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Lázaro P, Blasco AJ, Contreras I, González R, Zulueta J, Pinilla I. Perception of patients with retinal pathology on aspects of visual function and their management. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00114-2. [PMID: 38909889 DOI: 10.1016/j.oftale.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are highly prevalent. OBJECTIVE To explore perceptions of patients with AMD or DR about the impact of the disease and treatment on their daily living activities. MATERIALS AND METHODS Semi-structured interviews with a questionnaire developed from validated patient reported outcomes questionnaires. The questionnaire consisted of 19 questions about the disease and 9 about the treatment. The questions (items) were answered on a scale from 1 to 9. In addition, the patient interviewed was invited to make free comments on each question. Nine patients with AMD and 9 with DR were interviewed by videoconference or telephone call. A quantitative analysis of the responses and a qualitative analysis of the comments were carried out. RESULTS The most relevant item for patients with AMD or DR is "Recognize people when they are nearby", and "Read text in normal size font in a newspaper or book", followed, in patients with AMD, by "Do things what you would like" and, in patients with DR, "Feeling frustrated by the vision problems." Regarding the treatment, the most relevant aspects for both groups is that the treatment works and receiving appropriate information before and after the treatment. The qualitative comments were focused to the disease, the treatment, and to the role of doctors and the health system. CONCLUSION Quantitative responses and free comments can be useful to improve the care of patients with AMD or DR by physicians and the health system.
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Affiliation(s)
- P Lázaro
- Investigador Independiente en Servicios de Salud, Madrid. Spain
| | - A J Blasco
- Investigador Independiente en Servicios de Salud, Rivas Vaciamadrid, Madrid, Spain.
| | - I Contreras
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain; Clínica Rementería, Madrid, Spain
| | - R González
- Asociación Mácula Retina, Sevilla, Spain
| | - J Zulueta
- Asociación Mácula Retina, Sevilla, Spain
| | - I Pinilla
- Servicio de Oftalmología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Dukhanin V, Gamper MJ, Gleason KT, McDonald KM. Patient-reported outcome and experience domains for diagnostic excellence: a scoping review to inform future measure development. Qual Life Res 2024:10.1007/s11136-024-03709-w. [PMID: 38850395 DOI: 10.1007/s11136-024-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE "Diagnostic excellence," as a relatively new construct centered on the diagnostic process and its health-related outcomes, can be refined by patient reporting and its measurement. We aimed to explore the scope of patient-reported outcome (PRO) and patient-reported experience (PRE) domains that are diagnostically relevant, regardless of the future diagnosed condition, and to review the state of measurement of these patient-reported domains. METHODS We conducted an exploratory analysis to identify these domains by employing a scoping review supplemented with internal expert consultations, 24-member international expert convening, additional environmental scans, and the validation of the domains' diagnostic relevance via mapping these onto patient diagnostic journeys. We created a narrative bibliography of the domains illustrating them with existing measurement examples. RESULTS We identified 41 diagnostically relevant PRO and PRE domains. We classified 10 domains as PRO, 28 as PRE, and three as mixed PRO/PRE. Among these domains, 19 were captured in existing instruments, and 20 were captured only in qualitative studies. Two domains were conceptualized during this exploratory analysis with no examples identified of capturing these domains. For 27 domains, patients and care partners report on a specific encounter; for 14 domains, reporting relates to an entire diagnostic journey over time, which presents particular measurement opportunities and challenges. CONCLUSION The multitude of PRO and PRE domains, if measured rigorously, would allow the diagnostic excellence construct to evolve further and in a manner that is patient-centered, prospectively focused, and concentrates on effectiveness and efficiency of diagnostic care on patients' well-being.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Suite 643, Baltimore, MD 21205, USA.
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kelly T Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kathryn M McDonald
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pulia MS, Papanagnou D, Croskerry P. The Quest for Diagnostic Excellence in the Emergency Department. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00157-0. [PMID: 38824059 DOI: 10.1016/j.jcjq.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
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Oster A, Wiking E, Nilsson GH, Olsson CB. Patients' expectations of primary health care from both patients' and physicians' perspectives: a questionnaire study with a qualitative approach. BMC PRIMARY CARE 2024; 25:128. [PMID: 38658808 PMCID: PMC11040877 DOI: 10.1186/s12875-024-02389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Patients' ideas, concerns, and expectations are three important concepts in consultation techniques. Limited studies on these concepts include responses from both health care providers and care recipients of the same consultation. Highlighting both perspectives provides an increased understanding of the consultation. This study aims to explore the perspectives of patients and health care professionals about patients' expectations of primary health care during consultations with primary care physicians and compare the two sets of perspectives. METHODS A cross-sectional study. Patients (n = 113) and physicians (n = 67) from five primary health care centers completed a questionnaire after planned consultations. Their responses to open-ended questions about patients' expectations, from patients' and physicians' perspectives were analyzed with qualitative content analyses. RESULTS The patients expected a personal journey, through the primary health care system where they were the subject of interest. A journey, with ready access to a health care provider followed by a consultation with the physician, medical measures administered, their outcomes discussed, and a plan developed for continued health care. The physicians observed patients' expectations to concern the responsibilities placed on primary health care where patients were the object of interest. Patients' short-term expectations were described in a similar way by both patients and physicians. Patients expressed their long-term expectations as more personal and interpersonal whereas physicians observed them from a more professional and organizational standpoint. CONCLUSIONS Patients and physicians have different views of what patients expect of primary health care. While patients' short-term expectations were perceived by physicians, their long-term expectations were not. Patients expected more of a personal journey through the primary health care system while physicians observed patients' expectations to concern the responsibilities placed on primary health care. Identifying and meeting patients' expectations is an important part of patient-centered care, and a better understanding of patients' expectations is needed to improve health professionals' consultation skills.
