Examinando por Materia "England"

Mostrando 1 - 20 de 23

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Complications of cervical collar use in trauma patients requiring immobilization
(Universidad Privada Norbert Wiener, 2017-11-12) Montero Crisologo, Diana Carolina; Vega López, Karen Rocio; Gamarra Bustillos, Carlos
Methodology: Systematic, observational and retrospective review, the search has been restricted to articles with full text, and the selected articles were subjected to a critical reading to identify their level of evidence. In the final selection, 10 articles were chosen, we found that 30% (03) correspond to the United States, with 20% (02) in Holland, while with 10% (01) we find England, Iran, Norway, Australia and Iceland respectively. Among the systemic reviews we find the countries of the United States, Norway, England and Iran, which account for 40% of the studies carried out, also with 20% we have prospective studies belonging to Australia and Holland, 20% of retrospective studies carried out in the US and the Netherlands, 10% corresponds to a US randomized controlled trial. Results: Of the 10 articles found, 6 of them mention that one of the first most frequent complications are pressure ulcers, followed by 2 articles that tell us that there is an increase in intracranial pressure caused by excessive adjustment of the cervical collar and 2 articles where the authors agree with the presence of pressure ulcers and increased intracranial pressure. In this way we were able to confirm that there are complications from the use of the cervical collar in traumatized patients who require immobilization. The authors confirm that pressure ulcers are due to the patient's skin type and the length of time the collar is worn. Conclusions: Of the total number of articles analyzed, 100% confirm that the use of the cervical collar produces compilations such as pressure ulcers at primary and secondary level, jugular venous pressure and tissue interface pressure in traumatized patients requiring immobilization.
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Determination of the safe disinfectant Orthophthaldehyde versus Glutaraldehyde used by nurses in the High Level Disinfection Process
(Universidad Privada Norbert Wiener, 1905-07-09) Idrogo Maita, Zaida Karina; Ruiz Campos, Deysi; Gómez Gonzales, Walter Edgar
Objectives: Determine the safe disinfectant Orthophthaldehyde vs glutaraldehyde to be used by nurses in the high-level disinfection process. Materials and Methods: Observational and retrospective systematic review, the search has been restricted to 8 articles with full text, and the selected articles were subjected to critical reading. Published and indexed in scientific databases, dating back to the year 2000 and responding to articles published in Spanish, English and Portuguese. In the final selection, 4 articles were chosen, we found that 25% (01) corresponds to England, with 25% (01) to Spain, with 25% (01) to Brazil and while another 25% (01) we find Japan; Two systematic reviews and two cross-sectional studies were included. Results: 80% of the articles reviewed show that glutaraldehyde, compared to orthophthaldehyde, is the one that produces the most cytotoxicity at work, but that orthophthalaldehyde is still toxic. Orthophthaldehyde vs glutaraldehyde, in both cases its greatest adverse reaction when used is in the respiratory tract Conclusion: of the liquid chemical substances used as high-level disinfectants Orthophthaldehyde vs Glutaraldehyde It was evident that Glutaraldehyde is a volatile product that emanates cytotoxic substances causing effects adverse effects on the person who handles it, while Orthophthaldehyde, being exposed through inhalation, turns out to be a sensitizing this. The direct handling of high-level disinfectant substances focuses exposure on the inhalation route, requiring the use of personal protective equipment.
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Effective scale to assess the risk of pressure ulcer in pediatric patients
(Universidad Privada Norbert Wiener, 1905-07-09) Calla Ruiz, Oriele; Salvador Valenzuela, Norma Haydeé; Gómez Gonzales, Walter Edgar
Systematic, observational and retrospective review, the search has been restricted to articles with full text, and the selected articles were subjected to a critical reading, using the Grade evaluation to identify the degree of evidence. Results: In the final selection, 07 articles were chosen, 58% (4) correspond to Spain, with 14% (1) found in England, 14% Colombia and 14% Brazil. Likewise, according to the type of study, 43% correspond to Systematic Reviews, 14% Prospective Cohort, 29% Descriptive, 14% Cross-sectional Study. Conclusions: According to the results obtained from the systematic review, they show that of the total of 7 studies, equivalent to 58% corresponds to demonstrating that the Braden scale is effective in evaluating the risk of pressure ulcer in pediatric patients.
