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Erschienen in: European Journal of Trauma and Emergency Surgery 5/2019

26.02.2018 | Original Article

Evaluating the need to reform the organisation of care for major trauma patients in Belgium: an analysis of administrative databases

verfasst von: Koen Van den Heede, Cécile Dubois, Patriek Mistiaen, Sabine Stordeur, Audrey Cordon, Marie Isabel Farfan-Portet

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2019

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Abstract

Purpose

In light of the international evolutions to establish inclusive trauma systems and to concentrate the care for the most severely injured in major trauma centres, we evaluated the degree of dispersion of trauma care in Belgium.

Methods

We used descriptive statistics to illustrate the dispersion of major trauma care in Belgium based on two independent administrative databases: the registry of Mobile Intensive Care Units (2009–2015) and the Belgian Hospital Discharge Dataset (2009–2014).

Results

Patients with a severe trauma (n = 3856 in 2015) were transported towards 145 different hospital sites (on a total of 198 hospital sites) resulting in a median of 17 cases per hospital site (min = 1; P25 = 4; P75 = 30; max = 165). A minority of major trauma patients is after admission transferred to another hospital (8%) with a median of 10 days after admission to the hospital (IQR 3.5–24).

Conclusions

The dispersion of care for major trauma patients in Belgium is so high that a reorganisation of care for severe injured patients in major trauma centres concentrating professional expertise and specialised equipment is recommended to guarantee a high quality of care in a qualitative and sustainable way.
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Literatur
2.
Zurück zum Zitat European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2008–2010. Amsterdam; 2011. European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2008–2010. Amsterdam; 2011.
3.
Zurück zum Zitat European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2010–2012. Amsterdam; 2013. European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2010–2012. Amsterdam; 2013.
4.
Zurück zum Zitat European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2012–2014. Amsterdam; 2016. European Association for Injury Prevention and Safety Promotion (EuroSafe). Injuries in the European Union: summary of injury statistics for the years 2012–2014. Amsterdam; 2016.
5.
Zurück zum Zitat Kim YJ. Relationship of trauma centre characteristics and patient outcomes: a systematic review. J Clin Nurs. 2014;23(3–4):301–14.CrossRef Kim YJ. Relationship of trauma centre characteristics and patient outcomes: a systematic review. J Clin Nurs. 2014;23(3–4):301–14.CrossRef
6.
Zurück zum Zitat Caputo LM, Salottolo KM, Slone DS, Mains CW, Bar-Or D. The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury. 2014;45(3):478–86.CrossRef Caputo LM, Salottolo KM, Slone DS, Mains CW, Bar-Or D. The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury. 2014;45(3):478–86.CrossRef
7.
Zurück zum Zitat Minei JP, Fabian TC, Guffey DM, Newgard CD, Bulger EM, Brasel KJ, et al. Increased trauma center volume is associated with improved survival after severe injury: results of a Resuscitation Outcomes Consortium study. Ann Surg. 2014;260(3):456–64 (discussion 64).CrossRef Minei JP, Fabian TC, Guffey DM, Newgard CD, Bulger EM, Brasel KJ, et al. Increased trauma center volume is associated with improved survival after severe injury: results of a Resuscitation Outcomes Consortium study. Ann Surg. 2014;260(3):456–64 (discussion 64).CrossRef
8.
Zurück zum Zitat Zacher MT, Kanz KG, Hanschen M, Haberle S, van Griensven M, Lefering R, et al. Association between volume of severely injured patients and mortality in German trauma hospitals. Br J Surg. 2015;102(10):1213–9.CrossRef Zacher MT, Kanz KG, Hanschen M, Haberle S, van Griensven M, Lefering R, et al. Association between volume of severely injured patients and mortality in German trauma hospitals. Br J Surg. 2015;102(10):1213–9.CrossRef
