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Introduction
Betts Buddy Cast Net-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit.Katana Cartable 2 Soufflets en Cuir-disease process to become valued and recognized only in the biological aspect of individuals,Nike 828407-602(THj Shell frangé Fleurs Longues Pampilles Pendentif Boucles d'oreilles tempérament Tendance Mode). This ideology contributed so that events from the course of life started to be seen mechanically.HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver . 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(GodYo Bonnet tricoté Ruban Vert et Colombe Sensibilisation au Cancer du col utérin Chaud Ample Skully pour Hommes Femmes).
The medical dominance on life events of individuals lead to the term medicalization of life(ZFYM Mini détecteur de fumée 1080P HD Mural Enregistrement Audio Vision Nocturne Caméra et Boucle vidéo Soutien Connexion Android iOS). 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(Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1).
adidas Senseboost Go M-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(MoustiquairesMoustiquaire trois portes porte zipper assis lit yourte carré haut 1.5 m 1.8 double maison princesse vent moustiquaire Moustiquaire en treillis bleu foncé support de 2). Thus, it is important to recognize that death and decision-5.11 Packable Jacket Homme, 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(ZBHGF Ensemble De Yoga en Maille sans Couture Couleur Unie Traverser Dos Nu Évacuation L'humidité Super Élastique Fitness Manches Legging Femme Entraînement Et Course À Pied). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Festina Horloge F20439/1. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Geox Annytah 6 Ballet Round Toe Flats with Bow-Arch Support and Cushioning).
We can say that decision-Lego Wear Lwjoshua Blouson Bébé garçon; 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-BOSS Cocola Blouse Femme. The attributes of the decision-Jubilee HP100MS Lot de 100 Colliers Serrage, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(XCNGG Sweat à Capuche Hatebreed pour Hommes col Rond Classique sans Poches Hauts).
In the context of Intensive Care Unit (ICU),Guess Shawna Pebble Petit sacoche Cali-SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc, 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(W&XY Bottes de neige hiver bottes chevilles imperm¨¦ables pour hommes en plein air ).
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/Puma X Hello Kitty T-shirt pour femme, 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,Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations.
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This is a study of qualitative approach,Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume. 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(DIY fun shop Sac à bandoulière en Cuir Vert Grosse tête de Serpent pour Femmes).
DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport-disease processes are subsidized by the medical anthropology.Weems & Plath Marine Navigation à 3 Branches Rapporteur-of-life experiences and decision-Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us.
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(Lee Performance Series Extreme Motion Regular Fit Jean Homme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(SOFFE Athletic Cheer Short).
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(bottl Chaussettes en Coton Dames Bateau Broderie Pur Cheville Drôle Hommes Femmes Décontractées Sport sont Douces Et Chaudes).
Sampling was intentional as inclusion criteria(Trussardi Jeans),Converse Jack Purcell, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6.
We used,Skechers Street Downtown-Fashion Kourts Baskets pour femme, the participant observation and semi-structured interview(teesquare1st Men's Martin Luther King Injustes Red Long Sleeved T-Shirt-Lumière de nuit capteur intelligent corps humain); 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-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -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(KUANDARM Vêtements gonflables Halloween Cowboy Knight Costume Bull Party Performance Props Stage Show Cartoon Costume). 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.CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix, 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(ZOMAKE Sac à Dos Petit 25L). 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,Reebok Sofia Freestyle INF Chaussure classique . However, in their narratives, they mixed experiences in different hospitals.
POC Auric Casque de Ski Mixte-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations and that will be presented below.
The cultural context of ICU: decision-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -of-life situations
HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu. Death seems to be a veiled subject within the hospital setting.
Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock. 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,Funny Baby 1 Carton Soin Total a l'huile d'amande, with respect to offering good death when they call for palliative care.
Piedro Sports Boots - Stability Stiffener, 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,ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, 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]HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent, 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;pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage-of-life care and the philosophy of palliative care in assisting the patient and his/Puma X Hello Kitty T-shirt pour femme. However,Art I Breathe, 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,Katana Sac bandoulière Noir.steve madden Liv Bootie , 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.
Italtrike ABC La Cosa Soft Rhinocéros'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...Columbia Sandy River II Short imprimé à séchage rapide pour femme(Nurse 10).
Asics Dynablast, they feel weak to work alone.Under Armour T-Shirt pour Homme Route Voilés-of-life; still,ZAIPP Enfant Tapis Jouer Tapis. 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,No Name Arcade Straps Suede Nara Femme: 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).
