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Vol 2, No 4 (2017)
Review article
Published online: 2018-03-30
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Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Aldona Kubica1, Agata Kosobucka1, Piotr Michalski1, Tomasz Fabiszak2, Mirosława Felsmann3
DOI: 10.5603/MRJ.2017.0015
·
Medical Research Journal 2017;2(4):115-122.
Affiliations
  1. Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
  2. Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
  3. Laboratory of Basic Clinical Skills and Medical Simulations Collegium Medicum Nicolaus Copernicus University

open access

Vol 2, No 4 (2017)
REVIEW ARTICLES
Published online: 2018-03-30

Abstract

Introduction: The treatment of acute coronary syndromes, besides coronary interventions, includes pharmaco-therapy and lifestyle changes, which together determine a favourable prognosis. Adherence to treatment is a term describing a patient’s behaviour in respect to the patient’s maintenance of the health care provider’s recommendations. Unfortunately, according to WHO data, adherence to long-term therapies for chronic illnesses in developed countries averages only 50%.

Covered areas: Our study focused on available questionnaires for adherence assessment in everyday practice. A comprehensive search of data bases was conducted using appropriate keywords. Out of an initially identified 2081 citations, 93 articles were considered eligible for further analysis. Eventually, nine adherence scales were identified and reviewed.

Expert opinion: There is no so-called “gold standard survey” allowing accurate assessment of every patient for medication adherence. The use of a specific scale must be justified by its validation in a similar group of patients in well designed and properly conducted studies.

Abstract

Introduction: The treatment of acute coronary syndromes, besides coronary interventions, includes pharmaco-therapy and lifestyle changes, which together determine a favourable prognosis. Adherence to treatment is a term describing a patient’s behaviour in respect to the patient’s maintenance of the health care provider’s recommendations. Unfortunately, according to WHO data, adherence to long-term therapies for chronic illnesses in developed countries averages only 50%.

Covered areas: Our study focused on available questionnaires for adherence assessment in everyday practice. A comprehensive search of data bases was conducted using appropriate keywords. Out of an initially identified 2081 citations, 93 articles were considered eligible for further analysis. Eventually, nine adherence scales were identified and reviewed.

Expert opinion: There is no so-called “gold standard survey” allowing accurate assessment of every patient for medication adherence. The use of a specific scale must be justified by its validation in a similar group of patients in well designed and properly conducted studies.

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Keywords

adherence, assessment, coronary artery disease, questionnaire, scale, survey

About this article
Title

Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Journal

Medical Research Journal

Issue

Vol 2, No 4 (2017)

Article type

Review article

Pages

115-122

Published online

2018-03-30

Page views

2235

Article views/downloads

6913

DOI

10.5603/MRJ.2017.0015

Bibliographic record

Medical Research Journal 2017;2(4):115-122.

