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2.
Med Educ Online ; 26(1): 1847755, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33222656

RESUMO

Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency.


Assuntos
Estágio Clínico/organização & administração , Medicina Interna/educação , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Currículo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Adulto Jovem
3.
GMS J Med Educ ; 37(7): Doc84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33364363

RESUMO

Objective: The contact restrictions caused by the Covid-19 pandemic fundamentally limit patient-centered teaching. To realize a patient-oriented education in the block training "Internal Medicine" at the University Hospital Halle (Saale) despite the challenges, the already established teaching module "Interprofessional Teleconsultation" was adapted. The short article outlines the interprofessional teaching module including first evaluation results and describes the adapted block training. Method: In the "Internal Medicine" block training, students in a lecture hall navigated a telepresence system, which was accompanied by a physician across the ward and conducted an anamnesis via video and audio transmission without actual patient contact. Results: Students, physicians, and patients were open-minded about this form of communication during the Covid-19 pandemic and quickly got accustomed to the use of the telepresence system. To be able to react to technical challenges (e.g. unstable connection between the communication partners), a careful preparation of the lecturers is necessary. Conclusion: In using a telepresence system, patient-oriented teaching of students in the block training "Internal Medicine" can be ensured with low-threshold technical effort during the Covid-19 pandemic. The telepresence system allows for the involvement of patients into teaching while adhering to the necessary hygiene measures. Despite technical challenges, the teaching format based on telepresence is suitable as an alternative to face-to-face teaching if actual patient contact is not possible.


Assuntos
/epidemiologia , Educação a Distância/organização & administração , Educação Médica/organização & administração , Medicina Interna/educação , Telemedicina/organização & administração , Comunicação , Humanos , Educação Interprofissional/organização & administração , Pandemias
4.
Rev. cuba. med ; 59(4): e1398, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144503

RESUMO

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)


Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Especialização/normas , Medicina Interna/educação , Competência Profissional , Avaliação Educacional/métodos
7.
J Med Life ; 13(2): 183-186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742511

RESUMO

Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning. In order to evaluate the usefulness of an early rotation at internal medicine departments, we compared, via script concordance tests, the evolution of residents' clinical reasoning after an initial internal medicine rotation compared to rotations through other medical specialties. Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.


Assuntos
Medicina Interna/educação , Internato e Residência , Aprendizagem , Competência Clínica , Avaliação Educacional , Humanos
8.
PLoS One ; 15(8): e0236952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780751

RESUMO

Rotation schedules for residents must balance individual preferences, compliance with Accreditation Council for Graduate Medical Education guidelines, and institutional staffing requirements. Automation has the potential to improve the consistency and quality of schedules. We designed a novel rotation scheduling tool, the Automated Internal Medicine Scheduler (AIMS), and evaluated schedule quality and resident satisfaction and perceptions of fairness after implementation. We compared schedule uniformity, fulfillment of resident preferences, and conflicting shift assignments for the hand-made 2017-2018 schedule, and the AIMS-generated 2018-2019 schedule. Residents were surveyed in September 2018 to assess perception of schedule quality and fairness. With AIMS, 71/74 (96.0%) interns and 66/82 (80.5%) residents were assigned to their first-choice rotation, a significant increase from the 50/72 (69.4%) interns and 25/82 (30.5%) residents assigned their first-choice in the 2017-2018 academic year. AIMS also yielded significant improvements in the number of night shift/day shift conflicts at the time of rotation switches for interns, with a significant decrease to 0.3 conflicts per intern compared to 0.7 with the prior manual schedule. Twenty-two of 82 residents (27%) completed the survey, and average satisfaction and perception of fairness were 0.7 and 0.9 points higher on a 5-point Likert scale for the AIMS-generated schedule when compared to the non-AIMS schedule. There was no significant difference in the preference for assigned vacation blocks, or in variance for night or ICU rotations. Automated scheduling improved several metrics of schedule quality, as well as resident satisfaction. Future directions include evaluation of the tool in other residency programs and comparison with alternative scheduling algorithms.


