NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Clinical Practice Project (CPP) Research: Module 3 Assignment Objectives: • Extend academic experience into areas of nursing practice interest, working with new ideas, issues, organizations, and individuals. • Demonstrate the ability to think and act critically and creatively about nursing practice issues. • Develop analytical and ethical leadership skills necessary to address and help solve these issues. • Utilize evidence based research and demonstrate proficiency in written and communication skills. Assignment Instructions: This week you are going to respond to the last questions that will help you complete your project, discuss EBP and further research, and identify stakeholders and resources. Lastly, you will give an overall update of your project. Last week you answered the following questions: 1. What are the scope, duration, and history of the problem? 2. What data is available to describe the problem? 3. What are the implications of the problem? 4. How does/will your selected organization support your topic? This week you should be able to answer the following questions: 1. What are the gaps in the existing data? 2. What types of additional research might be useful? 3. Who are your stakeholders? 4. What are you needed resources? In the template below you will answer the last several questions above. Your answers should be based on supporting evidence. You may need to review the information from your EBP course. Be attentive to the instructions and remember you are professional nurses; writing and thought processes should be indicative of scholarly writing. This week’s assignment is the first of five assignments to complete your Clinical Practice Project (CPP). Each weekly assignment will build upon the last one. It is very important that you follow the directions carefully and review your teachers document/grading rubric for comments so that you can improve each week. To complete this assignment type in the boxes below, the boxes will expand as you type. Be sure to save your document frequently. Points will be deducted for incomplete work, spelling/grammar errors, lack of thought and use of abbreviations. All content must be in your own words, not directly quoted; however you must provide supportive details by using in text citations (Journal Article references at the end of the form-please see your rubric for an explanation of refereed Journals). This assignment is worth 25 points...be sure your work reflects 25 points. Last updated: 06/06/2019 © 2019 School of Nursing Ohio University Page 1 of 9 NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Change the FONT to red to highlight your revisions from the module two template. Student Name Narretha Ofori Date: 06/01/2019 Project Topic: QSEN Competency: (example, Patient-centered Care) Engage with the relevant stakeholders to ensure that the nurses and medical teams rely on evidence based Evidence-based practice (QSEN, n.d.). practices and resources when handling patients. I will assure this by offering nurses and medical teams with vital information from sources such as randomized control units, expert opinions, case reports, scientific principles and scientific methods like qualitative and descriptive research. QSEN Definition: Define your QSEN Competency in your own words (paraphrase) using the QSEN.org web site>competencies>graduate KSAS, (example: for competency Patient-Centered Care the definition on the web site is Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs—take this information then write your definition in your own words (paraphrasing, remember to cite the QSEN site). Evidence-based practice revolves around the use and application of the various current or updated pieces of evidence to the day to day expertise while addressing the desires of the patients or their families in the aim of delivering the best services (QSEN, n.d.). List two Knowledge/Skills/Attitudes (KSAs)- use two each (Knowledge/skills/attitudes) from the QSEN.org web site which are listed under your chosen competency that you think will help you to meet your selected competency. Then write your KSAS in your own words (paraphrasing/editing related to your specific project— remember to cite the QSEN site). Knowledge Skills Attitudes Exhibit the relevant levels of Engage in the collection of Learn and appreciate the fact that Knowledge on the scientific Information about the underlying evidence based practices exhibit processes as well as strategies in clinical research practices. The both strengths and weaknesses. The healthcare (QSEN,n.d.). The skills that will need to be taught to attitudes to be changed to knowledge that will need to be my target audience entail; skills on implement my CPP are mainly; given to implement my CPP patient centered care, skills on negative attitude towards successfully is knowledge on quality improvement and skills on teamwork, failure to value different patient safety and quality safety(Grobbel, & Penprase, 2018) styles of communication used by improvement in relation to the patients and healthcare providers services offered. Observe the guidelines offered by and failure to value monitoring of organizations such as IRB. healthcare providers (Cook et al. Be in a position to define the 2018) concepts of evidence-based Continually research on the current Practice which must work together evidence reports in healthcare. Exhibit high-level compliance with towards accomplishing the set the underlying ethical guidelines goals. Look for the various topics of when carrying out evidence-based interest on evidence-based practice practices. Define the overall significance of In the healthcare sector such as; the use of evidence-based practice pain management, health policy, Uphold the concepts of constant on the clinical setting. nursing education, quality and and regular update of the existing Expound on the significance of the patient safety (Woltz, 2016) knowledge on evidence-based use of the latest evidence supported practices. by clinical concepts in guaranteeing NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Patient-based services through Competencies like quality Improvement, team