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Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi

Yıl 2022, Cilt: 48 Sayı: 3, 279 - 285, 30.12.2022
https://doi.org/10.32708/uutfd.1143088

Öz

Çalışmamızın amacı Sağlık Bakanlığı Hastane Medulla Sistemi kullanılarak polifarmasiye maruz kalan 65 yaş ve üstü hastalarda, ilaç-ilaç etkileşimlerinin belirlenip, ciddi etkileşimleri olan hastalarda klinik önlem alınması için farkındalık yaratmaktır. Çalışmamız Gebze 1 nolu Aile Sağlığı Merkezi’nden hizmet almakta olan 65 yaş üstü, Hasta Yönetim Platformu veri tabanında yer alan 188 hasta üzerinde yapılmıştır. Lexicomb® ilaç etkileşimi modülü ile hastaların kronik olarak kullandıkları ilaçlar listelenerek etkileşim düzeyleri değerlendirilmiştir. Bununla birlikte yaşlılarda uygunsuz ilaç kullanımı değerlendirilmesinde kullanılan kriterler üzerinde de durulmuştur. Çalışma sonuçlarımıza göre, 167 hastada toplamda 529 potansiyel ilaç-ilaç etkileşimi görüldü. Bu etkileşimlerin 52’sinde (%9,8) bilinen bir etkileşim saptanmadı ve risk kategorisi A olarak tespit edildi. B, C, D ve X risk kategorilerinde ilaç-ilaç etkileşimi sayıları sırasıyla, 74 (%13,9), 363(%68,6), 33 (%6,2) ve 7 (%1,3) idi. Çalışmadaki hastaların %54’ünde esansiyel hipertansiyon tanısı mevcuttu. En çok kullanılan ilaç ise asetilsalisilik asit (%26)’di. C kategorisinde ilaç-ilaç etkileşim potansiyelinin verilerimize göre anlamlı oranda yüksek çıkması, hastaların tedavisinin daha düzenli ve etkili bir şekilde monitorize edilmesinin gerekliliğini vurgulamaktadır. D ve X kategorisinde saptanan ilaç-ilaç etkileşimleri en fazla nonsteroidal antiinflamatuar ilaçlar, antihipertansif ilaçlar, antipelet ilaçlar ve santral sinir sistemi ilaçlar arasında meydana gelmiştir. Bu ilaçların takibine özellikle dikkat edilmelidir.

Teşekkür

Kocaeli İl Sağlık Müdürlüğü'ne çalışmamızı desteklemesinden ötürü teşekkür ederiz.

