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Patient Safety Learning

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  1. Patient Safety Learning
    School-leavers could receive on-the-job training as part of an attempt to help address NHS workforce shortages, under plans to allow tens of thousands of doctors and nurses to join the health service via apprenticeships.
    Up to 1 in 10 doctors and a third of nurses could be trained through this vocational path in the coming years under the NHS workforce plan. The NHS’s doctor apprenticeship scheme is due to start in September, where medics in training will be able to earn money while they study.
    The concept was first introduced as an alternative route into medicine circumventing the standard undergraduate or graduate university programmes.
    Dr Latifa Patel, workforce lead for the British Medical Association, said innovative approaches to education and training are welcome but there were huge question marks over how far medical apprenticeships can solve the recruitment crisis.
    Patel said: “We don’t know if medical schools and employing organisations are going to be able to produce medical degree programmes to meet individual apprenticeship needs while also meeting the same high standards of training experienced by traditional medical students.
    “We have little evidence on whether the apprentice model will work at scale, and whether employers will want to take the investment risk with no guarantee of a return."
    Read full story
    Source: The Guardian, 10 May 2023
  2. Patient Safety Learning
    Up to 10 junior doctor posts will be reinstated at a small district general hospital after regulators agreed it had improved its learning environment.
    In 2021, Health Education England removed 10 doctors from Weston Hospital over concerns they were being left without adequate supervision on understaffed wards. 
    The unusual move prompted University Hospitals Bristol and Weston Foundation Trust to launch a “quality improvement approach” to improve its learner and clinical supervision environment.
    The regulator said the trust had made significant improvements that included:
    Better staff engagement with the trust leadership at all levels. Better clinical supervision, particularly around shift handovers and senior oversight of clinical decisions. Better learner experience in new training settings in rheumatology and intensive care medicine. Read full story (paywalled)
    Source: HSJ, 10 May 2023
  3. Patient Safety Learning
    Antidepressants commonly used to treat chronic pain lack evidence as to whether or not they work, researchers have said, declaring the situation a global public health concern.
    Chronic pain, typically defined as pain lasting three months or more, is a widespread problem affecting up to one in three people, with conditions ranging from osteoarthritis to fibromyalgia.
    While exercise is often recommended, this is difficult for some patients, while there are concerns that opioids and other painkillers such as aspirin and paracetamol could do more harm than good.
    Increasing numbers of patients are prescribed antidepressants to treat their pain, with hundreds of thousands in the UK estimated to be taking amitriptyline. Antidepressants affect chemicals known as neurotransmitters, which is how they are thought to relieve pain.
    But a new Cochrane review, led by Prof Tamar Pincus, professor in health psychology at the University of Southampton, has revealed there is little evidence whether or not amitriptyline and many other common antidepressants work when it comes to tackling chronic pain.
    “The fact that we don’t find evidence whether it works or not, is not the same as finding evidence that it doesn’t work,” she said. “We don’t know. The studies simply are not good enough.”
    Read full story
    Source: The Guardian, 10 May 2023
  4. Patient Safety Learning
    Delayed health checks among people with diabetes may have contributed to 7,000 more deaths than usual in England last year, a charity report suggests.
    The routine checks help cut the risk of serious complications like amputations and heart attacks.
    Diabetes UK says too many people are still being "left to go it alone" when managing their challenging condition.
    There are more than five million people in the UK living with diabetes, but around 1.9 million missed out on routine vital checks in 2021-22, Diabetes UK says.
    Disruption to care during the pandemic is likely to be a factor in the current backlog, which may be leading to higher numbers of deaths than usual in people with diabetes, it says.
    Between January and March 2023, for example, there were 1,461 excess deaths involving diabetes - three times higher than during the same period last year.
    "Urgent action is needed to reverse this trend and support everyone living with diabetes to live well with the condition," the report says.
    Read full story
    Source: BBC News, 10 May 2023
  5. Patient Safety Learning
    In an email to staff today (9 May 2023) NHS England (NHSE) have confirmed that to meet the deadline for implementing the new Learn From Patient Safety Events (LFPSE) service, Trusts will only need to ensure this is underway by the 30 September 2023, rather than fully implemented.
