Y HOC VIET NAM THANG 9 SO 1/2010 Co 3 benh nhan bi tac catheter, 1 benh nhan co dau hieu xuat huyet xung quanh vi tri catheter di qua va khong cd benh nhan nao cd bieu hien viem nao th|t sdm trong 26[.]
Trang 1Co 3 benh nhan bi tac catheter, 1 benh nhan co
dau hieu xuat huyet xung quanh vi tri catheter di qua
va khong cd benh nhan nao cd bieu hien viem nao
th|t sdm trong 26 benh nhan dUdc dieu tri
- Bien chutig sau khi da rut dan lull nao tha t
Cd 1 benh nhan sau khi rut dan lull 4 tuan
sau quay lai vdi chan doan la viem mang nao
Benh nhan nay cd dd dich nao tuy ra ngoai sau
khi rut din lUu Ve ky thuat neu nhu1
khau da tot sau khi rut dan lull thi cd the han che du'dc bien
chUng nay
IV KET LUAN
Dan lull nao that ra ngoai ngoai viec true hep lam
giam ALNS thong qua dan luU dich nao tuy tarn thdi
thi con la mot phu'dng phap tot de theo ddi ALNS tren
lam sang Ti le bien chutig ciia thu thuat (chu yeu la
tac dan luu) chi vao khoang tren 10%
TAI LIEU THAM KHAO
1 Adams, RA, Ropper, AH (1997) Principles of
neurology, 6th ed, McGraw Hill, New York
2 Battison C; Andrews PJ; Graham C; Petty T
(2005); Randomized, controlled trial on the effect
of a 20% mannitol solution and a 7.5% saline/6%
dextran solution on increased intracranial pressure
after brain injury Crit Care Med.;33(l): 196-202;
discussion 257-8
3 Francony G; Fauvage B; Falcon D; Canet C; Dilou H; Lavagne P; Jacquot C; Payen JF (2008); Equimolar doses of mannitol and hypertonic saline in the treatment of increased
intracranial pressure Crit Care Ato/,36(3):795-800
4 Mayhall CG; Archer NH; Lamb VA; Spadora AC; Baggett JW; Ward JD; Narayan RK (1984), Ventriculostomy-related infections A
prospective epidemiologic study., N Engl J
/Veo;310(9):553-9
5 Suarez JI; Qureshi Al; Bhardwaj A; Williams MA; Schnitzer MS; Mirski M; Hanley DF; Ulatowski JA (1998); Treatment of refractory
intracranial hypertension with 23.4% saline Crit Care A/e^26(6):1118-22
6 Vialet R; Albanese J; Thomachot L; Antonini F; Bourgouin A; Alliez B; Martin C (2003); Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20%
mannitol Crit Care Afetf.;31(6): 1683-7
DANH GIA CHUDNG TRINH VA THI/C TRANG GIANG DAY VE HIV/AIDS
CUA TRUONG DAI HOC Y HAI PHONG
Nguyen Thi Tham*, Nguyen Van Hung*,
Pham Van Han* TOM TAT
Nghien citu danh gia chudng trinh va viec thitc
hien dao tao ve HIV/AIDS: ndi dung, cau true chUdng
trinh dao tao, to chut giang day, phUdng phap giang
day, tai lieu giang day va hpc tap Cac phUdng phap
nghien cu'u dinh lUdng va dinh tinh da dupe sir dung
vdi sit tham gia ciia 225 sinh vien nam thir 5 va nam thir
6, 8 giang vien va can bp quan ly, ket qua cho thay:
Cac npi dung lien quan den HIV/AIDS dupe giang day
6 nhieu bp mon khac nhau tir nam thir nhat den nam thir
sau, kien thirc dUdc giang day con phan tan va triing lap d
* Tn/dng Dai hoc Y Hai Phong
mot so bp mdn Nhieu ndi dung va cac dich vu mdi lien quan den HIV con chua dUdc de cap trong chUdng trinh dao tao ChUa cd tai lieu dUdc xuat ban phuc vu giang day va nhieu thong tin chUa cap nhat PhUdng phap giang day ly thuyet chu yeu la thuyet trinh, chUa cd ndi dung thut hanh tai cac cd sd cham soc va dieu tri nhiem HIV tai cdng dong Da so sinh vien nam thir 5
