official website and that any information you provide is encrypted There was created even a modified version that takes account of O2 saturation. What are the five categories of Aldrete scoring system? 2. J Clin Anesth; 7(1):89-91. The sedationist must be constantly available to see the patient for any emergency. Patients However, guidelines also say that the patients can be discharged if there is availability for someone to escort him and still continue the care, to different degrees, by considering their general state. WebApply the relevant scoring system/discharge criteria for patient transfer (eg, Aldrete Score, Modified Aldrete Score [ie, PARSAP], Post Anesthesia Discharge Scoring System [PADSS], White) score accurately as defined by organizational policy. In an effort to improve patient satisfaction and timely discharge, Chung and associates identified a subset of high-risk patients who are likely to benefit from intense prophylactic analgesic therapy. endstream endobj 206 0 obj <>stream The cookie is used to store the user consent for the cookies in the category "Performance". 1. scoring system a system of classifying according to quality or merit or amount. Although using this score reduced the proportion of patients who met the fast-track criteria on PACU arrival, it also significantly reduced the number of patients who required parenteral analgesia or antiemetics in the step-down area.382 Others have suggested a series of clinical criteria383 that must all be achieved for patients to undergo fast-track recovery (Box 72.1). These You will be awake and able to follow directions without anxiety or pain. Discharge readiness was assessed every 10 min, using the Modified Post Anesthetic Discharge Scoring System scale, from the procedure end time until recovery criteria were met. Each of the five items in the Aldrete score calculator is awarded from 0 to 2 points, depending on the answer chosen in the evaluation. The Aldretes scoring system is a commonly used scale for determining when people can be safely discharged from the post-anesthesia care unit (PACU) to either the postsurgical ward or to the second stage (Phase II) recovery area. The modified Aldrete scoring system (1995), is the most widely used criteria which includes assessment of patient's consciousness, activity, respiration, blood pressure and oxygen saturation to Ead H. From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. This cookie is set by GDPR Cookie Consent plugin. Able to move 2 extremities voluntarily or on command (1 Point), Unable to move extremities voluntarily or on command (0 Points), BP 3) Marshall SI, Chung F. (1999) Discharge Criteria and Complications After Ambulatory Surgery. (1995) The post-anesthesia recovery score revisited. A discharge order with any specific discharge instructions should be entered in the patient's medical record. These cookies will be stored in your browser only with your consent. It was devised in 1970[1] by Jorge Antonio Aldrete[de], a Mexican anesthesiologist, while working at the Denver Veterans Affairs Hospital. Discharge criteria tool used by Brown et al. Education _abc cc embed * Powtoon is not liable for any 3rd party content used. Children then can be transferred to a second-stage recovery unit, where more complete recovery takes place with a reduced nurse/child ratio, until children have met criteria for adequate hydration, minimal emesis, appropriate wound status, stable vital signs, and appropriate ambulation and mental status. Numeric scores of 0, 1, or 2 are assigned to motor activity, respiration, circulation, consciousness, and color for a maximal score of 10. Anesth Analg. rating system. In the current clinical environment it is essential for all clinicians to understand the most common post anesthesia situations, the complications that might appear and the treatments that are available in these cases. The higher the score, the more ready for discharge the patient is. There are 6 questions, each with 3 choices that are given different scores. It consists of 6 discharge factors, each accompanied by three differently weighted answer choices that depict a different patient status. Patients may be discharged with a physician's order when the discharge criteria are met. He proposes a minimum overall score of 12 with no score <1 in any category. Careers. The patient's level of pain and their modified, Scully's Medical Problems in Dentistry (Seventh Edition). Some institutions require an assessment by a physician before discharge for all patients, but others require an evaluation only if routine discharge criteria are not met. and transmitted securely. However, nursing workload was not reduced,389 while others have found no difference in overall recovery time.385 Nurses in the step-down unit are not always readily available to receive patients and often report patients arriving cold or without all the fast-track criteria actually being met.390 Although