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Effectiveness of dialysate sodium concentration management for blood pressure changes in hemodialysis patients
(Universidad Privada Norbert Wiener, 2020-08-02) Saavedra Quintana, Vanesa Lisette; Taboada Masabel, Daniel Angel; Arevalo Marcos, Rodolfo Amado
Objective: Systematize and analyze the effectiveness of managing the sodium concentration in the dialysate for blood pressure changes in patients with hemodialysis. Material and methods: Observational and retrospective systematic review, which synthesizes the results of multiple primary investigations. They are an essential part of evidence-based nursing due to their rigorous methodology, identifying relevant studies to answer specific questions of clinical practice, the search has been restricted to articles with full text, and the selected articles were subjected to critical reading. using the GRADE system to assign the strength of recommendation, the 10 articles systematically reviewed 20% (n=2/10) are systematic reviews, 30% (3/10) are randomized controlled trials, 50% (5/10) control studies. The results obtained by this study come from; Iran 20%, United States 20%, United Kingdom 10%, England 10%, Italy 10%, Austria 10%, China 10%, New Zealand 10%. Results: The evidence found, 70% (7/10) indicates that the management of sodium concentration in the dialysate is effective for changes in blood pressure in patients with hemodialysis. Conclusions: The management of sodium concentration in dialysate is effective for blood pressure changes in patients with hemodialysis.
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Effectiveness of educational interventions for self-management in the care of epileptic patients in emergency services
(Universidad Privada Norbert Wiener, 2020-02-16) Chumbirayco Garcia, Karen Ana; Cuba Quispe, Janeth Emily; Basurto Santillán, Ivan Javier
Objective: Systematize the evidence on the effectiveness of educational interventions for self-management in the care of epileptic patients in emergency services Material and methods: A systematic review of international research studies is carried out, which have been obtained by searching in database: Epistemonikos, NCBI, PubMed, Elsevier, Google Scholar and Scielo, which have been chosen and analyzed using the grade system to locate the respective degree of evidence. The search has been carried out using the DeCS and MeSH descriptors for the search in Spanish and English respectively. 80% (8/10) of the articles reviewed correspond to England, and the remaining 20% (2/10) correspond to Holland and Germany respectively. Results: 80% (8/10) of the evidence indicates that educational interventions are effective for self-management in the care of epileptic patients in emergency services, and 20% (2/10) indicates that educational interventions are not effective for self-management in the care of epileptic patients in emergency services Conclusions: 8 out of 10 of the evidence indicates that educational interventions are effective for self-management in the care of epileptic patients in emergency services, and 2 out of 10 educational interventions are not effective for self-management in the care of epileptic patients in emergency services
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Effectiveness of Enhanced Recovery Program Versus Conventional Care in Decreasing Hospital Stay in Colorectal Surgery Patients
(Universidad Privada Norbert Wiener, 2020-01-25) Niebles Sotelo, Estefania; Padilla Chacpi, Jackeline Fabiola; Basurto Santillán, Ivan Javier
Material and methods: Systematic retrospective and quantitative observational review, subject to criticism, using the Grade evaluation method to establish the level of evidence, located in the following information sources: Researchgate, Sciencedirect, Epistemonikos, PubMed, Scielo. Of the 10 articles systematically reviewed, 80% are of high quality as described below: 50% (n= 5/10) are meta-analysis, 20% (n= 2/10) systematic review, 10% ( n= 1/10) is a randomized controlled trial and 20% of moderate quality as described below: 20% (n= 2/10) cohort studies. They come from the countries of the United States (20%), England (20%), China (20%), Italy (10%), Norway (10%), New Zealand (10%) and Holland (10%). Results: Of the evidence found, 100% (n=10/10) evidence concludes that the enhanced recovery program is more effective than conventional care in reducing hospital stay in colorectal surgery patients. Conclusion: 10/10 evidence concludes that the enhanced recovery program is more effective than conventional care in reducing hospital stay in colorectal surgery patients.
