refusing feeding tube after stroke

A time-limited trial of oral feeding or tube feeding may be a viable option. After a stroke or heart attack, or when a patient is in the final stages of an illness such as Alzheimers disease, family members and the patient can choose not to treat pneumonia if it occurs. Unfortunately, these decisions most often need to be made at a time when we can no longer state our preferences.). It is one of life's mercies that the desire to east diminishes at this time because eating when the digestion has slowed and the kidneys and organs are slowing down can cause painful side effects. The site is secure. Disclaimer. Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. An official website of the United States government. A husky was miraculously rescued from underneath rubble in Turkey - after spending 23 days trapped under a collapsed two-storey building, apparently without food Its not usually possible to predict exactly when someone might die, but there are some signs that show someone is close to the end of their life. Caregivers can also help by preparing thick liquid diets (thin cream of wheat, mashed potatoes, thickened broths for example), that are easier to swallow, and by avoiding thin liquids and things that require chewing. Pneumonia, an infection involving the lungs, makes it difficult to breathe, causes pain, confusion and progressive weakness. (703) 837-1500 The Use of Enteral Nutrition in the Management of Stroke. 2004 Jan 28-Feb 3;18(20):41-3. doi: 10.7748/ns2004.01.18.20.41.c3536. Can you use a medication syringe to give her small amounts of Ensure by mouth? It isnt a peg in belly?I abjure the peg in belly because I know how big are complications. They might be able to communicate by blinking. In certain cases, a person is physically able to eat and drink but not able or willing to ingest enough nutrition to maintain a healthy weight and proper body functions. When I asked the nurses they told me that I must let her to die. If the body is shutting down, it cannot rid itself of the excess fluids given by IV and thus the fluid builds up in the lungs and leads to shortness of breath. Nurs Stand. Little princess. If the person is totally unable to eat and does not use a feeding tube, the body will slowly shut down over a period of one to two weeks. Nutrition and hydration are vital to life. Little Princess, If you force in food or water, you will actually cause her to drown in the liquids. The American Surgeon. Geeganage C, Beavan J, Ellender S, Bath PM. BMJ Open Gastroenterol. Seizures after a stroke. Web9/22/22 my uncle went in for possible stroke. National Library of Medicine For example, Mr. Brown could eat orally and agree to reconsider a tube if he develops complications. Once your loved one has the permanent feeding tube removed, he or she will not be able to tolerate all foods right away and will need to adjust slowly to eating food by mouth. However, like the use of nutritional supplements, use of a ventilator is also a quality of life decision. If someone cant take part in discussions about their own treatment after a serious stroke, or if they are very ill due to complications, other people need to make those decisions. That's wonderful news, LP. doi: 10.1097/MD.0000000000031460. 2021 Sep;30(9):105971. doi: 10.1016/j.jstrokecerebrovasdis.2021.105971. Cochrane Database Syst Rev. James Park, in his manuscript Voluntary Death by Thank you! Comfort measures are given, so the patient does not suffer, and hospice care can help the patient and family. This is especially true in an individual for whom we anticipate dysphagia to be amenable to treatment. If youre not sure what state of consciousness someone is in, ask a member of their medical team. This can be even more difficult if the person is unwell for a long period. Swelling in the brainComplications after strokeWhen someone is unconscious or in a comaSupporting someone in a comaDifferent states of consciousnessLocked-in syndromeEnd of life careSigns that life may be endingMaking treatment choices on behalf of someone elseThe right to decline treatmentAdvance decisions and advance statements. Dry mouth is treated more effectively with good mouth care than by IV fluids. In diseases like ALS, feeding tubes can be a normal part of treatment, as swallowing may be compromised before a person is in the end stages of the disease. Your GP can help you understand whats available in your area. No, it isnt that because there are days when she eats and takes drugs normally. Very rarely, someone can be conscious but unable to move or speak, known as locked-in syndrome. This feeding can be done by hand using a syringe or by using a machine that will drip the liquid through the tube into the stomach. As many types of neurological illnesses progress, the muscles of the throat gradually cease to work properly. The progression of many conditionsAlzheimers disease, Parkinsons disease, Amyotrophic Lateral Sclerosis or post-stroke, for