Archive for the ‘nursing research’ Category

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Does Telephone Follow-up After Myocardial Revascularization Help?

May 3, 2013

By Sylvia Foley, AJN senior editor

Cellphone macro by Cubosh, via Flickr

Myocardial revascularization, an established treatment for coronary heart disease, is currently done via either percutaneous coronary intervention or coronary artery bypass graft surgery. But recovery and rehabilitation can be hard going, and patients need close monitoring. Investigators Rejane K. Furuya and colleagues wanted to learn more about the use of telephone follow-up with such patients. To that end, they searched the literature, identified relevant studies, and assessed and synthesized the results. In this month’s original research CE, “Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review,” they report on their findings. Here’s a short summary.

The review was conducted in accordance with the Cochrane method. The researchers searched six electronic databases for articles on clinical trials that studied patients after myocardial revascularization using telephone follow-up and were published in English, Spanish, or Portuguese. Of 170 identified studies, seven met the inclusion criteria and were analyzed.

Some findings. Both the purposes and contents of telephone follow-up varied in the analyzed studies. The researchers found that the contents could be grouped into four themes—cardiovascular illness; postoperative complications; self-care, including behavioral and lifestyle changes; and psychosocial evaluation and emotional support. Outcome measures also varied widely, but included health-related quality of life, pain, enrollment in cardiac rehabilitation programs, physical functioning, hospital readmission, mood symptoms, and medication compliance. Telephone follow-up was found to be “an effective intervention for most of the outcomes assessed.”

The researchers also explored various elements of telephone follow-up, such as the timing of follow-up, the number of calls made, and who was responsible for initiating calls. They noted that

in five of the seven analyzed studies, nurses performed the telephone follow-up; and in all five the content was more comprehensive, covering both education and counseling for patients discharged after myocardial revascularization.

Furuya and colleagues concluded that the findings support the use of telephone follow-up “to periodically assess patient knowledge, discuss patient concerns and offer help in addressing them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes.” But more research is needed to identify the optimal content and frequency, number, and duration of calls.

For full details, please read the article—it’s free online. And as always, we welcome your comments!

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AJN’s May Issue: Telephone Follow-Up After Myocardial Revascularization, Hemodynamic Monitoring, Staffing Levels, Nurses Week, More

April 26, 2013

AJN0513.Cover.OnlineAJN’s May issue is now available on our Web site. Here’s a selection of what not to miss.

Coronary heart disease afflicts more than 16 million American adults. Myocardial revascularization has long been considered an effective treatment for this disease. Findings presented in our May original research article, “Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review,” support the use of telephone follow-up intervention after hospital discharge to assess patient knowledge, discuss patient concerns, and encourage behavioral and lifestyle changes. This article can earn you 2.6 continuing education (CE) credits.

Recently, there’s been a shift toward less invasive or noninvasive hemodynamic monitoring methods, and the use of “functional” indicators that more accurately predict fluid responsiveness. “Using Functional Hemodynamic Indicators to Guide Fluid Therapy,” a CE article that can earn you 2.6 credits, reviews the physiologic principles of functional hemodynamic indicators, describes how these indicators are calculated, and discusses when and how nurses can use them to guide fluid resuscitation in critically ill patients.

Celebrating Nurses Week. May’s In Our Community article describes how nurses from one hospital decided to forego traditional gifts during National Nurses Week and instead implemented a “Nurses Give Back” program in their community. How does your hospital celebrate? If you’re reading AJN on your iPad, you can listen to a podcast interview with the authors by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

Finally, is it ever okay to tell patients about staffing levels? In our Ethical Issues article, nurse ethicist Douglas P. Olsen outlines when it’s right to share sensitive information with patients, and when it’s better not to.

There’s plenty more in this issue, so stop by and have a look. Tell us what you think on Facebook, or here on our blog.

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Article Types, Topics of Interest, and Other Considerations for Prospective AJN Authors

March 14, 2013

iPad app exhibit AORNBy Maureen Shawn Kennedy, AJN editor-in-chief

I recently wrote a post that attempted to give readers a clearer sense of what we are looking for in article submissions and what we are not looking for: “My Professor Said to Submit My Paper (We Hope They Also Told You This).”

