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Gupta S, Panchal P, Sadatsafavi M, Ghanouni P, Sin D, Pakhale S, To T, Zafari Z, Nimmon L. A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study. Addict Sci Clin Pract 2022; 17:1. [PMID: 34991699 PMCID: PMC8734321 DOI: 10.1186/s13722-021-00283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/03/2021] [Indexed: 01/24/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00283-1.
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Affiliation(s)
- Samir Gupta
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, St. Michael's Hospital, Suite 6044, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Puru Panchal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parisa Ghanouni
- Faculty of Health, School of Occupational Therapy, Halifax, NS, Canada
| | - Don Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Smita Pakhale
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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Haga SB, Mills R, Moaddeb J, Liu Y, Voora D. Delivery of Pharmacogenetic Testing with or without Medication Therapy Management in a Community Pharmacy Setting. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:785-796. [PMID: 34276225 PMCID: PMC8277445 DOI: 10.2147/pgpm.s314961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
Objective The delivery of pharmacogenetic (PGx) testing has primarily been through clinical and hospital settings. We conducted a study to explore the feasibility of delivering PGx testing through community pharmacies, a less-studied setting. Methods We conducted a cluster randomized trial of community pharmacies in North Carolina through two approaches: the provision of PGx testing alone or PGx testing with medication therapy management (MTM). Results A total of 150 patient participants were enrolled at 17 pharmacies and reported high satisfaction with their testing experience. Participants in the PGx plus MTM arm were more likely to recall a higher number of results (p=0.04) and more likely to clearly understand their choices for prevention or early detection of side effects (p=0.01). A medication or dose change based on the PGx results was made for 8.7% of participants. Conclusion Limited differences were observed in the provision of PGx testing as a standalone test or combined with MTM. A limited number of treatment changes were made based on PGx test results. Patient acceptance of PGx testing offered through the community pharmacy was very high, but the addition of MTM did not impact patient-reported perceptions about PGx testing or medication adherence.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Yiling Liu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Deepak Voora
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
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El-Daly I, Ibraheim H, Rajakulendran K, Culpan P, Bates P. Are patient-reported outcome measures in orthopaedics easily read by patients? Clin Orthop Relat Res 2016; 474:246-55. [PMID: 26472587 PMCID: PMC4686523 DOI: 10.1007/s11999-015-4595-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/06/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated. QUESTIONS/PURPOSES We wished to determine the readability of commonly used PROMs in orthopaedic surgery, as assessed by a validated tool that measures the complexity of the language in these surveys. METHODS We performed a MEDLINE search to identify the most-commonly reported PROMs in orthopaedic research. One hundred twenty-one PROMs were identified and reviewed by 19 attending orthopaedic surgeons at our institution. Fifty-nine were selected as the most commonly used in our department. Of these, 52 (78%) were disease specific and included: 12 (20%) knee, 10 (17%) shoulder, seven (12%) spine, six (10%) hip, five (8%) foot and ankle, four (7%) elbow, three (5%) pelvis, three (5%) hand and wrist, and two (3%) lower limb. The remaining seven (12%) PROMs were general health questionnaires. The Flesch Reading Ease Score is a validated readability tool measuring average sentence length and syllables per word. It is expressed on a scale from 0 to 100 with higher scores indicating easier reading. We extracted the text from each PROM and inserted it in the same online Flesch Reading Ease Score calculator to generate a score. RESULTS The mean readability score was 55 (range, 0-93), corresponding to text best understood by 16- to 18-year-old students (11th-12th grades). Twenty-nine PROMs (49%) scored less than 60, classifying them as at least fairly difficult to read. Eight (14%) scored less than 30, best understood by university graduates. Only seven of 59 PROMs analyzed scored greater than 79, corresponding to text that can be understood by the average UK adult. CONCLUSIONS The majority of PROMs analyzed are written at a level that is incomprehensible to the average UK adult. CLINICAL RELEVANCE This issue needs to be addressed if we are to continue basing our research conclusions on outcome scores. The information obtained is useful for patients to understand their musculoskeletal health, governmental agencies allocating healthcare resources, provision of management guidelines, and as a link to other data sets, such as hospital episodes statistics. Accurate and reliable data can be obtained only if patients who complete these evaluations are able to read and understand the questions asked.
