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Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C, Viallard JF, Pellegrin JL, Rivière E. Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice. BMC FAMILY PRACTICE 2020; 21:163. [PMID: 32787857 PMCID: PMC7425533 DOI: 10.1186/s12875-020-01237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022]
Abstract
Background Guidelines that detail preventive measures against Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b, and influenza are published annually in France to decrease the risk of severe infections in immunocompromised patients. We aimed at describing adherence to these guidelines by GPs in the management of their asplenic patients in France between 2013 and 2016. Method We conducted a multicenter retrospective study between January 2013 and December 2016 in three French hospitals: asplenic adults were identified and their GPs were questioned. A descriptive analysis was performed to identify the immunization coverage, type and length of antibiotic prophylaxis, number of infectious episodes, and education of patients. Results 103 patients were finally included in this study: only 57% were adequately vaccinated against Streptococcus pneumoniae or Neisseria meningitidis, 74% against Haemophilus influenzae type b, and 59% against influenza. Only 24% of patients received a combination of all four vaccinations. Two-thirds of patients received prophylactic antibiotics for at least 2 years. Overall, this study found that 50% of splenectomized patients experienced at least one pulmonary or otorhinolaryngological infection, or contracted influenza. Conclusions These data match those reported in other countries, including Australia and the United Kingdom, meaning a still insufficient coverage of preventive measures in asplenic patients. Improved medical data sharing strategies between healthcare professionals, along with educational measures to keep patients and physicians up to date in the prevention of infections after splenectomy would improve health outcomes of asplenic patients.
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Affiliation(s)
- Charlotte Quéffélec
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Louis Billet
- Medical Information Department, Pellegrin Hospital, University Hospital Centre of Bordeaux, F33076, Bordeaux, France
| | - Pierre Duffau
- Internal Medicine and Clinical Immunology Unit, Saint-André Hospital, University Hospital Centre of Bordeaux, F33000, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Irène Machelart
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Carine Greib
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Jean-François Viallard
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France
| | - Jean-Luc Pellegrin
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Etienne Rivière
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France. .,INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France.
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Arnott A, Jones P, Franklin LJ, Spelman D, Leder K, Cheng AC. A Registry for Patients With Asplenia/Hyposplenism Reduces the Risk of Infections With Encapsulated Organisms. Clin Infect Dis 2019; 67:557-561. [PMID: 29471470 DOI: 10.1093/cid/ciy141] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia. Clinical guidelines recommend numerous measures to reduce the risk of OPSI, but awareness and adherence to preventative measures are generally poor. We aimed to determine whether a registry for asplenic/hyposplenic patients was associated with a reduction in the incidence of infection with encapsulated bacteria. Methods We performed a retrospective cohort study of asplenic/hyposplenic patients in the state of Victoria, Australia, who registered with Spleen Australia from 2003 through 2014. Spleen Australia provides education, clinical guidance, and annual vaccination reminders to registrants and their healthcare providers. We compared the incidence of infection with Streptococcus pneumoniae, Haemophilus influenzae type B (Hib), and Neisseria meningitidis before and after registration. Registry data were linked with Victorian notifiable disease data on invasive pneumococcal disease (IPD), invasive meningococcal disease (IMD), and Hib between 2000 and 2014. Results Twenty-seven cases of IPD and 1 of IMD occurred among 3221 registrants. No cases of Hib were reported. The rate of IPD/IMD was 150 per 100000 patient-years prior to registration and 36 per 100000 patient-years after registration; registration was associated with a 69% reduction in the risk of infection (incidence rate ratio, 0.31; 95% confidence interval, 0.12 to 0.83; P = .019). Based on the absolute reduction in incidence, we estimate that Spleen Australia prevents 5-6 invasive infections with encapsulated organisms annually among registrants. Conclusions Systematic, long-term approaches to post-splenectomy care can significantly reduce the risk of infection with encapsulated organisms among individuals with asplenia/hyposplenism.
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Affiliation(s)
- Alicia Arnott
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne.,National Centre for Epidemiology and Public Health, Australian National University, Canberra
| | - Penelope Jones
- Spleen Australia, Department of Infectious Diseases, Alfred Health and Monash University
| | | | - Denis Spelman
- Spleen Australia, Department of Infectious Diseases, Alfred Health and Monash University
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University.,Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
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Mitchell AP, Boggan JC, Lau K, Simel DL. Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic. Am J Med 2017; 130:856-861. [PMID: 28213046 DOI: 10.1016/j.amjmed.2017.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/28/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans. METHODS Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines. RESULTS The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62). CONCLUSIONS Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.
