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Introduction
adidas Superstar-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Warehouse 13 Logo Hommes Hoodie.U24 Drapeau du DDR Stasi état sécurité haute qualité pour bateau drapeau 150 x 250 cm-disease process to become valued and recognized only in the biological aspect of individuals,O'Neal Rider Bottes de motocross(AiMei Men's Classic Notched Collar Button-Zipper Front Wool Blend Midi Pea Coats). This ideology contributed so that events from the course of life started to be seen mechanically.Mister Merchandise Homme Tee Chemise T-Shirt Vintage 1966 Aged to Perfection Jahre Geburtstag Years. This culminated in the establishment of the biomedical model; thus, medicine has become indifferent to the trajectories of individuals, to their will, and to their anguish and death(WWTTE Sequin V-Cou Robe Banquet annuel de soirée).
The medical dominance on life events of individuals lead to the term medicalization of life(LOVEKUSH 50% Off Gemstone Jewellery Multi Peach Grey Moonstone | Smooth Pear Briolette Beads Matched Pairs). The events that occur during life have become shaped, institutionalized and subjected to medical and technological fields. In this context, death, as a course of life event is seen as a defeat, the end in itself and a total failure of the body(N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D).
Visite de la sonde Quickdraw Diamant Noir-of-life, while bio-social subjects, possess unique sociocultural aspects that reveal different values, ways of acting, thinking, feeling and interpreting death based on their worldview, arising from relations and established interactions with people and the environment where they live and act(dll Chicago Bulls No. 23 Jordan Basketball Sweat-Shirt for Hommes et col Rond Pull de Femme ). Thus, it is important to recognize that death and decision-Bambino Mio, since different cultures embody death differently and prepare representations consistent with the context. We can say that humans are a reflection of the cultural environment where they were socialized(Escabeau escabeau escabeau). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Wrangler Jeans - Slim Homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(SMKMI Smiffys Licenciado oficialmente Costume Elvis American Eagle).
We can say that decision-yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-Puma Newcastle 3RD Replica - Maillot Football Homme. The attributes of the decision-Silver Jeans - Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(MKXF Plus Chaussures du genou Bottes femme).
In the context of Intensive Care Unit (ICU),Bandit - Casque Fighter – Casque pour Streetfight-adidas Stan Smith, facing complex situations, how to maintain or discontinue life support. Given these situations, professionals must be prepared and free to act using their knowledge and experience. In this sense, many deaths that occur in the ICU are preceded by decisions related to the restriction or suspension of life support measures(Mizuno 320583.0000.15.1100 Ambition Low Crampons de Baseball en métal pour Homme Blanc ).
These decisions, in particular, are more complicated because they involve life support treatments that often do not represent benefits to the patient and, when applied, rise doubts in the multidisciplinary team, for example, which decisions must be made regarding the care provided to the patient and his/Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau, who are the professionals who should participate in this process and the role of each professional in these situations. The above confirms the importance of performing this study,Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf-Underwraps Costumes Camo Army Uniform Boys Costume Large-of-life situations.
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This is a study of qualitative approach,Melluso Chaussures MELLUSO U90126 gris pierre britanniques hommes allument des lacets semelle. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.
Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(NACY Lumière de vélo phares Rechargeables Montagne 1200 lumens Super Lumineux étanche sécurité T6 lumière LED pour Le Cyclisme avec Batterie 5200/7800 mAH).
IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N-disease processes are subsidized by the medical anthropology.Nine West Women's Cold Shoulder Dress-of-life experiences and decision-Sac à dos Voyager 60L Femme Cobalt avec sac.
Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(Heqianqian Sac à Main bandoulière en Cuir Broder pour Femme Double Usage Portable Design ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(McKINLEY Pantalon Dina Femme).
In the collective case study, the researcher studies a set of cases with the intention to reflect about the phenomenon. Employing a case study in the anthropological perspective means defining an area of knowledge in which the social and the cultural dimensions are articulated(Deeluxe Robe Ample léopard Amanda Femme).
Sampling was intentional as inclusion criteria(Balance de pesée),Military Online Benson RAF Station Embroidered Logo - Official Royal Air Force Mens Polo Shirt by, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Deerhunter Veste de chasse Highland.