va nam thU 6 cho rang kien thirc ve du phong HIV/AIDS dUdc hpc trong trudng Dai hpc dap itng cdng viec sau nay d mUc dp thap va trung binh
23
Trang 2SUMMARY:
Evaluating curriculum and the implementation
of HIV/AIDS program-Haiphong Medical
University
The study aims to evaluate the existing HIV/AIDS
curriculum, teaching/learning materials and
methodology of Haiphong Medical University for
medical students Contents, structure, materials,
teaching methodology of related departments
Qualitative and quantitative methods have been used
with the participation of 225 students at the 5th and 6*
year, 8 faculty members, resutlts showed that:
HIV/AIDS related contents mentioned and
integrated in different departments for the first to the
sixth years students, some are scattered and
duplicated and not updated New services available
relating to HIV/AIDS at community level is not yet
addressed Most of subjects have been conducted as
theory based, traditional teaching methods There is
no official published teaching/learning materials on
HIV Most of students rated their own knowkedge
gained in the university at low and average level
Cung vdi sU gia tang so luting ngUdi nhiem
HIV/AIDS, cac cd sd y te trong thdi diem hien
nay va trong tUdng lai phai tiep nhan, phuc vu va
cham sdc ngay cang nhieu benh nhan HIV/AIDS
tai tat ca cac tuyen tif trung Udng den dia
phUdng Cac sinh vien sap tot nghiep cd dUdc
trang bi du kien thud va ky nang can thiet de doi
pho vdi dai dich HIV/AIDS ChUdng trinh dao tao
tai TrUdng dai hpc y hien nay cd phu hdp vdi nhu
cau ve kien thud va ky nang lien quan den cong
tac phong chong HIV/AIDS, nhUng van de nao
can sua doi, bo sung, cap nhat dap Ung nhu cau
thut te De tra Idi nhUng cau hoi tren chung toi
tien hanh nghien cu'u vdi muc tieu: Danh gia
chUdng trinh va thuc trang viec thuc hien
chUdng trinh dao tao ve HIV/AIDS cho sinh vien
y khoa ciia TrUdng dai hgc Y Hai Phong nam hgc 2007-2008
II OOI TUONG VA PHUONG PHAP NGHIEN CUO
2.1 Doi tudng va cd mau nghien cu'u
- 120 sinh vien nam thd 5 va toan bp 105
sinh vien nam the? 5
- Toan bp giang vien cac bp mon dang giang day cac chu de ve HIV/AIDS (7 giang vien)
- 01 can bp quan ly phong dao tao
2.2 Phu'dng phap nghien ciiu
Thiet ke nghien cu'u cat ngang phoi hdp 2 phUdng phap:
Nghien cu'u djnh lu'dng: Nghien cUu sU
dung phUdng phap so sanh cat ngang dUa vao bang cau hoi phat van true tiep dieu tra danh gia chUdng trinh dao tao ve HIV/AIDS
Nghien cu'u djnh tinh:
Nghien cUu cac tai lieu san cd: bai giang, bao cao, tai lieu hpc tap
Thao luan nhdm vdi sinh vien nam thU nam, thU sau
Phong van sau giang vien, can bp phong dao tao
2.3 Phan tich va sd ly so lieu:
So lieu dinh lUdng td bp cau hoi dUdc nhap
va xU ly tren phan mem SPSS 15.0
So lieu dinh tinh nhu thong tin tU thao luan nhom dUdc dpc, ma hoa, phan tich va xd ly theo phudng phap nghien cu'u xa hpi hpc thong thudng
