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Holthe E, Husby VS. Barriers to Organ Donation: A Qualitative Study of Intensive Care Nurses' Experiences. Dimens Crit Care Nurs 2023; 42:277-285. [PMID: 37523727 DOI: 10.1097/dcc.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families. AIMS AND OBJECTIVES The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process. DESIGN A descriptive qualitative study design was used. METHOD Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation. RESULTS Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges. CONCLUSIONS Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.
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Yazdimoghaddam H, Manzari ZS, Heydari A, Mohammadi E. The ethical obligation to provide care to patients diagnosed with brain death until the end stages based on grounded theory. J Med Ethics Hist Med 2021; 14:2. [PMID: 34849211 PMCID: PMC8595073 DOI: 10.18502/jmehm.v14i2.5435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022] Open
Abstract
Nurses are faced with tremendous pressure when providing brain-dead patients with care. There is limited guidance for nurses on the care of these patients. The present study aimed to report the experiences of nurses regarding the care of patients diagnosed with brain death. Semi-structured interviews were conducted with 31 nurses and other stakeholders, and the observations and field notes were analyzed using continuous and comparative analysis based on grounded theory. The qualitative analysis of the data resulted in extraction of six final categories, including 'facing increased tensions and conflicts', 'organ donation: a distinct care element', 'inconsistency of care management', 'effective care requirements', 'challenges, rights and duty requirements', and 'moral obligation to provide holistic care until the last minute'. Data analysis identified 'Challenges, rights and duty requirements' as the main issue and showed that the nurses managed this issue using the strategy of 'moral obligation to provide holistic care until the last minute' as the core variable. According to the results, it is recommended that the healthcare system (especially hospital management) take supportive action for nurses in various fields of care of brain-dead patients to resolve educational, moral and legal challenges.
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Affiliation(s)
- Hamideh Yazdimoghaddam
- Assistant Professor, Non-Communicable Diseases Research Center, Operating Room Department, Faculty of Paramedics, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra Sadat Manzari
- Associate Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Yazdimoghaddam H, Manzari ZS, Heydari A, Mohammadi E. Improving psychological security and empowerment: New model for nurses toward the care of potential organ donors. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:101. [PMID: 34084848 PMCID: PMC8150079 DOI: 10.4103/jehp.jehp_657_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Caring for brain dead patients is the heaviest of duties for nurses, and despite tremendous stress, there are no theories/models to support nurses in this situation. This study designed a supportive model for nurses to provide care for potential organ donors. MATERIALS AND METHODS This qualitative study was conducted in two stages. In the first stage, semi-structured interviews with 31 nurses and other stakeholders, observation and field notes continued until data saturation, (on 2018), were analyzed using continuous and comparative analysis through Corbin-Strauss method. In the second stage, theory synthesis of Walker and Avant's strategies for theory construction (2011) was used to design a supportive model/theory. The theory synthesis includes three stages: (i) selection of focal concept (the concept of "moral obligation to provide holistic care until the last minute" was selected); (ii) review of studies to identify the factors related to focal concept relevant studies (42 articles were reviewed, statements and concepts related to focal concept were then extracted and classified, and their relations were specified); and (iii) organization of concepts and statements within a relevant general and effective manifestation of the phenomenon under study which led to developing of a model. RESULTS In this supportive model/theory, "improving psychological security and empowerment" was conceptualized within the conceptual framework. This supportive model entails three main components, including (i) informational and educational support, (ii) systematically support, and (iii) management support. CONCLUSIONS According to the results, nurses with moral obligation to provide holistic care were faced with several challenges. Therefore, it is recommended that the healthcare system take supportive proceedings for nurses in various fields of the care for brain dead patients to resolve educational, moral, and legal challenges. This supportive model is essential for maintaining the nurses' health, increasing the quality of nursing care and the health of potential transplant organs.
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Affiliation(s)
- Hamideh Yazdimoghaddam
- Department of Operating Room, Iranian Research Center on Healthy Aging, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Kerstis B, Widarsson M. When Life Ceases-Relatives' Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor-A Literature Review. SAGE Open Nurs 2021; 6:2377960820922031. [PMID: 33415278 PMCID: PMC7774436 DOI: 10.1177/2377960820922031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/26/2020] [Accepted: 04/04/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient's family and need to have knowledge and understanding of the relatives' experiences. Objective To describe relatives' experiences when a family member is confirmed brain dead and becomes a potential organ donor. Methods A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019. Results The overarching theme When life ceases emerged as a description of relatives' experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss. Conclusion Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives' processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.
