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Tyler N, Planner C, Shears B, Hernan A, Panagioti M, Giles S. Developing the Resident Measure of Safety in Care Homes (RMOS): A Delphi and Think Aloud Study. Health Expect 2023; 26:1149-1158. [PMID: 36797827 PMCID: PMC10154851 DOI: 10.1111/hex.13730] [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: 10/23/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. INTRODUCTION Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. METHODS We developed 73 evidence-based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. RESULTS The 29-item RMOS was developed. Forty-three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. CONCLUSION We have a developed an evidence-based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia-friendly version to promote inclusivity. PATIENT OR PUBLIC INVOLVEMENT Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Bethany Shears
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Andrea Hernan
- Faculty of Health, Deakin University, Warrnambool, Australia
| | - Maria Panagioti
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Sally Giles
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Juliawati M, Darwita RR, Adiatman M, Lestari F. Patient Safety Culture in Dentistry Analysis Using the Safety Attitude Questionnaire in DKI Jakarta, Indonesia: A Cross-Cultural Adaptation and Validation Study. J Patient Saf 2022; 18:486-493. [PMID: 35121721 PMCID: PMC9329039 DOI: 10.1097/pts.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to analyze a cross-cultural adaptation of the Safety Attitude Questionnaire (SAQ) for Indonesian dentists. METHODS A cross-sectional study was conducted on 250 general dentists in health services in Jakarta, Indonesia. The first step included cultural adaptation and translation, which was followed by the development of the tested questionnaire through expert agreement and by validity and reliability analysis using Spearman correlation coefficient, Cronbach α , and interclass correlation coefficient. The SAQ consisted of 30 items and 6 dimensions (safety climate, teamwork climate, job satisfaction, stress recognition, perception of management, and working conditions).Respondents were members of the Indonesian Dental Association who voluntarily filled out a Google-based questionnaire from September to October 2020. RESULTS A total of 250 respondents with a response rate of 16.4% demonstrated a total Cronbach α value of 0.897, whereas the value per item ranged from 0.890 to 0.905, which suggested an acceptable and good to very good internal consistency. The interclass correlation coefficient value varied from 0.840 to 1.000, which meant almost perfect agreement. The correlation coefficient of 30 questions items resulted in a total SAQ score ranging from 0.422 to 0.699 (moderate to strong correlation) and between 6 dimensions to total SAQ score ranging from 0.648 to 0.772 (strong correlation). CONCLUSIONS The Indonesian version of the SAQ exhibited good validity and very good reliability and potential to be used for evaluating dentists' patient safety culture in Indonesia.
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Affiliation(s)
- Mita Juliawati
- From the Graduate School, Doctoral Study Programme, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Risqa R. Darwita
- Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, Universitas, Indonesia, Jakarta, Indonesia
| | - Melissa Adiatman
- Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, Universitas, Indonesia, Jakarta, Indonesia
| | - Fatma Lestari
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok Indonesia
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Faridah I, Setyowati S, Lestari F, Hariyati RTS. The correlation between work environment and patient safety in a general hospital in Indonesia. ENFERMERIA CLINICA 2021. [PMID: 33849167 DOI: 10.1016/j.enfcli.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient safety is an important for health care services in the hospital setting. The most difficult obstacle in ensuring patient safety is creating a safety. The objective of this study was to determine the correlation between the hospital work environment, nurses' characteristics, and patient safety. The method was a descriptive correlative study with a cross-sectional approach. The data were obtained from 123 ward nurses through using valid and reliable questionnaires. The results showed a significant relationship between hospital work environment and nurses' characteristics (education level, length of service, and training concerning patient safety) (p<.05). In contrast, nurses' age and marital status were not related to patient safety in the hospital (p>.05). Findings indicate that the hospital work environment and nurses' characteristics are related to patient safety. The study recommended to build a model of patient's safety culture that includes all aspects that influence patients' safety culture.
