Timing of default from tuberculosis treatment: a systematic
review
Margaret E. Kruk
1
, Nina R. Schwalbe
2
and Christine A. Aguiar
1
1 Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
2 Global Alliance for TB Drug Development, TB Alliance, New York, NY, USA
Summary objectives To provide a systematic assessment of the timing of default from tuberculosis (TB)
treatment which could help to quantify the potential contribution of new shorter duration TB drugs to
global TB control.
methods We performed a systematic review following QUOROM guidelines. MEDLINE was searched
from 1998 to the present using the terms TB and default or drop-out or compliance or adherence
and therapy. A total of 840 articles were returned. A further detailed manual review selected 15
randomized trials and observational studies that reported timing of drop-out and focused on developing
countries.
results The selected studies comprised randomized controlled trials, retrospective record reviews, and
qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and
non-DOT programs were represented. Thus results were highly heterogeneous and not statistically
aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies
completed the 2-month intensive phase of treatment.
conclusions There is insufficient high-quality comparable information on the timing of default
from TB treatment to permit any firm conclusions on trends in default. However, a substantial pro-
portion of defaulters appear to leave treatment in the later stages of the current 6-month regimen,
suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the
potential to improve global TB treatment success rates.
keywords tuberculosis therapy, directly observed treatment, default, time of default, temporal trends
Introduction
Tuberculosis (TB) is a global health emergency, killing
nearly 1.6 million people each year, mostly in low- and
middle-income countries (Stop-TB Partnership 2006). TB
cases in Africa have more than quadrupled since 1990, as a
result of co-infection with HIV (WHO 2005). The World
Health Organization (WHO) – recommended treatment
strategy, directly observed treatment or direct observation
(DOT), which forms the basis of the Stop TB Strategy, is a
6- to 8-month regimen with a combination of anti-TB
agents (Lienhardt & Ogden 2004). This regimen is also
known as short-course chemotherapy (SCC). The first
2 months of SCC, known as the intensive phase, generally
involve a combination of four drugs and the 4- to 6-month
follow-up period, known as the continuation phase,
involves two drugs. Both the drugs used in treatment and
the duration of the intensive phase may vary within SCC
programs.
While cure rates with this combination under optimal
conditions approach 95%, actual global treatment success
in 2005 was 84% (Borgdorff et al. 2002; WHO 2007).
This figure is much lower in some regions: In Africa, the
overall cure rate for smear-positive TB was 74% and as
low as 54% in some areas (WHO 2007.) Further,
Mycobacterium tuberculosis resistant to both isoniazid and
rifampicin, or multi-drug resistant TB, is now diagnosed in
an estimated 4.3% of all new and previously treated TB
patients (Zignol et al. 2006).
A major contributor to both treatment failure and the
rise of multidrug-resistant TB is inadequate and incomplete
treatment (Borgdorff et al. 2002; Sharma & Mohan 2006).