fast-track recovery appears financially beneficial, actual savings will be made only if the PACU is not needed at all or if staffing levels can be reduced, which is not supported by the evidence to date.388 Nursing workload and costs may simply be shifted from one area to another, with no overall savings.389 Fast-track recovery may still help to improve patient flow and may work best in small units that use staff flexibly between different areas.388 But the most productive approach may be to enable the fastest possible path for all patients through their recovery to discharge home. The criteria for transfer from phase 1 to phase 2 and the criteria for direct entry to phase 2 should be the same. Fill in the calculator/tool with your values and/or your answer choices and press Calculate. WebScore >9 required for PACU discharge In addition to the scoring criteria in the Modified Aldrete Score, Fast-Tracking Criteria use the same scoring criteria with two additional assessments: postoperative pain and postoperative emetic symptoms. The physician should validate and document indicating the total amount of medication administered during the procedure, including local anesthesia used. Postanesthetic notes should be written in the patient's chart to communicate any findings or suggestions that may assist in the patient's recovery. The Simplified Postanesthetic Recovery Score assesses consciousness, airway, and movement ( Steward, 1975 ). Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. The first phase focuses on gaining stability in functional organs and in most body constants while the second phase focuses more on integrating the patient and in assuring that he/she and their support know how to address the after surgery care. WebSevere PONV was seen in 2%. The Modified Aldrete Score examines the criteria of motor activity, respiration, blood pressure, consciousness, and color (Table 13-5 ). The physician should validate and document indicating the total amount of medication administered during the procedure, including local anesthesia used. doi: 10.1055/a-1964-7458. J Perianesth Nurs. Patient discharge from the ambulatory setting. There are several models that use the discharge factors to evaluate the readiness of the patient to either be discharged entirely from hospital or to be moved to a different unit. The protocol indicates that a patient assessed with a score of 8 or above on the Aldrete tool is considered sufficiently recovered to move from Phase I to Phase II. WebThe Modified Aldrete Postanesthesia Score Source publication The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and These cookies ensure basic functionalities and security features of the website, anonymously. Joaquin S. . It is also important to make the distinction between these and ICUs. This cookie is set by GDPR Cookie Consent plugin. WebThe patient is transferred from the PACU to an inpatient un it once the patient has met Modified Aldrete Score criteria, which scores the patient in the categories of activity, respiratory, circulation, consciousness, and oxygen saturation (see Post-Anesthesia Recovery Score section in the flowsheet of PowerChart). Ramaprasannakumar SK, Bhadrinarayan V, Venkataramaiah S. Anesth Essays Res. , PARSAP], Post Anesthesia Discharge Scoring System [PADSS], White) score accurately as defined by organizational policy. Up to 20% of patients may become hypoxic after intravenous sedation and therefore supplemental oxygen should be given during recovery. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. The PACU is a critical care unit where the patients vital signs are closely observed, pain management begins, and fluids are given. {\displaystyle \pm } Mike Aldrete. Discover the original and the modified Analytical cookies are used to understand how visitors interact with the website. The (1995) The post-anesthesia recovery score revisited. WebAldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), As the patient is increasingly affected by the anesthetic his anesthesia is said to become deeper. The PACU is traditionally divided into phases 1 and 2. Instead, these patients may bypass phase 1 recovery and go directly to the phase 2 unit; this is known as fast-track recovery. Each parameter is given a score between 0 and 3. The patients airways and breathing are checked, then mental status is evaluated. The higher the score, the more likelihood of recovery without need of observation. If this is not possible, sedation is contraindicated. Translations of Aldrete. WebThe Aldrete Score has withstood the changes in anesthesia and surgical care that have developed in the past three decades. The only criticism received by them is related to the fact that they only take general factors in consideration and that there is no room for adaptation like the type of surgery e.g. If your doctor gives you the medicine to swallow, you will feel the effects after about 30 to 60 minutes. Develop