scholarly journals Upaya Peningkatan Komunikasi Interprofesional Melalui Interprofessional Collaborative Practice (ICP) (Systematic Review)

2018 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Raihany Sholihatul Mukaromah ◽  
Luky Dwiantoro ◽  
Agus Santoso
Keyword(s):  
Systematic Review ◽  
Data Base ◽  
Care Provider ◽  
Full Text ◽  
Health Workers ◽  
Collaborative Practice ◽  
Google Scholar ◽  
Interprofessional Collaborative Practice ◽  
Advanced Search

Peran dan fungsi care provider  interdisiplin dalam pelayanan kesehatan masih terfragmentasi sehingga pelayanan kesehatan interdisiplin yang diberikan kepada pasien menjadi tumpang tindih.  Fragmentasi interdisiplin dapat diatasi melalui Interprofessional collaborative practice (ICP). Kolaborasi yang baik diantara tim profesional kesehatan sangat diperlukan, agar dapat bertukar informasi dengan jelas dan komprehensif. Kompetensi inti dalam Interprofessional collaborative practice (ICP) adalah komunikasi interprofesional yang efektif. Tujuan dari systematic review ini untuk mengetahui apakah ICP dapat meningkatkan kemampuan tenaga kesehatan dalam melakukan komunikasi interprofesional. Metode yang digunakan Systematic review dengan cara melakukan penelusuran literature data base dari Ebscho, Sciendirect, PubMed dan Google scholar dengan menggunakan advanced search keyword. Kata kunci yang dipilih adalah Interprofessional Collaborative Practice (ICP), Communication Interprofessional, health workers. Pencarian dibatasi pada tahun 2006 – 2016, pdf full text dan menggunakan bahasa inggris. Kriteria inklusi dari artikel, ini yaitu responden : tenaga kesehatan, intervensi yang digunakan Interprofessional Collaborative Practice (ICP), outcome yang diukur adalah kemampuan komunikasi interprofesional tenaga kesehatan. Didapatkan 6 artikel yang sesuai dengan kriteria inklusi, ke 6 artikel ini dilakukan review. Hasil : masing masing artikel memberikan outcome terhadap peningkatan komunikasi interprofesional dan 2 artikel menghasilkan 3 tema. ICP secara efektif dapat meningkatkan kemampuan tenaga kesehatan dalam melakukan komunikasi interprofesional. Diharapkan pimpinan rumah sakit dapat membuat kebijakan khusus terkait pelaksanaan ICP dan merancang model pelaksanaan ICP yang melibatkan semua profesi kesehatan agar dapat diaplikasikan di pelayanan kesehatan sebagai upaya pengembangan komunikasi interprofesional yang efektif serta meningkatkan kualitas pelayanan kesehatan yang bermutu sehingga peran profesional setiap disiplin berjalan dengan baik.

SYSTEMATIC REVIEW: EFEKTIFITAS METODE HANDOVER DALAM MENINGKATKAN KOMUNIKASI PERAWAT

2017 ◽  
Author(s):  
Hani Tuasikal
Keyword(s):  
Systematic Review ◽  
Data Base ◽  
Full Text ◽  
Advanced Search ◽  
Google Search

Latar belakang: Pelaksanaan handover di RS berkiatan erat dengan dengan peran perawat dalam menggunakan metode pada saat pergantian shift. Oleh karena itu, untuk meningkatkan komunikasi diantara perawat dibutuhkan metode-metode yang efektif dalam metode-melakukan handover. Adapun metode yang digunakan adalah verbal, dengan catatan, melalui telepon dan SBAR. Metode: Penelusuran literature data base dari EBSCO, sciendirect, google search dan PubMed dari tahun 2005-2015 dilakukan menggunakan advanced search keyword yang dipilih dalam pencarian adalah handover communication, patien savety. Pencarian dibatasi pada tahun 2005-2015, full text, dan harus yang berbahasa inggris. Setelah dilakukan search ditemukan 171 artikel pada sciendirect, 23 artikel pada PubMed, dan 32 artikel pada ebscho dan yang sesuai dengan kriteria inklusi adalah 6 artikel. 6 artikel tersebut sesuai dengan kriteria study yaitu RCTs, Cohor, Case Study dan Systematic Review. Responden dalam artikel ini adalah perawat yang melakukan handover. Intervensi yang dilakukan adalah metode-metode handover. Outcome meningkatkan komunikasi antar perawat. Hasil: temuan berupa 6 artikel hasil pembahasan menunjukan bahwa metode handover dengan SBAR sangat efektif untuk meningkatkan komunikasi antar perawat. Kesimpulan: Metode SBAR sangat efektif digunakan dalam handover. Dengan metode ini, dapat mengoptimalkan komunikasi antar perawat dalam melakukan handover di setiap pergantian shif.