This post will just provide a quick overview of the types of articles we publish, as well as a plug for why it’s good to be published in AJN.

In terms of impact factor, AJN ranks 29/95 among ranked nursing journals, with an impact factor of 1.119. (Nursing journals with higher impact factors tend to be specialty research journals, whereas AJN publishes a broad range of content in addition to research, and for a variety of audiences.) Through our robust print, digital, iPad, institutional, and social media channels, AJN reaches more nurses than any other nursing journal.

We publish original research, quality improvement (QI), and review articles as primary feature articles and as CE articles. We also publish shorter, focused columns. All submissions must be evidence based and are peer-reviewed.

Clinical features should cover epidemiology, pathology, current research/“what’s new” in knowledge and/or treatment, nursing implications. There is no specific limit for word count, though feature articles are usually in the range of 6,000 to 10,000 words. (We have done two-part and three-part series for larger papers.) For examples of feature articles, see any of the CE articles on our Web site, www.ajnonline.com.

Some specific clinical topics we are currently seeking articles about:

Sedating patients with dementia; pleural effusions; pneumonia; treatment options for chronic pain (or articles on other aspects of pain management); rheumatoid arthritis; most pediatric topics; hypertensive emergencies; strokes, seizures (and other neuro topics); approaches to managing prostate and ovarian cancer; adverse effects from therapies; updates on managing arrhythmias, rosacea, scoliosis and other orthopedic topics, progressive mobility

Columns are shorter, focused papers of 2,000–3,000 words. AJN columns (some monthly, some more intermittent) include:

Emerging Infections, Disaster Care, Emergency, Environments and Health, Correspondence from Abroad (international topics), In Our Community, Policy and Politics, Wound Care, iNurse, Diabetes Under Control, Professional Development, plus occasional columns that take an in-depth look at new research or treatment topics or provide drug updates for specific conditions.

Cultivating Quality is the section for QI reports (authors should follow the SQUIRE guidelines as detailed in the author guidelines).

And in several shorter columns, we publish opinion pieces (Viewpoint), narratives/personal essays (Reflections), and poetry and art (Art of Nursing).

We encourage all prospective authors to review AJN articles at www.ajnonline.com prior to submitting.

For author guidelines and submission information (do please read these, noting word limits and other important details; some specific columns have their own guidelines): www.editorialmanager.com/ajn.

Queries can be sent to alison.bulman@wolterskluwer.com. Note that all queries should include the article idea, including its focus; an abstract and outline; length of paper and target date for submission; background of all authors and their qualifications to write on the subject; the topic’s relevance to nursing today. Queries about completed papers should also give these same details about the paper. Please do not submit a paper as a query.

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Gel and a Poster: A Hand Hygiene Campaign Gets Tested in Two Outpatient Clinics

March 11, 2013

By Sylvia Foley, AJN senior editor

hand.sochacki.98193355_eb8473c967

Hand by sochacki.info, via Flickr

The trouble with hands is that they get into everything, and rapidly move between mouths, noses, eyes, and other people’s hands.

So says David Owen in his recent New Yorker article “Hands Across America,” which describes the development of the first gel sanitizer—and of course it’s nothing nurses and other clinicians don’t already know, just as they know that the practice of hand hygiene is crucial to reducing health care–associated infection rates. Yet adherence to hand hygiene guidelines among health care workers remains low. Interventions to improve hand hygiene have been tested in hospitals with demonstrated success, but have seldom been evaluated in other settings. In this month’s CE–Original Research feature, authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal (GI) clinic.

The intervention. At each clinic, the researchers observed health care workers for the frequency of hand hygiene (attempts versus opportunities). After compiling baseline data, they initiated an intervention, which consisted of introducing an alcohol-based gel sanitizer and an informational poster to each clinic. (The gel sanitizer was provided as an alternative to foam sanitizer and soap and water.) One week later, interventional data were collected for five nonconsecutive days. Afterwards the posters and gel sanitizers were removed, and one month later, follow-up data were collected. Lastly, three months after follow-up observations ended, workers at each clinic were surveyed to evaluate their perceptions of the campaign.

