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Patient Safety Learning

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  1. Patient Safety Learning
    Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in COVID-19 admissions combined with limited capacity, according to figures leaked to HSJ.
    Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed.
    It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity —  combines with potential additional winter demand in coming weeks.
    Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more.
    Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one.
    And another reason behind delays is waiting for covid test results before admitting patients.
    Read full story (paywalled)
    Source: HSJ, 4 January 2021
  2. Patient Safety Learning
    Doctors have sought to reassure parents that there has been no increase in the severity of COVID-19 cases among children because of the new variant.
    The Royal College of Paediatrics and Child Health (RCPCH) said children's wards are not seeing any "significant pressure" from COVID-19.
    It comes after a London hospital matron told BBC Radio 5 Live of having a ward full of children with coronavirus. 
    Laura Duffel said the surge in cases was "much scarier" than the first wave. Ms Duffel, who has been working on Covid wards since the beginning of the UK's epidemic and specialises in children's intensive care, told 5 Live's Chiles on Friday show that people were "wrong" to say busy hospitals were merely a reflection of normal winter pressures on the NHS.
    "This wave has just hit us so fast. It's literally in the space of a week that this has gotten so bad," she said.
    However, doctors denied that the virus is putting significant additional pressure on children's wards across the country. 
    Prof Russell Viner, president of the RCPCH, said: "Children's wards are usually busy in winter. As of now we are not seeing significant pressure from COVID-19 in paediatrics across the UK.
    "As cases in the community rise there will be a small increase in the number of children we see with Covid-19, but the overwhelming majority of children and young people have no symptoms or very mild illness only.
    "The new variant appears to affect all ages and, as yet, we are not seeing any greater severity amongst children and young people."
    Dr Ronny Cheung, a consultant paediatrician at Evelina Children's Hospital, in London, added: "I've been the on-call consultant in a London children's hospital this week. Covid is rife in hospitals, but not among children - and that is corroborated by my colleagues across London."
    Read full story
    Source: BBC News, 3 January 2021
  3. Patient Safety Learning
    When dentist Andy Bates offered to help administer the coronavirus vaccine, he hadn't bargained for the "overload of bureaucracy" he says came his way.
    Dr Bates, from North Yorkshire, is one of a number of health staff to criticise the paperwork needed to gain NHS approval to give the jabs.
    Some medics have been asked for proof they are trained in areas such as preventing radicalisation.
    The PM said the health secretary would be "taking steps" to address the issue.
    Asked about reports potential volunteers were being deterred by the additional training and forms about "de-radicalisation measures" and "fire drills", Mr Johnson told the BBC's Andrew Marr on Sunday: "I think it's absurd and I know that the health secretary is taking steps to get rid of that pointless bureaucracy."
    The NHS has previously said training and checks were needed for vaccinators.
    Read full story
    Source: BBC News, 3 January 2021
  4. Patient Safety Learning
    There are 14 hospital trusts on course to have at least a third of their beds filled by covid patients on New Year’s Eve.
    HSJ analysed current occupancy and growth at each general acute trust in the seven days to 21 December. Projecting the same rate of growth forward, the number of trusts with at least a third of their bedbase likely to be taken by covid patients would increase from 5 at present to 14.
    Three of the four acute trusts in Kent are projected to have covid bed occupancy of over 40%.
    Another two trusts are in areas covered by tier two restrictions. They are Queen Elizabeth in Norfolk, and Countess of Chester. A third, East Sussex, has one of its two general hospitals in “tier four” (St Leonards), and the other in Eastbourne, which is outside the Sussex “tier four” zone.
    There are also 27 trusts not in tier four areas which had more than 50 covid patients on 21 December, and where the number of covid patients grew by at least 20 per cent in that week. These include Liverpool University Hospitals and Sheffield Teaching Hospitals.
    HSJ last week projected that, if trends continued, English hospitals would have just short of 19,000 covid patients on New Year’s Eve in total — almost exactly the same as the 12 April first wave peak. Current projections put that number at over 20,000.
    Read full story (paywalled)
    Source: HSJ, 23 December 2020
  5. Patient Safety Learning
    A major survey of NHS IT chiefs has revealed that despite more positive attitudes and uptake towards technology as a result of COVID-19, the long-term challenges of digital transformation within hospital trusts remain unchanged and only 14% of respondents believe they have sufficient funding to cover business priorities.
