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Kilpatrick K, Savard I, Audet LA, Costanzo G, Khan M, Atallah R, Jabbour M, Zhou W, Wheeler K, Ladd E, Gray DC, Henderson C, Spies LA, McGrath H, Rogers M. A global perspective of advanced practice nursing research: A review of systematic reviews. PLoS One 2024; 19:e0305008. [PMID: 38954675 PMCID: PMC11218965 DOI: 10.1371/journal.pone.0305008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. OBJECTIVE To identify gaps in advanced practice nursing research globally. MATERIALS AND METHODS A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. RESULTS We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). CONCLUSION There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO REGISTRATION NUMBER CRD42021278532.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Isabelle Savard
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Li-Anne Audet
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mariam Khan
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; National University Health System, Singapore, Singapore
- Singapore National Neuroscience Institute, Singapore, Singapore
| | - Kathy Wheeler
- College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America
| | - Elissa Ladd
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, United States of America
| | - Deborah C. Gray
- School of Nursing, Old Dominion University, Virginia Beach, Virginia, United States of America
| | - Colette Henderson
- School of Health Sciences, University of Dundee, Dundee, Scotland, United States of America
| | - Lori A. Spies
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas, United States of America
| | - Heather McGrath
- St James Public Health Services, Montego Bay, St James, Jamaica
| | - Melanie Rogers
- Department of Nursing and Midwifery, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
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Savard I, Jabbour M, Tchouaket E, Gauthier N, Kilpatrick K. Evaluating the influence of primary healthcare nurse practitioners' interventions in home care on hospitalizations and emergency department transfers. J Eval Clin Pract 2024; 30:440-452. [PMID: 38234169 DOI: 10.1111/jep.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Abstract
RATIONALE Home care allows patients with functional limitations to receive services at home and prevent health decline. Home care can reduce hospitalization and emergency department (ED) transfers. Integrating primary healthcare nurse practitioners (PHCNPs) in home care increases the supply of services, but little is known about their influence on patients' ability to remain at home. AIMS AND OBJECTIVES Evaluate the influence of PHCNPs' interventions on hospitalizations and ED transfers in patients receiving care from interprofessional home care teams with PHCNPs. METHOD The retrospective cohort study employed multiple logistic regression and Cox modelling techniques to assess the influence of PHCNP interventions on hospitalizations and ED transfers. Descriptive and bivariate analyses examined sample characteristics and variable associations. Four purposively selected sites in Québec, Canada, were included. Data were collected from electronic health records of all patients (n = 343) receiving home care from these teams. RESULTS The characteristics of the sites, sample, and PHCNP interventions were described. Planned interventions led to a 5.8% decrease in hospitalizations and ED transfers (adjusted odds ratio [OR]: 0.058, p = 0.039), while unplanned interventions resulted in a 1.5-fold increase in this outcome (adjusted OR: 1.518, p < 0.001). The risk of hospitalization and ED transfers increased by 10.7 times with unplanned interventions (adjusted OR: 10.651, p = 0.002). Furthermore, imaging was associated with a 2-fold increased risk (adjusted OR: 1.954, p = 0.021), consultations with a 1.8-fold increased risk (adjusted OR: 1.849, p = 0.034), and laboratory test-related interventions after 30 or more days reduced the risk by 68.0% (adjusted OR: 0.320, p < 0.001). CONCLUSIONS PHCNPs in interprofessional home care teams show promise in reducing hospitalizations and ED transfers through planned visits. These findings provide valuable insights that can contribute to enhancing home care services for a population with limited access to healthcare and high healthcare needs. Further research is needed in other jurisdictions.
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Affiliation(s)
- Isabelle Savard
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Mira Jabbour
- Maisonneuve-Rosemont Hospital Site, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montréal, Québec, Canada
| | - Eric Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Nathalie Gauthier
- Direction des soins infirmiers et de la santé physique, Centre intégré universitaire de santé et des services sociaux de la Capitale Nationale, Quebec City, Québec, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Maisonneuve-Rosemont Hospital Site, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montréal, Québec, Canada
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Kornelsen J, Ho H, Williams K, Skinner T. Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme. J Interprof Care 2023:1-9. [PMID: 38038596 DOI: 10.1080/13561820.2023.2280586] [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: 11/28/2022] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018-2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.
