Archive for the ‘Communication skills’ Category

Illegible Medical Records based on a chapter by Peter Berge JD, MPA, PA

Wednesday, December 23rd, 2009
Waht is the name of the drug?

What is the name of the drug?

In 2009, people’s lives still hinge upon correct interpretation of handwritten records. Some handwritten records are virtually, or actually, illegible. The prescription above was written for Femara. Premarin was dispensed and harmed the patient who received it.

Plaintiff’s and defense attorneys and other reviewers should be familiar with state laws or regulations that permit the patient (or her representative) to require the healthcare provider to provide a timely transcription of notes. Defense attorneys are not likely to require transcriptions as they are representing the provider, who (if required) would voluntarily produce them. This can be very helpful in expediting the evaluation of otherwise opaque records in the setting of pretrial investigation. If transcriptions were not obtained during the investigative phase, they should be demanded after suit is filed if there is any doubt as to the interpretation of notations.

Regardless of when transcriptions were created, it is important for plaintiff’s counsel during depositions to verify the accuracy of the transcription. It is surprisingly common to find errors in transcription, especially when it turns out that opposing counsel provided the document without verifying the content with the witness.

Defense counsel will often have the advantage of direct access to defendants for assistance in deciphering medical records, except when dealing with the records of individuals with separate counsel. When in doubt, it is prudent to have the client interpret any handwritten notations of questionable legibility. There will be times, however, when the healthcare provider has no more idea of what the note says than the attorney does. While computerized records have some flaws, they eliminate guessing with people’s lives.

Modified from Peter Berge, JD, MPA,  PA. “Attorney Use of Medical Records in a Medical Malpractice Case”, from Patricia Iyer and Barbara Levin, Medical Legal Aspects of Medical Records, Second Edition, 2010.

Contact us for ordering information.

Read more about Med League’s services in medical record analysis.

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What Presenters Can Learn from Dancing with the Stars by Guest Author Stephanie Scotti

Monday, December 14th, 2009

What can you learn from Dancing with the Stars?

What can you learn from Dancing with the Stars?

Want to know a not-so-well-kept secret? I’m a “Dancing with the Stars” (DWTS) junkie. If you have yet to watch this hugely popular TV show, give it a try – it’s pure entertainment.

But what does a show about ballroom dancing have to do with giving a presentation? Everything! You see, both are live performances with high stakes. And just like DWTS contestants must both rehearse and mentally prepare for their performances each week, you should have a similar “ritual” to get ready for each and every presentation.

Lessons in becoming more memorable
Even if you’ve a crafted a wonderfully compelling story, effectiveness as a presenter is all in the telling. To ensure that your message sticks with your audience long after you’ve left the stage, try this effective five-step pre-performance ritual:

1. Rehearse aloud.
Like DWTS’ intensive dance rehearsals, now’s the time to work out any kinks. And the only way to be sure your content and delivery truly “work” is to practice aloud. Eliminate words you find hard to pronounce, determine pacing, and find where to pause or add emphasis. Recognize that a great deal of editing and rewriting can take place during your rehearsals.

2. Scout your presentation venue by arriving early.
My suggestion? Plan to arrive at the venue at least 30 minutes prior to your scheduled start time. Get comfortable, familiarize yourself with the room, test any equipment and troubleshoot any logistical problems.

3. Meet and greet.
As people arrive, circulate and introduce yourself to members of your audience. It’s the equivalent of DWTS competitors working the crowd and winning fans before they take the stage. Try to find out a little bit about attendees and their interest in your topic. This way, you’re gazing at familiar faces while you talk, and can use their names or reference their anecdotal comments as appropriate. This alone will help keep your audience alert and plugged in.

4. Practice the introduction.
Seek out the person who will be introducing you. Making a personal connection can transform a boring recitation of facts and figures into a friendly, engaging introduction that sets you up for success. I always ask the person who is introducing me to wait for me by the podium so I can shake his or her hand and have a “warm” hand-off.

5. Lights, camera, action!
You are “on” from the moment you’re introduced, so approach the podium with a confident stride and shake hands with your introducer. But remember, your audience is not quite ready for you to jump into your presentation – even if you’re having an adrenaline rush. Before you say a word, take a breath, look out and smile. Those few seconds allow everyone to settle down, change gears and prepare for your presentation.