    LFPSE is a new central national service for recording and analysing patient safety events that occur in healthcare. Some NHS organisations are now using this system, instead of the National Reporting and Learning System (NRLS), and all organisations will be expected to transition to this.
    The original date for Trusts to implement LFPSE was the 31 March 2023. However, in response to concerns about the achievability of this deadline, on the 18 October NHSE announced an optional six-month extension, meaning that Trusts needed to deploy the new system by the 30 September 2023.
    Today’s email to NHS staff noted that some Trusts “are still anticipating challenges with the time scales”. Responding to this, NHSE clarified that provided the LFPSE transition within organisations Local Risk Management Systems was underway by the end of September, and that application of the guidance to configure formals and fields was being actively worked on, this milestone should be considered as having been met.
    Commenting on this Helen Hughes, Chief Executive of charity Patient Safety Learning, said:
    “This is a welcome announcement by NHS England, reducing the immediate pressure on staff who had raised serious concerns on the ability to have LFPSE configured and ready to submit events by the 30 September deadline. This flexibility will ensure that the new LFPSE service has a stronger chance of successful transition and to enable patient safety improvement”.
  6. Patient Safety Learning
    Steve Barclay has refused to approve about 30 proposed community diagnostic centres (CDCs) – designed to speed up cancer treatment – unless they can be delivered in 2023, HSJ has learned.
    Mr Barclay’s stance means the CDCs which were due to open in 2024, and which officials say cannot be brought forward, have been left in limbo. NHS England and local systems are now exploring workarounds, such as temporarily using mobile imaging units while the CDCs are established in attempt to win Mr Barclay’s backing.
    Cancer Research UK director of evidence and implementation Naser Turabi said: “Community diagnostic centres can help the NHS diagnose cancers more quickly, but they require capital investment and funding for staff if they are to meet rising demand.
    “Restricting the promised expansion of these centres will only lead to longer waits and worse outcomes for cancer patients in England.”
    Read full story (paywalled)
    Source: HSJ, 9 May 2023
  7. Patient Safety Learning
    A leading consultant has warned that poor care is at the root of a growing outcry over an invasive medical test that has left women in agony.
    Dr Helgi Johannsson, vice-president of the Royal College of Anaesthetists, has spoken out about the hysteroscopy after the Sunday Mail revealed the suffering of a series of female patients.
    His intervention comes amid a growing backlash around the procedure used to investigate and treat problems in the womb, with more than 3000 women now reporting being left with post-traumatic stress and excruciating pain.
    The test involves a long scope being inserted into the womb, often without anaesthetic, leaving one in three in pain.
    Dr Johannsson, a consultant anaesthetist at Charing Cross Hospital in London, said: “It sounds like a lot of this is poor care and badly handled, and emotionally badly handled, and (they) didn’t stop when they were supposed to.
    “Stories of being held down to finish the procedure are just awful. It’s important that we make the OH as good as we can possibly make it, including some sort of inhalation sedation, but having the ability to say stop when you need to is so important and a measure of good care.”
    Read full story
    Source: Daily Record, 7 May 2023
    Further reading on the hub:
    Women share their experiences of painful hysteroscopy in the hub community. My experience of an outpatient hysteroscopy procedure Hysteroscopy: 6 calls for action to prevent avoidable harm
  8. Patient Safety Learning
    The vast majority of GP practices should allow patients to manage their care through the NHS App in less than a year, according to the primary care recovery plan published by government and NHS England today.  
    The plan says patients at more than 90% of practices should be able to use the app to see their records, book appointments and order repeat prescriptions by March 2024. Currently, only around 20% of practices offer this, and data revealed recently by HSJ suggested use of the app is flatlining.
    The plan says: “We want the public to have access to health information they can trust, find local services, and use the NHS App where this is their preference to see their medical records, order repeat prescriptions, manage routine appointments with their practice or local hospital and see messages from their practice.
    “The NHS App ambitions are already a reality for people registered with around 20% of practices, so this plan focuses on how to increase that to over 90% by March 2024.”
    Read full story (paywalled)
    Source: HSJ, 9 May 2023
  9. Patient Safety Learning
    Knocking on doors to check on people's health and catch problems before they escalate is common practice across Brazil. But could that approach work in the UK?
    Comfort and Nahima are two out of four door-knockers on round Churchill Gardens, a council estate in the Pimlico neighbourhood of London, visiting residents as part of a proactive community healthcare pilot.
