Itä-Suomen yliopistossa on kerätty palautetta terveyskeskuskoulutusjaksoista YEK-koulutuksessa olevilta koulutettavilta systemaattisesti vuodesta 2015 alkaen. Analysoituja vastauksia on yhteensä 289kpl. Tänä aikana koulutuksen laatu on pysynyt erittäin hyvänä. Yleisarvosanaksi terveyskeskukset saavat kouluarvosanoin keskimäärin kiitettävän.
Perehdytystä arvioitiin ligert-asteikolla 1-4, jossa 1=täysin eri mieltä, 2=jokseenkin eri mieltä, 3=jokseenkin samaa mieltä, 4=täysin samaa mieltä.
Koulutettaville on pääsääntöisesti nimetty oma ohjaava lääkäri ja ohjaamiseen käytettiin korvamerkattua aikaa. Myös muilla osa-alueilla koulutuksen tavoitteet toteutuvat hyvin, kuten alla olevasta kuvasta nähdään, vaikka lokikirjan käytössä alueellamme olisi tehostamisen varaa vielä. Koulutusvaatimuksista löydät lisää ajatuksia blogistani ”Voisiko ratkaisu olla näin yksinkertainen”.
1=täysin eri mieltä, 2=jokseenkin eri mieltä, 3=jokseenkin samaa mieltä, 4=täysin samaa mieltä.
Samaan aikaan koulutettavien määrä terveyskeskuksissa on lisääntynyt huomattavasti ja suhde kokeneiden lääkäreiden ja koulutettavien välillä on muuttunut epäedullisemmaksi. Kun vuosituhannen alussa reilun kymmenen lääkärin terveyskeskuksessa oli kesätöissä kaksi kandia ja muut kokeneita lääkäreitä, on tilanne tänä päivänä päinvastainen. Valmistuneiden määrä Itä-Suomen yliopistossa on lisääntynyt viimeisen kolmenkymmenen vuoden aikana noin 60:lla lääketieteen lisensiaatilla vuodessa. Suurentuneen sisäänoton huippuvuosien vaikutus valmistuneiden määrässä tullaan kuitenkin näkemään vasta tulevien vuosien aikana, sillä jättikurssit ovat vielä opiskelemassa.
Noin 35% alle 35-vuotiaista lääkäreistä työskentelee terveyskeskuksissa, mikä käytännössä tarkoittaa usein sitä, että terveyskeskukset opettavat lääketieteen lisensiaatit lääkäreiksi, minkä jälkeen monet heistä siirtyvät työskentelemään sairaaloihin. Kuten tiedämme, varsinkin uran alussa ohjauksen tarve on usein suurin.
Lääkäreiden kokonaismäärä Suomessa on viimeisen 13 vuoden aikana lisääntynyt 3700 kpl eli 21%, mutta lääkärivakanssien määrä terveyskeskuksissa on tänä aikana lisääntynyt kuitenkin vain 300 lääkärillä.
Hyvin koulutetut kouluttajalääkärit takaavat koulutuksen hyvän laadun
Koulutettavien määrän kasvun lisäksi perusterveydenhuoltoon on siirtynyt ja siirtyy koko ajan lisää tehtäviä, joita aikaisemmin on tehty erikoissairaanhoidossa. Kaikesta tästä huolimatta terveyskeskuksissa annettava koulutus on laadukasta, kuten seurantamme osoittaa. Yhtenä syynä tähän on systemaattinen pedagoginen koulutus, jota yleislääketieteen kouluttajalääkäreille on Itä-Suomen yliopistossa annettu vuodesta 2004 alkaen. Tällä hetkellä Itä-Suomen yliopisto yhteistyössä Pohjois-Savon sairaanhoitopiirin perusterveydenhuollon yksikön kanssa tarjoaa ja vaatii yleislääketieteen erikoislääkärikouluttajilta kahden opintopisteen perehdytyskurssia ja sen jälkeen 10:n opintopisteen Onnistu Ohjauksessa koulutusta. Täydennyskoulutusta annetaan kaksi lähipäivää vuodessa.
