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Pharmacist salary?

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  • Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    Fastidious wrote: »
    Back to bed with yourself commie


    Mod note
    Have a few days break from here
    Rob


  • Registered Users Posts: 255 ✭✭The Hound Gone Wild


    Fastidious wrote: »
    Anyone gullible enough to believe this really needs their heads examined. You keep telling yourself that you save millions of euros, I'm not buying that.

    I'd say he saves the HSE hundreds of thousands in malpractice suits alone. Forget about pushing biosimilars/generics/deprescribing/polypharmacy.

    On an average day in community I catch 2 serious prescribing errors. I'd have heart palpitations trying to manage interns and jr. doctors on a 150+ bed ward let alone the rest of the more senior doctors. The general public wouldn't believe half of the things doctors prescribe through lack of knowledge.


  • Registered Users Posts: 7,400 ✭✭✭Nonoperational


    I save millions of euros for the HSE though medicines governance. This allow this money to be used further afield than pharmacy in the HSE. I know more about drugs than the majority of doctors. I also write guidelines for doctors to follow for prescribing meds. I organise how meds are sorted for vulnerable patients once they are discharged from hospital. Whilst doing this, I'm responsible for 176 inpatients beds where any drug errors ultimately lie on my desk.

    Fair play. Millions of Euro. Impressive. Excuse my ignorance, but what does "medicines governance" translate to in practical terms?

    Do you work in Ireland? I don't think I have ever seen a pharmacist held accountable for prescribing errors on the wards. It's an issue I have with the service, some patients you see medication reconciliation and handy green notes, others nothing. Therefore I can't rely on the service with consistency.

    Prescribing guidelines, not so much, for me anyway. I prescribe based on the latest European and International guidelines and trials, taking cost benefit and hospital policy into consideration. I find that often pharmacists' notes suggest something as per hospital guidelines when actually the lack of clinical context make an incorrect recommendation. For example a beta blocker was suggested for a patient labelled "CCF". In fact the patient had HFpEF and postural hypotension and a beta blocker wasn't appropriate. This occurs daily.

    Perhaps the ultimate solution if the service is to be properly developed is to have the service staffed to a level that allows the pharmacist to go on 2 rounds a week with the team and discuss things instead of coming along after the fact.
    I'd say he saves the HSE hundreds of thousands in malpractice suits alone. Forget about pushing biosimilars/generics/deprescribing/polypharmacy.

    On an average day in community I catch 2 serious prescribing errors. I'd have heart palpitations trying to manage interns and jr. doctors on a 150+ bed ward let alone the rest of the more senior doctors. The general public wouldn't believe half of the things doctors prescribe through lack of knowledge.

    Yep. The absolutely horrendous conditions in Irish hospitals mean that juniors are very very overstretched and mistakes do happen. I try and check all the interns scripts but sometimes it isn't possible. It's a definite weak point of the service.

    To be fair that is part of a pharmacists job. To use your extensive knowledge of pharmacokinetics and pharmacodynamics to ensure the safe delivery of medications to the patient.

    I've worked as a pharmacist for a number of years and now I work as a senior Specialist Registrar, it's very interesting to see the two perspectives being discussed here. It's interesting to note the trend on the threads discussing the allied health professionals of portraying themselves almost as overseers of the hapless doctors!


  • Registered Users Posts: 255 ✭✭The Hound Gone Wild



    Yep. The absolutely horrendous conditions in Irish hospitals mean that juniors are very very overstretched and mistakes do happen. I try and check all the interns scripts but sometimes it isn't possible. It's a definite weak point of the service.

    To be fair that is part of a pharmacists job. To use your extensive knowledge of pharmacokinetics and pharmacodynamics to ensure the safe delivery of medications to the patient.

    I've worked as a pharmacist for a number of years and now I work as a senior Specialist Registrar, it's very interesting to see the two perspectives being discussed here. It's interesting to note the trend on the threads discussing the allied health professionals of portraying themselves almost as overseers of the hapless doctors!

