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An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures.

https://arctichealth.org/en/permalink/ahliterature120571
Source
J Bone Miner Res. 2013 Feb;28(2):383-94
Publication Type
Article
Date
Feb-2013
Author
Léon Nshimyumukiza
Audrey Durand
Mathieu Gagnon
Xavier Douville
Suzanne Morin
Carmen Lindsay
Julie Duplantie
Christian Gagné
Sonia Jean
Yves Giguère
Sylvie Dodin
François Rousseau
Daniel Reinharz
Author Affiliation
Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Québec, Canada.
Source
J Bone Miner Res. 2013 Feb;28(2):383-94
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada
Computer simulation
Cost-Benefit Analysis
Decision Support Techniques
Female
Humans
Middle Aged
Osteoporosis - complications - economics
Osteoporotic Fractures - complications - economics - prevention & control - therapy
Abstract
A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.
Notes
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PubMed ID
22991210 View in PubMed
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An integrated strategy of knowledge application for optimal e-health implementation: a multi-method study protocol.

https://arctichealth.org/en/permalink/ahliterature157541
Source
BMC Med Inform Decis Mak. 2008;8:17
Publication Type
Article
Date
2008
Author
Marie-Pierre Gagnon
France Légaré
Jean-Paul Fortin
Lise Lamothe
Michel Labrecque
Julie Duplantie
Author Affiliation
Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada. marie-pierre.gagnon@fsi.ulaval.ca
Source
BMC Med Inform Decis Mak. 2008;8:17
Date
2008
Language
English
Publication Type
Article
Keywords
Decision Support Techniques
Humans
Internet
Knowledge
Medical Records Systems, Computerized - utilization
Multivariate Analysis
Organizational Policy
Planning Techniques
Quebec
Telemedicine - utilization
Abstract
E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.
A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.
This study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects.
These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.
Notes
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PubMed ID
18435853 View in PubMed
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Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review.

https://arctichealth.org/en/permalink/ahliterature134945
Source
BMC Med. 2011;9:46
Publication Type
Article
Date
2011
Author
Carrie Anna McGinn
Sonya Grenier
Julie Duplantie
Nicola Shaw
Claude Sicotte
Luc Mathieu
Yvan Leduc
France Légaré
Marie-Pierre Gagnon
Author Affiliation
Research Centre of the Centre Hospitalier Universitaire du Québec, Québec, QC, Canada.
Source
BMC Med. 2011;9:46
Date
2011
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Computers
Canada
Data Collection - methods - standards
Electronic Health Records - organization & administration - utilization
Health Knowledge, Attitudes, Practice
Health Plan Implementation - methods - organization & administration
Humans
Patient Acceptance of Health Care - statistics & numerical data
Abstract
Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.
Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users.
Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities.
This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.
Notes
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PubMed ID
21524315 View in PubMed
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Cost-effectiveness of the management of rh-negative pregnant women.

https://arctichealth.org/en/permalink/ahliterature107439
Source
J Obstet Gynaecol Can. 2013 Aug;35(8):730-40
Publication Type
Article
Date
Aug-2013
Author
Julie Duplantie
Odilon Martinez Gonzales
Antoine Bois
Léon Nshimyumukiza
Jean Gekas
Emmanuel Bujold
Valérie Morin
Maud Vallée
Yves Giguère
Christian Gagné
François Rousseau
Daniel Reinharz
Author Affiliation
Département de médecine sociale et préventive, Université Laval, Québec, Québec.
Source
J Obstet Gynaecol Can. 2013 Aug;35(8):730-40
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adult
Cost-Benefit Analysis
Decision Support Techniques
Fathers
Female
Fetus - immunology
Genetic Testing - methods
Humans
Immunologic Factors - therapeutic use
Mass Screening - methods - organization & administration
Maternal-Fetal Exchange - drug effects - genetics - immunology
Models, organizational
Pregnancy
Preventive Health Services - economics - methods
Quebec
Rh Isoimmunization - genetics - prevention & control
Rh-Hr Blood-Group System
Rho(D) Immune Globulin - therapeutic use
Abstract
The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor.
A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father's Rh type; (4) mixed screening: immunological determination of the father's Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants.
In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option.
Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.
PubMed ID
24007709 View in PubMed
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Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions.

