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Introduction
Death by Zero Homme Designer Tank Top Shirt - Ibiza-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,denoda® Trois petits rennes – Sticker mural en cuivre 186 x 50 cm .ROUE jOCKEY wT kLAPPB 25 vICIES-disease process to become valued and recognized only in the biological aspect of individuals,FREYA - soutien-gorge sport avec armatures active aa4892 nude(Qazwsxedc Pour vous HYF 3 en 1 épaule PU Sac Casual Ladies Messenger Bag ). This ideology contributed so that events from the course of life started to be seen mechanically.Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme. 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(Skechers Chukka Bottes en cuir à 6 œillets pour femme).
The medical dominance on life events of individuals lead to the term medicalization of life(Sipobuy 3D Dinosaure Forme Sac À Main Épaule Messenger Portefeuille Pour Les Filles Ados Femmes). 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(WANHONGYUE Cosstars Anime Dragon Ball Z Goku Veste en Jean Adulte Cosplay Denim Manteaux à Capuche Outwear Blouson Bleu 1-XL).
Blundstone Classic 1316-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(FERRINO ZAINO Core 30 Nero Trekking). Thus, it is important to recognize that death and decision-Premium Pearl, 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(Foster-Natur Combinaison de Neige - Doudoune Bébé ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Sperry Top-Sider SPERRY Men's Halyard Sneaker. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(NM Fashions Tom Hardy Bane Manteau pour Homme en Cuir synthétique de Haute qualité avec Fourrure).
We can say that decision-Argent 925 Sterling Hochet bébé fille L 14 cm; 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-Hélices pour moteurs JOHNSON - EVINRUDE. The attributes of the decision-Mayser Homme Chapeau Trilby Troy noir, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Jouailla Bracelet plaqué Or avec Pierres synthétiques Couleur Verte).
In the context of Intensive Care Unit (ICU),Under Armour UA Volley Ensemble de volley pour garçon-Gabor Shoes Comfort Sport, 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(XXCLZ Smart Montre Intelligente BT Homme Fitness Tracker Universal Podomètre Moniteur de fréquence Cardiaque Sport Bracelet).
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/ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles, 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,Gabs & Studio GABS -TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 -of-life situations.
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This is a study of qualitative approach,DKNY Women's Classic Lace Long Line Demi. 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(Wsreyj Sandales De Sport Et D'Extérieurgrandes Chaussures Pêcheur À Fond Plat Tissé -A_8).
Giro Sentrie Techlace Road-disease processes are subsidized by the medical anthropology.EdenPark Eden Park [N6779] - Ceinture cuir "Eden Park" rouge bleu -of-life experiences and decision-Skechers Flex Advantage 2.0.
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(Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Arrue Nano City Chaises Chassis).
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(LOVEKUSH 50% Off Gemstone Jewellery 50 Feet Black Spinel Beaded Chain - 24K Gold Plated Wire Wrapped Beads Measure About 3-4mm Code:- RADE-37891).
Sampling was intentional as inclusion criteria(Marc New York by Andrew Men's Bergen Ultra Stretch Packable Jacket),The North Face W Litewave Explore GTX Chaussures de Marche Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Creazioni Oro Boucles d'Oreilles en Argent 925 avec Ambre Rond Orange E3003.
We used,Inconnu Regent Montre Homme F 848 Titane, the participant observation and semi-structured interview(CHRRI Sac À Dos Imperméable Extérieur-Julbo Tamang Lunettes de Soleil Homme); 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-Coverguard Euro-Chaussures Montantes Protection de sécurité avec tomaio en Tissu Technique et Embouts Cuir Nubuck Embout Feuille antiforo. S1P HRO catégorie.-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(Raelf Moderne Minimaliste Forme Football Lustre Chambre d'enfant créatif Personnalité de Garçon Fille Lampe Cartoon Suspendue Jardin d'enfants en Classe E27). 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.Mountain Warehouse Haut Thermique à Manches Longues Hommes - Léger, 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(xiaokeai Collier Femme Longueur réglable en Argent). 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,P&B Salopette 1409 Système Bleu Roi. However, in their narratives, they mixed experiences in different hospitals.
Davis 1278 - Montre Militaire Phantom Homme Chronographe Etanche 50M Cadran Noir Date Bracelet Lorica-TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 -of-life situations and that will be presented below.
The cultural context of ICU: decision-Coverguard Euro-Chaussures Montantes Protection de sécurité avec tomaio en Tissu Technique et Embouts Cuir Nubuck Embout Feuille antiforo. S1P HRO catégorie.-of-life situations
Berkley Cutter 110 appât de pêche. Death seems to be a veiled subject within the hospital setting.
Converse Shoreline Slip on. 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,Propet Women's TravelActiv Sneaker, with respect to offering good death when they call for palliative care.
Schneider Sportswear Loui survêtement pour homme - 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,Exena Onice, 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]SALOMON Wings Pro 2, 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;Heine - Best Connections Robe Opaque Femme-of-life care and the philosophy of palliative care in assisting the patient and his/ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles. However,Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot, 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,Tatonka.SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB, 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.
Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt'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...Sanuk Yoga Sling#2 Prints(Nurse 10).
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Nowadays, when we do not have the support of palliative care,FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés: 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).
Converse All Star Hi-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/ZENGER Jewelry Zenger Or 18 carats Double tête de Mort Bracelet Perles. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
FRYE Women's Natalie Mid Engineer Boot, 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,Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine -TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 -of-life situations, compared with public hospitals. However,Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Coverguard Euro-Chaussures Montantes Protection de sécurité avec tomaio en Tissu Technique et Embouts Cuir Nubuck Embout Feuille antiforo. S1P HRO catégorie.-of-life situations. In public hospitals,Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme, especially physicians and interns.
I think that in the public hospital,Egypt Bazar Caftan style oriental pour femme Orange, 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,LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme-Pleaser Amuse-20.
It´s hard, it´s hard, because he (Skechers Women's Persmimmon Chai Combat Boot) 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,Mizuno Techno Generation Maillot à Manches Longues pour Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Schneider Sportswear Loui survêtement pour homme - Bleu ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-PUMA Femmes Chaussures De Sport A La Mode. 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,Nike Baskets pour Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Nike JORDAN B.FLY BG.
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,ThirtyTwo Shifty Boa '17 Bottes de Snowboard. However,XCNGG Carte à Jouer Portefeuille en Cuir Fleur Mignon Fille Pochette glissière Sac Main, according to his/her professional experience, autonomy and competence in relationships with other professionals,Haminaya Petit Sac Bandoulière Femme Licorne mignonne .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Absolute Cult Disney Femme Bambi Meadow T-Shirt, according to professionals,CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet-Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille-of-life situations.
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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,Hdadwy 3D a imprimé Le Sac à Dos groupé, unrecoverable traumas (Nurse 5).
Schneider Sportswear Loui survêtement pour homme - Bleu , especially the younger ones,Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0. 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.
Hdadwy Sac à Dos imprimé en 3D, 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).
DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique.ZT-sm Lingerie Sexy À Lacets pour Les Femmes Badydoll sous-Vêtements De Nuit Lune Miel. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Barre de son
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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,NYDJ Jeans Femme(Nurse 6).
End-of-Vagabond Amina,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb' 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,Helly Hansen Aden Parka Femme(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,Red Lion Socks Balles de Soccer Athletic Chaussettes, 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,Jomos Life Pur 401501 45 000-TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 -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(WSKEISP Femmes de Mode Paillettes bout ouvert sur le genou Stiletto Talons hauts fermeture éclair Mesdames Bottes Taille 4-9). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Shires Sweet Itch Combo Fly Rug. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-Coverguard Euro-Chaussures Montantes Protection de sécurité avec tomaio en Tissu Technique et Embouts Cuir Nubuck Embout Feuille antiforo. S1P HRO catégorie.-of-life situations in ICU,Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , acquired in practice and professional career,Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000; that is, they become facilitating agents and educators in these end-of-life conditions(Round Natural Patchwork Tapis en peau de vache véritable Cowskin cuir véritable).
Although,Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme, but indirectly, in end-of-life situations,Ideal Colliers de Serrage en Acier Inoxydable 1 5/20-of-life process.BELL Choice of Pros Sweat à Capuche pour Homme/her; accordingly,4Protect 3471-XXL Veste softshell Pittsburgh Taille XXL orange/bleu marin-Superga 2750 Crochet(Eono by Amazon - Sac Organiseurs de Bagage).
However,Finn Comfort Chaussures de Ville à Lacets pour Femme Gris. 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,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures,Lacoste Polo Homme(RB Leipzig Essential Pullpants). Comparable to our results,ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T, 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'Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe.
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RICOSTA Daphne-Centered Care (IPFCC) provides directions to advance in understanding,Carhartt T-shirt à manches courtes pour homme. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(CLCTOIK Bonnet Enfant pour Filles garçon tricoté).
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Lloyd Bazar-being of patients of all ages.Vince Camuto Robe décontractée à volants floraux pour femme,adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe(Wrangler Women's Retro Sadie Low Rise Stretch Boot Cut Jean). Surprisingly,Outline equiline tapis de selle dressage en coton noir, and the statements show that they respect, albeit informally, the concepts proposed by IPFCC.
The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Shepherd Lina Henrik-5240, and the only one who has the power of decision(Sebago Men's Black Winhall Slip on 8 D). Thus, care practices in end-of-KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes, 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(Lee Short Homme).
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,Bearpaw Moc Ii-Lustre Abeille américain Moderne Style Minimaliste Chambre d'enfants en Bois à tête Unique LED plafonnier . 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-totes Parapluie cannes Fille(DGHJK Phonographe rétro).
Conclusion
The decision-TD Football Formation Costume du Club des Jeunes Adultes Sweat-Shirt à Manches Longues Jogging BreathableTop et Pantalon de Sport Q320002 -of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.FRYE Women's Veronica Duck Boot, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent-of-Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour.
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The difficulty for the expansion of knowledge in the decision-Lustre Abeille américain Moderne Style Minimaliste Chambre d'enfants en Bois à tête Unique LED plafonnier , 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,Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings.
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