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["TARGET antibiotics Audit tools: UTI audit for NON-CATHETERISED patients OVER 65"]
[null,"Audits aim to provide a snapshot of prescribing at a particular point in time. Conducting audits and action planning together enables a practice to understand current antibiotic prescribing patterns, discuss within the team and make improvements, if necessary. Use this audit template to evaluate antibiotic prescribing against current local and/or national guidelines.  The tool will allow prescribers to compare their prescribing decisions with local guidance and will support identification of areas for quality improvement.  "]
[]
[]
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[null,"AIM"]
[null,"To evaluate the diagnosis and management of urinary tract infections (UTI) in people over 65 years. Audit criteria are based on Public Health England (PHE) and NICE guidance and tools "]
[]
[null,"HOW TO USE THIS AUDIT\nStep 1: Familiarise yourself with the diagnostic and management of UTI guidance by reviewing:\nPHE diagnostic flowchart figure 1: Flowchart for suspected UTI in catheterised adults or those over 65 years [PHE Quick reference tool for primary care]. The flow-chart discourages the use of urine dipsticks in this age group. This is because urine dipstick tests detect asymptomatic bacteriuria (ASB). ASB is more common in care homes than in the community and increases with age and long-term urinary catheter use. This flow chart is used to assess your practice’s or your individual compliance with the recommended algorithm. You can also visit the website for more information and the rationale behind all the recommendations: https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis  The diagnostic flow chart for women under 65 years may be more appropriate in some women over 65 years who are not in care homes\n\nNICE/PHE UTI (lower): antimicrobial prescribing guideline Table 1: Familiarise yourself with the NICE/PHE Urinary tract infection (lower): antimicrobial prescribing guideline by reviewing Table 1 and 2: These tables cover 1) women aged 16 years and over 2) men aged 16 years and over. Use these tables to determine the proportion of your patients who have been prescribed the recommended antibiotics for UTI, including dose, frequency and duration. You can visit the NICE website for more information and the rationale behind the recommendations https://www.nice.org.uk/guidance/ng109\n\nIf there are symptoms of pyelonephritis or the person has a complicated UTI (associated with a structural or functional abnormality, or underlying disease, which increases the risk of a more serious outcome or treatment failure), see the recommendations on choice of antibiotic in the NICE antimicrobial prescribing guideline on acute pyelonephritis. \n\nYou may wish to use your local primary care organisation’s antibiotic guidance for UTI as an alternative.\n\nPlease view the TARGET older adult UTI leaflet for self-care safety netting and other patient advice to share during the consultation or with carers.\n\nCOVID-19: Be aware that from March 2020 onwards, practice will have considerably increased numbers of remote consultation to limit patient and healthcare worker exposure to COVID-19. It is assumed that COVID-19 will have been excluded as a likely cause for high temperature."]
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[null,"How to complete this audit"]
[null,"Use a new workbook for each audit period. Note: A paper based audit can be downloaded from the TARGET website to allow consultation details to be recorded by hand if preferred."]
[null,"Step 2: Search for 10-30 consultations relating to suspected UTI in older adults (use a minimum of 10 consultations, plus 1 consultation for every 1k patients if practice size is above 10k; maximum 30 consultations e.g. 15k list size = 15 consultations).  The Read codes below are a sample of codes that can be used but consider adding codes that you or your colleagues are likely to use when you see older adult patients with UTIs. Searching for just a few codes that you usually use may identify all the consultations you require for the audit. Additionally, if you know that coding is inconsistent, you may wish to search for patients over 65 who have been prescribed a UTI antibiotic i.e. Trimethoprim, Nitrofurantoin, Pivmecillinam, Fosfomycin, in the previous 3 months (Extend the time period if necessary). You may need to add ciprofloxacin, cefalexin and co-amoxiclav if these are used for UTI in your practice.\n\nFor an example of a search strategy used, please see appendix 1 for an EMIS screen shot."]