Whether waltzing on national television or presenting last quarter’s sales figures, all performers have one thing in common – when the lights go on, they must be ready to give it their all. By integrating these five steps into your preparation ritual, you’ll handle the podium as gracefully as the stars handle the dance floor.

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4 More Tips to Boost Sales by Guest Author Caryn Kopp

Monday, November 16th, 2009

guyonphonesm1. Look through your files and make a list of prospect decision-makers you’ve met, but have not closed sales with. Call to schedule meetings to discuss what is new since you last spoke, and whether there is an opportunity to work together now. Projects can come off hold and prospects can misplace your contact information. Make the most of the time you already invested in developing business. Stay in touch and be top-of-mind so when the dollars are on the table, you will be there to collect.

2. Look through your pending proposals and identify 3 strategy ideas which will move each proposal closer to a close. Choose the best one for each and execute! Here are a few suggestions. You can email the decision maker a direct question, “I want to be sure I am providing you with the support you need. Is the proposal, as outlined, exactly what you are looking for?” Another idea is to contact your prospect via email or phone noting that you would like to stop in to discuss a slight adjustment to the current proposal which provides additional benefits. Or, perhaps you can discuss a new opportunity. These strategies will help elicit a response and move your sale toward a close. (HINT: Ask for a follow up date and time when the decision-maker initially asks you for the proposal. That is when the proposal is MOST important to your client/prospect. At that moment, securing a next step is easy. Trying to get someone back on the phone to discuss it later can be time consuming and sometimes futile.)

3. Half-day HOORAY! Make calls after 2 pm on the Friday before a holiday weekend, and you will reach those hard-to-reach decision-makers without their gatekeepers answering the phone. Office staff usually goes home at 2 pm, leaving your decision-maker at the desk, relaxed and ready for your call! Were you thinking of leaving early that day? So is your competition. Don’t miss this valuable opportunity!

4. Prospect Purge. Delete prospects that don’t belong on your list. If they are not “A’s”, “B’s” or “C’s”, they aren’t worth your valuable time. This is true for referrals, as well. Just because you were given a referral doesn’t mean you should call. Spend your time on prospects you WANT to do business with. Check against your criteria and move on if it doesn’t fit. This will streamline your new business efforts with less stress and more financial success!

See this for more ideas.

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So You Want to be Published: Tips From an Experienced Author by Pat Iyer

Wednesday, November 11th, 2009

typing On October 15, 2009, I was interviewed by Dick Bruso, the chair of the National Speakers Association Writers and Publishers Professional Expert Group, for a teleseminar. I have written, coauthored, or edited over 120 books, online courses, chapters, case studies and articles.

Here are my top ten tips for having an article published.
1. Think about the purpose of getting published. Is it to present yourself as an expert? Is it to obtain speaking opportunities? Is it to share knowledge with other colleagues? Is it for career advancement? What is motivating you? This motivation will help you stay focused as you work on an article.
2. Determine where you want to get published. There are opportunities to have articles published on ezine sites and in traditional print journals.
3. If you decide to target a print journal, study past issues. Look at the target market of the readership. Look at the length and style of the journal.
4. Determine the publisher’s guidelines for formatting the manuscript and follow them exactly. For example, they may specify length of manuscript, or not placing your name on certain pages so as to conceal your identity from a reviewer.
5. Pick a subject that really interests you. If the article is successful and achieves the outcomes you specified in point 1 above, you may be living with subject matter for a long time.
6. Develop an outline for your material from the sources you have gathered.
7. At the top of each source you have collected (articles, book chapters, printed internet sites), write the letter that corresponds with the point in the outline.
8. Gather all of the sources that deal with the first point on your outline. Write that section, then move onto the second point. Work your way through the sources.
9. Submit the article to the publisher, and wait for reactions. Peer reviewed journals will use reviewers to go through your submission and make recommendations for publishing or changing the content. Learn from their feedback and resubmit.
10. Don’t expect to get rich off any article submission fee that may be paid to you. The doors that open will be the reward.
Learn more

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Presentation v. Conversation by Guest Author Stephanie Scotti

Monday, November 9th, 2009

Why overcoming nerves may be as simple as a shift in perspective
Do you sometimes doubt your ability to present well? The truth is, there’s not much difference between a presentation and a conversation. A presentation is nothing more than a conversation on a larger scale – perhaps with more purpose, more clarity, and some preparation, but a conversation nonetheless.