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Affiliation(s)
- Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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YazdiMoghaddam H, Manzari ZS, Mohammadi E. Nurses' Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:265-272. [PMID: 33014736 PMCID: PMC7494161 DOI: 10.4103/ijnmr.ijnmr_226_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 11/05/2022]
Abstract
Background: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. Materials and Methods: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000–2018 on the keywords “brain dead OR brain death” and “nurses OR nursing.” After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. Results: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. Conclusions: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be thefirst step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.
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Affiliation(s)
- Hamideh YazdiMoghaddam
- Iranian Research Center on Healthy Aging, Operating Room Department, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra-Sadat Manzari
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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YazdiMoghaddam H, Manzari ZS, Heydari A, Mohammadi E. Challenges in the Management of Care of Brain-Dead Patients in the Donation Process: A Qualitative Content Analysis. Int J Organ Transplant Med 2020; 11:129-142. [PMID: 32913589 PMCID: PMC7471611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In care of brain-dead patients, nurses face several challenges. It is important to determine the context behind these challenges since they affect the performance of nurses and the organ donation process. OBJECTIVE To identify factors affecting the emergence of challenges related to the management of brain-dead patients by nurses in the donation process. METHODS In this qualitative conventional content analysis, data were collected by performing 28 semi-structured and in-depth interviews with nurses working in the ICUs. Purposive sampling started from March 2014 until saturation, which was reached in June 2016. Data analysis occurred simultaneously with data collection. RESULTS Qualitative analysis of contents provided from interviews led to the extraction of themes that showed the experience of nurses about the challenges of caring for brain-dead patients in the donation process. These themes included "doubt and conflict in accepting the situation" and "defects in an effective and targeted care system." In the end, the main theme of "inconsistency and incompatibility of care management" was abstracted. CONCLUSION According to the results of the study, factors involved in the emergence of challenges for nurses in care management included defects in education or managerial problems, which increased tension for nurses.
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Affiliation(s)
- H. YazdiMoghaddam
- Iranian Research Center on Healthy Aging, Operating Room Department, Faculty of Paramedices, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Z. S. Manzari
- Department of MedicalSurgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A. Heydari
- Evidence-Based Care Research Center, Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - E. Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Contiero PP, Wilson DM. Understanding ambivalence toward organ donation and transplantation: An exploratory study of nursing students. NURSE EDUCATION TODAY 2019; 76:191-195. [PMID: 30822605 DOI: 10.1016/j.nedt.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a continuing shortage of organs for transplantation purposes worldwide. Determining why this is a recurring problem is necessary as organ transplantation is a highly successful life saving measure. It is possible that ambivalence is key to this shortage. OBJECTIVES To explore the possible existence of ambivalence toward organ donation and transplantation among Canadian nursing students, and gaining insights into this ambivalence when present. DESIGN An exploratory study using a structured questionnaire to explore the existence of ambivalence in relation to donating and receiving an organ for transplantation purposes. METHODS A total of 170 undergraduate nursing students at a Canadian university participated in this study by completing a brief questionnaire distributed to all five classes of nursing students who were taking a mandatory research course during the 2017-18 university calendar year. The survey tool was designed to collect quantitative and qualitative data in relation to their ambivalence toward organ donation and transplantation. RESULTS Nursing students are more willing to receive an organ than to donate. The willingness to donate or receive an organ was related to their personal beliefs and moral codes, religion, level of knowledge, and the existence of ambivalence. CONCLUSIONS This study reveals important insights into ambivalence about donating and receiving organs. The study found it was very easy to introduce ambivalence among nursing students, with this information highly relevant for student education and other applications.
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Affiliation(s)
- Paloma Peroni Contiero
- University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo 14040-902, Brazil.
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada; Faculty of Education and Health Sciences, University of Limerick, Ireland; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation. Can J Anaesth 2019; 66:686-695. [PMID: 30809778 DOI: 10.1007/s12630-019-01332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/23/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Rates of organ donation vary between otherwise comparable intensive care units (ICUs) suggesting that the process of donation must vary between ICUs. The purpose of this study was to describe the process of organ donation from the perspective of ICU staff, identify important drivers of successful donation, and develop strategies to improve the process of donation. METHODS We conducted qualitative interviews with 32 ICU staff, including physicians, nurses, and respiratory therapists, using an interview guide developed from previous studies on organ donation. Using a qualitative descriptive approach, we coded interviews using qualitative content analysis. We integrated findings from the interviews in a mixed-methods analysis with previously published data from a document analysis and cross-sectional survey to identify practices that may enhance organ donation in the ICU. RESULTS Five major themes important to the organ donation process emerged from the interviews: i) staff relationship with organ donation coordinators; ii) standardized processes; iii) ICU staff beliefs; iv) integration of donation and high quality end-of-life care; v) feedback and staff support. In the mixed-methods analysis, we identified 22 actionable practices to enhance the process of organ donation in the ICU. CONCLUSION Incorporating the perspectives of ICU staff, we were able to identify 22 practice changes that may have a significant cumulative impact on donation outcomes. Future research is required to evaluate whether these findings account for the variability of donation rates between otherwise comparable ICUs.
