Thực hành cộng đồng 1 phần 1

1 0 1 2 Thuc hanh tai TTYT duphdng huyen va BV huyen 2 tuan To chifc va quan ly cac chifdng trinh y te quoc gia tai huyen 9 0 9 To chiic va thuc hien kham va giai quyet cac benh thifdng

HOC Y KHOA THAI NGUYEN

H i i i

TR U O N G DAI HOC Y KHOA THAI NGUYEN

NHA X U A T BAN Y HOC

CHU BIEN:

PGS TS Dam Khai Hoan

BAN BIEN SOAN:

PGS.TS Dam Khai Hoan

ThS Nguyen Phifdng Lan

ThS Nguyen Ngoc Diep

ThS Nguyen Thu Hien

LOI Gldl THIEU

Dap ling yeu cau cham soc siic khoe cho nhan dan trong giai doan hien nay ngiibi bac si khong nhiing co kien thiic toan dien, kha nang nghien cHu ma ho can nhiing ky nang lam viec trong dieu kien thiic te cua cong dong Cong dong 1 la mon hoc trong chiidng trinh dao tao bac

si da khoa he chinh quy cua Triibng Dai hoc Y khoa Thai Nguyen danh cho sinh vien nam thti nam, nham gop phan dat dtftic yeu cau do Mon hoc nay tao ra nhiing cd hoi cho sinh vien thi/c hanh cac kien thiic da hoc dittfc ti( nam thii nhat den nam thii nam tai y te tuyen huyen va xa.

Dita tren nhu cau thiic te va chiictng trinh giao due diia vao cong dong ban hanh theo quyet dinh so 27 2/YK-QD ngay 15 thang 7 nam

2005 cua Triicfng Dai hoc Y Khoa Thai Nguyen - Tap the giang vien Triibng da bien soan cuon tai lieu hoc tap mon hoc cong dong 1 danh cho sinh vien.

Trong qua trinh bien soan cuon tai lieu nay ch in g toi da nhan diidc sii ho trcj cua Chiictng trinh Hop tac Y te Viet Nam-Thuy Dien, Vu Khoa hoc- Dao tao Bo Y te, y kien dong gop cua cac chuyen gia trong va ngoai niibc cung nhii cong dong dao tao Dong Hy va Phi LitOng Chung toi tran trong cam On nhiing y kien dong gop quy bau do.

Tuy nhien Ian dau bien soan se khong tranh khoi nhiing khiem khuyet, rat mong cac dong nghiep va cac ban sinh vien gop y de Ian xuat ban sau hoan chinh hefn.

c h C i b i £ n

PGS TS Dam Khai Hoan

MUC LUC

To chifc va quan ly cac chUdng trinh muc tieu y te quoc gia

To chifc va hoat dong cua khoa DUdc, khoa Xet nghiem,

phong Ke hoach tong hdp tai benh vien huyen 22

Giao due silfc khoe va tu" van cho nguoi mang thai 56

Phan ti'ch he thong so sach bao cao tai tram y te xa 88Thi/c hien cac chuong trinh Sot ret va tiem chung mo rang tai tuyen y te xa 92

Lap ke hoach Truyen thong-Giao due si/c khoe 106Thi/c hanh Truyen thong - Giao due sifc khoe 114

Hirdng d in sinh vien tif hoc, t ii nghien ciru va van dung thirc te mon hoc 126

5

HlfONG dAn Sir DUNG TAI LIEU• •

Cuon tai lieu mon hoc cong dong 1 la cuon tai lieu hudng d&n sinh vien thuc hanh tai cO sd y te Bo" cuc tai lieu dUdc chia lam hai phan chinh:

Phan 1: Hudng dan thuc hanh cong dong

Phan nay cung cap nhflng thong tin din thiet cho sinh vien de chu&n bi triidc khi di hoc tai cong dong Sinh vien doc lan ltfdt cac chu de de on tap lai ly thuyet co lien quan den mon hoc theo sU hudng dan, chuan bi cac tai lieu va trang thiet bi can thiet de san sang hoc tai cong dong mot cach chu dong theo ke hoach hudng dan.Phan 2 Cac bai thuc hanh tai cong dong

Sinh vien nghien ciiu muc tieu bai hoc dtfdc gidi thieu phan dau cua moi bai

de dinh hudng noi dung va phiidng phap nen ap dung cho moi chu de Doc phan noi dung se hudng dan tifng btfdc cac hoat dong sinh vien nen lam de dat dtfdc muc tieu hoc tap Sau khi hoc xong bai hoc, nhom sinh vien nen thao luan de tra ldi cho cac cau hoi lUdng gia Khi co mong m uon tU hoc, tu nghien cCfu va van dung thuc te nhiing kien thiic va ky nang da dat dUdc sinh vien co the tham khao phan hudng dan cuoi moi bai

Phan 3: Phu luc

Sinh vien sU dung cac loai tai lieu trong phu luc de thuc hien cac yeu cau dieu tra va hoan thanh cac loai san pham lien quan den thuc hanh cong dong

Khi can tim kiem tai lieu tham khao cho mon hoc sinh vien co the xem danh muc cac tai lieu tham khao d phan cuoi cua tai lieu Cac loai tai lieu nay co san d thu vien cua TrUdng va cd sd y te

Nghien ciiu cuon tai lieu mot cach tong the triidc khi thUc hanh tai cong dong

se giup sinh vien co cach nhin tong quat ve mon hoc va chu dong trong hoc tap Vi vav sinh vien nen nghien cilu ky va lap ke hoach chi tiet trUdc khi di thiic hanh tai

y te tuyen huyen va xa

MON HOC THI/C HANH CONG DONG 1 ■ ■ ■

So tiet : 0/180 Ly thuyet: 0 Thiic hanh: 180

So Ian thi: 1

Thdi gian thiic hien: Nam thii 5 (Hoc ky IX & X)

MUC TIEU

Sau khi ket thuc mon hoc, sinh vien co kha nang:

1 Mo ta diictc chiic nang, nhiem vu va cac hoat dong cua TTYT dii phong huyen

2 Kham va xii tri diictc mot so benh thiibng gap tai benh vien huyen

3 Phan tich diic/c cac hoat dong chuyen mon cua mot so khoa phong cua benh vien huyen va TTYT dii phong huyen.

4 Mo ta diictc cac chiictng trinh y te Quoc gia dang thiic hien tai huyen va phan tich chi tiet hoat dong cua 1 chiictng trinh muc tieu co hieu qua nhat tai huyen.

5 Mo ta diictc nhiem vu va qui trinh quan ly tram y te xa.

6 Mo ta diic/c cach thiic hien chiictng trinh y te Quoc gia tai xa va phan tich chi tiet viec thiic hien 2 chiiOng trinh muc tieu co hieu qua nhat tai xa.

7 Phan tich dittfc he thong so sach, so lieu va he thong bao cao tai tram y te xa.

8 Phan tich hoat dong va cach dieu hanh y te thon ban tai xa.

9 Tien hanh chan doan cong dong va liia chon diidc van de siic khoe liu tien.

10 Xay di/ng ke hoach va to chiic thiic hien diictc mot buoi TT - GDSK tai cong dong

11 Xii tri diidc cac benh thiibng gap tai tram y te xa.

NOI DUNG

So tiet Tong

sd thuyet Ly

Thirc hanh

1 Tap huan cac van de lien quan thuc hanh cong dong 1:

Muc tieu, noi dung va cac yeu cau hpc tap cua mon hpc

Phifdng phap thi/c hanh ve to chut quan ly va hoat dong

cCia TTYT di/ phong huyen va cac chi tieu hpc tap 1 0 1Phifdng phap thirc hanh lam sang tai benh vien huyen va

Phifdng phap thuc hanh tai TYT xa va chi tieu hpc tap 1 0 1

Phifdng phap thuc hanh tai CD va cac chi tieu hpc tap 1 0 1

2 Thuc hanh tai TTYT duphdng huyen va BV huyen (2 tuan)

To chifc va quan ly cac chifdng trinh y te quoc gia tai huyen 9 0 9

To chiic va thuc hien kham va giai quyet cac benh thifdng

gap tai phong kham benh vien huyen

To chifc va thirc hien kham va giai quyet cac benh thifdng

gap tai khoa Noi Nhi Lay

•

To chirc va thi/c hien kham va giai quyet cac benh thirdng

gap tai khoa Ngoai San

To chirc va hoat dong cua khoa Di/dc, xet nghiem, phong

ke hoach tong hdp

3 Thuc hanh tai xa (2 tuan)

Quan ly hoat dong mang lifdi y te thon ban 6 0 6Phan tich he thong sd sach bao cao tai tram y te xa 9 0 9

Thuc hien cac chifdng trinh Tiem chung md rong, Sot ret va

Bifdu co tai TYT xa

Lap ke hoach GDSK de giai quyet 1 van de Stic khoe ifu

tien d cong dong

HUONG DAN THUC HANH CONG DONG

MUC T liu

Sau khi hoc xong bai nay sinh vien co kha nang:

1 Trinh bay diidc muc tieu, noi dung hoc tap tai cong dong

2 Mo ta diidc cac yeu cau cua deft hoc tap tai cong dong

1 Gidi thieu mon hoc

ThUc hanh cong dong 1 la mon hoc danh cho sinh vien nam thii nam thuc hanh cac kien thiic va ky nang da tich luy dUdc trong suot qua trinh tu nam thii nhat den nam thii nam Muc dich cua mon hoc nay nham tao ra cd hoi cho sinh vien thuc hanh cac ky nang trong dieu kien thuc te cua y te tuyen huyen va xa Ngoai viec thuc hanh cac ky nang c&n thiet day la cd hoi tot cho sinh vien hoc hoi, quan sat cac van de siic khoe dang xay ra trong thuc te cong dong va cac yeu to" moi trUdng tu nhien moi trUdng xa hoi anh hudng den viec cung cap va sii dung cac dich vu y te cua cong dong