https://arctichealth.org/en/permalink/ahliterature165681
Source
BMC Health Serv Res. 2007;7:6
Publication Type
Article
Date
2007
Author
Marie-Pierre Gagnon
Julie Duplantie
Jean-Paul Fortin
Réjean Landry
Author Affiliation
Evaluative Research Unit, Quebec University Hospital Centre, Quebec, Canada. marie-pierre.gagnon@mfa.ulaval.ca
Source
BMC Health Serv Res. 2007;7:6
Date
2007
Language
English
Publication Type
Article
Keywords
Administrative Personnel - psychology
Attitude of Health Personnel
Career Choice
Delphi Technique
Education, Medical, Continuing
Female
Hospitals, Rural - manpower
Humans
Interviews as Topic
Job Satisfaction
Male
Medically underserved area
Organizational Case Studies
Physicians - psychology - supply & distribution
Professional Practice Location
Quebec
Rural Health Services - manpower
Telemedicine
Abstract
The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions.
A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel.
Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions.
Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.
Notes
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PubMed ID
17217534 View in PubMed
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Implementation of an electronic medical record in family practice: a case study.

https://arctichealth.org/en/permalink/ahliterature143906
Source
Inform Prim Care. 2010;18(1):31-40
Publication Type
Article
Date
2010
Author
Marie-Pierre Gagnon
Marie Desmartis
Michel Labrecque
France Légaré
Lise Lamothe
Jean-Paul Fortin
Jean-François Rancourt
Julie Duplantie
Author Affiliation
Québec University Hospital Research Centre, Québec City, Canada and Faculty of Nursing, Laval University, Québec City, Canada. marie-pierre.gagnon@fsi.ulaval.ca
Source
Inform Prim Care. 2010;18(1):31-40
Date
2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Computers
Family Practice
Humans
Leadership
Medical Records Systems, Computerized - economics - organization & administration
Organizational Case Studies
Organizational Innovation
Quebec
Workload
Abstract
Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge.
This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Québec, Canada.
A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Québec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants.
Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace.
This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy.
PubMed ID
20429976 View in PubMed
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Supporting work practices through telehealth: impact on nurses in peripheral regions.

https://arctichealth.org/en/permalink/ahliterature137322
Source
BMC Health Serv Res. 2011;11:27
Publication Type
Article
Date
2011
Author
Marie-Pierre Gagnon
Guy Paré
Hugo Pollender
Julie Duplantie
José Côté
Jean-Paul Fortin
Rita Labadie
Emmanuel Duplàa
Marie-Claude Thifault
François Courcy
Carrie Anna McGinn
Birama Apho Ly
Amélie Trépanier
François-Bernard Malo
Author Affiliation
Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada. marie-pierre.gagnon@fsi.ulaval.ca
Source
BMC Health Serv Res. 2011;11:27
Date
2011
Language
English
Publication Type
Article
Keywords
Efficiency, Organizational
Humans
Interviews as Topic
Nurses - statistics & numerical data - supply & distribution
Organizational Case Studies
Personnel Selection
Personnel Turnover - statistics & numerical data
Quebec
Questionnaires
Regression Analysis
Research Design
Rural Population
Students, Nursing
Telemedicine - manpower - organization & administration
Abstract
In Canada, workforce shortages in the health care sector constrain the ability of the health care system to meet the needs of its population and of its health care professionals. This issue is of particular importance in peripheral regions of Quebec, where significant inequalities in workforce distribution between regions has lead to acute nursing shortages and increased workloads. Information and communication technologies (ICTs) are innovative solutions that can be used to develop strategies to optimise the use of available resources and to design new nursing work practices. However, current knowledge is still limited about the real impact of ICTs on nursing recruitment and retention. Our aim is to better understand how work practice reorganization, supported by ICTs, and particularly by telehealth, may influence professional, educational, and organizational factors relating to Quebec nurses, notably those working in peripheral regions.
First, we will conduct a descriptive study on the issue of nursing recruitment. Stratified sampling will be used to select approximately twenty innovative projects relating to the reorganization of work practices based upon ICTs. Semi-structured interviews with key informants will determine professional, educational, and organizational recruitment factors. The results will be used to create a questionnaire which, using a convenience sampling method, will be mailed to 600 third year students and recent graduates of two Quebec university nursing faculties. Descriptive, correlation, and hierarchical regression analyses will be performed to identify factors influencing nursing graduates' intentions to practice in peripheral regions. Secondly, we will conduct five case studies pertaining to the issue of nursing retention. Five ICT projects in semi-urban, rural, and isolated regions have been identified. Qualitative data will be collected through field observation and approximately fifty semi-structured interviews with key stakeholders.
Data from both parts of this research project will be jointly analysed using triangulation of researchers, theoretical approaches, methods, and results. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the nursing recruitment and retention.
Notes
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PubMed ID
21294882 View in PubMed
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A survey in Alberta and Quebec of the telehealth applications that physicians need.