2.4 Van de dao diTc trong nghien cfru :
Nghien cUu vien giai thi'ch ro muc tieu nghien cud cho doi tUdng dUdc phong van, dUdc sU dong y va tu nguyen tham gia ciia ddi tUdng nghien ciiu NgUdi dUdc phong van cd quyen ti/
chdi tra Idi hoac ddng tra Idi bat cif khi nao
KET QUA NGHIEN CLfU
Bang 1 Ndi dung lien quan den HIV/AIDS trong chUdng trinh chi tie :
Chu de lien quan HIV/AIDS,
nghien va lam dung chat kich thich Bp mon giang day
So tiet Chu de lien quan HIV/AIDS,
nghien va lam dung chat kich thich Bp mon giang day Ly thuyet ThUc hanh
Trang 34 Lam dung rudu va nghien rUdu Tarn than 2 4
5 Nhiem HIV/AIDS/ Dich te hoc du1 phong
HIV/AIDS
11 Nhiem trung qua dudnq tinh due (HIV) Da lieu 1 2
Nhan xet: Trong chUdng trinh dao tao cho sinh vien he bac sT da khoa chinh quy ciia trudng Dai hgc Y Hai Phong, cac chu de lien quan den HIV/AIDS gom tong so 19 tiet ly thuyet va 23 tiet thUc hanh dUdc giang day d 11 bp mon khac nhau Mot so npi dung trung lap giua cac bp mon Y te cong cong, Truyen nhiem, Tarn than Mot sd ndi dung chUa dUdc de cap nhu giam hai trong phong chong HIV, nhiem trung cd hpi, cham soc giam nhe, dieu tri ngoai tru cho benh nhan, tu van xet nghiem HIV tU nguyen
Phu'dng phap giang day: Bai giang dUdc thUc hien theo phUdng phap thuyet trinh la chinh Viec hpc thUc hanh ve HIV/AIDS da dUdc dieu chinh tai mot so bp mon, nhu Truyen nhiem, Lao va benh phd'i Sinh vien chUa dupe tiep can cac dich vu mdi nhU tU van xet nghiem tU nguyen, cham soc cho ngUdi benh ngoai tru, dieu tri bang methadone
Bang 2 : Ket qua tra Idi cua sinh vien ve phUdng phap giang day ma giang vien da giang cho hp
— — — M i r e do ThUdng xuyen Khong thu'dng Thinh thoang ChUa bao
Nhan xet: Sinh vien Y5, Y6 la cac sinh vien da hpc qua tat ca cac bp mon danh gia, hpc thuyet trinh, day lam sang va cd cac phUdng tien nghe nhin thudng xuyen (57,2%, 49,8%, va 27,1%) Tai lieu giang day ve HIV:
Bang 3: Tai lieu day hpc theo danh gia cua giang vien
25
Trang 4Nhan xet: Ve tai lieu giang day, cd 7/7 giang vien da phat cho sinh vien handout/tai lieu phat tay, tap bai giang va tranh anh (2/7), cd 1/7 giang vien cd gidi thieu sach giao khoa
Cho den thdi diem nghien cu'u, cac bai giang du'dc soan va phat tay tuy theo bo mon, chu'a cd tai lieu du'dc xuat ban cho giang day ve HIV, ma tuy
Kha nang dap d'ng cong viec:
-jo
40 • ,—; 1 30.2 29.X
Hinh 1: Ket qua tra Idi cua sinh vien ve kha nang dap d'ng dUdc cdng viec sau khi ra trUdng Nhan xet: Sinh vien danh gia ve kien thud
dU phong dUdc hpc trong trUdng dap Ung cdng
viec sau nay d cac mUc dp: chUa dap Ung la
40%; dap Ung la 30,2% va dap Ung tot 29,8%
Ly do khong dap Ung dUdc sinh vien giai
thich trong cac cupc thao luan nhdm:
"Chung em khong biet kien thifc ve HIV du'dc
hoc trong tru&ng cd du de dap d'ng cdng viec
sau nay khong vi HIV chi la mot trong rat nhieu
ndi dung ma chung em dddc hoc Cd luc ditng
trddc benh nhan HIV thay khong du'dc td tin mac
dii sap trd thanh bac si"
Tom tat thao luan nhdm giang vien trUdng
Dai hpc Y Hai Phong: "nhieu giang vien co be
day kinh nghiem, yeu nghe va cd trach nhiem vdi