9.
Zurück zum Zitat Clement RC, Carr BG, Kallan MJ, Wolff C, Reilly PM, Malhotra NR. Volume–outcome relationship in neurotrauma care. J Neurosurg. 2013;118(3):687–93.CrossRef Clement RC, Carr BG, Kallan MJ, Wolff C, Reilly PM, Malhotra NR. Volume–outcome relationship in neurotrauma care. J Neurosurg. 2013;118(3):687–93.CrossRef
12.
Zurück zum Zitat German Society for Trauma Surgery, Professional Association of Orthopaedic and Trauma Specialists. Whitebook medical care of the severely injured. Berlin: Deutsche Gesellschaft für Unfallchirurgie; 2012. German Society for Trauma Surgery, Professional Association of Orthopaedic and Trauma Specialists. Whitebook medical care of the severely injured. Berlin: Deutsche Gesellschaft für Unfallchirurgie; 2012.
13.
Zurück zum Zitat Landelijk Netwerk Acute Zorg. Landelijke Traumaregistratie 2010–2014. Rapportage Nederland; 2015. Landelijk Netwerk Acute Zorg. Landelijke Traumaregistratie 2010–2014. Rapportage Nederland; 2015.
14.
Zurück zum Zitat Landelijk Netwerk Acute Zorg. Landelijke Traumaregistratie 2009–2013. Rapportage Nederland; 2014. Landelijk Netwerk Acute Zorg. Landelijke Traumaregistratie 2009–2013. Rapportage Nederland; 2014.
15.
Zurück zum Zitat Lansink KW, Gunning AC, Spijkers AT, Leenen LP. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37(10):2353–9.CrossRef Lansink KW, Gunning AC, Spijkers AT, Leenen LP. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37(10):2353–9.CrossRef
16.
Zurück zum Zitat TraumaRegister DGU. 20 years of trauma documentation in Germany—actual trends and developments. Injury. 2014;45(Supplement 3):S14–9. TraumaRegister DGU. 20 years of trauma documentation in Germany—actual trends and developments. Injury. 2014;45(Supplement 3):S14–9.
17.
Zurück zum Zitat Ruchholtz S, Mand C, Lewan U, Debus F, Dankowski C, Kühne C, et al. Regionalisation of trauma care in Germany: the “TraumaNetwork DGU®-Project”. Eur J Trauma Emerg Surg. 2011;38(1):11–7.CrossRef Ruchholtz S, Mand C, Lewan U, Debus F, Dankowski C, Kühne C, et al. Regionalisation of trauma care in Germany: the “TraumaNetwork DGU®-Project”. Eur J Trauma Emerg Surg. 2011;38(1):11–7.CrossRef
18.
Zurück zum Zitat NHS England. NHS standard contract for Major Trauma Services (all ages). London: NHS England; 2013. NHS England. NHS standard contract for Major Trauma Services (all ages). London: NHS England; 2013.
19.
Zurück zum Zitat Alfred Health Caring for the severely injured in Australia. Inaugural report of the Australian Trauma Registry. Melbourne: Alfred Health; 2014. Alfred Health Caring for the severely injured in Australia. Inaugural report of the Australian Trauma Registry. Melbourne: Alfred Health; 2014.
20.
Zurück zum Zitat Trauma Association of Canada, Association Canadienne de Traumatologie. Trauma system. Accreditation guidelines. 2011. Trauma Association of Canada, Association Canadienne de Traumatologie. Trauma system. Accreditation guidelines. 2011.
21.
Zurück zum Zitat Committee on trauma American College of Surgeons. Resources for optimal care of the injured patient. American college of Surgeons: Chicago; 2014 Committee on trauma American College of Surgeons. Resources for optimal care of the injured patient. American college of Surgeons: Chicago; 2014
22.
Zurück zum Zitat Innledning: nasjonal traumeplan—Traumesystem i Norge 2015 [Introduction: national trauma plan—Trauma System in Norway 2015]. Innledning: nasjonal traumeplan—Traumesystem i Norge 2015 [Introduction: national trauma plan—Trauma System in Norway 2015].
23.
Zurück zum Zitat Dehli T, Gaarder T, Christensen BJ, Vinjevoll OP, Wisborg T. Implementation of a trauma system in Norway: a national survey. Acta Anaesthesiol Scand. 2015;59(3):384–91.CrossRef Dehli T, Gaarder T, Christensen BJ, Vinjevoll OP, Wisborg T. Implementation of a trauma system in Norway: a national survey. Acta Anaesthesiol Scand. 2015;59(3):384–91.CrossRef
24.
Zurück zum Zitat Kristiansen T, Ringdal KG, Skotheimsvik T, Salthammer HK, Gaarder C, Naess PA, et al. Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey. Scand J Trauma Resusc Emerg Med. 2012;20:5.CrossRef Kristiansen T, Ringdal KG, Skotheimsvik T, Salthammer HK, Gaarder C, Naess PA, et al. Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey. Scand J Trauma Resusc Emerg Med. 2012;20:5.CrossRef