Exploring Quality of Life in End-of-Life Discussions

2019 ◽  
Vol 37 (6) ◽  
pp. 465-473
Author(s):  
Terry Eggenberger ◽  
Heather Howard ◽  
Dana Prescott ◽  
George Luck
Keyword(s):  
Quality Of Life ◽  
Activities Of Daily Living ◽  
End Of Life ◽  
Daily Living ◽  
Health Workers ◽  
Collaborative Practice ◽  
Health Care Proxy ◽  
Interprofessional Collaborative Practice ◽  
Value Based Care

Advance directives (ADs) allow individuals to legally determine their preferences for end-of-life (EOL) medical treatment and designate a health-care proxy to act on their behalf prior to losing the cognitive ability to make informed decisions for themselves. An interprofessional group of researchers (law, nursing, medicine, and social work) conducted an exploratory study to identify the differences in quality-of-life (QOL) language found within the AD state statutes from 50 US states and the District of Columbia. Data were coded using constant comparative analysis. Identified concepts were grouped into 2 focus areas for EOL discussions: communication/awareness of surroundings and activities of daily living. Language regarding communication/awareness of surroundings was present in the half of the statutes. Activities of daily living were addressed in only 18% of the statutes. Only 3 states (Arkansas, Nevada, and Tennessee) specifically addressed QOL. Patients are best served when professionals, regardless of discipline, can share and transform knowledge for patients in times of crisis and loss in ways that are empathetic and precise. Interprofessional collaborative practice (IPCP) comprises multiple health workers from different professional backgrounds working together with patients, families, and communities to deliver the highest quality of care. One of the major competencies of IPCP encompasses values and ethics. Interprofessional collaborative practice is offered as the means to deliver person-centered value-based care when facilitating these crucial dialogs and making recommendations for change.

Interprofessional Collaborative Practice

2020 ◽  
Author(s):  
Shelley Cohen Konrad
Keyword(s):  
Health Care ◽  
Interprofessional Education ◽  
Health Workers ◽  
Care Delivery ◽  
Core Competencies ◽  
Collaborative Practice ◽  
Direct Care ◽  
World Health ◽  
Quality Health Care ◽  
Interprofessional Collaborative Practice

The World Health Organization defines interprofessional collaborative practice (IPCP) as when multiple health workers from different professional backgrounds provide comprehensive health services working with patients/clients, families, caregivers, and communities to deliver quality health care across settings. IPCP has long been considered a best practice model to improve effective health-care delivery; however, implementation of collaborative practice models and evidence to support their efficacy have been relatively slow to develop. IPCP is inextricably linked to interprofessional education and practice (IPEP), which brings together students and practitioners across disciplines and practices, and includes direct care workforce, people/patients/clients, families, and communities to learn with, from, and about each other to prepare them for integrated workplace practice. The article will explore national and global interprofessional collaborative practice initiatives; outline core competencies and evidence for collaborative practice; provide examples of IPCP implementation; and discuss the role social work plays in the development and leadership of collaborative practice.

scholarly journals Komunikasi Interprofesional Dalam Peningkatan Keselamatan Pasien: Systematic Review

2018 ◽  
Vol 1 (1) ◽  
pp. 28
Author(s):  
Hirza Ainin Nur ◽  
Agus Santoso
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Full Text ◽  
Google Scholar

