PANDUAN PASIEN PADA AKHIR KEHIDUPAN
RUMAH SAKIT TK. III BALADHIKA HUSADA HUSADA JL. PB. SUDIRMAN No. 45 JEMBER TELP/FAX/E TELP/FAX/EMAIL MAIL (0331) 484674, 48!07/ (0331) 4!5673/ E"#$% & '#*#%#+$#+-## '#*#%#+$#+-###+oo #+oo
DAFTAR ISI
ATA PENANTAR....................................................................................................................... 3 BAB I DEFINISI............................................................................................................................4 A. P2#+-%-#.............................................................................................................4 B. T--#.......................................................................................................................4 . D2$$......................................................................................................................5 BAB II. RUAN LINUP..............................................................................................................6 A. R-# L$- P22'## P#-#.........................................................................6 B. P22'$"# I9o'"#$ P2%### A+$' 2+$-#.....................................................6 . P'o92$ T2'#$:...........................................................................................................6 D. J2$;2$ P2#$: T2'"$#%....................................................................................6 D. F#2;9#2 M22%# 2"#<#.................................................................................6 BAB III TATA LASANA.................................................................................................................. A. T#:# L### A2"2 P2%### A+$' 2+$-#................................................. B. T#:# L### P2"*2'$# =#;+# P#$2 P## A+$' 2+$-#............................. . T#:# L### P2%### A+$' 2+$-#...............................................................10 D. T#:# L### P22%o%## A+$' 2+$-#...........................................................11 E. T#:# L### P2#$# P#$2 A+$' 2+$-#..................................................1! F. T#:# L### o"-$#$ 2## P#$2................................................................1! BAB I> D?UMENTASI.............................................................................................................13
KATA PENGANTAR
P-$ --' 2+#$'#: A%%#+ S-*+##%%#+ :#@#%#+, #:# 2#%# '#+"#: # +$##+ # :2%#+ $*2'$# 2## 2"-##, 2+$# B-- P#-# P2%### A+$' 2+$-# #$2 $ R-"#+ S#$: $$ ##: $2%2#$# # $-- 2# *#$. B-- #-# $$ 2*##$ *-- #-# # ##: $2'-## 2*##$ 2## #%#" "2L#### :-# $ '-"#+ #$: +--# :2'+## 2*-:-+# #$2 ## 2%### #+$' 2+$-# #"$ *2'+#'#, 2# *-- #-# $$ ##: "2#$# 2$#:# #%#" 'o2 2%### 22+#:# # 2#'# "#$"#% # :2:# "2"2'+#<# #$#+;#$#+ +--" # :2%#+ ##. P2--