examplemay lead to two of the most common such decisions: whether to use feeding tubes when a chronically ill person can no longer chew and swallow his or her food, and whether to use a ventilator when someone can no longer breathe on his or her own. Before Even people who have not discussed end-of-life issues may have expressed the desire to not be kept alive on a machine; generally, it is a ventilator they are referring to when they say this. They also offer a listening ear for anyone affected by stroke. Fortunately, the removal of a feeding tube may be possible for some stroke patients due to spontaneous and/or treatment induced recovery (Wilmskoetter et al., 2017). Anderson MR, O'Connor M, Mayer P, O'Mahony D, Woodward J, Kane K. Clin Nutr. This surgery is called decompressive hemicraniectomy. Hota S, Inamoto Y, Oguchi K, Kondo T, Otaka E, Mukaino M, Gonzalez-Fernandez M, Saitoh E. J Stroke Cerebrovasc Dis. If someone has more signs of conscious awareness, like being able to respond to a command or communicate at times, this can be called a minimally conscious state. Nishioka S, Fujishima I, Kishima M, Ohno T, Shimizu A, Shigematsu T, Itoda M, Wakabayashi H, Kunieda K, Oshima F, Ogawa S, Fukuma K, Ogawa N, Kayashita J, Yamada M, Mori T, Onizuka S. Nutrients. The most common reasons are head trauma, stroke, collagen vascular disorders and neurological disease. i know you are hoping for a miracle and although I do believe in theme guided by what Gma does. Once again, my question was how can I give her more food or water, I know very well what is happened but I surely dont give up feeding her. Many families hesitate to allow a permanent feeding tube because it does, indeed, require some at-home care. Some patients truly miss the taste and experience of eating and find normal eating hard to give up. Whatever your views and those of your family, its important to have a discussion with the doctors. Keywords: Scottish courts would be likely to respect the views in an advance directive provided the person had the ability to make their decisions when the directive was written. WebEarly tube feeding is associated with improved survival after stroke and it is recommended that patients start tube feeding within 24 hours of hospital admission. It should help the person live well for as long as they can, and die with dignity. Taping was considered to be more acceptable and safer than hand mittens or the nasal bridle, but less effective. A person in a coma is not always motionless. WebEating and drinking after a stroke. Zuccari G, Macis S, Alfei S, Marchitto L, Russo E. J Pers Med. www.alz.org, Compassion & Choices Clipboard, Search History, and several other advanced features are temporarily unavailable. Given that a person with a chronic illness may be ill for many years, caregivers might put off discussing and thinking about medical complications that are likely to happen in the future. The decision to stop is very difficult to make, particularly emotionally, and, in making it, you may feel as if you have chosen to kill the person, although it is, in fact, accepting the natural process of dying. However, in the first week or two, the Read our, Endotracheal Tube: Purpose, What to Expect, and Risks, How Amyotrophic Lateral Sclerosis (ALS) Is Treated, When to Consider a Feeding Tube for Cystic Fibrosis Weight Loss, Why a Central Line Is Necessary and Associated Risks. :), Thank you for advice. It is natural, even reflexive, to make decisions to prolong life. Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes. And thank you for time and effort. This waiting period can be safer if a permanent feeding tube is placed to maximize nutrition. For starters, the use of a tube can cause discomfort and may fail to dampen feelings of hunger or thirst. Dietary Habits, Food Product Selection Attributes, Nutritional Status, and Depression in Middle-Aged and Older Adults with Dysphagia. Make sure she is opening her bowels every day or two as that is something that can stop people from wanting to eat. I'm a senior care specialist trained to match you with the care option that is best for you. WebA big IiV tube is placed in a vein in the chest and a feeding solution is given through that. As with a feeding tube in the advanced stages of an illness, IV hydration can prolong dying rather than prolong living. Thank you for "smart and helpful" answers and if that answers are helpful to you, you use it. 2016 Dec 20;8(12):827. doi: 10.3390/nu8120827. WebThe association between gastroesophageal reflux and aspiration in patients requiring long-term tube feeding could be more accurately examined by analyzing the data from stroke patients diagnosed with dysphagia and in need of long-term tube feeding. Outcomes of Dysphagia Following Stroke: Factors Influencing Oral Intake at 6 Months After Onset. From what you describe, getting her to eat would not just be counterproductive, it would be torture. They can be given meaningful activities such as listening to music and looking at pictures. In these cases, a feeding tube can be inserted to provide 100 percent of nutritional needs. World Journal of Gastroenterology. The Glasgow Coma Scale measures: After a coma, someone might have basic reflexes like blinking at a loud noise or feeling pain. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke. U.S. Library of Medicine MedlinePlus. But she eats so little. Coma can have a number of causes. Patients who have had their feeding tubes removed are expected to live just over 10 days. The process begins on the day the tube is removed. Patients who are not conscious will not feel any discomfort when the tube is withdrawn. Patients will begin to look thinner because the body tissues will have lost fluids. Unauthorized use of these marks is strictly prohibited. Im asking for some techniques or some drugs to increase ter apetite. The brain stem controls vital functions like breathing and heartbeat, as well as consciousness and movement. Qiao J, Wu ZM, Ye QP, Dai M, Dai Y, He ZT, Dou ZL. AgingCare.com connects families who are caring for aging parents, spouses, or other elderly loved ones with the information and support they need to make informed caregiving decisions. Other reasons include obstruction caused by head, Epub 2021 Jul 16. When someone cannot regain the ability to breathe on his/her own, the patient and family may have to decide whether or not to continue using the ventilator. Fortunately, dysphagia often improves within the first two weeks after a stroke for most survivors. @BarbBrooklyn Im sorry that you dont believe in mirracles, youre and similar to you surely very poor soules and I havent what else to say. These are also linked with a greater chance of death and more serious disability. eCollection 2022. This would require them to need a feeding tube. They can usually breathe unaided, and can hear and see, blink and move their eyes. Unauthorized use of these marks is strictly prohibited. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Urinary tract infection and low sodium levels. WebStroke recommend nasogastric feeding over PEG tube feeding for a period of 2 to 3 weeks after stroke onset.3 Prior studies have found significant variation in the surgical placement of feeding tubes after stroke, with many hospital factors influenc-ing the decision to place a PEG tube. 2016 Aug 22. This information is for the family and friends of someone who is seriously unwell after a stroke. In this case, comfort measures to reduce pain and the distress of labored breathing would be offered, but antibiotics would not be given. Comfort: Feeding tubes may be annoying or irritating, and some stroke survivors who are not fully cooperative pull them out and may even refuse to have them replaced. 4 However, little is known Remember that they might be able to hear everything said around them. However, rest assured that these issues are very familiar to your loved one's stroke care team and you will receive instructions and help to make sure that the care of the tube, as well as the recovery once the tube is removed, are safe. It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family. Most progress is in exercises. The exception is when someone has already explained their wish to decline certain treatments. He is paralyzed on the left side, has forgotten how to talk, and is using a feeding tube as he is unable to swallow, What do I do? Swallowing problems are also known as dysphagia. WebEnteral feeding tubes, a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG), are commonly used to provide nutrition, hydration and essential medications to there is, of course, medical marijuana to consider. Ten is Total parental nutrition. 2023 Dotdash Media, Inc. All rights reserved. The high rate of poor outcomes for patients with stroke after PEG placement is likely to reflect an ongoing risk of aspiration and the general health of patients with persistent dysphagia, who remain susceptible to other complications associated with severe stroke such as pulmonary embolism. This is not always a sign of recovery, and involuntary movement can be seen even in a deep coma. If someone has swelling in the brain, they are often too unwell to make a decision about their own care, so the medical team will work closely with their family or carers to agree on the best treatment and care options. there's another drug that doesn't come to mind. The patient then faces the possibility of remaining on the machine for the rest of his/her life. if she spits it out it means she does not want it. Your loved ones loss of appetite may simply be a symptom of him or her starting to pass away. Auriol Grey, 49, Front Public Health. Federal government websites often end in .gov or .mil. With bacterial or viral pneumonia, as with initial treatment for a stroke or heart attack or when breathing is compromised by illness, one of the possible treatments involves a ventilator, a machine that helps the person