Keywords

adherence
assessment
coronary artery disease
questionnaire
scale
survey

Authors

Aldona Kubica
Agata Kosobucka
Piotr Michalski
Tomasz Fabiszak
Mirosława Felsmann

References (93)
  1. Santulli G. Epidemiology of cardiovascular disease in the 21th century: Updated numbers and updated facts. J Cardiovasc Dis July. 2013; 1: 1–2.
  2. World Health Organization: Mortality and global burden of disease. www.who.int/gho/mortality_burden_disease/en/.
  3. Zhao S, Zhao H, Wang L, et al. Education is critical for medication adherence in patients with coronary heart disease. Acta Cardiol. 2015; 70(2): 197–204.
    CrossRefPubMed
  4. Ortolani P, Solinas E, Guastaroba P, et al. Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions. J Cardiovasc Med (Hagerstown). 2013; 14(6): 421–429.
    CrossRefPubMed
  5. Kubica A. Broszura - narzędzie edukacji zdrowotnej w kardiologii. Przyczynek do dyskusji o skuteczności profilaktyki wtórnej. Folia Cardiologica Excerpta. 2008; 3: 441.
  6. Kubica A. Współpraca z pacjentem – podstawowy warunek skuteczności terapii w chorobie wieńcowej. Choroby Serca i Naczyń. 2009; 6: 131.
  7. Kubica A. Psychologiczny aspekt zawału serca — niedoceniana zmienna w procesie terapii i rehabilitacji. Folia Cardiologica Excerpta. 2009; 4: 197.
  8. Albert NM. Improving medication adherence in chronic cardiovascular disease. Crit Care Nurse. 2008; 28(5): 54–64; quiz 65.
    PubMed
  9. Choudhry NK, Patrick AR, Antman EM, et al. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction Medicare beneficiaries. Circulation. 2008; 117(10): 1261–1268.
    CrossRefPubMed
  10. Polack J, Jorgenson D, Robertson P. Evaluation of different methods of providing medication-related education to patients following myocardial infarction. Can J Hosp Pharm. 2008; 141(4): 241–247.
  11. Kubica A, Pufal J, Moczulska B, et al. Ocena wiedzy dotyczącej profilaktyki i objawów choroby niedokrwiennej serca u osób hospitalizowanych w klinice kardiologii. Psychiatria w Praktyce Ogólnolekarskiej. 2004; 4: 135.
  12. Kubica A, Pufal J, Moczulska B, et al. Skuteczność edukacji zdrowotnej u osób hospitalizowanych w klinice kardiologii. Psychiatria w Praktyce Ogólnolekarskiej. 2005; 5: 61.
  13. Geest SDe, Sabaté E. Adherence to Long-Term Therapies: Evidence for Action. European Journal of Cardiovascular Nursing. 2016; 2(4): 323–323.
    CrossRef
  14. Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006; 333(7557): 15.
    CrossRefPubMed
  15. Kubica J, Adamski P, Buszko K, et al. Rationale and Design of the Effectiveness of LowEr maintenanCe dose of TicagRelor early After myocardial infarction (ELECTRA) pilot study. Eur Heart J Cardiovasc Pharmacother. 2017 [Epub ahead of print].
    CrossRefPubMed
  16. Winter MP, Grove EL, De Caterina R, et al. Advocating cardiovascular precision medicine with P2Y12 receptor inhibitors. Eur Heart J Cardiovasc Pharmacother. 2017; 3(4): 221–234.
    CrossRefPubMed
  17. Winter MP, Koziński M, Kubica J, et al. Personalized antiplatelet therapy with P2Y12 receptor inhibitors: benefits and pitfalls. Postepy Kardiol Interwencyjnej. 2015; 11(4): 259–280.
    CrossRefPubMed
  18. Stewart K, Mc Namara KP, George J. Challenges in measuring medication adherence: experiences from a controlled trial. Int J Clin Pharm. 2014; 36(1): 15–19.
    CrossRefPubMed
  19. Kubica A, Sinkiewicz W, Szymański P, et al. Edukacja zdrowotna w chorobach układu krążenia - możliwości i zagrożenia. Folia Cardiologica Excerpta. 2007; 2: 177.
  20. Kubica A. Wybrane problemy prewencji wtórnej u chorych po incydentach wieńcowych. Folia Cardiologica Excerpta. 2008; 3: 366.
  21. Kubica A, Obońska K, Kasprzak M, et al. The impact of metabolic syndrome on the antiplatelet effect of clopidogrel and aspirin in patients with acute coronary syndrome. : Folia Med Copernicana. 2014; 2: 66–72.
  22. Kubica A, Kasprzak M, Obońska K, et al. Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction. Medical Research Journal. 2016; 3(4): 154–159.
    CrossRef
  23. Li WW, Kuo CT, Hwang SL, et al. Factors related to medication non-adherence for patients with hypertension in Taiwan. J Clin Nurs. 2012; 21(13-14): 1816–1824.
    CrossRefPubMed