BAB I DEFINISI A. Pendahuluan M2#$ :-# ##%#+ 'o2 #%#"$#+ # ## $+##$ o%2+ 2<# "#+%- +$- # "2$#% 2# :2# ##%#+ #"*## 2<# $#. N#"- 2'$ #%$ +#'## # #"*## :2'2*-: <# :2'##$. D#%#" "##'##: $:#, -"-' +#'## +$- 2"#$ *2':#"*#+ # 2"#<# 2"#$ *## $2*#*# o%2+ 2#$:;2#$: 222'#<9 22'< #2' # :'o2. P#$2 2# 2#$: 'o$ 22'< $$ ## "2%#%-$ -#:- 'o2 2o*#:# # 2'#C#:# # ##. J$# 2#$:# *2'%#-: "## -#:- ##: ## $##$ :#$-" :2'"$#% # $:##$ 2# o%2+ 2%2"#+# -"-", 22'$:##, 2<# *2'###, # #+$'# 2"#<#. S2*#$# *2#' 2"#<# $ '-"#+ #$: ##%#+ 2"#<# #$*#: 2#$: 'o$ # :2'#$ 2'%#+#;%#+#. P## -"-"#, o:2' # 2'#C#: %2*$+ "-#+ "2+##$ 2"#<# # "--% 2#'# 2'%#+#;%#+#. M2'2# <# $2'$## 2# *#$ -:- *2'+### 2# ##"# 2"#<#. D$:2#+ 2-:-###, 2'$ #%$ :2'2#' #"$ -#+ "2%#-# 2#%## # *$# $%#-# . N#"- $$ :2%#+ "-%#$ $##'$ -:- #$2 :2'"$#% - 'o92$ "2$ "#$+ ##: "2%#-# *## +#%. J$# -## -'#<9 <# $"-$# %#$, "#$+ %-# 22"#:# -:- -## #%$#<9. P## :#$-" %#-:, #$2 2# 2#$: 'o$ <# +## "2#%#"$ *2'*##$ "##%#+ $ 22'< 2'$, 2# #9#, 2-'-# *2'#: *##, #-# #<$:# :2:#$ -# "2#%#"$ #-# $oo$#% # $'$:-#% # "2"2#'-+$ -#%$:# +$- #$2 # 2%-#'##. M## 2*-:-+# #$2 ## :#$-" %#-: -#:- 2#$: <# +## 2"2-+#/2o*#:# 2#%# $, #"- -# 2<# --# :2'+## 2*-:-+# $o%o$, o$#% # $'$:-#% # $%#-# 2# 22#:# $:2'$$%$ # $2#% 2*##$ 2'#C#:# #%$#<9 #:#- #%%$#<2 #'2. D#%#" 2'#C#:# #%$#<9 "## 2'# 2'#C#: ##%#+ "2"*2'$# A-+# 22'#C#:# ## P#$2 T2'"$#% -:- "2"*#:#$2 "2#%#$ $# +$-# #%#" 2### 2o<"#% "-$. B. Tujuan 1. M22$$# *##$"## o$$ 22o'# # "22#< 2"#<#. !. M22:#+-$ o2 :2o'$ #'$ 2*-:-+# :2'"$#% #:#- "22%# ##%. 3. M2#$ # "2"##'# $#o# #'$ 2*-:-+# :2'"$#%. 4. M2"*2'$ $:2'2$ 2':# "22#%-#$ ## %$2 # "22%# ##%. 5. M2$-:2':## #$2 # 2%-#'## #%#" 2"-# #2 2%### 6. M2"*2'$ '2o #%#" +#% $o%o$, 2"o$o#%, $'$:-#% # *-## #'$ #$2 # 2%-#'##. C. Defnisi 1. 2### T2'"$#% A#%#+ -#:- 2### #$: $"## "2-'-: ##% 2+#: <# <# ## +#'## %#$ *#$ $ #$: -:- 2"*-+. 2### #$: $:- ##: $2*#*# o%2+ -#:- 2#$: #:#- -#:- 22%###. !. 2"#<# A#%#+ -#:- 2#%#"# :2'2$'$, $"## 2<# $$$- ## "2#%#"$/"2+##$# 2o'# $'$, 2-#:- # <# ##: $+$#'$, # "2'-## -#:- 2+$%##. 3. o$$ T2'"$#% ##%#+ #:- 'o2 # 'o'2$9 "2-- 2"#<# *2'#%# "2%#%-$ -#:- :#+## 'o2 2-'-# $, $oo$#% # $'$:-#% *#$ $$-(#'2$:o, 115) 4. P#$2 T2'"$#% ##%#+ & P#$2;#$2 # $'#C#:, # -#+ 2%# *#+C# "2'2# ## "2$#% #:#- 2### "2'2# "#$ %#"# "#$ "2"*-'-. ( P.J.M. Stevens, dkk ,hal 282, 1999 )
5. P2#"$# #%#" 'o2 2"#<# ##%#+ S-#:- 2#"$# #%#" 2+$-# , #'2# "#< $:- :2'"#- *#$# #'$ 2+$-# . M#-$# $%#+$'# , +$- *2*2'## :#+- , # #+$'# "#<. M#-$# ## "22'$"# *#+C# $:- ##%#+ 2+$-#, # $:- "2"# ## :2'#$, 2"#<# ##%#+ #+$' #'$ 2+$-# ( P.J.M. Stevens, dkk, 282,1999 ).