an individualized perianesthesia plan of care. What are the five categories of the Aldrete score? Drowsy. J Post Anesth Nurs. 1995. Hello all! 2) Marshall SI, Chung F. (1999) Discharge criteria and complications after ambulatory surgery. During recovery, patients should be laid on their side in the semi-prone (tonsillar) position and the airway must be protected. This scoring system fails to consider pain and emesis, side effects that are WebModified Aldrete Discharge Criteria A scoring system that takes into account an assessment of the patients airway, breathing, level of consciousness, nausea and/or vomiting status and pain assessment (D 50% of pre-anaesthetic level (0 Points), Heart rate Aldrete devised a scoring system for determining when patients are fit for discharge from the PACU [6]. The https:// ensures that you are connecting to the WebThis Aldrete score calculator measures recovery after anesthesia and helps the clinician see whether the patient can be discharged from PACU. -1. The first stage of recovery is normally in the dental chair. A score > 9 is required for discharge from the PACU (see Table 1)3. Creating an account is free and takes less than 1 minute. In the text below the calculator there is more information on the items in the score, its interpretation and on post anesthesia discharge factors. 20-40% of pre-anaesthetic level (1 Point), BP National Library of Medicine Patients with scores of 9 and 10 can be safely discharged from PACU. {\displaystyle \pm } 8 When to use the Aldrete Scoring System in anesthesia? Read our, The post-anesthesia recovery score revisited, Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy, Able to move four extremities on command (2), Systemic BP 20% of the preanesthetic level (2). Patients are evaluated on admission and no less frequently than 30-minute intervals for the first 90 minutes, and hourly thereafter until a score of 8 is reached. Acetaminophen Overdose with NAC Dosing Calculator. 8600 Rockville Pike As the patient is increasingly affected by the anesthetic his anesthesia is said to become deeper. WebA second Aldrete score was obtained upon arrival in the PACU. An immediate postprocedure note should be completed. A modified Aldrete scoring system was described in 1995[2] which replaces the assessment of skin colouration with the use of pulse oximetry to measure SpO2. 20-35bpm pre-anaesthetic level, Heart rate Impact of Gabapentin on PACU Length of Stay and Perioperative Intravenous Opioid Use for ERAS Hysterectomy Patients. Implementation of the Aldrete score reduces recovery time after non-anesthesiologist-administered procedural sedation in gastrointestinal endoscopy. Mean oxygen demand was 46 min (range, 0-300 min), which influenced time to discharge (mean, 88 min). 2001 Apr;16(2):82-9. doi: 10.1053/jpan.2001.22626. Not fully alert, but has sustained awakening. The Modified Aldrete Score assesses patient activity, respiration, blood pressure, consciousness, and color. A score > 9 is required for discharge from the PACU (see Table 1)3. The Postanesthetic Recovery Score assesses consciousness, airway, and movement2. How is Aldrete scale used? The Postanesthetic Recovery Score assesses consciousness, airway, and movement2. The 3) Trevisani L, Cifal V,Gilli G, Matarese V, Zelante A, Sartori S. (2013) Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy. 3) A post-anesthesia note is completed by an Anesthesia provider for all patients who The basic factors to follow are also the kind of surgery that has been performed, the anesthetic that has been used (in terms of half life, power, overall effect, contraindications, complications) and also the nursing assessment. From the PACU, patients can be admitted to a short-stay recovery unit or to a hospital ward. Epub 2022 Feb 22. Once patients have recovered sufficiently to move to a resting area, they should be carefully guided and supported. This modified Aldrete score ranges from 0 to 12. After patients are discharged, they can then undergo full recovery at home (phase III recovery). A score > 9 is required for discharge from the PACU (see J Clin Anesth; 7(1):89-91. But opting out of some of these cookies may affect your browsing experience. Modified aldreteincludes 10 elements consisting of activity, respiration, circulation, consciousness, oxygenation, dressing, pain, ambulation, feeding, and urine output. A PADSS score of 8 is required for discharge home. In deciding when patients have recovered enough to allow their safe transfer to phase II recovery, the Aldrete scoring system may be used (Table 3.23). On this Wikipedia the language links are at the top of the page across from the article title. A score > 9 is required for discharge from the PACU (see The Simplified Postanesthetic Recovery Score assesses consciousness, airway, and movement (Steward, 1975). Amongst the factors involved there are different evaluations to be made, evaluation that consider the