    Intresting, Do you feel compelled to check your juniors scripts because you're also a pharmacist? Do your colleagues do something similar? (Im not a hospital Pharmacist & never have been)

    It's 100% a pharmacists job,l but I don't think pharmacists are fully utilized in Ireland. Expansion of the role and scope of practice would be a start to ease the pressure on the healthcare system. I'd be interested to hear your thoughts on that having been on both sides of the fence.

    Freshed faced and straight out of college, who wouldn't need overseeing? Be that from a senior doctor, a pharmacist or a nurse. Aside from that, not utilizing someone who has more knowledge on a potential fatal topic is foolish.


  • Registered Users Posts: 7,400 ✭✭✭Nonoperational


    Intresting, Do you feel compelled to check your juniors scripts because you're also a pharmacist? Do your colleagues do something similar? (Im not a hospital Pharmacist & never have been)

    It's 100% a pharmacists job,l but I don't think pharmacists are fully utilized in Ireland. Expansion of the role and scope of practice would be a start to ease the pressure on the healthcare system. I'd be interested to hear your thoughts on that having been on both sides of the fence.

    Freshed faced and straight out of college, who wouldn't need overseeing? Be that from a senior doctor, a pharmacist or a nurse. Aside from that, not utilizing someone who has more knowledge on a potential fatal topic is foolish.

    I agree. I've always been of the opinion that we all do different yet equally important jobs. We have a tendency to see it very much from our own perspective though. Which is completely understandable. When I changed career I though I would have a good idea of the day to day job I would be getting into, but it's very different to what I thought. Prescribing is actually quite a small part of my day to day job now. It's all the diagnoses and for me procedural skills in the cath lab. That's why a good pharmacist is vital to ensure safe delivery of medication.

    Absolutely, interns are often put into very unfair positions in my opinion. I feel like their discharge should be checked because medication errors both in prescribing and administration are massive. It scares me. The clinical significance of most of them is probably small, but as you said, if we knew the actual stats it would be frightening. Being a former pharmacist definitely highlights it more. Even simple things like a medication not being charted on admission and then it's left off the script for ever more, nobody really knowing if its intentional or not.

    Pharmacists are in a situation where they can focus completely on medications (in theory at least), and they are the final link in the chain. Interestingly they are essentially error free too. I'd like to see pharmacists integrated more into the team. As I said, lack of clinical context can diminish the impact of the role in hospitals. Coming around by yourself after is very difficult. I'd love to see a multidisciplinary team with a max of 10-15 patients with time to properly see and treat them.


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  • Posts: 8,647 Jameson Lemon Dachshund


    Fastidious wrote: »
    Because I don't want to..many other lucrative careers out there that require a fraction of the work

    I thought you wanted to study pharmacy!


  • Posts: 8,647 Jameson Lemon Dachshund


    Fair play. Millions of Euro. Impressive. Excuse my ignorance, but what does "medicines governance" translate to in practical terms?

    Do you work in Ireland? I don't think I have ever seen a pharmacist held accountable for prescribing errors on the wards. It's an issue I have with the service, some patients you see medication reconciliation and handy green notes, others nothing. Therefore I can't rely on the service with consistency.

    Prescribing guidelines, not so much, for me anyway. I prescribe based on the latest European and International guidelines and trials, taking cost benefit and hospital policy into consideration. I find that often pharmacists' notes suggest something as per hospital guidelines when actually the lack of clinical context make an incorrect recommendation. For example a beta blocker was suggested for a patient labelled "CCF". In fact the patient had HFpEF and postural hypotension and a beta blocker wasn't appropriate. This occurs daily.

    Perhaps the ultimate solution if the service is to be properly developed is to have the service staffed to a level that allows the pharmacist to go on 2 rounds a week with the team and discuss things instead of coming along after the fact.



    Yep. The absolutely horrendous conditions in Irish hospitals mean that juniors are very very overstretched and mistakes do happen. I try and check all the interns scripts but sometimes it isn't possible. It's a definite weak point of the service.

    To be fair that is part of a pharmacists job. To use your extensive knowledge of pharmacokinetics and pharmacodynamics to ensure the safe delivery of medications to the patient.

    I've worked as a pharmacist for a number of years and now I work as a senior Specialist Registrar, it's very interesting to see the two perspectives being discussed here. It's interesting to note the trend on the threads discussing the allied health professionals of portraying themselves almost as overseers of the hapless doctors!
    OK. I'm on mobile so this may be a bit disjointed.

