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Kim J, Gray JA. Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models. Palliat Support Care 2024; 22:146-154. [PMID: 36683394 DOI: 10.1017/s1478951522001833] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. METHODS Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. RESULTS The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. SIGNIFICANCE OF RESULTS Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.
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Affiliation(s)
- Jinsook Kim
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
| | - Jennifer A Gray
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
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Pesut B, Greig M. Resources for Educating, Training, and Mentoring Nurses and Unregulated Nursing Care Providers in Palliative Care: A Review and Expert Consultation. J Palliat Med 2020; 21:S50-S56. [PMID: 29283870 DOI: 10.1089/jpm.2017.0395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care providers who care for Canadians experiencing life-limiting illness and their families. METHODS This is a systematic search and narrative review in the Canadian context. RESULTS Six previous reviews and 26 primary studies were identified. Studies focusing on regulated nurses indicated that even amid variability in content, delivery methods, and duration, palliative education improves nurses' knowledge, confidence, attitudes, and communication abilities, and decreases nurses' stress. Results from palliative education in undergraduate curriculum were less definitive. However, studies on palliative simulation in undergraduate education suggest that it improves knowledge and confidence. Studies focusing on educating nursing care providers, either alone or in collaboration with regulated nurses, indicated positive outcomes in knowledge, confidence, communication, identification of clients who are dying, abilities to interact with patients and families, and a better understanding of their own contributions to care. Curricular resources in Canada have been developed. However, there is no dedicated and funded capacity-building strategy. DISCUSSION Resources exist to support palliative education for nurses and nursing care providers. Furthermore, the evidence suggests good outcomes from this education. However, there is no dedicated strategy for implementing those resources. Furthermore, there is little evidence of the critical role of knowledge translation in preparing nurses and nursing care providers for evidence-informed palliative practice.
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Affiliation(s)
- Barbara Pesut
- 1 Canada Research Chair, Health, Ethics and Diversity, Faculty of Health and Social Development, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
| | - Madeleine Greig
- 2 Faculty of Health and Social Development, School of Nursing, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
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Friesen L, Andersen E. Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary. J Nurs Manag 2018; 27:461-481. [PMID: 30194886 DOI: 10.1111/jonm.12714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore collaborative and interdisciplinary palliative educational strategies and corresponding outcomes for health care assistants. BACKGROUND Health care assistants are frontline staff who provide almost all hands-on care to seniors. Health care managers are responsible to provide ongoing support and a working environment conducive to health care assistants' abilities to provide quality, safe, evidence-based care. EVALUATION A Qualitative metasummary of collaborative and interdisciplinary teaching strategies was conducted following guidelines developed by Sandelowski et al. (). KEY ISSUES The gold standard of palliative care is interdisciplinary delivery of care, yet education is often monodisciplinary. Furthermore, evaluation of interdisciplinary continuing education is most often subjective via self-report questionnaires. CONCLUSIONS Findings from 16 articles representing 15 studies conducted between 2007 and 2017 were grouped thematically and summarized. Collaborative or interdisciplinary palliative interventions offer health care assistants opportunities to debrief, build their confidence, and critically reflect on the importance of psychosocial care for patients, family and colleagues. IMPLICATIONS FOR NURSING MANAGEMENT The metasummary provides six suggestions for managers who are considering implementing a collaborative palliative educational workshop and draws attention to the need to create contextual changes that support health care assistants to enact newly acquired knowledge and skills.
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Affiliation(s)
- Lynnelle Friesen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
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Dahlin C, Coyne PJ, Cassel JB. The Advanced Practice Registered Nurses Palliative Care Externship: A Model for Primary Palliative Care Education. J Palliat Med 2016; 19:753-9. [DOI: 10.1089/jpm.2015.0491] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Constance Dahlin
- Hospice and Palliative Nurses Association, Pittsburgh, Pennsylvania
- Center to Advance Palliative Care, New York, New York
- North Shore Medical Center, Salem, Massachusetts
| | - Patrick J. Coyne
- Medical University of South Carolina, Charleston, South Carolina
| | - J. Brian Cassel
- Hematology/Oncology and Palliative Care, School of Medicine, Virginia Commonwealth University, Richmond, Virgina
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Anstey S, Powell T, Coles B, Hale R, Gould D. Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Support Palliat Care 2016; 6:353-61. [PMID: 27329513 PMCID: PMC5013161 DOI: 10.1136/bmjspcare-2015-000956] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 05/05/2016] [Indexed: 11/09/2022]
Abstract
Background The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. Objectives To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. Design Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. Results Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. Conclusions There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.