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Effectiveness of hydrogen peroxide in reducing contamination of pathogenic microorganisms in the hospital environment
(Universidad Privada Norbert Wiener, 2020-12-27) Carrera Gonzales, Jarumi Ananda; Dominguez Cuevas, Eddy Johnny; Basurto Santillán, Ivan Javier
Objective: Systematize the evidence on the effectiveness of hydrogen peroxide to reduce the contamination of pathogenic microorganisms in the hospital environment. Material and methods: Systematic observational and retrospective review, subjected to critical reading and using the GRADE evaluation system to identify the degree of evidence of the articles published in the following databases Epistemonikos, Researchgate, PubMed, Scielo and Sciencedirect. Of the 10 articles systematically reviewed, 50% of high quality and 50% of moderate quality are described below: 20% (n= 2/10) are systematic reviews, 30% (n= 3/10) are randomized controlled trials, 10% (n= 1/10) are quasi-experimental and 40% (n= 4/10) are cohort studies and belong to the countries of England (40%), followed by the United States (30%), Greece (10%), France (10%) and Australia (10%). Results: 100% (n=10/10) indicate that hydrogen peroxide is effective in reducing the contamination of pathogenic microorganisms in the hospital environment. Conclusion: Hydrogen peroxide is effective in reducing contamination of pathogenic microorganisms in the hospital environment.
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Effectiveness of implementation strategies to improve adherence to care protocols in emergency services
(Universidad Privada Norbert Wiener, 2019-09-22) Ramos Cavero, Carla Vanessa; Chipa Quispe, Lisbeth; Matta Solis, Hernán Hugo
Objective: Systematize evidence on the effectiveness of implementation strategies to improve adherence to care protocols in emergency services. Material and methods: Systematic review, use of the GRADE evaluation system. Databases: Epistemonikos, NCBI, PubMed, Elsevier, Google Scholar and Scielo. The search has been carried out using the DECS and MESH descriptors for the search in Spanish and English respectively. 30% (3/10) of the articles reviewed correspond to the USA and Australia respectively, and 20% (2/10) correspond to Holland, Canada and England respectively. Results: 70% (07/10) of the evidence indicates that the implementation of strategies is effective in improving adherence to protocols in the emergency service, and 30% (3/10) indicates that there is insufficient information, heterogeneity of data and the need to adequately verify scientific articles to determine the effectiveness of implementation strategies in improving adherence to care protocols in emergency services. Conclusions: 7 out of 10 evidence demonstrate that implementation strategies are effective in improving adherence to protocols in emergency services, and 3 out of 10 evidence demonstrate that there is insufficient information, heterogeneity of data and the need to verify scientific articles in a manner adequate to determine the effectiveness of the topic under study.
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Effectiveness of physical exercise to reduce fatigue in patients with breast cancer
(Universidad Privada Norbert Wiener, 2019-09-01) Asto Cañavi, Miluska; Avila Vargas Machuca, Jeannette Giselle
Systematize the evidence on the effectiveness of exercise to reduce fatigue in patients with breast cancer. Material and methods: Systematic observational and retrospective quantitative review, subjected to critical selection, using the Grade evaluation system to identify the degree of evidence, found in the following databases: Pubmed, Liliacs, Scielo, Epistemonikos. Of the 10 articles systematically reviewed, 100% (n= 10/10) are systematic reviews. In relation to the origin of the evidence, 20% (2/10) are from China, 10% (1/10) from Ireland, 10% (1/10) from the United States, 10% (1/10) from Brazil , 10% (1/10) from Costa Rica, 10% (1/10) from Cyprus, 10% (1/10) from Canada, 10% (1/10) from Germany and 10% (1/10) from England. Results: 90% (n=9/10) indicate that exercise is effective in reducing fatigue in patients with breast cancer. 10% (n=1/10) indicate that physical exercise does not seem to reduce fatigue levels in women with breast cancer who present the symptom. Conclusion: Exercise is effective in reducing fatigue in patients with breast cancer.
