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Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients. Palliat Support Care 2021; 19:547-551. [PMID: 33958022 DOI: 10.1017/s1478951520001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The accurate estimation of expected survival in terminal cancer patients is important. The palliative performance scale (PPS) is an important factor in predicting survival of hospice patients. The purpose of this study was to examine how initial status of PPS and changes in PPS affect the survival of hospice patients in Korea. METHOD We retrospectively examined 315 patients who were admitted to our hospice unit between January 2017 and December 2018. The patients were divided based on the PPS of ≥50% (group A) and ≤40% (group B). We performed survival analysis for factors associated with the length of survival (LOS) in group A. Based on the hospice team's weekly evaluation of PPS, we examined the effect of initial levels and changes in group A on the prognosis of patients who survived for 2 weeks or more. RESULTS At the time of admission to hospice, 265 (84.1%) patients were PPS ≥50%, and 50 (15.9%) were PPS ≤40%. The median LOS of PPS ≥50% and PPS ≤40% were 15 (2-158 days) and 9 (2-43 days), respectively. Male, gastrointestinal cancer, and lower initial PPS all predicted poor prognosis in group A. Male, gastrointestinal cancer, and a PPS change of 10% or greater, compared with initial status 1 week and 2 weeks of hospitalization, were all predictors of poor prognosis in group A patients who survived for 2 weeks or longer. SIGNIFICANCE OF RESULTS Our research demonstrates the significance of PPS change at 1 week and 2 weeks, suggesting the importance of evaluating not only initial PPS but also change in PPS.
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Park EJ, Park K, Kim JJ, Oh SB, Jung KS, Oh SY, Hong YJ, Kim JH, Jang JY, Jeon UB. Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study. Cancer Res Treat 2020; 53:881-888. [PMID: 33355838 PMCID: PMC8291194 DOI: 10.4143/crt.2020.1008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access. Materials and Methods Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death). Results A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p < 0.001). Conclusion Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.
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Affiliation(s)
- Eun Ju Park
- Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kwonoh Park
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae-Joon Kim
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang-Bo Oh
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ki Sun Jung
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - So Yeon Oh
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Jeong Hong
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Joo Yeon Jang
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ung-Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Seo MS, Hwang IC, Jung J, Lee H, Choi JH, Shim JY. Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study. BMC Palliat Care 2020; 19:94. [PMID: 32611346 PMCID: PMC7331249 DOI: 10.1186/s12904-020-00607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although palliative care providers, patients, and their families rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention. Methods As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to a single hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independent prognostic factors. Results Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. The median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatremia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR = 1.45, 95% CI: 1.09–1.94), leukocytosis (HR = 1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR = 2.06, 95% CI: 1.49–2.73), and hypernatremia (HR = 1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis. Conclusion Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further large-scale prospective studies are needed to corroborate this finding.
