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Camp J, Bayrhuber M, Anka N, Heine V, Glattacker M, Farin-Glattacker E, Rieg S. Efficacy of a novel patient-focused intervention aimed at increasing adherence to guideline-based preventive measures in asplenic patients: the PrePSS trial. Infection 2023; 51:1787-1795. [PMID: 37653288 PMCID: PMC10665246 DOI: 10.1007/s15010-023-02088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS). METHODS We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific 'Preventing PSS score' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card. RESULTS At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation. CONCLUSIONS Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.
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Affiliation(s)
- Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marianne Bayrhuber
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natascha Anka
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valerie Heine
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bianchi FP, Stefanizzi P, Spinelli G, Mascipinto S, Tafuri S. Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2021; 20:297-308. [PMID: 33538617 DOI: 10.1080/14760584.2021.1886085] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asplenic or splenectomized patients have a higher risk (ranging from 10 to 50-fold) than the general population of developing an overwhelming post-splenectomy infection (OPSI). Thus, they should receive specific vaccinations to prevent bacterial infections and influenza. The aim of this meta-analysis was to estimate vaccination coverage (VC) with the recommended vaccines among splenectomized patients; strategies recommended in those studies to improve VC worldwide are considered as well. RESEARCH DESIGN AND METHODS Scopus, MEDLINE/PubMed, Google Scholar and ISI Web of Knowledge databases were searched. Research papers, short reports, reviews, and meta-analyses published between January 1, 2010 and July 18, 2020 were included; no geographic restrictions were included. Twenty-four studies were included in the meta-analysis. RESULTS For anti-pneumococcal vaccination, coverage was 55.1% (95%CI = 41.0-69.2%), for anti-Hib 48.3% (95%CI = 34.3-52.3%), for anti-meningococcal C/ACYW135 33.7% (95%CI = 23.6-43.9%), for anti-meningococcal B 13.3% (95%CI = 7.0-19.5%) and for anti-influenza 53.2% (95%CI = 22.0-84.4%). Most studies determined a lack of adherence to international guidelines by healthcare workers and suggested the need to better educate health professionals in the management of post-splenectomy patients. CONCLUSIONS The meta-analysis showed the suboptimal immunization coverage for the vaccines recommended for asplenic patients. Greater efforts must be made by public health professionals to increase VC in this group of patients at risk. Introducing specific prophylaxis protocols in the clinical routine seems to guarantee better immunization compliance in those patients.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Giuseppe Spinelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Simona Mascipinto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Rieg S, Bechet L, Naujoks K, Hromek J, Lange B, Juzek-Küpper MF, Stete K, Müller MC, Jost I, Kern WV, Theilacker C. A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention. Open Forum Infect Dis 2020; 7:ofaa050. [PMID: 32158777 PMCID: PMC7051034 DOI: 10.1093/ofid/ofaa050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis. Methods From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry (“early study entry”) and those who had splenectomy (or were asplenic) >3 months before study entry (“delayed study entry”). Results A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy. Conclusions With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena Bechet
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai Naujoks
- Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Hromek
- Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Berit Lange
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc-Fabian Juzek-Küpper
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katarina Stete
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias C Müller
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Insa Jost
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Theilacker
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Church EC, Banks R, Wilson B, Arfons L, Perez F, Jump R. Improving pneumococcal vaccine uptake in veterans with chronic lymphocytic leukemia through a virtual clinic. ACTA ACUST UNITED AC 2018; 25:e95-e98. [PMID: 29507501 DOI: 10.3747/co.25.3756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Through a "virtual clinic," we used the electronic medical record to identify and intervene upon patients with chronic lymphocytic leukemia (cll) who were not current for pneumococcal vaccines. Within 180 days, 100/160 patients (62%) received the recommended pneumococcal vaccine. A virtual clinic may improve vaccination rates among high-risk patient populations.