Latar Belakang : Komunikasi interprofesi merupakan elemen penting dalam pemberian pelayanan kesehatan kepada pasien. Kegagalan dalam komunikasi antar petugas kesehatan dapat mengakibatkan adverse event yang terjadi di rumah sakit. Tujuan penelitian : Mengetahui efektivitas komunikasi interprofesional untuk meningkatkan keselamatan pasien. Metode & Sumber data : Metode yang digunakan yaitu systematic review. Sumber data yang didapat berasal dari jurnal Ebsco, PubMed, dan Google Scholar. Kriteria inklusi & eksklusi  : Jurnal terkait bentuk pengembangn komunikasi interprofesi, jurnal berbahasa Inggris, tahun publikasi antara 2011-2016, jurnal pdf full text. Hasil : Dari empat artikel jurnal yang diriview didapatkan hasil bahwa komunikasi interprofesi efektiv untuk meningkatkan keselamatan pasien di rumah sakit. Kesimpulan : Komunikasi Interprofesional efektif untuk meningkatkan keselamatan pasien dan menurunkan angka insiden keselataman pasien di rumah sakit. 

scholarly journals Effects of Herbal Medicines on Nipple Fissures: A Systematic Review

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mehri Saffari ◽  
Narjes Bahri ◽  
Mohammad Ghorbani ◽  
Azamsadat Mahmoudian
Keyword(s):  
Systematic Review ◽  
Medicinal Plants ◽  
Olive Oil ◽  
Full Text ◽  
Aloe Vera ◽  
Herbal Medicines ◽  
Data Sources ◽  
Google Scholar ◽  
Pistacia Atlantica ◽  
Ziziphus Jujuba

Context: As a prevalent problem on the first days of childbirth, nipple fissures can cause pain and discomfort and lead to the early cessation of breastfeeding. Effectively treating this complication is therefore crucial. This systematic review investigated the effects of herbal medicines on the treatment of nipple fissures. Data Sources: Keywords such as “treatment”, “nipple fissure”, “fissure”, “medicinal plants”, “sore nipple” and “herbal ingredients” were used individually and in combination to extract relevant articles published by March 2020 from English databases, i.e., Science Direct, PubMed, Scopus and Google Scholar. The Persian equivalents of these keywords were used for extracting articles from Google Scholar, SID and Magiran. The selected articles were qualitatively evaluated using the checklist issued by Consolidated Standard of Reporting Trials (CONSORT) in 2017. Results: Out of 132 articles retrieved, 10 eligible ones were included in this study. Investigating the full text of the articles found herbal medicines such as purslane, Aloe vera, olive oil, frankincense, Pistacia atlantica, curcumin and Ziziphus jujuba effective in treating nipple fissures. Conclusions: Given the effects of herbal medicines on treating nipple fissures, it is recommended that comprehensive studies be conducted on different forms and doses of these compounds.

scholarly journals Self-management of iron and folic acid supplementation during pre-pregnancy, pregnancy and postnatal periods: a systematic review

2021 ◽  
Vol 6 (5) ◽  
pp. e005531
Author(s):  
Shannon E King ◽  
Ping Teresa Yeh ◽  
Dong Keun Rhee ◽  
Özge Tuncalp ◽  
Lisa M Rogers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Folic Acid ◽  
Full Text ◽  
Health Workers ◽  
Self Care ◽  
Folic Acid Supplementation ◽  
Self Management ◽  
Acid Supplementation ◽  
Full Text Review ◽  
Iron And Folic Acid

IntroductionWhile the use of folic acid pre-pregnancy and iron and folic acid (IFA) during pregnancy and postnatal have been demonstrated to be effective and are recommended interventions by WHO, ensuring individuals adhere to the supplementation regimen can be a challenge. Self-care interventions that support an individual’s ability to promote their own health with or without the support of health workers could help promote the uptake and adherence to supplementation. This systematic review assessed the evidence around self-management of IFA or folic acid supplementation accessed over-the-counter during pre-pregnancy, pregnancy and postnatal periods.MethodsPeer-reviewed studies were included if they compared self-management of IFA or folic acid supplementation with health worker-initiated supplement use on maternal and/or fetal and newborn health outcomes, end-users’ or health workers’ values and preferences, or cost and/or cost-effectiveness. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through November 2020, hand-searched clinical trial registries, reviewed databases and contacted experts in the field. Abstract screening and full-text review were conducted independently by two reviewers.ResultsOverall, 2344 results were identified, and 28 studies were identified for full-text review. All studies were excluded, as they were not primary research, lacked the outcomes of interest, lacked specificity in supplement type, and/or lacked a comparison group.ConclusionNo evidence was identified that distinguishes self-management of folic acid supplements pre-pregnancy and of IFA supplements during pregnancy and postnatal, highlighting a gap in our current understanding of self-care related to dietary supplementation in pregnancy. The findings of this review identify an area for further research to support the current movement towards self-care interventions as an added choice to help individuals more fully attain their reproductive health and rights.Systematic review registration numberPROSPERO CRD42020205548

scholarly journals Intervensi Perawatan Pasien Stroke selama di Rumah: Systematic Review