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Affiliation(s)
- Ibraheim El-Daly
- grid.416041.60000000107385466Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - Hajir Ibraheim
- Department of Trauma and Orthopaedic Surgery, Basildon and Thurrock University Hospitals, Basildon, Essex, UK
| | - Karthig Rajakulendran
- Department of Trauma and Orthopaedic Surgery, Basildon and Thurrock University Hospitals, Basildon, Essex, UK
| | - Paul Culpan
- grid.416041.60000000107385466Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - Peter Bates
- grid.416041.60000000107385466Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
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Okuhara T, Ishikawa H, Okada H, Kiuchi T. Readability, Suitability and Health Content Assessment of Cancer Screening Announcements in Municipal Newspapers in Japan. Asian Pac J Cancer Prev 2015; 16:6719-27. [DOI: 10.7314/apjcp.2015.16.15.6719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bailey SC, Navaratnam P, Black H, Russell AL, Wolf MS. Advancing Best Practices for Prescription Drug Labeling. Ann Pharmacother 2015; 49:1222-36. [DOI: 10.1177/1060028015602272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Problematic prescription drug labeling has been cited as a root cause of patient misunderstanding, medication errors, and nonadherence. Although numerous studies have recently been conducted to identify and test labeling best practices, the last systematic review on this topic was conducted a decade ago. The objective of this review was, therefore, to examine, summarize, and update best practices for conveying written prescription medication information and instructions to patients. Data Sources: English-language articles published from June 2005 to June 2015 were identified in MEDLINE and CINAHL by searching the following text words: ‘ medication OR prescription OR drug’ AND ‘label OR leaflet OR brochure OR pamphlet OR medication guide OR medication insert OR drug insert OR medication information OR drug information OR instructions’ AND ‘ patient OR consumer.’ Reference mining and secondary searches were also performed. Study Selection and Data Extraction: A total of 31 articles providing evidence on how to improve written, prescription drug labeling for patient use were selected. Two reviewers independently screened articles, rated their quality, and abstracted data. Data Synthesis: Identified best practices included the use of plain language, improved formatting and organization, and more explicit instructions to improve patient comprehension. The use of icons had conflicting findings, and few studies tested whether practices improved knowledge or behaviors with patients’ actual prescribed regimens. Conclusions: Future studies are needed to determine how specific modifications and improvements in drug labeling can enhance patient knowledge and behavior in actual use. Synthesizing best practices across all patient materials will create a more useful, coordinated system of prescription information.
