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1.
Artículo en Inglés | MEDLINE | ID: mdl-33807819

RESUMEN

(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.


Asunto(s)
Obstetricia , Comunicación , Femenino , Personal de Salud , Humanos , Seguridad del Paciente , Embarazo
3.
Wiad Lek ; 74(3 cz 2): 647-651, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33843628

RESUMEN

OBJECTIVE: The aim: To determine the priority directions for the integration of obstetric and gynecological care for the female population of Ukraine to the primary level of its provision. PATIENTS AND METHODS: Materials and methods: Sociological, statistical and bibliosemantic methods were used in the research. The systematic approach was the methodological basis of the study. 79 health care providers, 127 family doctors, 92 doctors of obstetrics and gynecology, and 248 women of reproductive age were interviewed as experts using a special questionnaire. RESULTS: Results: Some priority management and organizational measures that need to be carried out for the effective integration of obstetric and gynecological care to the female population of Ukraine at the primary level of its provision were identified in the research. They include, first of all, the training of family physicians and family nurses to provide medical services to the female population and the coordination of primary care and specialized obstetric and gynecological services. CONCLUSION: Conclusions: The priority of application of management and organizational measures for the effective integration of obstetric and gynecological care to the female population of Ukraine to the primary level of its provision was determined by an expert way.


Asunto(s)
Ginecología , Obstetricia , Femenino , Humanos , Médicos de Familia , Embarazo , Atención Primaria de Salud , Ucrania
4.
Medicine (Baltimore) ; 100(9): e24660, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655930

RESUMEN

BACKGROUND: A meta-analysis was conducted to assess the effectiveness of problem-based learning (PBL) in gynecology and obstetrics education in China. METHODS: English and Chinese databases were systematically searched for eligible studies that compared the effects of PBL and traditional teaching methods measuring theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores in gynecology and obstetrics education in China. The authors restricted included studies to randomized controlled trials and performed a meta-analysis. Standardized mean difference (SMD) and risk ratio with 95% confidence interval (CI) were estimated. RESULTS: A total of 38 randomized controlled trials with 3005 participants were included. Compared with traditional teaching group, the PBL group significantly increased theoretical knowledge scores (SMD: 3.17, 95% CI: 2.28, 4.07), student satisfaction (risk ratio: 1.29, 95% CI: 1.16, 1.43), clinical operations (SMD: 1.15, 95% CI: 0.93, 1.37) and clinical practice (SMD: 2.17, 95% CI: 3.63, 2.71). CONCLUSION: The current research shows that PBL in gynecology and obstetrics education in China is more effective than the traditional teaching in enhancing theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores. However, more delicate-designed studies on this topic are needed in the future to validate these results.


Asunto(s)
Educación Médica/métodos , Ginecología/educación , Obstetricia/educación , Aprendizaje Basado en Problemas/métodos , China , Evaluación Educacional , Femenino , Humanos , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
5.
South Med J ; 114(4): 218-222, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33787935

RESUMEN

OBJECTIVES: Physician trainees in obstetrics and gynecology (OBGYN) experience unexpected outcomes similar to those of supervising physicians. A relative lack of experience and perspective may make them more vulnerable to second victim experience (SVE), however. The objectives of our study were to contrast the prevalence of SVE between supervising physicians and trainees and to identify their preferred methods of support. METHODS: In 2019, the Second Victim Experience and Support Tool, a validated survey with supplemental questions, was administered to healthcare workers caring for OBGYN patients at a large academic center in the midwestern United States. RESULTS: The survey was sent to 571 healthcare workers working in OBGYN. A total of 205 healthcare workers completed the survey, including 18 (43.9% of 41) supervising physicians and 12 (48.0% of 25) resident/fellow physicians. The mean scores for the Second Victim Experience and Support Tool dimensions and outcomes were similar between the two groups. Seven (58.3%) trainees reported feeling like a second victim after an adverse patient safety event at some point in their work experience compared with 10 (55.6%) of the supervising physicians. Five (41.7%) trainees identified as a second victim in the previous 12 months compared with 3 (16.7%) supervising physicians (P = 0.21). The most common form of desired support for both groups was conversations with their peers. CONCLUSIONS: Trainees and supervising physicians are both at risk of SVE after an unexpected medical event and prefer conversations with peers as a desired form of support. Because trainees commonly encounter SVEs early in their careers, program directors should consider implementing a program for peer support after an unexpected event.