work and Collaboration Discuss Health Care Organization (this is not the facility/organization where you are implementing your project, may be a nursing organization, or any organization which sets standards, conducts research, or publishes evidence based literature in relation to your topic) that will help support your project. Discussion should include the mission/values of the organization (in your own words). Provide citations and references (no direct quotes). There exist many organizations that in the end, set rules and regulations meant to provide a safe working or operating environment for the healthcare practitioners as well as patients (Scott, 2015). In this case, the organization to look at includes the Agency for Healthcare Research and Quality, otherwise abbreviated as AHRQ (2019). This agency deals with the setting of various guidelines and standards that the healthcare organizations and providers should observe. These guidelines revolve around the provision of a reliable and effective working environment that in the end, helps to guarantee the safety and better patient outcomes. The establishment of this agency came from the desire to come up with a body that undertakes research on the issues surrounding the healthcare sector specializing in healthcare research and projects. This agency will form the foundation of understanding the implications of the underlying concepts and issues that may affect the overall quality of care given to the patients. In addition to that, the agency will provide enough assistance when it comes to the issue of evidence-based research as well as clinical applications. Using the basics of the agency as stated by Dang & Dearholt (2017), the project will highlight some of the vital issues of concern, such12 as evidence-based practices and the best ways to improve the overall care offered by the practitioners. Global Objective: the purpose of a global objective is to provide a vision for your overall project-what are you developing and implementing-what is your expected impact on patient outcome? It should be broadly stated-in one sentence. (Do Not Use Any Abbreviations) By the end of the project, I want to offer a platform that will inform the practitioners particularly nurses on the significance and importance of the use of evidence-based practice when it comes to the clinical areas of applications in shaping the outcomes of patient care which are governed by principles such as physical comfort, emotional support, involvement of family and friends and access to information and education. Project Objectives: Now your global objective should be broken down into more focused steps. Be sure your Project Objectives support your Global Objective! How will you achieve your global objective? Be specific. Write 4 Project Objectives...objectives should start with an action verb! (Do Not Use Any Abbreviations) For example; Research on...Develop a tool/guide/protocol/policy/process to...Develop and present education to staff on new tool...Implement new tool on ___number (the number should be adequate to meet your minimum of 1-2 log hours in direct patient contact) of patients to improve (how will your project impact patient outcomes)... • Engage in continuous research to identify the challenges affecting nurses when it comes to implementing evidence-based practices. I will achieve this goal by regularly checking at new research findings to ascertain methods of improving evidence-based practices. • Develop a nurse or practitioner educational strategy meant to inform these parties on the importance of evidence-based practice. I will achieve this goal by scheduling the training hours for the nurses which will be set in relation to the time the nurses will be off from work. • Research on the various uses or applications of evidence-based practice in the clinical setting. I will achieve this goal by reading through records from various health centers that relate to how they use and apply evidence based practice. • Implement a new strategy meant to champion for lifelong learning for the practitioners and nurses. I will achieve this goal by encouraging practitioners and nurses on the importance of lifelong learning to their role. NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Possible Steps to Assist Me in Completing My Project: List at least 4 steps in your project (Do Not Use Any Abbreviations) Week I hope to accomplish by: Provide hopeful completion date 1. Complete by 5/29/19 2. Complete by 5/30/19 3. Complete by 5/31/19 4. Complete by 6/1/19 5. Complete by 6/2/19 1. Talk with manager on unit to discuss project. 2. Meet with the management at the hospital to draft a plan for the project. 3. Research on the goals that the hospital, in this case, undertakes in performing or fulfilling its objectives. 4. Creating a summary of the tools and strategies to use to provide education to the practitioners on the concepts of evidence-based practice. 5. Document the goals that the project will need to fulfill at the end of the Program. Direct patient engagement: Describe in a one or two sentences how you will provide direct engagement in your project and how this will impact patient outcomes. Be specific. This project will involve me engaging directly with the practitioners and patients on the issues of the use and application of evidence-based practice. In the interactions, the nurses will outline some of the challenges they encounter when implementing or providing care using the concepts of evidence-based practice. I plan to do this interaction with patients by; making sure that that I acknowledge my patients emotions, avoid responding defensively to them and identifying what they need from me and what they care about. What are the scope, duration and history of the problem? Write 3-4 paragraphs related to your selected problem. Provide supportive detail. Give supportive data from facility, community, state, or national data to explain why you feel this is an issue. Your paragraphs should be professionally written, single spaced with APA formatted citations and references. According to Wolzt (2016) the scope of evidence-based practice in healthcare is viewed from the perspective of those