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Affiliation(s)
- Stacy Cooper Bailey
- Eshelman School of Pharmacy at The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Allison L. Russell
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Okuhara T, Ishikawa H, Okada H, Kiuchi T. Identification of gain- and loss-framed cancer screening messages that appeared in municipal newsletters in Japan. BMC Res Notes 2014; 7:896. [PMID: 25494623 PMCID: PMC4295292 DOI: 10.1186/1756-0500-7-896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background Research suggests that cancer screening messages are more persuasive when framed in terms of the costs of not obtaining screening (i.e., loss-framed) than when framed in terms of the benefits of obtaining screening (i.e., gain-framed). However, to what extent these findings have been integrated into public health practice is unknown. To analyze message framing of cancer screening information, the present study examined message framing of cancer screening announcement articles that appeared in municipal newsletters published from 23 wards in central Tokyo, Japan. Two independent raters coded the articles. Gain- and loss-framed sentences in each article were identified, and based on what the sentences conveyed, articles were classified into gain-framed, loss-framed, mixed-framed, and non-framed. Result Inter-rater reliability was acceptable (intraclass correlation coefficient = 0.88). Of the 129 articles evaluated, the total number of gain-framed sentences was 87, while that of loss-framed sentences was six. The total number of gain-framed articles was 32 (24.8%) while that of loss-framed articles was zero (0%). Five (3.9%) articles were mixed-framed. Ninety-two (71.3%) articles were non-framed. Conclusions Cancer screening announcement articles of municipal newsletters were mostly non-framed or gain-framed in 23 Tokyo wards in Japan. The absence of loss-framed articles and only a small number of loss-framed messages indicate a missed opportunity to persuade readers to obtain cancer screenings. Loss-framed messages and articles need to be increased to enhance the persuasiveness of cancer screening information in municipal newsletters.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Social Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Ryan L, Logsdon MC, McGill S, Stikes R, Senior B, Helinger B, Small B, Davis DW. Evaluation of printed health education materials for use by low-education families. J Nurs Scholarsh 2014; 46:218-28. [PMID: 24597957 DOI: 10.1111/jnu.12076] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. METHODS Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. RESULTS Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. CONCLUSIONS Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. CLINICAL RELEVANCE Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.
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Affiliation(s)
- Lesa Ryan
- Medical Student, University of Louisville, School of Medicine, Department of Pediatrics, Louisville, KY
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McGlone MS, Bell RA, Zaitchik ST, McGlynn J. Don't let the flu catch you: agency assignment in printed educational materials about the H1N1 influenza virus. JOURNAL OF HEALTH COMMUNICATION 2012; 18:740-756. [PMID: 23216010 DOI: 10.1080/10810730.2012.727950] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In English and in other languages, the agency for viral transmission can be grammatically assigned to people (e.g., Thousands may contract H1N1) or to the virus itself (e.g., H1N1 may infect thousands). These assignment options shape different conceptions of transmission as attributable either to social contact within one's control or to pursuit of an active predator. The authors tested the effect of agency assignment and agentic images on young adults' (N = 246) reactions to educational materials about H1N1 influenza. The authors hypothesized that assigning agency to the virus would heighten perceived severity and personal susceptibility relative to human agency assignment. Results were consistent with this hypothesis, indicating that virus agency increased perceptions of severity, personal susceptibility, and reported intentions to seek vaccination relative to human agency. The image manipulation did not directly affect these factors. The findings suggest that strategic agency assignment can improve the effectiveness of educational materials about influenza and other health threats.
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Affiliation(s)
- Matthew S McGlone
- Department of Communication Studies, University of Texas at Austin, Austin, TX 78712, USA.
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Faett BL, Geyer MJ, Hoffman LA, Brienza DM. Design and development of a telerehabilitation self-management program for persons with chronic lower limb swelling and mobility limitations: preliminary evidence. Nurs Res Pract 2012; 2012:608059. [PMID: 23227323 PMCID: PMC3514836 DOI: 10.1155/2012/608059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 11/21/2022] Open
Abstract
This paper describes design and development of a self-management program, delivered by telerehabilitation (TR), to address the problem of chronic lower limb swelling in persons with limited mobility. The 18.6 million persons with limited mobility in the USA are at increased risk for chronic lower limb swelling and related secondary complications, including cellulitis and skin ulcers. Over time, chronic swelling often progresses to lymphedema, an incurable condition requiring lifelong care. Without successful self-management, lymphedema and its related complications inevitably worsen. Access and adherence to appropriate treatment are challenging for persons with limited mobility. Program development involved a structured process to establish content validity (videos and manuals), readability, suitability, and selection of a TR platform to deliver the educational program. Our goal was to develop a program that would engage patients in self-management skills. The TR software platform chosen, Versatile and Integrated System for Telerehabilitation (VISYTER) was designed to facilitate face-to-face delivery of an interactive home-based self-management program via the internet in real time. Results demonstrated validity of the educational program and ease of use with TR. Future plans are to evaluate ability of this approach to promote self-management skills, home monitoring, and improved management of persons with lymphedema and limited mobility.
