Student Orientation Learning Opportunities · PDF file2 Student Nurses - Welcome to the...

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Student

Orientation

&

Learning

Opportunities

Radiology

Updated Jan 2010

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Student Nurses - Welcome to the Radiology Department

The Radiology Department is a busy unit, which provides an imperative imaging service to

Sunderland City and the surrounding districts of approximately 600,000 people. Our service

covers a wide range of diagnostic and interventional procedures to a population suffering

from various injuries, illnesses and diseases.

The directorate of Radiology can offer the student nurse a wide range of experience,

knowledge and skills, which can enlighten them towards procedures, which patients regularly

undergo as both in-patients and out-patients. There are many opportunities to develop

knowledge and understanding of anatomy and physiology, as well as developing a greater

understanding of disease and disease process.

You will be assigned to a mentor for your time spent in the department. Your learning

outcomes and competencies will provide direction during your placement and be facilitated

where possible by your mentor. Please remember that you are responsible for your own

learning and your mentor/associate mentor is only there to advice and facilitate your

learning (Student/mentor file section 2 Roles & Responsiblities of the Learner).

If you have any queries please feel free to ask your mentor or any other staff member. The

sister is also available to assist you with any difficulties you may experience.

The modalities within the department are:

Computer Tomography (CT)

Fluoroscopy

Ultrasound

Plain film radiography

Magnetic Renaissance Imaging (MRI)

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The Directorate

The Directorate of Radiology comes under the Division of Clinical Support

This includes clinical directorates:

Anaesthetics

Pathology

Radiology

Pharmacy

Paramedics

Directorate of Radiology

The department is headed by

Clinical Director

Business Manager

Imaging Service Manager

Nursing Staff

The nursing team consist of

Matron

Sister (mentor, Educational link, stores & supplies co-ordinator)

5 Staff Nurses (stores & supplies co-ordinator, mentor, infection control link)

Health Care Assistant

Consultants There are 11 Consultant Radiologists, who are doctors who specialise in the various

modalities of radiology.

Others members of the radiology team are

Radiographers

Clerical staff

Secretaries

Radiology Support workers

Porters

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General Information

Off Duty

The department operates Monday to Friday students are expected to work from 8.30am until

5pm, with exception of one 2pm early finish. Requests for an early finish on a certain day

may be written in the diary in advance, but are not guaranteed for that day. You must work at

least 50% of your placement with your mentor.

Uniforms

Uniforms should only be worn within the hospital therefore; changing facilities will be

arranged.

Patient Allocation

Primary nursing is in operation within the Radiology department. The primary nurse will be

responsible for the patient’s total welfare during the stay in the unit.

Daily Routine

Start 8.30

08.30 – 9.00 Set up rooms

09.00 Commence lists

13.00 – 13.30 Lunch

13.30 – 14.00 Set up rooms

14.00 Commence lists

Finish 17.00

Useful Telephone number

For reasons such as sickness or unforeseen circumstances, it may necessary to contact the

radiology nurses.

Direct line 0191 5699655

or 0191 5656256 ext 41313

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Departmental Philosophy

The radiology department aims to provide an efficient and effective diagnostic imaging

and interventional service. We accept referrals from Sunderland City and the

surrounding districts. Our immediate multidisciplinary team consists of:

Clerical staff, Domestic technicians, Nurses

Porters, Radiographers, Radiographic assistants, Radiologists

Furthermore, we strive to work in active partnership with our other colleagues

throughout the trust.

‘We Believe’

The Environment:

Whilst your stay in the department may be short, the atmosphere will be friendly. We

aim to be welcoming and approachable to all visitors. The department will be clean,

comfortable, safe and tidy, catering for your needs.

For our Patients:

Individual choices coupled with privacy, dignity and confidentiality. An identified

practitioner will be responsible for your care during your visit and an explanation of

each procedure undertaken will be offered to ensure you are well informed.

