MDT

MDT
  • 文章类型: Journal Article
    背景:近年来,甲状腺结节的发病率明显增加。治疗甲状腺结节的方法多种多样,而消融治疗是治疗甲状腺结节的重要方法之一。然而,目前甲状腺结节消融治疗存在许多并发症和不足,尤其是甲状腺癌结节的不完全消融,这限制了消融技术的进一步应用。在本文中,我们报告了2例甲状腺结节不完全消融术,其中一人由于消融后的焦虑而接受了手术治疗,术后病理证实仍有甲状腺乳头状癌残留,另一名患者在消融后接受了手术,但是由于颈部淋巴结转移在短时间内再次访问了我们的医疗机构,在根治性颈淋巴结清扫术后,病理证实为多发颈淋巴结转移。手术后进行放射性核素治疗,两名患者目前正在接受内分泌抑制治疗,病情稳定无复发迹象.
    结论:甲状腺癌结节的不完全消融限制了消融治疗的发展,使消融治疗成为一把双刃剑。准则和专家共识可以指导其发展,但是它们需要与时俱进,多学科诊断团队可以帮助筛选最合适的患者。只有更规范地使用这项技术,使用最合适的技术,治疗最合适的病人,可以使越来越多的患者受益。
    BACKGROUND: In recent years, the incidence of thyroid nodules has increased significantly. There are various ways to treat thyroid nodules, and ablation therapy is one of the important ways to treat thyroid nodules. However, there are many complications and deficiencies in the current ablation treatment of thyroid nodules, especially the incomplete ablation of thyroid cancer nodules, which limits the further application of ablation technology. In this paper, we report two cases of incomplete ablation of thyroid nodules, one of which underwent surgical treatment due to anxiety after ablation, and the postoperative pathology confirmed that there was still residual papillary thyroid carcinoma, and the other patient underwent an operation after ablation, but visited our medical institution again due to cervical lymph node metastasis in a short period of time, and after radical cervical lymph node dissection, pathology confirmed multiple cervical lymph node metastasis. Radionuclide therapy was performed after surgery, and two patients are currently receiving endocrine suppression therapy, and their condition is stable with no signs of recurrence.
    CONCLUSIONS: The incomplete ablation of thyroid cancer nodules limits the development of ablation therapy, making ablation treatment a double-edged sword. Guidelines and expert consensus can guide their development, but they need to evolve with the times, and a multidisciplinary diagnostic team can help screen the most suitable patients. Only by using this technology more standardly, using the most appropriate technology, and treating the most suitable patients, can benefit more and more patients.
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  • 文章类型: Journal Article
    中国临床肿瘤学会人工智能系统(CSCOAI)是利用中国乳腺癌数据开发的临床决策支持系统。我们的研究探讨了CSCOAI提供的乳腺癌治疗建议与其在临床环境中的实际应用之间的一致性。
    回顾性分析2017年1月至2022年12月在安徽医科大学第二附属医院接受治疗的537例乳腺癌患者。熟练的高级肿瘤学研究人员将患者数据手动输入到CSCOAI系统中。通过使我们的治疗方案与CSCOAI建议中的分类系统保持一致,定义了“一致”和“不一致”治疗类别。最初显示不一致的病例接受了医院多学科治疗(MDT)小组的第二次评估。当MDTS的治疗建议处于“一致”类别时,就达到了一致性。
    在所有乳腺癌患者的实际治疗方案和CSCOAI建议之间观察到令人印象深刻的80.4%的一致性。值得注意的是,与II期患者(76.06%,P=0.023)。此外,浸润性导管癌和小叶癌之间存在显着一致性(88.46%)。有趣的是,与其他分子亚型相比,三阴性乳腺癌(TNBC)的一致性率高(87.50%)。将MDT推荐的治疗方法与CSCOAI决策进行对比时,达成了总体92.4%的协议。此外,Logistic多变量分析强调了年龄的统计学意义,月经状态,肿瘤类型,分子亚型,肿瘤大小,和TNM阶段影响一致性。
    在乳腺癌治疗领域,CSCOAI提供的建议与MDT提供的建议之间的一致性占主导地位。CSCOAI可以成为乳腺癌治疗决策的有用工具。
    UNASSIGNED: The Chinese Society of Clinical Oncology Artificial Intelligence System (CSCO AI) serves as a clinical decision support system developed utilizing Chinese breast cancer data. Our study delved into the congruence between breast cancer treatment recommendations provided by CSCO AI and their practical application in clinical settings.