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Affiliation(s)
- Becky L. Faett
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
| | - Mary Jo Geyer
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
| | - Leslie A. Hoffman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - David M. Brienza
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
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Hoffmann T, Ladner Y. Assessing the suitability of written stroke materials: an evaluation of the interrater reliability of the suitability assessment of materials (SAM) checklist. Top Stroke Rehabil 2012; 19:417-22. [PMID: 22982829 DOI: 10.1310/tsr1905-417] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Written materials are frequently used to provide education to stroke patients and their carers. However, poor quality materials are a barrier to effective information provision. A quick and reliable method of evaluating material quality is needed. This study evaluated the interrater reliability of the Suitability Assessment of Materials (SAM) checklist in a sample of written stroke education materials. METHODS Two independent raters evaluated the materials (n = 25) using the SAM, and ratings were analyzed to reveal total percentage agreements and weighted kappa values for individual items and overall SAM rating. RESULTS The majority of the individual SAM items had high interrater reliability, with 17 of the 22 items achieving substantial, almost perfect, or perfect weighted kappa value scores. The overall SAM rating achieved a weighted kappa value of 0.60, with a percentage total agreement of 96%. CONCLUSION Health care professionals should evaluate the content and design characteristics of written education materials before using them with patients. A tool such as the SAM checklist can be used; however, raters should exercise caution when interpreting results from items with more subjective scoring criteria. Refinements to the scoring criteria for these items are recommended. The value of the SAM is that it can be used to identify specific elements that should be modified before education materials are provided to patients.
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Affiliation(s)
- Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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PDM volume 21 supplement 3 Cover and Back matter. Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x00015934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nasser S, Mullan J, Bajorek B. Assessing the quality, suitability and readability of internet-based health information about warfarin for patients. Australas Med J 2012; 5:194-203. [PMID: 22952566 PMCID: PMC3433734 DOI: 10.4066/amj.2012862] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet. METHOD Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites. RESULTS The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an 'adequate' score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an 'adequate' score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less). CONCLUSION Despite the overall 'adequate' quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills.
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Affiliation(s)
- Sayeed Nasser
- Faculty of Pharmacy, University of Sydney, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Australia
| | - Beata Bajorek
- Graduate School of Health (School of Pharmacy), University of Technology Sydney, Australia
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Abstract
Today, in the health care profession, all types of medication errors including missed dose, wrong dosage forms, wrong time interval, wrong route, etc., are a big deal for better patient care. Today, problems related to medications are common in the healthcare profession, and are responsible for significant morbidity, mortality, and cost. Several recent studies have demonstrated that patients frequently have difficulty in reading and understanding medication labels. According to the Institute of Medicine report, "Preventing Medication Errors", cited poor labeling as a central cause for medication errors in the USA. Evidence suggests that specific content and format of prescription drug labels facilitate communication with and comprehension by patients. Efforts to improve the labels should be guided by such evidence, although an additional study assessing the influence of label design on medication-taking behavior and health outcomes is needed. Several policy options exist to require minimal standards to optimize medical therapy, particularly in light of the new Medicare prescription drug benefit.