    I spent the vast majority of my hospital pharmacy career in the UK. Whilst medicines governance isn't as prevalent in Ireland. It should be. I've seen patients been started on adalidumab for RA numerous times without trying a conventional DMARD first. That's a cost difference of ca. 30000 euros per patient per year. Rheumatology is my niche by the way.

    The use of meropenem is obscene in Irish hospitals. There is no oversight and we are just increasing antimicrobial resistance which hurts the patients in the long term. We don't even record use of antimicrobials so as to establish trends for resistance/susceptibility.

    Medicines governance is the recognition and maintenance of good practice, learning from mistakes and improving quality of services provided to patients though appropriate medication interventions.

    I make no great claims about the hospital pharmacy service in Ireland. It's piss poor. Pharmacy isn't funded enough to provide med reconciliations for all patients. It's a particular bug bear of mine as the trust I worked for previously had 5 pharmacists working on the acute medicine unit. We went on post take ward rounds daily and had a service stretching from 7am-8pm. Also, it leaves me extremely uneasy at night that pharmacists don't screen discharges for patients in Ireland. Alas, at the last board meeting, they said this was cost prohibitive.

    With regards to HFpEF. The use of beta blockers would not be ideal if patient had not had a previous MI but would prob be necessary if they had a previous MI. It's been a few years since I've worked on a cardiac ward. I do remember that beta blockers dont decrease mortality or hospital readmission rates in this subset of patients.

    As an aside, did you talk to the pharmacist about the beta blocker? They may have been a junior/newly qualified pharmacist. I always make time to talk to the doctor about a medication error and see what they were trying to achieve.

    I don't mean to disparage doctors. They do great work whilst facing significant challenges. I just know more about medications than them. In reality most of my decisions in hospital are to protect patients first which tends to have the side effect of protecting doctors too.


  • Registered Users Posts: 3,292 ✭✭✭0lddog


    ....... I've seen patients been started on adalidumab for RA numerous times without trying a conventional DMARD first. That's a cost difference of ca. 30000 euros per patient per year. .........

    By way of an off topic diversion for the thread :

    'Suppose it depends on dose and frequency, I'm on this stuff ( 40mg every 14 days ) sticker price is nowhere near 30k pa ( and thanks to the DPS I only have to pay a small proportion of the sticker price ) .

    Whats your view on oral MTX exceeding 15mg per week ?


  • Posts: 8,647 Jameson Lemon Dachshund


    0lddog wrote: »
    By way of an off topic diversion for the thread :

    'Suppose it depends on dose and frequency, I'm on this stuff ( 40mg every 14 days ) sticker price is nowhere near 30k pa ( and thanks to the DPS I only have to pay a small proportion of the sticker price ) .

    Whats your view on oral MTX exceeding 15mg per week ?
    Sorry. I meant to say 3000 euro/patient/year. In comparison. Methotrexate costs about 35euro/year

    With regards to dosing of methotrexate. It depends what you are treating. In rheum, I'd prob be nervous about going above 15mg weekly.


  • Moderators, Science, Health & Environment Moderators Posts: 2,881 Mod ✭✭✭✭Kurtosis


    Pharmacists are in a situation where they can focus completely on medications (in theory at least), and they are the final link in the chain. Interestingly they are essentially error free too. I'd like to see pharmacists integrated more into the team. As I said, lack of clinical context can diminish the impact of the role in hospitals. Coming around by yourself after is very difficult. I'd love to see a multidisciplinary team with a max of 10-15 patients with time to properly see and treat them.

    There was a study published a few years back on reconfiguring pharmacist services from being ward-based to a more integrated team-based model in an Irish teaching hospital. It was an uncontrolled before and after study so comes with a few caveats but did show a reduction in medication errors at discharge. There's decent evidence for this kind of model of care internationally, what's needed is the resourcing and decision-makers with the inclination to implement it.


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  • Registered Users Posts: 885 ✭✭✭Dingle_berry


    I think all of healthcare is in a transition period. Straggling behind aviation with it's Multi Crew Cooperation, incident reporting, etc.