You… shy?
I work out with a fantastic personal trainer. He comes across as smart, entertaining, perceptive and very motivating. (I actually look forward to our sessions!) I asked him recently if he ever thought about building his business by making presentations within companies that want to promote health and fitness to their employees. He looked at me as if I had just suggested we head to McDonald’s for a healthy snack. Turns out he’s petrified of public speaking.

How could someone who’s so great at conversation lack the confidence to talk to more than one person at a time? Too often, people fail to appreciate their own strengths or see a broader use for the things they do well.

What skills do you use?
Think about it. When you’re having a conversation – with a friend, colleague, spouse, about something serious or frivolous – you use the same skills that make people good presenters, without thinking about it consciously.

You use words to communicate your thoughts
You use a tone that matches the subject (light, heavy, funny, sad, etc.)
You make sure the person can hear you
You use your hands, body and facial expressions for emphasis
You look directly at who you’re talking to

Sounds like what you do when making a presentation, doesn’t it? Of course it does! Think about that the next time you doubt your abilities.

Expanding the conversation

Yes, there are of course some differences between having a conversation and giving a presentation:

Proximity: Generally you’re much closer to your “audience” when having a conversation.
Pace: Most presentations are given at a slower pace than when speaking to a friend.
Tools: Rarely do we have conversations that involve a microphone!
Structure: Conversations are generally much less structured in language and format than more formal presentations.

But upon close examination, the similarities far outweigh the differences.

With a slight shift in thinking, it’s easy to start viewing a presentation as an enlarged and directed conversation…one that you’ve had the time to practice and prepare for. As for my trainer, we had a conversation about it and now he’s starting to look at public speaking from a slightly different perspective.

If similar fears have been holding you back, maybe it’s time you shift your perspective.

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The Stress of Leadership by Guest Author Sharyn Mosca

Wednesday, October 28th, 2009

Stress- When you are at the end of a frayed rope

Stress- When you at the end of a frayed rope

As the demands placed upon leaders increase, so does the level of stress. Researchers agree that a certain amount of stress is necessary to maintain vitality and a zest for life. However, too much stress can cause health problems, impair performance and curtail your creativity. It is important to step back and take stock of the stressors in your life and reevaluate how you might tackle them. It is the intent of this article to broaden your awareness of commonly shared work place stressors and ways to better diagnose your particular needs.

The Center for Creative Leadership in Greensboro, North Carolina (CCL) did several interesting surveys recently. * They sought out to find if particular issues or people were causing the most stress for leaders at work. Here is what they found:

Causes- the “What”
The number 1 cause of stress, according to the leaders surveyed, is trying to do more with fewer resources and do it faster. Other stress-contributing factors included;

• Developing people
• Managing limited resources
• Physical demands from travel, working hours and the work environment
• Motivating employees and providing feedback
• Making decisions
• Increased job responsibilities

Interestingly, interpersonal demands of leadership such as establishing and maintaining relationships were also cited as somewhat stressful. Managing difficult interpersonal issues such as difficult personalities, political maneuvering or conflict… not surprisingly, contributed highly as well.

Causes-the “Who”
CCL’s research also sought to uncover if there was a particular person(s) within working relationships that was a primary stressor? Was the boss usually the cause of stress? Their results showed that there was no one group to blame. That is, leaders reported experiencing stress equally from their bosses, peers, direct reports, and customers. However, while no one group caused more stress than any other group, the reasons for the stress differed.

Stress from the boss usually tended to emerge when people felt a lack of support or respect. Management style differences were also cited as a key factor for provoking stress. From peers, being overly competitive and demonstrating no inclination toward teamwork were the primary sources of stress. From direct reports, poor performance was the primary stress factor, and from customers, experiencing unreasonable demands or unreasonable expectations.