Relatives and Friends:

When a patient chooses to invite a friend or relative to participate in their care, we will

aim to accommodate, support and inform them where appropriate.

How we provide care:

Standards are constantly monitored to meet the changing needs and expectation of our

clients. Education is recognised by all staff as being essential for continuous

professional development and to keep abreast with research based practice.

We respect that all members of our team play a part in the delivery of care and the

maintenance of standards. As a team we strive to supports each other to reach our

goals. In order to improve our standards of care and our service to you we welcome

your constructive comments. Please use the comment boxes located around the

department or speak to a member of staff.

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ISSUES TO DISCUSS

Initial Interview……………………………………………………Mentor……………………………………….

DATE SIGNATURE

Layout of the Unit.

Role & Responsibilities of the Student/Mentor

Who's who in the Department: - Nurses, Consultants, Radiologists, Radiographers, Sonographers, Clerical Staff, Secretaries, Support workers and Porters.

Staff roles and link personnel.

Procedure in the event of Fire.

Location of Fire Points and Fire Fighting Equipment.

Procedure in the event of Cardiac Arrest.

Location of Emergency Equipment e.g. Defibrillator Resus Trolleys Emergency Call System

Location of Resource Files e.g.

Trust Policies Local Rules for Radiation Safety The Student Nurse Survival Guide Teaching Files Educational Videos Radiation Procedure File

Location of Emergency Drugs. The Trust Drug Administration Policy.

Health and Safety File.

Infection Control.

Biohazard File.

Blood Products File.

Complaints Procedure. (see policy in student file)

Incident Book.

Sickness Policy.

Hours of duty/holidays/requests

Manual Handling Policy and department facilitators.

Clinical Governance

Child Protection Procedure File

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RADIATION AWARENESS

Please tick to confirm you have been made aware and understand the following procedures.

1. You understand the use and meaning of the radiation warning signs located outside the

scan room.

2. You understand that you should not enter the scan room whilst an exposure is initiated

unless authorised to do so wearing appropriate lead protection garments.

3. In the event of an emergency you know how to terminate an exposure and remove the

patient from the gantry.

4. You are able to advise staff/carers accompanying the patient of the need to leave the

scan room during an exposure.

SIGNATURE:

PLEASE READ THE LEAFLET ABOUT THERMOLUMINESCENT

DOSIMETRY (TLD).

A TLD is available for student use, please ensure it is returned at the end of

your placement, as they are very expensive.

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COMMUNICATION SKILLS

LEARNING OPPORTUNITIES

SUGGESTIONS OF RESOURCE PERSONNEL&

INFORMATION SOURCES.

Communicating with: Patients and relatives Members of the multi disciplinary team VERBAL COMMUNICATION: Telephone skills The Emergency System (Fire & Cardiac Arrest) The Bleep System Giving and receiving information Observing confidentiality Answering patient enquires Patient Transportation Liaising with the clinical team Nurse hand over WRITTEN DOCUMENTATION & COMPUTER SKILLS: Care plans Hiss system Patient information Investigation results Daily lists etc.

The whole departmental team

Nursing staff, radiographers

Nursing staff, radiographers, doctors

Nursing staff, all department staff, patients and relatives.

All departmental staff, CHS polices

Nursing staff, radiographers, doctors, secretarial staff, patients

Ambulance liaison, portering service

Observation of roles

Registered nurses

CHS protocol and policies,

Nursing staff, radiographers, doctors, secretaries, administration

staff.

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PRACTICAL NURSING SKILLS



INFORMATION SOURCE S.

Practical nursing skills:

Recording physiological observations e.g.

Pulse, Blood pressure, Oxygen Saturations, Blood Glucose

Giving medication i.e. Oral/Intravenous/Controlled Drugs

Skin care/pressure area care IV infusions/Medical devices

Checking equipment/Emergency Crash Trolleys

Risk assessment/Patient safety

Moving and Handling/use of aids and hoists Aseptic technique

Setting Trolleys/Preparing for Investigations

Assisting Radiologists with investigation/treatment process eg.