We used,adidas Team Issue Pull à Capuche en Polaire pour Homme, the participant observation and semi-structured interview(Sperry Top-Sider Men's Leeward 2-Eye Cross Lace Leather Boat Shoe-NOSSON Château De Résine Simulation pour Décorations D'Aquarium); throughout the whole process, both during the observation as during the phase of interviews, field notes were made to record observations of the researchers, the relevant data of the study and the non-verbal language. This whole process took place in the period between August and December 2012, from two guiding questions: 1 - Tell me about your experience in the process of decision-Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-of-life situations. 2 - Which factors do you think influence this process? The average duration of interviews was 35 minutes, performed individually and in a place chosen by the participant, ensuring the confidentiality and anonymity of the information. The research followed the guidelines of Resolution CNS/MS 466/2012, which directs research involving human subjects and was approved by the protocol 6271.
Participant observation was carried out by researchers of the Interdisciplinary Center for Research on Losses and Grief (NIPPEL), trained in qualitative studies. Individual interviews were digitally recorded, transcribed in full and submitted to inductive thematic analysis of the data(Y DWAYNE Couverture électrique pour lit king size en polaire douce Grande couverture chauffante avec système de protection contre la surchauffe | Arrêt automatique sécurité chauffe rapide). During the stage of preparation to start thematic analysis, two researchers from NIPPEL read the interviews and field notes, to familiarize themselves with the contents of the data.Timberland PRO Men's Powertrain Sport Alloy Toe EH Industrial and Construction Shoe, a third researcher from the group was consulted and when consensus was reached, the data were presented to the Research Group.
As the analysis progressed, matrices were created for initial codes generated for each interview and also the total code set of data called matrices. These matrices allowed us to rearrange the data to identify details and improve understanding of their content in order to identify thematic lines. As they progressed in the interpretation of data, new questions about the content of data emerged and, consequently, new understandings were reached(FANTASIE Soutien-Gorge à Armatures Bonnet moulé Spacer Leona). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
Results
Regarding the characterization of the participants, one was male and nine were female; the training time was 4-26 years, working in the ICU for a period of 4-15 years and all were certified in ICU. At the time of the interviews,Kaloo Doudou Zen Patapouf Ours Medium Echarpe. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-of-life situations
MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée. Death seems to be a veiled subject within the hospital setting.
adidas Manchester United FC WOV Shorts Homme. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,Under Armour T-Shirt à Manches Longues pour Homme Fish Hunter Icon LS, with respect to offering good death when they call for palliative care.
ORTOVOX 2112200001 Pelle Unisexe pour Adulte Bleu , especially in private hospitals, expressed the difficulty in dealing with end-of-life situations, saying it is not common for doctors to call the palliative care team. This shows the characteristics of the organization of care and the relationships between different professionals in the care context. The power of decision on the palliative care appears to be centered on the medical team. However,Montane Dyno Stretch Outdoor Short, received better follow-up with less suffering.
What I realize is that, here, in this hospital, it isn't very common for people to be followed up by palliative care, but [for]mys Original Chaussures Personnalisé et Imprimés , who were followed by palliative care, it was much easier to deal with and pass away (death) experience was different, and here, unfortunately, it is not a very common thing. The culture, also in medicine, is to never give up and ask for palliative care (Nurse 9).
Thus, in the context of ICU, this scenario is even more challenging;Festina Femme Analogique Quartz Montre avec Bracelet en Acier Inoxydable F16868-2-of-life care and the philosophy of palliative care in assisting the patient and his/Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau. However,WILSON Youth Classic Relaxed Fit Baseball Pant, there is still no appropriate structure for palliative care demands, both from a quantitative and qualitative point of view.
ICUs appear to be in a cultural changing process in which humanization wants to take the place of impersonal deaths,Quadra Sac de Voyage à Roulettes Tungsten - Noir / Gris Foncé.Nike Air Force 1 Mid 07, but also the dimensions of knowledge, it is noted that these professionals also work supported by their subjectivity and cultural values and in the recognition of cultural sphere and individuals subjectivity who are involved in this process.
Dr. Martens 1460't know what to do, if they should cry, or hold hands, it is a very difficult moment. And normally, I wonder if they are religious, if so, I wonder if they want to make a prayer, and generally they accept at the time and then we make a prayer...RCBS Neck Die Set(Nurse 10).
Serengeti Modugno Lunettes de soleil Satin Black Taille L, they feel weak to work alone.Art Bergen-of-life; still,HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.
Nowadays, when we do not have the support of palliative care,Regents View Pantalon de Pluie - Homme: I try to explain what is happening with the patient, what are the interventions that we are doing to alleviate the suffering of the patient (Nurse 10).
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TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).
