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Zambrano SC, Haugen DF, van der Heide A, Tripodoro VA, Ellershaw J, Fürst CJ, Voltz R, Mason S, Daud ML, De Simone G, Kremeike K, Halfdanardottir SI, Sigurdardottir V, Johnson J, Allan S, Hafeez H, Simões C, Sigurdardottir KR, Rasmussen BH, Williamson P, Eychmüller S. Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol. BMC Palliat Care 2020; 19:184. [PMID: 33256786 PMCID: PMC7706044 DOI: 10.1186/s12904-020-00654-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person. METHODS Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set. DISCUSSION Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.
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Affiliation(s)
- Sofia C Zambrano
- University Center for Palliative Care, Department of Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | | | | | | | | | | | - Raymond Voltz
- Department of Palliative Care, Universitätsklinikum Köln (AöR), Köln, Germany
| | | | | | | | - Kerstin Kremeike
- Department of Palliative Care, Universitätsklinikum Köln (AöR), Köln, Germany
| | | | | | | | - Simon Allan
- Arohanui Hospice, Palmerston North, New Zealand
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Peshawar, Pakistan
| | - Catarina Simões
- Palliative Care Team H. Luz Arrábida, Vila Nova de Gaia, Portugal
| | | | | | | | - Steffen Eychmüller
- University Center for Palliative Care, Department of Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Johnston KN, Young M, Kay D, Booth S, Spathis A, Williams MT. Attitude change and increased confidence with management of chronic breathlessness following a health professional training workshop: a survey evaluation. BMC MEDICAL EDUCATION 2020; 20:90. [PMID: 32228544 PMCID: PMC7106669 DOI: 10.1186/s12909-020-02006-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/17/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Clinicians and people living with chronic breathlessness have expressed a need to better understand and manage this symptom. The aim of this study was to evaluate a 3-day health professional training workshop on the practical management of chronic breathlessness. METHODS Workshop design and delivery were based on current understandings and clinical models of chronic breathlessness management, principles of transformative learning, and included sessions co-designed with people living with breathlessness. Registrants were invited to complete pre and post-workshop surveys. Pre and 1-week post-workshop online questionnaires assessed familiarity and confidence about workshop objectives (0[lowest]-10[highest] visual analogue scale), attitudes and practices regarding chronic breathlessness (agreement with statements on 5-point Likert scales). Post-workshop, participants were asked to describe implementation plans and anticipated barriers. Baseline familiarity and confidence were reported as mean (SD) and change examined with paired t-tests. Pre-post attitudes and practices were summarised by frequency/percentages and change examined non-parametrically (5-point Likert scale responses) or using a McNemar test of change (binary responses). RESULTS Forty-seven of 55 registrants joined the study; 39 completed both pre and post-workshop questionnaires (35 female; 87% clinicians; median 8 years working with people with chronic breathlessness). Post-workshop, greatest gains in confidence were demonstrated for describing biopsychosocial concepts unpinning chronic breathlessness (mean change confidence = 3.2 points; 95% CI 2.7 to 4.0, p < 0.001). Respondents significantly changed their belief toward agreement that people are able to rate their breathlessness intensity on a scale (60 to 81% agreement) although only a minority strongly agreed with this statement at both time points (pre 11%, post 22%). The largest shift in attitude was toward agreement (z statistic 3.74, p < 0.001, effect size r = 0.6) that a person's experience of breathlessness should be used to guide treatment decisions (from 43 to 73% strong agreement). Participants' belief that cognitive behavioural strategies are effective for relief of breathlessness changed further toward agreement after the workshop (81 to 100%, McNemar test chi- square = 5.14, p = 0.02). CONCLUSION The focus of this training on biopsychosocial understandings of chronic breathlessness and involvement of people living with this symptom were valued. These features were identified as facilitators of change in fundamental attitudes and preparedness for practice.
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Affiliation(s)
- Kylie N Johnston
- School of Health Sciences, Innovation, Implementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.
| | - Mary Young
- Department of Thoracic Medicine, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Debra Kay
- , Adelaide, South Australia, Australia
| | - Sara Booth
- Cambridge Breathlessness Intervention Service, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Anna Spathis
- Cambridge Breathlessness Intervention Service, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Marie T Williams
- School of Health Sciences, Innovation, Implementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia
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The impact of early palliative care on the quality of care during the last days of life: what does the evidence say? Curr Opin Support Palliat Care 2018; 10:310-315. [PMID: 27635766 DOI: 10.1097/spc.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to critically appraise the existing evidence on 'early palliative care' (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. RECENT FINDINGS There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care. SUMMARY The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.
