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The Problem With Compliance In Diabetes,

Diabetics & Non-compliance

Diabetics & Non-compliance

Diabetics can develop high levels of glucose in their bloodstreams. Without proper diet, exercise, regular checkups and monitoring of blood glucose levels, high glucose can lead to several complications, including some that are life-threatening. Despite this danger, health professionals find too many diabetic patients don't follow medical advice for controlling their disease. Video of the Day Medically, noncompliance, also referred to as nonadherence, means not following a physician's recommendations. Typically, diabetics may be directed to follow a specific kind of diet, take prescribed medication and exercise. Physicians and counselors may recommend additional lifestyle changes for the patient's optimal health. Examples of Noncompliance A noncompliant diabetic patient may not check his blood glucose levels regularly. He make take his medication incorrectly or not at all. He may fail to lose weight, stop smoking or exercise. His diet may contain too much fat and too many carbohydrates to control blood glucose levels, and he may not visit his doctor for regular check-ups. Diabetics who are noncompliant do not realize or accept that proper self-care will have a positive effect in the long-term. As a result, they are in danger of developing complications that affect the eyes, kidneys, heart, nerves, feet and more. Over time, uncontrolled diabetes can lead to permanent damage of these areas as well as stroke, heart disease and blindness. Dangers of High Glucose High blood glucose, or hyperglycemia, occurs when the body doesn't have enough insulin or can't use insulin effectively. Hyperglycemia has a major impact on the complications of diabetes. Diabetic ketoacidosis occurs when the body burns fat instead of glucose for energy. It's a serious condition, affecting primarily Continue reading >>

The Relationship Between Depression And Adherence In Diabetes

The Relationship Between Depression And Adherence In Diabetes

Depression is a common problem among people with either type 1 or type 2 diabetes. It has been consistently associated with poor self-management and health outcomes in diabetes, both cross-sectionally and over time. Research suggests that depression may affect diabetes health outcomes through its relationship to suboptimal treatment adherence. Here we use the term ‘adherence’ to refer to the degree to which patients follow healthcare provider recommendations regarding prescribed medications and diabetes self-management activities. Although previous work often used the term compliance, this has fallen out of favor because of the passive role implied for the patient. Some may prefer the term ‘concordance’ to further emphasize the non-hierarchical nature of the relationship between doctor and patient in developing a self-management plan and the fact that patients must first agree with recommendations before they can be expected to follow them. Regardless of the term used, it is clear that many diabetes patients do not take medications as prescribed and struggle with self-management. It seems plausible that the symptoms of depression (e.g., concentration difficulties, loss of interest, pessimism about the future) would complicate the already difficult task of diabetes self-management for patients. However, the causal nature of this relationship has not been conclusively demonstrated. Furthermore, subclinical depressive symptoms and diabetes-related distress are more common than psychiatric presentations of depression, such as major depressive disorder, and are also consistently related to problems with adherence and glycemic control. Often, these non-psychiatric constructs may be confounded with measures of ‘clinical depression.’ Thus, assessment and treatment o Continue reading >>

Compliance Of Diabetic Patients With The Prescribed Clinical Regimen Attyia Aa, El Bahnasy Re, Abu Salem Me, Al-batanony Ma, Ahamed Ar - Menoufia Med J

Compliance Of Diabetic Patients With The Prescribed Clinical Regimen Attyia Aa, El Bahnasy Re, Abu Salem Me, Al-batanony Ma, Ahamed Ar - Menoufia Med J

This study aimed at studying the prevalence of noncompliance among diabetic patients in Gharbia governorate in Egypt as well its causes, its effect on glycemic control, and factors affecting it. There is growing evidence suggesting that because of the alarmingly low rates of compliance, increasing the effectiveness of compliance interventions may have a great impact on the health of the population. Promotion of therapeutic compliance is considered an integral component of patient care. It has been shown that despite effective methods of treatment, many diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality. A total of 339 diabetic patients who fulfilled the inclusion criteria were recruited in the present study. Compliance to treatment was evaluated during patients visits to health units in Gharbia governorate. Medication compliance was assessed during a personal interview with each patient using a multiple-choice questionnaire. Blood samples were obtained for measurement of glycated hemoglobin (HbA1c). In the study population, the compliance rates were observed to be suboptimal. The most important social factors that significantly affected compliance rates included age, income, and educational level. Among the factors that significantly affected compliance rates were duration of treatment, presence of diseases other than diabetes, and the number of prescribed drugs. Another factor that played an important role was diabetes care costs. The most common reasons for low rates of compliance were forgetfulness and high cost of treatment. An improvement in the compliance level may be achieved through improvement of patients economic levels as well as reduction in the cost of medication. Continue reading >>