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Affiliation(s)
- G Jeetu
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
| | - T Girish
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India
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Abstract
INTRODUCTION Increasingly, individuals are relying on the Internet as a major source of health information. When faced with sudden or pending disasters, people resort to the Internet in search of clear, current, and accurate instructions on how to prepare for and respond to such emergencies. Research about online health resources ascertained that information was written at the secondary education and college levels and extremely difficult for individuals with limited literacy to comprehend. This content analysis is the first to assess the reading difficulty level and format suitability of a large number of disaster and emergency preparedness Web pages intended for the general public. OBJECTIVES The aims of this study were to: (1) assess the readability and suitability of disaster and emergency preparedness information on the Web; and (2) determine whether the reading difficulty level and suitability of online resources differ by the type of disaster or emergency and/or Website domain. METHODS Fifty Websites containing information on disaster and/or emergency preparedness were retrieved using the Google search engine. Readability testing was conducted on the first Web page, suggested by Google, addressing preparedness for the general public. The reading level was assessed using Flesch-Kincaid (F-K) and Flesch Reading Ease (FRE) measures. The Suitability Assessment of Materials (SAM) instrument was used to evaluate additional factors such as graphics, layout, and cultural appropriateness. RESULTS The mean F-K readability score of the 50 Websites was Grade 10.74 (95% CI = 9.93, 11.55). The mean FRE score was 45.74 (95% CI = 41.38, 50.10), a score considered "difficult."A Web page with content about both risk and preparedness supplies was the most difficult to read according to F-K (Grade level = 12.1). Web pages with general disaster and emergency information and preparedness supplies were considered most difficult according to the FRE (38.58, 95% CI = 30.09, 47.08). The average SAM score was 48% or 0.48 (95% CI = 0.45, 0.51), implying below average suitability of these Websites. Websites on pandemics and bioterrorism were the most difficult to read (F-K: p = 0.012; FRE: p = 0.014) and least suitable (SAM: p = 0.035) compared with other disasters and emergencies. CONCLUSIONS The results suggest the need for readily accessible preparedness resources on the Web that are easy-to-read and visually appropriate. Interdisciplinary collaborations between public health educators, risk communication specialists, and Web page creators and writers are recommended to ensure the development and dissemination of disaster and emergency resources that consider literacy abilities of the general public.
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Franks AS, Ray SM, Wallace LS, Keenum AJ, Weiss BD. Do Medication Samples Jeopardize Patient Safety? Ann Pharmacother 2009; 43:51-6. [DOI: 10.1345/aph.1l362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Medication samples are commonly dispensed by prescribers. Written consumer medication information (CMI) provided with sample packaging is an important source of patient information. Although one-third of Americans have health literacy deficiencies, previous studies have found that CMI is often too complex for many patients to understand. This may prevent patients from using these medications appropriately. OBJECTIVE To evaluate readability and formatting characteristics of CMI included with nonsolid (ie, topical cream/lotion, inhalation, transdermal) drug samples. METHODS We collected a convenience sample of nonsolid dosage sample medications (N = 55) from several different private and university-affiliated primary care and specialty physician practices at a large academic medical center in the southeastern US. We noted whether CMI was present and, if it was, we assessed it for instruction presentation, reading level, text size, format/layout, and comprehensibility. RESULTS Most (43 of 55) products included CMI, either as a separate leaflet or directly on the packaging. Reading level of CMI leaflets ranged from the 6th- to 14th-grade level, with just 4 (16.0%) written at the recommended 6th-grade level. Text font point size was 9.48 ± 2.14 (mean ± SD; range 5–12). Text printed directly on sample packaging averaged 6.61 point ± 2.62 (4–11) font size. Ninety-two percent of CMI leaflets included a combination of text and pictures; only 11.1% of CMI printed directly on the packaging used pictorial aids. CONCLUSIONS Most CMI accompanying nonsolid medication samples is written at a reading level that exceeds that of many consumers and does not meet recommended standards for readability and comprehensibility of patient education material.