    We're in the end of the consultants being infallible gods, that role is changing to team leaders. Teams that are growing to include allied health care professionals. Its a two way street though, everyone needs to communicate far better than they currently do. Pass the note with a chart, script or report isn't good enough.

    With the leadership role falling on consultants shoulders though (and reflected in their pay), I would expect them to be exemplary leaders with NCHDs progressing towards that as they move up the ranks. Everyone else should show an equal standard of professionalism and none of that "well they're the Dr" or "I'm a clinician too what I say goes" sh!te.

    With regards to pay, it's a simple matter of economics. If the healthcare workers can't get a place to rent or a mortgage within commuting distance of the major hospitals on their current salaries, you either move the hospitals out or increase pay.
    There are few things I find more ignorant than the "the taxpayer pays your salary and funded your education" line trotted out every time public sector pay is mentioned. As if there is no good economic or social reason for a public service. As if public sector workers should volunteer their time and live like paupers because of what they chose to work at!


  • Registered Users Posts: 3,292 ✭✭✭0lddog


    .......With regards to dosing of methotrexate. It depends what you are treating. In rheum, I'd prob be nervous about going above 15mg weekly.

    Many papers ( pubmed etc ) support this. For some reason or other a lot of rheumatologists in the country write up 25mg weekly. Its hardly more effective than 15mg and causes problems for many of us punters.

    How can they be persuaded to think twice before writing up more than 15mg ?


  • Posts: 8,647 Jameson Lemon Dachshund


    0lddog wrote: »
    Many papers ( pubmed etc ) support this. For some reason or other a lot of rheumatologists in the country write up 25mg weekly. Its hardly more effective than 15mg and causes problems for many of us punters.

    How can they be persuaded to think twice before writing up more than 15mg ?

    Raise your concerns with the consultant. It's a two way process.


  • Registered Users Posts: 3,292 ✭✭✭0lddog


    Raise your concerns with the consultant. It's a two way process.

    I'm sorted on that thanks ( side effects were such that I'm now off MTX )

    Through networking, its clear that this an issue all over the country


  • Closed Accounts Posts: 117 ✭✭Fastidious


    I thought you wanted to study pharmacy!

    Yes I do...suppose a basic level of literacy isn't a prerequisite for pharmacy is it?


  • Registered Users Posts: 7,400 ✭✭✭Nonoperational


    OK. I'm on mobile so this may be a bit disjointed.

    I spent the vast majority of my hospital pharmacy career in the UK. Whilst medicines governance isn't as prevalent in Ireland. It should be. I've seen patients been started on adalidumab for RA numerous times without trying a conventional DMARD first. That's a cost difference of ca. 30000 euros per patient per year. Rheumatology is my niche by the way.

    The use of meropenem is obscene in Irish hospitals. There is no oversight and we are just increasing antimicrobial resistance which hurts the patients in the long term. We don't even record use of antimicrobials so as to establish trends for resistance/susceptibility.

    Medicines governance is the recognition and maintenance of good practice, learning from mistakes and improving quality of services provided to patients though appropriate medication interventions.

    I make no great claims about the hospital pharmacy service in Ireland. It's piss poor. Pharmacy isn't funded enough to provide med reconciliations for all patients. It's a particular bug bear of mine as the trust I worked for previously had 5 pharmacists working on the acute medicine unit. We went on post take ward rounds daily and had a service stretching from 7am-8pm. Also, it leaves me extremely uneasy at night that pharmacists don't screen discharges for patients in Ireland. Alas, at the last board meeting, they said this was cost prohibitive.

    With regards to HFpEF. The use of beta blockers would not be ideal if patient had not had a previous MI but would prob be necessary if they had a previous MI. It's been a few years since I've worked on a cardiac ward. I do remember that beta blockers dont decrease mortality or hospital readmission rates in this subset of patients.

    As an aside, did you talk to the pharmacist about the beta blocker? They may have been a junior/newly qualified pharmacist. I always make time to talk to the doctor about a medication error and see what they were trying to achieve.


    I don't mean to disparage doctors. They do great work whilst facing significant challenges. I just know more about medications than them. In reality most of my decisions in hospital are to protect patients first which tends to have the side effect of protecting doctors too.