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Affiliation(s)
- Aaron P Mitchell
- Department of Medicine, Durham Veterans Affairs Medical Center, NC; Department of Hematology/Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
| | - Joel C Boggan
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
| | - Karen Lau
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
| | - David L Simel
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
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Boam T, Sellars P, Isherwood J, Hollobone C, Pollard C, Lloyd DM, Dennison AR, Garcea G. Adherence to vaccination guidelines post splenectomy: A five year follow up study. J Infect Public Health 2017; 10:803-808. [PMID: 28189514 DOI: 10.1016/j.jiph.2017.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/21/2016] [Accepted: 01/07/2017] [Indexed: 11/16/2022] Open
Abstract
Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.
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Affiliation(s)
- Tristan Boam
- Nottingham University Hospitals, Nottingham, UK.
| | | | - John Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Chloe Hollobone
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Cristina Pollard
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - David M Lloyd
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Ashley R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
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Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study. Epidemiol Infect 2016; 145:397-400. [DOI: 10.1017/s0950268816002405] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYOverwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia and is associated with encapsulated organisms, most commonly Streptococcus pneumoniae, but also Haemophilus influenzae and Neisseria meningitidis. We aimed to estimate the risk of infection in this patient group. We reviewed data collected by the Victorian Spleen Registry in Australia. On registration, all patients are asked about significant infections requiring admission to hospital for intravenous antibiotics; those requiring admission to ICU were defined as OPSI. In the 3274 asplenic patients registered 492 patients reported at least one episode of infection. There were 47 episodes of OPSI requiring intensive care (incidence rate 1·11/1000 patient-years). The risk of OPSI was highest in older patients, and there were no statistically significant differences in incidence by reason for splenectomy except for a higher rate in patients with medical hyposplenia. This study reinforces that post-splenectomy infection is a clinically significant but uncommon complication, and that fulminant infection requiring intensive care is a minority of all infections.
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Meier-Stephenson V, McNeil S, Kew A, Sweetapple J, Thompson K, Slayter K. Effects of a pharmacy-driven perisplenectomy vaccination program on vaccination rates and adherence to guidelines. Can J Hosp Pharm 2014; 67:262-7. [PMID: 25214656 PMCID: PMC4152964 DOI: 10.4212/cjhp.v67i4.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Overwhelming postsplenectomy infection is a serious potential outcome for patients who have undergone resection of the spleen and is associated with a high mortality rate. The most common bacterial causes are the encapsulated organisms Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae type B, all of which are vaccine-preventable. Current guidelines recommend vaccination against these 3 bacteria, but adherence to these guidelines is less than ideal. In 2007, a "perisplenectomy vaccination kit" was introduced at the authors' institution to improve compliance with immunization guidelines by making the vaccines and necessary information for patients and providers more readily available. OBJECTIVE To evaluate and compare vaccination rates for patients who underwent splenectomy before and after introduction of the perisplenectomy vaccination kit and, secondarily, to identify any characteristics unique to those who did not receive appropriate perisplenectomy vaccinations. METHODS In this observational study, performed at the QEII Health Sciences Centre of Capital Health in Halifax, Nova Scotia, data were reviewed for patients who underwent splenectomy between 2008 and 2011. Vaccination rates and other descriptive statistics were calculated and compared with data for a 3-year period before implementation of the program. RESULTS Vaccination rates in the 3-year period following implementation of the perisplenectomy vaccination kit were 100% against S. pneumoniae, 97% against N. meningitidis, and 93% against H. influenzae type B. The corresponding rates in the 3 years before introduction of the kit were 91%, 75%, and 68%, respectively. No characteristics predicting inadequate immunization were identified in univariate or multivariate analysis. CONCLUSION Introduction of a pharmacy-driven perisplenectomy vaccination kit program improved rates of appropriate vaccination for patients who underwent splenectomy.