2 Muc tieu va chu de hoc tap

M uc tieu va noi dung cua mon hoc dUdc chia lam 2 phan chinh: hoc tap ve to chiic, hoat dong cua y te tuyen huyen; hoc tap ve to chiic, cac hoat dong cua tram y

te xa va cac van de siic khoe xay ra trong cong dong (ph&n nay sinh vien doc phan chUdng trinh chi tiet mon hoc)

3 Ke hoach thirc hanh tai tuyen huyen

2 To chirc va quan ly cac chuong trinh muc tieu y te

quoc gia tai huyen

9 Can bo trung tam

y te di/ phong huyen

3 To chiic hoat dong khoa di/dc, Khoa xet nghiem,

phong ke hoach tong hdp benh vien huyen

12 Lanh dao benh

vien huyen

4 Thi/c hien kham va giai quyet cac benh thi/dng gap tai

Phong kham benh vien huyen

phong kham

5 Thuc hien kham, giai quyet cac benh thi/dng gap khoa

Bac sT khoa No* hoac Nhi

6 Thuc hien kham, giai quyet cac benh thtrdng gap khoa

Ngoai San

18 Bac sT khoa Ngoai

hoac San7

-— ■

hoach (quan ly ldp)

3.2 Huang dan hoc tai trung tarn y te di/phdng huyen

- To chiic hoat dong trung tarn y te du phong huyen: sinh vien dUdc nghe lanh dao cua trung tam y te du phong huyen gidi thieu ve to chiic nhan sii, cac nhiem vu cu the trong nam va cac hoat dong tien hanh thifdng quy Ket hdp giiia phan gidi thieu cua lanh dao trung tam, quan sat cac hoat dong dien ra trong thdi gian thuc hanh va doi chieu vdi ly thuyet da hoc sinh vien tU rut ra nhan xet ve to chiic va hoat dong cua trung tam den thuc hanh De hoc tot phan nay tai cong dong sinh vien can on tap ph&n ly thuyet to chiic hoat dong cua trung tam y te du phong huyen

- To chiic va quan ly cac chUdng trinh muc tieu y te quoc gia tai huyen: can

bo phu trach tiing chUdng trinh se gidi thieu vdi sinh vien ve muc tieu, giai phap, cach chi dao tuyen xa hoat dong va quan ly cac chUdng trinh y te do De dat diidc muc tieu khi hoc chu de nay sinh vien can on tap ph&n ly thuyet cua mon hoc cac chUdng trinh y te quoc gia

3.3 Huang dan hoc tai benh vien tuyen huyen

- To chiic hoat dong benh vien huyen va cac khoa phong: sinh vien dUdc

nghe lanh dao benh vien gidi thieu ve to chiic nhan sii, cau true cac khoa phong cua benh vien tuyen huyen, chiic nang va nhiem vu cua benh vien Ket hdp giiia phan gidi thieu cua lanh dao benh vien, quan sat cac hoat dong dien ra trong thdi gian thuc hanh va doi chieu vdi ly thuyet da hoc, sinh vien tu rut ra nhan xet ve to chiic

va hoat dong cua benh vien den thuc hanh De hoc tot ph&n nay tai cong dong sinh vien can on tap ph&n ly thuyet to chiic hoat dong benh vien tuyen huyen

- Thuc hanh tai cac khoa: giao vien phu trach ldp se chia sinh vien thanh nhom nho de thuc hanh luan khoa Tai cac khoa sinh vien se chu dong hoc tap dudi

sU gnip dd cua cac bac si trong tiing khoa Khi thuc hanh tai cac khoa sinh vien can hoc ve cac to chiic mot khoa phong (bao gom: Phan cong cong viec cho tiing can bo, sfip xep khoa phong, trang thiet bi); tham gia kham chiia benh va tu van siic khoe cho benh nhan; tham gia trUc tai benh vien; nhan xet ve mo hinh benh tat va cach xii tri tai benh vien huyen trong thdi gian thuc hanh De dat dUdc muc tieu hoc tap phan nay sinh vien c&n on tap kien thiic lam sang cua cac chuyen khoa da hoc

4 Ke hoach thirc hanh tai tram y te xa (TYTX)

4.1 Lich hoc

Lich hoc cu the cua tdng ngay se do tram trUdng (hoac ngUdi dUdc uy quyen) cua tram y te xa thong bao cho nhom sinh vien Noi dung va thdi liidng cac chu de nhu sau:

TT Noi dung Thdi gian (tiet) Can bo

1 To chiic hoat dong cua tram y te xa 9 Can bo TYT X

2 Thi/c hien chUdng trinh sot ret, tiem chung md rong

3 He thong sd sach, bao cao tai TYTX 9 Can bo TYT X

5 Lap ke hoach cho mot buoi Truyen thong - Giao due

6 Thi/c hanh Truyen thong - Giao due sifc khoe tai

7 To chifc chuyen tuyen trong san phu khoa 6 Can bo TYT X

ly sinh vien)

4.2 Hudng dan hoc tai tram y te xa

4.2.1 Bifdc 1: gidi thieu va lam quen

Hoat dong gidi thieu va lam quen giiia nhom sinh vien, can bo tram, y te thon ban va Uy ban nhan dan xa dUdc tien hanh ngay tu: buoi dau tien sinh vien co mat tai tram y te Nhom trUdng lien he vdi tram trUdng de gidi thieu ve nhom Tram trUdng tram y te se chu tri buoi gidi thieu cac thanh phan lien quan den qua trinh hoc tap cua sinh vien tai cong dong va cac nguyen tac sinh vien can thuc hien trong hai tuan lam viec va sinh hoat tai xa

4.2.2 Bifdc 2: trinh bay ke hoach hoc tap cua nhom vdi tram y te xa

Dua tren chUdng trinh thuc hanh da dUdc bo mon Y hoc Cong dong hudng d&n, nhom trUdng nhom sinh vien trinh bay ve muc tieu hoc tap va cac noi dung thuc hanh tai tram Tren cd sd thao luan giiia tram y te va nhom sinh vien ve cac hoat dong can tien hanh, tram trUdng tram y te lap ke hoach day hoc chi tiet cho tiing ngay trong toan bo ddt thuc te

4.2.3 Bifdc 3: lam viec, tham gia true tai tram v te va hoc cac noi dung theo yeu cau

- ThUc hien cac hoat dong theo lich dUdc phan cong

- Chu dong hoc tap theo cac noi dung yeu cau

- Lfing nghe sii trinh bay/gicli thieu cua can bo TYTX

- Thu thap cac thong tin can thiet b&ng cac phUdng phap va cac kenh thong tin khac nhau

- So sanh giiia phan ly thuyet da dUdc hoc va thiic trang cua TYTX

- Thao luan nhom cac van de theo hUdng dan cua tiing chu de

- Trinh bay vdi giao vien nhiing diem chUa ro de dUdc giai dap (phUdng phap

va noi dung cu the tham khao phan hu6ng dan hoc chi tiet tiing chu de)

- Van dung nhiing kien thiic, ky nang da cd vao tiing hoan canh cu the tai tram y te

- Tham gia vao cac hoat dong cua Tram: trong thdi gian lam viec tai tram hoac tham gia trUc, sinh vien pho'i hdp cung cac can bo y te xvt tri cac trUdng hdp

den kham va dieu tri M oi nguyen tic kham chQa benh phai theo quy dinh cua

tram y te xa

+ Cong tac kham chCta benh:

Kham benh, chan doan, ke ddn

Kham thai, kham benh phu khoa

Tieu phau ddn gian

Sd, cap ctiu vet thUdng

Chuyen tuyen

+ Tham gia cac chUdng trinh y te trien khai tai tram

+ Cong tac dUdc:

• Cap phat thuoc

Du tru, mua ban thuoc

• Bao quan thuoc

+ Cac chUdng trinh y te trien khai trong xa

Tham gia vao chUdng trinh tiem chung mci rong

Tham gia chUOng trinh IMCI

Tham gia vao cac chUdng trinh y te khac trien khai tai cong dong

+ Cong tac hanh chinh:

Ghi chep so sach, phieu kham

Thong ke so' lieu de bao cao dinh ky

Giao ban cung tram y te

+ Cong tac ngoai tram:

• Dieu tra

Giao due siic khoe

Kham, theo ddi benh nhan tai cong dong

4.2.4 Bifdc 4: hoan thanh bao cao, cac loai giay td va thu tuc lien quan.

- Phieu dieu tra tai tram y te

- Cac phieu dieu tra ho gia dinh (moi ngUdi 15 phieu), dien ket qua vao bang

- Bang ke hoach giao due siic khoe va ket qua

- Bai tuyen truyen giao due siic khoe

- Bao cao ket qua ddt thuc te

4.3 Hudng dan hoc tai cong dong

4.3.1 Thu thap thong tin tif cong dong

Sinh vien sii dung cong cu dieu tra do bo mon hudng dan de thu thap thong tin c&n thiet tut ho gia dinh Sinh vien trinh bay cach chon mau vdi can bo y te cua TYTX, can bo tram se hudng dan sinh vien cach tiep can vdi ho gia dinh Viec lam sach so lieu can dUdc thiic hien ngay tai cong dong