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Affiliation(s)
- Andreas Oster
- Barkarby Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Eivor Wiking
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Christina B Olsson
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Alle 23, Stockholm, 141 83, Sweden.
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Huynh K, Brito JP, Bylund CL, Prokop LJ, Ospina NS. Understanding diagnostic conversations in clinical practice: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 116:107949. [PMID: 37660463 PMCID: PMC11002943 DOI: 10.1016/j.pec.2023.107949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Summarize frameworks to understand diagnostic conversations and assessments of diagnostic conversations in practice. METHODS We systematically searched MEDLINE, Scopus, Cochrane, and other databases from inception to July 2022 for reports of diagnostic conversations. Two authors independently reviewed studies for eligibility, assessed methodological quality with the mixed methods appraisal tool and extracted information related to study characteristics, frameworks and components evaluated in assessments of diagnostic conversations and results. RESULTS Eight studies were included. One study reported an empiric framework of diagnostic conversations that included the following components: identifying the problem that requires diagnosis, obtaining information, and delivering the diagnosis and treatment plan. Thematic analyses highlighted communication between patients and clinicians as central in diagnostic conversations as it allows a) patient's presentation of their symptoms which guide subsequent diagnostic steps, b) negotiation of the significance of the patient's symptoms through conversation and c) introducing and resolving diagnostic uncertainty. CONCLUSION Despite the importance of diagnostic conversation only one empiric framework described its components. Additionally, limited available evidence suggests patients can have an important role in the diagnostic process that expands beyond patients as an information source. PRACTICE IMPLICATIONS Patients should be included as active partners in co-development of diagnostic plans of care.
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Affiliation(s)
- Ky Huynh
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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Pandya A, Parashar S, Waller M, Portnoy J. Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic. Expert Rev Clin Immunol 2023; 19:1063-1073. [PMID: 37354030 DOI: 10.1080/1744666x.2023.2229956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes. AREAS COVERED Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs. EXPERT OPINION The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.
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Affiliation(s)
- Aarti Pandya
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Sonya Parashar
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Morgan Waller
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jay Portnoy
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
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Watari T, Schiff GD. Diagnostic excellence in primary care. J Gen Fam Med 2023; 24:143-145. [PMID: 37261043 PMCID: PMC10227729 DOI: 10.1002/jgf2.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/02/2023] Open
Abstract
Diagnostic excellence is based on six fundamental principles of healthcare quality proposed by the Institute of Medicine in 2001, which state that diagnoses must be safe, effective, patient-centered, timely, efficient, and equitable.
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Affiliation(s)
- Takashi Watari
- General Medicine CenterShimane University HospitalShimaneJapan
- Department of MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gordon D. Schiff
- Center for Primary CareHarvard Medical SchoolBostonMassachusettsUSA
- Center for Patient Safety ResearchBrigham and Women's HospitalBostonMassachusettsUSA
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Wiegand AA, Dukhanin V, Sheikh T, Zannath F, Jajodia A, Schrandt S, Haskell H, McDonald KM. Human centered design workshops as a meta-solution to diagnostic disparities. Diagnosis (Berl) 2022; 9:458-467. [PMID: 36027891 DOI: 10.1515/dx-2022-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/19/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Diagnostic errors - inaccurate or untimely diagnoses or failures to communicate diagnoses - are harmful and costly for patients and health systems. Diagnostic disparities occur when diagnostic errors are experienced at disproportionate rates by certain patient subgroups based, for example, on patients' age, sex/gender, or race/ethnicity. We aimed to develop and test the feasibility of a human centered design workshop series that engages diverse stakeholders to develop solutions for mitigating diagnostic disparities. METHODS We employed a series of human centered design workshops supplemented by semi-structured interviews and literature evidence scans. Co-creation sessions and rapid prototyping by patient, clinician, and researcher stakeholders were used to generate design challenges, solution concepts, and prototypes. RESULTS A series of four workshops attended by 25 unique participants was convened in 2019-2021. Workshops generated eight design challenges, envisioned 29 solutions, and formulated principles for developing solutions in an equitable, patient-centered manner. Workshops further resulted in the conceptualization of 37 solutions for addressing diagnostic disparities and prototypes for two of the solutions. Participants agreed that the workshop processes were replicable and could be implemented in other settings to allow stakeholders to generate context-specific solutions. CONCLUSIONS The incorporation of human centered design through a series of workshops promises to be a productive way of engaging patient-researcher stakeholders to mitigate and prevent further exacerbation of diagnostic disparities. Healthcare stakeholders can apply human centered design principles to guide thinking about improving diagnostic performance and to center diverse patients' needs and experiences when implementing quality and safety improvements.