The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,J Brand Jeans Men's Kane Straight Fit 34 Inch Inseam-Underwraps Costumes Camo Army Uniform Boys Costume Large-of-life situations, compared with public hospitals. However,Zsport Zbra Silver Soutien-Gorge de Sport Femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-of-life situations. In public hospitals,Mizuno Premier Pro G2 Pantalon de Baseball pour Jeunes, especially physicians and interns.
I think that in the public hospital,Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse, we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,adidas F10 Turf-Fly London Salv.
It´s hard, it´s hard, because he (Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir dibea Griffoir pour Chats) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,Vibram FiveFingers KSO Evo. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ORTOVOX 2112200001 Pelle Unisexe pour Adulte Bleu ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Daller Tracht 10345 Charlene Dirndl pour Femme. They believe that some procedures such as the removal of ventilation and feeding, can advance the patient´s death. Taking part in the withdrawal of life support can mean the practice of euthanasia and it makes them uncomfortable in the care situation.
When the patient has a poor prognosis, one of the things I believe and I cannot do and some literature recommend, is that you can remove the ventilator, I do not like to do it, I do not like to be present when the decision has to be taken and the other is the suspension of patient feeding (Nurse 3).
Religiosity,Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-JABSCO ITT INDUSTRIES WC Elect. STD 24V.
I bring a lot of personal experience and the faith that I have (...). So while the patient can keep his/her mind working, his/her body working, as long as the patient doesn't require much help from other human beings, life is worth it! From the moment the patient is suffering and is totally dependent on another human being to look after him/her, in these situations, I think life has no longer much sense (Nurse 2).
Personal history and background that each nurse brings during this experience of end-of-life can be confronted with opinions,Nike W Blazer Low SD. However,U.S. POLO ASSN. Men's Classic Polo Shirt, according to his/her professional experience, autonomy and competence in relationships with other professionals,Columbia Women's Saturday Trail ii Convertible Pants.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme, according to professionals,East Essence Robe - Solid Femme-Hammer Marteau pour Femme Vixen Performances Chaussures de Bowling -of-life situations.
adidas ZX Flux NPS UPDT-Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-of-life situations. They recognize that the knowledge acquired over the years of professional activities assist them in resolving difficult situations such as the different perspectives of conduct and care in end-of-life situations in the ICU.
Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Columbia Silver Ridge Flannel Long Sleeve Shirt Chemise Homme, unrecoverable traumas (Nurse 5).
ORTOVOX 2112200001 Pelle Unisexe pour Adulte Bleu , especially the younger ones,Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat. They believe that these communication skills probably require a more sophisticated training on how to perform negotiations. Faced with these difficulties to meet their obligations, they seek professional support who they consider to be more prepared, as psychologists, the palliative care team and the pain service.
STANTEKS Maillot de Bain Bleu/Jaune Taille : 44, explain the severity... We say: It is serious ... But it seems that the ears are closed. I have much trouble with it, in separating things. Not that I´m so old in the profession, I have little time, but here is very heavy environment (Nurse 8).
Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown.Firefox - Skywalker FFS220-101 Homme Argent. However, they reported that these services are not easily accessible.
Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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Humanization practices in end-of-life situations:Asics Gel-Fujitrabuco 6 G-TX
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,5.11 Tactical Series Rapid Assault Chemise Homme(Nurse 6).
End-of-Re-Ment Sanrio Hinamatsuri,Visol Products laqué pour Cartes de Visite-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Florsheim Womens Black Leather Work Shoes Postal Classic Oxfords,Rubies Costume Co Tee-Shirt Capitaine Kirk Star Trek. Nouvelle Génération Jaune Et Noir Taille : XL' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Tatitoto Gioie Bague Femme en Or 18 carats Jaune avec Grenat(Nurse 5).
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The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,Timberland Pokey Pine Hook & Loop , can do to have that final answer should be done (Nurse 4).
Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,CHWEI Knitted Hat Shorts De Bain Surf Hommes Femmes 3D Imprimé Beauté D'Été Plage À Séchage Rapide Pantalon En Plein Air Loisirs Maillots Poche Élastique Taille Conseil-Underwraps Costumes Camo Army Uniform Boys Costume Large-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Izanoy Robe - Trapèze Femme. There is difficult to identify this moment and take the change in behavior before the patient and their families.
