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Kirtania M, Katta A. Essential Elements of Home-based Palliative Care Model: A Rapid Review. Indian J Palliat Care 2023; 29:359-367. [PMID: 38058483 PMCID: PMC10696356 DOI: 10.25259/ijpc_227_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/05/2023] [Indexed: 12/08/2023] Open
Abstract
The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient's individual healthcare needs. Palliative care improves the patients' and caregivers' quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.
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Affiliation(s)
- Mousami Kirtania
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Ajitha Katta
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
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Prajitha KC, Subbaraman MR, Siddharth Raman SR, Sharahudeen A, Chandran D, Sawyer J, Kumar S, Anish TS. Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India. Palliat Care Soc Pract 2023; 17:26323524231196315. [PMID: 37692560 PMCID: PMC10486217 DOI: 10.1177/26323524231196315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background The existing palliative care services in India are concentrated in urban areas, attached to tertiary care hospitals. This poses issues relating to access and equity for people in rural locations and with low socioeconomic status. A Community-Based Palliative Care (CBPC) service named Sanjeevan has been initiated in Puducherry, a union territory of India to provide physical, social, psychological, and emotional support to incurably ill people, including older adults living in rural areas. Objectives To understand the social mechanisms that underpin the implementation of CBPC in rural parts of India and the challenges to its sustainability. Design Qualitative research using focus group discussions (FGDs) and key informant interviews (KIIs). Methods Community-based participatory research (CBPR) approach was used in this study, and descriptive analysis was done. Through CBPR it was possible to document and interpret local knowledge on the community concerns and assets along with the experiences of the community members. Purposive sampling was used to identify vocal participants involved in patient care and areas of the Sanjeevan program such as financial management, administration, and community mobilization. Seven KIIs and four FGDs were conducted, with 7-8 participants in each. Results The analysis indicated the need for a CBPC and the factors enabling its establishment. The findings revealed capacity building, resources for palliative care services, and the existing social structure of the community being the main challenges that need to be overcome for better penetration of CBPC services into society. Demand generation through sensitization and administration of services based on the need and regular follow-up remains the key strategies for the sustainability of the program. Conclusion The CBPC program like 'Sanjeevan' adopted in the rural area of Puducherry can be cited as an example and can be replicated in other rural settings with similar sociocultural characteristics to support people living with end-stage diseases.
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Affiliation(s)
| | | | | | - Anisha Sharahudeen
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Dhanusha Chandran
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Joseph Sawyer
- Academic Clinical Fellow in Palliative Medicine, UCL Division of Psychiatry, MCPCRD, London, UK
| | - Suresh Kumar
- WHO Collaborating Centre for Community Participation in Palliative Care and Long Term Care, Calicut, Kerala, India Director Sanjeevan, Puducherry India
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Mir WAY, Misra S, Sanghavi D. Life before Death in India: A Narrative Review. Indian J Palliat Care 2023; 29:207-211. [PMID: 37325266 PMCID: PMC10261930 DOI: 10.25259/ijpc_44_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/20/2022] [Indexed: 01/12/2023] Open
Abstract
Palliative care is an ever-increasing need in India, with its large population and rising burden of chronic illness. India ranks 67th out of 80 countries in the quality of death index, which measures the availability and quality of palliative care. Community-led projects in Kerala have proven successful in improving palliative care access with modest resources and volunteer involvement. In India, the number of hospice facilities is increasing; however, <1% of the Indian population has access to palliative care. Financial and human resources limitations in the health-care system, poverty and high health-care expenditure, the lack of awareness among the public about end-of-life care, hesitance to seek care due to social stigma, strict laws regarding opiates that hinder adequate pain relief and the apparent conflict between traditional social values and western values regarding death are the major obstacles to improving palliative care. Significant efforts focused on public awareness of end-of-life care and locally-tailored programmes with family and community involvement are necessary to address this issue and integrate palliative care into the primary care system. Furthermore, we discuss the effects of the COVID-19 pandemic that has been managed effectively by palliative care involvement.