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Affiliation(s)
- Andrea S Franks
- Andrea S Franks PharmD BCPS, Associate Professor, Departments of Clinical Pharmacy and Family Medicine, College of Pharmacy and Graduate School of Medicine, University of Tennessee, Knoxville, TN
| | - Shaunta’ M Ray
- Shaunta’ M Ray PharmD BCPS, Assistant Professor, Departments of Clinical Pharmacy and Family Medicine, College of Pharmacy and Graduate School of Medicine, University of Tennessee
| | - Lorraine S Wallace
- Lorraine S Wallace PhD, Associate Professor, Department of Family Medicine, Graduate School of Medicine, University of Tennessee
| | - Amy J Keenum
- Amy J Keenum PharmD DO, Associate Professor, Department of Family Medicine, Graduate School of Medicine, University of Tennessee
| | - Barry D Weiss
- Barry D Weiss MD, Professor, Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ
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Shieh C, Hosei B. Printed Health Information Materials: Evaluation of Readability and Suitability. J Community Health Nurs 2008; 25:73-90. [DOI: 10.1080/07370010802017083] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wallace LS, Keenum AJ, Roskos SE, Blake GH, Colwell ST, Weiss BD. Suitability and readability of consumer medical information accompanying prescription medication samples. PATIENT EDUCATION AND COUNSELING 2008; 70:420-425. [PMID: 18178363 DOI: 10.1016/j.pec.2007.11.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/21/2007] [Accepted: 11/22/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples. METHODS We collected the most commonly used prescription medication samples (n=100) from four out-patient clinics at a large teaching hospital in the Southeastern US. Seventeen percent of samples were not pills/tablets and of such diverse nature (e.g., injections, drops, and creams) that there were not enough in any category to draw conclusions. Therefore, our analyses were limited to 83pill/tablet samples, belonging to 11 drug classes (e.g., cardiovascular, and psychiatric). We noted if CMI was present, and if so we assessed it for how instructions were presented, reading level, text size, format/layout, and comprehensibility. RESULTS No CMI was present in 39 (46.9%) samples. In 19 (22.9%), CMI was contained in a package insert and in 25 (30.2%) it was printed on the medication package. Average reading difficulty of CMI was at the 10th grade level (range=6-15) using the Fry formula, and text point size was small (mean 9.9+/-2.2 on package inserts and 9.4+/-2.6 when printed on packages). CONCLUSIONS Almost half of samples did not include any type of CMI. For those that had CMI, it was often written at a reading difficulty level higher than the average reading skills of American adults, and the format of most CMI was not optimal for comprehensibility. It is likely that many patients do not understand the instructions accompanying medication samples they receive from clinicians. PRACTICE IMPLICATIONS Clinicians should be cognizant of the shortcomings of CMI accompanying medication samples and thereby, distribute them to patients with caution. Manufacturers too should consider revising CMI to comply with low-literacy guidelines.
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Affiliation(s)
- Lorraine S Wallace
- University of Tennessee Graduate School of Medicine, Department of Family Medicine, 1924 Alcoa Highway, U-67, Knoxville, TN 37920, United States.
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Wallace LS, Keenum AJ, Roskos SE, Koopman RJ, Young KG. Blood glucose monitor quick reference guides: are they suitable for patients? Diabetes Technol Ther 2008; 10:11-5. [PMID: 18275358 DOI: 10.1089/dia.2007.0258] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to assess readability and related characteristics of English-language Quick Reference Guides (QRGs) accompanying home blood glucose monitors (HBGMs), including reading grade level, dimensions, text point size, illustrations, and layout features. METHODS Using the 2006 Diabetes Forecast Resource Guide, we identified HBGMs currently available in the United States. Reading grade level was calculated using Flesch Reading Ease (FRE). Text point size was determined by measuring the distance from the ascent line to the descent line with a C-Thru (Bloomfield, CT) Ruler. Total number of illustrations per QRG was tallied. Illustration dimensions were measured to the nearest millimeter. We also assessed layout features-derived from the Suitability of Materials Assessment and User-Friendliness Tool-including, font style type, use of white space, sentence structure, language style, limited math skill, focus on "Need to Know," and appropriateness of illustrations. RESULTS FRE scores ranged from 5(th) to approximately 13(th) grade, while text point size averaged 9.9 +/- 1.6 (range, 8-12). QRGs averaged 15.8.2 +/- 6.0 (range, 6-25) clear and realistic illustrations, most slightly larger than a quarter. Most QRGs avoided use of specialty fonts (85.7%) and limited information to "Need to Know" (92.9%). All instructions required little math skill; however, ample white space was used in five (35.7%) QRGs. CONCLUSIONS HBGM manufacturers should increase the size of QRG fold-outs, thereby allowing for larger text size and illustrations, and increasing the amount of white space. Making these relatively small formatting changes would ensure that all patients with diabetes, particularly those with visual impairments, are able to follow HBGM instructions.