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Abstract
OBJECTIVE To identify barrier to achieving universal access to high quality palliative care in Canada, review published national strategies and frameworks to promote palliative care, examine key aspects that have been linked to successful outcomes, and make recommendations for Canada. BACKGROUND In 2014, the World Health Organization called on members to develop and implement policies to ensure palliative care is integrated into national health services. METHODS Rapid review supplemented by the author's personal files, outreach to colleagues within the international palliative care community, review of European Association for Palliative Care publications, and a subsequent search of the table of contents of the major palliative care journals. RESULTS Frameworks were found for 10 countries ranging from detailed and comprehensive multi-year strategies to more general approaches including laws guaranteeing access to palliative care services for "dying" patients or recommendations for the development of clinical infrastructure. Few formal evaluations were found minimal comparative data exist regarding the quality of care, access to palliative care services, timing of access in the disease trajectory, and patient and family satisfaction with care. Factors that appear to be associated with success include: 1) input and early involvement of senior policy makers; 2) comprehensive strategies that address major barriers to universal access and that involve the key constituents; 3) a focus on enhancing the evidence base and developing a national system of quality reporting; and 4) substantial and sustained government investment. DISCUSSION Comprehensive national strategies appear to improve access to high quality palliative care for persons with serious illness and their families. Such strategies require sustained government funding and address barriers related to infrastructure, professional and public education, workforce shortages, and an inadequate evidence base.
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Affiliation(s)
- R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
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Byrne A, Upton L, Townsend S. Mind the gap: a step forward in supporting hospice-based research. BMJ Support Palliat Care 2015; 5:4-6. [PMID: 25713220 DOI: 10.1136/bmjspcare-2014-000808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Anthony Byrne
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Laura Upton
- R&D Department, Velindre NHS Trust, Cardiff, UK
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Blum D, Inauen R, Binswanger J, Strasser F. Barriers to research in palliative care: A systematic literature review. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McIlfatrick SJ, Murphy T. Palliative care research on the island of Ireland over the last decade: a systematic review and thematic analysis of peer reviewed publications. BMC Palliat Care 2013; 12:33. [PMID: 24006932 PMCID: PMC3848123 DOI: 10.1186/1472-684x-12-33] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background As palliative care research continues to expand across Europe, and the world, questions exist about the nature and type of research undertaken in addition to the research priorities for the future. This systematic review, which is the first stage of a larger scale study to identify the research priorities for palliative care on the island of Ireland, examined palliative care research conducted on the island over the last decade. Methods A comprehensive search strategy was implemented and strict eligibility criteria were applied in order to identify relevant peer-reviewed journal articles. Inclusion criteria were all of the palliative care studies undertaken on the island of Ireland and published between January 2002 and May 2012. These were assessed in relation to year, setting, sample size, research methodology, and relevant findings. Results 412 publications were identified for screening and their abstracts obtained. After eliminating articles that did not meet the inclusion criteria, 151 remained for further analysis. A thematic analysis of 128 studies published between 2006 and 2012 revealed eight core themes: (1) specific groups/populations; (2) services and settings; (3) management of symptoms (physical, psychological, social); (4) bereavement; (5) communication and education; (6) death and dying; (7) spirituality; and (8) complementary and alternative medicine/intervention (CAM). There was an upward trend in the number of publications in palliative care research over the last ten years with over 72% of studies being published within the previous four years. A slightly higher number of studies were quantitative in nature (surveys, questionnaires, standardised assessments) followed by qualitative (individual and focus group interviews, case studies, documentary analysis and retrospective case note reviews), mixed methods, and systematic reviews. Conclusions Whilst there has been a welcome growth in palliative care research across Ireland, this has largely been needs-based and small scale studies. In contrast, international researchers and decision makers recommend the need for more outcomes focused multidisciplinary research. An examination of palliative care research is an essential first step in seeking to develop future priority areas for further research, highlighting opportunities for future collaboration both nationally and internationally.
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Affiliation(s)
- Sonja J McIlfatrick
- All Ireland Institute of Hospice and Palliative Care c/o Education and Research Centre, Our, Lady's Hospice and Care Services, Harold's Cross, Dublin 6w, Ireland.
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Rhondali W, Berthiller J, Hui D, Yennu S, Lafumas V, Ledoux M, Strasser F, Filbet M. Barriers to research in palliative care in France. BMJ Support Palliat Care 2013; 4:182-189. [PMID: 24644171 DOI: 10.1136/bmjspcare-2012-000360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/20/2013] [Accepted: 03/13/2013] [Indexed: 11/04/2022]
Abstract
PURPOSE Palliative care (PC) needs expansion of its research capacity to improve the quality of care. This is particularly true for France that contributed less than 2% of all European PC research publications. We conducted a survey to assess the barriers French healthcare professionals (HCPs) involved in PC research had to face. METHODS We surveyed all 420 PC departments registered in the French National Association for Palliative Care (SFAP) database using a previously used questionnaire. We documented the ethical limitations, time constraints, financial resources, patient issues and methodological issues related to PC research. RESULTS We obtained 382 responses. Ninety-two (24.1%) HCPs were involved in a research project during the last 5 years. In univariate results, predictors of being involved in PC research were men (p=0.004), physician (p=0.022), working at a university hospital (p<0.001). There was a trend towards working in a PC unit (p=0.052). The main barriers to participating in PC research were lack of time (80.1%) and patient issues (47.4%). Lack of methodological support (33.0%) and financial limitations (30.4%) were also reported as major barriers. CONCLUSIONS There is a consensus that PC research and publication in the English language for peer-reviewed journals must be expanded in France but at this stage, clinical teams still lack specific funding and appropriate support. More research is needed to confirm our results and to determine the best ways to develop PC research capacity in France.