  24. Jeffery RA, Navarro T, Wilczynski NL, et al. Adherence measurement and patient recruitment methods are poor in intervention trials to improve patient adherence. J Clin Epidemiol. 2014; 67(10): 1076–1082.
    CrossRefPubMed
  25. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353(5): 487–497.
    CrossRefPubMed
  26. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011; 26(3): 155–159.
    CrossRefPubMed
  27. Kubica A. Problems of long-term antiplatelet therapy after coronary stent implantation. Advances in Interventional Cardiology. 2009; 5: 158–161.
  28. Kubica A, Obońska K, Kasprzak M, et al. The impact of metabolic syndrome on the antiplatelet effect of clopidogrel and aspirin in patients with acute coronary syndrome. Folia Med Copernicana. 2014; 2: 66–72.
  29. Kubica A, Kozinski M, Grzesk G, et al. Genetic determinants of platelet response to clopidogrel. J Thromb Thrombolysis. 2011; 32(4): 459–466.
    CrossRefPubMed
  30. Adamski P, Sikora J, Laskowska E, et al. Comparison of bioavailability and antiplatelet action of ticagrelor in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: A prospective, observational, single-centre study. PLoS One. 2017; 12(10): e0186013.
    CrossRefPubMed
  31. Vrijens B, De Geest S, Hughes DA, et al. ABC Project Team. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012; 73(5): 691–705.
    CrossRefPubMed
  32. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015; 2015: 217047.
    CrossRefPubMed
  33. Kubica A, Grześk G, Sinkiewicz W, et al. Compliance, concordance, adherence in chronic therapy. Folia Cardiol Excerpta. 2010; 5: 54–57.
  34. Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009; 3(3): e123–e130.
    PubMed
  35. Cuevas CD, Peñate W. Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. International Journal of Clinical and Health Psychology. 2015; 15(2): 121–129.
    CrossRef
  36. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1): 67–74.
    PubMed
  37. Muntner P, Joyce C, Holt E, et al. Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale. Ann Pharmacother. 2011; 45(5): 569–575.
    CrossRefPubMed
  38. Tan Xi, Patel I, Chang J. Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8). INNOVATIONS in pharmacy. 2014; 5(3).
    CrossRef
  39. Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc (2003). 2011; 51(1): 90–94.
    CrossRefPubMed
  40. Afonso N, Nassif G, Aranba A, et al. Low-density lipoprotein cholesterol goal attainment among high- risk patient: does a combine intervention targeting patients and provides work? AM J Mang Care. 2006; 12(10): 589.
  41. George CF, Peveler RC, Heiliger S, et al. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol. 2000; 50(2): 166–171.
    PubMed
  42. Pandey A, Raza F, Velasco A, et al. Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring in apparent treatment-resistant hypertension. J Am Soc Hypertens. 2015; 9(6): 420–426.e2.
    CrossRefPubMed
  43. Marcum ZA, Zheng Y, Perera S, et al. Health ABC Study. Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Res Social Adm Pharm. 2013; 9(6): 817–827.
    CrossRefPubMed
  44. Kripalani S, Schmotzer B, Jacobson TA. Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): a randomized controlled trial. J Gen Intern Med. 2012; 27(12): 1609–1617.
    CrossRefPubMed
  45. Korb-Savoldelli V, Gillaizeau F, Pouchot J, et al. Validation of a French version of the 8-item Morisky medication adherence scale in hypertensive adults. J Clin Hypertens (Greenwich). 2012; 14(7): 429–434.
    CrossRefPubMed
  46. Unni EJ, Farris KB. Development of a new scale to measure self-reported medication nonadherence. Res Social Adm Pharm. 2015; 11(3): e133–e143.
    CrossRefPubMed
  47. Sakthong P, Chabunthom R, Charoenvisuthiwongs R. Psychometric properties of the Thai version of the 8-item Morisky Medication Adherence Scale in patients with type 2 diabetes. Ann Pharmacother. 2009; 43(5): 950–957.
    CrossRefPubMed
  48. Morisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008; 10(5): 348–354.
    PubMed
  49. Saleem F, Hassali MA, Shafie AA, et al. Translation and validation study of Morisky Medication Adherence Scale (MMAS): the Urdu version for facilitating person-centered healthcare in Pakistan. Int J Pers Cent Med. 2012; 2: 384–390.