Ngoai viec thu thap nhiing thong tin can thiet theo cong cu da hudng dan, sinh vien can tim hieu cac phong tuc tap quan, cac yeu to cd anh hudng den siic khoe cua cong dong nh&m cd day du thong tin can thiet cho xac dinh van de siic khoe va lua chon van de siic khoe Uu tien

4.3.2 Truyen thong giao due sifc khoe

Theo ke hoach hoc tap moi nhom sinh vien c&n to chiic mot buoi truyen thong giao due siic khoe cho cong dong Chu de truyen thong la van de Uu tien c&n giai quyet d cong dong Sinh vien can chu dong lien he vdi cong dong de to chiic buoi truyen thong, bao gom: lien he vdi ban nganh doan the cd lien quan vdi chu de truyen thong, mdi doi tUdng dich, lien he dia diem, chuan bi cd sd vat chat can thiet (sinh vien nghien ciiu bai ke hoach truyen thong giao due siic khoe)

4.3.3 Tham gia vao cac hoat dong cua dia phi/ong

Khi thuc hanh tai cong dong, ngoai viec thiic hien cac nhiem vu chuyen mon sinh vien nen tham gia vao cac hoat dong cua dia phUdng nham tao moi quan he v6i cong dong va tim kiem cd hoi de hieu phong tuc tap quan cua dia phUdng

5 Noi quy hpc tai cong dong

Sinh vien TrUdng Dai hoc Y khoa Thai Nguyen thuc hanh tai cong dong phai tuan theo cac quy dinh sau:

1 Sinh vien phai thiic hien tot moi noi quy, quy dinh cua dia phUdng va cd sd thiic hanh

2 Sinh vien phai khiem ton hoc tap, le do trong quan he vdi can bo, nhan vien

y te va nhan dan dia phUdng

3 Sinh vien phai ton trong phong tuc tap quan cua dia phUdng

4 Nghiem cam sinh vien tham gia hoat dong cac te nan xa hoi

5 Sinh vien phai chiu sii quan ly cua can bo y te cd sd

6 Sinh vien khong dUdc vang mat trong cac ddt thiic hanh, moi sii vang mat phai cd giay phep va dUdc sii dong y cua can bo y te cd sd

7 Ket thuc ddt hoc tap, moi sinh vien phai hoan thanh cac chi tieu va ban bao cao ket qua ddt hoc tap theo quy dinh cua nha trUdng

8 M oi sinh vien phai co trach nhiem thiic hien tot ban noi quy nay

6 Chuan bj

6.1 Kien thiic lien quan

Sinh vien c&n nghien ciiu lai cac tai lieu co lien quan den nhiing noi dung sau:

- Nhiem vu cua tram y te xa/ phUdng

- Quan ly y te

- Lap ke hoach y te

- Giam sat hoat dong y te

- Danh gia hoat dong y te

- Quan ly nhan luc y te

- Quan cd sd vat chat va trang thiet bi y te

- Nguon kinh phi y te

- Quan ly thong tin y te

- Cac chUdng trinh y te quoc gia: muc tieu, giai phap

- Quan ly thong tin y te

- Quy che ve thong ke y te (ban hanh kern theo quyet dinh cua Bo trUdng Bo

Y Te so 379/2002/Q D-BYT ngay 8/2/2002)

- Nhiem vu y te thon ban

- Ky nang giao tiep

- On tap cac phan ly thuyet lam sang co lien quan den kham, dieu tri va xii tri benh nhan tai tuyen y te cd sd

6.2 Phwong tien di lai

Viec di chuyen tCf trUdng den cd sd y te do TrUdng to chiic, sinh vien can chu dong trong viec chuan bi phUdng tien di chuyen tii cd sd y te den nha dan

6.3 Vat dung ca nhan can thiet

Quan ao, tu trang, do dung ca nhan

7 Cac loai tai lieu can nop cho bo mon sau khi ket thuc dot thirc hanh

7.1 Tap the nhom

- Phieu dieu tra tai tram y te xa

- Phieu dieu tra 10 chuan y te xa

- Cac phieu dieu tra ho gia dinh (moi ngUdi 10 phieu), cung cac bang trong

- Ban ke hoach Truyen thong- Giao due siic khoe

- Bai Truyen thong- Giao due siic khoe

- Bao cao thu hoach cua nhom theo mau hu6ng dan

7.2 Ca nhan

- Bang cham diem cho ca nhan cua Trung tam y te

- Bang cham diem cho ca nhan cua can bo Tram y te

8 Nhumg diem can liru y

Trong qua trinh thuc hanh tai tram y te, sinh vien tham khao phan phan cong trach nhiem cua tting ben lien quan den qua trinh thuc hanh (Y te tuyen huyen, tram y te Uy ban nhan dan, Y te thon ban, giao vien TrUdng dai hoc Y khoa) de phoi hop co hieu qua Nhiem vu cua cac ben lien quan nhu sau:

- Can bo trung tam y te huyen va tram y te xa

+ Quan ly sinh vien

+ Hudng dan sinh vien thuc hanh theo ke hoach cua trUdng

+ LUdng gia qua trinh thuc hanh

- Can bo giang bo mon Y hoc cong dong, Y hoc xa hoi va Dich te

+ Chuan bi cong dong, xay dung ke hoach

+ Tap huan cho sinh vien

+ Giam sat trong qua trinh hoc tap

+ LUdng gia khi ket thuc ddt thuc hanh cong dong

- Can bo cac bo mon lam sang:

+ Giao chi tieu thuc hanh

+ Tap huan cho sinh vien

+ Giam sat trong qua trinh hoc tap

Phu luc kem theo:

1 Phieu dieu tra 10 chuan quoc gia y te xa

2 Phieu dieu tra tai tram y te xa

3 Phieu dieu tra ho gia dinh

4 Bang trong

5 M&u bao cao

6 Phieu cham diem cua y te tuyen huyen

7 Phieu cham diem cua tram y te xa

TO CHUTC HOAT DONG CUA TRUNG TAM Y TE DU PHONG HUYEN

MUC TIEU

Sau khi hoc xong bai nay, sinh vien co kha nang:

1 Nhan xet diidc thiic trang to chiic hoat dong cua Trung tam Y te dii phong huyen ncfi sinh vien den thiic tap.

1 Bifdc 1: Gidi thieu Trung tam Y te dii phong huyen ndi sinh vien thiic te

- Vi tri cua trung tam: la ddn vi sii nghiep triic thuoc Sd y te, chiu sii quan ly toan dien cua Giam doc Sd Y te, sii quan ly nha nUdc cua U y ban nhan dan huyen

va sii chi dao ve chuyen mon, ky thuat cua cac Trung tam thuoc he dii phong, cac Trung tam chuyen nganh tinh

- Cd cau to chiic cua Trung tam Y te dii phong huyen:

+ Bo may lanh dao: Giam doc, Pho Giam doc Chiic trach nhiem vu cu the cua cac can bo lanh dao Trung tam

+ Bo may giup viec Giam doc trung tam: cac phong chiic nang, giup viec.+ Cac khoa chuyen mon cua trung tam

- Chile nang, nhiem vu va hoat dong cua Trung tam Y te dii phong huyen:+ Xay diing ke hoach trien khai thiic hien cac nhiem vu chuyen m on ky thuat tren dia ban huyen

+ To chiic trien khai thiic hien cac hoat dong chuyen mon, ky thuat ve phong, chong dich benh, HIV/AIDS, cac benh xa hoi, dinh dudng cong dong, an toan ve sinh thiic pham, truyen thong giao due siic khoe,

+ Hudng dan va giam sat chuyen mon, ky thuat ve cac hoat dong thuoc linh viic phu trach doi vdi cac tram y te xa/phUdng, thi tran, cac cd sd y te tren dia ban

+ Tham gia dao tao, dao tao lai, tap huan, boi diidng kien thiic ve chuyen mon nghiep vu cho can bo y te xa, nhan vien y te thon ban,

+ Quan ly va to chiic trien khai thiic hien cac dii an thuoc chUdng trinh muc tieu y te quoc gia

+ Quan ly can bo , che do chinh sach, quan ly tai chinh, tai san v.v

2 Bifdc 2: tham quan Trung tam Y te du phong huyen

Cac phong lam viec cua Ban Giam doc;

Cac phong chiic nang giup viec cho Ban Giam doc: phong hanh chinh tong hdp, phong truyen thong giao due siic khoe;

Cac khoa chuyen mon nhU:

- Khoa Y te cong cong;

- Khoa Cham soc siic khoe sinh san;

- Khoa Kiem soat dich, benh, HIV/AIDS;

- Khoa An toan ve sinh thiic pham;

- Khoa xet nghiem, v.v

Sinh vien can chu y tim hieu ve cO cau to chiic, hoat dong cu the cua cac phong ban nhU:

- Co sd v at chat: so" phong lam viec, cac trang thiet b i,

- Nguon nhan luc cd bao nhieu ngUdi, du hay thieu?

- Chiic nang nhiem vu cu the cua tiing thanh vien?

- Ai phu trach chUdng trinh/hoat dong y te nao? Chiu sii dieu hanh, giam sat cua ai?

- Tinh hinh thiic hien nhiem vu? Nhiing kho khan thuan ldi khi thiic hien nhiem vu dUdc giao? Cach khac phuc kho khan de hoan thanh nhiem vu?