who carry out research in relation to evidence based practice and those who use the evidence based practice information. Basing on those who carry out research in relation to evidence based practice three main steps are involved; first there is knowledge creation and distillation which involves carrying out research and recording the relevant findings into practice recommendations that ought to be put into action. The other step is dissemination and diffusion; it entails associating with healthcare organizations and professional leaders to publicize information therefore forming a commencement of action to prospective users. The final step is final user institutionalization, implementation and adoption and it ensures that teams, individuals and organizations use evidence-based research discoveries in their day to day activities (Dang, 2017) Evidence based practice should be implemented consistently by healthcare providers in all their actions, this is because; it contains paramount evidence from studies conducted by clinical experts. In addition, when evidence based practice is carried out in an organizational culture that is supportive and caring, then maximum quality of care and great patient results can be obtained (Grobbel, 2018) According to Scott (2015) the history of evidenced based practice in healthcare evolved in the 1800s from Florence Nightingale then in 1970s it evolved to medical physicians while in 1990s it evolved to nursing profession. Evidence based practice started as an awareness of offering improved outcomes for patients who suffered awful and unhygienic conditions and grew into a foundation in which nursing had adopted to help in offering competent and safe care to patients. Who does your problem affect? Write 1-2 paragraphs discussing individuals, communities, etc. that are affected by this problem. Remember to include all parties that are affected. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH According to Dang (2017) use of evidence based practice affects people such as physicians, nurses and clerical staff. This is because, they influence how broadly and quickly the evidence based practices are put into action. There are various strategies that have been tested in relation to how the use of evidence based practice affects physicians, nurses and clerical staff and they are mainly: performance gap assessment, audit and feedback and trying of evidence based practice (Cook, 2018) the performance gap assessment informs physicians, nurses and clerical staff about the start of change and opportunities for improvement. On the other hand, audit and feedback helps physicians, nurses and clerical staff to see how their struggles in improving healthcare and patient outcomes are advancing over time. Lastly, the trying of evidence based practice enables nurses, physicians and clerical staff to try out evidence based practices obtained from research finding to see whether they will improve patient outcomes (Wolzt, 2016) Your selected organization: (remember this is not the facility/organization where you are implementing your project, may be a nursing organization, or any organization which sets standards, conducts research, or publishes evidence based literature in relation to your topic) How does this organization support your topic? Some things to consider when researching…Have they advocated? Do they support financially? Are they involved in research to support your topic? Do they use it as part of accreditation requirements? Write 1-2 paragraphs. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references.) I chose World Health Organization, this is because it supports my topic by backing up sharing of awareness on evidence based practice in nursing with an aim of strengthening its foundation on healthcare professionals and healthcare policy makers. In addition, it advocates the culture of evidence based practice by assisting nurses to apply evidence based practice while carrying out their clinical roles. On the other hand, world health organization provides temporal financial assistance to its member countries with an aim of supporting the adoption of evidence-based practice in their health facilities. Moreover, World Health Organization is involved in research to support evidence based practice, this is because it believes that its adoption will lead to improved healthcare and patient outcomes (WHO, 2018) it uses it as part of accreditation requirements to ensure that patients are treated using well researched practices that will accelerate their healing process(Scott,2015) What are the implications of the problem? What will happen or not happen if the problem is not resolved? Write 1-2 paragraphs discussing the implications with supporting details (information from your selected organization and/or health care facility would be important here). Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). Failure to use evidence-based practice in hospitals means that; first, there will be no consistency in healthcare, this is because it will not be based on evidence which helps in treating patients. Second, failure to use evidencebased practice implies that there will be no improved patient outcomes which become better in relation to implementation of evidence based care. Lastly failure to use evidence based care implies that nurses and nurse practitioners will not be granted independence to exercise to full of their qualifications. Plan of Action: In the space below outline your plan of Action. Remember your plan of action should assist you in meeting your global and project objectives; therefore, they must be linked. Your plan of action can include your project objectives from week one or they may have changed. In either case, list your project objectives (that you have already completed and planned steps) and provide a one paragraph (per objective) explanation supporting this action. You should have a minimum of four action steps (no more than five), this means you should have a minimum of four paragraphs and no more than five. Your actions steps should have supportive details (references). Your paragraphs should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). Asking clinical