Improving Adherence In The Treatment Of Type 2 Diabetes

Improving Adherence In The Treatment Of Type 2 Diabetes

Improving Adherence in the Treatment of Type 2 Diabetes US Pharm. 2010;36(4)(Compliance & Adherence suppl):11-15. Former Surgeon General C. Everett Koop, MD, has often been cited for making the obvious but very poignant statement: Drugs dont work in patients that dont take them.1 There is a lot of wisdom in this remark that health care providers would do well to recognize and consider when choosing medications for their patients. While this statement was directed at pharmacotherapy in general, it is more likely to be a problem with the management of chronic disease, and may be at its worst, with the management of diabetes. Type 2 diabetes is a chronic, often silent condition that co-exists with a myriad of other medical problems. Hence, the patient may be taking multiple medications to treat several conditions such as diabetes, hyperlipidemia, and hypertension. This creates a complex situation that is likely to result in low adherence to the medication plan. It seems reasonable that the provider could employ some technique or method in this population that would uniformly enhance adherence. Unfortunately, a recent scientific analysis of interventions to enhance patient adherence to medication prescriptions concluded that current methods of improving medication adherence for chronic health problems are mostly complex, labor-intensive, and not predictably effective.2 Still, even though no single method is predictably effective, there are methods that have been successful and clearly some common-sense tactics that can be applied, particularly when choosing medications to manage hyperglycemia in patients with type 2 diabetes. This article will provide a succinct overview of the problem of nonadherence, an appraisal of its impact on the management of diabetes, and a common Continue reading >>

Adherence To Therapies In Patients With Type 2 Diabetes

Adherence To Therapies In Patients With Type 2 Diabetes

Go to: Introduction The prevalence of type 2 diabetes mellitus is increasing globally and has become a major public health problem. In the USA, a study of 17,306 people over 20 years of age showed that those diagnosed with diabetes increased significantly from 6.5% in the 1999–2002 period to 7.8% in 2003–2006 [1]. In 2011, 366 million people worldwide had diabetes and it is predicted that by 2030, this figure will be 552 million [2]. Diabetes is currently among the top five causes of death in most high-income countries and resulted in 4.6 million deaths globally in 2011. The majority of cases of diabetes mellitus are type 2, and the greatest numbers of people with this disease are aged from 40 to 59 years [2]. The increase in type 2 diabetes is associated with obesity, hypertension, and an increasingly elderly population. Over the last 18 years in the USA, the proportion of adults in the age group 40–74 years with a body mass index ≥30 kg/m2 has increased from 28% to 36%, while the proportion undergoing physical activity 12 times a month or more has decreased from 53% to 43%, exacerbating the obesity problem [3]. However, despite strong clinical recommendations for individuals with a history of diabetes to adopt a healthier lifestyle, adherence to improved diet and exercise is poor [3]. Although type 2 diabetes usually occurs in people over the age of 40 years, it is becoming increasingly common in children, adolescents and young adults due to reduced physical activity and unhealthy eating patterns, leading to obesity [4]. The majority of patients with type 2 diabetes fail to control glycemia with diet and exercise and require pharmacotherapy—in general, initially monotherapy with an oral hypoglycemic agents (OHA); however, owing to the progressive nature of t Continue reading >>

The Problem With Compliance In Diabetes

The Problem With Compliance In Diabetes

Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2000American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. JAMA. 2000;284(13):1709. doi:10.1001/jama.284.13.1709-JMS1004-6-1 What's the hardest thing about taking care of people with diabetes? Many health professionals would answer that patients with diabetes do not do what they are told. It is common to hear them express frustration and sorrow that their patients just don't follow their diet or exercise plans, that they don't check their blood sugars or even take their medicines. Behavioral scientists have studied the problem of noncompliance (or nonadherence) extensively. They have tried to find the right approach or technique to convince patients to follow medical advice. In talking with both health professionals and people with diabetes, we have come to believe that the traditional approach to the care of diabetes and other chronic diseases may actually promote noncompliance. The adage that every system is perfectly designed for the results that it achieves is true for the way most physicians presently deliver diabetes care. While it might be appropriate for patients with acute disease to turn over responsibility for their treatment to health care experts, this method is likely to fail when health professionals try to take responsibility for the care of chronic disease. Chronic disease care is fundamentally different. It requires a different vision and a redefinition of the patient-physician relationship. 1 More than 95% of diabetes care is done Continue reading >>