2021 ◽  
Vol 13 (3) ◽  
pp. 615-624
Author(s):  
Muhammad Agung Akbar ◽  
Henny Suzana Mediani ◽  
Neti Juniarti ◽  
Ahmad Yamin
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Experimental Study ◽  
Home Care ◽  
Data Base ◽  
Full Text ◽  
Stroke Patients

Stroke menjadi permasalahan yang saat ini terus mengalami peningkatan di seluruh dunia termasuk Indonesia. Penanganan pasien stroke membutuhkan perawatan jangka panjang yang komprehesif melibatkan tenaga kesehatan dan keluarga dalam perawatan sehari-hari. Tinjauan sistematis untuk menganalisis intervensi perawatan pasien stroke selama dirumah dalam meningkatkan kualitas hidupnya. Pencarian artikel dilakukan pada data base elektronik diantaranya Science Direct, Pro-Quest, dan EbscoHost. Kata Kunci yang digunakan adalah stroke patients AND home care OR home rehabilitation AND quality of life. Kriteria artikel dipilih 1)diterbitkan pada tahun 2012-2020 2)full-text 3)artikel dalam Bahasa inggris 4) penelitian RCT atau experimental study. Artikel diseleksi sesuai kriteria dan didapatkan total 5 dari 705 artikel menggunakan PRISMA. Tinjauan sistematis ini menemukan bahwa ada konsistensi temuan di antara penelitian yang menunjukkan bahwa perawatan pasien stroke di rumah adalah pilihan yang efektif dalam pemulihan pasien dan berlangsung dengan optimal selama dirumah. Dukungan kualitas hidup pasien stroke membutuhkan perawatan lanjutan maka dari itu diperlukan peran dari keluarga yang mampu merawat serta menjaga pasien dengan baik sehingga pemulihan pasien dapat berlangsung dengan optimal selama dirumah.

LITERATURE REVIEW EFEKTIFITAS TERAPI KOMPRES HANGAT JAHE UNTUK PENANGANAN NYERI PADA PASIEN GOUT ARTRITIS

2021 ◽  
Author(s):  
Indah Puspitasari ◽  
Meria Woro L
Keyword(s):  
Literature Review ◽  
Data Base ◽  
Full Text ◽  
Pain Scale ◽  
Google Scholar ◽  
Electronic Data ◽  
Electronic Data Base

Riskesdas 2018 menyatakan bahwa prevalensi penderita gout artritis di Indonesia saat ini sebanyak 7.3%sedangkan di provinsi Jawa Barat populasi penderita gout artritis sebanyak 8,86% dengan jumlah penderitaberjenis kelamin perempuan lebih banyak yaitu 8,46% dan pada penderita berjenis kelamin laki-laiki yaitusebanyak 6,13%. Telaah literatur review ini bertujuan untuk mengetahui pengaruh terapi kompres hangat jaheterhadap skala nyeri pada pasien gout artritis. Desain dalam Karya Tulis Ilmiah ini adalah literatur reviewdengan menggunakan metode pencarian electronic data base dan sumber pencarian google scholar. Kata kunciyang digunakan yaitu Gout artritis, kompres hangat jahe, dan skala nyeri, dalam pencarian artikel internasionalyaitu dengan menggunakan kata kunci : Gout arthritis, ginger warm compress, dan pain scale Kriteria inklusiyang digunakan yaitu artikel yang dapat diakses full text yang tersedia berbahasa Inggris dan Indonesia. Hasilditemukan 5 artikel di google scholar yang membahas tentang keefektifan kompres hangat jahe pada pasiengout artritis berdasarkan klasifikasi intervensi dan outcome yang sesuai dengan kriteria penelitian. Hasilliteratur review dari kelima artikel menunjukkan bahwa kompres hangat jahe efektif untuk menangani nyeripada pasien gout artritis.