    The Digital Health Intelligence NHS IT Leadership Survey, carried out annually by Digital Health Intelligence, offers a 'state of the nation' insight into the priorities, concerns and challenges faced by NHS chief clinical information officers (CCIO’s), Chief Information Officer’s (CIOs) and other relevant digital health leaders.
    It revealed that despite record levels of positivity for digital transformation - 83% of respondents said the pandemic had resulted in a more positive attitude to digital among board members, up on 63% the previous year - just 24% are expecting a significant rise in funding and 14% think budgets will decrease.
    Read full story
    Source: Digital Health, 15 December 2020
  6. Patient Safety Learning
    NHS leaders have raised concerns about the rollout of the coronavirus vaccine, with more than half of hospital trusts and two-thirds of GPs yet to receive supplies amid growing alarm over the new fast-spreading variant.
    Dr Richard Vautrey, the chair of the British Medical Association’s GP committee, urged the government to speed up delivery of the Pfizer/BioNTech vaccine in order to save lives. Experts also demanded greater transparency from ministers on how many doses are available.
    Vautrey said: “We need millions of doses to be made available as soon as possible – urgently – because it’s the number one priority for GP practices, our patients and the nation, especially given the new mutant strain.
    “GPs who haven’t got it yet are frustrated because they want to be getting on and vaccinating their patients as well. Their frustration is understandable. They want to protect their patients, especially their vulnerable patients, as quickly as possible.”
    Read full story
    Source: The Guardian, 22 December 2020
  7. Patient Safety Learning
    Patient and Public Voice (PPV) partners play a crucial role in specialised services and are represented across the board on NHS advisory groups and governance structures to ensure that the views of patients, carers and the public are at the heart of what we do.
    Specialised Services are currently recruiting to a range of vacancies for PPV partners, all of which can be found here.
    NHS England and NHS Improvement are committed to promoting equality and inclusion to ensure that our PPV partners reflect and represent our diverse population, and particularly encourage people from Black, Asian and Minority Ethnic (BAME) backgrounds to apply.
    Read more
    Source: NHS England/Improvement
  8. Patient Safety Learning
    Acutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned.
    GPs have reported receiving inappropriate NHS 111 referrals including:
    an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke;  a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice.
    From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices.
    Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots.
    The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’.
    GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care.
    One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP."
    Read full story
    Source: Pulse, 21 December 2020
  9. Patient Safety Learning
    People who suffer from the debilitating effects of long Covid should be offered psychiatric care, the first clinical guidance to be published on the subject recommends.
    The guidelines urge healthcare professionals to look out for signs that patients who continue to suffer symptoms of COVID-19 for weeks after contracting the virus are at risk of self-harm.
    In the new advice, the National Institute for Health and Care Excellence (NICE) and the Royal College of General Practitioners, say people with ongoing symptomatic COVID-19 or suspected post-Covid 19 syndrome, whose symptoms last longer than 12 weeks, should be “urgently” referred for assessment if they have severe psychiatric symptoms or are at risk of self-harm or suicide.
    The guidelines state: “Follow relevant national or local guidelines on referral for people who have anxiety and mood disorders or other psychiatric symptoms. Consider referral for psychological therapies if they have common mental health symptoms, such as symptoms of mild anxiety and mild depression, or to a liaison psychiatry service if they have more complex needs (especially if they have a complex physical and mental health presentation).”
    Read full story (paywalled)
    Source: The Telegraph, 18 December 2020
  10. Patient Safety Learning
    Doctors and nurses on the front line of the fight against coronavirus at the Royal London Hospital – which has the largest number of Covid patients in the capital – have been denied the Pfizer vaccine, The Independent has learnt.
    Hospital bosses at Barts Health Trust have written to staff today expressing their frustration over the decisions by NHS England, which meant the northeast of London – where the rate of infections and hospitalisations are worst – has not been given access to any vaccines.
    The Independent has learned that staff from the Royal London booked appointments to be vaccinated at University College London, but they were turned away because the vaccinations had been earmarked for NHS staff from University College London Hospital Trust.
    The trust’s chief medical officer wrote to senior doctors on Monday warning them the crisis facing the hospital would get worse before it gets better.
    Professor Alistair Chesser told staff: “It has been frustrating to see the vaccine delivered to other trusts and to GP surgeries but not to us in the last few days given the pressure we are under. Please be assured we are lobbying for our staff and our patients at the very highest levels and will not let this rest.”