    Ah ya, I discuss things with the ward pharmacist every day. I really like having a pharmacist on the ward. I just wish it was a properly resourced role. Yeah, HFpEF essentially has no disease modifying therapies at present, although the Russian and Georgian results of TOP CAT have possibly denied a large group of patients the potential benefits of a MRA. The subgroup analysis is interesting. Perhaps Sacubitril/valsartan will offer some hope.

    I agree about meropenem. I prescribe it probably 3 times per year but it is becoming more and more common and not necessarily in an evidence based way. It is a restricted antimicrobial in almost every hospital but again the resources aren't there in all to have each script reviewed by the antimicrobial MDT as it absolutely should.


  • Moderators, Science, Health & Environment Moderators Posts: 2,881 Mod ✭✭✭✭Kurtosis


    Fastidious wrote: »
    Yes I do...suppose a basic level of literacy isn't a prerequisite for pharmacy is it?

    Mod note

    Fastidious and everyone else, cut out the sniping. Any more personal digs from here on will result in cards/bans being handed out, this is the final warning.


  • Registered Users Posts: 5,175 ✭✭✭angeldelight




  • Registered Users Posts: 246 ✭✭palmcut


    Pharmacy salaries are dependent on the pharmacy that you work in. At present there are around 1,850 pharmacies registered with the HSE.

    In 2017, 46% of the pharmacies received less than €120,000 in HSE fees. It is estimated that it takes about €150,000 for a small pharmacy to break even. Some of these 46% are doing well because their front of shop business is very good.

    Generally about one third of the pharmacies are doing very well, one third are doing moderately well and the remaining third are not doing well.

    Like every other business pharmacy went down hill from around the of 2008 and this has continued in pharmacy with new cuts arriving all the time. Pharmacy salaries and wages dropped by about one third from 2008 on-wards.

    Of late there has been a bit of a recovery in pharmacy pay. However not all pharmacies have increased pharmacist pay. The bottom one third of pharmacies cannot afford to pay increased pharmacist wages.

    The other pharmacies are paying increased wages and salaries.

    Currently a new Irish graduate pharmacist can expect around €45K for the first year. This will probably increase by 2 to 3K a year during later years.

    A supervising pharmacist. (3 years experience and managing the dispensary) can expect around 55K per year plus bonus. That would increase with more experience and with more responsibility.

    A practicing Superintendent pharmacist can expect around 65K a year and more depending on experience and responsibility.

    A practicing Superintendent pharmacist who is also the business manager for the pharmacy can expect around 90K and bonus.

    These figures will not apply to the bottom one third of pharmacies.

    Locum rates are much different. For emergency work at late notice (such as a funeral) some locums can get up to €50 an hour and in some cases even more.
    Regular locum work is not as lucrative and can be anywhere between €30 to €40 an hour; again depending on the pharmacy.
    If the HSE reduce fee payments to pharmacies in the coming year then those wages and salaries above will come down.


  • Closed Accounts Posts: 117 ✭✭Fastidious


    palmcut wrote: »
    Pharmacy salaries are dependent on the pharmacy that you work in. At present there are around 1,850 pharmacies registered with the HSE.

    In 2017, 46% of the pharmacies received less than €120,000 in HSE fees. It is estimated that it takes about €150,000 for a small pharmacy to break even. Some of these 46% are doing well because their front of shop business is very good.

    Generally about one third of the pharmacies are doing very well, one third are doing moderately well and the remaining third are not doing well.

    Like every other business pharmacy went down hill from around the of 2008 and this has continued in pharmacy with new cuts arriving all the time. Pharmacy salaries and wages dropped by about one third from 2008 on-wards.

    Of late there has been a bit of a recovery in pharmacy pay. However not all pharmacies have increased pharmacist pay. The bottom one third of pharmacies cannot afford to pay increased pharmacist wages.

    The other pharmacies are paying increased wages and salaries.

    Currently a new Irish graduate pharmacist can expect around €45K for the first year. This will probably increase by 2 to 3K a year during later years.

    A supervising pharmacist. (3 years experience and managing the dispensary) can expect around 55K per year plus bonus. That would increase with more experience and with more responsibility.

