Opioid Alternative Medications: CRNA Beliefs, Opinions, and Practices

Abstract Background: Opioids are powerful pain medications that have significant side effects. Opioid alternative administration can treat analgesia and limit opioid administration. Objectives: The purpose of this study was to examine and describe CRNAs’ beliefs, opinions, and practices on administering opioid medications versus opioid alternative strategies to treat intraoperative pain. Method: A qualitative, survey study design using semi-structured interviews was conducted. Twelve CRNAs were interviewed and audio recorded discussing their perspectives and opinions on administering opioid alternatives. Results: Two themes were established: barriers and promoting factors with each theme containing sub themes. The subthemes under barriers included: opioid superiority (83%), inconsistent analgesia effects of opioid alternatives (83%), limited experience with opioid alternatives (58%), limited opioid alternative resources (42%), negative experiences with alternative administration (66%), and patient comorbidities (100%). Subthemes under promoting factors included: avoiding adverse effects of opioids (92%), institutional policies (50%), positive experiences with alternative administration (100%), and regional superiority (100%). Conclusion: Understanding the barriers and promoting factors to opioid alternative administration can be useful to enhance its usage. Larger studies and/or surveys are needed to assess greater sample sizes to further validate the current data. Keywords: anesthesia, opioids, perceptions, barriers, multimodal strategies, nurse anesthetist, provider

Candil de la calle, oscuridad de la casa. México ante el Consejo de Derechos Humanos de la ONU

En 2009 México compareció ante el CDH, en el llamado Examen Periódico Universal, al que todos los países miembros de la ONU han aceptado someterse para revisar la situación de los derechos humanos en sus naciones. En la primera parte, simplemente exponemos de manera breve en qué consiste el mecanismo y cómo se realizó para el caso de México. Una segunda parte la dedicamos a las críticas que se le hacen al informe presentado por México. En la tercera parte, destacamos los aspectos que consideramos de mayor relevancia en los diversos informes que prepararon las organizaciones de la sociedad civil, sobre la situación de los derechos humanos en México. La cuarta parte expone las recomendaciones del equipo de trabajo del CDH, en particular, las ocho que el Estado mexicano rechazó; en la quinta, de manera sintética se destacan los puntos medulares del informe oficial y el razonamiento de los representantes de México para rechazar ocho de las 93 recomendaciones hechas en el CDH, de modo que en la sexta parte retomamos los argumentos de las organizaciones civiles que cuestionan dicho razonamiento y desenmascaran las trampas de sus argumentos. Una séptima parte la dedicamos a establecer una hipótesis según la cual intenta explicar los obstáculos estructurales para la puesta en marcha de una real política de Estado en materia de derechos humanos, para terminar, en el octavo apartado, con otra hipótesis, muy incipiente, que propone otra manera de entender y practicar la lucha por la defensa y protección de los derechos humanos en México.ITESO, A.C

Bourdieu: una visión sintética de su teoría del sentido práctico

Se presenta una visión esquemática de la teoría del sentido práctico de Pierre Bourdieu: (habitus)(capital) + campo = prácticaITESO, A.C

De la pertinencia de la investigación en el ITESO a la investigación pertinente del ITESO

ITESO, A.C

Sobre otras vulnerabilidades

Participación en el Senado de la República, en la que se plantean otras vulnerabilidades, entre las que destaca el propio Estado mexicano.ITESO, A.C

Crisis de la Filosofía y autonomía de las Ciencias Sociales

Breve reflexión sobre la importancia del diálogo entre la Filosofía y las Ciencias Sociales a partir de un planteamiento de Pierre Bourdieu.ITESO, A.C

Jorge Enrique in Mexico: will he leave his home?

This book was born out of the hope that Jesuits around the world could build a network based on shared experience of the plight of poor people caught in the throes of economic globalization. It is addressed to all those who work in any way to help achieve sustainable development and confront the challenges of deep-seated poverty. The book, which features eleven people whose lives were altered by globalization, is the result of the work done in the Global Economy and Cultures (GEC) project at the Woodstock Theological Center (WTC) at Georgetown University in Washington, D.C. in collaboration with Jesuit social centers from around the world.This chapter: Jorge Enrique’s life changed dramatically when the tire factory where he worked, Euzkadi, shut down. Located in El Salto, Mexico, the factory was owned by a multinational company and in the past had had a strong labor union. It was a very good job for Jorge Enrique, with better wages and benefits than many other places in Mexico. But in 2001, the owners said that Mexico’s new lower import duties allowed cheaper foreign tires to enter the country and they couldn’t compete without concessions from labor. Now in his thirties, Jorge Enrique is involved with his union’s efforts to force the factory’s reopening. He wonders if he should go back to work in the United States, which he did when he was younger. It would be easy for him, because he has a “green card” − a legal entry visa. The old Mexican economic system crashed in 1982 under the weight of mounting international debt and fiscal deficits. It was a closed economy; domestic production was protected by high import tariffs and major industries were often in government hands. The immediate response to the crisis included severe economic austerity measures backed by loans from the IMF. This was followed by economic restructuring, particularly after 1988, marked by privatizations and liberalization of international trade and investment. Over the next decade, these measures were supported by Mexico’s implementing the Uruguay Round of trade negotiations and, in 1996, signing the North American Free Trade Area Agreement (NAFTA) with the U.S. and Canada. Mexico’s economic restructuring affected El Salto. Foreign companies made new investments − Continental Tire of Germany bought Euzkadi − and old plants, like the textile factory where Jorge Enrique’s father worked, had to close. In the country as a whole, the already ongoing migration to the U.S. accelerated as agriculture’s contribution to the economy fell by nearly two-thirds, down to 4 percent of GDP by 2000.ITESO, A.C

¿Por qué Filosofía y Ciencias Sociales?

Se plantea la necesidad de articular la filosofía con las ciencias sociales en un diálogo creativo y transdisciplinar.ITESO, A.C