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Hallas CN, Burke JL, White DG, Connelly DT. A Prospective 1-Year Study of Changes in Neuropsychological Functioning After Implantable Cardioverter-Defibrillator Surgery. Circ Arrhythm Electrophysiol 2010; 3:170-7. [DOI: 10.1161/circep.109.909580] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—The testing of the implantable cardioverter-defibrillator (ICD), through the induction of repeated episodes of ventricular fibrillation, has been associated with disturbances in cerebral activity and increased levels of cytoplasmic enzymes. However, the neuropsychological outcomes of cerebral changes and their quality-of-life implications are unknown.Methods and Results—Fifty-two ICD recipients completed standardized validated neuropsychological tests 1 to 3 days before ICD surgery and then 6 weeks, 6 months, and 12 months after surgery. They also completed psychometric tests measuring anxiety, depression, and quality of life. Between 31% and 39% of patients showed a significant neuropsychological impairment from their baseline function 6 weeks, 6 months, and 12 months after surgery. Ten percent of patients had late-onset deficits at 12 months only. Frequent areas of impairment were auditory and visual memory and attention. Neuropsychological impairment was not related to mood or quality of life at follow-up, although anxiety and depression predicted reduced quality of life.Conclusions—ICD implantation is associated with neuropsychological impairment that dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment.
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Affiliation(s)
- Claire N. Hallas
- From the Royal Brompton and Harefield NHS Trust (C.N.H.), United Kingdom; Centre for Health Psychology (J.L.B., D.G.W.), Staffordshire University, United Kingdom; and The Cardiothoracic Centre (D.T.C.), Liverpool, United Kingdom
| | - Julie L. Burke
- From the Royal Brompton and Harefield NHS Trust (C.N.H.), United Kingdom; Centre for Health Psychology (J.L.B., D.G.W.), Staffordshire University, United Kingdom; and The Cardiothoracic Centre (D.T.C.), Liverpool, United Kingdom
| | - David G. White
- From the Royal Brompton and Harefield NHS Trust (C.N.H.), United Kingdom; Centre for Health Psychology (J.L.B., D.G.W.), Staffordshire University, United Kingdom; and The Cardiothoracic Centre (D.T.C.), Liverpool, United Kingdom
| | - Derek T. Connelly
- From the Royal Brompton and Harefield NHS Trust (C.N.H.), United Kingdom; Centre for Health Psychology (J.L.B., D.G.W.), Staffordshire University, United Kingdom; and The Cardiothoracic Centre (D.T.C.), Liverpool, United Kingdom
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Palacios-Ceña D, Alonso-Blanco C, Cachón-Pérez JM, Alvarez-López C. [The daily experience of the patient with an implantable cardioverter defibrillator]. ENFERMERIA CLINICA 2010; 20:97-104. [PMID: 20199887 DOI: 10.1016/j.enfcli.2009.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 08/13/2009] [Accepted: 09/29/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the daily experience of patients with an automatic defibrillator (AD) implant and the adaptive changes of the patient. METHOD Qualitative and phenomenological research. Collection of data through; initially unstructured interview with half of the informants, semi-structured interviews through an open questions guide after the initial unstructured interviews and use of personal narratives of the informants. Analysis of the data using the Van Manen proposal. RESULTS We analysed the interviews of 10 participants. We collected socio-demographic variables and identified the following themes, which respond to the question "How is life with an AD": It is life "with the two sides of the coin," living in constant wait and uncertainty, accepting change, developing adaptation strategies, renegotiating relationships and sexuality and it is to live transformed. CONCLUSIONS The results of this study can be integrated into nurse clinical practice in areas such as valuation after discharge, changes in habits, control of treatment, notification of shocks, masking detection of symptoms and strategies that can jeopardise the bearer. Research needs to be developed that looks closer into the influence of other technological devices in people.