  50. Risser J, Jacobson TA, Kripalani S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2007; 15(3): 203–219.
    PubMed
  51. Rapin P, Yupin A, Sureeporn T, et al. Validity and Reliability of Thai Version of Questionnaire Measuring Self-efficacy for Appropriate Medication Use Scale among Thai with post-myocardial infarction. Songklanakarin J Sci Technol. 2014; 36: 411–417.
  52. Lambert EV, Steyn K, Stender S, et al. Cross-cultural validation of the hill-bone compliance to high blood pressure therapy scale in a South African, primary healthcare setting. Ethn Dis. 2006; 16(1): 286–291.
    PubMed
  53. Kim MT, Hill MN, Bone LR, et al. Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Prog Cardiovasc Nurs. 2000; 15(3): 90–96.
    PubMed
  54. Song Y, Han HR, Song HJ, et al. Psychometric evaluation of hill-bone medication adherence subscale. Asian Nurs Res (Korean Soc Nurs Sci). 2011; 5(3): 183–188.
    CrossRefPubMed
  55. Karademir M, Koseoglu IH, Vatansever K, et al. Validity and reliability of the Turkish version of the Hill-Bone compliance to high blood pressure therapy scale for use in primary health care settings. Eur J Gen Pract. 2009; 15(4): 207–211.
    CrossRefPubMed
  56. Svarstad BL, Chewning BA, Sleath BL, et al. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999; 37(2): 113–124.
    PubMed
  57. Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky-Green test to evaluate medication adherence. Rev Saude Publica. 2012; 46(2): 279–289.
    PubMed
  58. Krass I, Taylor SJ, Smith C, et al. Impact on medication use and adherence of Australian pharmacists' diabetes care services. J Am Pharm Assoc (2003). 2005; 45(1): 33–40.
    PubMed
  59. Rickles NM, Svarstad BL. Relationships between multiple self-reported nonadherence measures and pharmacy records. Res Social Adm Pharm. 2007; 3(4): 363–377.
    CrossRefPubMed
  60. Buszko K, Obońska K, Michalski P, et al. The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation. Medical Research Journal. 2016; 1(1): 37–42.
    CrossRef
  61. Lucca JM, Ramesh M, Parthasarathi G, et al. Incidence and factors associated with medication nonadherence in patients with mental illness: a cross-sectional study. J Postgrad Med. 2015; 61(4): 251–256.
    CrossRefPubMed
  62. Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Dig Dis Sci. 2008; 53(4): 1020–1024.
    CrossRefPubMed
  63. Haynes RB, Yao X, Degani A, et al. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews. 2005.
    CrossRef
  64. Kosobucka A, Michalski P, Pietrzykowski Ł, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient Preference and Adherence. 2018; Volume 12: 333–340.
    CrossRef
  65. Kubica A, Kosobucka A, Michalski P, et al. The Adherence in Chronic Diseases Scale — a new tool to monitor implementation of a treatment plan. Folia Cardiologica 2017;12:19-26, DOI: 10. 5603/FC. ; 2016: 0000.
    CrossRef
  66. Ma C, Chen S, You L, et al. Development and psychometric evaluation of the Treatment Adherence Questionnaire for Patients with Hypertension. J Adv Nurs. 2012; 68(6): 1402–1413.
    CrossRefPubMed
  67. Martin AL, Bayarre Ve. Grau Ábalo JA. Validation of MBG Questionnaire (Martin-Bayarre-Grau) for the evaluation of therapy adherence in blood hypertension patients. Rev Cuba Salud Publica. ; 2008: 34.
  68. Martínez JW, Villa Pe, Jaramillo J. Quintero Betancur AM, Calderón V. Validación del cuestionario de adherencia al tratamiento anti hipertensivo Martín Bayarré Grau. [Validation of a scale of adherence treatment antihypertensive: Martin Bayarre Grau Test]. Rev Med Risaralda. 2011; 17: 101–105.
  69. Zeller A, Schroeder K, Peters TJ. An adherence self-report questionnaire facilitated the differentiation between nonadherence and nonresponse to antihypertensive treatment. J Clin Epidemiol. 2008; 61(3): 282–288.
    CrossRefPubMed
  70. Kubica A, Jurek A, Olejarczyk E, et al. Wybrane czynniki demograficzno-społeczne a skuteczność edukacji zdrowotnej prowadzonej na podstawie broszur edukacyjnych u osób z ostrym zawałem serca. Folia Cardiologica Excerpta. 2008; 3: 199.