How Can I Become Better at Managing my Stress?

Probably, a good place to start would be to assess your current level of stress, more methodically and objectively. Responses to stress are very unique to the individual, and complex. We “feel” stress, but often do not have a good handle on our current stress managing “strengths” and stress-managing weaknesses or vulnerabilities, i.e. “my needs, my temperament, my way of looking at the world”. There are several good assessment tools available that can really help people really figure out all the factors involved, and target specific steps to remedy them.

“Stress is not what happens to us. It’s our response TO what happens. And RESPONSE is something we can choose.” Maureen Killoran

What Would Such an Assessment Uncover?

• A closer examination of your current environment, discerning the unique changes, pressures and satisfactions that are a part of your everyday world. An opportunity to see the whole of professional and personal issues and how they manifest as stress.
• Your current coping responses and their effectiveness.
• Insights into your current proficiency with basic skills that really help you manage under stressful situations. Skills such as; how to seek support, becoming more adaptable or learning how to manage your time more effectively.
• More discoveries into your inner world of thoughts and feelings. Behaviors such as having a positive outlook, connecting to others, expression and compassion are huge components in successful stress management.

What then?
When you uncover the full range of factors, more intelligent choices can be made for improving. Some examples;

• Basic time management techniques can be easily learned, but an unattended behavior of procrastination or avoidance will thwart any time management technique.
• Or, consider the person who has long forgotten how to give feedback, or receive feedback in a positive way. Rediscovering the importance of expressing yourself can be most effective when coupled with proper feedback techniques.
• Knowing how and when to seek support and confide in others is hugely important in managing stress, but happens only when people trust. Exploring your current trust “radius” may provide you with more information.

An honest assessment of cause and effect will put you in a place to choose more authentically, where and who you want to be.

“If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you have the power to revoke at any moment.” Marcus Aurelius

__________________________
Source
* Leading Effectively e-Newsletter. Center for Creative Leadership; June 2007

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Boost Sales by Guest Author Caryn Kopp

Wednesday, October 7th, 2009

Call your A prospects to get more business

Call your A prospects to get more business

Do you need to drum up new business? Here are three top tips for doing so.

1. Add 20 new “A” level prospects to your list and call them. An “A” level prospect is the person you most want to do business with. He/she buys the right amount, at the right price, in the right time frame. Criteria for an “A” level prospect can include industry, size of company, department, level of decision-maker and geography. To determine the makeup of your “A” level prospects, look at the makeup of your “A” level customers. Then, using the criteria, replicate the recipe. Block out a minimum of 1 hour twice a week with your phone off, email closed, Blackberry off, cell phone off and hammer away at the prospect list. You may even need to hang a “Do Not Disturb” sign on your office door!

2. Catch up with your current clients, and upsell by offering incremental programs and add-on services. Capture “Sweep-up Dollars” from the “use it or lose it by year end” client budget. One Sales Director in the media industry called one of his clients and said, “We have a really interesting program, and if you have any budget available for this year, I’d like to discuss the benefits of the program with you.” That simple call resulted in a $100K sale. That’s why I call it “sweep up dollars”. The money is lying around and you sweep it up!

3. While you’re talking with your current clients, ask for referrals to other departments, divisions, parent companies, sister companies, and subsidiaries who have a bucket of money to spend on what you have to sell. Surprisingly, this low lying fruit is often overlooked. Leveraging your relationships to capture all sales within any one company will quickly increase your earnings as well as solidify your position with your customers. When you are on the phone with your client, ask him/her to transfer your call to one of the referrals. Whose name is on the caller ID? Not yours! Your call is more likely to be picked up if it shows up as an internal call.