    Read full story
    Source: The Independent, 22 December 2020
  11. Patient Safety Learning
    Thousands of people who are at extreme risk from the coronavirus and live in tier 4 areas have been told to stay indoors at all times unless they are exercising or have medical appointments.
    The Department of Health and Social Care (DHSC) issued new advice on Monday warning people classed as “clinically extremely vulnerable” to stay home, in a bid to protect them from the new, more infectious strain of COVID-19.
    Those affected have been told not to leave their homes even if they cannot work remotely. The government said residents could be eligible for statutory sick pay, employment support allowance, or universal credit as well as the coronavirus job retention scheme.
    The DHSC said the high-risk group should stay at home as much as possible. Children who have been advised to shield should not attend school, the department added. 
    Read full story
    Source: The Independent, 21 December 2020
  12. Patient Safety Learning
    Cancer surgery in London is under threat as rising covid admissions put pressure on services that no longer have back-up capacity from the independent sector, HSJ has learned.
    Research by HSJ has discovered that NHS England ended contracts with HCA, The London Clinic and the Cromwell Hospital at the end of August, after concerns about underutilisation.
    Under the previous deal with the private sector, rules were in place to make sure low-priority private patients were not treated ahead of NHS patients who needed surgery urgently.
    HCA and The Cromwell have confirmed the contracts were ended in August and were not renewed. The London Clinic did not respond to a request for comment.
    As of 19 December, there were 2,909 covid inpatients being treated in London hospitals, a rise of 39% over the previous seven days. Barts Health Trust and Barking, Havering and Redbridge University Trust in the east of the city are under particular pressure.
    Should the number of covid patients reach a level that requires the capital to instigate surge protocols, theatre space set aside for cancer operations is likely to be commandeered. Under this scenario, the NHS in the capital would no longer have the option to transfer cancer patients to private facilities as it did during the first wave of the pandemic.
    A senior London-based source said: “This is a real and imminent threat to London’s ability to perform cancer surgery."
    Read full story (paywalled)
    Source: HSJ, 21 December 2020
  13. Patient Safety Learning
    A new training aid, developed in Fife, is helping to equip trainee medical staff from around the world with the skills to prevent late miscarriage and premature labour.
    It was invented by Dr Graham Tydeman, consultant in obstetrics and gynaecology at Kirkcaldy’s Victoria Hospital, in conjunction with the St Thomas’ Hospital, London, and Limbs and Things.
    The lifelike simulator allows trainees to perform hands on cervical cerclage in advance of a real-life emergency. The procedure involves an emergency stitching around the cervix and is necessary when the cervix shortens or opens too early during pregnancy, helping to prevent late miscarriage or extreme premature labour.
    It is not a common event and the simulator was developed by Dr Tydeman following a request from medical trainees across the UK.
    The device has already been warmly received by hospitals and training institutions across the world – with orders from countries including New Zealand and India.
    Dr Tydeman said: “The reason this was developed is that it is not a common procedure and is very difficult to teach trainees."
    “Increasingly women are understandably asking  about the experience of their surgeon and anyone having this procedure understandably does not want it to be the first one that a doctor has ever done because if it goes wrong there could be tragic consequences with loss of the baby. However, if a trainee has shown suitable skills using this simulator, I would be able to confidently reassure women that the doctor had been adequately trained, although a more experienced person would always help during the actual operation for the first few procedures on real women."
    Read full story
    Source: The Courier, 19 December 2020
  14. Patient Safety Learning
    Nearly 90% of hospital beds in England are full as hospitals try to cope with the demands of Covid in addition to normal winter pressures.
    Ambulances queuing to offload patients, staff sickness and a lack of beds mean hospitals are "at a really dangerous point", say emergency doctors. This could result in some trusts facing the decision to stop non-Covid work.
    Rises in hospital admissions are particularly affecting areas in the south.
    The percentage of NHS hospital beds which are occupied is increasing and has reached almost 89% in England for the week ending December 13.
    This is the highest occupancy rate so far this year - it's still lower than the same time last year, although the extra burden of Covid is likely to make hospitals feel they are much busier.
    A safe level for bed occupancy is below 90% but nearly half of NHS trusts report a figure currently higher than this - the largest proportion this season.
    Read full story
    Source: BBC News, 19 December 2020
  15. Patient Safety Learning
    Layla Moran, Lib Dem MP for Oxford West and Abingdon and Chair of the APPG on Coronavirus, has secured the first Commons debate on Long Covid on Thursday 7 January following cross-party support.
