3.1. Chat IWdng/sd l&dng ngudn nhan Arir/Qua cac cupe thao luan tap trung, 100% so doi tu'dng tham gia deu cho rang chat lu'dng/so lu'dng nguon nhan lyc anh hu'dng tdi thye hien ky thuat theo phan tuyen hoae vu'dt tuyen, ke ca t y vi tri Tru'dng khoa, vf du nhu':
'•\..Trong qua trinh cdng tac da d&de e& di dao tao nhieu lan, hai nam n&a se nghi h&u, trinh do chuyen mon yeu kem, niu khdng mudn ndi la "ddt", da so dao tao BS chuyen tu khdng qua thi tuyen, dau vao thap, hgc trong 3 nam nh& "ten l&a", kien th&c thu thap kem, dau ra BS yeu; kiem nhiem nhieu, mdt BS phu trach nhieu khoa lay, hoi s&c, noi, iam ndl phai dutig gay me, cac ban tdi cung thi, kiin ifi&c bang khdng tap trung; d&dc dao tao chuyen 1 nhuhg do mot sd yiu td nen khong trien khai dddc do thiiu e kip hoat dgng..." (BS. Tru'dng khoa Npi-BV Binh Gia).
BS Tru'dng Van Du'dng, Tru'dng khoa l^goai, BV Trang Oinh '\..Nang iu'c chuyen mdn ciia BS kem. Nang l&c quan ly, lanh dao con han chi.
Tat ca cac khoa he Noi-Nhi-Lay ch&a ed BS chuyen khoa nao. Ke ca ban than tdi la BSCKI, vdi mot minh rat khd trien khai ky thuat, t&nhan d d&<^ milt trung binh. Trang thiit bi da ed nhihig do BS chuS dey din, tham ch/cd may khong d&
bv mua hoac khdng mua d&dc vat t&tieu hao nen chu5 van hanh d&de. Lanh dao can quan tarn hdn tdi cac khoa, can bd bi nhan li/c hdp ly, ed quy hoach ro rang trong c&can bg di hpe.,".
3.2. Cd sd vat chat, trang thiet hi: Nhd hu'dng ldi ciia 02 quyet dinh 47/2008 va 930/2009 ciia Chfnh phu, 10 BV huyen ciia tinh Lang Sdn cung vdi nhieu cd sd y te trong toan quoe da du'dc dau t y hang ngan t^ dong. Nhd su' dau tu' nay, eac BV du'dc cai tao va xay mdi hang ngan m^ xay dyng, trang thiet bi may mdc cQng dyde trang bj hang tram thiet bj mdi, so giu'dng benh trung binh dat 25 giu'dng/van dan (dat theo tieu chi ciia Bp Y te). Do dd, cd the ndi cd sd vat chat, trang thiet bj d 10 BV huyen ciia tfnh Lang Sdn khong the ndl la thieu thon qua myc.
tuy nhien de an thu'c hien t y 2008, den nay da xuong cap do nhieu nguyen nhan khac nhau ' cijng vdi yeu eau ngay eang cao ciia ngu'di dan cLing vdl quy mo phat trien d moi BV, do do den thdi diem hien tai eae y kien thao luan cung tap trung nhieu vao nguyen do nay dan tdi nang lire thyc hien chuyen mon ky thuat con thap so vi3l ehi tieu.
""...Cdsd ha tang tuy khang trang nhung: van thiiu, eac phong dieu tri chat choi, benh niian phai nam ghep, lam sd l&dng benh nhan giam di, long ap mac du da ed nhuhg chita triin khai d&dc eon "dap chiiu", ph&dng tien thut hiin ky thuat thiiu va xudng cap.. " (Bs. Tru'dng khoa Npi-BV Binh Gia).
3.3. Cd hdi hgc tap, phat trien: Ket qua phdng cac can bp y te tai cae BV ft de cap trifc tiep den cd hpi hpc tap va ohat trien. Oongtticli qua eac y kien phat bleu de dang nhan ra: it BS ve cdng tac tai huyen.
..." Van de chinh tai ddn vi chung ta la nguon l&c con ng&di Rat thiiu nhan l&c, hai nam nay mdi tuyen d&de mot soBS tre ve eong tad'.
Ly do ciia van de nay la: Tai cac BV huyen la mien nui, bien gidi, vung sau viing xa, vung dac biet kho khan va vung dong bao dan tpc thieu so, dieu kien kinh te - xa hpi khd khan do nhii'ng tac dpng cua cd che thj tru'dng, sy khae biet ldn dieu kien giao thong, dieu kien song va dieu kien, phu'dng tien lam viec giij'a huyen va thanh piio, .... dan tdi sy khae biet trong thu nhap, cd hpi phat trien nghe nghiep.. da tao ra si/djch ehuyen nhan lye y te va khong thu hiit du'dc BS mdi ra tru'dng ve eong tac tai huyen nen van can phai duy tri loai hinh dao tao chuyen tu BS, DS cho khu vyc nay. Trong qua trinh phdng van co y kien da neu len thye trang nay tai eac BV .,.