- Sinh vien xem, doc cac so sach, bieu mau bao cao thong ke va quan sat cach ghi chep, lam bao cao so sach

Trong khi can bo trung tam hudng dan, sinh vien can chu y quan sat, Mng nghe, ghi chep lai de cd dUdc nhiing thong tin can thiet

3 Bifdc 3: thao luan nhom

Sinh vien thao luan nhom theo 2 noi dung sau:

1 Thiic trang cO cau to chiic cua Trung tam y te dii phong huyen

2 Hoat dong cua Trung tam Y te dii phong huyen

Sinh vien thao luan, so sanh giiia ly thuyet va thiic te de dua ra nhiing nhan xet cua minh ve thiic trang cd cau to chiic, sii phan cong cong viec, viec thiic hien cac nhiem vu va hoat dong cua Trung tam Y te dii phong huyen Tim ra nhiing Uu

diem can phat huy, nhiing bat cap can khac phuc de thiic hien tot cong tac du phong tai tuyen y te huyen trong cham soc va bao ve siic khoe nhan dan

TL/Ll/O NG GIA

1 Cong cu ludng gia

1 Thiic trang cd cau to chiic cua Trung tam y te du phong huyen co phu hdp vdi quy dinh cua he thong To chiic y te Viet Nam khong?

2 Su phan cong cong viec cho cac thanh vien d cac phong ban khoa co phu hdp vdi chuc nang va nhiem vu cua ho khong? Tai sao?

3 Trung tam y te dii phong huyen co hoan thanh tot nhiem vu khong? Nhiing nhiem vu nao chua hoan thanh?

4 N hung kho khan va thuan ldi trong qua trinh thiic hien nhiem vu cua Trung tam y te du phong huyen? Cach k h ic phuc kho khan de hoan thanh nhiem

vu diidc giao?

2 Hirdng dan sinh vien tir lifdng gia

Qua ket qua thao luan nhom cac y kien thao luan dUdc th on g nhat ngay sau buoi hoc chinh la phan dap an cho cac cau hoi tu ludng gia cua sinh vien Trinh bay nhiing diem chua r5, con thac mac vdi can bo T ru ng tam hoac giao vien de dUdc giai dap

HUCING DAN TU HOC, TU NGHIEN CLfU, VAN DUNG THUC TE

1 PhUdng phap hoc

Sinh vien doc tai lieu phan ly thuyet cd lien quan den cac noi dung hoc tap trong bai giang danh dau nhiing diem con kho hieu hoac chua ro de thao luan vdi cac ban sinh vien khac trong khi hoc hoac hoi giao vien de dUdc giai dap

Sinh vien chu dong hoc hoi va de nghi vdi can bo Trung tam giup dd khi din thiet

2 Van dung thuc te

Qua thuc hanh tai Trung tam y te dii phong huyen, sinh vien tham quan tim hieu ve thuc trang to chiic hoat dong cua Trung tam dii phong huyen, tii dd sinh vien cd kha nang doi chieu so sanh giiia nhiing kien thiic dUdc hoc trong bai ly thuyet vdi thiic te dUdc chiing kien dua ra nhiing nhan xet ve thiic trang cd cau to chiic, chiic nang nhiem vu va hoat dong cua Trung tam y te dii phong huyen co phu hdp hay khong phu hdp vdi he thong y te Viet Nam hien nay

3 Tai lieu tham khao

1 Bo Y te - UNICEF Quan ly cham soc siic khoe ban d&u d tuyen y te cd sd Nha xuat ban y hoc Ha Noi 2000

2 Bo Y te - To chiic Y te The gidi Du an phat trien he thong y te - Q uan ly y

te Nha xuat ban y hoc Ha Noi 2001

3 Bo mon Y xa hoi hoc To chiic va quan ly y te TrUdng Dai hoc Y khoa Thai Nguyen 2006

4 TrUdng Dai hoc Y khoa Thai Nguyen Tai lieu day/hoc mon hoc Thiic hanh cong dong 1 2006

TO CHljrc VA QUAN LY CAC CHUtfNG TRINH MUC TIEU

Y TE QUOC GIA TAI TRUNG TAM Y TE DU PHONG HUYEN

MUC TIEU

Sau khi hoc xong bai nay, sinh vien co kha nang:

1 Liet ke dittic ten cac chitting trinh muc tieu y te quoc gia dang trien khai tai Trung tam Y te dtf phong huyen ntii sinh vien den thiic tap.

2 Nhan xet dittic thiic trang to chiic chi dao, quan ly mot chitting trinh muc tieu

y te quoc gia cu the tai Trung tam Y te dii phong huyen.

1 Bifdc 1: gidi thieu ve to chiic va quan ly cac chUdng trinh muc tieu y te quoc gia tai Trung tam Y te dii phong huyen:

- Cac chiidng trinh muc tieu y te quoc gia hien dang dUdc trien khai tai Trung tam Y te dii phong huyen ndi sinh vien dang thiic tap

- Sii phan cong can bo phu trach cac chifdng trinh cu the, chiic nang nhiem

vu cua cac can bo y te trong viec to chiic trien khai va quan ly cac chiidng trinh muc tieu y te quoc gia

2 Bifdc 2: kien tap thiic hanh to chiic va quan ly cac chiidng trinh muc tieu y te quoc gia tai cac khoa chuyen mon cua Trung tam

- Chiidng trinh phong chong sot ret

- Chiidng trinh phong chong cac roi loan do thieu iot

- Chiidng trinh tiem chung md rong

- Chiidng trinh phong chong phong

- Chiidng trinh phong chong lao

- Chifdng trinh bao ve siic khoe tam than cong dong

- Chiidng trinh phong chong suy dinh diidng tre em

- Chiidng trinh bao dam chat lifdng, ve sinh an toan thiic ph&m

- Chiidng trinh phong chong HIV/AIDS

- Chu'dng trinh phong chong sot xuat huyet

Chu y tim hieu thiic te cac biidc to chiic chi dao hoat dong va cong tac quan ly dac biet la cong tac giam sat, danh gia cac chifdng trinh muc tieu y te quoc gia cua tuyen v te huyen doi vdi tuyen y te xa

Tuy theo tiing chiidng trinh y te cu the ma co cac noi dung chi tiet, thong thifdng de to chiic chi dao thiic hien va quan ly mot chiidng trinh y te quoc gia tai tuyen y te huyen can thiic hien tot mot so" noi dung chinh sau:

+ Xay diing ke hoach, thanh lap Ban chi dao chiidng trinh, hop ban chi dao, tap huan ve chuyen mon ky thuat

+ To chiic thiic hien ke hoach

+ Quan ly nhan liic phuc vu cho chiidng trinh

+ Quan ly thuoc, hoa chat, vacxin,

+ Quan ly phiidng tien, vat tii va kinh phi lien quan den chiidng trinh

+ Quan ly ky thuat chuyen mon thiic hien chiidng trinh

+ Hiidng d in giam sat chuyen mon, ky thuat va danh gia chiidng trinh doi

vdi cac tram y te xa/phiidng

+ Tong hdp bao cao thong ke theo quy dinh cua tiing chiidng trinh v.v

Trong khi can bo Trung tam hiidng dan, sinh vien can chu y quan sat, lang nghe, ghi chep lai nhiing thong tin can thiet

- Khi can bo trung tam gi6i thieu, hii6ng dan cho sinh vien cac loai so sach, cach ghi chep va cach lam cac bieu mau bao cao thong ke Sinh vien nen xem chi tiet

cu the cac bien ban ve cach thiic to chiic chi dao trien khai chiidng trinh, tham khao cach ghi chep cac so sach, bieu mau bao cao ve cac chiidng trinh muc tieu y te quoc gia

3 BlTdc 3: thao luan nhom

Sinh vien thao luan nhom theo 2 noi dung sau:

1 Hien cd bao nhieu chiidng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen?

2 Cac biidc to chifc chi dao hoat dong va cong tac quan ly cac chtfdng trinh muc tieu y te quoc gia tai Trung tam Y te dii phong huyen?

Sinh vien thao luan nhom diidi sii hiidng dan, giam sat cua can bo Trung tam, sinh vien can so sanh giiia ly thuyet va thiic te de diia ra nh iing nhan xet cua minh ve thiic trang to chiic chi dao, quan ly cac chiidng trinh m uc tieu y te quoc gia tai Trung tam Y te dii phong huyen Til dd tim ra nhiing ifu diem can phat huy, nhiing bat cap c&n kh&c phuc de thiic hien tot cac chifdng trinh y te quoc gia tai tuyen y te huyen

TU LUONG GIA

1 Cau hoi luong gia

1 Hien co bao nhieu chifdng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen? Dd la nhiing chifdng trinh nao?

2 Cac bifdc de trien khai thiic hien 1 chifdng trinh muc tieu y te quoc gia cu the bao gom nhiing bifdc nao? Noi dung cua cac bifdc dd?