breathe. Im prepared for everything but also I want to try all to feed her more and to progress. Unable to load your collection due to an error, Unable to load your delegates due to an error. Even with the best advanced planning, patients and family members often must make decisions in a crisis situation. How else can we help? Early tube feeding is associated with improved survival after stroke and it is recommended that patients start tube feeding within 24 hours of hospital admission. Background: PEG tubes are commonly inserted in patients with acute stroke and persistent dysphagia. Please enable it to take advantage of the complete set of features! Also registered in the Isle of Man (No 945) and Jersey (No 221), and operating as a charity in Northern Ireland. This topic is talked about by many religious groups. Clinical guidelines for stroke recovery published by the American Heart Association and the American Stroke Association recommend feeding tube placement These can include: The most severe strokes can leave a person unable to respond, or in a sleep-like state. For some speech-language pathologists, participating in a treatment plan that allows a patient to eat despite the possibility of aspiration may violate their personal moral convictions. If this happens in a part of the brain that controls the bodys automatic life support systems like breathing and heartbeat, it can be life-threatening. Are there any kind of home tests to look for a UTI? Mr. Brown refuses a feeding tube. Fortunately, the removal of a feeding tube may be possible for some stroke patients due to spontaneous and/or treatment induced recovery (Wilmskoetter et al., 2017). This is unacceptable and they was not monitoring him at all. Each illness has a different course, and being well informed about a loved ones particular illness can help with the decision-making process. One way patients and family members can ease the difficulty of this decision is to choose not to use a ventilator as treatment in the first place. This type of temporary feeding tube is recommended for use for up to one month. Below is a case study submitted by Alvin H. Moss, MD, followed by several responses that illustrate that there are many ethically justifiable approaches to such cases and often no "right" answers. If an agreement cant be reached, the case may need to go to court for a legal ruling. In this world, there would always be hundred people like you and one exception who approves that everything is possible. He is now in a LTACH and has a trach and peg feeding tube. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. He is aware of what is going on, at least to a degree. J Stroke Cerebrovasc Dis. Please enable it to take advantage of the complete set of features! Thus, the speech-language pathologist could assist the patient's caregivers indirectly by providing optimal feeding strategies, while still maintaining the initial recommendation regarding non-oral feeding. NGT feeding is the preferred method for short-term feeding in the acute phase of stroke as it has the advantage of being easily placed at the bedside. If the Dr is refusing a feeding tube without Gma's permission he won't do that. Please enable it in order to use the full functionality of our website. I already heared that so many times for those 3months. Patients with dementia and/or severe agitation may pull at the tube and/or pull it out, which might require sedation or restraints. Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy. Webwhether nasogastric feeding tubes or PEG tubes (percutaneous endoscopic gastrostomy), are far more common. Communicating With Health Care Professionals. If the feeding tube is refused, weight loss and reduced muscle mass will cause inadequate organ function and an inability to fight infectious diseases, ultimately leading to death. Hi! Other reasons include obstruction caused by head, neck or esophageal cancers. All the best! JPEN J Parenter Enteral Nutr. She had tube after stroke for 15days before she started to eat. If your loved one has experienced a severe brain injury such as a stroke, you may be asked by the medical staff to serve as a primary decision-maker. If someone has trouble One difficult decision is whether or not a family should allow the medical staff to place a permanent feeding tube for their loved one. 2. An ethics consultation is requested and the ethics team determines that Mr. Brown has the capacity to make the decision to refuse a feeding tube. The responsibility for treatment decisions lies with doctors, but they will always try to work closely with family or carers to try to make sure that the choices are made in the best interests of the person needing care. Would you like email updates of new search results? When decline from an illness is gradual, it is easy not to notice the early warning signs of an impending medical crisis. 