Medication Adherence And Determinants Of Non-adherence Among South Indian Diabetes Patients Medi Rk, Mateti Uv, Kanduri Kr, Konda Ss - J Soc Health Diabetes

Medication Adherence And Determinants Of Non-adherence Among South Indian Diabetes Patients Medi Rk, Mateti Uv, Kanduri Kr, Konda Ss - J Soc Health Diabetes

Objectives: The objective of the study is to determine the adherence and determinants of non-adherence among diabetes patients. Materials and Methods: A cross-sectional observation study was conducted for a period of six months in both inpatients and outpatients of diabetic clinic at a super speciality hospital. The structured medication adherence questionnaire (MAQ) was administered to the eligible diabetic patients to assess the adherence rate and determinants of non-adherence. Results: During the study period, a total of 140 patients were enrolled. Out of 140 patients, most of them were females (n = 79, 56.57%), than males (n = 61, 43.57%). Among them (n = 49, 35%) patients were in the age group greater than or equal to 61 years followed by (n = 42, 30%) patients between 51-60 years and others. The overall medication adherence rate was found to be 47.85%. The main factors for non-adherence were lack of finance (n = 43, 55.84%), forgetfulness (n = 36, 46.75%), being busy (n = 34, 44.15%), medicines inaccessibility (n = 15, 19.48%) and others. Conclusion: The overall medication adherence rate was found to be unsatisfactory. The main challenging factors affecting medication adherence were lack of finance, forgetfulness, being busy, medicines inaccessibility and side effects of drugs. Keywords:Adherence, determinants, diabetes, India Medi RK, Mateti UV, Kanduri KR, Konda SS. Medication adherence and determinants of non-adherence among south Indian diabetes patients. J Soc Health Diabetes 2015;3:48-51 Medi RK, Mateti UV, Kanduri KR, Konda SS. Medication adherence and determinants of non-adherence among south Indian diabetes patients. J Soc Health Diabetes [serial online] 2015 [cited2018 Mar 28];3:48-51. Available from: Medication adherence is a leading issue and a huge b Continue reading >>

[full Text] Poor Medication Adherence In Type 2 Diabetes: Recognizing The Scope Of | Ppa

[full Text] Poor Medication Adherence In Type 2 Diabetes: Recognizing The Scope Of | Ppa

Editor who approved publication: Dr Johnny Chen 1Behavioral Diabetes Institute, San Diego, 2University of California, San Diego, 3Center for Metabolic Research, VA San Diego Healthcare System, SanDiego, CA, USA Abstract: At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia). Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery. Keywords: glycemic control, HbA1c, hypoglycemia, medication adherence, psychosocial, type 2 diabetes The prevalence of type 2 diabetes (T2D) is at epidemic proportions worldwide, 1 , 2 and the incidence and prevalence of T2D continue to increa Continue reading >>

Medication Adherence And Patient Engagement In Patients With Type 2 Diabetes

Medication Adherence And Patient Engagement In Patients With Type 2 Diabetes

Medication Adherence and Patient Engagement in Patients with Type 2 Diabetes Medication adherence is a patients conformance with a providers recommendations concerning the timing, dosage, frequency, and duration of medication use.1 Unfortunately, 20% to 30% of prescriptions are never filled, and about 50% of medications filled are not taken as prescribed.1 This poor medication adherence is responsible for unnecessary illness, hospitalizations, disability, and premature death, particularly among patients with chronic diseases. According to the Centers for Disease Control and Prevention, about 29.1 million individuals in the United States had diabetes in 2014. Approximately 21 million of these individuals had received a diagnosis; the other 8.1 million individuals had not yet been given a diagnosis. This number is projected to increase substantially in the next 15 years. In addition, 86 million Americans have prediabetes. Without intervention, 15% to 30% of these individuals will develop type 2 diabetes (T2D) within 5 years.2 Treatment adherence problems are common in patients with T2D because they may look and feel perfectly fine. It may be hard to fathom that they have a serious disease that can cause significant problems in the future, such as hypertension, dyslipidemia, heart disease, neuropathy, kidney failure, blindness, amputation, and death. Sometimes patients do not understand that many of these conditions can be better managed or even eliminated by adhering to treatment plans. Uncontrolled diabetes is defined as not having met and/or sustained the goal glycated hemoglobin (A1C) level. The American Diabetes Association recommends individualized A1C goals for patients with diabetes. The goal is usually under 7%; however, it may be higher or lower in certain indiv Continue reading >>