25.
Zurück zum Zitat Kristiansen T, Soreide K, Ringdal KG, Rehn M, Kruger AJ, Reite A, et al. Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury. 2010;41(5):444–52.CrossRef Kristiansen T, Soreide K, Ringdal KG, Rehn M, Kruger AJ, Reite A, et al. Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury. 2010;41(5):444–52.CrossRef
26.
Zurück zum Zitat NHS Clinical Advisory Groups Report. Regional networks for major trauma. London: NHS England; 2010. NHS Clinical Advisory Groups Report. Regional networks for major trauma. London: NHS England; 2010.
27.
Zurück zum Zitat Australasian Trauma Verification Program Officer. The Australasian trauma verification program manual. Royal Australasian College of Surgeons: Melbourne; 2009. Australasian Trauma Verification Program Officer. The Australasian trauma verification program manual. Royal Australasian College of Surgeons: Melbourne; 2009.
28.
Zurück zum Zitat Ashley DW, Pracht EE, Medeiros RS, Atkins EV, NeSmith EG, Johns TJ, et al. An analysis of the effectiveness of a state trauma system: treatment at designated trauma centers is associated with an increased probability of survival. J Trauma Acute Care Surg. 2015;78(4):706–12 (discussion 12).CrossRef Ashley DW, Pracht EE, Medeiros RS, Atkins EV, NeSmith EG, Johns TJ, et al. An analysis of the effectiveness of a state trauma system: treatment at designated trauma centers is associated with an increased probability of survival. J Trauma Acute Care Surg. 2015;78(4):706–12 (discussion 12).CrossRef
29.
Zurück zum Zitat Di Bartolomeo S, Marino M, Ventura C, De Palma R. Evaluation of the survival benefit of trauma-centre care in the Italian setting. Injury. 2014;45(1):299–303.CrossRef Di Bartolomeo S, Marino M, Ventura C, De Palma R. Evaluation of the survival benefit of trauma-centre care in the Italian setting. Injury. 2014;45(1):299–303.CrossRef
30.
Zurück zum Zitat Glance LG, Osler TM, Mukamel DB, Dick AW. Impact of trauma center designation on outcomes: is there a difference between level I and level II trauma centers? J Am Coll Surg. 2012;215(3):372–8.CrossRef Glance LG, Osler TM, Mukamel DB, Dick AW. Impact of trauma center designation on outcomes: is there a difference between level I and level II trauma centers? J Am Coll Surg. 2012;215(3):372–8.CrossRef
31.
Zurück zum Zitat Kuimi BL, Moore L, Cisse B, Gagne M, Lavoie A, Bourgeois G, et al. Influence of access to an integrated trauma system on in-hospital mortality and length of stay. Injury. 2015;46(7):1257–61.CrossRef Kuimi BL, Moore L, Cisse B, Gagne M, Lavoie A, Bourgeois G, et al. Influence of access to an integrated trauma system on in-hospital mortality and length of stay. Injury. 2015;46(7):1257–61.CrossRef
32.
Zurück zum Zitat Matsushima K, Schaefer EW, Won EJ, Armen SB. The outcome of trauma patients with do-not-resuscitate orders. J Surg Res. 2016;200(2):631–6.CrossRef Matsushima K, Schaefer EW, Won EJ, Armen SB. The outcome of trauma patients with do-not-resuscitate orders. J Surg Res. 2016;200(2):631–6.CrossRef
33.
Zurück zum Zitat Vickers BP, Shi J, Lu B, Wheeler KK, Peng J, Groner JI, et al. Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers. Am J Emerg Med. 2015;33(9):1158–65.CrossRef Vickers BP, Shi J, Lu B, Wheeler KK, Peng J, Groner JI, et al. Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers. Am J Emerg Med. 2015;33(9):1158–65.CrossRef
34.
Zurück zum Zitat Dinh MM, Bein KJ, Gabbe BJ, Byrne CM, Petchell J, Lo S, et al. A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre. Injury. 2014;45(5):830–4.CrossRef Dinh MM, Bein KJ, Gabbe BJ, Byrne CM, Petchell J, Lo S, et al. A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre. Injury. 2014;45(5):830–4.CrossRef
35.