[null,null,null,null,null,null,"K15","Cystitis"]
[null,null,null,null,null,null,"K190","Urinary tract Infection"]
[null,null,null,null,null,null,"1J4","Suspected UTI"]
[null,"Step 3: Input your findings in data collection table found in the Input data tab. Where a patient had a consultation more than once in the audit period, a separate column should be completed for each consultation. Exclude people from the audit who are identified because they are prescribed prophylactic antibiotics but who have had no episodes of suspected UTI during the search period. "]
[]
[null,"a. Select the number of patients being audited from the drop down menu in cell C3"]
[null,"b. You need only enter results in the grey cells. Provided you have entered your findings accurately, using ONLY the numbers 1 and 0 where yes=1, no=0, the spreadsheet will automatically calculate your results. "]
[]
[null,"Step 4: How did you do? A summary of your audit and compliance with NICE / PHE tools is automatically provided at the bottom of the data collection table. "]
[]
[null,"Data Entry Instructions"]
[null,"Enter consultation data in the input data worksheet using the numerical values of either 1 or 0 where 1=yes and 0=no. "]
[null,"Complete/select data according to the options below:"]
[null,"Audit details",null,1,"Number of consultations",null,null,null,null,"Type number of consultations here - this will impact the formulas in the audit summary tab\nThis cell is used in further calculations"]
[null,null,null,2,"Audit date range",null,null,null,null,"Note the date or period when you completed the audit in AG3 and AI3"]
[null,"Diagnostic decision",null,"A","Telephone/surgery/visit",null,null,null,null,"T=telephone, S=surgery, V=visit"]
[null,null,null,"B","Male or Female patient",null,null,null,null,"1=Female and 0=Male. "]
[null,null,null,"C","Clinician initials or role"]
[null,null,null,"D","Vaginal/urethral causes excluded",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"E","Sepsis and pyelonephritis assessed",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"F","Features of pyelonephritis or sepsis present",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"G","New onset dysuria Or two or more other symptoms",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"H","If fever and delirium, other causes excluded?",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"I","Was a dipstick used to inform your treatment decision?",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"J","Care/nursing home resident?",null,null,null,null,"1=yes and 0=no."]
[null,null,null,"K","Use of dipstick in care home meets guidelines (When K=0 and L=1)",null,null,null,null,"This cell will autocalculate."]
[null,"Management decision / Treatment",null,"L","Immediate antibiotic given ",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"M","Management decision meets guidelines",null,null,null,null,"This cell will autocalculate."]
[null,"Giving Advice",null,"N","When to re-consult ",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"O","Antibiotic use and resistance ",null,null,null,null,"1=yes and 0=no. "]
[null,"If antibiotics were prescribed ",null,"P","Antibiotic choice correct ",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"Q","Dose/frequency correct ",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"R","Course length correct",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"S","Was urine culture sent if antibiotics prescribed?",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"T","Did culture result show organism resistant to antibiotic prescribed?",null,null,null,null,"1=yes and 0=no. "]
[null,null,null,"U","Was patient contacted if organism resistant?",null,null,null,null,"1=yes and 0=no. "]
[null,"Reports",null,"A summary report is automatically generated in the audit summary tab",null,null,null,null,null,null,null,null,"Version: 2.1      Published: July 2021      Review Date: July 2023"]

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["Antibiotic Prescribing in Primary Care: UTI Audit for NON-CATHETERISED patients OVER 65"]
[]
["Number of consultations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Audit date range",null,null,null,null,null,"to "]
["COVID-19: It is assumed that COVID-19 will have been excluded as a likely cause for high temperature."]
["Main results table (NOTE: complete the table using the numbers 1 and 0 where yes=1, no=0)"]
[null,null,"Patients in audit consulting with suspected UTI, DO NOT HAVE URINARY CATHETER and are OVER 65 years\ncomplete the table using the numbers 1 and 0 where yes=1, no=0"]
["Compliance with PHE Guidance for Management of UTI in over 65s",null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,"Number of patients (N)","% of Total with UTI","Your target % for good practice ","NOTES"]
["Patient ID"]
["Diagnostic decision"]
["A","Telephone/Surgery/Visit",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"T__S__V__","T__S__V__","T__S__V__"]