Child Routines And Youths Adherence To Treatment For Type 1 Diabetes

Child Routines And Youths Adherence To Treatment For Type 1 Diabetes

Child Routines and Youths Adherence to Treatment for Type 1 Diabetes University of Mississippi Medical Center and 2University of Southern Mississippi Search for other works by this author on: University of Mississippi Medical Center and 2University of Southern Mississippi Search for other works by this author on: University of Mississippi Medical Center and 2University of Southern Mississippi Search for other works by this author on: University of Mississippi Medical Center and 2University of Southern Mississippi Search for other works by this author on: University of Mississippi Medical Center and 2University of Southern Mississippi Search for other works by this author on: Journal of Pediatric Psychology, Volume 32, Issue 4, 1 May 2007, Pages 437447, Leilani Greening, Laura Stoppelbein, Carlos Konishi, Sara Sytsma Jordan, George Moll; Child Routines and Youths Adherence to Treatment for Type 1 Diabetes, Journal of Pediatric Psychology, Volume 32, Issue 4, 1 May 2007, Pages 437447, Objective Type 1 diabetes (T1DM) is a chronic life-threatening disease that requires strict adherence to daily treatment tasks. Although necessary for survival, children who present with behavior problems tend to show problems complying with the treatment regimen, thereby increasing their risk for morbidity and premature mortality. The risk of poor treatment adherence is hypothesized to be lower for these children, however, if they engage in more routine behaviors. Given the potential clinical implications, this hypothesis and two theoretical models proposed to elucidate the underlying psychological process for the role of child routines in treatment adherence were evaluated empirically. The first model hypothesized that child routines protect (moderator variable) behaviorally problematic c Continue reading >>

Glycemic Control And Medication Compliance In Diabetic Patients In A Pharmacist-managed Clinic In Hong Kong

Glycemic Control And Medication Compliance In Diabetic Patients In A Pharmacist-managed Clinic In Hong Kong

Diabetes mellitus is a cluster of metabolic disorders characterized by various degrees of insulin resistance and insulin deficiency that lead to a disturbance in blood glucose homeostasis. In Hong Kong, the age-adjusted prevalence of diabetes was 7.8% in 1990 and 7.3% in 1995.[ 1 , 2 ] Over 30% of patients admitted to the hospital in Hong Kong with stroke, heart failure, acute myocardial infarction, or renal failure requiring dialysis have diabetes as a major contributing factor.[ 3 ] The leading causes of death among diabetic patients in Hong Kong are renal failure and cerebrovascular accidents,[ 4 ] and some 200 diabetic patients become legally blind every year.[ 5 ] According to the government Hospital Authority, diabetes was one of Hong Kong's 10 leading causes of death in 2000. Compelling evidence exists that good blood glucose control leads to a lower frequency of the microvascular and macrovascular complications of diabetes and prevents their progression.[ 6 , 7 ] In 1993, Cockram et al.[ 8 ] found that Hong Kong patients received inadequate information on diabetes. The study identified two major problems: (1) a majority (62%) of those diagnosed with type 2 diabetes mellitus did not have access to programs providing patient education and ideal management of the disease and (2) an alarming proportion (approaching 50%) of patients with diabetes were not sufficiently informed about the risk of complications, such as diabetic retinopathy. In response, a pharmacist-managed compliance clinic in a local public hospital implemented a program to monitor and treat diabetic patients. The objective of this study was to evaluate the program's impact on the care of diabetic patients with drug compliance problems. Continue reading >>

Factors Contributing To Non-compliance Among Diabetics Attending Primary Health Centers In The Al Hasa District Of Saudi Arabia Khan Ar, Al-abdul Lateef Zn, Al Aithan Ma, Bu-khamseen Ma, Al Ibrahim I, Khan Sa - J Fam Community Med

Factors Contributing To Non-compliance Among Diabetics Attending Primary Health Centers In The Al Hasa District Of Saudi Arabia Khan Ar, Al-abdul Lateef Zn, Al Aithan Ma, Bu-khamseen Ma, Al Ibrahim I, Khan Sa - J Fam Community Med