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Affiliation(s)
- E C Church
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - R Banks
- Geriatric Research, Education and Clinical Center at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (lscvamc), Cleveland, Ohio
| | - B Wilson
- Geriatric Research, Education and Clinical Center at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (lscvamc), Cleveland, Ohio
| | - L Arfons
- Specialty Care Center of Innovation, lscvamc, Cleveland, Ohio.,Division of Hematology and Oncology; and
| | - F Perez
- Geriatric Research, Education and Clinical Center at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (lscvamc), Cleveland, Ohio.,Division Infectious Diseases and HIV Medicine, Department of Medicine at Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - R Jump
- Geriatric Research, Education and Clinical Center at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (lscvamc), Cleveland, Ohio.,Specialty Care Center of Innovation, lscvamc, Cleveland, Ohio.,Division Infectious Diseases and HIV Medicine, Department of Medicine at Case Western Reserve University School of Medicine, Cleveland, Ohio
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Burns CM, Banks RE, Wilson BM, Carter RR, Jump RLP, Perez F. A virtual clinic improves pneumococcal vaccination coverage among patients living with HIV at a Veterans Affairs Medical Center. AIDS Care 2017; 30:146-149. [PMID: 29052434 DOI: 10.1080/09540121.2017.1390542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People living with the human immunodeficiency virus (HIV) should receive pneumococcal vaccinations as part of their routine health maintenance. Our goal was to create a "virtual clinic" to help increase rates of pneumococcal vaccination among people living with HIV without adding substantially to the workload of primary providers. We used administrative data from our Veterans Affairs (VA) medical center to identify a cohort of veterans living with HIV who were not current with either the 13-valent pneumococcal conjugate vaccine (PCV13), the 23-valent pneumococcal polysaccharide vaccine (PPSV23) or both. We enrolled these individuals (n = 99) into a virtual clinic, notified providers via the electronic medical record and mailed letters to the veterans recommending they receive a pneumococcal vaccine. We also wrote orders for the appropriate pneumococcal vaccine that expired after 90 days. Among the virtual clinic cohort, 38% (38/99) of patients received the recommended vaccine within 180 days. Concurrent with our intervention, the Veterans Health Administration deployed a system-wide pneumococcal vaccine clinical reminder that incorporated recent PCV13 recommendations. To discern any effect of the virtual clinic beyond that of the clinical reminder, we compared the rate of PCV13 vaccinations among all HIV-positive veterans at our institution to the equivalent population from 2 other VA medical centers in Ohio. With consideration of the VHA's system-wide clinical reminder, the proportion of HIV-positive patients who received PCV13 in the first 90 days following the virtual clinic intervention was greater at our facility compared to another Ohio VA medical center (P < 0.05). The virtual clinic improved the pneumococcal vaccine coverage among HIV-positive veterans. These outcomes suggest that even in conjunction with a system-wide clinical reminder, the virtual clinic strategy improves vaccination rates among a high-risk population.
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Affiliation(s)
- Charles M Burns
- a Department of Medicine , University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - Richard E Banks
- b Geriatric Research, Education and Clinical Center , Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC) , Cleveland , OH , USA
| | - Brigid M Wilson
- b Geriatric Research, Education and Clinical Center , Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC) , Cleveland , OH , USA
| | - Rebecca R Carter
- c Department of Epidemiology & Biostatistics , Case Western Reserve University School of Medicine , Cleveland , OH , USA
| | - Robin L P Jump
- b Geriatric Research, Education and Clinical Center , Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC) , Cleveland , OH , USA.,c Department of Epidemiology & Biostatistics , Case Western Reserve University School of Medicine , Cleveland , OH , USA.,d Division of Infectious Diseases and HIV Medicine, Department of Medicine , Case Western Reserve University School of Medicine , Cleveland , OH , USA
| | - Federico Perez
- b Geriatric Research, Education and Clinical Center , Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC) , Cleveland , OH , USA.,d Division of Infectious Diseases and HIV Medicine, Department of Medicine , Case Western Reserve University School of Medicine , Cleveland , OH , USA