    UNASSIGNED: A retrospective analysis encompassed 537 breast cancer patients treated at the Second Affiliated Hospital of Anhui Medical University between January 2017 and December 2022. Proficient senior oncology researchers manually input patient data into the CSCO AI system. \"Consistent\" and \"Inconsistent\" treatment categories were defined by aligning our treatment protocols with the classification system in the CSCO AI recommendations. Cases that initially showed inconsistency underwent a second evaluation by the Multi-Disciplinary Treatment (MDT) team at the hospital. Concordance was achieved when MDTs\' treatment suggestions were in the \'Consistent\' categories.
    UNASSIGNED: An impressive 80.4% concurrence was observed between actual treatment protocols and CSCO AI recommendations across all breast cancer patients. Notably, the alignment was markedly higher for stage I (85.02%) and stage III (88.46%) patients in contrast to stage II patients (76.06%, P=0.023). Moreover, there was a significant concordance between invasive ductal carcinoma and lobular carcinoma (88.46%). Interestingly, triple-negative breast cancer (TNBC) exhibited a high concordance rate (87.50%) compared to other molecular subtypes. When contrasting MDT-recommended treatments with CSCO AI decisions, an overall 92.4% agreement was established. Furthermore, a logistic multivariate analysis highlighted the statistical significance of age, menstrual status, tumor type, molecular subtype, tumor size, and TNM stage in influencing consistency.
    UNASSIGNED: In the realm of breast cancer treatment, the alignment between recommendations offered by CSCO AI and those from MDT is predominant. CSCO AI can be a useful tool for breast cancer treatment decisions.
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  • 文章类型: Case Reports
    肺泡横纹肌肉瘤是一种严重恶性软组织肉瘤,主要影响儿童和青少年。然而,在这种肿瘤导致上肢局部骨破坏的情况下,医学领域缺乏关于最佳手术方法的共识。
    一名17岁男性左前臂有肿块,CT和MRI显示肿块穿透尺骨皮质,浸润髓质,导致形成偏心的跨心室肿瘤病灶。相当大的肿瘤影响了前臂的掌侧肌肉以及尺骨骨髓,对尺动脉和静脉施加压力。穿刺活检证实肿块为肺泡横纹肌肉瘤。经过两个疗程的新辅助化疗,肿瘤被广泛切除。在手术过程中,使用带有血管蒂的自体腓骨进行重建。在术后随访中,未观察到肿瘤局部复发.此外,患者在左前臂保留了令人满意的腕关节屈曲和内旋功能。
    肺泡横纹肌肉瘤是一种罕见且高度侵袭性的软组织肉瘤。科学管理需要多学科的方法,化疗与手术相结合。如果肿瘤侵入骨腔,应该仔细考虑肿瘤切除的边界,截骨的范围,以及设计手术计划时肌肉骨骼重建的方法。通过报告我们自己的病例并彻底回顾以前的临床经验,我们旨在为这种特殊疾病的治疗提供有价值的见解。
    UNASSIGNED: Alveolar Rhabdomyosarcoma is a profoundly malignant soft-tissue sarcoma that predominantly affects children and adolescents. However, the medical field lacks consensus regarding the optimal surgical approach to be undertaken in cases where this tumor causes local bone destruction in the upper limb.
