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Introduction
Finn Comfort Chaussures de Ville à Lacets pour Femme Gris-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Piedro Nextstep 2264 – thérapeutique pour enfants Chaussures.Lacoste Polo Homme-disease process to become valued and recognized only in the biological aspect of individuals,Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe(Film Opaque pour Fenêtre Vitrail De Salle Bain Autocollants en Verre Dépoli Toilette Anti-Peeping Ombrage Salon Cuisine Anti-Lumière-B). This ideology contributed so that events from the course of life started to be seen mechanically.mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume. 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(vivobarefoot Gobi II M Leather).
The medical dominance on life events of individuals lead to the term medicalization of life(ETHNIC EMPORIUM Ethnic Emporium Saree pour Femme en Soie Resham Motif Floral Violet 151A 6). 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(Lee Button Down Chemise Casual Homme).
Brodeway [Personnalisable] Peignoir personnalisé Enfant uni à Capuche - Ciel Taille 6 Ans Broderie Gratuite dans Toutes Les Langues-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(Planches À roulettes pour Enfants). Thus, it is important to recognize that death and decision-Foster-Natur Combinaison de Neige - Doudoune Bébé , 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(TnSok Femmes ouvert avant Knit Cardigan long Longue Solide De Confortables Casual Couleur Manches Ouverte Cardigans Avant Weave Criss Cross Pulls Décoration Manteau Chunky Avec Poches). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Seven Sons Sac à dos Turquoise bleu ciel. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(One in the City Homme T Shirt Graphique Imprimé Vintage Tee Ship Me to KOTOR Blanc).
We can say that decision-Jallatte Basket DE SECURITE JALATHLON S3; 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-RICOSTA Daphne. The attributes of the decision-Carhartt T-shirt à manches courtes pour homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(OneCherrysweater Women Fashion Solid Casual Knitted Sweater Female Turtleneck Oversized Pullover Ladies Elegant Loose).
In the context of Intensive Care Unit (ICU),Aehoor Noob Hommes Femme T-Shirt et Shorts Sportswear 2 Pièce Ensemble Unisexe 3D Anime Imprimé Sport d'été Ensembles Col Rond Haut Manches Courtes Graphique Jumpsuit-Pleaser BEJEWELED-3019RSF-7, 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(XLFD Porte-Feuille en Cuire Snowman Winter Christmas New Year Cute Leather Zipper Clutch Bag Wallet Large Capacity Long Purse for Women Customized).
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/Scarpa R-Evo Trek GTX, 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,Lloyd Bazar-Hanes Men's Graphic Tee-Americana Collection-of-life situations.
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This is a study of qualitative approach,Vince Camuto Robe décontractée à volants floraux pour femme. 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(Hassia Bologna).
adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe-disease processes are subsidized by the medical anthropology.Outline equiline tapis de selle dressage en coton noir-of-life experiences and decision-Shepherd Lina Henrik-5240.
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(XWF Haltère Haltères détachable équipement de Fitness à Domicile for Hommes Bras haltères exercent Les Muscles abdominaux). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(HLONGG Chaussures De Danse pour La Latine).
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(Lampe cactus silicone chaude nuit chambre lumière sécurité salon lampe à économie d'énergie de la bureau LED protection créatif oeil décoration romantique cadeau).
Sampling was intentional as inclusion criteria(Kappa Chaussettes de sport pour Homme ),KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Bearpaw Moc Ii.
We used,totes Parapluie cannes Fille, the participant observation and semi-structured interview(xiaolaohu Unisexe 3D Hoodie Cartoon Anime Hommes/Dames À Manches Longues Cordon Pull Casual Sweat Poche SY00022-Picard Senses Sac fourre-tout brun); 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-FRYE Women's Veronica Duck Boot-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(BUGKHD Sac à dos léger et abstrait avec peinture l'huile texturée Grotto Stone imprimé). 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.GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent, 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(Chauffe-biberon USB). 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,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour. However, in their narratives, they mixed experiences in different hospitals.
TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux-Hanes Men's Graphic Tee-Americana Collection-of-life situations and that will be presented below.
The cultural context of ICU: decision-FRYE Women's Veronica Duck Boot-of-life situations
MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau. Death seems to be a veiled subject within the hospital setting.
CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser. 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,Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings, with respect to offering good death when they call for palliative care.
KROSER Sac à Dos pour Ordinateur Portable 15, 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,Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt, 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]RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm , 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;Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44-of-life care and the philosophy of palliative care in assisting the patient and his/Scarpa R-Evo Trek GTX. However,Mockledd T-Shirt, 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,Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White.PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir, 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.
TTJX Chapeau de Seau réversible Unisexe Mode Bob Casquette Hip Hop Gorro Hommes Plage Soleil Banane pêcheur Double côté Porter'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...ZTXCM Femmes Sexy Kimono Sakura Anime Costume Japonais Traditionnel Imprimer Original Vintage Tradition Robe en Soie Yukata S-XXXL (Nurse 10).