Some findings. In both clinics, hand hygiene frequency was poor at baseline, just 11% at the oncology clinic and 21% at the GI clinic. But after the intervention it improved significantly, to 36% at the oncology clinic and 54% at the GI clinic—and the improvements were maintained during the follow-up period. Reported barriers to hand hygiene included skin irritation, forgetfulness, and insufficient time. Although a majority of surveyed workers at both clinics said they preferred soap and water, direct observations showed that once gel sanitizer was available, its use predominated. Indeed, when it was removed following the campaign’s end, many workers began carrying their own.

The researchers concluded that “introducing a gel sanitizer and providing informational posters can yield modest short-term improvements in overall hand hygiene performance in outpatient clinics.” They recommend that administrators and influential health care workers

  • collaborate in fostering an environment conducive to adherence.
  • provide a variety of hand hygiene products, including gel sanitizer.
  • encourage workers to participate in creating motivational posters.

For full details, please read the article—it’s free online. We’ve also got an exclusive podcast with the lead author. And as always, please consider sharing your thoughts and experiences with us in the comments.

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‘My Professor Said to Submit My Paper’ (We Hope They Also Told You This)

February 22, 2013

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

When we get a manuscript submission, I always read the cover letter first to learn about the author and why the article was written. Often, the first sentence goes something like this: “I am a student and I’m submitting my capstone paper as required by my professor.” Or the letter may say, “My professor encouraged me to submit this paper, my capstone work.”

The paper is usually the very paper the student wrote and submitted to the professor. And that almost always means it’s not suitable for a professional journal.

The problem is not that we won’t consider manuscripts written by students—we sometimes welcome them, especially papers written by nurses who are experienced clinicians and working toward a graduate degree. The problem with the submissions I’m talking about here is inherent in the purpose of the papers themselves. Student papers are written primarily to demonstrate what the student knows about a subject; these papers tend to be expansive, cover the topic in a superficial way, and include a long list of references of books, articles, and Web sites (or, conversely, they may only have a few references, mostly Web sites, plus perhaps one much-cited textbook—thankfully, few are citing Wikipedia).

Student papers that describe themselves as “literature reviews” often have no information about the search strategy—and little synthesis. Instead, they contain a long list of various studies related to the topic, with no real discussion of key findings or filtering of the information for relevance. Student  papers tend to cover what most nurses in practice already know. Writing them may help a student get a good overview of what’s known about a specific clinical topic or issue, but this doesn’t mean the papers should necessarily be published.

Articles written for professional journals have a different purpose. These articles, properly done, should be written with the reader in mind, presenting new information the reader needs to know or that provokes the reader to think about something in a different way. The reader should come away with new knowledge or a new perspective.

There are many good reasons that faculty should encourage students to write. For one, we need nurses at all levels to write about their work, and not enough of them do so. And the responsibility for nursing’s scholarly work cannot rest solely with academics and researchers; clinicians have the firsthand knowledge about care processes and outcomes, and they need to document their work. They need to communicate to the public about what it is that they do so that nurses’ work becomes more visible; they need to communicate to colleagues about what works and what doesn’t so that we can replicate successful quality improvement initiatives.

But in encouraging students to write, faculty members need to give the correct messages.

Here’s what faculty might tell students:

  1. Go to the journal’s Web site and review several articles similar to what you want to write. Note the tone, level of detail, sourcing. Search the journal to see if it recently published articles on a topic similar to what you want to write. Send a query letter to determine whether your topic is of interest.
  2. Review the submission guidelines. Pay special attention to the instructions for authors and to how to format the paper and the references. This isn’t just an academic exercise, but is necessary so that references appear correctly and are verifiable in online databases. Also keep in mind that many journals run software to detect plagiarism, and the results can be inaccurate if the software reads the references as part of the body of the manuscript because they are improperly formatted.
  3. Write the manuscript using the information you learned when preparing your capstone paper or thesis as a starting point. All information is not equal. Be selective. Perhaps include a case study, and focus on what’s new or important for nurses to know. In addition, write to the audience that makes up the readership of the journal. Use active voice; avoid jargon. If there’s a word limit, honor it.
  4. Be sure to use primary sources when providing citations to support facts. Ask the librarian to help you find the correct sources.
  5. Spell-check your article before you send it. Read it aloud. Ask a colleague to read it.

