Published on in Vol 12 (2023)

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Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Protocol for a Scoping Review

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Protocol for a Scoping Review

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Protocol for a Scoping Review


1University of Ottawa, Ottawa, ON, Canada

2The Ottawa Hospital, Ottawa, ON, Canada

3Bruyère Continuing Care, Ottawa, ON, Canada

4Alberta Health Services, Calgary, AB, Canada

Corresponding Author:

Chantal Backman, RN, MHA, PhD

University of Ottawa

451 Smyth Road

Ottawa, ON, K1N 6N5


Phone: 1 6135625800


Background: With the increased adoption of technology, the use of digital health interventions in health care settings has increased. Patient-clinician digital health interventions have the potential to improve patient care, especially during important transitions between hospital and home. Digital health interventions can provide support to patients during these transitions, thereby leading to better patient outcomes.

Objective: This scoping review aims to explore the available literature, specifically (1) to examine the impact of platform-based digital health interventions focused on care transitions on patient outcomes, and (2) to identify the barriers to and enablers for the uptake and implementation of these digital health interventions.

Methods: This protocol was developed based on Arksey and O’Malley’s, Levac and colleagues’, and JBI scoping review methodologies, and it has been reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews) format. The search strategies were developed for 4 databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials by using key words such as “hospital to home transition” and “platform-based digital health.” Studies involving patients 16 years or older that used a platform-based digital health intervention during their hospital to home transition will be included in this review. Two reviewers will independently screen articles for eligibility by using a 2-stage process (ie, title and abstract screening and full-text screening). We expect to refine the eligibility criteria during the title and abstract screening process as we anticipate retrieving a significant number of articles. In addition, we will also perform a targeted search of the grey literature, as well as data extraction. Data analysis will consist of a narrative and descriptive synthesis.

Results: The review is expected to identify research gaps that will inform the development of future patient-clinician digital health interventions. We have identified a total of 8333 articles. Screening began in September 2022, and data extraction is expected to commence in February 2023 and end by April 2023. Data analyses and final results will be submitted to a peer-reviewed journal in August 2023.

Conclusions: We expect to find a wide variety of postcare interventions, some gaps in the quality of research evidence, as well as a lack of detailed information on digital health interventions.

International Registered Report Identifier (IRRID): PRR1-10.2196/42056

JMIR Res Protoc 2023;12:e42056



Patient-clinician digital health interventions have been described by the World Health Organization as “targeted patient/client communication” [1] and have become increasingly popular in health care settings [2]. Such interventions can support patients and caregivers in navigating a complex health system by utilizing information technologies to facilitate communication between parties [1,3]. Digital health interventions that use platform-based technology to facilitate communication and information-sharing between patients and clinicians have the potential to improve care coordination and outcomes during care transitions.

Specifically, asynchronous digital platforms such as web-based or mobile applications contain information that is shared or stored between patients and clinicians. These digital platforms often include patient information and education for discharge planning, follow-up appointments and services, patient empowerment and engagement, and health status updates [1]. In a recent scoping review by Zhang and colleagues [4], the role of digital health interventions for patients with hip fractures was examined. Results of the scoping review indicated that digital health interventions were generally used to support health care providers in the care of such patients. In another systematic review by Free and colleagues [3], digital health interventions were shown to have increased the engagement of patients in their health care journey and a corresponding reduction in hospital admissions.

Engaging patients in their care through digital health interventions is possible given the widespread use of internet-based personal communication devices [5] and the effective use of such interventions with patients and their clinicians. Although asynchronous digital platforms can sometimes be challenging, especially in relation to technological issues [6], successful use of these platforms has been described with patients living with diabetes [7,8], cardiovascular disease [9,10], chronic obstructive pulmonary disease [11], and patients recovering post surgery [12-14].

The multi-service and multi-sector coordination of care after an acute event or diagnosis can be complicated for patients and caregivers to navigate. After acute care admission, patients often receive inadequate information about discharge instructions [15], whereas others have unanswered questions [16]. Some studies have described how patients may experience poor retention of verbal instructions during post-discharge periods [17,18], and how effective education and written discharge instructions may help improve a patient’s understanding and facilitate transition from hospital to home [19-23]. A critical gap that has been identified is poor communication between clinicians and patients and their caregivers [24,25]. Digital health interventions can provide opportunities for ongoing support from clinicians to patients and their caregivers [12], which can improve the overall level of communication and lead to better adherence to care instructions [26].