Kaynakça

  • 1. TÜİK, Aile Yapısı Araştırması. İstatistiklerle Yaşlılar, 2020; Erişim Adre-si: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2020-37227
  • 2. Hisar, K. M., Erdoğdu, H. Evde sağlık hizmeti alanlarda yaşam kalitesi durumu ve etki-leyen faktörlerin belirlenmesi. Genel Tip Dergisi, 2014;24(4):138-42.
  • 3. Medıcınes, N. S. F. Older. People Implementing medicines-related aspects of the NSF for older people. London: Department of Health, 2001.
  • 4. Akaltun, Hatice, and Fatma Ersin. Evde bakım hizmeti alan diyabetli hastaların diyabet tutum ve davranışlarının belirlenmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi 2016; 9(4): 126-33.
  • 5. Çok Yönlü Yaşlı Değerlendirmesi Ve İzlem Kılavuzu Sağlık Bakanlığı, Ankara, 2019; Erişim Adresi: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engelli-db/hastaliklar/Yasli_Sagligi/rehberler/Cok_Yonlu_Yasli_Izlem_Klavuzu_2021.pdf
  • 6. Hastalık Yönetimi Platformu Projesi Kullanım Kılavuzu, T. C. Sağlık Bakanlığı, 2021; Erişim Adre-si: https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklarengellidb/haberler/HYP_Haber/4HYPKilavuzu_gncel.pdf
  • 7. Anderson, K., Foster, M., Freeman, C., Luetsch, K., Scott, I. Negotiating “unmeasurable harm and benefit”: perspectives of general practitioners and consultant pharmacists on deprescribing in the primary care setting. Qualitative Health Research, 2017; 27(13): 1936-47.
  • 8. Ostini, R., Hegney, D., Jackson, C., Tett, S. E. Knowing how to stop: ceasing prescri-bing when the medicine is no longer required. Journal of Managed Care Phar-macy, 2012; 18(1): 68-72.
  • 9. Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., ... & Mar-tin, J. H. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 2015; 175(5): 827-34.
  • 10. Turnheim, Klaus. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Experimental gerontology 2003; 38(8): 843-53.
  • 11. Ghibelli, S., Marengoni, A., Djade, C. D., Nobili, A., Tettamanti, M., Franchi, C., Pa-sina, L. Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck®)." Drugs aging 2013; 30(10): 821-8.
  • 12. Prados-Torres, A., del Cura-González, I., Prados-Torres, D., López-Rodríguez, J. A., Leiva-Fernández, F., Calderón-Larrañaga, A., ... & Muth, C. Effectiveness of an inter-vention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP pro-ject). Implementation Science 2017;12(1): 54.
  • 13. Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Hughes, C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 2018;9(9).
  • 14. Li, Y., Zhang, X., Yang, L., Yang, Y., Qiao, G., Lu, C., Liu, K. Association between polypharmacy and mortality in the older adults: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 2022; 100:104630.
  • 15. Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract. 2008;14(1):23–9.
  • 16. Cruciol-Souza JM, Thomson JC. Prevalence of potential drugdrug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9(3):427–33.
  • 17. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.
  • 18. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30(10):911–8.
  • 19. El Desoky ES. Deprescription in elderly: A spotlight on pharmacoeconomic aspect. Clin Exp Pharmacol Physiol. 2020; 47(2): 333-6.
  • 20. Schneider KL, Kastenmüller K, Weckbecker K, Bleckwenn M, Böhme M, Stingl JC. Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment. Drugs Aging. 2018 Jun;35(6):559-568. doi: 10.1007/s40266-018-0550-6. PMID: 29737468; PMCID: PMC5999138.
  • 21. Chen YF, Avery AJ, Neil KE, Johnson C, Dewey ME, Stockley IH. Incidence and possible causes of prescribing potentially hazardous/contraindicated drug combinations in general practice. Drug Saf. 2005;28(1):67–80.
  • 22. Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69(3):565–71.
  • 23. Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug-drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23(5):489–97. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.
  • 24. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30(10):911–8.
  • 25. Gören, Z., Demirkapu, M. J., Acet, G. A., Cali, S., Oğlu, M. G. I. Potential drug-drug interactions among prescriptions for elderly patients in primary health care. Turkish Journal of Medical Sciences, 2017; 47(1): 47-54.
  • 26. Gümüştakım, R. Ş., Başer, D. A. Birinci basamakta yaşlılarda çoklu ilaç kullanımı: Bir kırsal alan örneği. Turk J Fam Pract, 2019;23(1):2-8.
  • 27. Jahnavi, K., Reddy, P. P., Vasudha, B., Narender, B. Non-steroidal anti-inflammatory drugs: an overview. Journal of Drug Delivery and Therapeutics, 2019; 9(1): 442-8.
  • 28. Ernst, R., Fischer, K., Molino, C. D. G. R. C., Orav, E. J., Theiler, R., Meyer, U., ... & Bischoff-Ferrari, H. A. (2020). Polypharmacy and kidney function in community-dwelling adults age 60 years and older: A prospective observational study. Journal of the American Medical Directors Association, 21(2), 254-259.
  • 29. Butkiewicz M, Restrepo NA, Haines JL, Crawford DC. Drugdrug interaction profi-les of medication regimens extracted from a de-identified electronic medical records sys-tem. AMIA Jt Summits Transl Sci Proc. 2016;2016:33–40.
  • 30. Secoli SR, Figueras A, Lebrao ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging. 2010;27(9):759–70.
  • 31. Frankenthal, D., Lerman, Y., Kalendaryev, E., Lerman, Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. Journal of the American Geriatrics Society. 2014; 62(9): 1658-65.