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Affiliation(s)
- Wadih Rhondali
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.,Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julien Berthiller
- Pole Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Veronique Lafumas
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Mathilde Ledoux
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Florian Strasser
- Oncological Palliative Medicine, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St Gallen, Switzerland
| | - Marilène Filbet
- Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
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Joyce BT, Lau DT. Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: a providers survey. Palliat Med 2013; 27:329-38. [PMID: 23175509 PMCID: PMC3606683 DOI: 10.1177/0269216312465650] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospice providers need to ensure that informal, unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life. AIM This study characterizes hospice providers' self-reported experiences and approaches to helping caregivers' medication management for home hospice patients. DESIGN Survey with mixed-method analysis. SETTING/PARTICIPANTS Surveys were administered to a convenience sample of 98 hospice providers (74 nurses, 6 physicians, 11 social workers, 7 chaplains) from 5 Chicago-based agencies in the United States. RESULTS Among respondents, 67% rated ensuring proper medication management as "most important" in hospice care delivery, and 33% reported frequently encountering caregivers with problems managing medications. To assess if caregivers had problems managing medications, two categories of approaches emerged from the data: prospective approaches and retrospective warning signs when a problem occurred (e.g. identifying medication nonadherence after observing a sudden patient health decline). Overall, 42% reported using at least one prospective approach, while 38% reported only retrospective signs. To help caregivers manage medications, three categories of approaches emerged: teaching to increase knowledge, supporting existing or simplifying medication management process, and counseling to overcome attitudinal barriers. Overall, 6% reported approaches from all three categories. About 28% frequently experienced difficulty teaching/supporting caregivers with medication management. As much as 47% believed that they would benefit "to a great extent" from additional resources to help caregivers. CONCLUSIONS Supporting caregivers in medication management is considered important, yet challenging, to hospice providers. Additional resources may be needed to help providers consistently and effectively teach, support, and assess caregivers' medication management.
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Affiliation(s)
- Brian T Joyce
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:543-52. [DOI: 10.1097/spc.0b013e32835ad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize the current state of the science in physical symptoms and other end-of-life care domains and/or illness-specific outcomes in palliative care. The review includes progress in outcome measure development and interpretation, with specific reference to the clinical trial context. RECENT FINDINGS There are validated measures in a wide range of domains, which can measure outcomes specific to palliative care interventions; which are sufficiently validated to ensure the results of the trial are robust and measuring differences which are both clinically meaningful. In several areas, consensus is emerging which will allow consolidation of outcome measurement and the ability to extend measurement from the clinical trial setting into routine clinical practice. Potential exists for composite measures covering areas prioritized by patients to improve comparability and efficiency. Adverse events need to be measured with the same degree of rigor as efficacy outcomes. SUMMARY Clinical trials of palliative care interventions need to consider a range of outcomes, however, the choice and timing of measurement of the primary outcome need to be guided by the domain most likely to be influenced by the intervention.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Daveson BA, Harding R, Derycke N, Vanden Berghe P, Edwards S, Higginson IJ. The PRISMA Symposium 4: how should Europe progress end-of-life and palliative clinical care research? Recommendations from the proceedings. J Pain Symptom Manage 2011; 42:511-6. [PMID: 21963120 DOI: 10.1016/j.jpainsymman.2011.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/23/2011] [Indexed: 11/29/2022]
Abstract
Within aging European populations, the need to progress end-of-life and palliative care policy is becoming increasingly important. PRISMA, a European Commission-funded project, aimed to identify and coordinate research priorities, measurement, and practice in end-of-life care for Europe. PRISMA conducted a three-year multidisciplinary program to advance science and policy and to enhance coordination of cross-national activity. The final PRISMA symposium was convened to disseminate our new knowledge and activities and was held for European Union-level and national-level policy makers, policy influencers, and funders. Nearly 100 international invited delegates participated in the symposium, with the understanding that European research is aided by international partnerships and the free exchange of ideas and resources across states. The series of invited speakers, roundtables, and floor discussions underlined the necessity for clinical and public priorities to inform holistic outcome measurement research supported by government action informed by policy. Sustainable leadership, clear terminology and pan-European collaborative networks, and protected research funding designated for end-of-life or palliative care were identified as essential to progress end-of-life and palliative care research and innovation in Europe. An agreed set of outcome measures for end-of-life and palliative care that builds on previous pan-European projects is fundamental to a cross-national program of development in order to advance research and innovation within Europe.
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Harding R. A rising prevalence of advanced cancer. Foreword. J Pain Symptom Manage 2011; 42:491-2. [PMID: 21963117 DOI: 10.1016/j.jpainsymman.2011.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
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