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Affiliation(s)
- Domingo Palacios-Ceña
- Departamento de Ciencias de la Salud II, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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SERBER EVAR, ROSEN ROCHELLEK. Qualitative Research Provides Insight into Quantitative Quality of Life Measurement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:253-5. [DOI: 10.1111/j.1540-8159.2009.02640.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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HALLAS CLAIREN, BURKE JULIEL, WHITE DAVIDG, CONNELLY DEREKT. Pre-ICD Illness Beliefs Affect Postimplant Perceptions of Control and Patient Quality of Life. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:256-65. [DOI: 10.1111/j.1540-8159.2009.02641.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus Statement: Consensus Statement of the European Heart Rhythm Association: Updated Recommendations for Driving by Patients with Implantable Cardioverter Defibrillators. Eur J Cardiovasc Nurs 2010; 9:3-14. [PMID: 20170847 DOI: 10.1016/j.ejcnurse.2010.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Johan Vijgen
- Department of Cardiology, Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - Gianluca Botto
- Department of Cardiology, St. Anna Hospital, Como, Italy
| | - John Camm
- Department of Cardiac and Vascular Sciences, St. George's University, London, United Kingdom
| | | | - Werner Jung
- Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany
| | | | - Andrzej Lubinski
- Department of Interventional Cardiology, Medical University of Lodz, Poland
| | - Tone M. Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Schmid
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion Crete, Greece
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Botsch MP, Franzbach B, Opgen-Rhein B, Berger F, Will JC. ICD Therapy in Children and Young Adults: Low Incidence of Inappropriate Shock Delivery. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:734-41. [PMID: 20149121 DOI: 10.1111/j.1540-8159.2010.02695.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Micha P Botsch
- Department of Pediatric Cardiology and Congenital Heart Disease, Charité Universitaetsmedizin, Berlin, Germany.
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Salmoirago-Blotcher E, Ockene IS. Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD) A systematic review. BMC Cardiovasc Disord 2009; 9:56. [PMID: 20040100 PMCID: PMC2809039 DOI: 10.1186/1471-2261-9-56] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 12/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the potentially life-saving benefits of the implantable cardioverter-defibrillator (ICD), a significant group of patients experiences emotional distress after ICD implantation. Different psychosocial interventions have been employed to improve this condition, but previous reviews have suggested that methodological issues may limit the validity of such interventions. AIM To review the methodology of previously published studies of psychosocial interventions in ICD patients, according to CONSORT statement guidelines for non-pharmacological interventions, and provide recommendations for future research. METHODS We electronically searched the PubMed, PsycInfo and Cochrane databases. To be included, studies needed to be published in a peer-reviewed journal between 1980 and 2008, to involve a human population aged 18+ years and to have an experimental design. RESULTS Twelve studies met the eligibility criteria. Samples were generally small. Interventions were very heterogeneous; most studies used cognitive behavioural therapy (CBT) and exercise programs either as unique interventions or as part of a multi-component program. Overall, studies showed a favourable effect on anxiety (6/9) and depression (4/8). CBT appeared to be the most effective intervention. There was no effect on the number of shocks and arrhythmic events, probably because studies were not powered to detect such an effect. Physical functioning improved in the three studies evaluating this outcome. Lack of information about the indication for ICD implantation (primary vs. secondary prevention), limited or no information regarding use of anti-arrhythmic (9/12) and psychotropic (10/12) treatment, lack of assessments of providers' treatment fidelity (12/12) and patients' adherence to the intervention (11/12) were the most common methodological limitations. CONCLUSIONS Overall, this review supports preliminary evidence of a positive effect of psychosocial interventions on anxiety and physical functioning in ICD patients. However, these initial findings must be interpreted cautiously because of important methodological limitations. Future studies should be designed as large RCTs, whose design takes into account the specific challenges associated with the evaluation of behavioural interventions.