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Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Hilary Ho
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, Canada
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Kilpatrick K, Tchouaket E, Savard I, Chouinard MC, Bouabdillah N, Provost-Bazinet B, Costanzo G, Houle J, St-Louis G, Jabbour M, Atallah R. Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews. PLoS One 2023; 18:e0290977. [PMID: 37676878 PMCID: PMC10484467 DOI: 10.1371/journal.pone.0290977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
AIM To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER CRD42020198182.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Isabelle Savard
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), Montréal, Québec, Canada
| | - Naima Bouabdillah
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Geneviève St-Louis
- Support and Development of Professional Practices in Nursing and Assistance Care and Infection Prevention Associate Directorate, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Li Y, Wang C, Tan W, Jiang Y. The transition to advanced practice nursing: A systematic review of qualitative studies. Int J Nurs Stud 2023; 144:104525. [PMID: 37263057 DOI: 10.1016/j.ijnurstu.2023.104525] [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: 12/18/2022] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes. AIM To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role. DESIGN A systematic review of qualitative studies. DATA SOURCES Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL. REVIEW METHODS This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis. FINDINGS A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition. CONCLUSIONS Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.
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Affiliation(s)
- Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Wei Tan
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
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Ma L, Wang X, Zou S, Lin M, Qiu S, Li W. A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses. BMC Health Serv Res 2023; 23:327. [PMID: 37005581 PMCID: PMC10067220 DOI: 10.1186/s12913-023-09303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND With the advent of an ageing society and an increase in the prevalence of chronic diseases, the role of primary health care has become increasingly important and reliant on multidisciplinary collaboration. As members of this interprofessional cooperative team, community nurses play a dominant role. Thus, the post competencies of community nurses study deserve our attention. In addition, organizational career management can affect nurses in some ways. This study aims to examine the current situation and relationship among interprofessional team collaboration, organizational career management and post-competency of community nurses. METHODS A survey was conducted among 530 nurses in 28 community medical institutions from November 2021 to April 2022 in Chengdu, Sichuan Province, China. Descriptive analysis was used for analysis, and a structural equation model was used to hypothesize and verify the model. A total of 88.2% of respondents met the inclusion criteria and did not meet the exclusion criteria. The main reason nurses gave for not participating was that they were too busy. RESULTS Among the competencies on the questionnaire, ensuring quality and helping roles scored the lowest. The teaching-coaching and diagnostic functions played a mediating role. Nurses with greater seniority and those who were transferred to administrative departments had lower scores, and the difference was statistically significant (p < 0.05). In the structural equation model, CFI = 0.992 and RMSEA = 0.049, which shows that the model fit well, suggesting that organizational career management had no statistically significant effect on post competency (β = -0.006, p = 0.932) but that interprofessional team collaboration had a statistically significant effect on post competency (β = 1.146, p < 0.001) and organizational career management had a statistically significant effect on interprofessional team collaboration (β = 0.684, p < 0.001). CONCLUSIONS Attention should be given to the improvement of community nurses' post competency in ensuring quality and performing helping, teaching-coaching, and diagnostic roles. Moreover, researchers should focus on the decline in community nurses' abilities, particularly for those with greater seniority or in administrative roles. The structural equation model shows that interprofessional team collaboration is a complete intermediary between organizational career management and post competency.
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Affiliation(s)
- Li Ma
- Institute of Hospital Management, Outpatient Department, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinwei Wang
- School of Business, Sichuan University, Chengdu, Sichuan, China
| | - Shiyue Zou
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Min Lin
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Shi Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network/Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Prakoeswa CRS, Hidayah N, Dewi A. A Systematic Review on Hospital’s Patient Satisfaction and Loyalty in Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Customer loyalty is identified as a critical component of a company's success and profitability including in hospitals. Customer loyalty can only be accomplished if the company can provide high-quality services. The purpose of this study was to understand the influence or factors behind patient loyalty. Methods: Systematic literature review methods were used to process articles found in various journals and databases such as Elsevier, NCBI, Lancet, Springer, Nature, Taylor and Francis, ProQuest, Emerald, JSTOR, Web of Science, and GARUDA SINTA (the Science and Technology Index of expertise in Indonesia). Results: The initial search resulted in 1.174 (1 duplicated) and 1.173 were screened based on title and abstract. Finally, 29 articles were included for review regarding inclusion and exclusion criteria. The finding shows that concern for medical staff, perceived value, price, trust, treatment effectiveness, Service Quality, Interaction, Infrastructure, Process, and brand image, consequently affect patient satisfaction and loyalty. Those factors as an intervening variable in patient loyalty. Conclusion: In general, hospital health workers' competency, tangible factors (facilities), communication, punctuality in work (responsiveness), patient waiting time (facility satisfaction and responsiveness), queuing system, drug availability (price factor, facility satisfaction), providing information to clients (trust and communication, guarantees), equal treatment for uninsured patients, and complaint system for clients (Hospital Image) impact patient loyalty directly or indirectly.
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