In this episode of SoundPractice, we dive into an engaging and informative discussion on the future of AI in healthcare and its implications for both doctors and patients. Host Mike Sacopulos is joined by Laura Landro to explore the emerging world of ambient listening technology.Laura Landro, an award-winning writer and journalist, former Wall Street Journal “Informed Patient” columnist, and author of Survivor: Taking Control of Your Fight Against Cancer, brings an innovative perspective on medical technology advancements.This technology captures clinician-patient conversations, aiming to alleviate documentation burdens, enhance patient care, and reduce clinician burnout. However, it also raises important concerns about privacy and data security. Tune in to learn how leading institutions are pioneering research while ethical considerations continue to shape its future, especially in sensitive areas of healthcare.Episode Highlights:Research Insights: Discover the benefits that institutions like Mass General Brigham are experiencing in terms of cost and time savings, and improved quality of care.Regulatory and Liability Concerns: Explore the potential need for FDA oversight if the technology influences clinical decisions, and the implications of errors in AI-generated documentation.Initial Patient Reactions: Gain first-hand insights from patients, including those who find the technology beneficial and others who have privacy concerns.Future Outlook: Project how ongoing development and ethical considerations will shape the integration of AI in healthcare.ResourcesLaura Landro’s WSJ Article: Why AI May Be Listening In On Your Next Doctor's AppointmentBook by Laura Landro: Survivor: Taking Control of Your Fight Against CancerLearn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.1453460720

Join us for an enlightening episode of SoundPractice featuring Lisa Kern, MD, MPH, a national expert, distinguished professor of medicine, and associate chief for research at Weill Cornell Medicine. In this episode, we explore Kern’s unique career path — from her early fascination with communication as a psychology major at Harvard to her impactful research on healthcare delivery in the United States.Her journey reveals an enduring commitment to understanding and improving the healthcare system, driven by the impact of external factors like insurance and policy on patient care. This episode not only sheds light on the complexities of the American healthcare system but also underscores the importance of inter-professional collaboration and patient engagement in shaping the future of medicine.Key Takeaways: Understanding Healthcare Fragmentation: Kern explains the concept of fragmentation, when patients see multiple providers without coordinated care, and the potential harm caused by a lack of coordination.A Patient’s Role in Healthcare Delivery: Fragmentation can lead to communication gaps and poor outcomes, particularly for older adults and minority populations. Kern provides tips for incorporating real-time patient input to enhance care coordination and satisfaction.Inter-Professional Collaboration: Explore proposed policy changes to improve care delivery that focus on value over volume. Kern highlights alternative models for healthcare payment and delivery to better serve patients and reduce provider burnout.The Future of Healthcare Delivery: Identify future challenges and opportunities in healthcare, including the integration of AI. She identifies the importance of ongoing dialogue and proactive measures to shape healthcare to meet the needs and expectations of the American population.Tune in for a thought-provoking discussion that challenges the status quo and explores innovative solutions for a more integrated and effective healthcare system.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.3770746765

Join us for an enlightening episode of SoundPractice with guest Jennifer Clark, MD, as she delves into the profound topic of suffering in healthcare. As an allopathic physician specializing in internal medicine, pediatrics, hospice, and palliative care, Clark’s journey from the bedside to the boardroom has been dedicated to healing, education, and innovation. Now volunteering as a medical liaison, she fosters a compassionate learning environment for students and professionals interested in community-based end-of-life care. In her forthcoming book, Suffer, she reflects on nearly 25 years of practice and passion to promote well-being.Tune in as Clark shares her journey from a career in business to medicine, highlighting the importance of finding purpose and meaning in one’s vocation.Episode Highlights: Purpose and Passion: Discover how Clark’s transition from corporate life to medicine was driven by a search for purpose and influenced by her family’s background in healthcare.Understanding Suffering: Clark discusses the importance of defining suffering and understanding its impact. She outlines how reframing pity into compassion can aid in the healing process.Art and Science in Medicine: Amidst technological and systemic pressures, Clark outlines the seemingly diminishing role of art in medicine. She addresses the disconnect between healthcare systems and the human aspect of medicine, advocating for compassionate care.Looking Ahead: Clark shares her optimism about the potential for healthcare professionals to use the understanding of suffering to improve patient care and clinician well-being.Don’t miss this compelling conversation that explores the intersection of medicine, compassion, and the quest for meaning in healthcare.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.2586114226