Assuntos
Medicina Interna/educação , Internato e Residência , Admissão e Escalonamento de Pessoal , Automação , Connecticut , Feminino , Humanos , Satisfação no Emprego , Masculino , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Jornada de Trabalho em Turnos/normas , Jornada de Trabalho em Turnos/estatística & dados numéricos , Software , Inquéritos e Questionários , Estados Unidos , Tolerância ao Trabalho Programado
9.
Am J Med Sci ; 360(4): 357-362, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32631577

RESUMO

BACKGROUND: The association between grit, defined as perseverance and passion for long-term goals, and professional burnout has not been studied in internal medicine residents. Our objective was to examine whether internal medicine residents' scores on a grit scale were associated with various measures of burnout. METHODS: All residents from a single internal medicine program were invited to participate in a study of grit and burnout. Grit and burnout were measured using the Short Grit Scale and modified Maslach Burnout Inventory, respectively. In addition, demographics, last In-Training Examination (ITE) score, and interest in a subspecialty were captured. RESULTS: A total of 139 of 168 eligible residents (83%) participated. Emotional exhaustion and depersonalization (i.e., burn out) were identified in 63% and 42% of residents, respectively. Endorsement of emotional exhaustion was higher for residents living with family members, postgraduate year (PGY)1 and PGY2 compared with PGY3 residents, and residents scoring above the 50th percentile on the last ITE. Grit scores were higher for residents not reporting emotional exhaustion. As grit score increases, the odds of reporting emotional exhaustion significantly decreased, after adjustments for demographics, ITE scores, type of medical school, PGY level, and interest in a subspecialty (odds ratio = 0.36, 95% CI 0.15-0.84). CONCLUSIONS: Grit appeared to be an independent predictor of burnout in internal medicine residents in this sample, with lower grit scores associated with higher burnout scores. By measuring grit early in residency, programs can potentially identify residents at risk for symptoms of burnout, specifically emotional exhaustion, and implement targeted interventions.


Assuntos
Esgotamento Profissional/psicologia , Medicina Interna/educação , Internato e Residência/organização & administração , Satisfação no Emprego , Estresse Psicológico , Estudantes de Medicina/psicologia , Estudos de Coortes , Humanos , Inquéritos e Questionários
10.
Nutr Metab Cardiovasc Dis ; 30(9): 1520-1524, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32665208

RESUMO

BACKGROUND AND AIMS: Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS: We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS: The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.


Assuntos
Endocrinologistas/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Medicina Interna , Complicações na Gravidez/prevenção & controle , Gravidez em Diabéticas/terapia , Adulto , Anticoncepção , Educação de Pós-Graduação em Medicina , Endocrinologistas/educação , Serviços de Planejamento Familiar , Bolsas de Estudo , Feminino , Humanos , Medicina Interna/educação , Internato e Residência , Masculino , Saúde Materna , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/fisiopatologia , Gravidez não Planejada , Medição de Risco , Fatores de Risco , Especialização , Inquéritos e Questionários
11.
In Vivo ; 34(3 Suppl): 1603-1611, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503818

RESUMO

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.


Assuntos
Infecções por Coronavirus , Educação Médica/organização & administração , Cirurgia Geral/educação , Medicina Interna/educação , Pandemias , Pneumonia Viral , Estudantes de Medicina/psicologia , Infecções por Coronavirus/prevenção & controle , Educação a Distância , Avaliação Educacional , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Internato e Residência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Equipamentos de Proteção/provisão & distribução , Treinamento por Simulação , Mídias Sociais , Telemedicina , Realidade Virtual , Carga de Trabalho
13.
Am J Med Sci ; 360(4): 342-347, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32553748