    The Backbench Business Committee granted the application by Layla Moran, co-sponsored by Dr Dan Poulter MP (Con) and Andrew Gwynne MP (Lab) and supported by many others.  Layla said that the debate “is long overdue” and called on “those with lived experience and clinical experience to tell us your stories” in advance of the debate.
    Layla Moran said: “I’m pleased that we’ve been able to secure this important debate on Long Covid, which is long overdue. The APPG on Coronavirus, which I chair, has submitted recommendations to the Government on this, and the debate will give us the opportunity to hold them to account and represent our constituents suffering from it."
    “What’s really important now is that as many MPs as possible take part in the debate, so we can give this the profile it deserves and give the Government the opportunity to listen and respond to our concerns. Thank you to my cross-party colleagues for supporting this. I’m calling on those with lived experience and clinical experience to tell us your stories between now and the 7 January. This is a crucial opportunity.”
    Read full story
    Source: Liberal Democrats, 19 December 2020
  16. Patient Safety Learning
    The number of people likely to have caught COVID-19 in NHS hospitals in England has risen by more than a third in the last week.
    The 35% rise in probable hospital-acquired COVID-19 from 6 to 13 December is the highest weekly increase since 30 October, HSJ analysis of NHS England data reveals.
    Hospital-acquired infections are rising across areas such as London, the South East, and South West, and also at some hospitals in the North East, Yorkshire and the Midlands.
    At some trusts, the weekly total of likely hospital-acquired COVID-19 infections has more than doubled since last week.
    Read full story (paywalled)
    Source: HSJ, 18 December 2020
  17. Patient Safety Learning
    Staff shortages and a lack of equipment are affecting the day-to-day decisions about patient care by doctors and nurses, a new YouGov survey has revealed.
    The representative survey of NHS clinicians revealed more than half, 54%, admitted that factors such as a lack of staff played a role in their decisions about patients beyond what was in their best interests.
    Almost a third of staff, 31%, said staffing levels were the top factor affecting decisions about patients. A fifth said the availability of services such as key tests were a significant factor; 16% cited a lack of equipment; and 12% cited beds. 10% of clinicians said a fear of being sued was part of their decision-making.
    YouGov carried out the research for JMW Solicitors and weighted the responses to be representative of the NHS workforce population.
    It also revealed more than two-fifths of clinicians, 42%, believe a “blame culture” in the NHS plays a top role in preventing staff admitting to mistakes in care.
    In maternity services specifically, 68% of nurses and midwives said at least one factor other than what was in patients’ best interest played a role in their decisions.
    Read full story
    Source: The Independent, 20 December 2020
  18. Patient Safety Learning
    Patients in hospital with coronavirus should be offered a follow-up six weeks later to check for "long Covid" symptoms, doctors are being advised.
    The guidance, drawn up by health officials across the UK, says the long-term effects can be "significant". They identified 28 of the most common symptoms, from breathlessness and dizziness to chest pain.
    Mental health problems including depression, anxiety and struggling to think clearly, have also been reported.
    "Because this is a new condition, there is still much that we don't know about it," said Paul Chrisp of the National Institute for Health and Care Excellence, which produces health guidance.
    The NHS has opened 69 specialist clinics across England to offer rehabilitation to people recovering from the disease.
    Read full story
    Source: BBC News, 18 December 2020
  19. Patient Safety Learning
    An independent children’s and adolescents’ mental health service has been taken out of special measures after cutting beds by two-thirds.
    The Care Quality Commission has rated St Andrew’s Healthcare’s CAMHS unit in Northamptonshire “requires improvement” but removed it from special measures. Among improvements noticed were a major change in the service’s leadership and staff raising concerns openly and honestly.
    The unit was rated “inadequate” and served with a section 31 notice following inspections in June and December last year. 
    After its December inspection, the charity reduced the number of beds within its CAMHS offering from 90 to 30. Around the same time, St Andrew’s Healthcare chief executive Katie Fisher also revealed plans to shrink its services by half to address the serious quality issues.
    Speaking to HSJ, St Andrew’s Healthcare chief executive, Kate Fisher, who was appointed in 2018, said: “this isn’t just words, we are absolutely walking the walk and seeing through the strategy we set ourselves.”