    They can help with anything from housing issues which impact health, such as overcrowding, or pick up the early signs of diabetes by chatting informally to residents about their lifestyle.
    These community health workers are partly funded by the local authority and partly by the NHS so they can co-ordinate between the local GP surgery and other social services.
    Local GP Dr Connie Junghans-Minton says the proactive approach had led to fewer requests for appointments
    The National Institute for Health Research helped crunch the data from the pilot. Households which had been visited regularly were 47% more likely to have received immunisations and 82% more likely to have taken up cancer screening, compared to other areas.
    The idea to import this model to the UK came from Dr Matthew Harris, a public health expert at Imperial College London who worked as a GP in Brazil for four years. There, community health workers have been credited with achieving a drop of 34% in cardiovascular deaths.
    "In Brazil they have scaled this role to such degree that they have 270,000 community health workers across the whole country, each of which looks after 150 households, visiting them at least once a month," Dr Harris said.
    "They've seen extraordinary outcomes in terms of population health in the last two or three decades. We think we've got a lot to learn from that."
    Read full story
    Source: BBC News, 9 May 2023
  10. Patient Safety Learning
    Millions of patients in England will be able to get prescriptions for seven common conditions, plus more blood pressure checks and the contraceptive pill, directly from pharmacies under proposals to tackle the crisis in GP surgeries.
    Those suffering from earache, a sore throat, sinusitis, impetigo, shingles, infected insect bites and uncomplicated urinary tract infections (UTIs) in women are set to be prescribed medicine by pharmacists without the need to see a doctor or nurse for the first time.
    The reforms are designed to free up 15m GP appointments over the next two years.
    The blueprint was broadly welcomed by health leaders, with Thorrun Govind, chair of the Royal Pharmaceutical Society in England, calling it a “real game-changer” for patients.
    But experts said not all pharmacies would be able to offer all or any of the new services, meaning the shake-up could result in frustrated patients being “bumped from pillar to post, only to end up back at the GP”.
    There are also concerns that patients may not be able to recognise the seriousness of some conditions, including whether a UTI can be classed as “uncomplicated”.
    Read full story
    Source: The Guardian, 9 May 2023
  11. Patient Safety Learning
    Patients are developing cancers and enduring so much pain that they cannot climb stairs because of the 7.2 million-strong waiting list for NHS scans and treatment, Britain’s top GP has said.
    Prof Kamila Hawthorne, the chair of the Royal College of GPs, said the record delays for care and the uncertainty for patients about when they would finally be seen was leaving people feeling “helpless and forgotten”.
    These included people with heart problems, those awaiting a hip or knee replacement, and people with potential signs of cancer whom GPs have said need to be seen urgently, she said.
    In an interview with the Guardian, she voiced serious concern that some of these patients saw their health deteriorate as a direct result of the delay in accessing hospital care.
    “Patients getting sicker while they are on the waiting list is something GPs see and worry about, because the risk to the patient is so much greater. It’s inevitable that some people stuck will get sicker, because that’s the nature of illness,” she said.
    Read full story
    Source: The Guardian, 7 May 2023
  12. Patient Safety Learning
    Managers at a medical rehabilitation unit are "covering it up" when issues are raised, a whistleblower has said.
    The whistleblower claimed Cambridge Rehabilitation Unit (CRU) management bullied staff who flagged concerns over shortages and unsafe practice.
    Documents detail claims of "dangerous" staffing levels, patients left in bed all day without therapy and a one-star food hygiene rating.
    Through the Freedom of Information Act, the BBC discovered three whistleblowing complaints were made to the Care Quality Commission (CQC) between May and August last year.
    The first said wards "run on dangerous levels of staff" and no action was taken when staff flagged concerns.
    The second stated there was "bullying occurring from management when staff raise concerns regarding short staffing and unsafe practice".
    They said: "When issues relating to patient safety are raised... management are 'covering it up'."
    Read full story
    Source: BBC News, 9 May 2023
  13. Patient Safety Learning
    Long-running supply issues with blood collection equipment risk delaying the elective recovery, according to an internal NHS Supply Chain communication seen by HSJ.