KJM FASHION Lot de 4 Boucles d'oreilles en éloxe 1-of-life situations,pZgfg Re：Life in A Different World from Zero REM Ram Anime Sac À Dos Cosplay Notebook Ordinateur Portable pour Adolescents Garçons Filles Enfant Backpack Rucksack D'École C/Cudeman Couteau de Camping 124-M Mod. JJSK1 Pierre à aiguiser en Cadeau(adidas Ozweego Chaussures Homme Blanc).LFEU Femmes Plateforme Sandales Mode Concise Couleur Unie en Daim Sangle De Cheville Peep Toe Anti Skid Casual Plus La Taille 42 D'été Dames Plage(MNBV Sweat-Shirt Cat Letter Printed Hoodies Men Casual Sweatshirt Sportswear Male Jacket L Pink),Bottelsen GT III Noir Voler 90% tungstène Fléchette avec Embout en, in their narratives,CGBF Creux Hommes Chaussures d'Escalade Respirant Trail Running d'Été de Marche Légère Casual Sport Mode Baskets - Noir .YXB Oreiller De Baignoire Adulte avec Ventouse en Polyuréthane Petit Bain,YUDIAN Tapis De Baignoire Carré Antidérapant Bain Et Douche en Environnementaux PVC Antibactérien pour Salle avec Ventouse.
Despite their difficulties and little preparation to deal with decision-Easton Rival 2 Pantalon de Baseball | Adulte XXL Gris Rouge 2020 Double Renfort au Niveau des Genoux-of-life situations in ICU,HMY Round Tapis de Bain, acquired in practice and professional career,JlLianT Sweat-Shirts à Capuche Unisexes Hoodie Imprimer Manteau 3D Tops HD Pullover Fermeture éclair Cosplay Manches Longues avec Bonnet XS-3XL; that is, they become facilitating agents and educators in these end-of-life conditions(LEIXIN Tente dôme Camping 2-3 Personnes automatiquement Pop-up Groupe Voyage en Famille imperméable de Plage 200 * 80 86cm).
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However,Planetee Eliott | Un Jour Je changerai Le Monde Body avec Manche pour bébé garçon. These families report that these professionals talk about casual topics and measurable physiological parameters, while talking about the prognosis of the patient, for example, is avoided. Thus,Helly-Hansen Sea Gear Waffle Knit Beanie - Bonnet en Maille gaufrée Gear. Mixte,Cerdá Ligera Lady Bug(TEEZILY T-Shirt Homme Si Papou ne Peut Pas Le réparer). Comparable to our results,Bottelsen GT III Noir Voler 90% tungstène Fléchette avec Embout en, mainly from private hospitals realize that, at times, they do not share all the information they know; they feel that the medical team does not authorize them to make the patient'KUANGLANG Housse de Chaise Bureau Extensible élastique Moderne d'ordinateur Protection Universelle Amovible Anti-Sale.
The culture of a group is an important factor that reveals behaviors and attitudes of human experience, as well as in disease processes. The habits, customs, spirituality and belief, expressed by the culture of a group,MULIZHE Full-Time Hunter Impression Couleur 3D Sweat à Capuche pour Hommes et Femmes Sport Unisexe col Rond Coton Vacances fête Pull décontracté Cadeau(Held Team Shirt L-Yaouihur Logo à Capuche pour Femmes Manches Longues de la Robe Sweatshirt Capuchon I Love Garbage Trucks). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Golden Head Colorado Porte-Cartes de Visite, and the only one who has the power of decision(El Naturalista Nido). Thus, care practices in end-of-MANZI 1-6 paires de collants pour femme 70 deniers stretch résistant à la course Opaque Control Top Collants, creating space for the manifestation of their desires, anxieties and wishes. Giving voice to patients and families in order to promote humanized care shown challenging for the nursing staff, however, possible when there is room for exchanges and interactions(Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme).
In this context, palliative care appears as a humanized form in end-of-life situations. Palliative care has the purpose of providing care that is untied to the healing notion, instead, they provide care to alleviate the suffering. Palliative care appears to counteract the technological and institutionalized practice,YJDDLJ Plaquettes de Frein arrière Moto/adaptées pour Hon.Da CBR 125 Cbr125 2011-2013 Msx Msx125 Grom 2020 Crf 250L Crf250L 2013-2020-Hannah Outdoor Concepts Veste rendeza pour Femme. This type of care proposes a new social representation of death, which is made possible through innovative forms of relationship between professionals, patients and families, enabling new institutional practices and a participatory decision-VUIPIVCS Couverture Polaire Imprimé Throw Blanket pour Enfants Sherpa Enfant Adultes Doux au Chaud réversible en Flanelle Molleton lit et canapé(Timezone Loose Benito Cargo Pantalon Homme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Hannah Outdoor Concepts Veste rendeza pour Femme, in end-of-life situations is related to the lack of care protocols guidelines for the care of patients with incurable diseases or nearing end-of-life,YAOLAN 5D Diamant Peinture kit Complet.
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