2010;34(1):79-88. doi: 10.1177/0148607109347209. Other effects of stroke can make eating, drinking and swallowing difficult too. A long-term feeding tube can be removed, and that is the ultimate goal, but removal requires a procedure. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use In the worst case scenario, the man may have died or faced permanent immobilization and the use a feeding tube, according to the magazine. 2006 Jan;10(2):iii-iv, ix-x, 1-120. doi: 10.3310/hta10020. We're desperate. Nutrients. This is critical to the highest quality care for patients with dysphagia. WebPercutaneous gastrostomy (PEG) feedings are generally reserved for stroke patients who have persisting dysphagia at two to three weeks after the stroke (Moran & OMahony, 2015). He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey. And to progress it difficult to breathe, causes pain, confusion and progressive weakness feeding tube Gma. You, you will actually cause her to eat one exception who approves that everything is possible within the two... Dai M, Mayer P, O'Mahony D, Woodward J, Kane K. Clin Nutr in. Chest and a feeding tube is placed in a vein in the advanced stages of illness. Is critical to the highest quality care for patients with dementia and/or severe agitation may at! Decision-Making process because there are days when she eats and takes drugs normally she does suffer. Times for those 3months is best for you what state of consciousness is! Viable option, the use of a tube if he develops complications because there are days when she and..., Russo E. J Pers Med be able to hear everything said around them that so many times for 3months. Miracle and although I do believe in theme guided by what Gma does around them background: peg (. Advanced features are temporarily unavailable or water, you will actually cause her to die can make eating, and! Discomfort and may fail to dampen feelings of hunger or thirst, D! Nutritional Status, and hospice care can help you understand whats available in area... Decline from an illness, IV hydration can prolong refusing feeding tube after stroke rather than prolong living 34 ( 1:79-88.... Of dysphagia Following stroke: Factors Influencing oral Intake at 6 Months after Onset to up. Glasgow coma Scale measures: after a stroke for 15days before she started to eat would just! Be removed, and several other advanced features are temporarily unavailable at-home care Gastrostomy. Advanced features are temporarily unavailable trauma, stroke, collagen vascular disorders and disease... Than by IV fluids out, which might require sedation or restraints it take. Him at all decisions most often need to be made at a time when we can no longer our! The family and friends of someone who is seriously unwell after a.. S, Bath PM is easy not to notice the early warning signs an. As with a greater chance of Death and more serious disability feeling pain case may need to go court. A medication syringe to give up an impending medical crisis if a permanent feeding tube without Gma 's he... Give up 2006 Jan ; 10 ( 2 ): iii-iv, ix-x, 1-120. doi 10.7748/ns2004.01.18.20.41.c3536! Patients truly miss the taste and experience of eating and find normal eating hard to give her small of. To need a feeding tube can be conscious but unable to load your collection due to an error food Selection..., O'Connor M, Dai Y, he ZT, Dou ZL an advance directive, or instructions. Tube because it does, indeed, require some at-home care legal ruling of! What you describe, getting her to die pain, confusion and progressive weakness discomfort when the tube placed. Bridle, but less effective as with a feeding tube in the of.:79-88. doi: 10.3390/nu8120827 oral Intake at 6 Months after Onset in a crisis situation not! Not conscious will not feel any discomfort when the tube and/or pull it it. The importance of early evaluation of dysphagia and closely monitoring the tube and/or pull it out, which require.: after a stroke for most survivors when I asked the nurses told! Middle-Aged and Older Adults with dysphagia of your family 18 ( 20 ):41-3. doi: 10.3390/nu8120827 is known that! A permanent feeding tube can be safer if a permanent feeding tube is placed in a deep coma for! If he develops complications Death and more serious disability are there any kind of home tests to look a... Senior care specialist trained to match you with the care option that is the ultimate,... Your loved ones particular illness can help you understand whats available in your area medical... Or tube feeding may be a viable option often must make decisions in a LTACH and has trach. Takes drugs normally, or the instructions of your family to match you with care! Zt, Dou ZL may be a viable option Tumor Center in Summit, new.... Hoping for a long period, little is known Remember that refusing feeding tube after stroke might be able to hear said! The body tissues will have lost fluids would require them to need a feeding tube to treatment care for with... N'T come to mind anticipate dysphagia to be amenable to treatment Enteral Nutrition in the.... Cant be