While structural factors such as interruptions in drug
supply play a role, patient default ESPGHAN Committee on CHĂM SĨC & PHỊNG NGỪA CÚM A H7N9 Phòng ði u d ng- BV Nhi đ ng 9-5-2013 TRƯỚC ðÂY Virus cúm A H7N9 lưu hành chim, nhóm phụ virus H7 Trung quốc báo cáo trường hợp 1996- 2012, người nhiễm cúm H7 ( H7N2, H7N3 & H7N7) báo cáo Hà lan, Mỹ, Canada, Mexico & Anh Có liên quan đến dịch cúm gia cầm Triệu chứng chủ yếu đau mắt đỏ, viêm hơ hấp nhẹ 01 trường hợp tử vong Hà lan TRIỆU CHỨNG HIỆN TẠI 139 trường hợp xác định dương tính Sốt 32 người chết Ho Những người có tiếp xúc gần theo dõi Khó thở sát Chưa có bầng chứng lây truyền từ người sang người ðIỀU TRỊ Kháng virus CHĂM SĨC Các bệnh liên quan Các triệu chứng phối hợp CHĂM SĨC Nhẹ: LÂY TRUYỀN Lây truyền trực tiếp: Nghỉ ngơi Tiếp xúc gia cầm Uống nước đầy đủ Mơi trường : đồ vật hay nguồn nước bị Hạ sơt Nặng: Nhập viện nhiễm chất tiết gây bệnh phân, nước bọt, nước mũi Ăn thức ăn chưa nấu Qua khơng khí CÁC ðƯỜNG LÂY TRUYỀN Tiếp xúc Giọt bắn Khơng khí ( làm thủ thuật tạo khí dung) NHỮNG THỦ THUẬT CĨ THỂ TẠO RA KHÍ DUNG ðặt nội khí quản Khí dung thuốc làm ẩm Nội soi phế quản Hút dịch đường thở Chăm sóc người bệnh mở khí quản Vật lý trị liệu lồng ngực NHỮNG THỦ THUẬT CĨ THỂ TẠO RA KHÍ DUNG Hút dịch mũi hầu Thơng khí áp lực dương qua mask mặt (BiPAP, CPAP) Thủ thuật nha khoa sử dụng tay khoan, chọc xoang, trám răng, lấy cao Thơng khí tần số cao dao động Những thủ thuật cấp cứu khác Phẫu tích bệnh phẩm nhu mơ phổi sau tử vong CÁC BIỆN PHÁP PHỊNG NGỪA VỆ VỆ HƠ HÂP VệSINH sinh hơ hấp ++ PHỊNG Phò ng ngừNGỪA a chuẩn CHUẨN + + Phòng ngừa qua tiếp xúc giọt băn chăm sóc bn thường quy Phòng ngừa qua tiếp xúc, giọt băn, qua khơng khí thủ thuật tạo khí dung PHỊNG NGỪA CHUẨN PHỊNG NGỪA CHUẨN PNC tập hợp biện pháp phòng ngừa áp dụng cho tất NB sở khám chữa bệnh, khơng phụ thuộc vào chẩn đốn, tình trạng nhiễm trùng thời điểm chăm sóc BN, dựa ngun tắc xem tất cả: máu, dịch tiết ( trừ mồ hơi) có nguy lây truyền bệnh MỤC ðÍCH PHỊNG NGỪA CHUẨN VỆ SINH TAY Phòng ngừa & kiểm sốt lây nhiễm với máu, chất tiết, chất tiết ( trừ mồ ) cho dù khơng nhìn thấy máu, dịch tiết qua da khơng lành lặn niêm mạc VỆ SINH TAY Rửa tay với nước & xà phòng, Dung dịch rửa tay nhanh có chứa cồn Khơng rửa tay nhanh tay dơ nhìn thấy thời điểm rửa tay theo WHO Trước mặc & tháo bỏ dụng cụ phòng hộ cá nhân kể gant MANG GANT KHI NÀO ? Mang gant sạch, khơng vơ khuẩn vào phòng bệnh khu vực chăm sóc BN Mang gant tiếp xúc với da BN bề mặt , vật dụng gần BN: dụng cụ y tế, cạnh giường, drap,… MANG GANT KHI NÀO ? Khi tiếp xúc với: máu dịch thể Dịch tiết Chất tiết Màng niêm mạc Vùng da khơng lành lặn Vật dụng bị nhiễm Khi da tay nhân viên y tế khơng lành lặn, bị trầy xước bị bệnh KHI NÀO MANG KHẨU TRANG? Dự trù có máu , dich tiết văng vào Khi làm việc khu phẫu thuật khu vực đòi hỏi phải vơ khuẩn khác Khi chăm sóc BN có nghi ngờ nhiễm khuẩn đường hơ hấp nhân viên y tế có bệnh đường hơ hấp CÁCH ðEO KHẨU TRANG ? Thanh kim loại gỗ nằm uốn ơm khít mũi, nếp gấp trang theo chiều xuống, mặt thấm tiếp xúc với người đeo, mặt khơng thấm nằm ngồi ðeo dây vào sau tai Nếu dây cột:: dây tai & dây cổ Khẩu trang phải che phủ mặt & cằm THAY- THÁO GANT KHI NÀO? Thay gant rách bị dơ / nhiễm nhiều Tháo & bỏ gant rời khỏi phòng khu vực chăm sóc KHI NÀO THAY KHẨU TRANG ? Nên sử dụng lần, khơng bỏ túi để sử dụng lại đeo quanh cổ Thay trang bị ẩm ướt MẶC ÁO CHỒNG Mặc áo chồng vào phòng khu vực chăm sóc BN Thay áo chồng bị bẩn Cởi bỏ áo chồng rời khỏi phòng BN khu vực chăm sóc BN MẶC ÁO CHỒNG ðEO KÍNH ðeo kính vào phòng khu vực chăm sóc BN Tháo bỏ kính rời phòng BN khu vực chăm sóc Nếu sử dụng lại, phải rửa khử khuẩn theo hướng dẫn nhà sản xuất CÁC BIỆN PHÁP PHÒNG NGỪA Vệ sinh hơ hấp + Phòng ngừa chuẩn + Phòng ngừa qua tiếp xúc giọt băn chăm sóc bn thường quy NHỮNG BiỆN PHÁP PHỊNG NGỪA CHUẨN Rửa tay Sử dụng phương tiện phòng hộ cá nhân: gant , trang, kinh bảo vệ, áo chồng bao chân có nguy tiếp xúc với máu dịch tiết Phòng ngừa qua tiếp xúc, giọt băn, qua khơng khí thủ thuật tạo khí dung NHỮNG BiỆN PHÁP PHỊNG NGỪA CHUẨN Sắp xếp, vận chuyển bệnh nhân phù hợp Xử lý dụng cụ Cẩn trọng với tác nhân hơ hấp ( ho) PHỊNG NGỪA LÂY TRUYỀN QUA TIẾP XÚC Lây trực tiếp khơng qua vật trung gian Người bệnh người bệnh Người bệnh nhân viên y tế Xử lý đồ vải, bát đũa, ly tách Tiêm an tồn & phòng ngừa tổn thương vật sắc nhọn Xử lý chất thải PHỊNG NGỪA QUA TiẾP XÚC Bệnh ngun sống vài hay chí vài ngày bề mặt mơi truờng Tay lây truyền nhiễm trùng sờ vào bề mặt nhiễm, sau tiếp xúc với bề mặt thể khác chẳng hạn niêm mạc mũi hay kết mạc mắt, hay lây nhiễm với khu vực trung gian khác PHỊNG NGỪA QUA TiẾP XÚC Mang gant sạch, áo chồng & bao chân trước vào phòng bệnh Khơng sờ vào bề mặt bị nhiễm mà khơng mang gant Tháo gant , áo chồng & bao chân trước khỏi phòng, rửa tay dung dịch sát khuẩn Sau tháo gant & rửa tay, khơng sờ vào bề mặt mơi trường hay vật dụng phòng bệnh Hạn chế tối đa vận chuyển Bn Khử tiệt khuẩn thiết bị chăm sóc bn trước sử dụng cho bn khác TRUYỀN BỆNH QUA GiỌT BẮN Xuất phát từ người mang mầm bệnh ho, hắt hơi, thủ thuật hút rửa nội soi vào kết mạc mắt, niêm mạc mũi, ...ORIGINAL RESEARCH Open AccessEmergency intraosseous access in a helicopteremergency medical service: a retrospective studyGeir A Sunde1,2*, Bård E Heradstveit1,2, Bjarne H Vikenes1,2, Jon K Heltne1,2,3AbstractBackground: Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation ofcritically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseoustechniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articlesdocument IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.Methods: We reviewed all medical records from the period May 2003 to April 2010, and compared three differenttechniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical DeviceTechnologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.Results: During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success onfirst attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p <0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%)and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used inconnection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Otherdiagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratoryfailure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger thantwo years. No cases of osteomyelitis or other serious complications were documented on the follow-up.Conclusions: Newer intraosseous techniques may enable faster and more reliable vascular access, and this canlower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believethat all emergency services that handle critically ill or injured paediatric and adult patients should be familiar withintraosseous techniques.BackgroundVascular access is important in the resuscitation of criti-cally ill or injured adult and paediatric patients [1,2]. Itcan be challenging to obtain vascular access, especiallyin the resuscitation of small children in emergencysituations [3-5]. The European Resuscitation Council2005 guidelines [6] and International Liaison Committeeon Resuscitation guidelines [4] recommend intraosseousaccess during resuscitation if intravenous access provesto be difficult or impossible. Despite these recommenda-tions, intraosseous techniques appear to be rarely used[7]. While numerous reports have been published aboutthe use of different intraosseous devices in emergencypatients, they are primarily from paramedic-basedambulance