Pendekatan modelling keperawatan anak pada orang tua dalam menstimulasi anak usia dini dengan masalah perubahan perilaku dengan kebiasaan menggunakan gadget

2020 ◽  
Vol 1 (1) ◽  
pp. 1-6
Author(s):  
Yola Suryani ◽  
Rini Palupi ◽  
Anggi Kusuma
Keyword(s):  
Early Childhood ◽  
Literature Review ◽  
Data Base ◽  
Critical Review ◽  
Full Text ◽  
Negative Impact ◽  
Self Control ◽  
Google Scholar ◽  
Social Unit ◽  
Children's Attitudes

Parents are the smallest social unit that has an important role and are the basis of children's development, where parents are the deciding factors for the successful formation of children's attitudes and behaviors. A mother who has children must have knowledge. Often we meet many parents who give gadgets to early childhood (3-6 years). The use of gadgets continuously will have a negative impact on children's behavior in their daily lives, children tend to be very dependent and become more emotional, get bored easily when someone advises, complains a lot, self-control is uncontrolled, personal is closed, health is disturbed, sleep disorders , aloof, mental illness, aggressive, addictive. This literature review uses critical review of full text articles in the last ten years, from 2010-2020 in Indonesian and English. Because of the limitations of the article, quantitative studies are used to obtain a more accurate review. Google Scholar data base search, National Library of the Republic of Indonesia, PubMed, Proquest with the keywords “Role of Parents”, “Early Childhood”, “Gadgets”, “Modeling Approach “to get articles that match the topic and purpose. 47 articles in Google Scholar, Then the article is read intensively and a summary of each article is made. Knowledge of the mother who is the closest person to the child in health care has a significant influence on children's attitudes and behavior in looking after and educating children. It is recommended that mothers of children aged 3-6 years give gadgets to their children and choose applications according to their age, and limit the time to use gadgets so that children do not experience addiction so that children can adapt to the environment and avoid developmental delays, especially social and emotional. Abstrak: Orangtua merupakan unit sosial terkecil yang memiliki peranan penting dan menjadi dasar perkembangan anak, dimana orang tua menjadi faktor penentu bagi keberhasilan pembentukan sikap dan perilaku anak. Seorang ibu yang memiliki anak wajib memiliki pengetahuan. Sering kita temui banyak orang tua yang memberikan gadget pada anak usia dini (3-6 tahun). Penggunaan gadget secara terus-menerus akan berdampak buruk bagi perilaku anak dalam kesehariannya, anak-anak cenderung akan sangat tergantung dan menjadi lebih emosional, cepat bosan ketika ada yang menasehati, banyak mengeluh, egois tidak terkendali, pribadi yang tertutup, kesehatan terganggu, gangguan tidur, suka menyendiri, penyakit mental, agresif, adikasi. Literature review ini memakai critical review artikel full text sepuluh tahun terakhir  yaitu  dari  tahun  2010-2020  dalam  bahasa indonesia dan bahasa inggris. Karena keterbatasan  artikel  maka  digunakan  studi  kuantitatif untuk mendapatkan hasil review yang lebih akurat. Pencarian data base Google Scholar, Perpustakaan Nasional Republik Indonesia, PubMed, Proquest dengan kata kunci “Peran Orang tua”, “Anak Usia Dini”, “Gadget”, “Pendekatan Modelling” untuk mendapatkan artikel yang sesuai dengan topik dan tujuan. Didapatkan 47 artikel di Google Scholar, Selanjutnya   dilakukan   pembacaan   artikel secara intensif dan dibuatkan ringkasan dari setiap artikel. Pengetahuan ibu yang merupakan orang terdekat dengan anak dalam pemeliharaan kesehatan memberikan pengaruh yang signifikan terhadap sikap dan perilaku anak dalam menjaga dan mendidik anak. Sebaiknya ibu anak usia(3-6tahun) memberikan gadget kepada anaknya dan memilih aplikasi sesuai dengan usianya, serta membatasi waktu penggunaan gadget agar anak tidak mengalami kecanduan sehingg aanak dapat beradaptasi dengan lingkungan dan terhindar dari keterlambatan perkembangan khususnya social dan emosional.