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Effectiveness of Prehospital Spine Motion Restriction in Penetrating Trauma
(Universidad Privada Norbert Wiener, 2019-08-25) Rios Prado, Magali Cristina; Yauri Yauri, Magale Yole; Calsin Pacompia, Wilmer
Objective: Systematize the evidence on the effectiveness of prehospital spinal movement restriction in penetrating trauma to prevent neurological complications. MATERIAL AND METHOD: The study was quantitative, with a systematic, observational and retrospective review design; of articles with full text, which identified their grade or quality of evidence and strength of recommendation according to the GRADE System. Likewise, the population was made up of 25 articles and the sample included 10 most relevant articles, obtained from the following databases Pubmed, Medline, Embase, Cochrane Library, Dialnet, Scielo, and Lilacs. Results: Of the articles found, 40% Spain, 40% United States, 10% England, and 10% Iran. Likewise, the systematic review was the study design used in 70% of the investigations; and followed by 30% were retrospective studies. Of the 10 articles reviewed, 60% demonstrate that prehospital spinal movement restriction in penetrating trauma is not effective in preventing neurological complications; and 40% demonstrate that prehospital spinal movement restriction in penetrating trauma is effective in preventing neurological complications. Conclusions: 60% showed that prehospital restriction of movement of the spine in penetrating trauma is not effective in preventing neurological complications, presents harmful effects, increases risks of neurological disability and possible deaths in the short or long term depending on the patient's condition and 40 % showed that prehospital restriction of spinal column movement in penetrating trauma is effective in preventing neurological complications; because during the pre-hospital transfer it avoids or prevents traumatic and neurological injuries, disabilities, sequelae, paraplegics and even the death of the patient.
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Effectiveness of rapid response systems in reducing hospital mortality
(Universidad Privada Norbert Wiener, 1905-07-09) Vilela Cruz, Miguel Fabrisius; Calsin Pacompia, Wilmer
Objectives: Determine the effectiveness of rapid response systems in reducing hospital mortality. Materials and methods: The methodology was based on a systematic review, meta-analysis and the search for international articles with full text, the most important ones according to level and degree of evidence were included. Results: In the final selection, 10 articles were chosen, 80% (8) from the United States, 20% (2) from England. Where the majority of the articles analyzed with 80% affirm that there is effectiveness in rapid response systems in reducing hospital mortality. Conclusions: It was evident that in the 8 research articles reviewed there is effectiveness in rapid response systems in reducing hospital mortality. It was shown that there is efficacy in terms of: reduction in unexpected hospital mortality, rates of cardiac arrest and/or unexpected death, reductions in in-hospital code rates.
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Effectiveness of sucrose for pain control during invasive procedures in the newborn
(Universidad Privada Norbert Wiener, 1905-07-09) Quispe Riveros, Rosy; Tarazona Nuñez, Rosa Kelly; Remuzgo Artezano, Anika
Objective: Determine the effectiveness of sucrose for pain control during invasive procedures in the newborn Materials and Methods: Observational and retrospective systematic review, the search has been restricted to articles with full text, and the selected articles underwent a critical reading, using Jover's evaluation to identify its level of evidence. Results: In the final selection, 10 articles were chosen, we found that 30% (03) correspond to the United States, while with 10% (01) we find England, Uruguay, Canada, Mexico, Argentina, Peru, Korea, Arabia Saudi respectively. Most experimental studies have been studied, with 90%, mainly in the countries of England, Uruguay, Canada, Mexico, Argentina, Peru, Korea, Saudi Arabia. Among systematic reviews we find the country of the United States, with 10%. Where, of the total number of articles analyzed, 100% stated that those newborns who received oral sucrose reduced their pain. Conclusions: The effectiveness of sucrose in controlling pain in newborns undergoing invasive procedures was evidenced in the reviewed research. It is recommended to use 24% sucrose in full-term newborns, as an optimal dose: 0.5ml/kg/po maximum 8 times in 24 hours, 2 minutes before the painful procedure.
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Effectiveness of Surgical Care Bundles in Reducing the Risk of Surgical Site Infections in Patients Undergoing Colorectal Surgery
(Universidad Privada Norbert Wiener, 2020-08-02) Rodriguez Oro, Kharen Fabiola; Arevalo Marcos, Rodolfo Amado
Objective: Systematize evidence on the effectiveness of surgical care bundles to reduce the risk of surgical site infections in patients undergoing colorectal surgery. Material and methods: Systematic retrospective and observational review subject to critical reading and using the GRADE system as an evaluation tool to identify the quality of scientific evidence published in the following sources of information. Epistemonikos, Scielo, Sciencedirect Researchgate and PubMed. Of the 10 articles systematically reviewed, 20% of high quality and 80% of moderate quality are described below: 20% (n= 2/10) are meta-analyses and 80% (n= 8/10) are cohort studies respectively and belong to the countries of the United States (60%), Japan (10%), Australia (10%), Holland (10%) and England (10%).Results: 100% (n=10/10) indicate that surgical care bundles are effective in reducing the risk of surgical site infections in patients undergoing colorectal surgery. Conclusion: Surgical care bundles are effective in reducing the risk of surgical site infections in patients undergoing colorectal surgeries.