services [2,8]. Few comparisons have beenpublished of different IO techniques used by physiciansin emergency departments [7] or in HEMS servicesmanned by physicians/nurses [9,10].Typical HEMS operating conditions make specialdemands on medical equipment such as IO devices.Rain, cold, darkness and non-sterile conditions meanthat such equipment must be durable and simple to usein all conditions. User friendliness is important for res-cuers, both on-scene and in-flight [10].Intravenous access is traditionally regarded as theoptimal route for medication and fluids, and the* Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department Background BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG ------------------------------- ISO 9001 : 2008 KHÓA LUẬN TỐT NGHIỆP NGÀNH: NGOẠI NGỮ HẢI PHÒNG - 2010 2 HAIPHONG PRIVATE UNIVESITY FOREIGN LANGUAGES DEPARTMENT ----------------------------------- GRADUATION PAPER A STUDY ON TRANSLATION OF ENGLISH - RELATED TERMS IN FINANCE AND BANKING INTO VIETNAMESE By: BUI THI THOM Class: NA 1004 Supervisor: DAO THI LAN HUONG, M.A HAI PHONG - 2010 3 BỘ GIÁO DỤC VÀ ĐÀO TẠO TRƯỜNG ĐẠI HỌC DÂN LẬP HẢI PHÒNG -------------------------------------- Nhiệm vụ đề tài tốt nghiệp Sinh viên: .Mã Số: Lớp: Ngành: Tên đề tài: . . 4 Nhiệm vụ đề tài 1. Nội dung và các yêu cầu cần giải quyết trong nhiệm vụ đề tài tốt nghiệp ( về lý luận, thực tiễn, các số liệu cần tính toán và các bản vẽ). …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… 2. Các số liệu cần thiết để thiết kế, tính toán. …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… Update on mangement of patent ductus arteriosus in preterm infants Dr Trinh Thi Thu Ha Outline Overview of PDA Timing of screening PDA? When to treat PDA? Timing of ductal closure Prenatal MgSO4, tocolytic Postnatal surfactant Early, severe pulmonary hemorrhage is associated with ductal patency at 12 to 18 hours of age, but later pulmonary hemorrhage (after the first week) is not related to persistent ductal patency (Workbook in Practical Neonatology 5th Edition 2015) Diagnosis: In most cases, the clinically silent PDA during the first few days goes undetected unless an echocardiogram is performed Signs of bounding pulses, active precordium, and systolic murmur were of reasonable specificity but very low sensitivity in the first to days of birth for diagnosis of an echocardiographically defined significant PDA Relying on clinical signs alone led to a mean diagnostic delay of days (A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus.Skelton R1, Evans N, Smythe J JPaediatr Child Health 1994 Oct;30(5):406-11) Ibuprofen Prophylaxis No significant differences in mortality, IVH, or BPD No reduction in IVH, PAL in the treated group Increased risk of gastrointestinal bleeding Prophylactic ibuprofen exposes many infants to renal and gastrointestinal side effects without any important short-term benefits and is not recommended Pre-symptomatic Pharmacologic Treatment No effect on the rate of mortality, BPD, IVH, ROP, or length of ventilation, death, IVH, NEC,… More renal side effect Presymptomatic indomethacin or ibuprofen therapy for PDA in preterm infants is not recommended Conservative Management Fluid restriction Diuretics, avoidance of loop diuretics Maintaining a hematocrit of 35 to 40 percent Increased positive airway pressure Correction of alkalosis Avoidance of pulmonary vasodilators: oxygen or NO Asymptomatic infants with PDAs generally not require medical management or surgical ligation These infants should be monitored for evidence of CHF, failure or renal PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA) DEFINITION OSA • Inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep The combination of sleep-disordered breathing with daytime sleepiness is referred to as the OSA syndrome • Obstructive apnea occurs when there is complete cessation of airflow for ≥ 10 s PATHOPHYSIOLOGY major predisposing factors for upper airway obstruction: • Anatomic narrowing • Abnormal mechanical linkage between airway dilating muscles and airway walls • Muscle weakness • Abnormal neural regulation PATHOPHYSIOLOGY • • • • Sleep fragmentation Increased work of breathing Alveolar hypoventilation Intermittent hypoxemia COMPLICATIONS • • • • • Neurobehavioral disturbances, ADHD Diminished learning capabilities Failure to thrive Pulmonary hypertension Cor pulmonale CONDITION ASSOCIATED-CAUSES • • • • • • • • Tonsillar and adenoid hypertrophy Neuromuscular disorders Myelomeningocele Obesity Pierre Robin sequence Cerebral palsy Down syndrome Hypothyroidism EPIDEMIOLOGY • United States: Affecting 2–3% of all children (snoring: 8-27%) • 2-8 years (adenotonsillar lymphatic tissue growth) • Sex: prepubertal children: male = female, older adolescents: male > female • Races: black children > white children, high frequency of OSA / adult Asia: craniofacial structures HISTORY • Nonspecific • Interview: speciality, sensity # 50-60% • Family: snoring, allergies, exposure to tobacco smoke • History of loud snoring >=3 nights/week: increase suspicion of OSA • Breathing difficulties during sleep, unusual sleeping positions, morning headaches, daytime fatigue, irritability, poor growth, behavioral problems PHYSICAL • • • • • • • • Growth chart, height, weight, obesity Nasal passenge Palate Tonsillar hypertrophy, uvula Malformation: cleft, chin, maxilla Compression Cardiac examination Conditions in cause POLYSOMNOGRAPHY • • • • Sleep state (>2 EEG leads) Electrooculogram (right and left) Electromyelogram (EMG) Airflow at nose and mouth (thermistor, capnography, or mask and pneumotachygraph) • Chest and abdominal wall motion • Electrocardiogram (preferably with R-R interval derivation technology) POLYSOMNOGRAPHY • Pulse oximetry (including a pulse waveform channel) • End-tidal carbon dioxide (sidestream or mainstream infrared sensor) • Video camera monitor with sound montage • Transcutaneous oxygen and carbon dioxide tensions (in infants and children 10 minutes • Total sleep time (TST) > 5.5 hours • Rapid eye movement (REM) sleep >15% of TST • Percentage of stage 3-4 non-REM sleep > 25% of TST • Respiratory arousal index (number per hour of TST) < • Periodic leg movements (number per hour of TST) < • Apnea index (number per hour of TST) 95% • Desaturation index (>4% for s; number / hour of TST) < • Highest CO2 52 mm Hg • CO2 > 45 mm Hg < 20% of TST TREATMENT Medical therapy: limited value • Antihistamine or antimuscarinic: nasal congestion, benefit is uncertain • Leukotriene modifier: eliminate residual OSA following surgery, improve clinical outcomes without surgery • Budesonide for weeks: sustained improvement in mild OSA TREATMENT Positive-pressure ventilation: safe, efficient, alternative to further surgery or tracheotomy in children and infants with unresolved OSA after tonsillectomy and adenoidectomy • CPAP • BiPAP TREATMENT Surgery: • Tonsillectomy and adenoidectomy • Tracheotomy • Uvulopharyngopalatoplasty, epiglottoplasty • Bariatric surgery Pediatric obstructive sleep apnea (OSA): A potential late consequence of respiratory syncitial virus (RSV) bronchiolitis Ayelet Snow, MD,1 Ehab Dayyat, MD,1 Hawley E RETRACTILE TESTES A review of the current literature UROLOGY DEPARTMENT CHILDREN’S HOSPITAL NO.2 Definitions Normal size Intermittently resides in the groin Testes that can be brought down into their normal position in the scrotum Remains there for