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Browne C, Davis NF, Mac Craith ED, Lennon GM, Galvin DJ, Mulvin DW. Prospective evaluation of a virtual urology outpatient clinic. Ir J Med Sci 2017; 187:251-254. [PMID: 28474234 DOI: 10.1007/s11845-017-1615-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Outpatient department (OPD) clinics account for a significant proportion of healthcare expenditure. We report on a pilot study of a virtual outpatient clinic (VC) for urology patients as an alternative to a general urology clinic review. AIMS The study aims to assess the safety and cost-effectiveness of a virtual clinic as an alternative to general OPD review. METHODS A prospective study performed between March 2015 and December 2015 investigated the effectiveness of a VC in our institution. Eligible patients were recruited from general urology outpatient visits, from medical team members and from general practitioners (GP). Data recorded on each VC review included patient demographics, indication for referral to VC, outcome of VC and method of communication with the patient and their GP after the VC. RESULTS Three hundred eighty-five patients were registered for the VC. Indications for referral included review of imaging results (n = 136), doctor or patient query (n = 112) and review of laboratory results (n = 67). Outcomes after VC review included general OPD follow-up (n = 134), discharge from urology care (n = 39), referral for urological intervention (n = 29) and referral for radiological investigation (n = 23). VC review prevented 217 OPD clinic visits, saved €17,360 and provided a failsafe mechanism for reviewing investigation results. Two patients booked for OPD review following VC review did not receive appointments. CONCLUSIONS Virtual clinic is a safe and cost-effective alternative to general OPD review in appropriately selected patients.
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Affiliation(s)
- C Browne
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - N F Davis
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E D Mac Craith
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - G M Lennon
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D J Galvin
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D W Mulvin
- Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Alharbi NS, Al-Barrak AM, Al-Moamary MS, Zeitouni MO, Idrees MM, Al-Ghobain MO, Al-Shimemeri AA, Al-Hajjaj MS. The Saudi Thoracic Society pneumococcal vaccination guidelines-2016. Ann Thorac Med 2016; 11:93-102. [PMID: 27168856 PMCID: PMC4854068 DOI: 10.4103/1817-1737.177470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 01/19/2023] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is the leading cause of morbidity and mortality worldwide. Saudi Arabia is a host to millions of pilgrims who travel annually from all over the world for Umrah and the Hajj pilgrimages and are at risk of developing pneumococcal pneumonia or invasive pneumococcal disease (IPD). There is also the risk of transmission of S. pneumoniae including antibiotic resistant strains between pilgrims and their potential global spread upon their return. The country also has unique challenges posed by susceptible population to IPD due to people with hemoglobinopathies, younger age groups with chronic conditions, and growing problem of antibiotic resistance. Since the epidemiology of pneumococcal disease is constantly changing, with an increase in nonvaccine pneumococcal serotypes, vaccination policies on the effectiveness and usefulness of vaccines require regular revision. As part of the Saudi Thoracic Society (STS) commitment to promote the best practices in the field of respiratory diseases, we conducted a review of S. pneumoniae infections and the best evidence base available in the literature. The aim of the present study is to develop the STS pneumococcal vaccination guidelines for healthcare workers in Saudi Arabia. We recommend vaccination against pneumococcal infections for all children <5 years old, adults ≥50 years old, and people ≥6 years old with certain risk factors. These recommendations are based on the presence of a large number of comorbidities in Saudi Arabia population <50 years of age, many of whom have risk factors for contracting pneumococcal infections. A section for pneumococcal vaccination before the Umrah and Hajj pilgrimages is included as well.
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Affiliation(s)
- N. S. Alharbi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A. M. Al-Barrak
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M. S. Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M. O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M. M. Idrees
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M. O. Al-Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A. A. Al-Shimemeri
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Al-Hajjaj M, Alharbi NS, Zeitouni MO, Idrees MM, Al-Barrak AM, Al-Moamary MS, Al-Ghobain MO, Al-Shimemeri AA. The Saudi Thoracic Society pneumococcal vaccination guidelines-2016. Ann Thorac Med 2016. [DOI: 10.4103/1817-1737.180030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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