Zurück zum Zitat Dinh MM, Curtis K, Mitchell RJ, Bein KJ, Balogh ZJ, Seppelt I, et al. Major trauma mortality in rural and metropolitan NSW, 2009–2014: a retrospective analysis of trauma registry data. Med J Aust. 2016;205(9):403–7.CrossRef Dinh MM, Curtis K, Mitchell RJ, Bein KJ, Balogh ZJ, Seppelt I, et al. Major trauma mortality in rural and metropolitan NSW, 2009–2014: a retrospective analysis of trauma registry data. Med J Aust. 2016;205(9):403–7.CrossRef
36.
Zurück zum Zitat Moore L, Hanley JA, Turgeon AF, Lavoie A. Evaluation of the long-term trend in mortality from injury in a mature inclusive trauma system. World J Surg. 2010;34(9):2069–75.CrossRef Moore L, Hanley JA, Turgeon AF, Lavoie A. Evaluation of the long-term trend in mortality from injury in a mature inclusive trauma system. World J Surg. 2010;34(9):2069–75.CrossRef
37.
Zurück zum Zitat Moore L, Turgeon AF, Lauzier F, Emond M, Berthelot S, Clement J, et al. Evolution of patient outcomes over 14 years in a mature, inclusive Canadian trauma system. World J Surg. 2015;39(6):1397–405.CrossRef Moore L, Turgeon AF, Lauzier F, Emond M, Berthelot S, Clement J, et al. Evolution of patient outcomes over 14 years in a mature, inclusive Canadian trauma system. World J Surg. 2015;39(6):1397–405.CrossRef
38.
Zurück zum Zitat Moore L, Stelfox HT, Evans D, Hameed SM, Yanchar NL, Simons R, et al. Trends in injury outcomes across Canadian trauma systems. JAMA Surg. 2016;152(2):168–74.CrossRef Moore L, Stelfox HT, Evans D, Hameed SM, Yanchar NL, Simons R, et al. Trends in injury outcomes across Canadian trauma systems. JAMA Surg. 2016;152(2):168–74.CrossRef
39.
Zurück zum Zitat Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma. 2010;69(3):620–6.CrossRef Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma. 2010;69(3):620–6.CrossRef
40.
Zurück zum Zitat Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, Hemmila MR, Park PK, Raghavendran K, et al. American College of Surgeons’ Committee on Trauma Performance Improvement and Patient Safety program: maximal impact in a mature trauma center. J Trauma. 2011;71(5):1447–53 (discussion 53–4).CrossRef Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, Hemmila MR, Park PK, Raghavendran K, et al. American College of Surgeons’ Committee on Trauma Performance Improvement and Patient Safety program: maximal impact in a mature trauma center. J Trauma. 2011;71(5):1447–53 (discussion 53–4).CrossRef
41.
Zurück zum Zitat Moore L, Champion H, Tardif PA, Kuimi BL, O’Reilly G, Leppaniemi A, et al. Impact of trauma system structure on injury outcomes: a systematic review and meta-analysis. World J Surg. 2017. Moore L, Champion H, Tardif PA, Kuimi BL, O’Reilly G, Leppaniemi A, et al. Impact of trauma system structure on injury outcomes: a systematic review and meta-analysis. World J Surg. 2017.
42.
Zurück zum Zitat Jansen JO, Lendrum RA, Morrison JJ. Trauma care in Scotland: the role of major trauma centres, trauma units, and local emergency hospitals. Surg J R Coll Surg Edinb Irel. 2016;14(5). Jansen JO, Lendrum RA, Morrison JJ. Trauma care in Scotland: the role of major trauma centres, trauma units, and local emergency hospitals. Surg J R Coll Surg Edinb Irel. 2016;14(5).
43.
Zurück zum Zitat Jansen JO, Morrison JJ, Wang H, He S, Lawrenson R, Hutchison JD, et al. Access to specialist care: optimizing the geographic configuration of trauma systems. J Trauma Acute Care Surg. 2015;79(5):756–65.CrossRef Jansen JO, Morrison JJ, Wang H, He S, Lawrenson R, Hutchison JD, et al. Access to specialist care: optimizing the geographic configuration of trauma systems. J Trauma Acute Care Surg. 2015;79(5):756–65.CrossRef
44.
Zurück zum Zitat Deasy C, Cronin M, Cahill F, Geary U, Houlihan P, Woodford M, et al. Implementing major trauma audit in Ireland. Injury. 2016;47(1):166–72.CrossRef Deasy C, Cronin M, Cahill F, Geary U, Houlihan P, Woodford M, et al. Implementing major trauma audit in Ireland. Injury. 2016;47(1):166–72.CrossRef
45.
Zurück zum Zitat Décision concernant la planification de la médecine hautement spécialisée (MHS) dans le domaine de la prise en charge des blessés graves; 2015. Décision concernant la planification de la médecine hautement spécialisée (MHS) dans le domaine de la prise en charge des blessés graves; 2015.
46.