In this episode of SoundPractice, we welcome Corey M. Cronrath, DO, MPH, MBA, FACOEM, CPE, FAAPL, a triple board-certified physician and fellow of the American Association for Physician Leadership. Cronrath’s journey is a testament to resilience and dedication. From overcoming a challenging socioeconomic background and serving in the military, he has emerged as a prominent physician leader with aspirations for the future.Cronrath has committed his career to enhancing chronic disease care with a passion for supporting patients with mental illness. With his extensive list of credentials, he provides valuable insights and personal experiences on the optimal timing for physicians to pursue leadership education and certification.Key Topics:Growing in Your Career: Cronrath discusses the importance of post-clinical education and career planning while prioritizing self-reflection. Driven by patient-centered values, he also shares his future goals of transitioning from Chief Medical Officer (CMO) to Chief Executive Officer (CEO).Lessons From the Military: Learn from his experience in military healthcare and the valuable lessons he learned through training and service. The unique challenges and learning experiences in the military still shape his approach to civilian healthcare today.Embracing Value-Based Care: In his current role at Mental Health Cooperative in Nashville, TN, Cronrath shares his work on implementing and expanding a successful value-based care model in a state that does not participate in Medicaid expansion.Listen to the Episode: Tune in to this episode on SoundPractice, or subscribe on your favorite podcast platform to stay updated with our latest episodes.Learn more about the American Association for Physician Leadership. https://doi.org/10.55834/sp.6357437841

In this insightful episode of SoundPractice, we welcome Heather McGowan, BFA, MBA, a prominent future-of-work strategist, keynote speaker, and bestselling author. With a background in industrial design and extensive expertise in the evolving landscape of work, McGowan is a leading voice on how we can adapt to the future.Join us as Heather McGowan shares her fascinating journey and insights into the dynamic changes shaping the workforce. From the influence of AI to the pivotal role of leadership in healthcare and beyond, this episode offers a deep dive into what lies ahead.Key Points: Sustainable LeadershipDiscover the essential traits future healthcare leaders need to foster human connection in a digital world.Learn about the importance of hope and purpose in leadership and how it can significantly enhance team performance.Healthcare and TechnologyExplore the integration of advanced technologies like AI to support and elevate clinician performance.Find the balance between utilizing technology and maintaining human connection to ensure accuracy and efficiency in patient care.Ensuring PrivacyUnderstand the fine line between data sharing for innovation and protecting privacy.Recognize the impact of employer surveillance on trust and autonomy in the workplace.Resilience and High-Performing Teams:Learn strategies to promote employee well-being and build resilient teams.Discover how reframing loneliness, building strong social connections, and managing failure can positively impact work and patient outcomes.Learn more about McGowan’s work.Tune in for an optimistic and forward-thinking discussion that will equip you with strategies to navigate and thrive in the ever-changing world of work.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.2122406838

Episode Summary: In this episode of SoundPractice, host Mike Sacopulos sits down with Mark Katlic, MD, the chair emeritus of surgery for LifeBridge Health System in Baltimore, Maryland. Katlic opens up about his illustrious career, the creation of the Aging Surgeon Program, and the essential topic of maintaining surgical competence as surgeons age.The Aging Surgeon Program:The program addresses the critical issue of age-related competency in the surgical field. It offers a comprehensive and unbiased evaluation that assesses the physical and cognitive functions of surgeons over the age of 70. Aimed to ensure the ongoing safety and proficiency of aging surgeons, it identifies treatable or reversible conditions that, if addressed, could enhance their functional capacity. By fostering a culture of self-regulation within multidisciplinary surgical teams, the program helps maintain public trust in the healthcare system.Key Points:The necessity of avoiding a mandatory retirement age, as individual capabilities can vary widely.The role of strict confidentiality protocols in identifying and addressing issues that might affect a surgeon’s performance.Potential solutions that modify work conditions, allowing experienced surgeons to continue contributing without compromising safety or forcing retirement.About Mark Katlic, MD: Katlic pursued education at Washington and Jefferson College, Johns Hopkins School of Medicine, and Massachusetts General Hospital. His extensive career spans private practice, general and thoracic surgery, and academic positions at Geisinger Health System and LifeBridge Health System.Tune in to this insightful episode to learn how the Aging Surgeon Program is making a difference in the surgical community.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.1651854012