The emerging research highlighting the benefits of patient engagement [27] reinforces the importance of developing patient-centered discharge planning processes [28]. This may include education for patients and their caregivers regarding their health conditions, medication, and common symptoms; a mechanism for exchanging questions and obtaining feedback from patients; and guidance on when to seek appropriate medical care or follow-ups. Using integrated [29] and holistic patient and caregiver interventions [19-23,30], and digital platforms [31] in particular, can help minimize avoidable readmissions and other challenges with the transition of patients from hospital to their homes. Digital health interventions should be inclusive and consider unique patient characteristics such as age, disability, and level of cognition to optimize success [32]. The usability of digital health interventions for patients and clinicians is also crucial for their successful uptake [33].

Despite the widespread development and use of information technology [5], the desire of patients and caregivers for readily available information [34], and the need for better engaging patients in their care process to optimize patient outcomes, only limited research has examined the specific platform-based patient-clinician digital health interventions that are in use for discharge and care transitions.

Our goal is to explore the available literature, specifically (1) to examine the impact of platform-based digital health interventions specific to care transitions on patient outcomes, and (2) to identify the barriers to and enablers for the uptake and implementation of these digital health interventions. The findings from this work would inform future work on the “MyPath to Home” digital health intervention [35].

Protocol Design

This protocol was developed based on Arksey and O’Malley’s [36] methodology, elaborated by Levac and colleagues [37] and JBI Manual for Evidence Synthesis [38], which involves the following stages: (1) identify the research question; (2) identify relevant studies: (3) select studies; (4) chart the data; and (5) collate, synthesize, and report results. For this protocol, we also followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews) reporting format [39].

Stage 1: Identify the Research Question

The research questions guiding this scoping review are as follows: 

  1. What is the impact of platform-based patient-clinician digital health interventions used for discharge or care transitions on patient outcomes?
  2. What are the barriers to and enablers for the uptake and implementation of these interventions for clinicians and patients transitioning from hospital to home?

Stage 2: Identify Relevant Studies

A comprehensive search strategy will be developed by an information specialist relevant to MEDLINE, CINAHL, Embase, and the Cochrane Central Register for Controlled Trials. The MEDLINE strategy will be peer-reviewed by another information specialist according to the PRESS (Peer Review of Electronic Search Strategies) guidelines [40]. The search strategies are available in Multimedia Appendix 1.

Once the searches have been completed, the results will be exported to Covidence [41] for storage, removal of duplicates, and screening. In addition, we will conduct a manual search of the references from the included studies and a targeted grey literature search of [42] and the International Clinical Trials Registry Platform Search Portal [43], as well as key digital health technology websites.

Stage 3: Select Studies

Preliminary inclusion criteria are defined following the Population, Concept, Context (PCC) format:

  • Population: Patients (16 years or older) recruited before hospital discharge;
  • Concept: Postcare interventions (eg, self-care, symptom monitoring, pain control and management, mobilization, follow-up appointments, ability to ask questions) using any asynchronous digital platforms such as web-based or mobile applications where information is shared or stored between patients and clinicians; and
  • Context: Discharge episode from hospital to the community.

We will include primary studies (ie, randomized controlled trials [RCTs], quasi-experimental studies, pilot or feasibility studies, observational studies [case-control, cohort, cross-sectional, and descriptive studies], and qualitative studies) published between 2012 and 2022. Preliminary exclusion criteria will include: (1) pediatric, newborn care, mental health, and cancer populations; (2) synchronous non–platform-based digital health care interventions (eg, chat platform, wearable devices, prosthetics, robotics, medical imaging technology such as x-rays and ultrasounds, interventions only using a standard telephone); and (3) nonprimary studies (eg, commentaries, editorials, study protocols, and policy briefs).

Study selection will be performed independently by two reviewers (AF and RP) in two steps: (1) screening of abstracts and titles and (2) screening of full-text articles. Any disagreement in screening decisions will be resolved through discussion among the reviewers or by a third reviewer (CB). A list of the excluded studies from the full-text review will be reported using the PRISMA-ScR reporting format [39].