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Affiliation(s)
- Min-Seok Seo
- Department of Family Medicine, Incheon St. Mary's Hospital, 56 Dongsuro, Bupyung-gu, Incheon, Republic of Korea.,Department of Family Medicine, Yonsei University Graduate School of Medicine, 211 Eonju-ro, Dogok-dong, Gangnam-gu, Seoul, Republic of Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
| | - Jaehun Jung
- Artificial Intelligence and Bigdata Convergence Center, Gachon University College of Medicine, Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
| | - Hwanhee Lee
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Jae Hee Choi
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Jae-Yong Shim
- Department of Family Medicine, Yonsei University Graduate School of Medicine, 211 Eonju-ro, Dogok-dong, Gangnam-gu, Seoul, Republic of Korea
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Golčić M, Dobrila-Dintinjana R, Golčić G, Gović-Golčić L, Čubranić A. Physical Exercise: An Evaluation of a New Clinical Biomarker of Survival in Hospice Patients. Am J Hosp Palliat Care 2018; 35:1377-1383. [PMID: 29699417 DOI: 10.1177/1049909118772566] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Survival analysis is an important issue in palliative care. However, there is a lack of quality clinical biomarkers for assessing survival, especially in bedridden patients. Recent research supports the benefit of physiotherapy in palliative care, as majority of hospice patients are able to perform physical therapy. We propose the hypothesis that the difference in activity during physical exercise can be used as a biomarker of survival in hospice care. METHODS We examined 536 consecutive patients who performed physical exercises in our hospice from March 2013 to July 2017. Univariate, multivariate, and Kaplan-Meier analysis were performed to explore the association between the level of physical exercise activity and survival. RESULTS Physical exercises were performed by almost 70% of our hospice patients. The patients who initially performed active exercises lived longer, on average, compared to patients who only managed passive exercises (15 days vs 6 days, hazard ratio 0.60, 0.49-0.74). Surprisingly, the difference in survival based on the level of physical activity remained consistent regardless of the patient performance score, emphasizing its usefulness as an independent survival biomarker in a hospice setting. This tool also gave us an option to recognize a significant proportion of bedridden patients performing active exercises (30%), previously unrecognized using standard performance scales, exhibiting longer survival compared to others with the same performance score. CONCLUSION Patients' level of activity during physical exercises has the potential to be a valuable new clinical biomarker in palliative care, whether used individually or combined with commonly used performance scales.
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Affiliation(s)
- Marin Golčić
- 1 Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Krešimirova, Rijeka, Croatia
| | - Renata Dobrila-Dintinjana
- 1 Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Krešimirova, Rijeka, Croatia
| | - Goran Golčić
- 1 Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Krešimirova, Rijeka, Croatia
| | | | - Aleksandar Čubranić
- 3 Department of Gastroenterology, Clinical Hospital Center Rijeka, Krešimirova, Rijeka, Croatia
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Lee Y, Lee SH, Kim YJ, Lee SY, Lee JG, Jeong DW, Yi YH, Tak YJ, Hwang HR, Gwon M. Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea. BMC Palliat Care 2018. [PMID: 29514632 PMCID: PMC5842575 DOI: 10.1186/s12904-018-0300-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. Method At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, “old” and “new,” by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Results Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p < 0.001); however, the new system registers lower patient out-of-pocket expenses (p < 0.001). Conclusion The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.
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Affiliation(s)
- Youngin Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Seung Hun Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea. .,Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, South Korea. .,Department of Family Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea.
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Sang Yeoup Lee
- Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, 626-870, South Korea.,Obesity, Nutrition and Metabolism Clinic, Department of Family Medicine and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 626-770, South Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Dong Wook Jeong
- Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, 626-770, South Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Hye Rim Hwang
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
| | - Mieun Gwon
- Department of Family Medicine, Pusan National University Hospital, Busan, 602-739, South Korea
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Golčić M, Dobrila-Dintinjana R, Golčić G, Čubranić A. The Impact of Combined Use of Opioids, Antipsychotics, and Anxiolytics on Survival in the Hospice Setting. J Pain Symptom Manage 2018; 55:22-30. [PMID: 28803083 DOI: 10.1016/j.jpainsymman.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Opioids and sedatives are the cornerstone of symptom management in the end-of-life patients, but undertreatment is a common problem. Although several studies explored the individual effect of opioids, anxiolytics, and antipsychotics on survival, not much is known regarding their combined use. As these drugs share similar and potentially fatal side effects, primarily respiratory depression which occurs more often during night-hours, it is crucial to explore whether their interaction poses a danger for fragile hospice patients. OBJECTIVES To analyze the relationship of a combination of opioids, anxiolytics, and antipsychotics on survival and the change of night-time death percentage. METHODS A retrospective study of 765 consecutive patients admitted to hospice in Croatia over the period of four years (2013-2017). The main outcome was the total length of survival of hospice patients regarding different drug combination, along with night-time death percentage. RESULTS Different combinations of opioids, anxiolytics, and antipsychotics were associated with longer survival in hospice compared with patients using no such drugs. When we included different parameters which affected overall survival into a multivariate analysis, only the patients who had the combination of both opioids, anxiolytics, and antipsychotics in their regular therapy were associated with longer survival in hospice (11 vs. five days, hazard ratio 0.54, P < 0.001). No combination of opioids, anxiolytics, and antipsychotics significantly changed the night-time death percentage. CONCLUSION This research supports the safety of opioids, anxiolytics, and antipsychotics in the hospice setting when used both individually as well as in combination.