RESUMO

BACKGROUND: The academic half day (AHD) has emerged in recent years as an alternative to the traditional noon conference model of didactic teaching in graduate medical education. However, the effects of this change on learners are not fully understood. This study aimed to assess the effects of the AHD on attendance, satisfaction, perceived value and wellness of resident physicians. METHODS: A survey aimed to assess housestaff satisfaction, perceived value and relevance to medical literature of the core educational curriculum was developed and validated. This, along with a wellness assessment survey, was distributed to residents electronically prior to the implementation of the AHD and again at the end of the academic year. Attendance was tracked for all conferences. RESULTS: The survey was administered to residents before and after implementation of the AHD (response rates were 100% and 83%, respectively at these time points [n = 95]). Implementation of the AHD lead to a significant increase in average time spent in the core conference series per week (29.7 versus 64.8 minutes). It additionally led to a statistically significant improvement of resident satisfaction with the core curriculum, perceived value of the core conference series, understanding of medical literature and promotion of reading outside of work. CONCLUSIONS: The AHD significantly improved resident time in conference, resident satisfaction and perceived educational value of the core conference series compared to a noon conference model. While challenges will exist with any educational conference model, the AHD appears to be a highly attractive approach to medical resident education.


Assuntos
Currículo , Medicina Interna/educação , Internato e Residência/organização & administração , Satisfação Pessoal , Carga de Trabalho , Adulto , Humanos , Admissão e Escalonamento de Pessoal , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Fatores de Tempo
15.
PLoS One ; 15(5): e0232511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384090

RESUMO

BACKGROUND: Mentoring's success in enhancing a mentee's professional and personal development, and a host organisations' reputation has been called into question, amidst a lack of effective tools to evaluate mentoring relationships and guide oversight of mentoring programs. A scoping review is proposed to map available literature on mentoring assessment tools in Internal Medicine to guide design of new tools. OBJECTIVE: The review aims to explore how novice mentoring is assessed in Internal Medicine, including the domains assessed, and the strengths and limitations of the assessment methods. METHODS: Guided by Levac et al.'s framework for scoping reviews, 12 reviewers conducted independent literature reviews of assessment tools in novice mentoring in PubMed, Embase, Scopus, ERIC, Cochrane, GreyLit, Web of Science, Open Dissertations and British Education Index databases. A 'split approach' saw research members adopting either Braun and Clarke's approach to thematic analysis or directed content analysis to independently evaluate the data and improve validity and objectivity of the findings. RESULTS: 9662 abstracts were identified, 187 full-text articles reviewed, and 54 full-text articles included. There was consensus on the themes and categories identified through the use of the split approach, which were the domains assessed and methods of assessment. CONCLUSION: Most tools fail to contend with mentoring's evolving nature and provide mere snap shots of the mentoring process largely from the mentee's perspective. The lack of holistic, longitudinal and validated assessments propagate fears that ethical issues in mentoring are poorly recognized and addressed. To this end, we forward a framework for the design of 'fit for purpose' multi-dimensional tools. PRACTICE POINTS: Most tools focus on the mentee's perspective, do not consider mentoring's evolving nature and fail to consider mentoring holistically nor longitudinallyA new tool capable of addressing these gaps must also consider inputs from all stakeholders and take a longitudinal perspective of mentoring.


Assuntos
Medicina Interna/educação , Tutoria , Mentores , Avaliação Educacional/métodos , Humanos
16.
Ann Intern Med ; 172(12): 810-816, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32365356

RESUMO

Hahnemann University Hospital provided care for Philadelphians starting in 1848, but its recent history has been riddled with financial turmoil that culminated in its rapid closure in summer 2019. As the hospital shuttered its doors to patients, it also orphaned 583 medical trainees. This crisis exposed vulnerabilities in graduate medical education (GME). In a firsthand account of the situation that developed in Philadelphia and reached academic institutions across the country, the authors reflect on lessons learned that may help leaders at other institutions mitigate the inevitable difficulties that arise when academic hospitals close. These lessons pertain to handling panic and administrative burdens in the aftermath of closure, the importance of well-defined processes, a clear understanding of GME funding, and strategies for placement of trainees that minimize disruption of their education.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Medicina Interna/educação , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Humanos , Internato e Residência , Estados Unidos
17.
South Med J ; 113(5): 201-204, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358612