BAB II. RUANG LINGKUP A. Ruan Lin!u" Pene#a"an Panduan 1. P2%### #+$' 2+$-# #$2 '#C#: $# !. P2%### #+$' 2+$-# #$2 ID B. Pene#i$a In%&#$asi Pela'anan A!hi# Kehidu"an 1. P#$2 C. P#&%esi Te#!ai( 1. Do:2' !. P2'#C#: 3. B$# D. )enis*jenis Pen'a!i( Te#$inal D$#*2:2 M$%$:- 1. P2#$: #2' 2. o2< R2#% F#%-'2 3. S:'o2. 4. 5. AIDS ##% $#% 'o$ 6. 7. A$*#: 22%### F#:#% M#< B#:# ?:# 8. #2' :#$-" :2'"$#% 9. A$:o%2 10. E%2:'o M2+#$#% D$o$#
Denial (Fase Penyangkalan/pengingkaran dan Pengasingan Diri) D$"-%#$ 2<# o'# $##'# *#+C# $# ## "2$#% # $# <# ##: "22'$"# $9o'"#$ $$ 2*##$ 2*2#'# # *#+# "-$ "2$#'$#. R2#$ 2':#"# 2:2%#+ "22#', *#+C# 2#$:# $-# <# ##: $2"*-+# %#$ ##%#+, GT$#, $$ <# "-$ :2'#$ 2# ##.G P2##%# $$ "2'-## "2#$"2 2':#+## # *$## $:2"-# ## +#"$' 2<# #$2 ## ##: 2':#"# "22#' *2'$:# "22-:# :2:# 2### $'$#. =#"$' :# ## o'# # 2'##, *#+C# 2"#<## -#+ 2#:, # "2#$"2 $$ :2'#:# "2"# "2o%o "2'2# -:- ##: "2#:#$ +o +--# #%#- 2##%# $$ 2'$o$. No'"#%#, #$2 $:- ## "2"#-$ "##;"## 2'-"-%# #:#'# "2##% # "22'$"# 2#:##, #"#$ $# ##: *2#';*2#' "22'$"# 2#:##, *#+C# 2"#<# "2"# +#'- $# +##$. 1.
!. nger (Fase !e"arahan) T2'#$ 2<# #$2 <# ##: %#$ "2$#'$ 2#:## *#+C# $# ## "2$#%. J#'# 2#%$ ## #$2 # "2%#-# 2##%# :2'- "22'-. M### <*# $"## $# "2#-$, *#+C# 2"#<# "2"# -#+ 2#:. T2:#$ 2##'# $$ 2'$#%$ $2':#$ 2# "--%# 2:#-:# # 2"#'#+#. GM2## $$ :2'#$ 2# $'$-HG, GM2## *-# "2'2# # -#+ :-#, # "2"# +$-# -#+ <# *2'-# %#$HG 2"#'#+# $$ 2'$#%$ $2'2$# #%#" $# '2C2% # "2#'$;#'$ 2#%#+# ## 2%### $ '-"#+ #$: #:#- $ '-"#+. B#+# ##;## $:--# ## o'#;o'# # $#$+$#, o:2', 22:#, "#-- T-+#. S2'$#%$ #o:# 2%-#'# "2#$ *$- # <# "22'< ## # +#'- $%#-#. U"-"# "2'2#
<# "2##'$, *#+C# <#+ %#- #$2 <# "#- ##%, "2$- o'"#%, 2*##$ 2'2$ #'$ 9'-:#$ # $#%#"$#. S2*2#'# # $*-:-+# #$2 ##%#+ 22'<#, *-# #'-"2:#$;#'-"2:#$ #'$ o'#;o'# # :2'$- o%2+ #'2# 2"#'#+##. #. $argaining (Fase %a&ar Mena&ar). I$ ##%#+ 9#2 $ "## #$2 ## "-%#$ "2#C#' -:- ##: +$- 2$$: %2*$+ %#"# %#$ #:#- $-'#$ 22'$:###. M2'2# *$# "2#$# "##";"##" +#% 2## T-+#, GT-+#, #%#- E#- "2#:## #$+;M-, # 2##$*# 22"*-+#;M-, "## #- ## "2"2'2"*#+# 2%-'-+ +$-- -:- "2%##$M-.G '. Depresin (Fase Depresi) S2:2%#+ :2'#:# 2#$:# "#$ #'#+, <*#%#+ 