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Affiliation(s)
- Ida Faridah
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia; Faculty of Nursing, STIKes Yatsi, Tangerang, Banten, Indonesia
| | | | - Fatma Lestari
- Faculty of Public Health Universitas Indonesia, Depok, West Java, Indonesia
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Jachan DE, Müller‐Werdan U, Lahmann NA. Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services. Nurs Open 2021; 8:755-765. [PMID: 33570279 PMCID: PMC7877149 DOI: 10.1002/nop2.678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
AIM To identify factors for and perceived consequences of nursing errors by nursing staff in home care services in correlation with qualification, work experience, working hours and trainings. BACKGROUND Patient safety has increasingly been brought into focus of politics and care practices over the past few years. However, little evidence has been provided yet on nursing errors in out-of-hospital settings. DESIGN A cross-sectional study. METHODS Randomized sample of 107 home care services and 656 nurses and nursing assistants recruited from all 16 federal states in Germany. RESULTS Missing trainings on error management within the past 2 years were identified to be an important factor for mistakes regarding hygienic measures and medication administration. However, most errors arose in documentation without any significant differences in qualification, work experience, training and working hours. CONCLUSION Findings indicate that insufficient hygiene and medication administration might be reduced by implementing error management trainings on a regular basis in home care services.
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Affiliation(s)
- Deborah Elisabeth Jachan
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
| | - Ursula Müller‐Werdan
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
| | - Nils Axel Lahmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
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Fernholm R, Wachtler C, Malm-Willadsen K, Holzmann MJ, Carlsson AC, Nilsson GH, Pukk Härenstam K. Validation and initial results of surveys exploring perspectives on risks and solutions for diagnostic and medication errors in primary care in Sweden. Scand J Prim Health Care 2020; 38:381-390. [PMID: 33307931 PMCID: PMC7782021 DOI: 10.1080/02813432.2020.1841531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To (1) validate and (2) display initial results of surveys to health care professionals and patients on the importance and mitigation of specified risks for diagnostic and medication errors. DESIGN For validation, psychometric properties were analysed by assessment of construct validity and internal consistency by factor analysis. Non-parametric analyses were used concerning areas of risk, and top ranking of solutions were reported descriptively. SETTING Primary health care in Sweden. PARTICIPANTS Health care professionals (HCPs); including physicians, nurses and practice managers, as well as patients who had experienced diagnostic or medication errors. MAIN OUTCOME MEASURES Psychometric properties of the surveys. Median ratings for risks and top rankings of solutions for professionals and patients. RESULTS There were 939 respondents to the HCP survey. Construct validity resulted in a model with four dimensions: Patient-provider level; Support systems for every day clinical work; Shared information and cooperation between different caregivers; Risks in the environment. Internal consistency was acceptable with Cronbach's α values above 0.7. Confirmatory factor analysis generally showed an acceptable fit. Initial results from the professionals showed the importance of continuity of care, a nationwide on-line medical platform and cooperation in transfer of care. The patient survey could not be validated because of low response rate. CONCLUSION The HCP survey showed some contradicting results regarding model fit and may be tentatively acceptable but validity needs further study. HCP survey answers indicated that relational continuity of care and a nationwide on-line medical platform are highly valued. Current awareness Health care professionals and patients are rather untapped sources of knowledge regarding patient safety in primary health care Main statements Validation is performed on a new survey capturing rating of risks and solutions. The validation of the health care professional survey is tentatively acceptable. Survey answers indicate that health care professionals' and patients' perspectives are complementary.
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Affiliation(s)
- Rita Fernholm
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Caroline Wachtler
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Karolina Malm-Willadsen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Martin J. Holzmann
- Department of Medicine, Stockholm, Sweden
- Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Gunnar H. Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Karin Pukk Härenstam
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden
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Kakemam E, Kalhor R, Khakdel Z, Khezri A, West S, Visentin D, Cleary M. Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey. J Adv Nurs 2020; 75:3609-3618. [PMID: 31531990 DOI: 10.1111/jan.14201] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/07/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events. DESIGN Cross-sectional nationwide survey. METHODS Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression. RESULTS This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards. CONCLUSIONS Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events. IMPACT Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.