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Affiliation(s)
- Wasey Ali Yadullahi Mir
- Department of Pulmonary and Critical Care, Saint Elizabeth Medical Center, Chicago, Illinois, United States
| | - Sudha Misra
- Department of Internal Medicine, Saint Joseph Hospital, University of Illinois, Chicago, Illinois, United States
| | - Devang Sanghavi
- Department on Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, United States
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Zelko E, Vrbek L, Koletnik M. Last Aid Course—The Slovenian Experience. Healthcare (Basel) 2022; 10:healthcare10071154. [PMID: 35885681 PMCID: PMC9315648 DOI: 10.3390/healthcare10071154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Educating and raising awareness among lay members of the public about palliative care can significantly improve the care for terminally ill patients and their quality of life. This paper reports on the survey aimed at assessing the experience and expectations of participants in the Last Aid course launched in Slovenia in 2019 to train hospice volunteers and promote dialogue on death and dying. The course implementation was supported by materials prepared, translated, and/or adapted from German under the PO-LAST project, which linked Slovenian medical and healthcare professionals, hospice representatives, and university students. The Last Aid course follows an international four-module curriculum that has been successfully applied in 18 countries so far. In Slovenia, the course was delivered 30 times with 21 in-person deliveries and 9 online events attended by 450 participants of different sexes, ages, and professions. The surveyed population included 250 people who returned the evaluation questionnaires by October 2020. The aim of the analysis was to gain insight that can be applied broadly in future work and research on adult education on palliative care and the erasure of death-related taboos.
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Affiliation(s)
- Erika Zelko
- Institute for General practice, Johannes Keppler University, 4020 Linz, Austria
- Department for Family Medicine, Faculty of Medicine University Maribor, Taborska cesta 8, 2000 Maribor, Slovenia
- Correspondence:
| | - Larisa Vrbek
- Cerebral Paralysis Association of Slovenia, Rožanska ulica 2, 1000 Ljubljana, Slovenia;
| | - Melita Koletnik
- Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia;
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Rosa WE, Parekh de Campos A, Abedini NC, Gray TF, Huijer HAS, Bhadelia A, Boit JM, Byiringiro S, Crisp N, Dahlin C, Davidson PM, Davis S, De Lima L, Farmer PE, Ferrell BR, Hategekimana V, Karanja V, Knaul FM, Kpoeh JDN, Lusaka J, Matula ST, McMahon C, Meghani SH, Moreland PJ, Ntizimira C, Radbruch L, Rajagopal MR, Downing J. Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide. J Pain Symptom Manage 2022; 63:e224-e236. [PMID: 34332044 PMCID: PMC8799766 DOI: 10.1016/j.jpainsymman.2021.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/21/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Amisha Parekh de Campos
- University of Connecticut School of Nursing (A.P.D.C.), Storrs & Hospice Program, Middlesex Health, Connecticut, USA
| | - Nauzley C Abedini
- Division of Gerontology and Geriatric Medicine (N.C.A.), Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Tamryn F Gray
- Harvard Medical School (T.F.G.), Department of Psychosocial Oncology and Palliative Care, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health (A.B.), Boston, Massachusetts, USA
| | | | - Samuel Byiringiro
- Johns Hopkins University School of Nursing (S.B.), Baltimore, Maryland, USA
| | - Nigel Crisp
- All-Party Parliamentary Group on Global Health (N.C.), House of Lords, Nursing Now Global Campaign, London, UK
| | | | - Patricia M Davidson
- The Vice-Chancellor's Unit (P.M.D.), University of Wollongong, New South Wales, Australia
| | - Sheila Davis
- Partners In Health (S.D., C.M.), Boston, Massachusetts, USA
| | - Liliana De Lima
- International Association for Hospice & Palliative Care (L.D.L.), Houston, Texas, USA
| | - Paul E Farmer
- Department of Global Health and Social Medicine (P.E.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Betty R Ferrell
- Division of Nursing Research and Education (B.R.F.), Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Vedaste Hategekimana
- Pain Free Hospital Initiative (V.H.), Rwanda Biomedical Center and Ministry of Health, Butaro, Rwanda
| | - Viola Karanja
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Felicia Marie Knaul
- University of Miami Institute for Advanced Study of the Americas (F.M.K.), Coral Gables, Florida, USA
| | - Julius D N Kpoeh
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Joseph Lusaka
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Samuel T Matula
- University of Botswana School of Nursing (S.T.M.), Gabarone, Botswana
| | - Cory McMahon
- Partners In Health (S.D., C.M.), Boston, Massachusetts, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing (S.H.M.), Philadelphia, Pennsylvania, USA
| | - Patricia J Moreland
- Emory University Nell Hodgson Woodruff School of Nursing (P.J.M.), Atlanta, Georgia, USA
| | | | - Lukas Radbruch
- Department of Palliative Medicine (L.R.), University Hospital Bonn, Bonn, Germany
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences (M.R.R.), Trivandrum, Kerala, India
| | - Julia Downing
- International Children's Palliative Care Network (J.D.), Makerere University, Kampala, Uganda