We often suggest that new authors invite a colleague or faculty member who has published in a peer-reviewed journal to be a coauthor. And perhaps faculty should rethink requiring all students to submit papers and instead only encourage those students whose papers go beyond competence and add to our knowledge or understanding of a topic. We want students to want to write, and their first experience with publishing shouldn’t be one in which they have little chance of success.

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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

February 4, 2013

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained minimal nursing notes and patients were discharged quickly, only inpatient EHRs were reviewed.)

figure_captureThe authors offer several recommendations, which include a call for improved nursing education about Parkinson’s disease; they state,

nursing education should stress the importance of patients continuing to take their antiparkinson medications with a sip of water up until shortly before the initiation of anesthesia, and of their resuming these medications as soon as possible after surgery.

The qualitative study—the patients’ take. The second CE, “The Perioperative Experience of Patients with Parkinson’s Disease,” discusses findings from a qualitative study by Lisa Carney Anderson and Kathleen Fagerlund. Read the rest of this entry ?

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What’s So Hard to Understand: Patient Safety, Quality Care Linked to Nurse Staffing

January 29, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

shawnkennedyThe data linking nurse staffing as well as shift length with patient outcomes and satisfaction with care continue to roll in. The latest report on nurse staffing, published in the January 13 issue of Medical Care by McHugh and MA, links higher nurse–patient ratios and good work environments to reduced 30-day readmission rates. Read the abstract here.

Most nurses seem to support better nurse–patient ratios, but there’s continuing ambivalence about reducing shift length, as seen in the comments we received on a recent blog post asking whether it’s time to retire the 12-hour nursing shift.

In August, researchers reported a link between nurse staffing and hospital-acquired infections.  Publishing in the American Journal of Infection Control, the authors noted a “significant association” between nurse–patient staffing ratios and both urinary tract infections and surgical site infections. Further, they noted that reducing nurse burnout was associated with fewer infections. (Read our news report on the study here.)

Health Affairs published a report in November called “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction.” The findings were there, loud and clear—researchers Stimpfel, Sloane, and Aiken found that “extended shifts undermine nurses’ well-being, may result in expensive turnover and can negatively affect patient care.”

And in December, we published a CE article (“Staffing Matters—Every Shift”) that looked at data suggesting that not just nurse–patient ratios, but the skill mix and relative experience levels among nurses in a unit, affected patient outcomes. (Here’s the blog post we ran describing the article’s main points.)

But all this shouldn’t be news. In 2004, Health Affairs carried a report by Ann Rogers and colleagues noting the link between long working hours and the risk of error. And in 2002, researchers led by Jack Needleman and Peter Buerhaus reported study findings in the New England Journal of Medicine: in brief, data from 799 hospitals in 11 states showed that more care by RNs (as opposed to LPNs or nurse aides) led to better patient outcomes. Read the rest of this entry ?

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Original Research: Perioperative Medication Withholding in Patients With Parkinson’s Disease

January 18, 2013

Drawing of the face of a Parkinson's disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,... ; par Paul Richer,... Gilles de la Tourette,... Albert Londe,.... - 1888. Chapter "Habitude exterieure et facies dans la paralyse agitante". Plate XL1V

1888 drawing of face of a Parkinson’s patient revealing “characteristic symptoms: mainly hypomimia, a expression-less mask-like face.” Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux./Wikimedia

Here’s the abstract of our January original research CE article, “Original Research: Perioperative Medication Withholding in Patients with Parkinson’s Disease: A Retrospective Electronic Health Records Review.”

Abstract

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson’s disease, has a short half-life of one to two hours. When patients with Parkinson’s disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson’s disease symptoms. Clear guidelines regarding perioperative symptom management are lacking.

Objectives: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson’s disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson’s disease symptoms.

Methods: We conducted a retrospective review of patient electronic health records at a Midwestern public medical center. After applying inclusion and exclusion criteria and evaluating the eligible records, we had a final sample of 89 separate surgical events for 67 discrete patients who had been diagnosed with Parkinson’s disease, had undergone any type of surgery excepting Parkinson’s disease surgeries, and were taking carbidopa-levodopa.

Results: The median duration of carbidopa-levodopa withholding was 12.35 hours, with most surgical procedures (86%) starting at 9 AM or later. The most commonly reported exacerbation of Parkinson’s disease symptoms was agitation or confusion.