Stage 4: Chart the Data

Two reviewers (AF and RP) will independently pilot the data extraction by using a form designed in Microsoft Excel (Microsoft Corp.). These reviewers will then independently extract the data from the eligible studies. Data extracted will include authors, year of publication, study location, purpose, study design, theoretical approach, study population, description of intervention (and comparator), data analysis, and study results or outcomes (eg, patient outcomes, barriers, and enablers). To describe the interventions, we will follow recommendations from the Template for Intervention Description and Replication checklist [44], comprising brief name of the intervention; why; materials used; procedures; who provided; how; where; when and how much; tailoring; modifications; how well (planned); and how well (implemented).

Stage 5: Collate, Synthesize, and Report Results

We will conduct a narrative data synthesis, including quantitative descriptive analyses for quantitative studies and thematic analyses for qualitative studies. We will group data into tables by type of intervention, and by outcomes or findings.

For the barriers and enablers analysis, we will group the findings using the 14 domains of the Theoretical Domain Framework: knowledge, skills, social or professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, goals, memory, attention, and decision processes, environmental context and resources, social influences, emotion, and behavioral regulation [45-47]. Specifically, the analysis will follow 3 steps. First, two reviewers (AF and RP) will independently map the findings to each of the Theoretical Domain Framework domains. Second, similar findings will be themed and grouped together. Third, each theme will be coded as either a barrier or an enabler. We will report the top barriers and enablers using descriptive statistics (eg, frequency and percentage for each barrier and enabler). Disagreements will be discussed and resolved by the two reviewers (AF and RP) or by consulting a third reviewer (CB).

The scoping review began in September 2022 and is expected to be completed in August 2023. We have identified a total of 8333 articles. The screening process took place between September 2022 and February 2023, and data extraction is expected to be completed in April 2023. Data analyses and final results will be submitted to a peer-reviewed journal in August 2023.

Through this review, we intend to provide an overview of the current state of research on platform-based, patient-clinician digital health interventions for care transitions, including a discussion of the different types of platforms and interventions that have been studied, the evidence for their effectiveness, and the barriers to and enablers for future research in this area.

Overall, we will provide a comprehensive picture of the current state of knowledge on the use of digital health interventions in care transitions, and the potential for these interventions to improve patient outcomes. We expect to find a wide variety of postcare interventions, some gaps in the quality of the research evidence, as well as a lack of detailed information on the digital health interventions. Our results will include an overview of patient-clinician digital health interventions for discharge or care transitions, as well as barriers to and enablers for their implementation. In addition, this review is expected to identify research gaps that will inform the development of future patient-clinician digital health interventions.

Our review has several strengths and limitations. We designed an in-depth a priori protocol. The search strategy was developed and peer-reviewed by a research librarian with extensive knowledge in scoping and systematic reviews.  However, we anticipate that the digital health interventions will be heterogeneous, making it more difficult to make comparisons and draw specific conclusions.

The results of our review would be beneficial to various stakeholders such as researchers, clinicians, administrators, and policymakers. We will disseminate our findings through publication in a peer-reviewed journal as well as by presenting our results at a scientific conference.


We thank Valentina Ly, MLIS (Health Sciences Library, University of Ottawa) for peer review of the MEDLINE search strategy and Rosie Papp for assisting with the full-text screening and data extraction.

Conflicts of Interest

None declared.

Multimedia Appendix 1

Search strategies.