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Affiliation(s)
- Sally Anstey
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tom Powell
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Bernadette Coles
- Cancer Research Wales (CRW) Library, Velindre National Health Trust, Cardiff, UK
| | - Rachel Hale
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Selman L, Robinson V, Klass L, Khan S, George R, Shepherd K, Burman R, Koffman J. Improving confidence and competence of healthcare professionals in end-of-life care: an evaluation of the 'Transforming End of Life Care' course at an acute hospital trust. BMJ Support Palliat Care 2015; 6:231-6. [PMID: 26597902 PMCID: PMC4893143 DOI: 10.1136/bmjspcare-2015-000879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
Abstract
Background UK policymakers, clinicians and public wish to see improvements in end-of-life care (EoLC). However, healthcare professionals’ skills and knowledge to deliver high-quality care are often lacking. Since May 2012, palliative care staff in an inner-city tertiary hospital have run a 2-day Transforming End of Life Care (TEoLC) course to improve EoLC confidence, and competence among hospital and community staff. Aim To evaluate course participants’ self-rated confidence, competence and knowledge of EoLC topics. Evaluation design A before-and-after design using self-completion questionnaires, precourse and postcourse. 14 self-assessment questions examined confidence, understanding and knowledge of EoLC topics. Mean change scores and paired t tests were calculated and free-text responses analysed thematically. Participants 236 staff members completed the course between May 2012 and April 2014. 42% worked in hospitals and 55% in the community; the most frequent staff roles were qualified nurses (49%), senior nurses (16%) and general practitioners (15%). Results All 14 self-assessment topics improved significantly (p<0.001); most improved was ‘understanding and implementing Fast Track discharge’. Qualitative data showed increased knowledge and confidence in EoLC, particularly in communication, commitment to team work and holistic care. Overall, 217 (92%) participants would recommend the course and 215 (98%) indicated it would influence their practice. Conclusions The TEoLC course improved participants’ self-rated confidence, competence and knowledge in EoLC. Findings have utility beyond the UK in light of the international policy recommendations to improve the palliative care skills of generalist healthcare providers.
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Affiliation(s)
- Lucy Selman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | | | - Lara Klass
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Shaheen Khan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rob George
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kate Shepherd
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rachel Burman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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van Riet Paap J, Vernooij-Dassen M, Sommerbakk R, Moyle W, Hjermstad MJ, Leppert W, Vissers K, Engels Y. Implementation of improvement strategies in palliative care: an integrative review. Implement Sci 2015. [PMID: 26210499 PMCID: PMC4515317 DOI: 10.1186/s13012-015-0293-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia. Although a growing number of new insights and best practices in palliative care have been published, they are often not implemented in daily practice. The aim of this integrative review is to provide an overview of implementation strategies that have been used to improve the organisation of palliative care. Methods Using an integrative literature review, we evaluated publications with strategies to improve the organisation of palliative care. Qualitative analysis of the included studies involved categorisation of the implementation strategies into subgroups, according to the type of implementation strategy. Results From the 2379 publications identified, 68 studies with an experimental or quasi-experimental design were included. These studies described improvements using educational strategies (n = 14), process mapping (n = 1), feedback (n = 1), multidisciplinary meetings (n = 1) and multi-faceted implementation strategies (n = 51). Fifty-three studies reported positive outcomes, 11 studies reported mixed effects and four studies showed a limited effect (two educational and two multi-faceted strategies). Conclusions This review is one of the first to provide an overview of the available literature in relation to strategies used to improve the organisation of palliative care. Since most studies reported positive results, further research is needed to identify and improve the effects of strategies aiming to improve the organisation of palliative care. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0293-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Nijmegen Alzheimer Centre, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Kalorama Foundation, Nijmegen, The Netherlands.
| | - Ragni Sommerbakk
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway.
| | - Wendy Moyle
- Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan, Brisbane, Australia.
| | - Marianne J Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway. .,Regional Centre for Excellence in Palliative Care Department of Oncology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland.
| | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Potter G, Pesut B, Hooper BP, Erbacker L. Team-Based Education in a Palliative Approach for Rural Nurses and Unlicensed Care Providers. J Contin Educ Nurs 2015; 46:279-88. [DOI: 10.3928/00220124-20150518-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 02/04/2015] [Indexed: 11/20/2022]
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Pesut B, Potter G, Stajduhar K, Sawatzky R, McLeod B, Drabot K. Palliative approach education for rural nurses and health-care workers: a mixed-method study. Int J Palliat Nurs 2015; 21:142-51. [DOI: 10.12968/ijpn.2015.21.3.142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barbara Pesut
- Associate Professor of Nursing, Canada Research Chair in Health, Ethics and Diversity, University of British Columbia
| | - Gail Potter
- Nursing Faculty, Selkirk College, British Columbia
| | - Kelli Stajduhar
- Professor School of Nursing and Centre on Aging, University of Victoria and Research Scientist, Fraser Health Authority End of Life Program, Fraser Health, British Columbia
| | - Richard Sawatzky
- Associate Professor and Canada Research Chair, Trinity Western University, British Columbia and Research Scientist, Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute
| | - Barbara McLeod
- Hospice Palliative Care Clinical Nurse Specialist, Fraser Health and Adjunct Professor, School of Nursing, University of British Columbia
| | - Karly Drabot
- Research Coordinator, University of British Columbia, Okanagan, Canada
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Stanhope J, Pearce C. Role, implementation, and effectiveness of advanced allied health assistants: a systematic review. J Multidiscip Healthc 2013; 6:423-34. [PMID: 24324337 PMCID: PMC3855013 DOI: 10.2147/jmdh.s50185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this systematic review was to determine the effectiveness and implementation of advanced allied health assistant roles. Methods A systematic search of seven databases and Google Scholar was conducted to identify studies published in English peer-reviewed journals from 2003 to 2013 and reporting on the effectiveness and implementation of advanced allied health assistant (A/AHA) roles. Reference lists were also screened to identify additional studies, and the authors’ personal collections of studies were searched. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, and appraisal of higher-level studies (III-1 and above) conducted using the Centre for Evidence Based Medicine Systematic Review Critical Appraisal Sheet for included systematic reviews or the PEDro scale for level II and III-1 studies. Data regarding country, A/AHA title, disciplines, competencies, tasks, level of autonomy, clients, training, and issues regarding the implementation of these roles were extracted, as were outcomes used and key findings for studies investigating their effectiveness. Results Fifty-three studies were included, and most because they reported background information rather than investigating A/AHA roles, this representing low-level information. A/AHAs work in a range of disciplines, with a variety of client groups, and in a number of different settings. Little was reported regarding the training available for A/AHAs. Four studies investigated the effectiveness of these roles, finding that they were generally well accepted by clients, and provided more therapy time. Issues in integrating these new roles into existing health systems were also reported. Conclusion A/AHA roles are being implemented in a range of settings, and appear to be effective in terms of process measures and stakeholder perceptions. Few studies have investigated these roles, indicating a need for research to be conducted in this area to enable policy-makers to consider the value of these positions and how they can best be utilized.
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Affiliation(s)
- Jessica Stanhope
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
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Frey R, Gott M, Banfield R. What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers? A critical literature review. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pulsford D, Jackson G, O'Brien T, Yates S, Duxbury J. Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review. Palliat Med 2013; 27:221-35. [PMID: 22126845 DOI: 10.1177/0269216311429496] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Staff from a range of health and social care professions report deficits in their knowledge and skills when providing end-of-life and palliative care, and education and training has been advocated at a range of levels. AIMS To review the literature related to classroom-based and distance learning education and training initiatives for health and social care staff in end-of-life and palliative care, in terms of their target audience, extent, modes of delivery, content and teaching and learning strategies, and to identify the most effective educational strategies for enhancing care. DESIGN A systematic review of the literature evaluating classroom-based and distance learning education and training courses for health and social care staff in end-of-life and palliative care. DATA SOURCES Online databases CINAHL, MEDLINE, EMBASE and PSYCHINFO between January 2000 and July 2010. Studies were selected that discussed specific education and training initiatives and included pre-and post-test evaluation of participants' learning. RESULTS 30 studies met eligibility criteria. The majority reported successful outcomes, though there were some exceptions. Level of prior experience and availability of practice reinforcement influenced learning. Participative and interactive learning strategies were predominantly used along with discussion of case scenarios. Multi-professional learning was infrequently reported and service user and carer input to curriculum development and delivery was reported in only one study. CONCLUSIONS Classroom-based education and training is useful for enhancing professionals' skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience.
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Affiliation(s)
- David Pulsford
- School of Health, University of Central Lancashire, Preston, UK.
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