    UNASSIGNED: A 17-year-old male presented a mass in his left forearm and CT and MRI indicated that the mass had penetrated the ulnar cortex and infiltrating the medulla, resulting in the formation of an eccentric trans-ventricular tumor focus. The sizable tumor affected the volar muscles of the forearm as well as the ulnar bone marrow, exerting pressure on the ulnar artery and vein. It was confirmed by needle biopsy that the mass is alveolar rhabdomyosarcoma. Following two courses of neoadjuvant chemotherapy, the tumor was widely excised en bloc. Autologous fibula with a vascular pedicle was utilized for reconstruction during the procedure. In the postoperative follow-up, no local recurrence of the tumor was observed. Furthermore, the patient retained satisfactory wrist flexion and pronation function in the left forearm.
    UNASSIGNED: Alveolar rhabdomyosarcoma is an uncommon and highly aggressive form of soft tissue sarcoma. Scientific management necessitates a multidisciplinary approach, combining chemotherapy with surgery. In cases where the tumor invaded into compartment of the bone, careful consideration should be given to the boundaries of tumor resection, the extent of osteotomy, and the approach to musculoskeletal reconstruction when designing the surgical plan. Through reporting our own case and thoroughly reviewing previous clinical experiences, we aim to provide valuable insights for the treatment of this particular disease.
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  • 文章类型: Case Reports
    我们报告一例新生儿Carmi综合征。
    分享我们在Carmi综合征病例诊断方面的经验教训。
    Carmi综合征是一种极其罕见的常染色体隐性遗传病,其特征是幽门闭锁和交界性大疱性表皮松解症并存,大约28%的患者患有先天性皮肤发育不全。在这种情况下,一名足月男性新生儿在医院通过剖宫产分娩出生到G4P2+1L1经产妇,与4000mLII°胎粪染色羊水非血缘婚姻.他被发现小腿和其他部位大面积皮肤脱落,有分散的水疱和双侧小耳畸形。腹部X线平片显示胃气泡大,远端无气体。由于未知原因,母亲先前有宫内胎儿丢失。皮肤科医生诊断新生儿患有巴特综合症,而儿科外科医生诊断为先天性幽门闭锁(CPA)。父母拒绝进一步治疗,新生儿在出生后约30小时去世。
    新生儿出生后约30小时死亡。
    这个案例的教训:①。排除PA患者的Carmi综合征,并区分Bart综合征和Carmi综合征患者的皮肤异常表现。②.对于罕见和/或严重的疾病,应建立多学科小组(MDT)。③.在随后的生育之前,遗传咨询和产前诊断是必要的。④.如果发现某些指标,则可以考虑终止妊娠。
    UNASSIGNED: We report a case of Carmi Syndrome in a neonate.
    UNASSIGNED: To share our lessons in diagnosis of the case of Carmi Syndrome.
    UNASSIGNED: Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a G4P2+1L1 multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth.
    UNASSIGNED: The neonate passed away about 30 hours after birth.
    UNASSIGNED: Lessons from this case:①.Rule out Carmi Syndrome in patients with PA, and differentiate Bart syndrome and Carmi Syndrome in patients with abnormal skin manifestations. ②. For rare and/or severe diseases, multidisciplinary teams(MDTs) should be establish. ③. Genetic counseling and prenatal diagnosis are necessary prior to subsequent childbearings. ④.Termination of pregnancy might be contemplated if certain indicators are revealed.
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  • 文章类型: Journal Article
    同时进行TA-TAVR和Mckeown双重微创手术的病例非常罕见。临床特征的回顾性分析,1例老年食管癌合并中重度主动脉瓣反流患者的围手术期手术配合及护理.