Angiographic catheter and wire manipulation

Cannulation/care of intravenous cannulas

Infection Control issues:

Hand washing technique as part of investigation process giving

barium/water soluble contrast:- orally

intravenously arterially rectally

Books, articles, courses, library resources and various literature, Registered Nurses. Books, articles, courses, library resources and various literature Registered Nurses, Drug Administration Protocols, Radiographers, Trust Protocols, moving and handling facilitator, Doctors

Infection control link nurse. Registered Nurses. Infection Control File, Infection Control Link Nurse. Poster Campaigns.

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ANATOMY, PHYSIOLOGY AND PATHOLOGY




PROCEDURES/INVESTIGATIONS:

CT Scan

MRI

Angiography (vascular/coronary)

Angiography for the Biliary and Renal Systems

Angioplasty /Stent insertion/Thrombolysis

Balloon dilatation and stenting of oesophageal strictures

Percutaneous Transhepatic Cholangiogram (PTC)

Ultrasound examinations

Fine needle aspiration (FNA)

Biopsies

Drainages

Intravenous Urograms (IVU)

Micturating Cystograms

Barium Examinations (swallows/meals/enemas/follow-through)

INFECTION:

Observation of Infection Control Policies i.e. when acting as scrub

nurse. Causes, spread & prevention

Books, articles, courses, library resources and various literature

Radiologists, Radiographers, Registered Nurses, Ultrasound

Stenographers, Doctors, Radiology Procedure File

Books, articles, courses, library resources and various literature Registered Nurses, Doctors, Infection Control Nurse Infection Control Nurse,

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ANATOMY, PHYSIOLOGY AND PATHOLOGY

LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL&

INFORMATION SOURCE S.

NORMAL ANATOMY AND PHYSIOLOGY

ABNORMAL ANATOMY. PHYSIOLOGY AND

PATHOLOGY

(Examples you may encounter on the department)

DISORDERS OF THE CARDIOVASCULAR SYSTEM

Coronary Heart Disease

Congestive Heart Failure

Cardiac Valve Disease

Hypertension

Atherosclerosis/Peripheral Vascular Disease

Aortic Aneurysm

DISORDERS OF THE NERVOUS SYSTEM

Traumatic Brain Injury

Stroke

Subarachnoid Haemorrhage

Brain Tumour

Spinal Injury

Books, Library Resources, Posters/visual aids, x-rays Books, articles, courses, library resources and various literature

Radiologists. Cardiologists. Registered Nurses. Specialist

Vascular Nurse. CCU. Literature. Investigations/Diagnostic

Procedures e.g. CT, Angiography, Ultrasound/Doppler,

Electrocardiography (ECG)'


Doctors. Registered Nurses. Radiographers. Specialist Nurses,

Literature, Rehabilitation Nurses, Investigations/Diagnostic

Procedures E.g. CT. MRI. X-RAY

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ANATOMY, PHYSIOLOGY & PATHOLOGY




DISORDERS OF THE RESPIRATORY SYSTEM:

Chronic Bronchitis/Emphysema Asthma Cystic Fibrosis Lung Cancer Chest Trauma Pulmonary Embolism Pneumothorax Chest Drainage DISORDERS OF THE RENAL AND URINARY SYSTEM

Acute/Chronic Renal Failure

Polycystic Kidney Disease

Renal Cancers Urinary Tract Infections Bladder Cancers Acute/Chronic Pyelonephritis


Doctors, Registered Nurses, Specialist Respiratory Nurse, Chest

Clinic, Respiratory Ward, laboratory, Macmillan Nurse,

Investigations/Diagnostic Procedures e.g. CT, X-Ray ,

Ultrasound, CT /Ultrasound guided Biopsies, Drainage


Doctors, Registered Nurses, Renal Ward, Renal Dialysis Unit,

Literature, Laboratory , Investigations/Diagnostic Procedures e.g.