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Magalhães ALP, Erdmann AL, Sousa FGMD, Lanzoni GMDM, Silva ELD, Mello ALSFD. Meaning of nursing care to brain dead potential organ donors. ACTA ACUST UNITED AC 2018; 39:e20170274. [PMID: 29995076 DOI: 10.1590/1983-1447.2018.2017-0274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To understand the meanings of care to brain dead potential organ donors for nurses, and construct a theoretical model. METHOD Qualitative study based on the Grounded Theory approach. Data were collected through open interviews with 12 nurses, distributed in three sample groups in a university hospital in northeastern Brazil, from December 2010 to June 2011. RESULTS The phenomenon Unveiling multiple relationships and interactions of nurses in the complexity of patient care in brain dead potential donors is supported by the interrelationship of five categories and results from the need to organize care practices in the context of the intensive care unit, considering the factors involved in the relationship between nurses, staff and family and reveals challenges for nurses imposed by the complexity of the care process. CONCLUSIONS The meaning of care to brain dead potential donors involves understanding the complexity of this patient who can save somebody's life through organ donation.
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Affiliation(s)
- Aline Lima Pestana Magalhães
- Universidade Federal de Santa Catarina (UFSC), Departamento de Enfermagem. Florianópolis, Santa Catarina, Brasil
| | - Alacoque Lorenzini Erdmann
- Universidade Federal de Santa Catarina (UFSC), Curso de Enfermagem, Programa de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | | | | | - Elza Lima da Silva
- Universidade Federal do Maranhão (UFMA), Curso de Graduação em Enfermagem, Mestrado Acadêmico em Enfermagem. São Luís, Maranhão, Brasil
| | - Ana Lúcia Schaefer Ferreira de Mello
- Universidade Federal de Santa Catarina (UFSC), Curso de Odontologia, Programa de Pós-Graduação em Enfermagem e de Odontologia. Florianópolis, Santa Catarina, Brasil
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Moghaddam HY, Pouresmaeili A, Manzari ZS. Analysis of the reasons for nurses' confusion in relation to the concept of brain death from clinical and legal points of view. Electron Physician 2018; 10:6868-6876. [PMID: 29997774 PMCID: PMC6033127 DOI: 10.19082/6868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background Nurses in intensive care units (ICU) play a key role in taking care of brain dead patients and they are often in contact with such patients given the high rate of brain deaths. Consequently, they are in a challenging and stressful condition, which may be aggravated due to the need for increased organ donation, and this may also affect the quality of care provided for these patients. Objective This review analyzes the different studies on the concept of brain death from both medical and legal points of view. The aim of this study was to identify the challenges the nurses face with the perception of the concept of brain death and its effects on the care provided for the patients suffering from brain death, as well as organ donation. Methods This Narrative review study summarizes the information obtained from relevant literature through a targeted search of library texts and electronic resources including Science Direct, PubMed, Google Scholar, Scientific Information Database (SID), IranMedex, and Magiran databases during 2000–2017 in English and Persian, on the subject of interest by keywords such as brain death, organ donation, care, legal, regulations and nursing. Finally, a total of 44 relevant articles were reviewed. Results Nurses play an important role in taking care of brain dead patients; therefore, recognizing challenges can be the first step in taking accurate care of these patients and subsequently maintaining the organs’ health for transplants. Although there are clinical and legal uncertainties regarding the concept of brain death, nurses have an important effect on taking care of brain dead patients as well as the rate of organ donation. Conclusion Nurses in intensive care units should have a clear understanding of the concept of brain death in order to be able to take care of brain dead patients by avoiding psychological effects. In this regard, it is recommended that a comprehensive educational program be designed on the dimensions of brain death. Therefore, the nurses’ awareness of brain death and their ability to clarify this concept to the patients’ relatives would have a great effect on the decrease in the challenges and the stress imposed on the nurses. Also, there would be an increase in the quality of the care given to brain dead patients and even the rate of organ donation.
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Affiliation(s)
- Hamideh Yazdi Moghaddam
- Ph.D. in Nursing, Faculty of Paramedical, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Alireza Pouresmaeili
- Ph.D. in Private Law, Assistant Professor, Department of Law, Faculty of Theology and Islamic Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Zahra Sadat Manzari
- Ph.D. of Nursing, Assistant Professor, Department of Medical-surgical nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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