Overview: In this episode, Mike Sacopulos interviews Naakesh Dewan, MD, CPE, DLFAPA, FASAM, a certified physician executive and internationally recognized expert in healthcare quality and digital innovations. Dewan shares his journey from collegiate athlete to physician executive and discusses the parallels between high performance in sports and medicine.Key Topics:Physicians versus Professional Athletes:Dewan compares physicians to world-class cognitive athletes and discusses how sports techniques can influence medical practice and leadership, emphasizing the importance of mental health and well-being in both fields.Well-Being and Burnout:Both physicians and athletes must manage purpose, satisfaction, adaptability, and control to maintain their well-being. Dewan addresses the root causes of physician burnout and offers individual-level strategies for tackling it.Role of Organizations and Leaders:Healthcare leaders have a responsibility to create supportive work environments to reduce the impact burnout has on physicians and regulatory and productive aspects of the organization.Lessons in Leadership and High Performance:Setting ambitious goals and adapting to challenges are crucial. Dewan highlights the importance of learning from others and maintaining mutual accountability within support systems.Takeaway: High performance in sports and medicine requires a balance of technical skills, mental resilience, and well-being. As healthcare leaders, we must create environments that support physicians' well-being, prioritize self-care, and foster peer-to-peer support. By building trust and addressing burnout, we can maintain positive and effective practices.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.9441473763

Episode Summary: Join host Mike Sacopulos in an engaging conversation with Lisa Herbert, MD, FAAFP, PCC, a board-certified family physician and the visionary founder and CEO of Just the Right Balance. Herbert shares her inspiring journey from an early interest in medicine to becoming a transformative coach for physician leaders. "Physicians being in a leadership role is crucial,” says Herbert. “We need people who have done the work and been in the frontlines to continue making important healthcare decisions." In this discussion, discover the pivotal role of physician leadership coaching in today's healthcare landscape.At a Glance:Early Inspiration: Herbert's passion for medicine was ignited by her grandfather’s passing due to healthcare inequities. This personal experience motivated her to pursue a career in family medicine to prevent similar tragedies for others.Career Path: Influenced by mentors and driven by her desire to help others, she has held various roles, including medical director and private practice owner, gaining extensive experience in healthcare leadership.Transition to Coaching: Recognizing the profound impact coaching had on her life, Herbert dedicated herself to helping other physicians navigate their careers and develop essential leadership skills.Challenges in Healthcare: She emphasizes the urgent need for leadership development programs to address workforce shortages and combat physician burnout.Making a Lasting Impact: Herbert offers personalized coaching, focusing on achieving each physician’s career goals and overcoming challenges.Learn More: Visit her website to explore her books: Physicians Rise Up and Take Back Your LifeConnect with her on LinkedIn and FacebookDiscover her insights on the Forbes Coaches Council and in the Huffington PostAbout Lisa Herbert, MD, FAAFP, PCC: Lisa Herbert is a distinguished family physician, executive leadership coach, and national speaker with more than 25 years of experience in healthcare. She holds an MD from Upstate Medical Center and is a professional certified coach recognized by the International Coaching Federation. Herbert is dedicated to bridging gaps in healthcare through her coaching, consulting, and training programs, aiming to create collaborative cultures where physicians thrive and patient outcomes improve.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.8146379788