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Pedersen SS, Spek V, Theuns DAMJ, Alings M, van der Voort P, Jordaens L, Cuijpers P, Denollet J, van den Broek KC. Rationale and design of WEBCARE: a randomized, controlled, web-based behavioral intervention trial in cardioverter-defibrillator patients to reduce anxiety and device concerns and enhance quality of life. Trials 2009; 10:120. [PMID: 20030843 PMCID: PMC2813226 DOI: 10.1186/1745-6215-10-120] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 12/23/2009] [Indexed: 12/15/2022] Open
Abstract
Background The implantable cardioverter defibrillator (ICD) is generally well accepted, but 25-33% of patients experience clinical levels of anxiety, depression, and impaired quality of life (QoL) following implantation. Few trials in ICD patients have investigated whether behavioral intervention may mitigate the development of these adjustment problems. We present the rationale and study design of the WEB-based distress management program for implantable CARdioverter dEfibrillator patients (WEBCARE) trial. Methods WEBCARE is a multi-center, multi-disciplinary, randomized, controlled behavioral intervention trial designed to examine the effectiveness of a web-based approach in terms of reducing levels of anxiety and device concerns and enhancing QoL. Consecutive patients hospitalized for the implantation of an ICD will be approached for study participation while in hospital and randomized to the intervention arm (n = 175) versus usual care (n = 175) at baseline (5-10 days post implantation). Patients will complete assessments of patient-centered outcomes at baseline, 14, 26, and 52 weeks after implantation. Patients randomized to the intervention arm will receive a 12-week web-based behavioral intervention starting 2 weeks after implantation. Primary endpoints include (ii) patient-centered outcomes (i.e., anxiety, depression, ICD acceptance, QoL); (iii) health care utilization; and (iiii) cost-effectiveness. All primary endpoints will be assessed with standardized and validated disease-specific or generic questionnaires. Secondary endpoints include (iii) cortisol awakening response; and (iiii) ventricular arrhythmias. Discussion WEBCARE will show whether a behavioral intervention using a web-based approach is feasible and effective in reducing anxiety and ICD concerns and improving QoL in ICD patients. Trial Registration http://www.ClinicalTrials.gov. Identifier: NCT00895700.
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Affiliation(s)
- Susanne S Pedersen
- CoRPS, Department of Medical Psychology, Tilburg University, Tilburg, the Netherlands.
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Alconero-Camarero AR, Cobo-Sánchez JL, Muñoz-Cacho P, Sainz-Laso R, Mancebo-Salas N, Casaus-Pérez M, Gutiérrez-Caloca N, Olalla-Antolín JJ. [Quality of life analysis in patients with an implantable cardioverter-defibrillator]. ENFERMERIA CLINICA 2009; 19:275-9. [PMID: 19766519 DOI: 10.1016/j.enfcli.2009.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 04/28/2009] [Accepted: 05/05/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe possible changes in the quality of life (QL) and to identify possible differences associated to sociodemographic and clinical variables after being given an implantable cardioverter-defibrillator (ICD). METHOD Descriptive cross-sectional study, selecting 241 consecutive patients for a subcutaneous or subpectoral ICD implantation. One-hundred and fifty-seven patients met inclusion criteria. Introduction letter along with the assessment tool was mailed to them. Assessment tool used was the Euroqol-5D (EQ5D), validated and translated for a Spanish population. EQ5D describes health status in 5 domains: mobility (MO), self-care (SC), usual activity (UA), pain/discomfort (PD) and anxiety/depression (AD). It included a visual analogue scale (VAS) where the endpoints are labelled 'Best imaginable health state' and 'Worst imaginable health state'; one before and another after ICD implantation. RESULTS Ninety valid assessments were received: 80 males, mean age 61.2+/-13.1 years. Patients with EQ5D problems: MO 25 (27.7%), SC 8 (8.8%), UA 32 (35.5%), PD 22 (24.4%) and AD 29 (32.2%). Patients with ICD discharges had a higher percentage of problems in all EQ5D domains, being significant in PD and AD. Fifty four patients (60%) experienced a significant improvement in QL after ICD implant using the visual analogue scale score (75 points after vs. 50 points before; P<0.001). CONCLUSIONS The majority of ICD patients gain QL after implantation, but this gain is more limited in younger patients and those who have received discharges.
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Vijgen J, Botto G, Camm J, Hoijer CJ, Jung W, Le Heuzey JY, Lubinski A, Norekvål TM, Santomauro M, Schalij M, Schmid JP, Vardas P. Consensus statement of the European Heart Rhythm Association: updated recommendations for driving by patients with implantable cardioverter defibrillators. Europace 2009; 11:1097-1107. [PMID: 19525498 DOI: 10.1093/europace/eup112] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Patients with an implantable cardioverter defibrillator (ICD) have an ongoing risk of sudden incapacitation that might cause harm to others while driving a car. Driving restrictions vary across different countries in Europe. The most recent recommendations for driving of ICD patients in Europe were published in 1997 and focused mainly on patients implanted for secondary prevention. In recent years there has been a vast increase in the number of patients with an ICD and in the percentage of patients implanted for primary prevention. The EHRA task force on ICD and driving was formed to reassess the risk of driving for ICD patients based on the literature available. The recommendations are summarized in the following table and are further explained in the document. [table: see text] Driving restrictions are perceived as difficult for patients and their families, and have an immediate consequence for their lifestyle. To increase the adherence to the driving restrictions, adequate discharge of education and follow-up of patients and family are pivotal. The task force members hope this document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.