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Affiliation(s)
- Lorraine S Wallace
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, U-67 Knoxville, TN 37920, USA.
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Roskos SE, Wallace LS, Weiss BD. Readability of consumer medication information for intranasal corticosteroid inhalers. Am J Health Syst Pharm 2008; 65:65-8. [DOI: 10.2146/ajhp070087] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Steven E. Roskos
- Department of Family Medicine, Michigan State University, East Lansing; when this article was written, he was Assistant Professor, Department of Family Medicine, University of Tennessee Graduate School of Medicine (UTGSM), Knoxville
| | | | - Barry D. Weiss
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson
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Roskos SE, Keenum AJ, Newman LM, Wallace LS. Literacy Demands and Formatting Characteristics of Opioid Contracts in Chronic Nonmalignant Pain Management. THE JOURNAL OF PAIN 2007; 8:753-8. [PMID: 17382596 DOI: 10.1016/j.jpain.2007.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 12/05/2006] [Accepted: 01/05/2007] [Indexed: 11/22/2022]
Abstract
UNLABELLED Chronic nonmalignant pain affects a significant number of adults, with many requiring opioid medications to manage their symptoms. Although the content of typical opioid contracts (OCs) has been explored, no studies have examined the literacy demands and formatting characteristics of OCs currently used throughout the United States. We evaluated 162 English-language OCs submitted to us by current American Pain Society members residing in the United States. OCs were evaluated for reading grade level and formatting characteristics. The mean readability of OCs was at grade level 13.8 +/- 1.3 (range = 10-17), whereas the average text point size was 11.0 +/- 1.4 (range = 6-16). Active voice was used exclusively in almost half of OCs (n = 79, 48.8%). Most OCs contained not only sophisticated medical language but multisyllable, nonmedical terms and vocabulary not used in typical everyday conversation. Overall, most OCs reviewed presented information at much too high a reading grade level, and with formatting characteristics that probably would make these documents difficult for the average patient to fully comprehend. PERSPECTIVE This study indicates that there is a mismatch between the reading demands of most OCs and the actual health literacy skills of American adults. Accordingly, those developing OCs should be cognizant of the actual literacy abilities of their patient population and design and evaluate OCs accordingly.
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Affiliation(s)
- Steven E Roskos
- University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, Tennessee 37920, USA
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Wallace LS, Keenum AJ, Roskos SE, McDaniel KS. Development and Validation of a Low-Literacy Opioid Contract. THE JOURNAL OF PAIN 2007; 8:759-66. [PMID: 17569596 DOI: 10.1016/j.jpain.2007.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/30/2007] [Accepted: 05/08/2007] [Indexed: 01/22/2023]
Abstract
UNLABELLED Opioid contracts (OPCs) are often used to outline the criteria and circumstances for which opioid medications are prescribed. The purpose of this study was to develop and validate an English-language, low-literacy OPC. Specifically, the low-literacy OPC was designed to outline proper administration of prescribed medication(s) as well as highlight patient responsibilities and expectations. A 4-step process was used to develop and validate the low-literacy OPC, including: (1) content identification; (2) attention to low-literacy guidelines; (3) evaluation based on Suitability Assessment of Materials (SAM) criteria; and (4) pilot testing with patients (n = 18) to assess comprehension. Final OPC content, presented largely in bulleted format, was based on current literature and consensus of the first 3 authors. The 4-part OPC was formatted on 8(1/2) x 11 inch paper using 16- to 24-point size Arial-style font. The 6-page OPC, written at the 7(th) reading grade level, included 12 recognizable clipart-type illustrations to supplement written text. Two reviewers scored the OPC in the superior range based on total SAM percentage scores. Nineteen (n = 19) of the 26 statements were comprehended by all patients completing the pilot testing. Overall, the low-literacy OPC is comprehensive, valid, readable, and formatted according to established low-literacy guidelines. PERSPECTIVE This study describes the development and validation of a low-literacy, English-language OPC. The OPC was formatted using low-literacy guidelines and validated with a sample of patients to confirm understanding of content. Accordingly, the low-literacy OPC is suitable for use in routine clinical practice.