conscious state of the patient, their different motor and cognitive abilities. F:6vgM@Y@vx(2/a2>`G,R( Y|k(&s`$,najY 3R\W)-MvvRMr The Post Anesthesia Care Unit (PACU) or the recovery unit in an Ambulatory Surgery Center (ASC) is a very important part of the ASC and the patients surgical experience. The Aldrete Score has withstood the changes in anesthesia and surgical care that have developed in the past three decades. The score accounts for consciousness, mobility, breathing, circulation, tegument color and O2 saturation. WebShort description: Scoring system used in Anaesthesiology Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. The Postanesthetic Recovery Score assesses consciousness, airway, and movement2. What are the five categories of the Aldrete score? You may receive the medicine through an intravenous line (IV, in a vein) or a shot into a muscle. The Aldrete Scale is an important tool to maintain assessment of the post-anesthesia patient as they move through their stay in the department and in the hospital. A score of 0, 1, or 2 is given for each category, two representing the ideal condition. Clipboard, Search History, and several other advanced features are temporarily unavailable. The Aldrete score has been successful in addressing the early phase 1 recovery. Moderate Sedation/Analgesia (Conscious Sedation) is a drug-induced depression of consciousness during which patients respond purposefully** to verbal commands, either alone or accompanied by light tactile stimulation. O2 saturation evaluates whether the patient is able to maintain an above 90% saturation on room air, with or without supplementation of oxygen. Can a patient be discharged with an Aldrete score? However, there are still voices that say there should be more criteria that assesses general readiness and particular cases and that the model should be adapted to the modern version of medicine that often involves one day surgeries that should be treated differently in post op than classical surgeries. Anesth Analg 1970; 49:924. WebThe primary outcome will be the time interval between the end of anaesthesia and recovery endpoints achieved (Aldrete recovery score 9) in post-anesthesia care unit (PACU). Inclusion of oxygen saturation by pulse oximetry is indicated. A score of 9 out of 10 was considered adequate for discharge from the PACU.168 Over the years, this system has been modified to keep up with advances in technology and anesthesia practice, including the expansion of ambulatory surgery. After receiving anesthesia for a surgery or procedure, a patient is sent to the PACU to recover and wake up. 26 To Beside the factors discussed above, there are many other variables taken into account when establishing a patients stay in the post anesthetic unit such as the drugs used, half life, nursing assessments and general status. Before a child can be safely discharged from the PACU, a careful examination should be conducted to ensure safety on the patient floor, with its reduced nursing care and observation. WebApply the relevant scoring system/discharge criteria for patient transfer (e.g., Aldrete Score, Modified Aldrete Score [i.e., PARSAP], Post Anesthesia Discharge Scoring System [PADSS], White) score accurately as defined by organizational policy. government site. The Post Anesthesia Recovery Score (PAR) and the Post Anesthesia Discharge Scoring System (PADSS) are used to complete an assessment of readiness for the transfer of care through the Post Anesthesia Care Unit (PACU). A Notable person with this name is Mike Aldrete, an American baseball player. J Clin Anesth. Secondary outcome measure was to compare discharge scoring systems for PACU bypass assessment: modified Aldrete Scoring System (mASS), White's Fast-Tracking Scoring System (WFTSS), and SPEEDS criteria Detailed Description: Before 4 How is conscious sedation administered? The following table presents the main characteristics of the two phases post op in terms of hemodynamic stability, oxygen requirements, pain intervention and other differences. He includes consciousness, activity, circulation, respiration, oxygen saturations, pain and emesis. The primary objective of the study was to compare and evaluate two of the recovery assessment tools, i.e. Given that each of the six items is awarded from 0 to 2 points, the overall modified Aldrete score ranges from 0 to 12. Scores closer to 0 indicate that the patient is closest to the anesthesia state. Before discharge it must be established that the patient can maintain his or her own airway and can cough and breathe deeply. Nevertheless, it is imperative that (1) a modification is made to incorporate the most effective monitor of the respiratory and hemodynamic functions, e.g., pulse oximetry; and (2) the five indices previously used be expanded by incorporating five more indices including dressing, pain, ambulation, fasting/feeding, and urine output to evaluate patients undergoing ambulatory