RESUMO

OBJECTIVES: A large discrepancy exists in resident educational activities between daytime and nighttime medical rotations. The Accreditation Council for Graduate Medical Education duty-hour regulations led to the increased adoption of the dedicated nighttime rotation called night float. Nighttime education has largely been negatively perceived by night float medical residents. Although there have been attempts to improve nighttime education, none of the initiatives included faculty-guided structured night curriculum. Our objective was to improve resident experience with and perception of nighttime education by implementing a structured, faculty-guided, nighttime educational curriculum. METHODS: This was an assessment of an educational initiative at a single academic medical center, Virginia Commonwealth University Health System. The internal medicine residency program implemented a teaching nocturnist program in 2013 and a novel faculty-guided nighttime teaching curriculum in 2016 called midnight report. We then evaluated resident experience with and perception of nighttime education at our institution using anonymous free-response surveys for the academic year July 2016-June 2017. RESULTS: Of the 142 eligible residents, 95 (67%) responded to the survey. The majority of the residents (54%-77%) positively perceived their experience of the nighttime educational environment during their night float rotation after implementation of the teaching nocturnist program and midnight report. CONCLUSIONS: Compared with the published literature reporting negative perceptions of the nighttime educational environment by residents at different academic centers, our results showed that the majority of our residents positively perceived the impact of our new faculty-guided nighttime educational curriculum.


Assuntos
Currículo , Educação de Pós-Graduação em Medicina/métodos , Docentes de Medicina , Medicina Interna/educação , Jornada de Trabalho em Turnos , Educação de Pós-Graduação em Medicina/organização & administração , Humanos
19.
J Grad Med Educ ; 12(2): 168-175, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322350

RESUMO

Background: In the era of competency-based assessment, medical education faculty are frequently challenged to develop unique teaching approaches. One method to address faculty development needs in a real-time clinical learning environment is peer coaching. Objective: We implemented and evaluated a faculty development program involving peer observation and feedback for attending physicians. Methods: Hospital internal medicine faculty assigned to a teaching service were recruited for the study. Participants voluntarily agreed to observe and be observed by a peer attending physician during a 2-week block of teaching rounds. When serving in the coaching role, faculty were asked to observe 4 separate occasions using an observation tool based on the Stanford Faculty Development Program framework to guide feedback. An outside consultant facilitated a focus group and completed a qualitative content analysis to categorize all participants' experiences during the faculty development activity. Results: Of the 22 eligible faculty, 14 (64%) agreed to participate by committing to 6 to 8 hours observing another faculty member during rounds, 2 feedback sessions, and 90 minutes to provide program feedback during a focus group. The analysis of the focus group revealed favorable reactions to the faculty development program, including (1) observed attending awareness of unrecognized habits; (2) personalized teaching tips for the observed attending to improve teaching quality based on individual style/preferences; and (3) exposure to new teaching techniques. Conclusions: An inpatient-based peer-coaching faculty development program was acceptable and feasible for a majority of faculty and may improve individual teaching effectiveness among conventionally trained physicians.


Assuntos
Docentes de Medicina , Medicina Interna/educação , Grupo Associado , Desenvolvimento de Pessoal/métodos , Centros Médicos Acadêmicos , Retroalimentação , Grupos Focais , Humanos , Internato e Residência/métodos , Corpo Clínico Hospitalar , Visitas com Preceptor/métodos
20.
J Grad Med Educ ; 12(2): 208-211, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322355

RESUMO

Background: Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective: We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods: This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results: During the study period, mean resident continuity was 23% (range 13%-37%) in the comparison clinic (57 residents) and 54% (range 38%-66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P < .001 for all comparisons). Conclusions: Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.


Assuntos
Agendamento de Consultas , Continuidade da Assistência ao Paciente , Medicina Interna/organização & administração , Internato e Residência/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Humanos , Medicina Interna/educação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Carga de Trabalho
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