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Effectiveness of the CPSS scale in the prognostic assessment of patients with stroke in emergency services
(Universidad Privada Norbert Wiener, 2021-07-04) Cornejo Olazabal, Dina Yolanda; Guerra Condorpusa, María Asunta; Pretell Aguilar, Rosa María
A systematic review of international research is carried out, obtained through a database search: Epistemonikos, PubMed, Elsevier, Google Academic and Scielo, which have been analyzed using the grade system to locate the level of evidence. The search has been carried out using the DeCS and MeSH descriptors for the search in Spanish and English respectively. The studied population consisted of 89 scientific articles, of which 10 represent the sample. 40% (4/10) of the articles reviewed correspond to the USA, and 60% (6/10) to Germany, France, China, Egypt, England, and Italy respectively. 40% (4/10) correspond to systematic reviews, randomized clinical trials, non-randomized clinical trials, and observational studies respectively and 60% (6/10) to cohort studies. Results: 100% (10/10) of the evidence indicates that the CPSS scale is effective in the prognostic assessment of patients with stroke in emergency services. Proving to be a reliable instrument that allows timely and appropriate decision making. Conclusions: 10 out of 10 evidence demonstrate that the CPSS scale is effective in the prognostic assessment of stroke patients treated in emergency services.
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Effectiveness of the use of polyethylene bags for the prevention of hypothermia in premature and low birth weight newborns
(Universidad Privada Norbert Wiener, 1905-07-09) Hernández Julca, Bertha Gladys; Pérez Franco, Sandra Jesús; Remuzgo Artezano, Anika
Objective: Determine the effectiveness of the use of polyethylene bags for the prevention of hypothermia in premature and low birth weight newborns. Materials and Methods: Observational and retrospective systematic review, the search has been restricted to articles with full text, and the selected articles were subjected to a critical reading, together with the intensive bibliographic search algorithm and the PICO strategy. Results: 10 articles were obtained as a population, of which 100% (10/10) demonstrated that the use of the polyethylene bag to prevent hypothermia in premature and low birth weight newborns is effective; We also point out that of these, 20% correspond to the United States as well as those from Mexico, while 10% are from Uruguay, Canada, Thailand, Zambia, Brazil and England respectively. Therefore, it is concluded to consider the use of polyethylene bags as an additional effective and safe intervention to prevent hypothermia in premature and low birth weight newborns. Conclusions: 100% (10/10) of scientific articles have shown that the use of polyethylene bags is effective in interrupting heat loss through convection, conduction and evaporation mechanisms. Likewise, by preventing hypothermia we not only find stable oxygen saturation but also other vital functions and consequently the most serious complication such as neurological damage is avoided.
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Efficacy of ambulatory exercise to improve the quality of life of patients with chronic heart failure
(Universidad Privada Norbert Wiener, 2019-09-29) Alvarado Valdivia, Gloria Carmen; Penadillo Cueva, Lizbeth; Arevalo Marcos, Rodolfo Amado
Objective: Systematize evidence on the effectiveness of ambulatory aerobic exercise to improve quality of life in patients with congestive heart failure. Material and methods: Systematic observational and retrospective review, subjected to critical reading and the GRADE evaluation system was used to identify the degree of evidence of the articles published in the following databases: Epistemonikos, Infomed and Pubmed. Of the 11 articles systematically reviewed, 100% were of high quality as described below: 82% (n= 9/11) are Systematic Review, 9% (n=1/11) are experimental and 9% ( n=1/11) is a meta-analysis and comes from the following countries: England (27.2%), Australia (18.2%), United States (18.2%), Japan (9.1%), Cuba (9.1%) and Netherlands (9.1%) and Taiwan (9.1%). Results: 100% (11/11) (10/12) indicate that outpatient exercise is effective in improving the quality of life of patients with Chronic Heart Failure. Conclusion: Ambulatory exercise is effective in improving the quality of life of patients with congestive heart failure.