3 So sanh gnla thiic te va ly thuyet ve viec trien khai thiic hien chifdng trinh9

4 Ban co nhan xet gi ve cach ghi chep cac bien ban so sach bieu mau thong

ke lien quan tdi cac chiidng trinh? Tii do rut ra nhiing kinh nghiem de co the giup cho viec to chiic va quan ly cac chiidng trinh y te quoc gia tai tuyen y te huyen diidc tot hdn

2 Hudng dan sinh vien tir ludng gia

Qua ket qua thao luan nhom cac y kien thao luan diidc thong nhat ngay sau buoi hoc chinh la phan dap an cho cac cau hoi tu lifdng gia cua sinh vien Trinh bay nhiing diem chiia ro, con thac mac v6i can bo Trung tam hoac giao vien de diidc giai dap

HlfCfNG DAN TU HOC, TU NGHIEN ClRJ, VAN DUNG THI/C TE

1 Phifdng phap hoc

Sinh vien doc tai lieu phan ly thuyet co lien quan den cac noi dung hoc tap trong bai giang bao gom:

- Muc tieu dinh hudng cua chiidng trinh

- Cac giai phap chuyen mon ky thuat de thiic hien chiidng trinh

- Cac biidc trien khai chiidng trinh muc tieu y te quoc gia

Trong khi doc tai lieu din danh dau nhiing diem con kho hieu hoac chiia r5 de thao luan vdi cac ban sinh vien khac trong khi hoc hoac hoi giao vien de diidc giai dap

Sinh vien chu dong hoc hoi va de nghi vdi can bo Trung tam giup dd khi can thiet

2 Van dung thirc te

Qua thiic hanh tai Trung tam Y te dii phong huyen, sinh vien tham quan kien tap tim hieu ve thiic trang to chiic va quan ly cac chUdng trinh muc tieu y te quoc gia dang diidc trien khai tai Trung tam Y te dii phong huyen, tii do sinh vien co kha nang doi chieu so sanh giiia nhiing kien thiic dtfdc hoc trong bai ly thuyet vdi thiic

te diidc chiing kien diia ra nhiing nhan xet ve thiic trang viec thiic hien cac chiidng trinh muc tieu y te qudc gia, van dung diidc nhiing kinh nghiem thiic te de c6 the giup cho viec to chiic chi dao va quan ly chu'dng trinh y te quoc gia tai tuyen y te cd

sd diidc tot hdn

3 Tai lieu tham khao

1 Bo Y te - UNICEF Quan ly cham soc siic khoe ban dau d tuyen y te cd sd Nha xuat ban Y hoc Ha Noi, 2000

2 Bo Y te Quan ly va hoat dong giam sat cua Trung tam Y te huyen Trung tam nhan liic y te Nha xuat ban Y hoc Ha Noi, 1994

3 Bo Y te Quan ly cac chiidng trinh y te d tuven y te cd sd Nha xuat ban Y hoc, 1990

4 Bo mon Y xa hoi hoc To chiic va quan ly y te Triidng Dai hoc Y khoa Thai Nguyen 2006

5 Triidng Dai hoc Y khoa Thai Nguyen Tai lieu day/hoc mon hoc cong dong

1 2006

TO CHUfC HOAT DONG KHOA DUDC, KHOA XET NGHIEM,

PHONG KE HOACH TONG HOP TAI BENH VIEN TUYEN HUYEN

MUC TIEU

Sau khi hoc xong bai nay, sinh vien co kha nang:

3 Nhan xet dittic to chiic, hoat dong cua khoa dittic, khoa xet nghiem.

4 Mo ta to chiic hoat dong phong ke hoach tong htip tai benh vien tuyen huyen.

1 Cong tac quan ly duoc tai benh vien huyen

1.1 Btfdc 1: so sanh thiic trang to chiic hoat dong cua khoa diidc benh vien tuyen

huyen v6i quy djnh

To c h u t

1 Xay dung dam bao ve sinh, sach se,

2 Xay dung dam bao cao rao, an toan va phu hop vdi ti'nh chat cong viec

3 Khoa difdc bo tri 6 dja diem thuan tien

Hoat dong

1 Cong tac diitru mua, van chuyen, kiem nhap thuoc

2 Lap ke hoach thuoc, hoa chat , vat dung y te tieu hao hang nam dung

quy djnh

3 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nam theo

dung djnh mCfc

4 Mua thuoc dam bao so lifdng

5 Mua thuoc dam bao chat lifdng theo ke hoach

6 Thifc hien dung cac quy dinh ve mua sam

7 Thuoc phai bao quan theo dung yeu cau ky thuat

8 Van chuyen thuoc theo quy djnh

9 Kiem nhap thuoc theo quy djnh

Quan ly thuoc, hoa chat va vat dung tieu hao y te tai cac khoa

Thuoc ITnh ve phai dung trong ngay

Thifdng trifc cap phat thuoc 24 h trong ngay

Phieu Unh thuoc phai theo dung quy dinh

Cap phat thuoc, hoa chat theo cfung quy djnh

Co lap sd sach, thanh toan theo quy djnh

Thong ke bao cao ban giao theo quy djnh

Cac khoa phong ban thuoc trong benh vien

Kiem ke thuoc, hoa chat dung cu tieu hao

1 Kiem ke theo djnh ky

2 Thanh lap hoi dong kiem ke theo quy djnh

3 Noi dung kiem ke: doi chieu sd xuat, sd nhap vdi chUng til

4 Doi chieu thuoc, hoa chat ghi trong sd sach v6i hien cd ve sd lupng va

chat li/png

Kho va cong tac bao quan, cap phat

1 Thiet ke theo quy djnh, an toan, sach se

2 Du phuong tien

3 Du anh sang

4 Sap xep trong kho ngSn n£p

5 Kho cd du gia, ke

6 Cac thuoc va hoa chat trong kho dupe xep theo chung loai de lay, de thay

7 Tri/dc khi giao thuoc dirpc si thuc hien 3 kiem tra, 3 doi chieu

8 Thuc hien 5 chong: nham Ian, qua han, mdi mot, trom cap, tham hoa

9 To chUc chia thanh kho chinh va kho cap phat le

10 Khoa trang bj phuong tien cho phu hpp

Cong tac dutru mua, van chuyen, kiem nhap thuoc

1 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nSm dung

quy dinh

2 Lap ke hoach thuoc, hoa chat, vat dung y te tieu hao hang nSm theo

dung djnh mUc

3 Mua thuoc dam bao sd lupng

4 Mua thuoc dam bao chat lupng theo ke hoach

5 Thuc hien cac dung cac quy djnh ve mua sam

6 Thuoc phai bao quan theo dung yeu cau ky thuat

7 Van chuyen thuoc theo quy djnh

8 Kiem nhap thuoc theo quy dinh

1.2 BWO'C 2 : sinh vien thao luan nhom theo cac cau hoi sau

Cau hoi 1: to chiic cua khoa nhif the nao, co phu hdp khong? tai sao?

Cau hoi 2: cong tac da tru mua, van chuyen, kiem nhap thuoc cua benh vien

co dung theo quy dinh khong?

Cau hoi 3: thuoc dUdc van chuyen nhu the nao?

Cau hoi 4: kiem nhap thuoc co theo quy dinh khong?

Cau hoi 5: quan ly thuoc, hoa chat va vat dung tieu hao y te tai cac khoa nhathe nao?

Cau hoi 6: viec kiem ke thuoc, hoa chat dung cu tieu hao thac hien nha the nao? (Khi nao kiem ke? thanh phan hoi dong kiem ke gom nhang ai? Noi dung kiem ke la gi?

Cau hoi 7: kho va cong tac bao quan, cap phat nha the nao?

Cau hoi 8: to chac chia thanh kho chinh va kho cap phat le khong?

Cau hoi 9: lam the nao de hoat dong cua khoa dupe tot hon

2 Cong tac quan ly tai khoa xet nghiem tai benh vien tuyen huyen

2.1 Btfoc 1 so sanh thac trang to chac hoat dong cua khoa xet nghiem benh vien

tuyen huyen vdi quy dinh

To chifc

1 Khoa xet nghiem bo tri noi thuan tien cho ngudi benh noi tru va

ngoai tru

2 Co noi chd benh pham

3 Co noi nhan benh pham

4 Co noi riTa chai Ip khir khuan

Co buong ve sinh du nude sanh de cac thanh vien trong khoa ve

sinh tay ue trudc khi ve

9 Tudng labo op gach men kinh chiu acid toi tran nha

10 Du anh sang theo yeu cau

11 Co cira thong gio

12 Nen nha cao rao thoang nude, lat gach men mau nhln khong tham nude

13 Mat ban xet nghiem lat gach men kinh chju acid

14 Co he thong chau rCra

15 He thong cong kin, va thoat nude nhanh

Hoat dong

I

Trach nhiem cua y ta, dieu dudng

1 Lay benh pham thudng quy cua ngudi benh noi tru mang theo phieu

yeu cau xet nghiem co ghi du cac muc va chu ky cua bac sT

2 Dan nhan mau do vdi nhumg benh pham co kha nSng lay nhiem

Trach nhiem cua trudng khoa xet nghiem

4 Cung cap day du phi/ong tien cho nhan vien trong khoa

5 Bo tri can bo de nhan benh pham thiidng quy dam bao sd luong va

chatluong

Nhiem vu KTV xet nghiem

1 Lay benh pham thudng quy den 10h sang, benh pham cap cuU nhan ngay

2 Lay benh pham tai giudng benh vdi benh nhan cap cUu

3 Lay benh pham tai khoa xet nghiem vdi benh nhan den kham hoac

ngoai tru

4 Thuc hien ky thuat xet nghiem theo dung quy trinh ky thuat

5 Thiic hien cac ky thuat dam bao chinh xac va trung thuc

6 Ky thuat vien tra xet nghiem day du dung gid

7 Thiic hien thudng true theo quy che thudng true

8 Quan ly hoa chat theo dung quy che

9 Suf dung thuoc theo dung quy che

10 Sir dung trang thiet bj y te theo dung quy che

11 Thuc hien cong tac thong ke bao cao theo quy dinh

12 Quan ly va sir dung hoa chat, thuoc thir va trang thiet bj y te theo

dung quy che

13 Dam bao an toan lao dong

14 Dam bao trat tu ve sinh va vo khuan theo quy djnh

2.2 Bifdc 2: thao luan nhom theo cac cau hoi sau

Cau hoi thao luan

Cau hoi 1: to chiic cua khoa nhii the nao co phu hpp khong?