DOCX File , 22 KB

  1. World Health Organization. Recommendations on digital interventions for health system strengthening. 2019 Jun 06.   URL: [accessed 2022-05-03]
  2. Meskó B, Drobni Z, Bényei É, Gergely B, Győrffy Z. Digital health is a cultural transformation of traditional healthcare. Mhealth 2017 Sep;3:38 [FREE Full text] [CrossRef] [Medline]
  3. Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med 2013 Jan 15;10(1):e1001363 [FREE Full text] [CrossRef] [Medline]
  4. Zhang J, Yang M, Ge Y, Ivers R, Webster R, Tian M. The role of digital health for post-surgery care of older patients with hip fracture: a scoping review. Int J Med Inform 2022 Apr;160:104709 [FREE Full text] [CrossRef] [Medline]
  5. Dobkin BH, Dorsch A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil Neural Repair 2011;25(9):788-798 [FREE Full text] [CrossRef] [Medline]
  6. Iyamu I, Gómez-Ramírez O, Xu AX, Chang H, Watt S, Mckee G, et al. Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review. Digit Health 2022;8:20552076221102255 [FREE Full text] [CrossRef] [Medline]
  7. Wayne N, Perez DF, Kaplan DM, Ritvo P. Health coaching reduces HbA1c in type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial. J Med Internet Res 2015 Oct 05;17(10):e224 [FREE Full text] [CrossRef] [Medline]
  8. Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res 2012 May 08;14(3):e70 [FREE Full text] [CrossRef] [Medline]
  9. Hale TM, Jethwani K, Kandola MS, Saldana F, Kvedar JC. A remote medication monitoring system for chronic heart failure patients to reduce readmissions: a two-arm randomized pilot study. J Med Internet Res 2016 Apr 17;18(5):e91 [FREE Full text] [CrossRef] [Medline]
  10. Morken IM, Storm M, Søreide JA, Urstad KH, Karlsen B, Husebø AML. Posthospitalization follow-up of patients with heart failure using eHealth solutions: restricted systematic review. J Med Internet Res 2022 Feb 15;24(2):e32946 [FREE Full text] [CrossRef] [Medline]
  11. Fairbrother P, Pinnock H, Hanley J, McCloughan L, Sheikh A, Pagliari C, et al. Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. Patient Educ Couns 2013 Dec;93(3):403-410. [CrossRef] [Medline]
  12. Wikström L, Schildmeijer K, Nylander EM, Eriksson K. Patients' and providers' perspectives on e-health applications designed for self-care in association with surgery - a scoping review. BMC Health Serv Res 2022 Mar 23;22(1):386 [FREE Full text] [CrossRef] [Medline]
  13. Dawes AJ, Lin AY, Varghese C, Russell MM, Lin AY. Mobile health technology for remote home monitoring after surgery: a meta-analysis. Br J Surg 2021 Nov 11;108(11):1304-1314. [CrossRef] [Medline]
  14. van der Meij E, Anema JR, Otten RHJ, Huirne JAF, Schaafsma FG. The effect of perioperative e-health interventions on the postoperative course: a systematic review of randomised and non-randomised controlled trials. PLoS One 2016 Jul 6;11(7):e0158612 [FREE Full text] [CrossRef] [Medline]
  15. Enhancing the Continuum of Care – Report of the Avoidable Hospitalization Advisory Panel. Ontario Ministry of Health and Long-Term Care. 2011 Nov.   URL: [accessed 2023-02-21]
  16. Rognan SE, Kälvemark Sporrong S, Bengtsson K, Lie HB, Andersson Y, Mowé M, et al. Discharge processes and medicines communication from the patient perspective: a qualitative study at an internal medicines ward in Norway. Health Expect 2021 Jun;24(3):892-904 [FREE Full text] [CrossRef] [Medline]
  17. Krumholz HM. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med 2013 Jan 10;368(2):100-102 [FREE Full text] [CrossRef] [Medline]
  18. Rao M, Fogarty P. What did the doctor say? J Obstet Gynaecol 2009 Jul 02;27(5):479-480 [FREE Full text] [CrossRef]
  19. Horwitz LI, Moriarty JP, Chen C, Fogerty RL, Brewster UC, Kanade S, et al. Quality of discharge practices and patient understanding at an academic medical center. JAMA Intern Med 2013 Oct 14;173(18):1715-1722 [FREE Full text] [CrossRef] [Medline]
  20. Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 2005 Aug;80(8):991-994. [CrossRef] [Medline]
  21. Al-Damluji MS, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, et al. Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes 2015 Jan;8(1):77-86 [FREE Full text] [CrossRef] [Medline]
  22. Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med 2014 Jul 01;174(7):1095-1107 [FREE Full text] [CrossRef] [Medline]
  23. Okrainec K, Lau D, Abrams H, Hahn-Goldberg S, Brahmbhatt R, Huynh T, et al. Impact of patient-centered discharge tools: a systematic review. J Hosp Med 2017 Feb;12(2):110-117. [CrossRef] [Medline]