cdng viec ciia minh"; "so lu'dng giang vien cd
hitu cua cac bd mon dii dieu kien de giang day
cac chu de lien quan den td van di/ phong
HIV/AIDS, nghien ma tuy, nghien rtfdu va lam
dung rddu"
IV BAN LUAN
Qua nghien cifu cho thay, cac ndi dung lien
quan den HIV dddc giang day tai nhieu bd mon,
kha phan tan va chong cheo trong khi nhieu ndi
dung chu'a dddc de cap: sinh vien dUdc hpc cac
chu de lien quan den HIV/AIDS vdi 19 tiet ly
thuyet va 23 tiet thUc hanh Mot sd kien thuc ve
dU phong lay nhiem nhu dU phong lay nhiem HIV
nghe nghiep va tU van noi chung, tU van
HIV/AIDS, giam hai chUa dUdc de cap d bp
mon nao Hdn nUa vdi sd lUdng thdi gian hpc ly
thuyet va thUc hanh khong nhieu nhUng lai rai ra
d 11 bp mon va moi bp mon chi giang mot vai tiet, trong khi cd mot so ndi dung lai lap lai nhieu lan da lam giam hieu qua dao tao ciia chUdng trinh giang day
Nhieu noi dung ly thuyet chda du'dc cap nhat, cac dich vu cham soc va ho trd ngudi nhiem HIV tai cdng dong chua dddc gidi thieu, chua cd tai lieu xuat ban ve HIV: Phan tich tai
lieu hpc tap hien dang ap dung giang day tai trUdng va so vdi yeu cau ve Kien thirc, Thai dp
va Ky nang (KAS) can dat khi tot nghiep bac sT
da khoa, cd nhieu ndi dung lien quan den HIV/AIDS de cap trong yeu cau, nhUng thud te con chUa dUdc de cap trong chUdng trinh giang day va tai lieu day hpc nhU: anh hudng ciia HIV/AIDS den gia dinh va xa hpi; phUdng phap
tU van, giao due sire khoe cho benh nhan nhiem HIV/AIDS; ky thi va phan biet ddi xU; tuyen truyen giao due cdng dong ve HIV/AIDS, tu van xet nghiem tu nguyen, cham soc giam nhe, cham soc ngoai tru, cac chUdng trinh giam hai Tai lieu giang day chUa cap nhat d nhieu npi dung: dich
te hpc ve HIV/AIDS; cd che benh sinh, chien lUdc phong chong lay truyen tU me sang con [l, 3]
Ve phu'dng phap giang day: Trong khi tai' lieu hgc tap chda dddc hoan thien, viec giang day ly thuyet chu yeu van theo each thuyet trinh truyen thong Viec hpc thuc hanh chUa theo kip sU phat
trien nhanh chong ciia cac dich vu du phong, cham soc va dieu tri HIV/AIDS Trong khi nhieu dich vu y te da xuat hien va van hanh tai khu vUc Hai Phong [4] nhUng sinh vien van chUa cd cd hpi dUdc hpc tap, tim hieu ve cac dich vu nay
Trang 5Day la nhutig dich vu het site quan trgng, vdi
nhutig can bo y te da dUdc dao tao cd ky nang
tot, cd tiem nang Idn trong viec hd trd sinh vien
phat trien cac kien thcVc va ky nang cho cdng tac
cham soc site khoe ndi chung va cho ngudi
nhiem HIV ndi rieng
Tai lieu hoc tap hien tai chu yeu la tai' lieu
phat tay cua giang vien Khao sat cac chUOng
trinh va tai lieu hgc tap ciia cac trudng dai hpc y
trong ca nUdc cho thay, chUa cd tai lieu giang
day dUdc xuat ban theo hudng mot chuyen de cd
tinh toan dien Hdn nUa, do nhieu bp mon cirng
tham gia giang day nhUng chUa cd sU phoi hop,
viec chong cheo ve ndi dung la khd tranh khdi
La mot ITnh vitc sUc khoe quan trong, da cd
nhieu van ban phap ly, cac chUdng trinh hanh
ddng qudc gia de cap den cdng tac phong chong
HIV, viec xay ditng mot chUdng trinh va tai lieu