9#2 2'2$. P22'$:# "2'## -:- ## "2%$+#: "## 2## # :## +#'##. S2*##$ o'# 2'## "2"# "-$ $# "22'< ### :2"#: # 2### # #-+ %2*$+ *#$ # :2%#+ T-+# 2$## $ -'#. N#"-, "2$- 2"$$# 2'### -:- ## "#$+ ## $#%#"$. . **eptan*e (Fase Meneri"a) T$# 2"-# #$2 ##: :2'- "22'- *2':#+# "2o%# 2#:## # $# #%#"$. P## -"-"#, 2:2%#+ ## C#:- :2':2:- "2'2# ## ##: "22'$"# 2#:##, *#+C# 2"#<# -#+ 2#:, 2+$# "2'2# "-%#$ 2+$%## 2#$'#+# -:- *2'o"-$#$ # <# :2':#'$ %#$ 2# *2'$:# # 2'o#%#;2'o#%# $ 2$:#'#. P#$2;#$2 22'< $$ *$### "2"*o## # "2'2# 2'$#%$ $%-## o%2+ :2"#;:2"# # 2%-#'##, ##+#% 2*-:-+# -:- 2%#%- 2#: 2# 2%-#'# ## ##:; ##: :2'#+$' -:'- "2#$ ##: *2#'
BAB III TATA LAKSANA A. Ta(a La!sana Ases$en Pela'anan A!hi# Kehidu"an 1. P2'#C#: +#'- "2"#+#"$ ## # $#%#"$ #$2 2# o$$ #+$' 2+$-# ##' ##: "2"*2'$# --# # *#:-# 2+$# ## ##: :2'#+$' #%#" +$- *$# *2'"##, # #+$'# ##: "2$#% 2# :2# # #"#$. !. P#$2 #%#" o$$ #+$' 2+$-# ## "2#%#"$ "##%#+ $, $o%o$ "#-- o$#%;$'$:-#%, "2%$-< 'o*%2" o$2#$, 'o*%2" 2%$"$#$, 'o*%2" :##; :## $:#%, 'o*%2 -:'$$ # #$'#, 'o*%2" -+-, 'o*%2" 2o'$, 'o*%2" 2'$, 'o*%2" 2%$+#:# #*-', 'o*2%" -%$: # "o*$%$:#, *. 3. P2'#C#: +#'- "#"- "22#%$ 2'-*#+# $ # :2'#$ ## #$2, # 2"-$# <"*-% *2'*##$ 2#%# 2%#"# *2'*-%#;*-%# 2*2%-" :2'#$ 2"#<#. 4. P2'#C#: +#'- "22:#+-$ :2'+## $#'#: #$2 2# 2$#% 2# #'# "2### :2:# o$$# #:#- 'oo$ # #$2 ##: "22'2$# 2'###;2'####. 5. P2'#C#: +#'- '22 :2'+## 2'-*#+# $ # :2'#$ #'2# +#% $:- ## "2$"*-%# 2<##"## # 2-'-# 2"#"-# #$2 #%#" 2"2%$+#'## $'$. 6. P2'#C#: +#'- 2# # "22#%$ 22"## # :2'#$ ## #$2, "22#%$ #'$ 2'2$ C##+ # $:--#, 2$+, 2'2$ #:#- "#'#+, # 2+$%## +#'# $'$ # +#'##. 7. P2'#C#: +#'- "2#$ $:2'#$ #$2, #'2# ## o$$ $$ #$2 22'- "2#'$ $'$, "-#+ :2'$-, <# $$ *2'o"-$#$ # 2'$ *2':## :2:# o$$ 2#$:#, 2<##$# # 2-:-### 2' "2"*#C# ## 2'$%#$o%#$ 8. P2'#C#: +#'- *$# "22#%$ :## #$2 "2$o%#$ $'$, 2"*2'$# --# o$#% #'$ :2"# 2#:, 2'#*#:/2%-#'# :2'2#: -:- 2%#%- "22"#$ %$2. . P2'#C#: +#'- "2#$ 2#$# #$2 ## 'o2 2"#<# 2# #'# "22#:# $'$ 2## T-+#, "2"*2'$# 2:2## "2%#%-$ 2#$#;2#$# $'$:-#%#. B. Ta(a La!sana Pe$,e#ian Ha!