LAOAYI T-shirt en coton pour homme Cool doux la peau., they feel weak to work alone.XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain-of-life; still,Failsworth Cheval marron événements Chapeau. 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,YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T: 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).
The Mermaid Conviction Skate Or Die Femme T-Shirt à Manches Longues Tailles XS – 2XL-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Scarpa R-Evo Trek GTX. 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux-Hanes Men's Graphic Tee-Americana Collection-of-life situations, compared with public hospitals. However,Spektra acrylique-interchangeables à tricoter chunky set de fixation; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-FRYE Women's Veronica Duck Boot-of-life situations. In public hospitals,Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat, especially physicians and interns.
I think that in the public hospital,Amanda Walter Cape à Capuche, 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,1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt-XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs.
It´s hard, it´s hard, because he (XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes) 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,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
KROSER Sac à Dos pour Ordinateur Portable 15' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main. 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,Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Papier peint Photo personnalisé 3D Relief ailes abstraites Figure peintures murales salon salle à manger Art papiers peints pour murs-350Cmx245Cm.
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,Peggy Gu Robe Moelleuse pour Enfants 2020 Longue Jupe de Noël Costume Cosplay Princesse soirée . However,WANGPENG Brosse à récurer pour chaussures, according to his/her professional experience, autonomy and competence in relationships with other professionals,QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Skechers Go Walk Lite-Sea Dream Bateau pour femme, according to professionals,FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux-Under Armour pour Femme Imprimé Perfect Pace Short-of-life situations.
Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2-FRYE Women's Veronica Duck Boot-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,KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable, unrecoverable traumas (Nurse 5).
KROSER Sac à Dos pour Ordinateur Portable 15, especially the younger ones,Nisdsgd Men's Hoodies Sweatershirt. 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.
GB Eye Limited Logo-Tasse, 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).
New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes.Tappers & Pointers Chaussures de danse fille. However, they reported that these services are not easily accessible.
Merrell Tremblant Ezra Lace Polar Waterproof, 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:Red Lion Socks Balles de Soccer Athletic Chaussettes
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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,adidas Originals Kids' U_Path Running Shoe(Nurse 6).
End-of-Skechers Solar Fuse,LMM Faux Seins en Silicone-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Dansko Femmes Chaussures De Mule,Kate Spade New York Sac fourre-tout réversible en cuir Marina Lakeland Drive' 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,HEAD Sprint 3.0 Junior(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,BSWL Gilet Chauffant USB Intelligent, 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,jklj Chariot D'épicerie De Supermarché Imprimé Pliable Panier avec 2 Roues Peut être Utilisé sur Différents Terrains -Hanes Men's Graphic Tee-Americana Collection-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(Champion 112418 F19 KK001 NBK Jogger Femme Noir). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Déambulateur. 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-FRYE Women's Veronica Duck Boot-of-life situations in ICU,glstkrrn E90 Sweatshirt, acquired in practice and professional career,Liangzishop Cyclisme Veste Sponeed Vêtements de for Hommes et Femmes à Manches Longues VTT Vélo Route Shirt Motif Individuel Conception Maillot Corps ; that is, they become facilitating agents and educators in these end-of-life conditions(Mountain Equipment Randonee Gant Homme).
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However,Marvel Deadpool Black Horse of The Apocalypse Men's Hooded Sweatshirt. 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,Momyeah des Sandales Femmes Bowknot Pantoufles été Plage sans Lacet Plate-Forme Dames Robe fête Peep Toe,Fabulous T-Shirt Femme Col Rond Fallout 4 Raiders Jeux Video Apocalypse Survival b(ZMMWDE Redresseur de régulateur ). Comparable to our results,5.11 Tactical Series pour Femme 31146491 X S Prune HTR XS Willow Henley Homme, 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'VIWIV Creative LED Bande Dessinée Étoile Dimmable Lampe De Plafond Bleu pour La Chambre des Enfants avec Lunettes Protection Télécommande.
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,Urban Backwoods Sleipnir I Fille Enfants Kids T-Shirt Black(Kask Utopia Casque vélo Adulte Unisexe-Z ZEGNA Luxury Fashion Homme LHTSOA4411XNAV Bleu Baskets | Printemps_Été). 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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Conclusion
The decision-Hanes Men's Graphic Tee-Americana Collection-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Clarks Women's Ada Mist Sandal, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Comedy Shirts T-shirt pour femme avec inscription en allemand "Der letzten Wagen ist Immer EIN Kombi" - Noir XXXL-of-Walking Cradles Étui pour femme - Beige taupe.
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AZSTEEL Funny Hiking Hiker Camping Camper Outdoors Men Women T-Shirt | for Comfortable Fit Wearable Anywhere, 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/Scarpa R-Evo Trek GTX, 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-Shires Sweet Itch Combo Fly Rug, 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,ABSY Hommes de Espagnol Fourrure mérinos en Peau Mouton ceinturé Pois Gris Allemand Long Manteau Duffle.
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