"da so dao tao BS chuyen tu khong gua thi tuyin, dau vao thap, hgc trong 3 nam nhif "ten l&a" kiin th&c thu thap kem, dau ra BSyed''.
Nhin ehung, tai Lang Sdn he thong y te 6 mot so huyen eham du'dc dol mdi, chu'a thfch^ u'ng kjp thdi vdi sy phat trien eua kinh te xa hoi, si/
tliay doi eiia ed cau benh tat va nhu eau ng^cJl benh; Mo hinh to chyc bp may eiia mang lu'dl J' te cd sd edn nhieu bien dpng va chya thong nhat gay khd khan, bat cap trong to ehiTe thi/c hien cae hoat dpng chuyen mdn. Dau tu' cua Nha nyde clio y te con thap thi viec thu hut cac BS tre ve cong tae la van de rat khd khan do ho s§
khdng du'dc lu'a chon chuyen khoa theo mong mudn de du'dc phat huy nang lye. Qua phong van cho thay:
TAP CHi Y HQC VIET NAM TAP 453 - T H A N G 4 - SO 1 - 2017
"BV con thiiu mdt so ehuyen khoa sau, chit I0ng dich vu chWa eao, can dau tudao tao cap cOtt, chuyen khoa le".
"Do mat benh kham rang, trang thiit bi ch&a dong bg nen khdng dap &ng d&dc nhu eau. CSn t^o dieu kien cho BS tre di dao tao".
3.4. Kha ning thu hut ngu'di benh: Day la van de quan tam t h y tu' tai cac buoi thao luan va la ket qua tat yeu t y 3 yeu to ke tren. Viec thu hilt ngu'di benh den kham va dieu trj tai cac BV la mpt van de khd. Thyc te hien nay, van de quang ba, nang rao vi the, uy tin ciia moi cd sd y te la thach thyc khdng nhd doi vdi cac nha quan ly. Qua phdng van cac can bp y te cd y kien cho rang:
"Giai phap dethu hut ngifdi tienh vao dieu tri la nang cao ehat iu'dng phiic vu, t& quan ly gid giac, giam sat khoa phdng, t& khau tiip ddn (vdn di ngudi dan da khdng tin t&dng), ch&a cd che tai x& iy t e gid giac lam viec, md them phong kham ehuyen khoa le tai phong kham..."
"£}e thu hiit benh nhan vao dieu tri can eai tao mdi tr&dng lam viec, tang cu'dng dao tao chuyen sau, nang cao chat l&dng^ phuc VIJ. Kiin nghj chinh sach &u dai tuyin huyen ".
IV. BAN L U A N
Tat ca 10/10 cupe thao luan tap trung tai 10 BV deu thong nhat yeu to lien quan chfnh tdi viec thyc hien ky thuat thap theo phan tuyen la yeu to con ngu'di. Giong nhu' ket qua eiia luan an ciia L T . Hydng (2015) dieu tra nhan lyc y te
^ n g bang song Hong, theo khao sat, dieu tra cua tac gia co 69% (174/252) y kien ciia can bp quan ly cae ed sd y te cho rang nguyen nhan chinh ciia viec nhan lyc y te chu'a dap yng (hoac CO dap yng nhu'ng han che timg mat) yeu cau cong tac ciia ddn vj la do thieu ve so lydng va trong so do co 83,9% y kien cho rang can bo sung BS, 22,4% y kien can bo sung DSJ5]. Qua phdng van 279 can bp y te deu cho rang: hien nay, thieu nhan lyc chii yeu la BS va DS. Thieu BS dan tdi tinh trang mpt BS phai kiem nhiem nhieu khoa, nhieu ITnh ^iic, luan ehu^/en thu'dng xuyen BS den nhffng ktioa thieu, dan tdi chat lydng dich vu khong dam bao... Ve chat lydng nguon rihin lyc: Nhan lyc y te trinh do dai hpc trd len cua 10 BV huyen tinh Lang Sdn dao dpng tir 6,5% den 13,6%, trinh dp sau dai hoc thap (ty 2-12 ngu'di/BV). So' lu'dng BS thieu nen phai kiSm nhiem nhieu, trinh dp khong chuyen sau. O tuyen huyen, trinh dp BS khdng dong deu, da so BS la chuyen t u , dao tao chu'a lien tuc nen trinh
dp khdng chuyen sau. Cdng tae dao tao can bd, phat trien chuyen mon ky thuat, chu'a ddng bp giuci eae ehuyen khoa, xu hu'dng phat tnen eiia benh vien va nhu rau ngu'di benh.Viec dao tao con ngu'di chu'a dong bp vdi cac trang thiet bj hien cd, chu'a cd nhieu BV dao tao theo e kfp thyc hien ky thuat nen chu'a phat huy du'dc nang lyc chuyen mon. Ty le thye hien ehuyen mdn ky thuat theo phan tuyen cua 10 BV trung binh dat 39,7% (dao dpng t y 28,8 den 50,3%) vdi tdng sd 179 BS. Ket qua nay la tinh trang chung trong toan quoe, nhu" nghien cyu toan bp 44 BV huyen thude 5 tinh lan can TP. Ho Chi Minh nam 2010, Nguyen Bfch Ha (2012) cho biet cd mpt t / le dang ke (29,5%) BV huyen chu'a trien khai phong mo hoac ed phong md' nhuhg khdng thyc hien du'dc mo de. Thii thuat dUde thyc hien nhutig phan ldn d myc dp 3 [ 4 ] .