    Global supply and manufacturing delays have caused the delivery of blood collection sets, apparatus used to draw intravenous blood into vacuum tubes, by months. The problems are affecting multiple products and suppliers.
    An NHS Supply Chain procurement advisory cell communication warned trusts: “There is a risk that the continued supply disruption of blood collection sets is delaying elective recovery, with providers restricting blood collection to continue to prioritise urgent procedures.” 
    This is the second “important customer notice” relating to supply problems with blood collection equipment issued by the national procurement agency.
    Read full story (paywalled)
    Source: HSJ, 9 May 2023
  14. Patient Safety Learning
    The World Health Organization (WHO) has declared that Covid-19 no longer represents a "global health emergency".
    The statement represents a major step towards ending the pandemic and comes three years after it first declared its highest level of alert over the virus.
    Officials said the virus' death rate had dropped from a peak of more than 100,000 people per week in January 2021 to just over 3,500 on 24 April.
    The head of the WHO said at least seven million people died in the pandemic.
    But Dr Tedros Adhanom Ghebreyesus said that the true figure was "likely" closer to 20 million deaths - nearly three times the official estimate - and he warned that the virus remained a significant threat.
    "Yesterday, the Emergency Committee met for the 15th time and recommended to me that I declare an end to the public health emergency of international concern. I've accepted that advice. It is therefore with great hope that I declare Covid-19 over as a global health emergency," Dr Tedros said.
    Read full story
    Source: BBC News, 6 May 2023
  15. Patient Safety Learning
    The Government’s “blanket erasure” of older people with learning disabilities is leaving a growing population unsupported and piling further pressure on family carers, new research will warn.
    Byline Times has seen early findings from a forthcoming national study which outlines the urgent need to avoid a crisis by creating a government strategy for this unacknowledged community.
    With around 1.5 million people with learning disabilities in the UK, Manchester Metropolitan University (MMU)’s ‘Growing Older Planning Ahead‘ research lays bare the Government’s short-sighted approach to learning disability support. 
    The study estimates around 81,000 over-50s within this population in England alone, many of whom are not in contact with services. In addition, figures show that between 2012 and 2030 in England, the number of learning disabled people needing social care will have increased by almost 70% (from more than 140,000 to 235,000).
    Sara Ryan, MMU Professor of Social Care who led the three-year project, said: “Ageing opens up all sorts of different things, you turn down the dial on some things and up on others. If you’re lucky enough, you have a lot to look forward to – but for people with learning disabilities, there’s a blanket erasure of age.”
    Read full story
    Source: Byline Times, 3 May 2023
  16. Patient Safety Learning
    The high proportion of pregnant women from black and ethnic minority (BAME) groups admitted to hospital with COVID-19 "needs urgent investigation", says a study in the British Medical Journal.
    Out of 427 pregnant women studied between March and April, more than half were from these backgrounds - nearly three times the expected number. Most were admitted late in pregnancy and did not become seriously ill. Although babies can be infected, the researchers said this was "uncommon".
    When other factors such as obesity and age were taken into account, there was still a much higher proportion from ethnic minority groups than expected, the authors said.
    But the explanation for why BAME pregnant women are disproportionately affected by coronavirus is not simple "or easily solved," says Professor Knight, lead author.
    "We have to talk to women themselves, as well as health professionals, to give us more of a clue."
    Gill Walton from the Royal College of Midwives says, "Even before the pandemic, women from black, Asian or ethnic minority backgrounds were more likely to die in and around their pregnancy,"
    She said they were "still at unacceptable risk" and getting help and support to affected communities was crucial. 
    Ms Walton added: "The system is failing them and that has got to change quickly, because they matter, their lives matter and they deserve the best and safest care."
    Read full story
    Source: BBC News, 8 June 2020
  17. Patient Safety Learning
    Only one NHS trust in England provides dedicated training to prevent sexual harassment, according to research, raising concerns that the NHS is failing to adequately protect staff and patients.
    According to health union figures, sexual harassment of staff is pervasive. A 2019 survey by Unison found that one in 12 NHS staff had experienced sexual harassment at work during the past year, with more than half saying the perpetrator was a co-worker. In a recent BMA survey, 91% of female doctors reported sexism, 31% had experienced unwanted physical contact and 56% unwanted verbal comments.