scholarly journals Low Level Evidence Suggests That Librarian-Led Instruction in Evidence Based Practice is Effective Regardless of Instructional Model

2017 ◽  
Vol 12 (2) ◽  
pp. 163
Author(s):  
Lindsay J. Alcock
Keyword(s):  
Systematic Review ◽  
Teaching Methods ◽  
Full Text ◽  
Literature Search ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
Instructional Methods ◽  
Health Sciences ◽  
Google Scholar ◽  
Evidence Based

A Review of: Swanberg, S. M., Dennison, C. C., Farrell, A., Machel, V., Marton, C., O'Brien, K. K., … & Holyoke, A. N. (2016). Instructional methods used by health sciences librarians to teach evidence-based practice (EBP): a systematic review. Journal of the Medical Library Association: JMLA, 104(3), 197-208. http://dx.doi.org/10.3163/1536-5050.104.3.004 Abstract Objective – To determine both the instructional methods and their effectiveness in teaching evidence based practice (EBP) by librarians in health sciences curricula. Design – Systematic review. Setting – A total of 16 databases, Google Scholar, and MLA Annual Meeting abstracts. Subjects – There were 27 studies identified through a systematic literature search. Methods – An exhaustive list of potential articles was gathered through searching 16 online databases, Google Scholar, and MLA Annual Conference abstracts. Inclusion and exclusion criteria were identified to inform the literature search and determine article eligibility. Duplicates were removed and the remaining search results were divided into sets and assigned to two reviewers who screened first by title/abstract and then by full-text. A third reviewer addressed disagreement in article inclusion. Data extraction, using a validated method described by Koufogiannakis and Wiebe (2006), and critical appraisal, using the Glasgow checklist (1999), were performed concurrently. Main Results – After removal of duplicates 30,043 articles were identified for initial title/abstract screening. Of the 637 articles assessed for full-text screening 26 articles and 1 conference proceeding ultimately met all eligibility criteria. There was no meta-analysis included in the synthesis. There were 16 articles published in library and information science journals and 10 in health sciences journals. Of those studies, 22 were conducted in the United States. A wide range of user groups was identified as participants in the studies with medical students and residents representing the highest percentage and nursing and other allied health professional programs also included. While there was variation in sample size and group allocation, the authors estimate an average of 50 participants per instructional session. Included studies represented research undertaken since the 1990s. All studies addressed at least one of the standard EBP steps including obtaining the best evidence through a literature search (27 studies), developing a clinical question (22 studies), and critical appraisal (12 studies). There were 11 studies which addressed applying evidence to clinical scenarios, and 1 study which addressed the efficacy and efficiency of the EBP process. The majority of studies indicated that literature searching was the primary focus of EBP instruction with MEDLINE being the most utilized database and Cochrane second. Other resources include databases and clinical decision support tools. Teaching methods, including lecture, small group, computer lab, and online instruction, varied amongst the studies. There were 7 studies which employed 1 instructional method while 20 employed a combination of teaching methods. Only one study compared instructional methods and found that students obtained better scores when they received online instruction as compared with face-to-face instruction. The difference, however, was not statistically significant. Skills assessments were conducted in most of the studies utilizing various measurements both validated and not validated. Given the variation in measurement tools a cross-study analysis was not possible. The most common assessment methods included self-reporting and pre- and post-surveys of participants’ attitudes and confidence in EBP skills. Randomization was utilized in 10 studies, and an additional 3 studies had a “clearly defined intervention group.” There were 10 blinded studies and 15 studies utilized cohorts with pre- and post- intervention assessments. There were 25 studies which included descriptive statistics and many also included inferential statistics intended to show significance. Differences between groups were assessed with parametric measures in 9 studies and non-parametric measures in 15 studies. Good to high statistical significance on at least 1 measurement was achieved in 23 studies. Given the absence of effect sizes, the level of differences between study groups could not be determined. Conclusion – Numerous pedagogical methods are used in librarian-led instruction in evidence based practice. However, there is a paucity of high level evidence and the literature suggests that no instructional method is demonstrated to be more effective than another.

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