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The Eyes Have It: Confidence, Credibility, Connection by Guest Author Stephanie Scotti, modified by Pat Iyer

Wednesday, September 30th, 2009

Eye contact is crucial for successful presentations

Eye contact is crucial for successful presentations

Recently, when conducting training for the U.S. Army Corps of Engineers’ Leadership Development Program (LDP), we helped prepare participants for their “final” – a 45-minute briefing to the Brigadier General and his senor leadership team. Upon being introduced to the 23 participants, I was impressed right from the start. Each person greeted me with a strong handshake while looking me straight in the eye. Holding my gaze for just those few moments communicated confidence, credibility and connection. I know these are big words for such a simple gesture, and yet direct eye contact conveys that, and more. It says, “I am important – and so are you.” This resonated with me for two reasons. First, since I was coming from a military family, the participants’ demeanor made me feel immediately welcome. Second, it is this sense of engagement that every presenter wants to build among his or her audience. As an attorney, you may be presenting to mediators or the jury. As a legal nurse consultant, you may be testifying as an expert or presenting medical issues to a group of attorneys. Use your eyes to engage your audience. This is critical to creating a sense of confidence, establishing credibility, and building rapport.

Make your next presentation an eye-opening experience
So, how can you use eye contact to elevate the effectiveness of your next presentation? As a start, I suggest you arrive at least 30 minutes before audience members start to assemble. (The audience may be other attorneys at a mediation or the jury and attorneys in a court room or conference room.) This allows you to greet your listeners as they gather, following the same protocol the LDP participants extended to me. This initial greeting with direct eye contact helps build rapport, which turns into support during your presentation. Once you’re introduced – but before you say a word – stop, look out at your audience directly, and smile. This “pause and welcome” moment (as I call it) allows your audience to get settled, helps make a strong connection, and establishes your authority. This may feel awkward at first, but compare it to how you greet a house guest when they enter your home. It’s not that different – you’re fostering a sense of hospitality that allows people to connect with you.

Managing meaningful eye contact
During your presentation, shoot for a minimum of 90% direct, continuous and roving eye contact. “Direct” is looking your listeners right in the eye, not over their heads or at the back wall. By “continuous and roving,” I mean scan the room – looking at people seated right and left, front and center, and in the back. That may mean turning your head, panning your body, or walking around. You may find it helpful to pick out several friendly faces scattered around the room – those people you welcomed upon arrival – and direct your eye contact at them. End your remarks by looking out, scanning the audience, and smiling. Like putting a period at the end of a sentence, this gesture signals completion and allows your listeners to realize you are completed. It also gives you a chance to take a breath and connect with your audience one last time. Remember, if you want “all eyes on you,” you need to be “all eyes.” By following these best practices for strong eye contact, you’ll be much better able to communicate that valuable sense of confidence, credibility, and connection to your own audience.

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Managing the Stress of Change by Guest Author Sharyn Mosca

Wednesday, September 23rd, 2009

Close communication helps during changing times

Close communication helps during changing times

As a leader, you probably have discovered the number 1 stressor for leaders is “trying to do more with fewer resources and do it faster”. Perhaps your organization is downsizing, or under pretty stringent budget cuts. Perhaps that open job position you had, suddenly was taken away, and on hold indefinitely. Oh well, you say. I guess we will have to figure out how to “do without”. As a leader, not only do you need to manage change from a business perspective…you also have to manage the reactions of your staff going through the change. Certainly, a complex set of expectations.

Firstly, Put On Your Own Oxygen Mask
As we have heard so many times, while preparing to take off on a flight, we need to put our oxygen mask on first, before attempting to help others. The oxygen mask involves taking care of your own concerns through private discussions with trusted friends, family and advisors. Do I know how I feel about this change? Am I supportive of it? Confused? Threatened? Leveling with yourself and bouncing concerns off others is a very healthy start. “Stress is simply the adaptation of our bodies and minds to change; and change, as we noted, is about the only constant left in the workplace.” Peter G. Hanson, M.D.

Step Up Your Communication With Your Staff
This is the easiest yet hardest thing to do. Didn’t we just say we are going to do more with less? I don’t have time for much of anything, let alone wandering around to talk to staff. The issue is, there probably is not better place to be than discussing, sharing ideas, and keeping the channels of communication open and authentic during change. Start with one on one discussions, “How are you feeling about this latest change? “ Do you have any ideas on how we might pull together on this one?” Asking if there a better way to organize our work to deal with this resource or issue can yield hugely helpful ideas that just may bring the team to new levels of trust and cohesion. Make it a regular part of doing business to talk about change at staff meetings, and create a culture with your group that discusses the “what we do, with the how we do it”.