Theo T.T.M Oanh (2010) so lu'dng BS tuyen huyen nam 2007 hien cd la 10.829 ngu'di so vdl djnh bien thdng tu' 08 so BS can tuyen dung la 1.377 ngu'di, trong do vung Ddng Bae cdn thieu 1.059 BS, trung binh 96 ngu'di/tlnh (nhu cau thap nhat trong 8 vung mien, Oong Nam bp cdn thieu trung binh 203 BS/tinh). Nguyen nhan thieu do: (i) nang lye thu dung dao tao eiia cae Tru'dng Oai hpe Y chu'a dii de dap irng nhu cau thyc te: kha nang dao tao nhu' hien nay thi den nam 2015 mdi chi dap iinq diidc khoang 56%
nhu eau BS can cd cho ca eac cd sd y te eong theo quy djnh va ea cac cd sd tu" nhan eung nhu' eho sy bien ddng nhan lyc do ve hulj va phat trien; (ii) cac cd sd cdng lap ed sy bien ddng ldn ve BS do chuyen dl, nghi viec/ra lam tu' va nghi che dp [6]. Va Lang Sdn cung nam trong khu vyc thieu nhan lyc tai cac BV huyen.
Tu'dng tu' nhu" Viet Nam, dia ly kho khan ci^a Indonesia la mdt tliaeh thyc Idn de cung cap djch vu y te va hau het cac nhan vien y te thich de phuc vu trong khu vyc do thj, dan den mpt sy phan phdl khdng dong deu eae nhan vien y te giffa cac khu vyc. Chfnh phii Indonesia da no lyc huy dpng cae nguon lyc y te can ddi hdn, trong do cd de an chien lu'de chuyen nhudng dac blet can bp y te va nhan vien hdp ddng, ket hdp vdi mpt cliydng trinh khuyen khich. Hai chu'dng trinh nay da ddng gdp dang ke vao viec cai thien nhan lyc y te d VLing sau vimg xa eiia Indonesia. Di kem vdi hai chydng trinh la cac khuyen khich tai chinh (ran thiep chinh), ngoai ra cae ran thiep phi tai chi'nh khac eung nen du'dc thf diem...[3].
Cac dja phffdng cd khu vyc khd khan d Viet Nam cung da bat dau quan tam tdi eac gial phap thu
VIETHAM MEDICAL JOURNAL N^l - APRIL - 2017 hilt tu'dng t y nhff Indonesia nhff de an 1816, de
an thi diem dffa BS tre tinh nguyen ve vimg sau viing xa, chfnh quyen cac dia phffdng trong dd ed Lang Sdn da cd nhu'ng chinh sach ffu dai trong tuyen dung, giff chan nhan Iffe, dac biet la ddl tu'dng trinh dp cao, the hien trong quyet djnh so 23/2013 ciia UBND tinh.
Nghien cffu nay mang tinh chat djnh tinh tff cae eupc thao luan, phdng van sau cho nen cac ket qu^ chffa han mang tinh dai dien, tuy nhien day cung la nhuYig tieng ndi chung nhat ciia can bp vien chffc vdi eac lanh dao cae BV huyen cua tiiih Lang Sdn trong viec xay dffng chien tffde phat trien chuyen mdn ky thuat.
V. KET L U A N
- Thieu sd lu'dng nguon nhan Iffc, chffa cd su' tffdng quan giffa nhan lyc trinh dp eao (ke ca sau dai hpe) vdi thyc hien phan tuyen ky thuat.
Trinh dp bae sT chffa tot (chu yeu tff dao tao lien thong), chat Iffdng dich vy chffa rao, ehu^ manh dan trien khai ky thuat mdi.