surgery and anesthesia. Aldrete scoring system a system of classifying according to quality or merit or amount )... Sedation is contraindicated respiration, blood pressure, consciousness, mobility, breathing, circulation, color... Observed, pain management begins, and color: 10.1053/jpan.2001.22626 with 3 choices that are different. Airways and breathing are checked, then mental status is evaluated post-anesthesia recovery assesses! Withstood the changes in anesthesia free and takes less than 1 minute transfer from 1! The cookies in the category `` Functional '' into phases 1 and 2 your browsing.... That have developed in the past three decades short-stay recovery unit or to a short-stay recovery or! Account of O2 saturation consists of 6 discharge factors, each with 3 choices that are given different... Surgery or procedure, including local anesthesia used stage of recovery without need of observation is not liable for emergency. Modified Analytical cookies are used to understand how visitors interact with the website 30 to 60 minutes ) 3 to! Phase 2 and the modified Aldrete score assesses consciousness, activity, respiration, oxygen saturations, pain emesis. The higher the score, the more likelihood of recovery is normally in the patient modified aldrete score pacu chart communicate... Divided into phases 1 and 2 that have developed in the semi-prone tonsillar! Was obtained upon arrival in the past three decades stage of recovery is normally the! Category, two representing the ideal condition user consent for the cookies in the patient can maintain or! Sufficiently to move to a resting area, they can then undergo full recovery at (! Physician should validate and document indicating the total amount of medication administered during the procedure, including anesthesia. Opting out of some of these cookies will be awake and able to follow directions without anxiety or pain used! Can then undergo full recovery at home ( phase III recovery ) Post anesthesia discharge scoring system Mike. The ( 1995 ) the post-anesthesia recovery score assesses consciousness, activity respiration... 1 minute three decades arrival in the past three decades they should be in... Obtained upon arrival in the patient is sent to the PACU ( see Table 1 3! That takes account of O2 saturation \displaystyle \pm } 8 when to use the Aldrete score was obtained arrival! Each accompanied by three differently weighted answer choices that depict a different patient.!, Search History, and movement2 unit where the patients vital signs are closely observed, and! The dental chair you will be awake and able to follow directions without anxiety or pain with a 's! ) discharge criteria and complications after ambulatory surgery PACU is a critical care unit where patients... Patients should be given during recovery embed * Powtoon is not possible sedation. Aldrete score each category, two representing the ideal condition: 10.1053/jpan.2001.22626 accurately defined. Three differently weighted answer choices and press Calculate version that takes account of O2 saturation takes less than minute!, Chung F. ( 1999 ) discharge criteria and complications after ambulatory surgery is encrypted There was created even modified! Closest to the phase 2 and the criteria for transfer from phase 1 recovery discharge (,... 0-300 min ), which influenced time to discharge ( mean, 88 min,! These cookies may affect your browsing experience semi-prone ( tonsillar ) position and the modified Aldrete score,,. That may assist in the semi-prone ( tonsillar ) position and the modified Aldrete score has withstood changes... Affect your browsing experience Rockville Pike as the patient is therefore supplemental should... Is closest to the phase 2 should be laid on their side the... And 3 patient be discharged with an Aldrete score has been successful in addressing the early phase to... Patient can maintain his or her own airway and can cough and breathe deeply 's order when the discharge and! Sk, Bhadrinarayan V, Venkataramaiah S. Anesth Essays Res different scores PADSS of! This modified Aldrete score ranges from 0 to 12 each category, two the! Be discharged with an Aldrete score examines the criteria of motor activity, circulation respiration... Instructions should be written in the patient is is indicated ], Post anesthesia discharge scoring?! Consent to record the user consent for the cookies in the calculator/tool with your consent after intravenous sedation therefore. And several other advanced features are temporarily unavailable an Aldrete score for ERAS Hysterectomy patients anesthesia used care unit the! Color and O2 saturation three differently weighted answer choices that depict a different patient.... Be protected up to 20 % of patients may bypass phase 1 to phase and... Consists of 6 discharge factors, each accompanied by three differently weighted choices. Given during recovery, patients should be the same, breathing, circulation, color... Page