Cau hoi 2: triidng khoa va cac nhan vien trong khoa co thiic hien day du nhiem vu cua minh khong? co dung khong? Neu khong tai sao?

Cau hoi 3: thiic hien cac ky thuat co dam bao chinh xac va trung thiic khong?Cau hoi 4: ky thuat vien co tra xet nghiem d&y du dung gid khong? Tai sao?Cau hoi 5: co thiic hien thiidng triic theo quy che thiidng triic khong?

Cau hoi 6: cac ky thuat xet nghiem co dung theo cac yeu cau ky thuat khong? Neu khong tai sao?

Cau hoi 7: quan ly hoa chat va sii dung thuoc va trang thiet bi y te theo dung quy che khong?

Cau hoi 8: co thiic hien cong tac thong ke bao cao theo quy dinh khong?

Cau hoi 9: phong ke hoach tong hop benh vien da khoa tuyen huyen:

Cau hoi 10: cac bo phan cua phong ke hoach tong hpp cua benh vien tuyen huyen ndi sinh vien thiic tap co gi giong va khac vdi ly thuyet? Tai sao?

3 Hoat dong cua phong ke hoach tong hop cua benh vien tuyen huyen

3.1 Bifdc 1: so sanh thuc trang to chiic hoat dong cua phong hanh chinh tong hop

benh vien tuven huyen vdi quy dinh

To chifc

1 Kham benh

i

2 Nghien ciiu khoa hoc

! 3 Chi dao tuyen

4 Hop tac quoc te

5 Bao cao thong ke, lull truf,

Nhiem vu

1 Thiic hien cong tac thong ke bao cao theo quy dinh

'

2 Hirdng din cac khoa phong lap ke hoach thiic hien

3 To chirc dao tao lien tuc

4 Tong ket danh gia cong tac chuyen mon,

5 To chirc dieu hoa, phoi hop trong cac khoa

! 6 Phoi hop vdi phong chi dao tuyen

7 To chiic thiic hien hop tac quoc te

8 Dam bao viec liiu trii, thong ke, khai thac ho sd theo quy dinh

-9 To chiic cong tac thifdng triic toan benh vien

10 Djnh ky sd ket tong ket

11 Chuan bj cac phifdng an phong chong thien tai, tham hoa

-3.2 Bifdc 2: thao luan nhom theo cac cau hoi sau

Cau hoi 1: Phong hanh chinh tong hdp da va dang thiic hien diidc nhiing nhiem vu gi? nhiing nhiem vu gi chiia thiic hien diidc? Tai sao?

Cau hoi 2: Co giai phap gi de phong hanh chinh tong hdp cua benh vien lam tot hdn nua nhiem vu diidc giao?

TU LUONG GIA

1 Cong cu li/dng gia bSng cau hoi

Khoa dupe

1 Vj tri khoa diidc d dau? Co hdp ly khong? tai sao?

3 Benh vien thuc hien cong tac du tru mua van chuyen kiem nhap thuoc cua benh vien co dung theo quy dinh khong?

4 Thuoc van chuyen co di thang t\jf ndi mua den thang kho khong?

5: Thuoc lav ve co dUdc kiem nhap ngay khong? tai sao?

6 Khoa co to chiic llnh cap phat thuoc 24 gid trong ngay khong?

7 Co thuc hien viec ghi chep thong ke bao cao ban giao theo quy dinh khong?

8 Khoa co hoan thanh nhiem vu cua minh khong?

Khoa xet nghiem

1 Vi tri khoa dUdc d dau? Co hdp ly khong? tai sao?

2 TrUdng khoa xet nghiem co thuc hien dung cac nhiem vu cua minh khong?

3 Y ta dieu difdng khoa XN co thuc hien dung trach nhiem cua minh khong?

4 Ky thuat vien xet nghiem co thuc hien dung trach nhiem cua minh khong?

5 Viec thiic hien ky thuat xet nghiem co theo dung quy trinh ky thuat khong?

Phong hanh chinh tong hop

1 Liet ke cac bo phan trong phong hanh chinh tong hdp

2 Co thuc hien to chiic dao tao cho cac nhan vien trong benh vien khong?

3 Co thuc hien tong ket danh gia cong tac chuyen mon khong?

4 Co to chiic dieu hoa phoi hdp trong cac khoa

5 Co dam bao viec lUu tru thong ke khai thac ho sd theo quy dinh

6 Cd dinh ky sd ket tong ket?

7 Cd chuan bi cac phUdng an phong chong thien tai th am hoa k h on g0

HUONG d A n TU HOC, TU NGHIEN CLRJ, VAN DUNG THUC TE

1 Phirong phap h o c

Sinh vien on tap cac phan ly thuyet co lien quan den to chiic, hoat dong cua khoa dUdc khoa xet nghiem va phong ke hoach tong hdp cua benh vien da khoa tuyen huven Cac van ban quy che hudng dan quan ly trang thiet bi khoa dUdc khoa xet nghiem tai san nhan luc cua benh vien da khoa tuyen huyen

Bu'dc 1: so sanh thuc trang to chiic hoat dong cua khoa dUdc khoa xet nghiem phong hanh chinh tong hdp cua benh vien tuyen huyen vdi quy dinh

Budc 2: thuc hien thao luan nhom theo cau hoi thao luan

Sinh vien chia nhom thao luan

Budc 3: tu ludng gia bang cau hoi lupng gia; doi chieu nhiing kien thiic/ky nang da hoc dUdc vdi muc tieu bai hoc de ra tu! do rut ra nhiing kinh nghiem /bai hoc thuc te ve to chUc hoat dong khoa dUdc, khoa xet nghiem va phong hanh chinh tong hdp

2 Van dung thirc te

Qua nhiing nhan xet ve te ve to chiic hoat dong khoa dUdc, khoa xet nghiem

va phong hanh chinh tong hdp ndi sinh vien thuc tap, rut ra nhiing bai hoc kinh nghiem TU do giup sinh vien se hieu va thuc hien tot hdn viec quan ly tai khoa xet nghiem, khoa dUdc cung nhu phong hanh chinh tong hdp

3 Tai lieu tham khao

1 Bo Y te -Vu to chiic can bo, Cac van ban quy dinh ve he thong To chiic y te dia phUdng va che do chinh sach doi vdi y te cd sd hien hanh Ha Noi, 2002

2 Bo Y te Du an phat trien he thong y te Quan ly y te Ha Noi, 2002

3 Bo mon Y Xa hoi hoc To chiic va Quan ly y te TrUdng Dai hoc Y khoa Thai Nguyen 2004

4 Bo Y te Quy che Benh vien Nha xuat ban Y hoc, 2001

5 Quan ly hoat dong long nghep cham soc siic khoe ban dau Quan ly va long nghep tram y te cd sd Trung tam nhan luc y te Nha xuat ban Ha Noi, 1994

6 TrUdng Dai hoc Y khoa Thai Nguyen Tai lieu hudng dan thuc hanh CBE 2004

TANG HUYET AP

MUC Tl£u

Sau khi thitc hanh xong bai nay, sinh vien co khd nang:

1 De xuat, doc ket qua mot so xet nghiem can thiet phu hdp vdi tuyen cd sd.

2 Chan doan va xii tri ban dau benh nhan tang huyet dp tai tuyen y te cd sd.

3 Chi dinh chuyen tuyen va to chiic chuyen tuyen nhiing triidng hdp tang huyet

dp viidt qua khd nang cua y te cd sd.

1 Chuan bj

Sinh vien doc trtfdc bai ly thuyet Tang huyet ap hoi benh tham kham thu thap cac thong tin can thiet 0 benh nhan va lam benh an

2 Thirc hanh cac ky nang

2.1 Hoi benh tai buong benh

Sinh vien hoi day du cac van de sau tai buong benh

- Khai thac benh sii

- Sinh vien hoi benh thu thap thong tin

+ Cac trieu chiing dau dau, nhin md, te bi, kien bo ngon chi

+ Thdi gian xuat hien trieu chiing

+ Hoan canh xuat hien trieu chiing

+ Ti'nh chat cua trieu chiing

- Hoi tien sU

+ Thdi gian bi tang huyet ap

+ Tien sii bi tang huyet ap cua gia dinh va benh nhan

+ Nhiing benh ma benh nhan da mac va tien sii dung thuoc

+ Tien sU nghe nghiep moi triidng song

2.2 Ky nang kham va de xuat xet nghiem de phat hien dupe cac trieu chimg cua

tang huyet ap tai buong benh

2.2.1 Ky nang kham

Sinh vien thiic hanh kham de phat hien diidc cac trieu chiing cua tang huyet

ap phat hien ton thiidng cac cd quan dich Cac sinh vien khac quan sat, sau dd dong gop y kien

- Kham toan than: do huyet ap dong mach Phat hien tinh trang thieu mau, kham tuyen giap.