Monet kouluttajamme ovat innostuneita ja motivoituneita tekemään tätä työtä ja kehittävät paikallisesti terveyskeskuksessa annettavaa koulutusta. Kouluttaminen on kuitenkin usein lisänä potilastyölle eikä sitä valitettavasti nähdä samanarvoisena työnä kuin potilastyötä tai muita terveyskeskuksissa tehtäviä sektoritöitä. Jokohan vihdoin koittaisi se aika, jolloin terveyskeskuksissa annettavalle koulutukselle annettaisiin sille kuuluva arvostus ja tämä myös huomioitaisiin palvelujärjestelmän rakenteissa?
Nina Tusa
yleislääketieteen erikoislääkäri, lääkärikouluttajan erityispätevyys
kliininen opettaja, Itä-Suomen yliopisto
terveyskeskuslääkäri, perhelääkäri, Siilinjärven terveyskeskus
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When steroid substances are used by men, their natural
manufacturing of male hormones is lowered. The longer they rely
upon steroids and heavier the dose the extra it impacts their hormonal balance.
The degree of testosterone keeps getting decrease and the extent of female hormones (estradiol, progesterone, and prolactin)
keeps increasing. This leads to the expansion of feminine
breasts in men, also known as gynecomastia,
and it even causes fluid retention in their bodies.
This hormonal imbalance can be normalized
with the help of antiestrogens, and the most secure, most popular, and most effective
antiestrogen is Clomiphene (Clomid). No matter what type of steroid a bodybuilder is utilizing and for
a way lengthy, Clomid is often instructed to them to get desired results.
This action tricks the brain into pondering that estrogen levels are low,
prompting the pituitary gland to release more luteinizing hormone
(LH) and follicle-stimulating hormone (FSH).
Clomid is mostly nicely tolerated, however there are
a couple of potential unwanted side effects to focus on.
Nolvadex has the flexibility to interact with many cellular pathways, but certainly one of its major features is its position as a selective estrogen receptor antagonist.
Subsequently, the drug should not be considered as a potential enhancer of bodybuilding
efforts. Whereas some research have suggested that Clomid may have the ability to
enhance energy in sure people, the proof for that is restricted.
Tamoxifen can reduce LDL and complete cholesterol, though you shouldn’t rely solely on this SERM on your
on-cycle ldl cholesterol assist. Nolvadex’s core
operate as a PCT drug is to stimulate the discharge of Luteinizing Hormone (LH)
and Follicle Stimulating Hormone (FSH). LH is what stimulates the testicles to provide testosterone, whereas FSH
stimulates the manufacturing of sperm.
Continue utilizing HCG at 500iu every two days for 2 weeks after your final
dosage of Masteron and Testosterone. Then, begin with Enclomiphene PCT at 25mg/day for 3 weeks, then cut
back it to 12.5mg/day for week 4. Thanks to its decrease androgenic ranking,
Deca is considered one of the few steroids men can tolerate – if not higher – than testosterone itself.
Deca-Durabolin generally causes much less water retention than Testosterone Enanthate
at greater doses – but food plan and particular person response
play a substantial function. A 12-week beginner cycle dosed
at 250mg to 500mg weekly provides a superb introduction for the newbie by using the most secure steroid in testosterone.
Aspect results should be simply mitigated at this dose, and
a beginner will gain an insight into the results of Testosterone Enanthate on the body
during this primary cycle. An intermediate Testosterone Enanthate dose is within the range of 750mg/week.
For this cause, most bodybuilders and athletes will select one of many faster-acting esters of testosterone as an alternative.
Bone density and joint strength will be improved, which is one good thing about
the conversion to estrogen that happens (aromatization).
Different results indirectly related to bodybuilding embrace
improved well-being, heightened mental energy and focus, improved libido, and extra.
Most males using testosterone enanthate will find they feel
higher in all elements of life – mentally and bodily.
Testosterone Enanthate speeds this restore up noticeably (but you’ll need to wait a quantity of weeks to see this profit with
Testosterone Enanthate). With the means in which this steroid improves your muscle
recovery effectivity, the time between exercises can be decreased, leading to
extra common workouts with less threat of overtraining and damage and
more rapid muscle positive aspects. While not a
fat-loss steroid by any means, the increase in muscle mass on Testosterone Enanthate will naturally result in a more
efficient fat-burning process together with your metabolism working at a higher price.