CT, X-RA y , Angiography, Stenting, Ultrasound, Ultrasound

guided biopsies/ drainages

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DISORDERS OF THE GASTROINTESTINAL SYSTEM:

Nausea and Vomiting Dysphasia Diarrhoea/Constipation

Gastrointestinal Bleeding

Bowel Obstruction/Colorectal Cancer Diverticular Disease

Crohn's Disease/Ulcerative Colitis Eating Disorders/Obesity

Gastric Cancer Oesophageal Cancer

DISORDERS OF THE ENDOCRINE SYSTEM :

Hypo thyroidism/ Hyperthyroidism Goitres Thyroid Cancer

Diabetes Mellitus Pancreatitis Pancreatic Cancer


Doctors, Registered Nurses, Specialist Colorectal Nurse, Library

Resources, Surgical Team, Speech Therapist, Dietician,

Investigations/ Diagnostic Procedures e.g. CT, Barium

investigations, Endoscopic Procedures, X-Ray, Angiography,

Stenting

Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Diabetic Specialist Nurse, Laboratory, Specialist GI Nurse, Literature, Investigations/Diagnostic Procedures E.g. Ultrasound, Ultrasound guided Biopsy/FNA, Angiography, ERCP, Blood Tests

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DISORDERS OF THE LIVER AND BILIARY SYSTEM:

Alcoholic Liver Disease

Cirrhosis Hepatic Failure Tumors/Metastatic Liver Cancer Jaundice Clotting Disorders

DISORDERS OF THE REPRODUCTIVE SYSTEM:

Testicular/Prostate Cancer

Ovarian Cysts/Ovarian Cancer Cervical Cancer Breast Cancer

DISORDERS OF THE SKELETAL SYSTEM :

Osteoarthritis/Osteoporosis

Trauma/fractures

Metastatic Bone Disease


Doctors, Registered Nurses, Specialist Nurses, Laboratory,

Literature, Investigations/Diagnostic Procedures e.g. CT,

Angiography, Stenting, Ultrasound, Ultrasound Guided Biopsies,

Blood Tests i.e. Clotting Studies


Doctors, Registered Nurses, Oncology Team. Breast Care Nurse.

Screening Clinics, Literature. Library Resources. Investigations!

Diagnostic Procedures e.g. CT, MRI. Ultrasound. Ultrasound

Guided Biopsy Fine Needle Aspiration (FNA)


Doctors. Nurses, Radiographers, Accident and Emergency Dept.,

Literature. Investigations/Diagnostic Procedures e.g. CT. MRI, X-

Ray

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HEALTH EDUCATION AND PROMOTION




LIFESTYLE ISSUES IN RELATION TO COMMONLY

PRESENTED CONDITIONS:

Smoking Obesity

Alcoholic Liver Disease

Diabetes

Heart Disease

Peripheral Vascular Disease

Accidental Injury

Gastrointestinal Disorders

INFLUENCED BY:

Government Target Initiatives The role of the X-Ray Department e.g. Fast-Track Services

The Nurses Role in Health Education/Promotion

Giving Appropriate Advice

Leaflets/Poster Displays


Registered Nurses, Mentor, Library Resources, Department of

Health Document, Government Target Initiatives. Health Action

Zones. Trust Strategies and Documents


Mentor. Registered Nurses. Trust Strategies and Documents

Health Promotion and Health Education Literature, Specialist

Nurses

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THE PATIENT JOURNEY AND THE NURSING PROCESS




Many of the procedures and investigations within radiology involve nursing care. On the patient ‘s journey through Radiology nurse contact may be brief but this should never interfere with the standard of care given. At all times the following things should be unheld: Philosophy of care Nursing models Nursing policies Standards Protocols Documentation Managing Patient Care: Prioritising The nursing process – assessment, planning implementation & evaluation. Nurse handovers/discharge home.

Policies and procedure files.