Evaluation of Polypharmacy in Elderly Individuals in the Scope of Family Medicine Elderly Patient Follow-up

Yıl 2022, Cilt: 48 Sayı: 3, 279 - 285, 30.12.2022
https://doi.org/10.32708/uutfd.1143088

Öz

The aim of our study is to determine drug-drug interactions in patients aged 65 and over who are exposed to polypharmacy by using the Ministry of Health Hospital Medulla System, and to raise awareness to take clinical precautions in patients with serious interactions. Our study was carried out on 188 patients over the age of 65 who were receiving service from the Family Health Center No. 1 in Gebze and included in the Disease Management Platform database. The results of the follow-up and evaluation of the elderly over 65 years of age, the Lexicomb® drug interaction module, and the drugs used chronically by the patients were listed and their interaction levels were evaluated. In addition, the criteria used in the evaluation of inappropriate drug use in the elderly are also discussed. According to our study results, a total of 529 potential drug-drug interactions were detected in 167 patients. No known interaction was detected in 52 (9.8%) of 529 interactions and the risk category was determined as A. The number of drug-drug interactions in the B, C, D and X risk categories were 74 (13,9%), 363 (68,6%), 33 (6,2%) and 7 (1,3%), respectively. A diagnosis of essential hypertension was present in 54% of the patients in the study. The most commonly used drug was acetylsalicylic acid (26%). The fact that the drug-drug interaction potential in category C is significantly higher than our data highlights the necessity of monitoring the treatment of patients more regularly and effectively. Drug-drug interactions detected in categories D and X mostly occurred between nonsteroidal anti-inflammatory drugs, antihypertensive drugs, antipellet drugs, and central nerves system drugs. Particular attention should be paid to the follow-up of these drugs.

Kaynakça

  • 1. TÜİK, Aile Yapısı Araştırması. İstatistiklerle Yaşlılar, 2020; Erişim Adre-si: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2020-37227
  • 2. Hisar, K. M., Erdoğdu, H. Evde sağlık hizmeti alanlarda yaşam kalitesi durumu ve etki-leyen faktörlerin belirlenmesi. Genel Tip Dergisi, 2014;24(4):138-42.
  • 3. Medıcınes, N. S. F. Older. People Implementing medicines-related aspects of the NSF for older people. London: Department of Health, 2001.
  • 4. Akaltun, Hatice, and Fatma Ersin. Evde bakım hizmeti alan diyabetli hastaların diyabet tutum ve davranışlarının belirlenmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi 2016; 9(4): 126-33.
  • 5. Çok Yönlü Yaşlı Değerlendirmesi Ve İzlem Kılavuzu Sağlık Bakanlığı, Ankara, 2019; Erişim Adresi: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engelli-db/hastaliklar/Yasli_Sagligi/rehberler/Cok_Yonlu_Yasli_Izlem_Klavuzu_2021.pdf
  • 6. Hastalık Yönetimi Platformu Projesi Kullanım Kılavuzu, T. C. Sağlık Bakanlığı, 2021; Erişim Adre-si: https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklarengellidb/haberler/HYP_Haber/4HYPKilavuzu_gncel.pdf
  • 7. Anderson, K., Foster, M., Freeman, C., Luetsch, K., Scott, I. Negotiating “unmeasurable harm and benefit”: perspectives of general practitioners and consultant pharmacists on deprescribing in the primary care setting. Qualitative Health Research, 2017; 27(13): 1936-47.
  • 8. Ostini, R., Hegney, D., Jackson, C., Tett, S. E. Knowing how to stop: ceasing prescri-bing when the medicine is no longer required. Journal of Managed Care Phar-macy, 2012; 18(1): 68-72.
  • 9. Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., ... & Mar-tin, J. H. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 2015; 175(5): 827-34.
  • 10. Turnheim, Klaus. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Experimental gerontology 2003; 38(8): 843-53.
  • 11. Ghibelli, S., Marengoni, A., Djade, C. D., Nobili, A., Tettamanti, M., Franchi, C., Pa-sina, L. Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck®)." Drugs aging 2013; 30(10): 821-8.
  • 12. Prados-Torres, A., del Cura-González, I., Prados-Torres, D., López-Rodríguez, J. A., Leiva-Fernández, F., Calderón-Larrañaga, A., ... & Muth, C. Effectiveness of an inter-vention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP pro-ject). Implementation Science 2017;12(1): 54.
  • 13. Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Hughes, C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 2018;9(9).
  • 14. Li, Y., Zhang, X., Yang, L., Yang, Y., Qiao, G., Lu, C., Liu, K. Association between polypharmacy and mortality in the older adults: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 2022; 100:104630.
  • 15. Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract. 2008;14(1):23–9.
  • 16. Cruciol-Souza JM, Thomson JC. Prevalence of potential drugdrug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9(3):427–33.
  • 17. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.
  • 18. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30(10):911–8.
  • 19. El Desoky ES. Deprescription in elderly: A spotlight on pharmacoeconomic aspect. Clin Exp Pharmacol Physiol. 2020; 47(2): 333-6.
  • 20. Schneider KL, Kastenmüller K, Weckbecker K, Bleckwenn M, Böhme M, Stingl JC. Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment. Drugs Aging. 2018 Jun;35(6):559-568. doi: 10.1007/s40266-018-0550-6. PMID: 29737468; PMCID: PMC5999138.
  • 21. Chen YF, Avery AJ, Neil KE, Johnson C, Dewey ME, Stockley IH. Incidence and possible causes of prescribing potentially hazardous/contraindicated drug combinations in general practice. Drug Saf. 2005;28(1):67–80.
  • 22. Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69(3):565–71.
  • 23. Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug-drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23(5):489–97. Nobili A, Pasina L, Tettamanti M, Lucca U, Riva E, Marzona I, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.
  • 24. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30(10):911–8.
  • 25. Gören, Z., Demirkapu, M. J., Acet, G. A., Cali, S., Oğlu, M. G. I. Potential drug-drug interactions among prescriptions for elderly patients in primary health care. Turkish Journal of Medical Sciences, 2017; 47(1): 47-54.
  • 26. Gümüştakım, R. Ş., Başer, D. A. Birinci basamakta yaşlılarda çoklu ilaç kullanımı: Bir kırsal alan örneği. Turk J Fam Pract, 2019;23(1):2-8.
  • 27. Jahnavi, K., Reddy, P. P., Vasudha, B., Narender, B. Non-steroidal anti-inflammatory drugs: an overview. Journal of Drug Delivery and Therapeutics, 2019; 9(1): 442-8.
  • 28. Ernst, R., Fischer, K., Molino, C. D. G. R. C., Orav, E. J., Theiler, R., Meyer, U., ... & Bischoff-Ferrari, H. A. (2020). Polypharmacy and kidney function in community-dwelling adults age 60 years and older: A prospective observational study. Journal of the American Medical Directors Association, 21(2), 254-259.
  • 29. Butkiewicz M, Restrepo NA, Haines JL, Crawford DC. Drugdrug interaction profi-les of medication regimens extracted from a de-identified electronic medical records sys-tem. AMIA Jt Summits Transl Sci Proc. 2016;2016:33–40.
  • 30. Secoli SR, Figueras A, Lebrao ML, de Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly: a population-based, cross-sectional study. Drugs Aging. 2010;27(9):759–70.
  • 31. Frankenthal, D., Lerman, Y., Kalendaryev, E., Lerman, Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. Journal of the American Geriatrics Society. 2014; 62(9): 1658-65.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Halk Sağlığı, Çevre Sağlığı
Bölüm Özgün Araştırma Makaleleri
Yazarlar