    一名食管癌合并中重度主动脉瓣反流的老年患者入住胸外科,华西医院,四川大学2022年9月。通过术前MDT讨论,确定并分析了两种微创手术方案,以制定个性化和标准化的围手术期手术室护理和手术配合.均获得了知情书面同意和机构审查委员会的批准(编号:2021-879;2022年7月25日)用于手术和研究数据的发布。
    经过彻底的术前MDT讨论以及制定个性化和标准化的手术室护理计划,两次手术共持续5h35分钟,总出血量为150毫升。手术进行得很顺利,患者被送往ICU,并在手术后第二天转移回普通病房,没有并发症。
    同时进行双重微创IV级手术确实是一种高风险的程序,这对患者和医护人员来说都是一个新的挑战。标准化或护理计划和手术协调也是MDT的重要方面,反映OR护理在手术团队中也是不可或缺的角色。
    UNASSIGNED: Cases of simultaneous TA-TAVR and Mckeown dual minimally invasive surgery are very rare. A retrospective analysis of the clinical features, perioperative surgical cooperation and care of an elderly patient with esophageal cancer combined with moderate-to-severe aortic regurgitation.
    UNASSIGNED: An elderly patient with esophageal cancer combined with moderate to severe aortic valve regurgitation was admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University in September 2022. Through preoperative MDT discussion, two minimally invasive surgical options were identified and analyzed to develop personalized and standardized perioperative operating room care and surgical coordination. Informed written consent and institutional review board approval were both obtained (No. 2021-879; July 25, 2022) for the surgery and the publication of the study data.
    UNASSIGNED: After a thorough preoperative MDT discussion and the development of a personalized and standardized operating room care plan, the two surgeries lasted a total of 5h 35mins with a total bleeding volume of 150 ml. The surgeries went smoothly, and the patients were sent to the ICU and transferred back to the general ward on the second day after surgery without complications.
    UNASSIGNED: The simultaneous performance of dual minimally invasive level IV surgery is indeed a high-risk procedure, which is a new challenge for both patients and health care workers. Standardized OR care planning and surgical coordination are also important aspects of MDT, reflecting that OR care is an indispensable role in the surgical team as well.
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  • 文章类型: Journal Article
    癌症多学科团队(MDT)会议是顾问工作量的重要组成部分,然而,以前的文献表明,受训者在准备MDT工作时对他们目前的课程不满意。
    该教育试点评估了是否具有预定义学习目标的多专业模拟场景,可以准备专业注册商在MDT内进行交互。参与者完成了问卷前和问卷后评估的一些领域,包括:当前的培训经验,向患者展示信心,以及该课程是否会改变未来的实践。
    受训人员信心从5的平均值显着增加到7(平均到最接近的整数,p<0.01)。受训人员对会议的实用性和改变其未来实践的评价很高(两者的平均得分为9分,Outof10).
    模拟在其他多学科教学中取得了成功,然而,据我们所知,没有针对癌症的培训计划。我们的结果凸显了英国专业培训的潜在差距,并建议模拟可能有利于准备学员参加MDT会议。
    UNASSIGNED: Cancer multi-disciplinary team (MDT) meetings are an important component of consultant workload, however previous literature has suggested trainees are not satisfied with their current curriculum in preparing for MDT working.
    UNASSIGNED: This educational pilot assessed whether multi-speciality simulated scenarios with pre-defined learning objectives, could prepare specialist registrars for interacting within an MDT. Participants completed pre- and post-questionnaires assessing a number of areas including: current experience of training, confidence presenting patients and whether the course would alter future practice.
    UNASSIGNED: Trainee confidence increased significantly from a mean of 5 to 7 (mean to nearest whole number, p < 0.01). Trainees rated the session highly for utility and altering their future practice (mean scores of 9 for both respectively, out of 10).
    UNASSIGNED: Simulation has shown success in other multidisciplinary teaching, however to our knowledge there are no cancer specific training programmes. Our results highlight a potential gap in UK specialist training, and suggest simulation may be beneficial in preparing trainees to present in MDT meetings.