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Affiliation(s)
- Vanessa Meier-Stephenson
- MD, PhD, was, at the time of manuscript preparation, an Internal Medicine resident with the Faculty of Medicine, Dalhousie University, and the Department of Medicine, Capital Health, Halifax, Nova Scotia. She is currently completing an Infectious Diseases residency at the University of Calgary, Calgary, Alberta
| | - Shelly McNeil
- MD, is with the Faculty of Medicine, Dalhousie University, and the Department of Medicine and Division of Infectious Diseases, Capital Health, Halifax, Nova Scotia
| | - Andrea Kew
- MD, is with the Faculty of Medicine, Dalhousie University, and the Department of Medicine and Division of Hematology, Capital Health, Halifax, Nova Scotia
| | - Jennifer Sweetapple
- MSc, is with the Department of Pharmacy, Capital Health, Halifax, Nova Scotia
| | - Kara Thompson
- MSc, is with the Research Methods Unit, IWK Health Centre and Capital Health, Halifax, Nova Scotia
| | - Kathryn Slayter
- PharmD, is with the Department of Medicine, the Division of Infectious Diseases, and the Department of Pharmacy, Capital Health, Halifax, Nova Scotia
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7
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Wang J, Jones P, Cheng AC, Leder K. Adherence to infection prevention measures in a statewide spleen registry. Med J Aust 2014; 200:538-40. [DOI: 10.5694/mja13.10630] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 02/20/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Allen C Cheng
- Alfred Hospital, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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8
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Elbadawi O, Ali SR, Waheed A, Khan S. An overwhelming post-splenectomy infection (OPSI). JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2012. [DOI: 10.5339/jemtac.2012.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- O Elbadawi
- Department of Internal Medicine, PO Box 10513, Makkah Almokaramah 21955 Hera Hospital, Makkah Almokaramah, Kingdom of Saudi Arabia
| | - SR Ali
- Department of Internal Medicine, PO Box 10513, Makkah Almokaramah 21955 Hera Hospital, Makkah Almokaramah, Kingdom of Saudi Arabia
| | - A Waheed
- Department of Internal Medicine, PO Box 10513, Makkah Almokaramah 21955 Hera Hospital, Makkah Almokaramah, Kingdom of Saudi Arabia
| | - S Khan
- Department of Internal Medicine, PO Box 10513, Makkah Almokaramah 21955 Hera Hospital, Makkah Almokaramah, Kingdom of Saudi Arabia
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McHugh SM, O’Donnell J, Leahy A, Broe P. Transforming management of patients undergoing splenectomy in an Irish teaching hospital. Ir J Med Sci 2011; 180:655-9. [DOI: 10.1007/s11845-010-0510-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 05/20/2010] [Indexed: 11/30/2022]
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Lammers AJJ, Veninga D, Lombarts MJMH, Hoekstra JBL, Speelman P. Management of post-splenectomy patients in the Netherlands. Eur J Clin Microbiol Infect Dis 2010; 29:399-405. [DOI: 10.1007/s10096-009-0870-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 12/23/2009] [Indexed: 11/24/2022]
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Couvrat V, Mcheik JN, Ravasse P, Levard G. [Nonoperative management of splenic trauma in children]. Arch Pediatr 2007; 14:1196-8. [PMID: 17702548 DOI: 10.1016/j.arcped.2007.06.031] [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: 09/08/2006] [Accepted: 06/27/2007] [Indexed: 11/19/2022]
Abstract
In haemodynamically stable children with splenic trauma, conservative treatment is recommended to preserve the spleen and prevent potentially lethal post-splenectomy infectious complications. We report on the case of a 11-year-old child who suffered a fistula of a huge subcapsular splenic hematoma into the colon, 16 days after the traumatism. Decision to sustain the non-operative treatment allowed the preservation of the spleen without complications.
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Affiliation(s)
- V Couvrat
- Département médicochirurgical de pédiatrie, hôpital J-Bernard, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
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Peppas G, Fragoulis KN, Falagas ME. Successful conservative management of large splenic infarct masquerading as infection. J Gastroenterol Hepatol 2007; 22:282-3. [PMID: 17295889 DOI: 10.1111/j.1440-1746.2006.04428.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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13
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O'Connell B. Prevention of infection post-splenectomy: time for implementation of guidelines. Ir J Med Sci 2005; 173:125. [PMID: 15693378 DOI: 10.1007/bf03167923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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