    Yet research by the University of Cambridge, published in the Journal of the Royal Society of Medicine found that the vast majority of NHS trusts did not provide any dedicated training to prevent sexual harassment.
    The report analysed data from freedom of information requests from 199 trusts in England and found that just 35 offered their workers any sort of active bystander training (ABT), while only one NHS trust had a specific module on sexual harassment.
    ABT is designed to give individuals the skills to call out unacceptable behaviour, from workplace bullying to racism and sexual misconduct. It is widely used by the military, universities and Whitehall, including the Home Office.
    Read full story
    Source: The Guardian, 5 May 2023
  18. Patient Safety Learning
    GPs in South London have eradicated a large gap in blood pressure control between white patients and those from a Black or minority ethnic background, after a year-long project.
    AT Medics Streatham PCN in Lambeth found that among their patients under 80 diagnosed with hypertension, there was a 12% inequality gap in blood pressure control, with 67% of white patients and 55% of black patients treated to target.
    The two practices in the PCN have 45,000 patients, with around 3,100 diagnosed with hypertension. They set up a centralised recall system and made use of practice pharmacists and healthcare assistants to provide guidance, education around self-care, lifestyle and medicines.
    Dr Tarek Radwan, GP director said: ‘This project has delivered incredible results, and this is all down to the dedication of our amazing team, especially our administrators, healthcare assistants and pharmacists.
    "The last 12 months have proved that we can not just reduce but actually eradicate health inequalities and raise the quality of care for everyone at the same time.
    "I know the difference this will make to our local communities, and it really shows what is possible with a highly motivated multidisciplinary team."
    Read full story
    Source: Pulse, 3 May 2023
  19. Patient Safety Learning
    The Royal College of Surgeons of England is conducting a census to gain a better understanding of the surgical workforce.
    Through the census, they will be able to gather comprehensive information on the composition of the surgical workforce, its demographics and working practices. Most importantly, it allows members of the surgical workforce to share the most pressing challenges they are facing. 
    It aims to:
    Better appreciate the needs, challenges, and working practices of the surgical workforce. More effectively represent and advocate for the workforce. Offer better support Create a better working environment. Enhance sustainability, including measures to improve retention, recruitment and work-life balance. Improve future planning. Take part in the survey
  20. Patient Safety Learning
    A former top medic on the Isle of Man who was unfairly dismissed has said her career has been "shattered" by her treatment.
    Rosalind Ranson was the Department of Health and Social Care's (DHSC) medical director from January 2020.
    She was awarded a record £3.19m in compensation after a lengthy tribunal which ruled she had been unfairly dismissed for whistleblowing.
    Dr Ranson raised a number of serious concerns about the coronavirus advice on the island that was not being passed on to ministers.
    She was later marginalised before being dismissed as the island's top medic when the operational services of DHSC transitioned into Manx Care.
    Dr Ranson said: "For me it is a tragedy that my 35-year career in medicine has come to an end through these circumstances.
    "I was proud of my professional integrity, my resilience, and my strength to stand up for those that I protected through my work as a doctor."
    Read full story
    Source: BBC News, 4 May 2023
  21. Patient Safety Learning
    A host of algorithms used by medics to assess disease risk and help make decisions on treatment are failing to take transgender patients into account, doctors have said.
    Many metrics and thresholds in medicine, including ideal body weight, alcohol clearance rates, kidney function and risk of cardiovascular disease vary by gender.
    A team of UK doctors and medical students have issued a warning over a lack of evidence as to whether trans patients should be considered for these gender-based scores according to their gender assigned at birth or the gender they have transitioned to – or whether alternative scores are required.
    In an effort to tackle the issue, the team have launched a research initiative called Trans Gap Project.
    Dr Michael Niman, a junior NHS doctor and chair of the project, said: “Currently, daily medical decisions involving gender-based scores have limited to no research for the trans community. This means that trans patients are often forgotten about or not considered in the medical world, leading to a significant gap in their access to appropriate medical care.”
    “When scores that haven’t considered trans people are used, patient autonomy is impaired for trans and gender-diverse patients, as they can’t make true informed decisions on their care – which is one of the bioethic pillars,” Niman said.