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  • 文章类型: Journal Article
    由于麻风病病例急剧下降,麻风病的发病率在过去几年一直保持稳定,表明多药治疗似乎无法根除麻风病。更严重的是,利福平耐药菌株的出现也会影响治疗的有效性.免疫预防主要通过BCG疫苗接种进行,但也包括LepVax和MiP等疫苗。同时,众所周知,感染和发病机制在很大程度上取决于宿主的遗传背景和免疫力,疾病的发作是由基因调控的。免疫过程严重影响疾病的临床进程。然而,麻风病的免疫过程和遗传调控对发病机制和免疫水平的影响在很大程度上是未知的。因此,总结麻风病治疗的最新研究进展,预防,免疫和基因功能。这些领域的综合研究将有助于阐明麻风病的发病机制,并为制定麻风病消除策略提供依据。
    Since the leprosy cases have fallen dramatically, the incidence of leprosy has remained stable over the past years, indicating that multidrug therapy seems unable to eradicate leprosy. More seriously, the emergence of rifampicin-resistant strains also affects the effectiveness of treatment. Immunoprophylaxis was mainly carried out through vaccination with the BCG but also included vaccines such as LepVax and MiP. Meanwhile, it is well known that the infection and pathogenesis largely depend on the host\'s genetic background and immunity, with the onset of the disease being genetically regulated. The immune process heavily influences the clinical course of the disease. However, the impact of immune processes and genetic regulation of leprosy on pathogenesis and immunological levels is largely unknown. Therefore, we summarize the latest research progress in leprosy treatment, prevention, immunity and gene function. The comprehensive research in these areas will help elucidate the pathogenesis of leprosy and provide a basis for developing leprosy elimination strategies.
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  • 文章类型: Journal Article
    为了进一步个性化治疗转移性癌症,转移导向局部治疗(MDT)的适应症和寡转移疾病(OMD)的生物学特性在概念上应该分开.两者都需要大力调查。肿瘤生长动力学-生长速率与转移性播种效率相结合-是决定MDT在个体患者中成功的可能性的最重要的生物学特征。这甚至可能对缓慢发展的多转移性疾病有益。这可以使用适当的临床成像进行合理的评估。在考虑MDT的适当适应症的背景下,因此,在图像分辨率的边缘检测转移应该建议推迟MDT。虽然通常使用三到五个病变来定义OMD,可以说,在转移性疾病的整个过程中,而不是特定的最大病变数量,可以作为指导MDT的更好参数。在这里,我们认为MDT作为转移性癌症的治疗选择的单位可能最好被定义为不是在单个时间点的单个程序。而是作为一系列治疗,可以在一个或多个疗程中随着时间的推移不同的病变。新出现的病变仍然适合MDT,而不会触发新的全身治疗的开始,系统治疗的改变,或者开始最佳的支持性治疗,因此不会构成MDT的失败。这将对临床试验和注册中的终点定义产生影响:而不是任何疾病进展,MDT失败仅在多转移性疾病进展时宣布,这就排除了MDT的进一步选择。
    To further personalise treatment in metastatic cancer, the indications for metastases-directed local therapy (MDT) and the biology of oligometastatic disease (OMD) should be kept conceptually apart. Both need to be vigorously investigated. Tumour growth dynamics - growth rate combined with metastatic seeding efficiency - is the single most important biological feature determining the likelihood of success of MDT in an individual patient, which might even be beneficial in slowly developing polymetastatic disease. This can be reasonably well assessed using appropriate clinical imaging. In the context of considering appropriate indications for MDT, detecting metastases at the edge of image resolution should therefore suggest postponing MDT. While three to five lesions are typically used to define OMD, it could be argued that countability throughout the course of metastatic disease, rather than a specific maximum number of lesions, could serve as a better parameter for guiding MDT. Here we argue that the unit of MDT as a treatment option in metastatic cancer might best be defined not as a single procedure at a single point in time, but as a series of treatments that can be delivered in a single or multiple sessions to different lesions over time. Newly emerging lesions that remain amenable to MDT without triggering the start of a new systemic treatment, a change in systemic therapy, or initiation of best supportive care, would thus not constitute a failure of MDT. This would have implications for defining endpoints in clinical trials and registries: Rather than with any disease progression, failure of MDT would only be declared when there is progression to polymetastatic disease, which then precludes further options for MDT.