Emphasize That With Change… Learning Happens
Stay vigilant with your staff on the importance of learning through all the change. Ask them to keep a “learning diary” to record all the new situations that the change evokes, and what new skills, strategies or process improvements occurred as a result of dealing with the change. Short term you might get some skepticism, but 6 months from now, the new learning’s become very evident. Encourage your staff to consider what type of development they could use to meet new job duties or tasks. If budgets are tight, think creatively on how the development might happen. Job sharing? Rotation? Find a mentor? On the job classes by a resident expert? On line learning? The most beneficial outcome of rapid change is that it forces us to deal with new situations. Change masters are aware of this and learn from the experience. Make it a point to ensure each staff member has learning or professional development goals included in their performance plan. The more energy spent on developing through the change…the better.

Take Time…to Take a Break

We all need time to pause and refresh…even if it is busy. Create some “timeouts” like pizza once a month on a Friday or “bagels on Monday’s”. Create a loose agenda that serves more to just use the time to catch up with one another. Early in my career, a neighboring supervisor (not my own) regularly brought in baked goods for his staff. Coffee breaks were enjoyed with these goodies, and this simple gesture was admired and envied by surrounding departments. Who would ever think that something so simple would be this long remembered? In times of change, it is comforting to know that “we” have some rituals, and “we” can stand together and meet any challenge. The best change masters create teams that stick together during good times and bad.

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Using technology to make patient care safe by Pat Iyer

Monday, September 14th, 2009

A recent issue of Healthcare Informatics provides hope that technological advances can improve patient safety. One of the most significant barriers to care delivery is communication. Nurses, says Turisco, are often placed in the middle of the communication loop, where they constantly receive and place calls to physicians, pharmacy and lab, all while trying to tend to patients. Fran Turisco is research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.) “So the issue is how you cut out some of the middle men in these communication loops,” she says. “And how do you shorten the time frame between when a nurse needs to talk to someone and when she actually gets to talk to that person, then either make a care decision or figure out what needs to get done next.” Nurses act as the hub in the wheel, and communicate with every other department in a healthcare facility. This communication is vital but time-consuming.

A hands-free voice activated badge in use at University Hospitals Case Medical Center in Cleveland, leadership addressed the problem by rolling out hands-free communication systems from San Jose, Calif.-based Vocera in the NICU. The technology enabled clinicians to call for assistance or answer pages by using a voice recognition button. With the badges, which run on the hospital’s wireless platform, nurses can call for help or communicate with colleagues across departments. This innovation addresses the ongoing issue of placing calls to others, and being interrupted when the call is returned.

Bar-code technology is gaining ground as a way to reduce medication errors. The medication is scanned at the bedside and verified as being correct for the patient, whose arm band is also scanned. The system catches errors at the point of administration, the last step before the medication enters the patient.

Another common theme in patient safety is workflow issues. A number of organizations are addressing the problem by deploying patient flow systems to provide nurses with improved visibility of both bed availability and patient status. With these solutions, instead of making several calls and chasing down charts, nurses can look at a screen to find out what rooms are available, how long patients have been waiting to see a physician, and when patients need to be turned.

When I was a nursing quality assurance coordinator, we tackled the seemingly simple issue of getting beds ready after a discharge. The backup of patients in emergency departments, medical surgical units, and recovery rooms waiting for a bed has important quality of care issues. One of the biggest selling points for patient flow systems, according to Turisco, is the ease of use factor. “It’s one of these technologies that you almost think is too good to be true because it’s not that hard to install. You can configure it in a short period of time to do exactly what you want.”

Here are the take home messages:

  1. The proliferation of wireless technologies in the hospital setting has significantly impacted the way nurses deliver care.
  2. The primary goals chief information officers are looking to achieve in implementing wireless technologies are to improve communication, workflow efficiency and patient safety.
  3. Organizations that have successfully implemented wireless technologies have had nursing leaders involved in every key step of the process.

Read more about 10 common errors and what is being done to make patient care safer here.

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