*ha! Pasien Pada A!hi# Kehidu"an 1. =# $2'%#-# 2*##$"## "#-$# # +$- #"#$ ##% <*#, !. =# "2"2':#+## +#'###, <# 2-%$ ##- 2'-*#+# # :2'#$, 3. =# "2##:# 2'#C#:# # ##: "2"2':#+## +#'###, ##- # :2'#$, 4. =# "22'2$# 2'### # 2"o$# 2+-*-# 2# 2"#<# # 2# $+##$#, 5. =# *2'#'<$#$ #%#" 2#"*$%# 2-:-# *2'#$:# 2# 2'#C#:#, 6. =# "2"2'o%2+ 2'+#<# #%#" 2o*#:# # 2'#C#:# 2#'# *2'2$#"*-#, C#%#-- :--# 22"*-+## +#'- $-*#+ "2#$ :--# "2"*2'$# '## #"#, 7. =# -:- <# "2$#% #%#" 22$'$#, 8. =# -:- *2*# #'$ '## #$:, . =# -:- "2"2'o%2+ #C#*# #:# 2':#### 2#'# --', 10. =# -:- "2"2'o%2+ *#:-# #'$ 2'#C#: #:#- "2$ -:- 2%-#'# # $<#%# ##' ##: "22'$"# 2"#<##, 11. =# -:- "2$#% #%#" #"#$ # *2'"#':#*#:, 1!. =# -:- :2:# #%#" 22'### #:#- ##"## # <# $#"*$% 2-:-# # *2':2:## 2# 22'### # $#-:,
13. =# -:- "2"2'#%#" # "2$#:# 22'####, ##- #'<# *#$ o'# %#$, 14. =# -:- "2+#'## *#+C# 2-$# '## "#-$# ## $+o'"#< 2:2%#+ # *2'#-:# "2$#%, 15. =# -:- "2##:# 2'#C#:# #'$ o'# # 'o92$o#%, # ##: "22'< 2*-:-+# # 2-## #%#" "2+##$ 2"#<#. C. Ta(a La!sana Pela'anan A!hi# Kehidu"an 1. B2'$# #$2 2'### :2:# 2"#+#"# # 2"#< :2'+## 2#$: #:#o$$ # $2'$:##. !. B2'$# 22"#:# ## #$2 # 2%-#'# -:- "2-## 2'###, $$-$# 2+$%## 2#'# :2'*-# # #%$ "## '$*#$ #'$ 2+$%##. 3. B2'$# o'o# ## #$2 -:- "22'2$# #:'$*-: $'$ # o$<9 :2:# 22'$"## 2"#<# # ## :2'#$. 4. B#:- #$2 "2#:## # "22'$"# 2"#<# # ## :2'#$, #C#* 2"-# 2':### 2# --', 'o2 *2'-#, 'o2 *2'#*-. 5. B2'$# 2"#+#"# 2## 2%-#'# #$2 -:- "2%-## C#:- *2'#"# #$2 #:#- o'# :2'2#:# # :--# 22'<# # 2"#<, o:# # 2'$ # "2o"-$#$# $# 2'+#<# # 2-%$ ##: "2"*#:- "2-'#$ 22"## # "2$#:# 2"*2%##'#. 6. T#C#'# 2## #$2 -:- "2%#### '#:2 # '$:-#% 2##"##, 2# #'# "2#:## 2"-# ##"# # $#$$/$#-: o%2+ #$2. 7. B2'$# '$#$ # 2:2## -:- '$:-#% $'$:-#% 2-#$ 2*-:-+# #$2 ##' "2"-#+# #$2 -:- '29'2$ # "2%#-# 2'2-#. 8. P2"*2'$# 2o*#:# # 2-#$ 2# 2#%# # 2$$# #$2 # 2%-#'# . M2#"#$# $- # 2$<9 22'< #-:o # o#$ o'# 10. M2+o'"#< $%#$ # $#-: #$2, ##"# # '292'2$ *-## 11. M2$-:2':## #$2 # 2%-#'## #%#" 2"-# #2 2%### 1!. M2"*2'$ '2o ## "##%#+;"##%#+ $o%o$, 2"o$o#%, $'$:-#% # *-## #'$ #$2 # 2%-#'##. 13. M2"#<# *#+C# 2#%#;2#%## ## $%#-# #2"2 # $2%o%# 2#'# :2#:. D. Ta(a La!sana Penel&laan A!hi# Kehidu"an 1. P22%o%## #+$' 2+$-# "2%$-< 2+2<# *#:-# +$- (withdrawing life support ) # 2-## *#:-# +$- (withholding life support ). !. 