["B","Female = 1 Male = 0",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"F___M___"]
["C","Clinician initials or role",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N__G__"]
["D","Urethral/Vaginal cause excluded e.g. notes mention absence of discharge, e.g. vulvovaginal atrophy, STI or urethritis",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C13:AF13)","v":0},{"$f":"SUM(AG13/C$3)","v":{"$error":"#DIV/0!"}}]
["E","Pyelonephritis and sepsis assessed  and recorded e.g.\n• kidney pain\n• new/different myalgia\n• nausea/vomiting\n• rigors\nOR temp over 37.9°C or 36°C or below.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C14:AF14)","v":0},{"$f":"SUM(AG14/C$3)","v":{"$error":"#DIV/0!"}},1]
["F","Features of pyelonephritis or sepsis present",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C15:AF15)","v":0},{"$f":"SUM(AG15/AG14)","v":{"$error":"#DIV/0!"}}]
["Diagnostic criteria for UTI"]
["G","New onset dysuria OR\nTwo or more:\n• temperature 1.5°C above patient’s normal. \n• new frequency or urgency\n• new incontinence\n• new or worsening delirium/debility\n• new suprapubic pain\n• visible haematuria",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C17:AF17)","v":0},{"$error":"#DIV/0!"}]
["H","If fever and delirium, do notes contain evidence of exclusion of other causes?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(AG18/AG15)","v":{"$error":"#DIV/0!"}}]
["I","Was a dipstick used to inform your treatment decision?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$error":"#DIV/0!"}]
["J","Care/nursing home resident?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C20:AF20)","v":0},{"$f":"SUM(AG20/C$3)","v":{"$error":"#DIV/0!"}}]
["K","Use of dipstick in care home meets guidelines (When I=0 and J=1)",{"$f":"IF(AND(C19=0,C20=1),1,0)","v":0},{"$f":"IF(AND(D19=0,D20=1),1,0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(C21:AF21)","v":0},{"$f":"SUM(AG21/AG20)","v":{"$error":"#DIV/0!"}}]
["Management decision / treatment"]
["L","Immediate antibiotic given",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C23:AF23)","v":0},{"$error":"#DIV/0!"}]
[null,"HIDDEN ROW FOR SUMMARY POINT 8",{"$f":"SUM(C23:C23)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$error":"#DIV/0!"}]
[null,"HIDDEN ROW FOR SUMMARY POINT 8",{"$f":"IF(C24>0,1,0)","v":0},{"$f":"IF(D24>0,1,0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(C25:AF25)","v":0}]
["M","Management decision meets UTI diagnostic guide. When immediate antibiotic given (L=1), sepsis/pyelonephritis present (F=1), AND/OR Dysuria or two or more urinary symptoms (G =1)",{"$f":"IF(OR(C15=1,C17=1),1,0)*AND(C23=1)","v":0},0,{"$f":"IF(OR(E15=1,E17=1),1,0)*AND(E23=1)","v":0},{"$f":"IF(OR(F15=1,F17=1),1,0)*AND(F23=1)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(C26:AF26)","v":0},{"$error":"#DIV/0!"}]
["Giving advice"]
["N","Information on when to re-consult\nsafety netting advice",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C28:AF28)","v":0},{"$error":"#DIV/0!"}]
["O","Information shared on antibiotic use and resistance e.g. TARGET UTI leaflet for older adults",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C29:AF29)","v":0},{"$error":"#DIV/0!"}]
[null,"HIDDEN ROW FOR SUMMARY POINT 7",{"$f":"SUM(C28:C29)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0]
[null,"HIDDEN ROW FOR SUMMARY POINT 7",{"$f":"IF(OR(C30=2,),1,0)","v":0},{"$f":"IF(OR(D30=2,),1,0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"C31+D31+E31+F31+G31+H31+I31+J31+K31+L31+M31+N31+O31+P31+Q31+R31+S31+T31+U31+V31+W31+X31+Y31+Z31+AA31+AB31+AC31+AD31+AE31+AF31","v":0},{"$f":"SUM(AG31/C$3)","v":{"$error":"#DIV/0!"}}]
["If antibiotics were prescribed was the following correct? If not, add reason to notes below"]
["P","Antibiotic choice correct: \n1st line: Nitrofurantoin eGFR ≥45ml/minute or Trimethoprim (If low risk of resistance)\n2nd line: Nitrofurantoin (if not first line), Pivmecillinam and Fosfomycin    ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C33:AF33)","v":0},{"$f":"SUM(AG33/AG23)","v":{"$error":"#DIV/0!"}}]
["Q","Dose/frequency correct:\nNitrofurantoin 100mg m/r BD (or if unavailable, 50mg QDS), Trimethoprim 200mg BD, Pivmecillinam 400mg stat then 200mg TDS, fosfomycin 3g single dose",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(AG34/AG23)","v":{"$error":"#DIV/0!"}}]
["R","Course length correct:\nWomen, uncomplicated lower UTI: 3 days. Add rationale in notes if recurrent UTI or structural abnormality\nMen: 7 days\nFosfomycin single dose",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(AG35/AG23)","v":{"$error":"#DIV/0!"}}]
[null,"HIDDEN ROW FOR SUMMARY POINT 8",{"$f":"SUM(C33:C35)","v":0},{"$f":"SUM(D33:D35)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(V33:V35)","v":0},0,0,0,0,0,0,0,0,0,{"$f":"SUM(AF33:AF35)","v":0},null,{"$f":"SUM(AG36/C$3)","v":{"$error":"#DIV/0!"}}]