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Carneiro AF, Telles Mathias LAS, Rassi Júnior A, de Morais NS, Gozzani JL, de Miranda AP. Evaluation Of Preoperative Anxiety And Depression In Patients Undergoing Invasive Cardiac Procedures. Rev Bras Anestesiol 2009; 59:431-8. [DOI: 10.1590/s0034-70942009000400005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/08/2009] [Indexed: 11/22/2022] Open
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Jacq F, Foulldrin G, Savouré A, Anselme F, Baguelin-Pinaud A, Cribier A, Thibaut F. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry 2009; 31:266-73. [PMID: 19410106 DOI: 10.1016/j.genhosppsych.2009.01.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 01/12/2009] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Using standardized scales, we assessed the point prevalence, the severity of anxiety and depressive disorders, and the quality of life (QOL) in implantable cardioverter defibrillator (ICD) recipients who received a device shock. METHODS Forty research subjects with device shocks (Group 1) and 25 without shocks (Group 2) were interviewed after ICD implantation using the Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS) and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS The point prevalence of anxiety disorders was higher in Group 1 (37.5%) than in Group 2 (8%) (P=.009). Depressive symptoms scores were higher in Group 1 (4.75) than in Group 2 (2.24) (P=.04)), but the prevalence of depressive disorders or the anxiety scores were not significantly different. A positive correlation was found between the number of shocks and the depressive symptoms scores (P=.05, r=0.24); there was a negative correlation between the mental health subscore of the SF-36 and the number of shocks (r=-0.36, P=.003). The point prevalence of depressive disorders was higher in the group with congenital cardiac diseases (50%) than in the valvular (8%) and ischemic groups (23%) (P=.04), and the mental health composite summary score of the SF-36 was lower in this group (46.34) than in those with valvular and ischemic disease (56.09 and 52.61, respectively) (P=.03). CONCLUSION Exposure to shocks may lead to an increased risk of anxiety and depressive symptoms. Research subjects receiving a high number of shocks and research subjects with congenital cardiovascular diseases were at higher risk of depressive symptoms or at higher risk of poorer psychological aspects of QOL.
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Affiliation(s)
- Fanny Jacq
- Department of Psychiatry, INSERM U 614, University Hospital Ch. Nicolle, University of Medicine, Rouen, France
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PETRUCCI ETTORE, BRAGA SIMONASARZI, BALIAN VRUYR, PEDRETTI ROBERTOF. Right Ventricular Pressure Changes During Induced Ventricular Tachycardias Predict Clinical Symptoms of Cerebral Hypoperfusion: Implications for a Reduction of Unnecessary, Painful ICD Shocks. J Cardiovasc Electrophysiol 2009; 20:299-306. [DOI: 10.1111/j.1540-8167.2008.01306.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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PEDERSEN SUSANNES, SPINDLER HELLE, JOHANSEN JENSB, MORTENSEN PETERT. Clustering of Poor Device Acceptance and Type D Personality is Associated with Increased Distress in Danish Cardioverter-Defibrillator Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:29-36. [DOI: 10.1111/j.1540-8159.2009.02173.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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VAZQUEZ LAUREND, KUHL EMILYA, SHEA JULIEBISHOP, KIRKNESS ANN, LEMON JIM, WHALLEY DAVID, CONTI JAMIEB, SEARS SAMUELF. Age-Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1528-34. [DOI: 10.1111/j.1540-8159.2008.01223.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
This review presents five cases that highlight the complexity of taking care of patients with ventricular arrhythmias. Three of the cases discuss management of patients with nonsustained ventricular tachycardia in the setting of structural heart disease: dilated cardiomyopathy, hypertrophic cardiomyopathy, and after myocardial infarction. A fourth case asks whether data from implantable cardioverter defibrillator (ICD) trials can be extrapolated to older patients, and the fifth case discusses management of recurrent ventricular arrhythmias in a patient with an ICD.
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Affiliation(s)
- Fred Kusumoto
- Department of Medicine, Mayo Clinic School of Medicine, Jacksonville, FL 32224, USA.
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