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Affiliation(s)
- Aaron A Wiegand
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Anushka Jajodia
- Center for Social Design, Maryland Institute College of Art, Baltimore, MD, USA
| | | | | | - Kathryn M McDonald
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Amano M, Harada Y, Shimizu T. Effectual Diagnostic Approach: A New Strategy to Achieve Diagnostic Excellence in High Diagnostic Uncertainty. Int J Gen Med 2022; 15:8327-8332. [DOI: 10.2147/ijgm.s389691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
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Isbister JP, Pearse BL, Delaforce AS, Farmer SL. Patients' Choice, Consent, and Ethics in Patient Blood Management. Anesth Analg 2022; 135:489-500. [PMID: 35977359 DOI: 10.1213/ane.0000000000006105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The goal of patient blood management (PBM) is to optimize clinical outcomes for individual patients by managing their blood as a precious and unique resource to be safeguarded and managed judiciously. A corollary to successful PBM is the minimization or avoidance of blood transfusion and stewardship of donated blood. The first is achieved by a multidisciplinary approach with personalized management plans shared and decided on with the patient or their substitute. It follows that the physician-patient relationship is an integral component of medical practice and the fundamental link between patient and doctor based on trust and honest communication. Central to PBM is accurate and timely diagnosis based on sound physiology and pathophysiology as the bedrock on which scientifically based medicine is founded. PBM in all disease contexts starts with the questions, "What is the status of the patient's blood?" "If there are specific abnormalities in the blood, how should they be managed?" and "If allogeneic blood transfusion is considered, is there no reasonable alternative therapy?" There are compelling scientific reasons to implement a nontransfusion default position when there is clinical uncertainty and questionable evidence of clinical efficacy for allogeneic blood transfusion due to known potential hazards. Patients must be informed of their diagnosis, the nature, severity and prognosis of the disease, and treatment options along with risks and benefits. They should be involved in decision-making regarding their management. However, as part of this process, there are multifaceted medical, legal, ethical, and economic issues, encompassing shared decision-making, patient choice, and informed consent. Furthermore, variability in patient circumstances and preferences, the complexity of medical science, and the workings of health care systems in which consent takes place can be bewildering, not only for the patient but also for clinicians obtaining consent. Adding "patient" to the concept of blood management differentiates it from "donor" blood management to avoid confusion and the perception that PBM is a specific medical intervention. Personalized PBM is tailoring the PBM to the specific characteristics of each patient. With this approach, there should be no difficulty addressing the informed consent and ethical aspects of PBM. Patients can usually be reassured that there is nothing out of order with their blood, in which case the focus of PBM is to keep it that way. In some circumstances, a hematologist may be involved as a patient's blood advocate when abnormalities require expert involvement while the primary disease is being managed.
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Affiliation(s)
- James P Isbister
- From the Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bronwyn L Pearse
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Departments of Surgery, Anaesthesia and Critical Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alana S Delaforce
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.,Mater Research Institute-UQ, South Brisbane, Queensland, Australia
| | - Shannon L Farmer
- Discipline of Surgery, Medical School, The University of Western Australia, Perth, Western Australia.,Department of Haematology, Royal Perth Hospital, Perth, Western Australia
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Affiliation(s)
- Allan S Detsky
- Institute for Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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Cognitive Bias and Diagnostic Errors among Physicians in Japan: A Self-Reflection Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084645. [PMID: 35457511 PMCID: PMC9032995 DOI: 10.3390/ijerph19084645] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
This cross-sectional study aimed to clarify how cognitive biases and situational factors related to diagnostic errors among physicians. A self-reflection questionnaire survey on physicians’ most memorable diagnostic error cases was conducted at seven conferences: one each in Okayama, Hiroshima, Matsue, Izumo City, and Osaka, and two in Tokyo. Among the 147 recruited participants, 130 completed and returned the questionnaires. We recruited primary care physicians working in various specialty areas and settings (e.g., clinics and hospitals). Results indicated that the emergency department was the most common setting (47.7%), and the highest frequency of errors occurred during night-time work. An average of 3.08 cognitive biases was attributed to each error. The participants reported anchoring bias (60.0%), premature closure (58.5%), availability bias (46.2%), and hassle bias (33.1%), with the first three being most frequent. Further, multivariate logistic regression analysis for cognitive bias showed that emergency room care can easily induce cognitive bias (adjusted odds ratio 3.96, 95% CI 1.16−13.6, p-value = 0.028). Although limited to a certain extent by its sample collection, due to the sensitive nature of information regarding physicians’ diagnostic errors, this study nonetheless shows correlations with environmental factors (emergency room care situations) that induce cognitive biases which, in turn, cause diagnostic errors.
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