Sema Ketenci 0000-0002-6695-7003

Nazife Gökçe Akpınar 0000-0002-1625-3008

Yayımlanma Tarihi 30 Aralık 2022
Kabul Tarihi 7 Ekim 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 48 Sayı: 3

Kaynak Göster

APA Ketenci, S., & Akpınar, N. G. (2022). Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 48(3), 279-285. https://doi.org/10.32708/uutfd.1143088
AMA Ketenci S, Akpınar NG. Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi. Uludağ Tıp Derg. Aralık 2022;48(3):279-285. doi:10.32708/uutfd.1143088
Chicago Ketenci, Sema, ve Nazife Gökçe Akpınar. “Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 48, sy. 3 (Aralık 2022): 279-85. https://doi.org/10.32708/uutfd.1143088.
EndNote Ketenci S, Akpınar NG (01 Aralık 2022) Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 48 3 279–285.
IEEE S. Ketenci ve N. G. Akpınar, “Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi”, Uludağ Tıp Derg, c. 48, sy. 3, ss. 279–285, 2022, doi: 10.32708/uutfd.1143088.
ISNAD Ketenci, Sema - Akpınar, Nazife Gökçe. “Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 48/3 (Aralık 2022), 279-285. https://doi.org/10.32708/uutfd.1143088.
JAMA Ketenci S, Akpınar NG. Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi. Uludağ Tıp Derg. 2022;48:279–285.
MLA Ketenci, Sema ve Nazife Gökçe Akpınar. “Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, c. 48, sy. 3, 2022, ss. 279-85, doi:10.32708/uutfd.1143088.
Vancouver Ketenci S, Akpınar NG. Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi. Uludağ Tıp Derg. 2022;48(3):279-85.

ISSN: 1300-414X, e-ISSN: 2645-9027

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