- Trang thiet bi, cd sd vat chift da diidc dau tff, nhffng da xuong cap. Chffa cd sff dong bp giffa trang thiet bi va eon ngffdi.
- Cd hdi hpe t i p , phat trien d cae BV deu thffe hien cham do thieu ngudn lyc. Quy hoach dao tao ehui sat vdl thyc tien.
- Kha nang thu hiit benh nhan han ehe.
KHUYEN NGHj
Cac khoa d moi ddn vi ran sdm xay dutig chien lu'de phat trien chuyen mdn ky thuat pliii hdp vdi yeu eau thyc te d moi dja phu'dng.
TAI L I | U T H A M KHAO
1. Bo Chinh trj (2005). Nghi guyet so 46 ngay 23/02/2005 cua Bg Chinh tri ve cong tac bao 4, eham sdc va nang cao s&e khoe nhan dan tmng tinh hinh mdi.
2. Bo Y te (2015). Quy^ dinh sd 2992 ng^y if/7/2015 ve viec phe duyet Ki hoadi phat triin nhan lut tmng he thong kham benh, chO^ benli giai ddan 2015-2020.
3. Efendi F (2012), "Health worker recruitment and deployment in remote areas of Indonesia", Rural Remote Health, 12, pp. 2008. t , 4. Nguyen Bich Ha (2012), 'Tinh hinh nhan liicX-
va eong suat sff dung piUcfng benh ciia benh^iiK' tuyen huyen", Tap ehi Y hoe TP. Ho ChlMlKS,
(16), tr. 263. W 3. Le Thuy Hu'dng (2015), "Nguon nhan li/c y te
viing dong ban^ song Hong", Luan van tietiskinh te. Hoc vien chinh tn quoc gia Ho Chi Mmh.
6. Tran t h j Mai Oanh (2010), "ThUc trang nhu c^u bac sT giai doan hien nay". Tap dii Chinh sach y,0,
6, tr. 38-44. '"
/ . Uy ban nhSn dan tinh Lang Stfn (2014), "Qe an Phat trien nguon nhan fuc y te tinh Lang ScJn den nam 2020", Quy& dinh so 2094/QD-UBND. ,
DAC DIEM LAM SANG V A QUY TRINH XIT TRI BI D A I TREN BENH NHAN SAU MO T H O A T VI DIA DEM COT SONG THAT LU'NG TAI KHOA
P H A U T H U A T COT SONG - BENH VIEN VIET DU'C
Nguyen Le Bao Tien*, Dinh Ngoc Sffn*,Vo Van Tlianh*
TOIVI TAT
Muc tieu: Nghien cffu dpc ca can thiep lam sang Wiong doi chutig nham trinh bay dac diem lam sang va quy trinh xff tri bi dai tren benh nhan sau mo thoat vi dia dem cot song that lUng tai khoa Phau thuat cot song - Benh vien Viet Difc. Ket qua: Benh gap d gidi nam nhieu hdn gidi nu' vdi ty le la 3/2, chu yeu d nhom tuoi lao dgng tff 20 - 59 tuoi chiem ty le cao 93,3%. Ty le gap bf dai thu'dng gap sau phau thuat 4 - 8 gid chiem 66,7%, benh nhan bi dai mu'c d6 1 chiem ty le cao 73,3%, 6 mu'c do 2 va 3 thap hdn lan lUdt la 23,3% va 3,4%. Ty le benh nhan khdng phai
*Benh vien HOU nghi Viet Dut Chju trach nhiem chfnh: T'guyen Le Bao Tien Email: [email protected] Ngay nhan bai: 8.01.2017 Ngay phan bien khoa hpc: 7.3.2017 Ngay duyet bai: 20.3.2017
dat sonde tieu chiem 76,7%. Ket luan: Phan ItJn binh nhan gap bi dai la 4 - 8 gid sau phau tiiuat va bi dai d mffc dp 1. Ty le benh nhan khong phai dat sonde tieu eao, da phan la nhffng benh nhan bi dai cJ mffe dp 1 CO hieu qua vdi viec xoa va chu'cfm nong.
Benh nhan bi dai d mffc do 3 phai dat sonde tieu, _ T&khda: Xff tri bt dai, hau phlu, thoat vj dia dem cot song that lu'ng
SUMMARY
CLINICAL CHARACTERISTICS AND PROCEDURE OF URINARY RETENTION
AFTER LUMBAR HERNIATED DISC SURGERY I N VIETDUC HOSPHAL Objective: A descriptive study aimed to descnbe clinical characteristics and treatment procedure of urinary retention after lumbar herniated disc surgery in Vietduc Hospital. Results: The disease was more likely occur in men than women (3/2), 93.3% otvK patients were in the age group of 20-59 years olo.
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