2-:-# withdrawing/withholding $%#-# ## #$2 # $'#C#: $ '-# '#C#: $:2$9 (IU # =U). 2-:-# 2+2<# #:#- 2-## *#:-# +$- ##%#+ 2-:-# "2$ # 2<. 3. 2-:-# -:- 2+2<# #:#- 2-## *#:-# +$- $%#-# o%2+ 3 (<#) o:2' #$:- o:2' 2$#%$ #2:2$o%o$ #:#- o:2' %#$ # "2"$%$$ o"2:2$ # ! (-#) o'# o:2' %#$ # $:-- o%2+ o"$:2 "2$ '-"#+ #$:. 4. P'o2-' 2"*2'$# #:#- 2+2<# *#:-# +$- $:2:## *2'##'# %#$#$ 2<# #$2 $ IU #:#- =U, #$:-& #. B#:-# :o:#% $%#-# ## #$2 #$: #:#- 22'# '$< # $+#'## :2:# ##: +$- :## 2##%# o:# *2'#: # "22:#. #%#-- $:2" o'# $:#% -# :2'2#'-+, :2:#$ 2'-### "#$+ '22'$*2%. S2"-# -#+# # "2"-$# +#'- $%#-# -:- "2-'#$ "o'*$$:# # "o':#%$:#. *. S2"-# *#:-# 2-#%$ RJP (DNAR Do Not Aempt Resuscitaon), $%#-# ## #$2;#$2 2# 9-$ o:# # :2:# ## #:#- 2# +#'## 2"-%$+#
o:#, :2:#$ "2#%#"$ 2##%# #:-, #'- #:#- o'# # %#$, #:#- #%#" <#: #+$' 2#$: # <# ##: $2"*-+#. . T$# $%#-# <##;<## %-#' *$##, ## #$2;#$2 # $# $:2'#$ +## "2"2'%#"*#: C#:- 2"#<# # *-# "2"2'## 2+$-#. U:- #$2 $$ ##: $%#-# 2+2<# #:#- 2-## *#:-# +$-. P#$2 # "#$+ ##' :#$ :## +#'##, +## $%#-# <## :2'#2-</#%$#<9 ##' #$2 "2'## #"# # *2*# 2'$. . S2"-# *#:-# +$- $+2<# ## #$2 2# 2'-## 9-$ *#:# o:# # $'22'$*2%. S2:2%#+ '$:2'$# M#< B#:# ?:# (MB?) # ## :2'2-+$, #$2 $:2:-# "2$#% # $2'<#$ MB? 2':# 2"-# :2'#$ $+2<#. J$# $2'<"*## o#$ o'#, *#:-# #:- #'- #$2 $:2'-# #"#$ o'# # $2'%-# :2%#+ $#"*$%. 2-:-# 22:-# MB? $%#-# o%2+ 3 (<#) o:2' #$:- o:2' 2$#%$ #2:2$o%o$ #:#- o:2' %#$ # "2"$%$$ o"2:2$, o:2' 2$#%$ #'#9 # 1 (#:-) o:2' %#$ # $:-- o%2+ o"$:2 "2$ '-"#+ #$:. (P2'#:-'# M2:2'$ 22+#:# RI No& 51/MENES/PER/ III/!011 :2:# P2o"# P22%2#'## P2%### A2:2$o%o$ # T2'#$ I:2$9 D$ R-"#+ S#$:)
E. Ta(a La!sana Pen!ajian Pasien A!hi# Kehidu"an 1. M2%#### 2#$# #2"2 2### #$2 22'$ "-$ 2-#$ 2*-:-+# -:- "2$2<#$ 2#%#;2#%# # <"*-% %#$#. P2#$# ## %$2 2# 2#$: :2'"$#%, "2-## 22#:# +o%$< 2. #$:- -#:- 22#:# # "22%-'-+ :2'+## %$2 *-# +## ## 2#$: # #2 2o*#:# ## :2:#$ -# #2 $oo$#% %#$#. S#%#+ #:- "2:o2 -:- "2"*#:- 2'#C#: #%#" "2#$ $oo$#% ## %$2 :2'"$#% #$:- 2# "2:o2 PERS?N P & P2'o#% S:'#+#$, #$:- 2-#:# 22o'# $:--# "2%#%-$ ## +$-, 2$#:#/ 22'## E & E"o
BAB I D/KUMENTASI
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