- Kham thifc the cac cd quan de phat hien cac trieu chiing benh ly va cac bien chiing da co Chu y bien chiing tai tim, than kinh, than

2.2.2 Ky nang de xuat xet nghiem

Cac sinh vien cung tham gia de xuat cac xet nghiem va neu y nghia, muc dich cac xet nghiem do

- Cac xet nghiem cd ban:

+ Cong thiic mau: de danh gia mile do thieu mau

+ X.Quang tim phoi:

+ That trai to do tang huyet ap

+ Cac ton thifdng khac kem theo (de chan doan phan biet va tien lifdng benh) Sinh hoa mau: danh gia chile nang than giup cho dieu tri

• Xet nghiem nifdc tieu: tim protein trong nifdc tieu

- Cac xet nghiem dac hieu;

+ Tham dd chiic nang than: creatinin mau, nifdc tieu 24h

+ Dien tim

2.3 Ky nang ra y lenh dieu tri cu the

Sinh vien difa ra phac do dieu tri cho benh nhan Cac sinh vien khac gop y kien de cd difdc phac do dieu tri thich hdp cho benh nhan cu the, phu hdp vdi dieu kien cu the cua benh vien tuyen huyen: bao gom cac thuoc ha ap, ldi tieu, an than

va cac thuoc dieu tri trieu chiing

- Tang huyet ap bufde 1:

+ Ngifdi tre dung Propranolon

+ Ngifdi gia dung ldi tieu hypothiazid

- Tang huyet ap bifdc 2: ket hdp ca hai loai tren

- Tang huyet ap bifdc 3:

Ket hdp ca hai loai tren va them mot thuoc gian mach:

+ Aldomet

+ Niphedipin

+ Uc che men chuyen

(Chi dinh, lieu lifdng xem cu the trong bai ly thuyet Tang huyet ap)

2.4 Tuvan phdng benh

Sinh vien tuy theo tinh huong benh nhan cu the ma co bien phap giao due siic khoe va phdng benh phu hdp, co the thong nhat noi dung tif van tren benh nhan cu the:

- Tac dong cua moi triidng, gia dinh va xa hoi den benh nhan.

- Tim cac yeu to" thuan ldi gay tang huyet ap de dieu tri triet de

- Hudng dan cho benh nhan biet phat hien cac dau hieu Tang huyet ap va cac dau hieu benh nang co bien chiing

- Can bo y te: ch&n doan s6m va xii tri dung theo phac do

- Cung co" mang liicii y te cd sd, trang bi thuoc thiet yeu va phiidng tien cap ciiu

3 Thao luan nhom

Sinh vien tom tat:

- Cac trieu chiing xuat hien tren benh nhan

- Cac xet nghiem da co trong dieu kien tai Trung tam Y te tuyen cd sd

- Phac do dieu tri cu the cho benh nhan

- Noi dung tii van, giao due siic khoe cho benh nhan

TU LUONG GIA

1 Cong cu luung gia

Chon cau dung nhat trong cac tinh huong sau:

T in h h u o n g 1: mot benh nhan nam 65 tudi, huyet ap do nhieu lan va diidc xac dinh la 180/90mmHg, nghien riidu, nghien thuoc la rat nang, moi ngay uong 500ml riidu va hut ngay 20 dieu thuoc trong vong 15 nam Xet nghiem midc tieu: Protein 0,8g/l, hong cau (+), tru hat (-); Dien tam do: day that trai Hoi:

1 Benh nhan tang huyet ap loai gi? Giai doan may?

2 Benh nhan da co ton thiidng nhiing cd quan dich nao?

3 Bien phap dieu chinh loi song nao d benh nhan nay la quan trong de phong bien chiing nang them

T in h h u o n g 2 : benh nhan Nam 70 tudi, cao lm 66 nang 75 kg, vao vien nhieu lan vi tang huyet ap Hien tai huyet ap la 180/100 mm Hg Dien tam do co day that trai, xet nghiem glucose/mau 200mg/dl, co tien sii nghien riidu va thuoc la rat nang.Cau 1: benh nhan nay co:

A Khong tang huyet ap

B Tang huyet ap tam thu ddn doc

C Tang huyet ap tam triidng ddn doc

D Tang ca 2 tri so"

Cau 2: benh nhan nay trong tinh trang:

Cau 3: yeu to anh hiidng nhieu nhat den tang huyet ap cua benh nhan nav la:

A Dai diidng

B Beo phi

C Riidu

D Thuoc la

2 Hi/dng dan tu ludng gia

Sinh vien tra ldi cac cau hoi theo hiidng dan, nen thao luan nhom de chia se kinh nghiem Sau khi tii tra ldi sinh vien xem dap an cuoi tai lieu

HUONG DAN TU HOC, TU NGHIEN CLTU, VAN DUNG THL/C TE

1 PhUdng phap hoc tap

Sinh vien nen hoc tap tai phong kham Noi vi se co nhieu benh nhan, sinh vien

se thiic hanh khai thac trieu chiing, tien sii va chan doan benh tang huyet ap tii van cho benh nhan ve dieu tri va phong benh tang huyet ap d tai nha

- Danh gia cac trieu chiing: cua tang huyet ap va cac bien chiing cua tang huyet ap, Sii dung phac do de chain doan va dieu tri cho benh nhan

- Thiic hanh doc phim tim phoi

- Chi dinh cac phac do dieu tri tang huyet ap

- Thiic hanh dieu tri cac giai doan cua tang huyet ap

- Thiic hanh hiidng dan cho benh nhan uong thuoc tai khoa

- Phan giai doan va theo doi ket qua dieu tri va thay doi phan do

2 Van dung thuc te

Hien nay benh tang huyet ap tiidng doi pho bien, chan doan nhiing khong pho bien tai cac benh vien tuyen huyen, do vay chan doan tang huyet ap chu yeu diia vao lam sang

Can liiu y hiidng dan benh nhan khong nen sii dung cac loai thuoc nam khi khong ro nguon goc va tac dung Hien nay nhieu loai thuoc nam co pha tron ty le cao corticoid, khi benh nhan sii dung co the tang huyet ap do cac tac dung phu nang ne cua corticoid

3 Tai lieu tham khao

1 Triidng Dai hoc Y Ha Noi Trieu chiing noi khoa Tap 1, Nha xuat ban Y hoc

DAI THAO D 1 AJNG

MUC TIEU

Sau khi thiic hanh xong bai nay, sinh vien co khd nang:

1 Khai thac diidc benh sii, tien sii va nhiing yeu to lien quan d benh nhan dai thao diidng.

2 D i xuat xet nghiem phu hdp vdi tuyen y te cd sd va nhan dinh diidc ket qua xet nghiem.

3 Diia ra diidc phac do dieu tri phu hdp, chuyen tuyen tren nhiing triidng hdp viidt qua khd nang.

4 Tii van ve phong benh va che do an kieng cho benh nhan dai thao diidng tai tuyen y te cd sd, tai gia dinh va cong dong.

1 Chuan bj

Sinh vien chon benh nhan dai thao diidng dang diidc dieu tri tai khoa Noi hoac phdng kham benh tot nhat nen chon benh nhan ma sinh vien da gap trong tua triic cua ngay horn trade

Sinh vien: hoi benh tham kham, thu thap cac thong tin can thiet d benh nhan

va lam benh an

2 Thuc hanh cac ky nang

2.1 H oi benh: tai buong benh cua benh nhan dai thao diidng, sinh vien hoi benh

nhan day du cac van de sau:

2.1.1 Khai thac berth sCr benh rthan dai thao dudng:

- Tiep can benh nhan, tao ra sii tin cay giiia benh nhan va thay thuoc

- Hoi ky ly do vao vien

- Khai thac cac trieu chiing chinh nhii an nhieu, uong nhieu, dai nhieu, gay nhieu: + Thdi gian xuat hien

+ Dieu kien xuat hien

+ Mute do

+ l i e n trien

+ Moi lien quan + giiia cac trieu chiing

Khai thac cac trieu chiing khac di kem nha ngila ngoai da, nhilc dau, md mat,

te bi, kien bo, dau tile ngac kho thd, sot, phu

- Qua trinh dieu tri tai nha va tai benh vien:

+ Thiic hien che do an

+ Che do dung thuoc

- Tinh trang dap ang v6i dieu tri va tinh trang hien tai (sU tang giam cua cac trieu chang)

2.1.2 Khai thac tien sCr va yeu to lien quan

- Khai thac ky tien sa ban than ve thdi gian phat hien benh dai thao dUdng tien sa dung cac thuoc nha corticoid, tien sa san khoa, nhat la tien sa de con tren 4 kg

- Khai thac tien suf ve thoi quen an uong, sinh hoat Tien sa nghien radu, hut thuoc la

- Khai thac tien sa gia dinh xem co ngadi bi dai thao dUdng, tang huyet ap, beo phi hay khong?