hoan chinh ve HIV/AIDS la het sUc can thiet
Qua phong van sinh vien y da khoa nam thU
nam, thU sau ve mUc dp dap Ung nhu cau cdng
viec sau nay ciia kien thiic da dupe hpc trong
trudng dai hpc ve cac chu de lien quan den
HIV/AIDS Ket qua cho thay mire dp dap irng
trung binh va thiip rat cao (70,2% ), trong khi
mUc dap Ung td't theo quan niem ciia sinh vien
chi dat 28,8% Ly do khong dap Ung la "kien
thtic ve HIV/AIDS du'dc hoc d nhieu bo mon va
khong lien tuc nen kien thut khong he thong",
"noi dung hpc tap qua nhieu; dieu kien thut
hanh kern, thieu cd hpi thut hanh cac ky nang
can thiet" va cd nhieu sinh vien con cd tarn ly
"ngai tiep xuc vdi benh nhan HIV/AIDS" vi con
"5d"benh nhan HIV/AIDS nen cang lam cho sinh
vien cd it cd hpi thud hanh ky nang dUdc hpc
Van de ky thi ddi vdi benh nhan HIV/AIDS da trd
thanh rao can ddi vdi sinh vien trong viec hieu,
thong cam, chia se cung nhu thut hanh cac ky
nang dUdc hpc trong trUdng Qua dd cung cho
thay hieu qua ciia chUdng trinh dao tao ve
HIV/AIDS ciia trUdng chUa thUc sU dat hieu qua,
con nhieu han che Ket qua nghien ciru ciia
chiing tdi ve kha nang dap irng cdng viec sau
nay thap hdn ciia Le Hong PhUOng cd 65% hpc
sinh cho rang kien thUc hpc trong trUdng dap
Ung tot cdng viec sau nay [2]
V KET LUAN ChUdng trinh dao tao ve HIV/AIDS cd npi dung triing lap va phan tan d nhieu bp mon Nhieu npi dung lien quan trite tiep den du phong, cham soc va dieu tri nhiem HIV chUa dUdc de cap d bp mon nao
ChUa cd tai lieu dUdc xuat ban phuc vu giang day mot each toan dien ve HIV va nhutig chu de sUc khoe lien quan trite tiep, nhu ma tuy, cham sdc giam nhe, giam hai
Sinh vien chUa dUdc thUc hanh va gidi thieu ve cac dich vu du phong, cham sdc va dieu tri ngUdi nhiem HIV/AIDS tai cdng dong nhu tu van xet nghiem tit nguyen (VCT), dieu tri ngoai tru cho benh nhan (OPC), giao due ddng dang
Khuyen nghi :
1 Can cd chUdng trinh toan dien de giang day ve HIV theo hudng mot chu de sire khoe: dam bao dap Ung kien thUc, thai dp cung nhu ky nang trong cham sdc va dieu tri benh nhan HIV/AIDS va cac van de lien quan dUdc de cap
2 Xay ditng tai lieu giang day va hpc tap dap irng nhu cau thut te cdng tac phong chong HIV Cac npi dung lien quan den cac qui dinh hien tai trong Luat phong chong HIV, nhu van de chong phan biet ky thi, bao mat thong tin can dUdc gidi thieu
3 Viec hpc tap ve kien thirc va k9 nang tu van, giao tiep, y dire cd the dUdc tang cUdng thong qua gidi thieu cac djch vu mdi cho sinh vien nhu TU van xet nghiem tu nguyen, cham sdc giam nhe, dieu tri ngoai tru cho benh nhan trong chUdng trinh dao tao
TAI LIEU THAAA KHAO
1 Bo Y te (2006) Kien thUc - Thai dp - Ky nang can dat khi td't nghiep bac si da khoa Nha xuat ban Y hpc
2 Le Hong Phudng (2008) Kien thirc, thai dp ciia hpc sinh dieu dudng, hp sinh ve HIV/AIDS Khoa luan td't nghiep cU nhan Y te cdng cdng TrUdng Dai hpc Y Ha Ndi
3 Trudng Dai hoc Y Hai phong (2001) ChUdng trinh Dao tao Bac si da khoa he dai han
4 Uy ban phong chong AIDS Hai Phong Bao cao cdng tac phong chong HIV/AIDS nganh Y te Hai Phong 1998-1999-2000-2007
27