  24. Backman C, Stacey D, Crick M, Cho-Young D, Marck PB. Use of participatory visual narrative methods to explore older adults' experiences of managing multiple chronic conditions during care transitions. BMC Health Serv Res 2018 Jun 20;18(1):482 [FREE Full text] [CrossRef] [Medline]
  25. Ghazzawi A, Kuziemsky C, O'Sullivan T. Using a complex adaptive system lens to understand family caregiving experiences navigating the stroke rehabilitation system. BMC Health Serv Res 2016 Oct 01;16(1):538 [FREE Full text] [CrossRef] [Medline]
  26. Chang P, Lin L, Zhang H, Zhao Y, Xie J, Yu Y, et al. Effect of smartphone application assisted medical service on follow-up adherence improvement in pediatric cataract patients. Graefes Arch Clin Exp Ophthalmol 2018 Oct 30;256(10):1923-1931. [CrossRef] [Medline]
  27. Baker GR. Evidence boost: a review of research highlighting how patient engagement contributes to improved care. Canadian Foundation for Healthcare Improvement. 2014 Aug.   URL: https:/​/www.​​docs/​default-source/​itr/​tools-and-resources/​evidenceboost-rossbaker-peimprovedcare-e.​pdf [accessed 2023-02-24]
  28. Health SFROMOHTC2. Available: programs/ecfa/funding/hs_funding. aspx.   URL: [accessed 2023-02-23]
  29. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 2004 Oct 05;141(7):533-536. [CrossRef] [Medline]
  30. Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 2014 Aug 15;14(1):346 [FREE Full text] [CrossRef] [Medline]
  31. Mashhadi SF, Hisam A, Sikander S, Rathore MA, Rifaq F, Khan SA, et al. Post discharge mHealth and teach-back communication effectiveness on hospital readmissions: a systematic review. Int J Environ Res Public Health 2021 Oct 04;18(19) [FREE Full text] [CrossRef] [Medline]
  32. Kokorelias KM, Nelson ML, Tang T, Steele Gray C, Ellen M, Plett D, et al. Inclusion of older adults in digital health technologies to support hospital-to-home transitions: secondary analysis of a rapid review and equity-informed recommendations. JMIR Aging 2022 Apr 27;5(2):e35925 [FREE Full text] [CrossRef] [Medline]
  33. Patel B, Thind A. Usability of mobile health apps for postoperative care: systematic review. JMIR Perioper Med 2020 Jul 20;3(2):e19099 [FREE Full text] [CrossRef] [Medline]
  34. Elliott J, Forbes D, Chesworth BM, Ceci C, Stolee P. Information sharing with rural family caregivers during care transitions of hip fracture patients. Int J Integr Care 2014 Apr 16;14(2):e018 [FREE Full text] [CrossRef] [Medline]
  35. Backman C, Harley A, Kuziemsky C, Mercer J, Peyton L. MyPath to Home web-based application for the geriatric rehabilitation program at Bruyère Continuing Care: user-centered design and feasibility testing study. JMIR Form Res 2020 Sep 14;4(9):e18169 [FREE Full text] [CrossRef] [Medline]
  36. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005 Feb;8(1):19-32. [CrossRef]
  37. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010 Sep 20;5:69 [FREE Full text] [CrossRef] [Medline]
  38. Peters M, Godfrey C, Mclnerney P, Munn Z, Tricco A, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020.
  39. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018 Oct 02;169(7):467-473 [FREE Full text] [CrossRef] [Medline]
  40. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 2016 Jul;75:40-46 [FREE Full text] [CrossRef] [Medline]
  41. A Cochrane technology program. Covidence.   URL: [accessed 2022-05-03]
  42. U.S. National Library of Medicine   URL: [accessed 2023-02-22]
  43. ICTRP Search Portal.: World Health Organization   URL: [accessed 2023-02-22]
  44. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014 Mar 07;348(mar07 3):g1687-g1687 [FREE Full text] [CrossRef] [Medline]
  45. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005 Feb 01;14(1):26-33 [FREE Full text] [CrossRef] [Medline]
  46. Atkins L, Francis J, Islam R, O'Connor D, Patey A, Ivers N, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci 2017 Jun 21;12(1):77 [FREE Full text] [CrossRef] [Medline]
  47. Michie S, Atkins L, West R. The behaviour change wheel. A guide to designing interventions 1st ed Great Britain: Silverback Publishin; 2014.

PCC: Population, Concept, Context
PRESS: Peer Review of Electronic Search Strategies
PRISMA-ScR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews

Edited by T Leung; submitted 19.08.22; peer-reviewed by A Bucher, W Tumuhimbise; comments to author 25.12.22; revised version received 18.01.23; accepted 24.01.23; published 05.04.23


©Chantal Backman, Steve Papp, Anne Harley, Aurelie Tonjock Kolle, Sarah Visintini, Soha Shah, Randa Berdusco, Stéphane Poitras, Paul E Beaulé, Veronique French-Merkley. Originally published in JMIR Research Protocols (, 05.04.2023.

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