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Affiliation(s)
- Lorraine S Wallace
- University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, Tennessee 37920, USA.
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Zite NB, Philipson SJ, Wallace LS. Consent to Sterilization section of the Medicaid-Title XIX form: is it understandable? Contraception 2007; 75:256-60. [PMID: 17362702 DOI: 10.1016/j.contraception.2006.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 11/27/2006] [Accepted: 12/11/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We sought to assess readability and comprehension characteristics of the Consent to Sterilization section of the Medicaid-Title XIX form (Title XIX-SCF) in order to determine if it was likely providing informed consent to the Medicaid population. MATERIALS AND METHODS The current Title XIX-SCF was evaluated using the Readability and Processability Form (RPF). The RPF, designed to assess the format of informed consent documents, assigns points to each of 20 areas of comprehension analysis according to established scoring criteria. Finally, a modified Title XIX-SCF was developed and evaluated using the RPF. RESULTS The overall RPF score for the current Title XIX-SCF was in the "poor" range (total=37), while the Fry reading level was at the ninth grade. The modified Title XIX-SCF scored in the "excellent" range (total=92), while the Fry reading level was at the sixth grade. CONCLUSIONS The readability and comprehension demands of the current Title XIX-SCF exceed recommended guidelines for patient education and informed consent materials. The current Title XIX-SCF should be revised to ensure that women understand, desire and consent to permanent sterilization.
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Affiliation(s)
- Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.
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Wallace LS, Roskos SE, Weiss BD. Readability characteristics of consumer medication information for asthma inhalation devices. J Asthma 2006; 43:375-8. [PMID: 16801142 DOI: 10.1080/02770900600709856] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Successful control of asthma relies heavily on patient adherence to prescribed inhalation therapies. Many patients are unable to use inhalers correctly and, therefore, do not reap the full therapeutic benefits. The purpose of this study was to assess the readability and related characteristics of Consumer Medication Information (CMI) for all prescription asthma inhalation devices currently available in the United States. METHODS We identified all brand-name (n = 18) and generic (n = 2) asthma inhalation devices currently available in the United States. English language CMI was obtained from pharmaceutical manufacturers of each identified product. The CMI from these products was evaluated for readability characteristics, including reading grade level using the Fry formula, text point size, dimensions (length and width), diagrams, and directions. RESULTS The mean Fry readability of the CMI was at grade level 8.2 +/- 1.5 (range = 5-11), while the average text point size was 9.2 +/- 2.2 (range = 6-12). The mean length of the pages on which the CMI was printed was 33.7 +/- 21.5 cm, while the average width of pages was 12.9 +/- 9.5 cm. There was an average of 6.2 +/- 3.6 (range = 2-12) illustrations per CMI, while a device overview diagram was included in 14 (70%). Eleven (n = 11) instructions included detailed step-by-step diagrams to supplement directions. CONCLUSIONS Overall, most CMI for prescription inhalers is presented with a reading difficulty level, text size, diagrams, and instructions that make it suboptimal for patient education. Prescription inhaler manufacturers should consider revising their CMI to comply with generally accepted guidelines preparing patient education information.
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Affiliation(s)
- Lorraine S Wallace
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
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