Asunto(s)
Desgaste por Empatía/epidemiología , Ginecología/educación , Internado y Residencia , Obstetricia/educación , Médicos/psicología , Apoyo Social , Desgaste por Empatía/diagnóstico , Desgaste por Empatía/etiología , Desgaste por Empatía/terapia , Encuestas Epidemiológicas , Humanos , Relaciones Interprofesionales , Minnesota/epidemiología , Prevalencia , Factores de Riesgo
6.
Arch Gynecol Obstet ; 303(4): 871-876, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33558990

RESUMEN

BACKGROUND: The rapid technical development and portability of ultrasound systems over recent years has had a profound impact on the area of point-of-care-ultrasound (POCUS), both in general medicine and in obstetrics and gynecology. The use of POCUS enables the clinician to perform the ultrasound scan either at the medical office or the patient's bedside and used as an extension of the physical examination. Real-time images can immediately be correlated with the patient's symptoms, and any changes in a (critical) patient's condition can be more rapidly detected. POCUS IN OBGYN: POCUS is also suitable for time-critical scenarios, and depending on the situation and its dynamics, the course and results of any therapy may be observed in real time. POCUS should be considered to be a routine extension of practice for most OB/GYN clinicians as it can give immediate answers to what could be life-threatening situations for the mother and/or baby. With its proven usefulness, the applications and use of POCUS should be incorporated in teaching programs for medical students, OBGYN residents and emergency physicians.


Asunto(s)
Ginecología/métodos , Obstetricia/métodos , Sistemas de Atención de Punto/normas , Ultrasonografía/métodos , Humanos , Examen Físico
7.
Eur J Obstet Gynecol Reprod Biol ; 258: 457-458, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33518409

RESUMEN

The specialty of Obstetrics and Gynaecology has been on the forefront of introducing simulation in post graduate education for the past two decades. Simulation training is known to enhance psychomotor skills and is considered an important step in the transition from classroom learning to clinical practice. Training on simulators allows trainees to acquire basic skills before getting involved in day to day care in real life situations. Clinical circumstances around the COVID 19 pandemic have highlighted the key importance of simulation training in delivering post graduate curriculum.


Asunto(s)
Ginecología/educación , Obstetricia/educación , Entrenamiento Simulado/normas , /epidemiología , Curriculum , Femenino , Humanos , Pandemias , Embarazo
8.
Reprod Health ; 18(1): 50, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639966

RESUMEN

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Partería , Obstetricia/normas , Calidad de la Atención de Salud , Adulto , Benin/epidemiología , Lista de Verificación , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Parto Obstétrico/enfermería , Parto Obstétrico/normas , Parto Obstétrico/estadística & datos numéricos , Femenino , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Humanos , Cuidado del Lactante/normas , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Malaui/epidemiología , Partería/educación , Partería/normas , Partería/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Embarazo , Encuestas y Cuestionarios , Tanzanía/epidemiología , Uganda/epidemiología , Adulto Joven
9.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33633928

RESUMEN

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Asunto(s)
Anestesia/normas , Cirugía General , Salud Global , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/organización & administración , Obstetricia/normas , /epidemiología , Cirugía General/organización & administración , Cirugía General/normas , Salud Global/normas , Salud Global/tendencias , Humanos , Mejoramiento de la Calidad
10.
Aust N Z J Obstet Gynaecol ; 61(1): 9-10, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33523473
11.
South Med J ; 114(1): 4-7, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33398352

RESUMEN

OBJECTIVE: Our primary objective was to assess the current state of pain and opioid education in obstetrics and gynecology (OBGYN) by performing a detailed review of the national educational curricula guiding OBGYN residency and fellowship training programs in the United States. METHODS: From 2019 to 2020 we reviewed seven documents created to guide learning and structure educational training for OBGYN residency and fellowship programs in the United States: the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives Core Curriculum in Obstetrics and Gynecology, the 2016 Educational Objectives-Fellowship in Minimally Invasive Gynecologic Surgery, and the 2018 Guides to Learning in Complex Family Planning, Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology and Infertility. Each document was reviewed by two authors to assess for items referring to pain or opioids. RESULTS: The CREOG educational objectives, used to inform educational curricula for residency programs, were the most comprehensive, mentioning pain and/or opioid educational objectives the highest number of times and including the most categories. The CREOG document was followed by the Guides to Learning for Gynecologic Oncology and for Minimally Invasive Gynecologic Surgery. The Reproductive Endocrinology and Infertility Guide to Learning did not mention pain and/or opioids in the educational objectives. CONCLUSIONS: Our study identifies an opportunity for consistent and appropriate opioid and pain management education in OBGYN training.