Sister, Mentor, Registered Nurses Sister, Mentor,

Books, articles, courses, library resources and various literature Policies and procedure files.

Registered Nurses, Specialised Nurses, Sister, Mentor.


Policies and procedure files.

Sister, Mentor. Registered Nurses.

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MANAGERIAL AND ORGANISATIONAL SKILLS




ORGANISATIONAL SKILLS

Prioritising

Time Management

Organising Procedure Lists Organising Patient Transportation/Portering Services Team Preparation Organising Appropriate Skill Mix

Patient Preparation for Procedures e.g. Clotting Studies

Leadership Skills

QUALITY ISSUES

Policies

Clinical Governance

Standards of Practice

Clinical Audit

Changing Practice

Handling Complaints

Research

RESOURCE PERSONNEL~INFORMATION SOURCE

Books, articles, courses, library resources and various literature.

Registered Nurses, Sister, Mentor, Radiographers, Doctors, etc

Books, articles, courses, library resources and various literature.

Registered Nurses, Policy File, Performance and Governance

Dept, Library Resources, Mentor, Sister

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MANAGERIAL AND ORGANISATIONAL SKILLS




RESOURCE MANAGEMENT

Stock Control

Ordering Pharmacy

Budget Management

RISK MANAGEMENT Standards, Policies and Procedures Infection Control Clinical Supervision

Moving and Handling

Equipment/Environment Safety Check

HANDLING EMERGENCY SITUATIONS

Fire

Cardiac Arrest Security Incidents

Accidents/Near Miss Register


Policy and Procedure Files

Sister, Mentor, Registered Nurses

Books, articles, courses, library resources and various literature Registered Nurses. Policy Files, Infection Control Link Nurse,

Moving and Handling Facilitator, Radiographers,

Relevant literature

Fire Officer/Safety Department, Mentor, Registered Nurses

Security Officer, IM&T Security Officer. Sister, Senior

Radiographers

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FAST –TRACK

BREAST ASSESSMENT

CLINIC

BREAST CARE

SPECIALIST NURSE

SPECIALIST

VASCULAR NURSE

BARIUM

EXAMINATIONS

ULTRASOUND

INTERVENTIONAL

PROCEDURES

COLORECTAL

SPECIALIST NURSE

MEDICAL DAY-CASE

UNIT

RENAL UNIT CT SCANNERS

SURGICAL

DAY CASE UNIT

MRI

CORONARY CARE

UNIT

RADIOLOGY

DEPARTMENT

LEARNING

ZONE

ANGIOGRAPHIC

PROCEDURES

ADMISSION

UNIT

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Terminology

Abscess Localised collection of pus.

Aneurysm A sac formed by local enlargement of a weakened artery wall.

Angiography The radiographic study of vessels.

Angioma A benign tumour associated with blood vessels.

Angioplasty An angiographic procedure where a balloon is passed into a stenosed artery

And inflated with contrast medium; it presses the artheroma against the

Vessel wall, thereby increasing the lumen.

Anterior Forward part of the body or organ.

Artefact An area of information on a reconstructed image that does not exist in reality. It may be

caused by operator, patient motion or equipment peculiarities.

Artheriography The radiographic examination of arteries after the injection of a radiopaque contrast

medium.

Atherosclerosis Fibrous and fatty deposits on the luminal wall of an artery that may cause an obstruction

of the vessel.

Benign Non malignant, simple tumour.

Bifurcation The place where an artery divides into two branches.

Calculus A stone.

Carcinogen Any cancer producing substance or material such as nicotine, radiation, ingested

uranium.

Cerebrovascular Pertaining to the blood vessels of the brain.

Crohn’s Disease Chronic non-specific inflammation of any part of the intestine.

CT Computed Tomography – computer constructed imaging technique of thin slices through

the body, derived from x-ray absorption data collected during a circular scanning

motion.

Cyst Hollow sac containing fluid or semi-solid material.