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Efficacy of interventions to prevent overweight and obesity in children under five years of age
(Universidad Privada Norbert Wiener, 2020-02-08) Rodriguez Gonzales, Raquel; Torres Paucar, Milena Haais; Cárdenas de Fernández, María Hilda
Objective: Systematize evidence on the effectiveness of interventions to prevent overweight and obesity in children under 5 years of age. Material and methods: Systematic Reviews are an observational and retrospective approach. 10 articles were selected and the analysis of the review is constituted in a summary table. The database was used: Journal, Scielo, Cochrane Plus, etc. Results: In the conclusive selection, 10 articles were chosen, 30% belong to Australia, 20% to Spain, and 50% belong to Peru, Mexico, England, the USA and Italy, respectively. Of the studies reviewed, 70% are systematic reviews and 30% are clinical trials. Where 85% effectiveness of interventions to prevent overweight and obesity in children under 5 years of age is evident. Conclusions: Of the 10 articles reviewed, an effectiveness of 85% is confirmed, having a greater impact on small or local groups, which use different mechanisms to change nutrition styles in children under 5 years of age. Experimental research shows changes in diet, physical activity and decreased hours of entertainment, for which mothers actively participate.
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Efficacy of mindfulness-based interventions to reduce ruminative thoughts in adult patients with depression
(Universidad Privada Norbert Wiener, 2019-09-22) Castro Cortez, Marcos Antonio; Avila Vargas Machuca, Jeannette Giselle
Objective: Systematize evidence on the effectiveness of mindfulness-based interventions to reduce ruminative thoughts in adult patients with depression. Material and methods: Systematic observational and retrospective quantitative review, subjected to critical selection, using the Grade evaluation system to identify the degree of evidence, selected from the following databases: Sciencedirect, Wiley Online Library, Dialnet, PubMed. Of the 10 articles systematically reviewed, 40% (n= 4/10) are systematic reviews, 30% (n= 3/10) are randomized controlled trials and 30% (n= 3/10) are meta-analyses. The results obtained from the systematic review carried out in the present study come from the countries of England (10%), United Kingdom (20%), Switzerland (10%), China (10%), Spain (10%), USA ( 20%) and Netherlands (20%). Results: Of the evidence found, 70% (n=7/10) indicate that the intervention based on mindfulness is effective in reducing symptoms of depression. Conclusion: the intervention based on mindfulness is effective in reducing symptoms of depression such as ruminative thoughts.
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Efficacy of nutritional interventions to reduce malnutrition in cancer patients
(Universidad Privada Norbert Wiener, 2020-02-16) Berrospi Meza, Marily; Tirado Abanto, Maria Isabel; Uturunco Vera, Milagros Lizbeth
It is a quantitative observational and retrospective systematic review, subjected to critical selection, using the Grade evaluation system to identify the degree of evidence, found in the various databases: PubMed, Scielo, Cochrane, Epistemonikos. Of the 10 articles systematically reviewed, 70% (n= 7/10) are systematic reviews, 30% (n= 3/10) are randomized controlled trials. According to the studies found in the following systematic reviews, they come from the following countries: Portugal (10%), Australia (20%), England (10%), USA (30%), Singapore (10%), Europe (10%) and Brazil (10%).
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Efficacy of using ultrasound guidance in catheter placement in patients with difficult vascular access
(Universidad Privada Norbert Wiener, 2019-08-25) Matos Bonifacio, Yeny; Pretell Aguilar, Rosa María
Objective: Systematize the evidence on the effectiveness of the use of ultrasound guidance in the placement of catheters in patients with difficult vascular disease. Materials and Methods: The type and design of the study was quantitative and systematic review respectively, 10 scientific articles made up the population and sample, of 100%, 10% correspond to Spain, 10% correspond to France, 10% London England, 10% Ireland, 30% USA, 10% Great Britain, 10% Canada and 10% Japan. The systematic review of the 10 scientific articles of which according to the type of research design, 10% (n=1/10) are randomized trials, 80% (n=8/10) are a systematic review and meta-analysis, and 10 % (n=1/10) are randomized studies. Results We found in 100% (10/10) of the studies that the use of ultrasound guidance in the placement of catheters in patients with difficult vascular access was effective in older adult patients, children, oncology patients, and diabetic patients who undergo dialysis. Conclusions: 10 of the 10 evidence concluded that the use of ultrasound in the placement of peripheral catheters is effective, because it has significant beneficial effects, being successful on the first attempt, reducing the risk of arterial puncture and hematomas, reducing complications.