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Ghoshal A, Deodhar J, Adhikarla C, Tiwari A, Dy S, Pramesh CS. Implementation of an Early Palliative Care Referral Program in Lung Cancer: A Quality Improvement Project at the Tata Memorial Hospital, Mumbai, India. Indian J Palliat Care 2021; 27:211-215. [PMID: 34511786 PMCID: PMC8428894 DOI: 10.25259/ijpc_394_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/20/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Access to early palliative care (EPC) for all patients with metastatic lung cancer is yet to be achieved in spite of recommendations. This quality improvement (QI) project was initialized to improve the rates of such referrals from the thoracic oncology clinic for all new outpatients in a premier cancer center in India. MATERIALS AND METHODS Change in the proportion of patients receiving referrals for EPC during and after intervention (April-May 2018), compared to baseline (January-March 2018) were explored. Interventions included understanding of the process flow, identification of key drivers, and root cause analysis which identified the gaps as lack of documentation for EPC. Teaching and encouraging staff at the clinic to incorporate referrals into all initial visits for patients with metastatic lung cancer were incorporated. RESULTS The bundle of QI interventions increased referrals from an average of 50% to 75%, mean difference = 12.64 (standard deviation = 10.13) (95% confidence interval = 22.01-3.29), P = 0.016 (two-tailed) on paired sample test. CONCLUSION Improved referral rates for EPC in a multidisciplinary cancer clinic is possible with a QI project. This project also identifies the importance of data documentation and patient information processes that can be targeted for improvement.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Chandana Adhikarla
- Department of Cardiovascular and Thoracic Surgery, King Edward Memorial Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Avinash Tiwari
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
| | - Sydney Dy
- Health Policy and Management, Medicine and Oncology, Johns Hopkins, Mumbai, Maharashtra, India
| | - CS Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, Maharashtra, India
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Nair M, Kumar P, Mahajan R, Harshana A, Richardson K, Moreto-Planas L, Burza S. Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India. BMJ Open 2020; 10:e036179. [PMID: 33020082 PMCID: PMC7537445 DOI: 10.1136/bmjopen-2019-036179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar. DESIGN This was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion. SETTING All interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA. PARTICIPANTS We purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations. RESULTS Critically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as 'palliative care' and 'end-of-life care'. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients' deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves. CONCLUSIONS Despite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients' preferences.
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Affiliation(s)
- Mohit Nair
- Medecins Sans Frontieres, New Delhi, Delhi, India
| | - Pragya Kumar
- Community & Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | | | | | | | - Sakib Burza
- Medecins Sans Frontieres, New Delhi, Delhi, India
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Chakkaravarthy K, Ibrahim N, Mahmud M, Venkatasalu MR. Predictors for nurses and midwives' readiness towards self-directed learning: An integrated review. NURSE EDUCATION TODAY 2018; 69:60-66. [PMID: 30007149 DOI: 10.1016/j.nedt.2018.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
AIM To systematically review the existing evidence on predictors for nurses and midwives' readiness towards Self-directed Learning (SDL). BACKGROUND Increased complexities in healthcare settings demand that nurses and midwives become involved in lifelong learning by means of self-directed learning (SDL) for delivering quality healthcare. More evidence is available for the self-directed learning readiness (SDLR) of nursing and midwifery students, less is systematically derived on predictors for nurses and midwives' readiness to SDL. DESIGN An integrative systematic review. METHODS Systematic searches were carried out using the following five electronic databases: PubMed, Science Direct, Google Scholar, Ovid Medline and Embase. Studies published in English language from 2000 to 2017 were included. The integrative systematic review framework developed by Whittemore and Knafl (2005) was used to analyse and summarise the key themes. RESULTS Of 804 initial screening papers, in total of eight eligible studies (six quantitative and two qualitative) were found. Integrative analysis resulted in four themes as predictors for nurses and midwives' readiness towards SDL: 1) personal characteristics, 2) working environment, 3) online learning and SDLR, and 4) process of SDL. Review found that, although demographic characteristics of nurses and midwives do not influence their SDLR, work environment often influences their SDLR. Furthermore, nurses and midwives have a positive interest in online learning that is often used to improve their knowledge acquisition. CONCLUSION The review concludes that qualified nurses and midwives have a unique SDL predictors and process; hence, a personalized SDL programme should be prescribed based on personality traits so as to achieve better SDL outcomes. Future research should address the facilitating factors for SDLR, barriers to SDLR and strategies to improve SDLR among nurses and more importantly midwives, as limited evidence is available with respect to the latter.
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Affiliation(s)
- Karpagam Chakkaravarthy
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong, BE1410, Negara, Brunei Darussalam.
| | - Norzihan Ibrahim
- Department of Nursing Services, Ministry of Health, Brunei Darussalam, Negara, Brunei Darussalam.
| | - Mardiah Mahmud
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong, BE1410, Negara, Brunei Darussalam.
| | - Munikumar Ramasamy Venkatasalu
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong, BE1410, Negara, Brunei Darussalam.
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