Episode Overview: Join SoundPractice host, Mike Sacopulos, as he explores the rapid evolution and integral role of private equity (PE) in healthcare with expert Max Reiboldt, CPA. This episode is essential for physicians, health system leaders, PE sponsors, payers, and anyone involved in the healthcare industry.Key Topics:About Max Reiboldt:Learn about Max Reiboldt’s extensive experience in healthcare consulting.Discover his book, Private Equity and Healthcare: Leadership, Economics, and Trends for the Future, which equips you with the knowledge to tackle PE challenges head-on.History:Gain insights into the genesis and evolution of PE in healthcare over the past decade.Deal Metrics: Understand how PE determines a practice’s value and makes diverse investments in healthcare entities like physician groups, surgery centers, and small hospitals.Regulatory Concerns:Discover how increased regulatory scrutiny is impacting transactions and may lead to changes in investment strategies and governance.Benefits, Challenges, and Future Predictions:Examine how PE benefits physicians nearing retirement, while younger physicians remain hesitant.Get a concise forecast for the future of PE in healthcare, its impact on group cohesion, and potential challenges.Additional Insights: Reiboldt also shares insights from his book, Private Equity and Healthcare, recently published by the American Association for Physician Leadership. This book, written by a distinguished group of contributing authors from Coker, provides an unbiased and fact-based examination of this complex field.Listen Now: Tune in to gain a comprehensive understanding of private equity in healthcare and stay ahead of the trends shaping the industry.Subscribe and Follow: Don't miss out on future episodes of SoundPractice. Subscribe to our podcast and follow us on social media to stay updated on the latest in physician leadership and healthcare insights.Learn more about the American Association for Physician Leadership .https://doi.org/10.55834/sp.5092858535

Summary: In this episode of SoundPractice, we delve into the specialized area of healthcare law and the intricacies of physician contracts. Join us as we sit down with Kyle Claussen, CEO of Resolve.com, a firm renowned for its expertise in the legal, financial, and strategic aspects of physicians' employment agreements. Claussen offers insight into fair market value, noncompete clauses, and the influence of private equity in healthcare.Key Points:Advice for Physicians:Gain actionable strategies for negotiating better contract terms by understanding fair market value and compensation benchmarks.Challenges in Compensation:Understand common RVU (Relative Value Unit) tracking and accounting issues to ensure accurate and fair compensation.Leadership Roles:Identify compensation structures for physicians balancing clinical and administrative responsibilities in leadership positions.Industry Influence:Discover how industry trends and changes, like private equity, impact healthcare employment contracts.Best Practices for Contract Review:Know what key elements to look for in employment agreements to ensure long-term satisfaction and career growth during contract reviews.Dive Deeper: Explore educational resources, access compensation data, and connect with expert attorneys to help you navigate your employment agreements. To learn more or get in touch with Kyle Claussen, visit Resolve.com. Conclusion: Kyle Claussen offers invaluable advice for physicians at all career stages on how to navigate and negotiate their employment agreements effectively. Whether you’re a mid-career physician or just starting, this conversation is packed with insights to help you secure a fair and favorable contract. Tune in to learn more about the legal, financial, and strategic aspects of physician employment agreements and gain valuable knowledge and practical tips from Kyle Claussen on mastering physician employment contracts and compensation.Subscribe & Follow: Don't miss out on future episodes of SoundPractice. Subscribe to our podcast and follow us on social media to stay updated on the latest in physician leadership and healthcare insights.SoundPractice Podcast: Your go-to source for physician leadership insights and expert advice. Hosted by Mike Sacopulos, each episode features industry leaders and professionals sharing their knowledge to help you navigate the complexities of healthcare.https://doi.org/10.55834/sp.9539043943

Join host Mike Sacopulos in this compelling episode of SoundPractice as he sits down with David Matchar, MD, to delve into the transformative potential of systems thinking in healthcare. Matchar is a distinguished expert in the industry with a rich career from his early days at Duke University to current influential roles. Drawing from lived experiences, he shares unique insights on how viewing healthcare as an interconnected system, rather than isolated silos, can significantly enhance organizational performance.Whether you're a healthcare professional, administrator, or simply interested in the future of healthcare, this episode offers valuable insights into the practical application of systems thinking to solve complex problems and improve patient outcomes. Episode Highlights: Introducing David Matchar, MD: Discover his career journey, including current roles as professor of medicine at Duke University School of Medicine and professor in the Health Services and Systems Research program at Duke-NUS Medical School in Singapore.Understanding Systems Thinking: Matchar explains why short-term fixes are insufficient and stresses collaborating with all stakeholders to address underlying systemic issues and identify sustainable solutions.Adopting A Holistic Approach: Boost employee morale, enhance healthcare delivery, and improve patient outcomes by identifying leverage points that can stabilize the entire healthcare organization rather than addressing isolated problems.Impact of Private Equity on Healthcare: Analyze the influence of private equity on healthcare and its misalignment with the goals of improving health outcomes, reducing costs, and enhancing patient and provider satisfaction.The Role of Clinical Guidelines and Public Health Policy: Using insights from Matchar’s work in Singapore where they effectively integrated genetic testing into the healthcare system, learn how future guidelines and policies can benefit from a systems thinking framework.Tune in today to better understand how you can transform healthcare delivery and policy within your organization. Don’t miss this opportunity to learn from industry expert David Matchar, MD, and discover actionable strategies to enhance your healthcare organization's performance.https://doi.org/10.55834/sp.1809645926