    In some cases, there could be safety concerns. “Clinicians are currently faced with uncertainty regarding the best clinical practice to address these scenarios, owing to a lack of evidence-based guidance,” Niman said. “It is vital clinicians take a vested interest in the research of gender-based scores for the trans community due to the importance of safe practice considerations within the NHS.”
    Read full story
    Source: The Guardian, 5 May 2023
  22. Patient Safety Learning
    Distress and heartbreak for millions could have been avoided if the government had not missed opportunities to prepare social care for a pandemic, according to a big investigation into how the first wave of Covid hit care homes.
    A review of events in spring 2020, when almost 20,000 care home residents died with Covid in England and Wales, found it was the result of “letting one of our most important public services languish in constant crisis for years”.
    A two-year study by the Nuffield Trust health thinktank and the London School of Economics found successive governments failed to respond to risks already exposed by cross-government pandemic planning exercises, didn’t have enough civil servants working on social care, and failed to appreciate the sector’s fragility when sending patients into ill-prepared care homes.
    The study is the latest independent assessment to undermine the claim by the former health secretary, Matt Hancock, to have thrown “a protective ring around social care”. It comes before the Covid-19 public inquiry’s investigation into the care sector, the timing of which has yet to be announced.
    Read full story
    Source: The Guardian, 5 May 2023
  23. Patient Safety Learning
    A patient who was left scarred for life when a botched operation left him with horrific burns has received a payout after suing the NHS.
    Paul Hickman, 44, underwent routine surgery to improve circulation in his legs when medics at Russell Hall Hospital in Dudley, West Midlands, wrongly used a heated mattress.
    He ended up with significant burns on his buttocks after an alcohol-based solution came into contact with the back of both thighs and his backside.
    Mr Hickman, of Walsall, West Midlands, said: “I hoped that the surgery would go well and would improve my health.
    “However, all I remember afterwards was being in severe pain.
    “To be told I had suffered burns was a complete shock and at first was difficult to try and take in. I couldn’t understand how that had happened".
    An NHS investigation found the use of heated mattresses was stopped in the type of procedure Mr Hickman underwent after another patient was burnt in 2016.
    The report found the use of alcohol-based solution during Mr Hickman’s preparation for surgery and the “inappropriate use” of a heated mattress in surgery led to his burns.
    Read full story
    Source: The Independent, 4 May 2023
  24. Patient Safety Learning
    A "very concerning" rise in the number of people catching measles in the UK has been reported by health officials.
    There were 54 cases of measles in the whole of last year. However, there have already been 49 in the first four months of 2023.
    The UK Health Security Agency (UKHSA) is encouraging parents to ensure their children's vaccinations are up to date.
    The main symptoms of measles are a fever and a rash. But it can cause more serious complications including meningitis, and an infection can be fatal.
    Vaccination rates had been falling in the UK before the Covid pandemic. However, the disruption caused by Covid has dented vaccination programmes around the world, including in the UK, meaning even more children have missed out.
    The World Health Organization has already warned of a "perfect storm" for measles, because the fewer people who receive protection from vaccines, the easier it is for outbreaks to happen.
    Read full story
    Source: BBC News, 4 May 2023
  25. Patient Safety Learning
    A national Long Covid and Covid-19 database is among the key recommendations of a unanimous report released by an Australian parliamentary Committee for its inquiry into Long Covid and repeated Covid infections.
    The House of Representative’s Standing Committee on Health, Aged Care and Sport’s report aims to improve Australia’s response to Long Covid, an often-debilitating condition possibly affecting hundreds of thousands of Australians.
    The Chair of the Committee, Dr Mike Freelander MP said: ‘It is clear that the emergence of Long Covid has created challenges for patients and health care professionals alike. People with Long Covid suffer from a lack of information and treatment options. Health care professionals, who worked tirelessly over the acute phase of the pandemic, are now in a difficult situation trying to support patients with this new and poorly understood condition.’
    The Committee made nine unanimous recommendations aimed at strengthening the Australian Government’s management of Long Covid, including regarding:
    A definition of long COVID for use in Australia Evidence-based living guidelines for long COVID, co-designed with patients with lived experience A nationally coordinated research program for long COVID and COVID-19 The COVID-19 vaccination communication strategy Access to antiviral treatments for COVID-19 Support for primary healthcare providers Indoor air quality and ventilation. Read full story
    Source: Parliament of Australia, 24 April 2023
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