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Affiliation(s)
- Edris Kakemam
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roholla Kalhor
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Khakdel
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Khezri
- Student Research Committee, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sancia West
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Denis Visentin
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
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Curran C, Lydon S, Kelly ME, Murphy AW, O'Connor P. An analysis of general practitioners' perspectives on patient safety incidents using critical incident technique interviews. Fam Pract 2019; 36:736-742. [PMID: 30926981 DOI: 10.1093/fampra/cmz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND General practitioners report difficulty in knowing how to improve patient safety. OBJECTIVES To analyse general practitioners' perspectives of contributing factors to patient safety incidents by collecting accounts of incidents, identifying the contributory factors to these incidents, assessing the impact and likelihood of occurrence of these incidents and examining whether certain categories of contributory factors were associated with the occurrence of high-risk incidents. METHODS Critical incident technique interviews were carried out with 30 general practitioners in Ireland about a patient safety incident they had experienced. The Yorkshire Contributory Factors Framework was used to classify the contributory factors to incidents. Seven subject matter experts rated the impact and likelihood of occurrence of each incident. RESULTS A total of 26 interviews were analysed. Almost two-thirds of the patient safety incidents were rated as having a major-to-extreme impact on the patient, and over a third were judged as having at least a bimonthly likelihood of occurrence. The most commonly described active failures were 'Medication Error' (34.6%) and 'Diagnostic Error' (30.8%). 'Situational Domain' was identified as a contributory domain in all patient safety incidents. 'Communication' breakdown at both practice and other healthcare-provider interfaces (69.2%) was also a commonly cited contributory factor. There were no significant differences in the levels of risk associated with the contributory factors. CONCLUSIONS Critical incident technique interviews support the identification of contributory factors to patient safety incidents. There is a need to explore the use of the resulting data for quality and safety improvement in general practice.
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Affiliation(s)
- Ciara Curran
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | | | - Paul O'Connor
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
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Michel P, Brami J, Chanelière M, Kret M, Mosnier A, Dupie I, Haeringer-Cholet A, Keriel-Gascou M, Maradan C, Villebrun F, Makeham M, Quenon JL. Patient safety incidents are common in primary care: A national prospective active incident reporting survey. PLoS One 2017; 12:e0165455. [PMID: 28196076 PMCID: PMC5308773 DOI: 10.1371/journal.pone.0165455] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The study objectives were to describe the incidence and the nature of patient safety incidents (PSIs) in primary care general practice settings, and to explore the association between these incidents and practice or organizational characteristics. METHODS GPs, randomly selected from a national influenza surveillance network (n = 800) across France, prospectively reported any incidents observed each day over a one-week period between May and July 2013. An incident was an event or circumstance that could have resulted, or did result, in harm to a patient, which the GP would not wish to recur. Primary outcome was the incidence of PSIs which was determined by counting reports per total number of patient encounters. Reports were categorized using existing taxonomies. The association with practice and organizational characteristics was calculated using a negative binomial regression model. RESULTS 127 GPs (participation rate 79%) reported 317 incidents of which 270 were deemed to be a posteriori judged preventable, among 12,348 encounters. 77% had no consequences for the patient. The incidence of reported PSIs was 26 per 1000 patient encounters per week (95% CI [23‰ -28‰]). Incidents were three times more frequently related to the organization of healthcare than to knowledge and skills of health professionals, and especially to the workflow in the GPs' offices and to the communication between providers and with patients. Among GP characteristics, three were related with an increased incidence in the final multivariable model: length of consultation higher than 15 minutes, method of receiving radiological results (by fax compared to paper or email), and being in a multidisciplinary clinic compared with sole practitioners. CONCLUSIONS Patient safety incidents (PSIs) occurred in mean once every two days in the sampled GPs and 2% of them were associated with a definite possibility for harm. Studying the association between organizational features of general practices and PSIs remains a major challenge and one of the most important issues for safety in primary care.
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Affiliation(s)
- Philippe Michel
- Comité de coordination de l’évaluation et de la qualité en Aquitaine, Bordeaux, France
- Hospices Civils de Lyon and Univ. Lyon, Université Claude Bernard Lyon 1, HESPER, Lyon, France
| | - Jean Brami
- Haute Autorité de santé, Saint Denis, France
| | - Marc Chanelière
- Département de médecine générale, Université Lyon I, Lyon, France
| | - Marion Kret
- Comité de coordination de l’évaluation et de la qualité en Aquitaine, Bordeaux, France
| | | | | | | | | | | | - Frédéric Villebrun
- Augustines' clinic, Malestroit, France
- Centres municipaux de santé, Saint-Denis, France
| | - Meredith Makeham
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jean-Luc Quenon
- Comité de coordination de l’évaluation et de la qualité en Aquitaine, Bordeaux, France
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The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.43444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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