Summary: In this insightful episode of SoundPractice, host Mike Sacopulos engages in a compelling conversation with Linda Roszak Burton, an accomplished author, researcher, and executive coach. Linda, the author of The Power of Gratitude to Heal the World, delves into the integration of neuroscience-based methodologies in her coaching to enhance well-being and performance in the healthcare sector.Key Takeaways:Linda's Fascination with Neuroscience:Linda shares her journey into neuroscience through a NeuroLeadership program.Emphasizes the importance of understanding brain functionality to improve coaching effectiveness.Virtuous Practice in Healthcare:Discusses her article in Wharton Healthcare Quarterly on clinician burnout and job satisfaction.Highlights the concept of the virtuous cycle, where reconnecting with the purpose and values in medicine enhances clinician well-being and patient care.Gratitude in Clinical Practice:Explores how gratitude and virtues like empathy and compassion can transform patient-physician relationships.Discusses reciprocity and its impact on both clinicians and patients.Addressing Anger in Healthcare:Linda talks about societal anger towards the healthcare system.Emphasizes the need for holistic well-being, including emotional, mental, and social aspects.Gratitude Practices and Neuroscience:The significance of gratitude practices in reshaping neural pathways for improved mental health.Practical tips on incorporating gratitude into daily routines for healthcare professionals.Generational Benefits of Gratitude:Research shows the universal benefits of gratitude across different generations.Implementing Gratitude in Leadership:Strategies for healthcare leaders to foster a culture of gratitude and well-being.The importance of positive deviance and learning from high-functioning teams.Practical Tips:Schedule a regular gratitude practice, be it morning or evening.Integrate gratitude into existing activities, like a mindful walk, to make it a sustainable habit.Listen Now: Tune in to this episode of SoundPractice for an enriching discussion on how gratitude and neuroscience can revolutionize healthcare practice and clinician well-being.Learn more about the American Association for Physician Leadership. https://doi.org/10.55834/sp.7650743615

Episode Overview: Today’s guests have had immense impacts reaching far beyond the healthcare system. Their transformative work has revolutionized mental health reporting requirements and licensed over 1.2 million healthcare workers with the skills to reduce stigma and improve access to care. Join host Mike Sacopulos as he interviews Tim Fischer, president of Jackson and Coker, and J. Corey Feist, JD, MBA, founder and CEO of the Dr. Lorna Breen Heroes’ Foundation about their vital work supporting the mental health and well-being of healthcare professionals. Key Takeaways:Healthcare’s Mental Health Crisis:The CDC reports that healthcare workers in the U.S. face worse mental health conditions than any other job sector.We can address this crisis by changing institutional practices and reducing the stigma of seeking mental health treatment.Inspire Change Today:Revise mental health-related questions in applications and credentials with resources in the Dr. Lorna Breen Heroes’ Foundation’s toolkit.Create a supportive environment for healthcare workers by creating a safe space where you can discuss mental health challenges.Dig Deeper:Jackson and Coker:Jackson and Coker specialize in locum tenens, connecting physicians and advanced practitioners with communities.They collaborate with the Dr. Lorna Breen Heroes’ Foundation to support healthcare worker well-being.Dr. Lorna Breen Heroes’ Foundation:Focusing on improving mental health and well-being for healthcare workers, the foundation was established in 2020 to honor Dr. Lorna Breen, an emergency medicine physician.The foundation aims to reduce burnout and destigmatize mental health treatment for healthcare professionals.Partnership and Initiatives:ALL IN: WellBeing First for Healthcare: A coalition with diverse partners like Harvard School of Public Health and Johnson & Johnson, aiming to scale well-being solutions and remove barriers to mental health access.Champion Badge Program: Recognizes organizations that audit and revise their mental health-related questions to reduce stigma and improve access to care.Get InvolvedFor more information and to become an ambassador visit Dr. Lorna Breen Heroes’ Foundation.Listen Now: Tune in and learn how you can support your peers’ mental health and well-being today!Learn more about the American Association for Physician Leadership. https://doi.org/10.55834/sp.9846570067