Distal Refers to parts of the body farthest from the centre, midline or trunk.

Diverticulitis Inflammation of the diverticulae of the bowel.

Dysphasia Difficulty in swallowing.

Despoil Difficulty in breathing.

Embolus Thrombus that detaches and moves freely in the bloodstream.

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Extravasation The escape of fluid from a vessel into the surrounding tissue.

Film Badge A piece of photographic film in a lightproof holder worn to measure the amount of

radiation to which an individual is exposed.

Fistula Abnormal communication between organs.

Haematemesis Vomiting of blood.

Haematology The science of dealing with the formation, composition, functions and diseases of the

blood.

Haematoma A local swelling filled with blood.

Haematuria Blood in the urine.

Haemoptysis The coughing up of blood.

Haemorrhage The escape of blood from a vessel.

Hydronephrosis Distension of the kidney pelvis with urine caused by urethral obstruction.

Hypertension Abnormally high blood pressure.

Hypotension Abnormally low blood pressure.

Hysterosalpingogram Radiological examination of the uterus and the uterine tubes used to investigate the

patency of fallopian tubes.

IVU Intravenous urography – radiographic visualisation of the renal pelvis and ureter by

injection of a radiopaque liquid into the blood stream.

Leaded Apron Protective apron worn to shield the trunk of the wearer from scattered radiation.

Laryngoscope Instrument for exposure and visualisation of the larynx.

Lateral At or belonging to the side away from the median line.

Malignant Life threatening tumour producing secondary effects.

Mastectomy Surgical removal of the breast.

Medial Pertaining to or near the middle.

Metastasis The spread of tumour cells from one part of the body to another.

MRI Magnetic Resonance imaging – a technique of imaging by computer using a strong

magnetic field and radiofrequency signals to examine thin slices through the body.

Nephrostomy Surgical drainage of the kidney.

Pancreatitis Inflammation of the pancreas.

Percutaneous Effected or introduced through the skin.

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Pneumothorax The presence of air in the pleural cavity.

Proximal Refers to a part closest to the centre, midline or trunk.

Radiograph A photographic image formed by exposure to x-rays. (The correct term for a x-ray).

Radiographer A person qualified in the techniques of diagnostic or therapeutic radiography.

Radiography The use of x – radiation to create images of the body from which medical diagnosis can

be made (diagnostic), or to treat a person suffering from a malignant disease, according

to a prescribed regime (therapeutic).

Radiologist A medical specialist in diagnosis by using x-rays and other allied imaging techniques.

Radiopaque Having the property of significantly absorbing x-rays, therefore becoming visible on a

radiograph. Barium and iodine compounds are used as a contrast media to produce

artificial radiopacity.

Stenosis Constriction or narrowing of a passage or orifice.

Thrombosis Formation of a clot within a blood vessel.

U.S. Ultrasonography – production of a visible image from the use of ultrasound. A

controlled beam is directed into the body. The echoes of reflected ultrasound are used to

build up an electronic image of various structures in the body.

Varices Dilated veins.

Venogram The radiographic study of veins after the injection of radiopaque contrast medium.

References

Ballinger, P.W. (1986) Merrill’s Atlas of Radiographic positions and Radiological Procedures. 6th

ed.

The C.V. Mosby Company.

Brown, G. (1998) A Radiographer’s Handbook. W.B. Saunders Company Ltd.

Roper, N. Ed. (1987) Pocket Medical Dictionary. 14th

ed. Churchill Livingstone

VERSION HISTORY

Version Date Issued

Brief Summary of Change Owner’s Name

Live 2001 First Version Judy Smith Staff Nurse Radiology

Live Jan 2004 Revised Version Claire Elwell Staff Nurse Radiology

Updated Aug 2005 In line with Ed audit Joy Champion sister Radiology

Updated April 2008 Staff Changes Joy Champion Sister Radiology

Updated Jan 2010 In line with audit Joy Champion Sister Radiology

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