Compliance in healthcare is defined as the extent to which a patient's behavior (in terms of taking medication, executing the lifestyle changes, undergoing medical tests or keeping appointments with the physicians) coincides with the healthcare provider's recommendations for health and medical advice. [1] Non-compliant patients are those whose health-seeking or maintenance behaviors lack congruence with the recommendations prescribed by a healthcare provider. [2] Patient non-compliance is a serious healthcare concern that poses a great challenge to the successful delivery of healthcare. This is widespread and has been reported from all over the world. [3] According to a study by the New England Health Care Institute, one-third to one-half of the American patients are non-compliant. [3] Patient non-compliance is not only limited to the failure to take medication , but also the failure to make lifestyle changes, undergo tests or keep appointments with physicians. The non-compliant patients especially with chronic diseases are more prone to encountering serious difficulties. [4] The rate of non-compliance in patients with chronic diseases in developed countries, on long-term treatment, is on the order of 50%This could be even higher in developing countries (WHO) [5] One study showed that while diabetic and cardiac patients who take medication correctly have a 7% death rate; for those who are non-compliant the death rate is 12%. In another study, the rate of non-compliance ranged between 16.7 and 80% among the patients suffering from tuberculosis, hypertension, asthma, diabetes, epilepsy, and congestive cardiac failure. [6] A compliance study conducted in Saudi Arabia for those on short-term medication found 67.8% compliance. However, compliance of patients tend to decreas Continue reading >>

Medication Adherence In Type 2 Diabetes: The Entred Study 2007, A French Population-based Study

Medication Adherence In Type 2 Diabetes: The Entred Study 2007, A French Population-based Study

Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study Affiliation Medical Information Department, University Hospital of Besanon, Besanon, France Affiliation Medical Information Department, University Hospital of Besanon, Besanon, France Affiliation Medical Information Department, University Hospital of Besanon, Besanon, France Affiliation Institut National de la Sant et de la Recherche Mdicale (Inserm), Villejuif, France Affiliation French National Health Insurance Fund for Salaried Workers (CnamTS), Paris, France Affiliation Institute for Health Prevention and Education (Inpes), Saint Denis, France Affiliation Institute of Public Health Surveillance (InVS), Saint-Maurice, France Affiliation Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean Minjoz Hospital, University of Franche-Comt, Besanon, France Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study Adherence to prescribed medications is a key dimension of healthcare quality. The aim of this large population-based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France. The ENTRED study 2007, a French national survey of people treated for diabetes, was based on a representative sample of patients who claimed reimbursement for oral hypoglycaemic agents and/or insulin at least three times between August 2006 and July 2007, and who were randomly selected from the database of the two main National Health Insurance Systems. Medication adherence was determined using a six-item self-administered questionnaire. A multinomial polychotomous logistic regression model was used to identify factors associated with medication adhere Continue reading >>

Gps' Perspectives Of Type 2 Diabetes Patients' Adherence To Treatment: A Qualitative Analysis Of Barriers And Solutions

Gps' Perspectives Of Type 2 Diabetes Patients' Adherence To Treatment: A Qualitative Analysis Of Barriers And Solutions

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions Wens et al; licensee BioMed Central Ltd.2005 The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration. In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness. General practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in Continue reading >>

The Risk And Cost Of Medication Non Adherence In Hypertensive And Diabetic Patients - Vaica

The Risk And Cost Of Medication Non Adherence In Hypertensive And Diabetic Patients - Vaica

The Risk and Cost of Medication Non AdherenceIn Hypertensive and Diabetic Patients A leading study on the Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost [1] published peer-reviewed journalRefereed journal Academia A professional journal that only publishes articles subjected to a rigorous peer validity review process. Cf Throwaway journal. by the American Public Health Association was based on a sample of over 137,000 patients under the age of 65 with diabetes, high cholesterol, hypertension, or congestive heart failure congestive heart failure,inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. . This study was one of the first to demonstrate the savings generated by medication adherence for these prevalent chronic medical conditions. The study found that the least compliant diabetes patients were more than twice as likely to be hospitalized compared to those who were most compliant, and their total health care costs were nearly double, as well. For diabetes patients, every additional dollar spent on medication saved $7 in medical costs. Diabetes patients who are highly compliant with their treatment programs have a 13 percent hospitalization risk for a diabetes- related problem, but patients with low compliance have more than twice the risk at 30 percent. The combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group. The same article also analyzed Hypertensive and Hypercholesterolemia (high cholesterol) patients. The medical cost savings were $5.10 for each additional dollar spent Continue reading >>

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