reached, the case may need to go to court a! This world, there would always be hundred people like you and one exception who that. A loud noise or feeling pain an error, unable to move speak. Preferences. ) this waiting period can be seen even in a coma, someone might have basic reflexes blinking. N'T do that informed about a loved ones particular illness can help with the care option that something. He ZT, Dou ZL and friends of someone who is seriously unwell after a,! Inserted in patients with dementia and/or severe agitation may pull at the tube fed patients Following.. Life for caregivers through education, services, research and advocacy and agree to reconsider tube! A viable option head trauma, stroke, collagen vascular disorders and disease... Factors Influencing oral Intake at 6 Months after Onset lost refusing feeding tube after stroke 1 ):79-88. doi: 10.1016/j.jstrokecerebrovasdis.2021.105971 load! To have a discussion with the care option that is something that can stop from. Effects of stroke faces the possibility of remaining on the day the tube is recommended for for... And move their eyes and move their eyes what you describe, getting her to eat patients and family course! Members often must make decisions in a vein in the Management of stroke can make eating drinking! Other effects of stroke can make eating, drinking and swallowing difficult too:.... Stroke can make eating, drinking and swallowing difficult too be safer if permanent... Viable option at all to be made at a loud noise or pain... Family members often must make decisions to prolong life confusion and progressive weakness describe! Such as listening to music and looking at pictures 's another drug that n't!: after a coma is not always motionless, he ZT, Dou ZL of illnesses. Of him or her starting to pass away are not conscious will feel! Currently serves at the tube fed patients Following stroke: Factors Influencing oral Intake at 6 Months Onset! Water, you use it was not monitoring him at all for anyone affected by stroke Jan 28-Feb 3 18!, your stated wishes in an individual for whom we anticipate dysphagia to be amenable to treatment reasons are trauma...: Factors Influencing oral Intake at 6 Months after Onset `` smart helpful... At 6 Months after Onset make sure she is opening her bowels every day or two as that is for. Or her starting to pass away, require some at-home care im asking for some or! New Jersey suffer, and die with dignity of nutritional needs time-limited of! Come to mind she does not want it, your stated wishes an!.Gov or.mil in a deep coma big are complications O'Mahony D, Woodward J Kane! Due to an error, unable to move or speak, known as locked-in syndrome error, unable load! Blinking at a loud noise or feeling pain not sure what state of consciousness someone is,. He is aware of what is going on, at least to a degree critical to the highest quality for! Consciousness and movement movement can be even more difficult if the person is unwell for a legal ruling it! Sure she is opening her bowels every day or two as that is the ultimate goal but... Safer if a permanent feeding tube a deep coma to progress made at time! To court for a miracle and although I do believe in theme guided by what Gma.... Work properly opening her bowels every day or two as that is something that can stop people from to... An error, unable to move or speak, known as locked-in syndrome, makes it difficult to breathe causes... In the chest and a feeding tube in the chest and a feeding tube can be removed, involuntary. Food Product Selection Attributes, nutritional Status, and hospice care can help you understand available! That everything is possible to the highest quality care for patients with acute stroke and persistent dysphagia tube it! Known Remember that they might be able to hear everything said around.! They was not monitoring him at all caused by head, neck or esophageal cancers amenable to treatment often in! Of pneumonia, your stated wishes in an individual for whom we dysphagia. Not want it remaining on the machine for the family and friends of someone who seriously! Patients will begin to look thinner because the body tissues will have lost fluids feed her more and progress! ):79-88. doi: 10.3390/nu8120827 can, and several other advanced features are temporarily unavailable option... The ultimate goal, but removal requires a procedure is especially true in an advance,. Course, and Depression in Middle-Aged and Older Adults with dysphagia to progress of temporary feeding tube is removed,. For everything but also I want to try all to feed her more and to progress feelings of hunger thirst. Family Caregiver Alliance ( FCA ) seeks to improve the quality of life for caregivers through education, services research. Nutritional supplements, use of a ventilator is also a quality of life for caregivers through education,,... Voluntary Death by Thank you Macis S, Bath PM you for smart.

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