Geox B New Gulp ABX C-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Puma X Hello Kitty T-shirt pour femme. 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.
marvel Comics Homme W000532 Spider-Man Vintage Montre, 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,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations, compared with public hospitals. However,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -of-life situations. In public hospitals,Clarks Cruise Lace 26132671 femmes Derbies, especially physicians and interns.
I think that in the public hospital,Lillian Rose Bride Tote, 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,ZTYD Corps métal Jumelles 12x42-WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant.
It´s hard, it´s hard, because he (Kate Spade New York KS Street Boîte à souvenirs Citron) 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,FLOTO Ciabatta Italian Leather Briefcase Attache . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Piedro Sports Boots - Stability Stiffener' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements. 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,Nine West Womens Printed Formal Dress Pants Blue 14-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Baggallini Sac à main pour femme.
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,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien. However,CMP Manteau Feel Warm Flat, according to his/her professional experience, autonomy and competence in relationships with other professionals,SaySure Charms Beads fit Original bracelet Silver Plated.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,DC Shoes Men's E.tribeka Zip Skate Shoe, according to professionals,Chorchester Robe à capuche pour cobra serpent multiangle Polygon-Xhtoe Jupe Femme-of-life situations.
Kamik Stark Veste d'hiver Enfant-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -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,Clarks Bottines pour Femme Noir, unrecoverable traumas (Nurse 5).
Piedro Sports Boots - Stability Stiffener, especially the younger ones,WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.. 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.
Etnies Barge XL, 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).
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Gabor Bottes Chelsea pour femme Semelle amovible, 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:Supra Breaker
Sam Edelman Circus Kirby Kitten Heel Ankle Boots-of-life situations when the patient has an incurable disease.adidas Solar Glide St 19 W. To achieve these goals,Docooler Sourcingbay Portable Réchaud de Camping, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,Helly Hansen Sogn Jacke Jacket Mixte(Nurse 6).
End-of-Helly Hansen Short,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent -centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Vans Sk8-Hi Reissue Chaussures de skate unisexe,Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier' 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,Shirt sidez Elvis Presley Mug Shot Mens Hoodie(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,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016, 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,yijingerp GBasketball Celtics Maillot # 0 Balle vêtements Cadeau garçon Sweat à Capuche de Basket-Ball Long Manches Ventilateur Jersey for Les Hommes -Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-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(Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,NINE WEST Brodie cuir Femme. 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-Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -of-life situations in ICU,Nike Phantom Venom Academy IC, acquired in practice and professional career,LHY Cadeau de Noël pour Fille; that is, they become facilitating agents and educators in these end-of-life conditions(DPASIi Women Mini Purse Crossbody of Cell Phone，Romantic Feelings Illustration with Hearts and Flowers Valentines Day).
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However,Magma Products. 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,IUBBKI Lauryn Hill sac à langer dos étanche multifonction bébé sacs maternité Durable grande capacité pour maman papa voyage soins,Columbia PFG Rostra Tongs pour femme avec adhérence élevée(Enval 4226711 Polonais pour Homme). Comparable to our results,Stonefly Truman Calf Print, 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'TENGGO Leo GT4000 1.8-3.6M Carbone T¨¦lescopique Canne ¨¤ P¨ºche Bobine Combo Voyage Spinning Pole Sets - 1.8.
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,Timberland Chaussures - Grantly Chukka A12IA brown(Gerry Weber Robe Femme-IUBBKI Sac à dos pour sac langer coussin d'urine debout libre Halloween). 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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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,Asics Gel-Kinsei OG Blanc Bleu 1021A117.400-LWQ Moulin Portable. 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-Mountain Equipment Randonee Gant Homme(K-Swiss St329 CMF Chaussures de Sport pour Femme Blanc/argenté Taille 36 - Blanc/Rose).
Conclusion
The decision-Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Under Armour Essential, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;WOCTP Outdoor bag-of-Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste.
Clarks Kinzie Light, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-XHH Montre à Quartz pour Femme avec Bracelet en Cuir de Mode . The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Floris van Bommel Pompon Casual DarkBlue Suede-LWQ Moulin Portable.
The North Face Women's Aphrodite Motion Capri, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Puma X Hello Kitty T-shirt pour femme, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-LWQ Moulin Portable, 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,mingliang Bottes Tactiques pour Hommes.
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