Asunto(s)
Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Curriculum/normas , Educación de Postgrado en Medicina/métodos , Obstetricia/educación , Analgésicos Opioides/administración & dosificación , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Curriculum/estadística & datos numéricos , Educación de Postgrado en Medicina/normas , Educación de Postgrado en Medicina/estadística & datos numéricos , Humanos , Obstetricia/métodos , Enseñanza/normas , Enseñanza/estadística & datos numéricos , Estados Unidos
12.
Am J Obstet Gynecol ; 224(1): B2-B14, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33386103

RESUMEN

Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.


Asunto(s)
Placenta Accreta/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Ultrasonografía Prenatal/normas , Cesárea/efectos adversos , Cicatriz/diagnóstico por imagen , Femenino , Edad Gestacional , Ginecología , Humanos , Obstetricia , Placenta/diagnóstico por imagen , Placenta Accreta/epidemiología , Embarazo , Sensibilidad y Especificidad , Sociedades Médicas , Estados Unidos , Útero/diagnóstico por imagen
13.
Obstet Gynecol ; 137(1): 207, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33399427

RESUMEN

ABSTRACT: Epilepsy is a common disease that affects 1.5 million women of childbearing age in the United States. Approximately 24,000 women with epilepsy give birth each year. The challenges for women with epilepsy extend from menarche to postmenopause, including prepregnancy, pregnancy, intrapartum and postpartum periods, menopause, and postreproductive age. The most up-to-date neurology and epilepsy guidelines provided in this monograph will enable obstetrician-gynecologists to provide care to women with this complex condition across the life span.


Asunto(s)
Complicaciones del Embarazo , Atención Primaria de Salud , Convulsiones , Femenino , Ginecología , Humanos , Obstetricia , Embarazo , Salud de la Mujer
14.
Can J Anaesth ; 68(4): 546-565, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33438172

RESUMEN

PURPOSE: The incidence of difficult and failed intubation is higher in obstetrical patients than in the general population because of anatomic and physiologic changes in pregnancy. Videolaryngoscopy improves the success rate of intubation and reduces complications when compared with direct laryngoscopy in adults; however, it is not known whether this extends to obstetrical surgery. The aim of this study was to examine the efficacy, efficiency, and safety of videolaryngoscopy compared with direct laryngoscopy in obstetrics. SOURCE: Central, CINAHL, Embase, MEDLINE and Web of Science databases were searched from inception to 27 May 2020 with no restrictions. Inclusion criteria included randomized-controlled trials (RCTs), observational studies, case series, and case reports that reported the application of videolaryngoscopy to intubate the trachea in pregnant patients having general anesthesia. PRINCIPAL FINDINGS: Overall, four RCTs with 428 participants, nine observational studies, and 35 case reports/series with 100 participants were included. On meta-analysis of three trials, the co-primary outcomes of first-attempt success rate (risk ratio, 1.02; 95% confidence intervals [CI], 0.98 to 1.06; P = 0.29; I2 = 0%) and time to tracheal intubation (mean difference, 1.20 sec; 95% CI, -6.63 to 9.04; P = 0.76; I2 = 95%) demonstrated no difference between videolaryngoscopy and direct laryngoscopy in parturients without difficult airways. Observational studies and case reports underline the role of videolaryngoscopy as a primary choice when difficulty with tracheal intubation is expected or as a rescue modality in difficult or failed intubations. CONCLUSIONS: Evidence for the utility of videolaryngoscopy continues to evolve but supports its increased adoption in obstetrics where videolaryngoscopes should be immediately available for use as a first-line device. TRIAL REGISTRATION: PROSPERO (CRD42020189521); registered 6 July 2020.


Asunto(s)
Laringoscopios , Obstetricia , Adulto , Humanos , Intubación Intratraqueal/efectos adversos , Laringoscopía , Tráquea , Grabación en Video
18.
Artículo en Inglés | MEDLINE | ID: mdl-33514070

RESUMEN

Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women's HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.