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  • 文章类型: Journal Article
    这篇合作文章从由呼吸医师组成的多学科团队的角度对慢性肺曲霉病(CPA)进行了综述,放射科医生,真菌学家,营养师,药剂师,物理治疗师和姑息治疗专家。这篇综述综合了当前关于注册会计师的知识,强调临床,放射学,和微生物学方面。我们强调评估每位患者作为多学科团队的重要性,以确保个性化的治疗策略和全面的患者护理方法。
    This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care.
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  • 文章类型: Journal Article
    以患者为中心的护理(PCC)被认为是确定高质量的医疗保健标准。尊重患者的价值观,经验,需要,以及设计中的偏好,协调,提供护理强调了患者和医疗保健提供者之间治疗融洽的增强。伤口治疗涉及包括诊断和局部伤口敷料的多阶段过程。这通过一个协调的跨学科团队降低了感染的风险。在这个团队中,护士承担着特定的职业职能和角色。使用创新和科学证实的方法实施局部治疗可能会受到工作人员和患者自身知识不足或不适当知识的阻碍。这项研究提出了有关使用Luciliasericata幼虫治疗的慢性伤口患者护理的挑战,基于对当前科学文献的回顾。使用Medline对2002年至2022年的文献进行了批判性分析,PubMed,科克伦,和Termedia数据库,在接受和感知方面使用关键词,如“虫清创疗法”。作为初步选择的结果,472篇论文被确认,其中12种出版物被包括在这一概念的发展中。所获得的数据以表格的形式整理并呈现在结论部分,伴随着对个别研究的描述和参考。消极的心理和躯体感觉是使用Maggot清创疗法(MDT)治疗的患者中最突出的挑战之一。该组患者中与外周缺血或感染相关的疼痛需要预防疼痛,包括痛觉过敏和异常性疼痛,以提高方法公差。另一方面,增强患者对MDT的理解会减少负面情绪,加强积极的行为,并减轻焦虑程度。MDT是一种有效且安全的方法。其广泛用于慢性伤口需要医疗保健专业人员和患者教育的大量知识,以及他们的照顾者,培养积极的态度。
    Patient-centered care (PCC) is recognized as a standard in healthcare for determining high quality. Honoring patients\' values, experiences, needs, and preferences in devising, coordinating, and delivering care underscores the enhancement of the therapeutic rapport between patients and healthcare providers. Wound treatment involves a multi-stage process encompassing diagnostics and local wound dressing, which reduces the risk of infection through a coordinated interdisciplinary team. Within this team, nurses undertake specific professional functions and roles. The implementation of local therapy using innovative and scientifically substantiated methods may be hindered by a deficit of knowledge or inappropriate knowledge among staff and patients themselves. This study presents the challenges concerning the care of patients with chronic wounds treated using Lucilia sericata larvae, based on a review of the current scientific literature. A critical analysis of the literature spanning from 2002 to 2022 was conducted using the Medline, PubMed, Cochrane, and Termedia databases, employing keywords such as \"maggot debridement therapy\" in relation to acceptance and perception. As a result of the preliminary selection, 472 papers were identified, of which 12 publications were included in the development of this concept. The acquired data were organized and presented in the concluding section in the form of tables, accompanied by descriptions and references to individual studies. Negative psychological and somatic sensations were among the most prominent challenges among patients treated with Maggot Debridement Therapy (MDT). Pain related to peripheral ischemia or infection in this group of patients requires pain prophylaxis, including hyperalgesia and allodynia, in order to improve method tolerance. On the other hand, augmenting patients\' understanding of MDT diminishes negative emotions, reinforces positive behaviors, and mitigates anxiety levels. MDT constitutes an effective and safe method. Its widespread use for chronic wounds requires substantial knowledge among healthcare professionals and patient education, along with that of their caregivers, to develop a positive attitude.
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