    Read full story (paywalled)
    Source: HSJ, 18 December 2020
  20. Patient Safety Learning
    Thousands of patients suffering with the long term symptoms of coronavirus can now access specialist help at more than 60 sites, NHS England announced today.
    The assessment centres are taking referrals from GPs for people experiencing brain fog, anxiety, depression, breathlessness, fatigue and other debilitating symptoms.
    NHS England has provided £10 million for the network of clinics, which started opening last month. There are now 69 operating across the country with hundreds of patients already getting help.
    The new centres bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.
    Ten sites are now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West and a further 18 across the North East and Yorkshire.
    A further 12 sites are earmarked to launch in January in the East Midlands, Lancashire, Cornwall and Isle of Wight.
    The National Institute for Clinical Excellence (NICE) has today also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.
    Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms.
    Read full story
    Source: NHS England, 18 December 2020
  21. Patient Safety Learning
    More needs to be done to tackle safe staffing levels in Northern Ireland's health service, according to the Royal College of Nursing (RCN).
    A year on from the nurses' strike, the union has warned that problems caused by poor workforce planning and chronic underfunding have not been addressed.
    Instead they have been exacerbated by the CoOVID-19 pandemic, said the RCN.
    The Department of Health said dealing with staff shortfalls was a "key priority" for the health minister.
    Pat Cullen, the Northern Ireland director of the RCN, said "very little has actually changed" since about 15,000 healthcare workers took to the picket line in December last year for a series of protests over pay and safe staffing levels.
    "We need to remind the government that many of these issues have sadly not gone away," she added.
    Read full story
    Source: BBC News, 18 December 2020
  22. Patient Safety Learning
    London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned.
    The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity.
    More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice.
    On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen.
    Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%.
    Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running.
    A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.”
    Read full story
    Source: The Independent, 17 December 2020
  23. Patient Safety Learning
    All NHS trusts in England have been given a deadline of Monday to enact safety improvements in maternity care amid Shropshire's baby deaths scandal.
    Heath chiefs have told hospitals they must have the 12 "urgent clinical priorities" in place by 17:00 GMT. The move is to address "too much variation" in outcomes for families.
    It comes during a probe into the maternity care of more than 1,800 families in Shropshire.
    The inquiry, launched amid concerns of repeated failings at Shrewsbury and Telford Hospital NHS Trust (SaTH), focuses on the experience of 1,862 in total, and includes instances of infant fatality.
    An interim report published last week found poor care over nearly two decades had harmed dozens of women and their babies.
    The report called for seven "essential actions" to be implemented at maternity units across England. But that has since been transformed into 12 clinical tasks, including giving women with complex pregnancies a named consultant, ensuring regular training of fetal heart rate monitoring, and developing a proper process to gather the views of families.
    The directions are revealed in a letter in which NHS England says there is "too much variation in experience and outcomes for women and their families".
    Read full story
    Source: BBC News, 15 December 2020
  24. Patient Safety Learning
    One in 10 people infected with the coronavirus experience symptoms that last for three months or longer, the Office for National Statistics (ONS) has said.
    A new analysis aimed at determining the extent of the “long Covid” problem among infected patients also found that one in five reported having symptoms that lasted for five weeks or longer.
    The ONS said it estimated that during the week ending on 28 November, there were about 186,000 people in England living with COVID-19 symptoms that had lasted between five and 12 weeks.
    This number could be as high as 221,000, the ONS warned. It said the data was experimental and based on the findings from its infection survey of households.
    Read full story
    Source: The Independent, 16 December 2020
  25. Patient Safety Learning
    An Independent Patients' Commissioner is set to be appointed to act as champion for people who have been harmed by medicines or medical devices.   
    Baroness Cumberlege, who recommended the new role in a landmark report earlier this year, announced that the government had budged on the issue after initial resistance.
    She welcomed the move saying: "Had there been a patient safety commissioner before now, much of the suffering we have witnessed could have been avoided."
    But she added "the risk still remains" and further urgent action is needed to protect patients from potentially harmful drugs."
    At an online meeting of parliamentarians, the baroness described the testimony of a victim of the medical device vaginal mesh, which has left some patients in chronic pain.
    The woman had told her review team: "This device took everything from me. My health, my life, my job, my dignity, my marriage, my freedom."
    Reflecting on this the baroness added: "The scale of suffering we witnessed means nothing short of profound change is necessary. Not necessary in a couple or three years, but necessary now."
    Read full story
    Source: Sky News, 16 December 2020
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