Asunto(s)
Alfabetización en Salud , Servicios de Salud Materna , Obstetricia , Toma de Decisiones , Femenino , Humanos , Embarazo
19.
J Assist Reprod Genet ; 38(3): 621-626, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33447949

RESUMEN

PURPOSE: The objective of this study was to evaluate the perception of the initial ASRM COVID-19 recommendations for infertility treatment held by women's health providers within varying subspecialties, as well as their attitudes toward pregnancy and fertility during this time. METHODS: An electronic survey was sent to all women's healthcare providers, including physicians, mid-level providers and nurses, in all subspecialties of obstetrics and gynaecology (Ob/Gyn) at a large tertiary care university-affiliated hospital. RESULTS: Of the 278 eligible providers, the survey response rate was 45% (n = 127). Participants represented 8 Ob/Gyn subspecialties and all professional levels. Participants age 18-30 years were significantly more likely to feel that women should have access to infertility treatment despite the burden level of COVID-19 in respective community/states (p = 0.0058). Participants within the subspecialties of general Ob/Gyn, maternal foetal medicine and gynecologic oncology were significantly more likely to disagree that all women should refrain from planned conception during the COVID-19 pandemic, in comparison to those in urogynecology and reproductive endocrinology and infertility (p = 0.0003). CONCLUSIONS: Considering the immediate and unknown long-term impact of the COVID-19 pandemic on fertility care delivery, a better understanding of perceptions regarding infertility management during this time is important. Our study shows overall support for the initial ASRM recommendations, representing a wide spectrum of women's health providers.


Asunto(s)
/epidemiología , Personal de Salud/psicología , Medicina Reproductiva/métodos , Salud de la Mujer , Adulto , Actitud del Personal de Salud , Femenino , Ginecología/métodos , Humanos , Masculino , Obstetricia , Pandemias , Percepción/fisiología , Encuestas y Cuestionarios
20.
Alerta (San Salvador) ; 4(1): 5-11, ene, 22, 2021. ilus, tab
Artículo en Español | LILACS, BISSAL | ID: biblio-1146423

RESUMEN

El embarazo ectópico abdominal es el más raro de los embarazos. El saco gestacional se implanta en la pelvis o en estructuras vascularizadas como el hígado, bazo o mesenterio. El riesgo de complicación es 7 a 8 veces mayor que el riesgo de un embarazo ectópico tubárico, y es 90 veces mayor que el de un embarazo intrauterino. Por esta razón, tiene una elevada mortalidad y el diagnóstico temprano, así como, su tratamiento oportuno, salva vidas. Este caso relata la historia de una mujer de 43 años multípara, de la zona rural, quien consultó por sensación de plenitud, dolor abdominal relacionado a la ingesta de comidas grasosas y ausencia de menstruación de 7 semanas. Sin precisar un diagnóstico, presentó signos de shock hipovolémico, por tal motivo, fue referida al Hospital San Juan de Dios de San Miguel, donde fue atendida en máxima urgencia, se hizo el diagnóstico de embarazo ectópico hepático roto y se realizó cirugía de emergencia en conjunto con cirugía general. Se le extirpó el lóbulo hepático derecho que contenía el embarazo y luego se le colocó un parche de epiplón. El manejo en unidad de cuidados intensivos tuvo buen término, a pesar de la inestabilidad hemodinámica que presentó.


Ectopic abdominal pregnancy is the rarest of all kind of pregnancies. The gestational sac is implanted in the pelvis or in vascularized structures such as the liver, spleen or mesentery. The risk of complication is 7 to 8 times higher than a tubal ectopic pregnancy and 90 times higher that than an intrauterine pregnancy. For this reason, it has a high mortality rate and early diagnosis and timely treatment save lives. This clinical case it's about a 43-year-old multiparous woman from the rural area, who consulted for a sensation of fullness, diffuse abdominal pain related to the ingestion of fatty foods and absence of menstruation for 7 weeks. without specifying a diagnosis, the patient presented signs of hypovolemic shock, for which she was referred to the San Juan de Dios Hospital in San Miguel, where she was treated urgently, performing a diagnostic of ripped ectopic hepatic pregnancy requiring an emergency surgery along with a general surgery. The right lobe of the liver that contained the pregnancy was removed and then an omentum patch was placed. The intensive care management was accomplished, yet the homodynamic instability presented


Asunto(s)
Embarazo Ectópico , Hígado , Obstetricia
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