    A practicing Superintendent pharmacist can expect around 65K a year and more depending on experience and responsibility.

    A practicing Superintendent pharmacist who is also the business manager for the pharmacy can expect around 90K and bonus.

    These figures will not apply to the bottom one third of pharmacies.

    Locum rates are much different. For emergency work at late notice (such as a funeral) some locums can get up to €50 an hour and in some cases even more.
    Regular locum work is not as lucrative and can be anywhere between €30 to €40 an hour; again depending on the pharmacy.
    If the HSE reduce fee payments to pharmacies in the coming year then those wages and salaries above will come down.

    So the bulk of pharmacists on here are overpaid?


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  • Closed Accounts Posts: 117 ✭✭Fastidious



    What exactly do you people want? This is what you signed up for..you're well paid for it. God forbid you have to do a bit of paperwork, who'd have thought that! Pure scaremongering from the IPU...Judging by the demand for the undergraduate pharmacy courses, the supply of future community pharmacists is anything but under threat.


  • Closed Accounts Posts: 150 ✭✭mazwell


    Fastidious wrote: »
    I'm hoping to study pharmacy-but to tell the truth, this thread has really put me off doing so.
    I'd appreciate if anyone could shed light on the employment situation atm, and if the situation is going to further deteriorate.
    I know I'd love to study chemistry/pharmacology, but really don't want to study for five years only to be paid pittance or worse be unemployed.

    Thanks!

    No you aren't hoping to study pharmacy or you wouldn't be the only person on here insulting pharmacists


  • Closed Accounts Posts: 117 ✭✭Fastidious


    mazwell wrote: »
    No you aren't hoping to study pharmacy or you wouldn't be the only person on here insulting pharmacists

    Yes cause you know me better than I do


  • Posts: 8,647 Jameson Lemon Dachshund


    Fastidious wrote: »
    What exactly do you people want? This is what you signed up for..you're well paid for it. God forbid you have to do a bit of paperwork, who'd have thought that! Pure scaremongering from the IPU...Judging by the demand for the undergraduate pharmacy courses, the supply of future community pharmacists is anything but under threat.

    Demand for a course doesn't mean great riches when you qualify.


  • Registered Users Posts: 173 ✭✭RoamingDoc


    Demand for a course doesn't mean great riches when you qualify.

    +1

    The idea that CAO points equates to anything other than how many people (typically teenagers btw!) want a course is very widespread and means nothing.

    This inability to understand course demand is why so many people end up in the wrong course etc.


  • Registered Users Posts: 14 MarkTR


    What do you thing about current pharmacist salary? Up to 90k this is low?

    Could it increase to + 100,000 in the future?

    Saw a one job offer at mullingar for 90-100k.


  • Registered Users Posts: 5,175 ✭✭✭angeldelight


    MarkTR wrote: »
    What do you thing about current pharmacist salary? Up to 90k this is low?

    Could it increase to + 100,000 in the future?

    Saw a one job offer at mullingar for 90-100k.

    There would be some pharmacists earning 100k+ Usually in a management role of a large pharmacy with plenty of staff or superintendent pharmacist of a chain or group of pharmacies


  • Posts: 8,647 Jameson Lemon Dachshund


    up to 104k in hospital although that's a chief one salary.


  • Registered Users Posts: 14 MarkTR


    In general, what do you think about pharmacists' salaries and job prospects in the future? Do you like working in an irish pharmacy?


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  • Registered Users Posts: 5,175 ✭✭✭angeldelight


    MarkTR wrote: »
    In general, what do you think about pharmacists' salaries and job prospects in the future? Do you like working in an irish pharmacy?

    I don’t love it... but I’ve made my peace with it. It gives me the flexibility I want. I’m not career-driven at all any more, I enjoy being home with my kids. I can work one day a week plus one Saturday a month and earn enough for it to be worth my while. Would I recommend it to a friend? No, probably not, but it’s not the worst either.

    I’ve never struggled to find work in that time - I’ve made the decision not to work as a supervising pharmacist as it’s just not for me. I prefer to do my job and then go home and not think too much about work on my time off.

    One thing I did really appreciate was being frontline through COVID and being able to continue working, it definitely helped my mental health through the past year


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