  71. Kubica A, Kochman W, Bogdan M, et al. The influence of undergone percutaneous coronary interventions, and earlier hospitalizations with myocardial infarction on the level of knowledge and the effectiveness of health education in patients with myocardial infarction. Advances in Interventional Cardiology. 2009; 5: 25–30.
  72. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004; 42(3): 200–209.
    PubMed
  73. Tang L, Patao C, Chuang J, et al. Cardiovascular risk factor control and adherence to recommended lifestyle and medical therapies in persons with coronary heart disease (from the National Health and Nutrition Examination Survey 2007-2010). Am J Cardiol. 2013; 112(8): 1126–1132.
    CrossRefPubMed
  74. Galema-Boers JMH, Lenzen MJ, van Domburg RT, et al. Predicting non-adherence in patients with familial hypercholesterolemia. Eur J Clin Pharmacol. 2014; 70(4): 391–397.
    CrossRefPubMed
  75. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006; 113(24): 2803–2809.
    CrossRefPubMed
  76. Kubica A, Kasprzak M, Obońska K, et al. Discrepancies in assessment of adherence to antiplatelet treatment after myocardial infarction. Pharmacology. 2015; 95(1-2): 50–58.
    CrossRefPubMed
  77. Kubica A, Obońska K, Fabiszak T, et al. Adherence to antiplatelet treatment with P2Y12 receptor inhibitors. Is there anything we can do to improve it? A systematic review of randomized trials. Curr Med Res Opin. 2016; 32(8): 1441–1451.
    CrossRefPubMed
  78. Kubica A, Kasprzak M, Siller-Matula J, et al. Time-related changes in determinants of antiplatelet effect of clopidogrel in patients after myocardial infarction. Eur J Pharmacol. 2014; 742: 47–54.
    CrossRefPubMed
  79. Muntner P, Mann DM, Woodward M, et al. Predictors of low clopidogrel adherence following percutaneous coronary intervention. Am J Cardiol. 2011; 108(6): 822–827.
    CrossRefPubMed
  80. Kubica A, Obońska K, Kasprzak M, et al. Prediction of high risk of non-adherence to antiplatelet treatment. Kardiol Pol. 2016; 74(1): 61–67.
    CrossRefPubMed
  81. Vitolins MZ, Rand CS, Rapp SR, et al. Measuring adherence to behavioral and medical interventions. Control Clin Trials. 2000; 21(5 Suppl): 188S–94S.
    PubMed
  82. Garber MC, Nau DP, Erickson SR, et al. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care. 2004; 42(7): 649–652.
    PubMed
  83. Cook CL, Wade WE, Martin BC, et al. Concordance among three self-reported measures of medication adherence and pharmacy refill records. J Am Pharm Assoc (2003). 2005; 45(2): 151–159.
    PubMed
  84. Wang PS, Benner JS, Glynn RJ, et al. How well do patients report noncompliance with antihypertensive medications?: a comparison of self-report versus filled prescriptions. Pharmacoepidemiol Drug Saf. 2004; 13(1): 11–19.
    CrossRefPubMed
  85. Frost MH, Reeve BB, Liepa AM, et al. Mayo/FDA Patient-Reported Outcomes Consensus Meeting Group;. What is sufficient evidence for the reliability and validity of patient-reported outcome measures? Value Health. 2007; 10 Suppl 2: S94–S9S105.
    CrossRefPubMed
  86. Krousel-Wood M, Muntner P, Jannu A, et al. Reliability of a medication adherence measure in an outpatient setting. Am J Med Sci. 2005; 330(3): 128–133.
    PubMed
  87. Kubica A. Collaboration with the patient - a basic condition of therapy effectiveness in coronary artery disease. Chor. Serca Nacz. 2009; 6: 131–134.
  88. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999; 21(6): 1074–90; discussion 1073.
    CrossRefPubMed
  89. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009; 119(23): 3028–3035.
    CrossRefPubMed
  90. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006; 166(17): 1842–1847.
    CrossRefPubMed
  91. Vermeire E, Hearnshaw H, Van Royen P, et al. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001; 26(5): 331–342.
    PubMed
  92. Shi L, Liu J, Fonseca V, et al. Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis. Health Qual Life Outcomes. 2010; 8: 99.
    CrossRefPubMed
  93. Pérez-Escamilla B, Franco-Trigo L, Moullin JC, et al. Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments. Patient Prefer Adherence. 2015; 9: 569–578.
    CrossRefPubMed

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