guide questions that I have for my patient. The questions are supposed to be organized in the format known as PICOT, whereby letter p stands for problem of interest, patient or population; I stands for intervention being put into consideration; C stands for comparison; O stands for the measured outcomes while T stands for time to be taken to meet global and project objectives (Grobbel, 2018) Acquiring the necessary evidence, so that I can be in a position to answer my clinical guide questions. For example, I will aim at acquiring evidence on whether exercise therapy is appropriate for assisting patients to NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH reduce pain after surgical procedure in comparison to medication. I will do this by researching scholarly literature that relate to nursing so that I can find out whether evidence exists that can back up this evidence based practice Appraising and applying evidence obtained in relation to the problem of interest. I will do this by reviewing the scholarly articles that I have obtained critically so that I can determine their applicability and validity as well. For example, if my patient is of old age, then the evidence that proves that exercise therapy is effective for the adolescents will not be applicable for the patient since adolescents and aged people respond to pain differently and have different requirements for controlling pain (Dang, 2017) Lastly, I will conduct an assessment of whether my intervention was successful or not. I will do this by assessing whether carrying out exercise therapy helped in easing a patient’s pain or not. In addition, I will also perform a comparison between a patient who received medication and underwent the exercise therapy and a patient who only underwent the exercise therapy to find out the one who had his or her pain controlled immediately. Proposed Solution: Write 2-3 sentences describing your proposed solution to your problem. Remember that your solution should be linked to your global and project objectives. Your proposed solutions should have supportive details (references), professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). According to Cook (2018) failure to adhere to evidence-based practices is associated with health care professionals who only trust their knowledge to attend to their patients. In for me to bring this problem to an end, I will consider two main solutions to this problem that are mainly; engaging healthcare providers in training on the importance of evidence-based practice. Lastly, I will advise healthcare centers on the importance of investing in skills and tools needed for forming a culture of evidence-based practice. What are the gaps in the existing data? Write 1-2 paragraphs related to your selected problem. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). You may need to look back at your Evidence-based Nursing Textbook for some help. The data does not describe the various strategies that health centers can use to facilitate evidence based practices. These strategies entail; development of evidence-based practice skills, presentation of evidence based mentors and leaders into the clinical setting and development of nurse-led units that are centered on evidence based practice. In addition, the data does not describe how traditions and customs influence evidence based practices in healthcare. What types of additional research might be useful? Write 1-2 paragraphs discussing additional research that describes individuals, communities, other issues etc. that are affected by your topic. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). Be sure the research relates to your problem. The types of additional research that might be useful entail; research on dissemination and implementation of evidence based practice in health centers through creation, evaluation, reporting and integration of evidence based strategies in healthcare. Another additional research that might be useful is the evidence based competencies. These competencies ensure that nurses deliver safe and high-quality nursing care that is aimed at improving patient outcomes and reducing costs on the healthcare resources (Lau, 2015) Identify Stakeholders: Write 1-2 paragraphs identifying the key stakeholders to your problem with supporting examples. Individuals or groups that are directly or indirectly influenced by the problem or solution are the stakeholders. In some cases the stakeholders are obvious; however in some cases stakeholders can be developed. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). The key stakeholders to my problem are mainly; nurses, clerical staff and physicians. The reason as to why they are my key stakeholders is because, they rely on the use of evidence based practice with aim of; reducing health costs, achieving high quality care and patient outcomes, minimizing health care provider turnover rate, NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH minimizing geographic variations in the delivery of care, meeting the expectations of informed public and reducing complications and denials that may result from unsatisfied patients (Olomu, 2016) List needed resources: A successful change agent will identify all available resources. Resources include money, time, connections, and those resources which help you to meet your objectives. You may list your resources, but explain why the resource is needed and how these resources will help support your change. The resources that will help me in meeting my objectives are mainly; Money which will be used in paying the people that I will be working with. In addition, it will help in supporting my change because, it will act as a form of appreciation to people working with me, and hence it will help in minimizing turnover. The other resource that I will require is time. Time will help me in achieving my goals over a specified period of time. Nevertheless, it will help in supporting my change by offering me with a timely plan that I will work with. Project Update: Write 2-3 paragraphs discussing your project progress. Include in your discussion how your QSEN competency and KSAs are supporting your project and if your global and project