Episode Summary:Join us for an enlightening episode of SoundPractice as host Mike Sacopulos interviews Tom Rossi, the vice president of executive search at Jackson Physician Search. With more than three decades of experience, Rossi shares his expertise on physician recruitment, leadership development, and the pressing need for effective physician leaders today.Key Takeaways:The Importance of Physician Leaders:Physicians seek to have a voice and make a difference in patient care and experience at various levels in the healthcare system.The report “Developing the Next Generation of Physician Executives” by Jackson Physician Search and MGMA underscores the crucial role of physician leaders in improving healthcare outcomes and organizational efficiency.Challenges and Opportunities:Many organizations lack adequate physician leadership development programs.Discover how organizations in rural and major metro areas are tackling physician recruitment challenges.Essential Elements of Leadership Programs:Rossi highlights the importance of mentorship, group learning, 360 feedback, and executive coaching.Discover how leveraging technology and staying updated with advancements like AI can enhance your team’s healthcare delivery.Skills and Training for Physician Leaders:Aspiring physician leaders must develop relationship-building skills and effective communication.Explore various educational paths, including MBAs, MHAs, and specialized certifications like the Certified Physician Executive (CPE).About Jackson Physician Search:Jackson Physician Search specializes in permanent physician recruitment, with a distinct focus on physician leadership roles. Their mission is to improve the delivery of patient care and the lives of everyone it touches by supporting facilities across the country that serve more than 10 million patients each year.Resource:Report: Developing the Next Generation of Physician Executives by Jackson Physician Search and MGMAListen Now: Gain valuable insights into the critical and evolving role of physician leaders in the healthcare sector and how to effectively prepare for and excel in these pivotal roles.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.4297212128

Episode Summary: Are you a physician feeling stuck in the traditional career path of clinical medicine? Join us for an enlightening episode of SoundPractice as host Mike Sacopulos welcomes Naomi Lawrence-Reid, MD, a board-certified pediatrician and the visionary founder of Doctoring Differently.Lawrence-Reid shares her inspiring journey from traditional clinical medicine to exploring innovative and fulfilling career paths outside of full-time clinical practice. Her story is a testament to the power of courage, curiosity, and the willingness to challenge the status quo.At a Glance:Introducing Naomi Lawrence-Reid, MD:From her medical training in Massachusetts and New York to founding an innovative online community for physicians, discover her inspiring journey.Acknowledging Limitations:While working in a pediatric ER, the limitations and challenges of traditional clinical medicine became apparent.The Breaking Point:Lawrence-Reid’s career shift can be pinpointed to a pivotal moment in the ER when the administrator’s lack of attention to a broken chair led to her resignation.Challenges and Resistance:While exploring non-traditional career options, physicians are met with skepticism and resistance from colleagues and supervisors.Founding Doctoring Differently:Using her lived experiences, Lawrence-Reid founded Doctoring Differently to help educate physicians and give them “permission” to explore diverse career opportunities.Empowerment through Knowledge:Understanding one’s career options immensely impacts professional and personal well-being, making it easier to address and overcome barriers.Future Vision: Lawrence-Reid’s goal is to improve healthcare through physician empowerment by integrating Doctoring Differently into medical educationWhy Listen? Whether looking for a career change, better work-life balance, or simply curious about what's possible, this episode provides valuable insights and actionable steps. Lawrence-Reid’s journey is a powerful reminder that physicians have the autonomy and capability to explore diverse and rewarding career paths. By challenging the traditional norms and seeking innovative opportunities, doctors can find fulfillment and contribute to healthcare in meaningful ways.Learn more about the American Association for Physician Leadership.https://doi.org/10.55834/sp.7642717126