https://arctichealth.org/en/permalink/ahliterature160631
Source
J Telemed Telecare. 2007;13(7):352-6
Publication Type
Article
Date
2007
Author
Marie-Pierre Gagnon
Julie Duplantie
Jean-Paul Fortin
Penny Jennett
Richard Scott
Author Affiliation
Evaluative Research Unit, Quebec University Hospital Centre, Quebec, Canada.
Source
J Telemed Telecare. 2007;13(7):352-6
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Analysis of Variance
Attitude of Health Personnel
Female
Health services needs and demand
Humans
Male
Middle Aged
Quebec
Questionnaires
Rural Health Services
Telemedicine - utilization
Abstract
We studied the utility of various telehealth applications to support practice in rural and remote regions from the physicians' point of view. A postal survey was conducted among physicians from rural and remote regions of Alberta and Eastern Quebec. A total of 321 questionnaires were returned (13% response rate), comprising 180 from Quebec (16%) and 141 from Alberta (11%). Differences in the perceived utility of telehealth applications were explored using univariate and multivariate analyses. Telehealth applications were grouped into four categories: (1) asynchronous; (2) synchronous; (3) education; and (4) access to health information. The perceived utility of each application varied significantly between provinces. However, the two categories of telehealth applications perceived to be the most relevant were the same in both provinces: access to health information and applications for tele-education.
PubMed ID
17958937 View in PubMed
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Users' perspectives of key factors to implementing electronic health records in Canada: a Delphi study.

https://arctichealth.org/en/permalink/ahliterature120808
Source
BMC Med Inform Decis Mak. 2012;12:105
Publication Type
Article
Date
2012
Author
Carrie Anna McGinn
Marie-Pierre Gagnon
Nicola Shaw
Claude Sicotte
Luc Mathieu
Yvan Leduc
Sonya Grenier
Julie Duplantie
Anis Ben Abdeljelil
France Légaré
Author Affiliation
Institut de réadaptation en déficience physique de Québec, Québec, Canada.
Source
BMC Med Inform Decis Mak. 2012;12:105
Date
2012
Language
English
Publication Type
Article
Keywords
Administrative Personnel
Attitude of Health Personnel
Attitude to Computers
Canada
Consensus
Decision Support Systems, Clinical
Delphi Technique
Efficiency, Organizational
Electronic Health Records - manpower - organization & administration - standards
Female
Health Knowledge, Attitudes, Practice
Health Plan Implementation
Humans
Male
Organizational Culture
Organizational Innovation
Questionnaires
Abstract
Interoperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users' perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature.
A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (= 75%) or moderate (= 60-74%) according to user groups' level of agreement on applicability and importance, partial (= 60%) when participants agreed only on applicability or importance, or as no consensus (
Notes
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PubMed ID
22967231 View in PubMed
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[Using telemedicine to improve chronic disease monitoring].

https://arctichealth.org/en/permalink/ahliterature107904
Source
Sante Publique. 2013 Mar-Apr;25(2):203-11
Publication Type
Article
Author
Lise Lamothe
Marie-Andrée Paquette
Jean-Paul Fortin
Françoise Labbé
Djamel Messikhs
Julie Duplantie
Author Affiliation
Département d'administration de la sant&-IRSPUM, Université de Montreal - C.P. 6128 - Succ. Centre-ville, Montréal, QC H3C 3J7, Canada. lise.lamothe@umontreal.ca
Source
Sante Publique. 2013 Mar-Apr;25(2):203-11
Language
French
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Diabetes Mellitus - epidemiology - therapy
Disease Management
Heart Failure - epidemiology - therapy
Humans
Hypertension - epidemiology - therapy
Patient satisfaction
Pulmonary Disease, Chronic Obstructive - epidemiology - therapy
Quebec
Telemedicine
Abstract
The purpose of this study was to understand how home telecare technologies can be used to improve services for people with chronic diseases.
Canadian elders with at least one of the targeted chronic diseases (COPD, heart failure, hypertension, diabetes) were asked to use telehomecare equipment. The data needed to assess the implementation process and to monitor outcomes were collected through participatory observation, documentary analysis and interviews.
The study found that the technology has a number of benefits for patients, particularly in terms of access to health services. By enabling patients to access more information about their health, the use of the technology, combined with an educational program, contributes to increasing their capacity for self-management. The results also indicate that the telehomecare equipment had a positive impact on clinical decision-making. By facilitating health professionals' access to information and expertise, it was found to promote interprofessional practice. The study found that telehomecare technology has an organizational impact on practice and requires organizational adaptation, the form of which will depend on local organizational and clinical settings.
The results suggest that telehomecare technology helps to create conditions that need to be met by health care organizations in order to improve service delivery to people with chronic diseases, particularly with regard to interprofessional collaboration, health professionals' access to information and expertise and active patient participation. However, the successful implementation of the technology requires a detailed analysis of the settings in which it is used.
PubMed ID
23964545 View in PubMed
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