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Affiliation(s)
- Marin Golčić
- Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Goran Golčić
- Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Aleksandar Čubranić
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Lin TC, Liang KL, Lee LC, Hsu CY, Yen TT. Cancer-related hypercalcemia in oral cancer. Int J Oral Maxillofac Surg 2017; 47:685-691. [PMID: 29153824 DOI: 10.1016/j.ijom.2017.10.015] [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: 04/19/2017] [Revised: 09/03/2017] [Accepted: 10/26/2017] [Indexed: 12/09/2022]
Abstract
Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death. The total incidence of CRH was 6.95‰ per year. A total of 91 patients were enrolled; their median survival time was 28 days. The patients were divided into two groups by survival time, with a cut-off point of 30 days. Reduced serum albumin, leucocytosis, and clodronate use had a statistically significant effect on survival in the univariate analysis (all P<0.05). Forty-five patients (49.5%) had recurrence of CRH, of whom nine died within 30days. These nine patients had a shorter interval to the first episode of CRH recurrence (median 13 days) than those who survived ≥30days (median 28 days) (P<0.001). It was observed that a short interval to the first episode of CRH recurrence is a poor prognostic factor.
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Affiliation(s)
- T-C Lin
- Division of Family Medicine, Dachien General Hospital, Miaoli, Taiwan
| | - K-L Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - L-C Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-Y Hsu
- Taiwan Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - T-T Yen
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Safety, efficacy, and patient-perceived satisfaction of peripherally inserted central catheters in terminally ill cancer patients: a prospective multicenter observational study. Support Care Cancer 2016; 24:4987-4992. [DOI: 10.1007/s00520-016-3360-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Lunetta C, Lizio A, Melazzini MG, Maestri E, Sansone VA. Amyotrophic Lateral Sclerosis Survival Score (ALS-SS): A simple scoring system for early prediction of patient survival. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:93-100. [PMID: 26470943 DOI: 10.3109/21678421.2015.1083585] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our objectives were: (1) to identify independent prognostic factors to determine a survival score for amyotrophic lateral sclerosis (ALS) in a cohort of patients followed in the NEMO Centre (NEuroMuscular Omnicentre); (2) to replicate results in an independent cohort obtained from the Pooled Resource Open Access ALS Clinical Trial Consortium (PRO-ACT) database. Samples were collected from 428 ALS patients from the NEMO database and 2481 patients from the PRO-ACT database. Study design was a retrospective analysis with clinical and biochemical variables, using univariable and multivariable Cox models of analysis. Results showed that, in multivariable analysis, age at diagnosis, diagnostic delay, ALSFRS-R total score, Body Mass Index, aspartate aminotransferase and creatinine level were independently related to survival. These factors were recoded as categorical variables assigning a score from 5 to 15, and the sums of these scores were used to obtain the ALS-Survival Score (ALS-SS). This then allowed to identify three groups having different survival curves. The ALS-SS results were also replicated using data from the PRO-ACT database. In conclusion, considering independent prognostic factors, we were able to give an estimate of survival in our cohort of ALS patients. Whether this ALS-SS may be useful in clinical practice, and potentially in clinical trials, will have to be determined prospectively.
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Affiliation(s)
- Christian Lunetta
- a NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Niguarda Ca' Granda Hospital , Milan
| | - Andrea Lizio
- a NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Niguarda Ca' Granda Hospital , Milan
| | - Mario Giovanni Melazzini
- a NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Niguarda Ca' Granda Hospital , Milan
| | - Eleonora Maestri
- a NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Niguarda Ca' Granda Hospital , Milan
| | - Valeria A Sansone
- a NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Niguarda Ca' Granda Hospital , Milan.,b Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
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