Suchergebnisse

El presente trabajo tiene dos objetivos. El primero consiste en sistematizar contribuciones analíticas enfocadas a interpretar el incumplimiento normativo englobándolas en cuatro grandes perspectivas: a) la ineficiencia del gobierno; b) un orden o institucionalidad informal o paralela; c) el umbral de deshonestidad; y d) la falta de sincronía entre motivos (morales, éticos y legales) e incentivos. El segundo se centra en esbozar tres estrategias políticas novedosas que puedan ayudar a combatir el incumplimiento, especialmente en América Latina. Por un lado, las nudges (intervenciones en la arquitectura de decisión); por el otro, el enfoque think (interiorizar distintas normas sociales); y, finalmente, el desafío de construir nuevas identidades colectivas. ; The present paper has two goals. The first is to sum up some analytical contributions to interpret normative non-compliance which put the focus on: a) government inefficiency; b) an informal or parallel order; c) the threshold of dishonesty; and d) a lack of synchronicity between motives (moral, ethical and legal) and incentives. The second is to outline new political strategies that could be useful to combat non-compliance, primarily in Latin America: nudges (interventions in the decision architecture), the think approach (internalize new social norms), and the challenge of building new collective identities. ; Aquest treball té dos objectius. El primer consisteix a sistematitzar contribucions analítiques enfocades a interpretar l'incompliment normatiu englobant-les en quatre grans perspectives: a) la ineficiència del govern; b) un ordre o institucionalitat informal o paral·lela; c) el llindar de deshonestedat; i d) la manca de sincronia entre motius (morals, ètics i legals) i incentius. El segon se centra a esbossar tres estratègies polítiques innovadores que puguin ajudar a combatre l'incompliment, especialment a l'Amèrica Llatina. D'una banda, les nudges (intervencions en l'arquitectura de decisió); de l'altra, l'enfocament think (interioritzar diferents normes socials); i, finalment, el desafiament de construir noves identitats col·lectives.

Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0, 6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described. Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0, 6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.