Conclusions: For best symptom management, careful consideration should be given to scheduling surgery at the earliest possible time, administering medications as close to the patient’s usual dosing schedule as possible, and providing nursing education about optimal medication management for this patient population.

This will be the first of two CE articles we run on Parkinson’s disease. Following this report of findings from a quantitative study exploring symptom management and antiparkinson medication withholding times during hospitalization, the second article will report on “findings from a qualitative study of patients with Parkinson’s disease that focused on their hospitalization experiences, particularly with medication withholding.”


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The Depression Project

January 9, 2013

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012 issue) of AJN. She currently has an essay appearing in The Examined Life Journal.

Wikimedia Commons

Wikimedia Commons

Lately, as a long-time runner, I can’t help but draw parallels between working on a nursing research project and training for a distance race set far in the future. Especially in the middle of a long run, when frazzled edges smooth out and clarity settles over me, the similarities between the two are striking. Both require inspiration and a goal, fluid planning and accommodation for the unexpected, and patience.

I casually refer to the nursing research project I’m involved in as “The Depression Project.” It was borne of concern among the ICU nurses about the mental states of the trauma patients in our unit. As the bedside care providers, we often come to know our patients very well; we don’t just care for these people, we sincerely care, and so we’re troubled when we observe, time and again, trauma patients who seem to lose the motivation to engage in their recoveries. They become flat and despondent; they lose hope.

It’s clear to the nurses that while the physical injuries sustained present enormous challenges, the emotional toll is sometimes just as debilitating—yet underestimated. And so we devised a study to illustrate the correlation of depression and recovery.

It’s been a difficult process, rife with unanticipated road blocks that have required study modifications, with each modification requiring re-review by the Internal Review Board. Even now, deep into the project, I see problems, the most significant one being the impossibility to adequately control for an endless list of confounding variables. But despite the many challenges, what I’ve found most significant—and what keeps me from giving up on this project—is that not a single person has declined inclusion in our study.

No matter how devastating the injury or how dire the prognosis—and at a time when they’re most vulnerable—each person has been willing to answer our questions and be involved. Each has been willing to believe that their experiences can help the greater good and make a difference to someone else. And so, despite the confounding variables and obstacles, and whether or not this study ever yields scientifically significant results, the personal stories and hope displayed by the participants already feels powerful and inspiring to me.

I’ve spent countless hours working on The Depression Project in the past year. I’ve spent even more hours running, logging long miles on quiet wooded trails, training for races that I never plan to win. My mind wanders as I run, sorting and settling the issues that preoccupy me. Throughout the year, the two activities have somehow become linked, complementing each other in certain ways: after a long day at work, I sometimes run to relieve my own stress; and then, much of The Depression Project was devised while running.

And so I carry on with running and research both, ignoring an occasional doubt as to the end result of either. I hold on, instead, to the conviction that there may be more value in the processes than the end results, but that I’ll cross the finish lines . . . eventually.

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AJN’s January Issue: Men in Nursing, Perioperative Medication Withholding in Patients with PD, Book of the Year Awards, More

December 28, 2012

AJN0113.Cover.Online

AJNs January issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Even though more men are starting to become nurses, they still make up less than 7% of all RNs.  In “Men in Nursing,” the authors discuss the challenges of recruiting and retaining men in the nursing profession. This article is open access and can earn you 2.1 CE credits.

 In this month’s original research article, the authors report on findings from a quantitative study exploring antiparkinson medication withholding times during hospitalization and symptom management. Part one of a two-part series, this article is open access and can earn you 2.5 CE credits. Look for part two in our next issue, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with PD.

After sustaining a needlestick injury during a research study, nurse Lynn Petrik created a new safety device for a commonly used glucose sensor. “From Putty to Prototype” takes readers through the steps of her invention, from the prototype to the provisional patent.

 Looking for a good read? The votes are in, and the winners of AJN’s annual Book of the Year Awards are listed in this issue. A supplemental online only companion to the article gives the judges reviews for each book.  

 And finally, read “The Clinical Nurse Leader and the Case Manager: Are Both Roles Needed?” for an exploration of these two roles, how they complement each other, and why each is necessary.

 There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog. And have a happy and healthy New Year!


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