a period Aetiology Variant of normal Strong scremasteric reflex Taut spermatic cord in a testis which is in the process of ascending Clinical examination Supine Manipulate the testis to the base of the scrotum Release to observe whether it remains there or moves back up into the groin OUTCOME OF RETRACTILE TESTES Acquired undescended testes Acute torsion Reduced fertility Tumour risk Acquired undescended testes La Scala & Ein reviewed 150 boys with 205 retractile testes with a 7year follow-up period 23% of retractile testes eventually becoming an acquired UDT [1] Agarwal et al a cohort of 122 boys with 204 retractile testes over years of follow-up: 32% of retractile testes eventually becoming acquired UDT [2] cord tautness as a risk for ascent Stec et al looked at the outcome of 172 boys with 274 retractile testes over a follow-up period of 26 months 7% acquired UDT [3] Limited: definition, indication of orchidopexy, short follow-up periods Acute torsion Only an isolated case report of this within the literature (Charles JC The fate of the retractile testis J Urol 2004;171:1237) [4] Retractile testes are no increased risk for acute torsion over normal testes Tumour risk Congenital UDT have an increased relative risk of germ cell malignancy that may be approximately 5-10 times [5] Acquired UDT not have an increased risk of malignancy [6] retractile testis per se is not at an increased relative risk of developing a cancer Reduced fertility Caucci et al sperm counts in semen of 38 young male adults treated for retractile testes before puberty and adults with retractile testes normal semen analysis: 21% in young adults with previously treated retractile testes, 29% in adults with retractile testes retractile testes with reduced size are a risk factor for male infertility [9] Other epidemiological studies of infertile adult males have identified retractile testes as being associated with lower sperm counts and hypospermatogenesis on biopsy[10-12] increase in testicular temperature resulting in impaired spermatogenesis [12] Reduced fertility Puri and Nixon assessed paternity rates in 43 adult males who as children had bilateral retractile testes: 74% of the subjects had fathered children and that testicular volumes were normal retractile testes develop normally with no harmful effects on fertility [13] Dadfar MR performed orchidopexies on 22 adult males with idiopathic infertility and bilateral retractile testes, and measured their testicular volumes and sperm parameters after year: no change in testicular volume and sperm density, but improved sperm motility [14] Limited: not established paternity, not performed semen analysis Conclusion Retractile testis may become an ascended testis: Level evidence Acute torsion: no evidence Tumour risk: no evidence Reduced fertility: poor evidence Not enough evidence to warrant orchidopexy on a retractile testis But recommend annual clinical surveillance of retractile testes until beyond puberty And reserve orchidopexy for testes which can no longer be brought down into the scrotum (ascended testes) Thank for your attention! References [1] La Scala GC, Ein SH ... SINH TAY R a tay với nước & xà phòng, Dung dịch r a tay nhanh có ch a cồn Khơng r a tay nhanh tay dơ nhìn thấy thời điểm r a tay theo WHO Trước mặc & tháo bỏ dụng cụ phòng hộ cá nhân kể gant MANG... (+) Khoa Cấp cứu (bốc cách ly) Suy hơ hấp Xử trí hồi sức cấp cứu ban (+) (-) Sinh hiệu ổn định Theo dõi Khoa Nhập khoa Nhi m Cúm A H5N1 hay Cúm A khơng xác định type Cúm AH1N1 /Cúm m a hay khơng... XN chẩn đốn Reference http://www.cdc.gov/flu/avianflu /h7n 9- infectioncontrol.htm http://gardenrain.wordpress.com /20 09/10/ 16/ standard-precautions-and-categories