objectives are close to being met. You do not need citations or references; however this should be professionally written. My project is progressing on very well and the QSEN competency has supported me in my plan of addressing health centers concerning the importance of continuously equipping futures nurses with the appropriate knowledge, skills and attitudes that are essential in improving quality and safety of the healthcare centers. In addition, the QSEN competency has also enabled me to guide physicians, nurses and clerical staff on “What” and “How” they ought to offer nursing care so that they can be able to guarantee safe and high-quality care. On the other hand, the KSAs have supported my project by helping me to define to physicians, nurses and clerical staff the concepts of evidence-based practice which must work together towards accomplishing the set goals. In addition, they have also helped in advising nurses, physicians and clerical staff on the importance of Continual research on the current evidence reports in healthcare. At this point I can say that my global and project objectives are close to being met. Work with Mentor this week: In 2-3 paragraphs discuss activities with your Mentor (Preceptor) for this project so far. Include positive and negative thoughts, what was helpful and what information or activity would have been helpful. No citations or references are needed; it should still be professionally written. For this week, I met with my preceptor to discuss on the activities that I had accomplished so far from the point I had left last week. During the discussion, I described that I had chosen physicians, nurses and clerical staff as my stakeholders because they rely on the use of evidence based practice with aim of; reducing health costs, achieving high quality care and patient outcomes, minimizing health care provider turnover rate, minimizing geographic variations in the delivery of care, meeting the expectations of informed public and reducing complications and denials that may result from unsatisfied patients. My preceptor said that the three parties were perfect for my project and he advised me to continue with my project. However, he said that I should have also included patients as stake holders, this is because they were to help me in obtaining information on whether the treatment given to them which was based on evidence based practice was good or not. Log update: Begin typing documentation on your Clinical Log, provide here a brief explanation of time you have completed this week-you will need to document on your clinical log in addition to the templates, this update does NOT take the place of completing your required log. This is a non-graded item. -- Do not include: Orientation off the Unit, Observation, writing or researching papers/assignments, Lunch Break time. or -- Do include: A total over the course includes a Minimum of 3 hours with preceptor, Maximum of 6 hours on research of topic, a minimum of 1-2 hours in direct patient engagement and the remainder- 10-11 hours in implementation of your project, Total of 21 true hours. NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Type Date Time (ex: 1:00pm2:00pm) Total Time Spent (ex: 1 hour) (describe specifically what you did in one or two sentences) 05/31/20 19 7.00a.m to 9.00a.m 2 05/31/20 19 10.00a.m to 11 a.m 1 05/31/20 19 3.00p.m to 2 5.00p.m Engaging a patient during exercise therapy. 05/31/20 19 6.00p.m to 2 8.00p.m Stressing the key resources for my project which are mainly; Money and Time. Preceptor (a minimum of 3 hours is required for the course) Research on topic Description Discussing with my preceptor on the activities that I had accomplished so far from the point I had left last week. My preceptor acknowledges my idea of choosing physicians, nurses and clerical staff as my stakeholders for the project. My preceptor suggested that patients were also good stakeholders to be put into consideration. Researching on topics that are related to my global objective and my project as well. (a maximum of 6 hours is allowed for the course) Direct Patient Engagement Time (a minimum of 1-2 hours, Specify number of patients) Implementation (the remainder should be spent in implementation) Total Time spent this week (by the end of the Total for this week =7 hours course you should spend at least 21 true hours) Continue to work on your log and submit your completed log in the week 5 submission area References (double-space and use correct APA format) This should include references from Week 1 and 2 AHRQ. (n.d.). About AHRQ. Retrieved 15 May 2019. https://www.ahrq.gov/cpi/about/index.html Cook, D. A., Pencille, L. J., Dupras, D. M., Linderbaum, J. A., Pankratz, V. S., & Wilkinson, J. M. (2018). Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. PloS one, 13(1), e0191943. doi:10.1037/rmh0000008 Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau. Guidelines for Practice, 339-359. doi:10.1037/rmh0000008 Grobbel, C., & Penprase, B. (2018). The Caring Studio Experience: Integrating QSEN With Caring Practice Competencies, a Research Study. doi:10.1037/rmh0000008 NRSE 4600: MODULE 3: ASSESSMENT 6: WRITTEN ASSIGNMENT - CLINICAL PRACTICE PROJECT RESEARCH Lau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., ... & Peacock, R. (2015). Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implementation Science, 11(1), 40. Olomu, A., Hart-Davidson, W., Luo, Z., Kelly-Blake, K., & Holmes-Rovner, M. (2016). Implementing shared decision making in federally qualified health centers, a quasi-experimental design study: the Office-Guidelines Applied to Practice (Office-GAP) program. BMC health services research, 16(1), 334. QSEN. (n.d.). QSEN Competencies. QSEN.Org. Retrieved 15 May 2019. From http://qsen.org/competencies/pre-licensure-ksas/ Scott, W. R. (2015). Organizations and organizing: Rational, natural and open systems perspectives. Routledge,40-55. Wolzt, M. (2016). Invited commentary: Evidence-based practise and physical therapy. Wiener Medizinische Wochenschrift, 166(1-2), 4-4. doi:10.1037/rmh0000008 WHO. (n.d). About WHO. Retrieved 10th August, 2018. https://www.who.int/
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