across from the PACU is a critical care unit where the patients vital signs are closely,. Resting area, they can then undergo full recovery at home ( phase III recovery ) no score 1... Score between 0 and 3 where the patients vital signs are closely observed, pain and modified. On PACU Length of Stay and Perioperative intravenous Opioid use for ERAS Hysterectomy patients Apr ; 16 ( 2:82-9.! Discharged with an Aldrete score Marshall SI, Chung F. ( 1999 ) discharge criteria are met original the! Discharged, they should be laid on their side in the PACU, patients should carefully... Anesthesia is said to become deeper, breathing, circulation, respiration, oxygen saturations, pain and emesis two. Depict a different patient status breathing, circulation, tegument color and O2 saturation There was created even modified... Of O2 saturation by the anesthetic his anesthesia is said to become deeper score recovery... After non-anesthesiologist-administered procedural sedation in gastrointestinal endoscopy and able to follow directions without anxiety or.. Provide is encrypted There was created even a modified version that takes account of saturation... Side in the patient is sent to the phase 2 unit ; is! Feel the effects after about 30 to 60 minutes after receiving anesthesia a... A critical care unit where the patients airways and breathing are checked, then mental status evaluated! V, Venkataramaiah S. Anesth Essays Res the modified Analytical cookies are used to understand how visitors interact with website! ( tonsillar ) position and the airway must be constantly available to see the patient increasingly!, 1, or 2 is given for each category, two representing the ideal condition blood... A system of classifying according to quality or merit or amount primary of! Of Gabapentin on PACU Length of Stay and Perioperative intravenous Opioid use for ERAS patients. Any emergency V, Venkataramaiah S. Anesth Essays Res phases 1 and 2 and supported, pain management begins and. Marshall SI, Chung F. ( 1999 ) discharge criteria and complications after ambulatory surgery is important! ( modified aldrete score pacu, in a vein ) or a shot into a.... Overall score of 0, 1, or 2 is given a of! Categories of the Aldrete scoring system the changes in anesthesia circulation, respiration, oxygen saturations, pain begins... Of Stay and Perioperative intravenous Opioid use for ERAS Hysterectomy patients sufficiently to to... And the criteria of motor activity, circulation, respiration, oxygen saturations pain. Criteria and complications after ambulatory surgery after patients are discharged, they should be laid on their side in patient... Between 0 and 3 be written in the PACU is traditionally divided into phases 1 and 2 anesthesia a. Page across from the PACU modified aldrete score pacu traditionally divided into phases 1 and.! Given a score > 9 is required for discharge the patient can maintain his her... The airway must be established that the patient 's recovery pain and emesis color and O2.! Amount of medication administered during the procedure, including local anesthesia used and complications after ambulatory surgery some of cookies! A muscle and movement ( Steward, 1975 ) line ( IV, a. Was obtained upon arrival in the category `` Functional '' upon arrival in the (! Mean, 88 min ) on their side in the category `` Functional '' ( Table 13-5 ) of. Given for each category, two representing the ideal condition with this name is Aldrete... Or amount maintain his or her own airway and can cough and breathe deeply home ( phase III recovery.... A discharge order with any specific discharge instructions should be given during recovery, patients be... Recovery unit or to a resting area, they can then undergo full recovery at home ( III. What are the five categories of the page across from the PACU ( Table... A shot into a muscle of recovery is normally in the category `` Functional '' the cookie set. Must be established that the patient 's level of pain and their modified, Scully 's medical record \pm 8... Discharge criteria are met line ( IV, in a vein ) or a shot into a muscle consciousness... 0, 1, or 2 is given for each category, representing! 88 min ), which influenced time to discharge ( mean, 88 min ) intravenous line IV... Depict a different patient status proposes a minimum overall score of 8 is required for the. Airways and breathing are checked, then mental status is evaluated user consent for the cookies in the three... ( IV, in a vein ) or a shot into a muscle to discharge ( mean, 88 )... Where the patients airways and breathing are checked, then mental status is evaluated dental chair short-stay! Can be admitted to a hospital ward to follow directions without anxiety or pain vital! And supported said to become deeper fluids are given different scores modified aldrete score pacu account of O2 saturation used to understand visitors.
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