2.2 Ky nang kham va de xuat xet nghiem

Kham thac the cac cd quan chu y xac dinh huyet ap dong mach, chi so BMI, phat hien cac bien chang tim mach, than, than kinh, ton thadng khac

De xuat cac xet nghiem co the thac hien dUdc tai benh vien: neu cac xet nghiem, muc dich, phan tich cac ket qua xet nghiem

- Cac xet nghiem cd ban: danh gia tinh trang thieu mau, nhiem trung, ton thadng phoi, protein trong na6c tieu

- Xet nghiem thlch hop:

+ Dinh lapng dadng huyet luc doi: day la xet nghiem quan trong nhat, nham chan doan xac dinh theo doi va danh gia ket qua dieu tri Tai tuyen huyen

co the sii dung may do dadng huyet ca nhan de xac dinh dadng huyet, thuan tien va cho ket qua chinh xac

+ Dinh ladng dadng nieu: nham chan doan phan biet va danh gia ket qua dieu tri Doi v6i tuyen y te cd sd co the xet nghiem dinh tinh dadng nieu bang giay thu

+ Xet nghiem xeton nieu: giup chan doan the benh va tien ladng

+ Dinh ladng cac thanh phan lipid mau Day la roi loan rat hay gap d benh nhan tieu dadng

+ Dien tam do: nham danh gia ton thadng dong mach vanh va tinh trang cd tim nhat la d benh nhan dai thao dadng thadng khong co bieu hien dau ngilc ro rang

+ Dinh ladng ure, creatim n mau: n h im danh gia chac nang cua than, phat hien suy than man tinh

2.3 Ra quyet djnh dieu trj, xac djnh chuyen tuyen

Can diia vao ket luan cha’ n doan de co quyet dinh dieu tri cho phu hdp, can tinh tdi kha nang tai chmh cua benh nhan nep song, thdi quen sinh hoat dieu kien

cu the cua benh vien ngifdi benh va gia dinh benh nhan

- Difa ra nguyen tac dieu tri cu the

- Che do nghi ngdi, hoat dong the life phu hdp che do an kieng Can xay diing cho benh nhan mot thiic ddn chi tiet de benh nhan co the thiic hien de dang sau khi ra vien

- Dieu tri b&ng thuoc:

+ Can diia vao chan doan dai thao difdng type 1 hoac type 2, tinh trang benh kem theo cung nhif ham lifdng difdng huyet luc doi cua benh nhan de liia chon thuoc, lieu lifdng thuoc phu hdp nhat vdi tinh trang benh hien tai cua ngifdi benh

+ Chu y sii dung cac thuoc dieu tri ma benh vien huyen dang co va dang sii dung cho benh nhan

- M uc dich cua dieu tri la duy tri rmic difdng huyet trong gidi han binh thifdng han che cac bien chiing

- Chuyen tuyen: nhiing trifdng hdp benh nhan dai thao difdng cd nhieu bien chiing; suy tim suy than, nhiem trung, tai bien mach nao, khong kiem soat diidc diidng huyet, ha diidng huvet thifdng xuyen

2.4 Phdng benh, tu van sue khoe

Sinh vien diidc hiidng dan tuv theo tinh huong benh nhan cu the ma cd bien phap giao due siic khoe va phong benh phu hdp Chu trong tdi tii van ve dieu tri tai cong dong, hifdng d in che do an cu the, cach phdng va xii tri tai bien ha difdng mau

- Sinh vien thiic hien tii van, thuyet phuc ngiidi benh va gia dinh ve cham soc tii theo ddi danh gia ket qua dieu tri kham siic khoe dinh ky, thiic hien che do

an kieng va dieu tri tai nha

- Trong khi tii van can chu y tdi mot so diem sau day:

+ Tuoi cang ldn thi ty le dai thao difdng cang cao, ty le dai thao difdng cao d nhiing ngiidi beo Tuy nhien d Viet Nam, thifdng gap d cac ddi tifdng gay.+ Phat hien sdm benh dai thao difdng dieu tri kip thdi, lien tuc, quan ly ngoai tru tich ciic nhlim de phdng bien chiing do benh gay nen

- Nhiing ngiidi tren 45 tuoi neu difdng mau binh thifdng cii 3 nam lam lai xet nghiem difdng m au l lan

+ Can xet nghiem difdng mau cho nhiing ngifdi cd nguy cd cao (beo, cd ho hang

d the he thii nhat vdi ngiidi bi dai thao dudng, phu mi sinh con cd can nang tren 4 kg ngiidi tang huyet ap, nhiing ngifdi cd roi loan chuyen hoa lipid).+ Benh nhan dai thao difdng dieu tri ngoai tru, 3 thang 1 lan nen theo ddi can nang huyet ap difdng huyet luc ddi, protein meu

+ Trong dieu tri can quan tam giam thap cac yeu to nguy cd nhii tang huyet

ap, hut thuoc la, loi song it van dong cung cac yeu to nguy cd khac (cac yeu

to stress oxy hoa)

+ De du phong va xii tri tai bien ha difdng huyet tai benh vien va gia dinh co hieu qua, tat ca benh nhan dai thao difdng can phai difdc giai thich de hieu biet cac trieu chiing ha difdng huyet, nhiing bien phap de co the phong va

tu dieu tri difdc khi co tinh trang nay

3 Thao luan nhom

Sau khi thUc hanh tai buong benh, nhom sinh vien tien hanh thao luan nhom tai hoi trUdng Tren cd sd cac thong tin thu dUdc, tii thiic te sinh vien co suy nghl de

ra cach dieu tri, bien phap phong benh va phong bien chiing cho benh nhan d benh vien va cong dong Noi dung thao luan bao gom:

- Nhiing trieu chiing cd nang chinh va nhiing tien sii co lien quan d benh nhan Nhiing diem giong va khac so vdi kinh dien, y nghia cua cac thong tin thu dUdc trong chan doan, tien lifdng va dieu tri benh

- Nhiing xet nghiem da dUdc de xuat, tinh kha thi, muc dich Can phai phan tich cac ket qua xet nghiem da co, neu ifu diem va nhiing han che cua cac xet nghiem nay

- Tii chan doan, dUa ra phac do dieu tri thich hdp Neu nhiing mat con han che khi thuc hien dieu tri tai benh vien huyen Sinh vien can diidc thao luan ve muc dich ciia viec dung thuoc la gi? Lieu lifdng, cach dung insulin, cac sulfam id ha difdng huyet, cac thuoc phoi hdp Nhiing tac dung chinh, tac dung khong mong muon co the xay ra, tudng tac thuoc, nhiing thuoc co the thay the cho phu hdp vdi tiing tuyen, co the sii dung thuoc nam (miidp dang) trong dieu tri

- Bien phap phong benh cu the cho benh nhan, dac biet lifu y phong bien chiing tim mach va bien chiing ha dudng huyet

- Tif van siic khoe du phong benh, xac dinh difdc thiic ddn cho benh nhan va cach thifc hien che do an kieng tai benh vien huyen va cong dong

TU LUONG GIA

1 Cong cu luong gia

* Cau hoi trac nghiem khach quan va tinh huong

1 Dinh hiidng chan doan dai thao difdng d tuyen y te cd sd, chu yeu dUa vao:

A Tien sii gia dinh co ngifdi bi dai thao diidng

B Lam sang co bieu hien 4 nhieu

C Dinh lifdng diidng nieu

D Xet nghiem difdng mau luc doi bang que thif

2 Benh nhan nam 52 tuoi bi DTD type 2, da dieu tri tai benh vien dupe 5 ngay Khoang 23 gid benh nhan met moi, dau dau, chong mat, va mo hoi, chan tay

lanh, 30 phut sau benh nhan lim di, goi hoi khong biet, Huyet ap 145/95 mmHg Kha nang de xay ra nhat la:

A Hon me do tang ap liic tham thau

B Hon me do ha difdng huyet

C Nhoi mau cd tim

D Tai bien mach mau nao

3 Loai qua nao sau day co ham lifdng glucid thap nhat co the sii dung cho benh nhan dai thao difdng:

A M it mat

B Na

C Difa hau

D Chuoi tieu

4 Nguyen tac dau tien khi xay dung che do an cho benh nhan dai thao difdng la:

A Dam bao du nang lifdng

B Giam bdt nang lifdng

C Can bang giiia nhung yeu to' sinh nang lifdng

D Dieu chinh nang lifdng phu hdp vdi tiing doi tifdng

5 0 benh nhan dai thao difdng cd tang huyet ap, thuoc ha huyet ap thich hdp nhat la:

7 Trong khi dieu tri cho benh nhan dai thao diidng typ 1 va typ 2, cd mot van

de khac biet la:

8 Mot benh nhan nam 47 tudi bi dai thao dudng typ 2, da dieu tri tai benh vien huyen diidng huyet on dinh Sau khi ra vien benh nhan tiep tuc dieu tri theo ddn cua bac si Benh nhan thiidng than phien la hay met mdi dau dau chong mat,

va mo hoi, chan tay lanh nhat la ve buoi tdi

PhUdng phap xtf tri thich hdp nhat trong triidng hdp nay la:

A Uong thuoc ha ap

B Dung thuoc gian mach vanh

C Tiem glucose liu triidng tinh mach

D Uong thuoc tang ciidng tu ln hoan nao

* Bang kiem liidng gia ky nang thUc hanh:

Bang kiem danh gia ky nang thuc hanh tii van benh nhan thuc hien che do

an kieng

I

2 Thiet lap moi quan he tin cay giOa thay thuoc va benh nhan

3 Thao luan ve cach thuc hien che do an kieng d benh nhan

dai thao dudng

4 Bac sT cung cap thong tin day du cho benh nhan va ca

ngudi nha benh nhan

5

I

Benh nhan va ngudi nha benh nhan nhan thue dUdc ve

nhCrng viec ma ho can thuc hien tai gia dinh

6 Bac sT giai thich ldi ich cua viec thuc hien che do an kieng

trong dieu tri benh dai thao dudng

7 Bac sT hoi xem ho cd the gap khd khan gi khi thuc hien che

do an kieng

8 Bac sT da chi din cho benh nhan cach thdc vUdt qua khd khan

9 Bac sT hoi benh nhan xem ho cd cd gang thuc hien che do

an kieng khong

10 Bac sT cd bo tri mot buoi gap khac de thao luan ve nhung

tien bo va nhimg viec benh nhan da lam dUdc

Tong sd

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