Relying on the individual’s well being, way of life, and goals, the dosage might have to be altered, but
following this common regimen ensures that the physique will restore its personal hormone
manufacturing ranges naturally. After a cycle of steroids, it’s critical
to renew the body’s natural manufacturing of testosterone.
Nonetheless, it may be very important note that increased ranges of estrogen because of incorrect use may lead to gynocomastia
the development of breast tissue in males. This permits testosterone
levels to be regulated and regularized after a cycle resulting in enhanced efficiency while minimizing
any opposed unwanted effects. Clomid is therefore an essential component of any post-cycle remedy
program.
Discuss to your healthcare provider in regards to
the potential complications of becoming pregnant with a quantity of infants while taking clomiphene.
Taking clomiphene might trigger imaginative and prescient problems similar to blurry vision or seeing spots
or flashes of light. These imaginative and prescient
adjustments could final for a very long time and might be everlasting, particularly with higher doses and if taken for a
very long time. Tell your healthcare supplier right away should you
experience any imaginative and prescient changes. Many guys’ huge query is whether
or not or not you should take Arimidex on your whole cycle or solely when needed.
There are MANY variables to consider, the primary being what
AAS you’re using and how they influence your estrogen levels.
Once you’re snug using Arimidex and know how you reply, it’s a wonderful method of managing and even micro-managing
your estrogen on-cycle.
Testosterone can be included to offer a useful stage of the hormone.
Parabolan can be utilized at as much as 300mg weekly,
and Winstrol oral at 50mg day by day most. The next step
is to extend your Tren dosage if you’re tolerating it
well at lower doses. You will see substantial physical changes and rapid
muscle progress at such a dose. With Trenbolone’s immense androgenic rating
of 500, this isn’t a steroid that nearly all
females shall be reaching for.
Clomid is normally taken for 5 days, beginning on the fifth day of your menstrual interval.
Fertility therapy might improve your chance of getting a quantity of births (twins, triplets).
Clomid is used to trigger ovulation in ladies with sure
medical circumstances (such as polycystic ovary syndrome)
that stop naturally occurring ovulation. SERMs like Nolvadex are preferable for PCT and must be your first alternative over Arimidex for testosterone restoration.
Nolvadex is drastically higher at stimulating
testosterone, and you will hardly ever come throughout a bodybuilder who believes an AI
must be used as an alternative of a SERM for PCT.
Toremifene successfully reduces gyno flare-ups, and I’ve heard
of men who have been satisfied with using it as a substitute of Nolvadex.
Low to regular LH at baseline appears to foretell
biochemical and medical effectiveness. Further analysis with clear inclusion criteria,
enough measurement of hormonal ranges and registration of symptoms and unwanted effects is recommended.
I am a muscular guy with much consideration and recognition for
my physique. I started with little or no and at all times put 110% into the health club to get to
the place I am now. From anabolic steroids to SARMs to peptides and ancillary drugs, I’ve done
it at some point in my life, and I can relate. Your dosage will differ depending on the steroid
cycle you were on, with stronger cycles requiring stronger Clomid doses.
Moreover, if you’re using other medication throughout PCT,
you’ll want to regulate the dosages accordingly.
Men taking CC may experience plateau in TT at 6 months and first profit in sperm concentration at 9 months.
A biopsychosocial method to administration was employed by intensifying life-style practices including sleep hygiene, train, and stress reduction as
first line. Our affected person declined androgen alternative because of concerns about testicular atrophy; however, he reported a earlier 1-month trial of clomiphene
citrate while abroad that yielded good symptom enchancment.
Although Letro also wants to reduce fluid retention, we don’t use
it for this purpose as a end result of it might require use over most of
your cycle. And as we all know, Letrozole is way too
harsh to be working for weeks on end. Like most AIs, Letrozole’s main function is for use as a medical remedy for breast most
cancers in postmenopausal ladies following conventional most cancers remedies like radiation or after a 5-year remedy
of Nolvadex. I even have been utilizing Tamoxifen for over a year now and I couldn’t imagine my PCT with out it.
I know that a lot of people say that they don’t need to make use
of Tamoxifen, however trust me, you do. I am seeing lots of comparability with Tamoxifen vs Clomid in phrases of publish cycle therapy product.
References:
guys on steroids before and after (jbhnews.com)
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