Zurück zum Zitat Van den Heede K, Dubois C, Devriese S, Baier N, Camaly O, Depuijdt E, et al. Organisation and payment of emergency care services in Belgium: current situation and options for reform. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE); 2016. Van den Heede K, Dubois C, Devriese S, Baier N, Camaly O, Depuijdt E, et al. Organisation and payment of emergency care services in Belgium: current situation and options for reform. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE); 2016.
47.
Zurück zum Zitat Koninklijk besluit van 27 april 1998 houdende vaststelling van de normen waaraan een functie “gespecialiseerde spoedgevallenzorg” moet voldoen om erkend te worden. B.S. 19 juni 1998. Koninklijk besluit van 27 april 1998 houdende vaststelling van de normen waaraan een functie “gespecialiseerde spoedgevallenzorg” moet voldoen om erkend te worden. B.S. 19 juni 1998.
48.
Zurück zum Zitat Van de Voorde C, Van den Heede K, Obyn C, Quentin W, Geissler A, Wittenbecher F, Busse R, Magnussen J, Camaly O, Devriese S, Gerkens S, Misplon S, Neyt M, Mertens R. Conceptual framework for the reform of the Belgian hospital payment system. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2014. KCE Reports 229. D/2014/10.273/68. Van de Voorde C, Van den Heede K, Obyn C, Quentin W, Geissler A, Wittenbecher F, Busse R, Magnussen J, Camaly O, Devriese S, Gerkens S, Misplon S, Neyt M, Mertens R. Conceptual framework for the reform of the Belgian hospital payment system. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2014. KCE Reports 229. D/2014/10.273/68.
49.
Zurück zum Zitat Matsushima K, Schaefer EW, Won EJ, Armen SB, Indeck MC, Soybel DI. Positive and negative volume-outcome relationships in the geriatric trauma population. JAMA Surg. 2014;149(4):319–26.CrossRef Matsushima K, Schaefer EW, Won EJ, Armen SB, Indeck MC, Soybel DI. Positive and negative volume-outcome relationships in the geriatric trauma population. JAMA Surg. 2014;149(4):319–26.CrossRef
50.
Zurück zum Zitat Ambulancezorg Nederland, Nederlands Vereniging van Medisch Managers Ambulancezorg,V&NV Ambulancezorg. Landelijk Protocol Ambulancezorg; 2014. Ambulancezorg Nederland, Nederlands Vereniging van Medisch Managers Ambulancezorg,V&NV Ambulancezorg. Landelijk Protocol Ambulancezorg; 2014.
51.
Zurück zum Zitat German Trauma Society, German Society of General and Visceral Surgery, German Society of Anesthesiology and Intensive Care Medicine, German Society of Endovascular and Vascular Surgery, German Society of Hand Surgery, German Society of Oto-Rhino-Laryngology HaNS, et al. S3—guideline on treatrment of patients with severe and multiple injuries. English Version of the German Guideline S3—Leitlinie Polytrauma/Schwerverletzten-Behandlung. Berlin: German Trauma Society (DGU); 2012. German Trauma Society, German Society of General and Visceral Surgery, German Society of Anesthesiology and Intensive Care Medicine, German Society of Endovascular and Vascular Surgery, German Society of Hand Surgery, German Society of Oto-Rhino-Laryngology HaNS, et al. S3—guideline on treatrment of patients with severe and multiple injuries. English Version of the German Guideline S3—Leitlinie Polytrauma/Schwerverletzten-Behandlung. Berlin: German Trauma Society (DGU); 2012.
52.
Zurück zum Zitat Christiaens W, Van de Walle E, Devresse S, Van Halewyck D, Benahmed N, Paulus D, et al. The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study. BMC Health Serv Res. 2015;15:302.CrossRef Christiaens W, Van de Walle E, Devresse S, Van Halewyck D, Benahmed N, Paulus D, et al. The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study. BMC Health Serv Res. 2015;15:302.CrossRef
Metadaten
Titel
Evaluating the need to reform the organisation of care for major trauma patients in Belgium: an analysis of administrative databases
verfasst von
Koen Van den Heede
Cécile Dubois
Patriek Mistiaen
Sabine Stordeur
Audrey Cordon
Marie Isabel Farfan-Portet
Publikationsdatum
26.02.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 5/2019
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-0932-9

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