[null,"HIDDEN ROW FOR SUMMARY POINT 8",{"$f":"IF(OR(C36=3),1,0)","v":0},{"$f":"IF(OR(D36=3),1,0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"C37+D37+E37+F37+G37+H37+I37+J37+K37+L37+M37+N37+O37+P37+Q37+R37+S37+T37+U37+V37+W37+X37+Y37+Z37+AA37+AB37+AC37+AD37+AE37+AF37","v":0},{"$f":"SUM(AG37/AG25)","v":{"$error":"#DIV/0!"}}]
["S","Was urine culture sent if antibiotics prescribed?\nAdd rationale to notes column  if not sent",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(AG38/AG23)","v":{"$error":"#DIV/0!"}}]
["T","Did culture result show organism resistant to antibiotic prescribed?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(C39:AF39)","v":0},{"$f":"SUM(AG39/AG38)","v":{"$error":"#DIV/0!"}}]
["U","If culture result showed organism resistant to antibiotic prescribed, was the patient contacted to assess symptoms",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"SUM(AG40/AG39)","v":{"$error":"#DIV/0!"}}]
["V","NOTES"]

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["Antibiotic Prescribing in Primary Care"]
["UTI Audit for NON-CATHETERISED patients OVER 65"]
["Summary Findings"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Audit date range",null,null,null,null,{"$f":"'Input data'!AG3","v":"00:00:00"},null,null,"to",{"$f":"'Input data'!AI3","v":"00:00:00"}]
[null,"Total number of patients in audit",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!C3","v":0}]
[null,"Criteria",null,null,null,null,null,null,null,null,null,null,null,null,"Number of patients",null,null,"Total % patients",null,null,"Target %",null,null,null,null,"What can you do to improve guidance compliance? Reflect on your performance and complete the questions below."]
[null,1,"Telephone consultations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"The 3 criteria we had the best compliance with are:\n1.\n2.\n3.\n\nThe 3 criteria which are priority areas for discussion are:\n1.\n2.\n3.\n\nReflection: How will I improve our low compliance?\n\n\nReflection: How will I maintain our good compliance?\n\n\nTips to share with other practices and clinicians:\n\n\nThings that might help are:\n1. Agree a diagnostic and treatment target and re-audit in 1 - 3 months\nThings that could help you:\n1. Monitor use of Urine dipsticks in your practice\n2. Promote use of PHE or local antimicrobial/management of infection guidelines in practice\n3. Encourage use of TARGET Treating Your Infection – Urinary Tract infection (TYI-UTI) leaflet for older adults\n4. Share TARGET TYI-UTI leaflet on clinical system \n5. Promote and conduct TARGET webinars and eModules \n\nRe-audit in ____ months - identify a date when you will repeat the audit ( ___ / ___ / ___ )"]
[null,2,"Patients where sepsis and pyelonephritis assessed",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG14","v":0},null,null,{"$f":"'Input data'!AH14","v":{"$error":"#DIV/0!"}},null,null,1]
[null,3,"Proportion of patients where vaginal causes excluded ",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG13","v":0},null,null,{"$f":"'Input data'!AH13","v":{"$error":"#DIV/0!"}},null,null,1]
[null,4,"If fever and delirium, percentage with written evidence of exclusion of other causes ",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG18","v":0},null,null,{"$f":"'Input data'!AH18","v":{"$error":"#DIV/0!"}}]
[null,5,"Care/nursing home residents where treatment was not based on dipstick test",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG21","v":0},null,null,{"$f":"'Input data'!AH21","v":{"$error":"#DIV/0!"}}]
[null,6,"Antibiotic decision based correctly on diagnostic criteria for UTI",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG26","v":0},null,null,{"$f":"'Input data'!AH26","v":{"$error":"#DIV/0!"}}]
[null,7,"Overall compliance with giving advice",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG31","v":0},null,null,{"$f":"'Input data'!AH31","v":{"$error":"#DIV/0!"}}]
[null,8,"If antibiotics were used, total number given correct antibiotic, dose/frequency and course length (QRS)",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG37","v":0},null,null,{"$f":"'Input data'!AH37","v":{"$error":"#DIV/0!"}}]
[null,9,"Proportion of patients where urine culture was sent when antibiotics were prescribed",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG38","v":0},null,null,{"$f":"'Input data'!AH38","v":{"$error":"#DIV/0!"}}]
[null,10,"Number of those resistant (If over 20% consider in those resistant whether antibiotic choice is correct)",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG39","v":0},null,null,{"$f":"'Input data'!AH39","v":{"$error":"#DIV/0!"}}]
[null,11,"Proportion of patients contacted if results shows resistance to antibiotic prescribed",null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Input data'!AG40","v":0},null,null,{"$f":"'Input data'!AH40","v":{"$error":"#DIV/0!"}}]

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