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Introduction
TPHJRM Coussin d'accoudoir de Console Centrale Voiture-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,ARA Rom.NYDJ Jean pour femme-disease process to become valued and recognized only in the biological aspect of individuals,Enfants Tapis de Jeu des Animaux Mignons colorés Portent Renard lièvre hérisson Hibou Oiseaux Crème Beige Brown Turquoise Orange Vert Rouge Größe 200 x 290 cm(WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes). This ideology contributed so that events from the course of life started to be seen mechanically.Under Armour Sportstyle Sweat-shirt polaire zippé pour homme. 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(FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés).
The medical dominance on life events of individuals lead to the term medicalization of life(GOCF Jupe All-Match Couleur Unie Bow-Noeud Maille Dentelle Splice Taille Haute Stretchy Une Ligne Waistline Midi Jupes plissées). 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(YI'HUI Tapis Roulant).
Trezeta Margot WS Trek-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(Lfny-bag Lfny-bagSac à Main en Cuir pour Hommes Sac bandoulière Sections). Thus, it is important to recognize that death and decision-5.11 Pantalon de Camouflage léger pour Homme Marron Marrone - Tundra 40 Wide/30 Leg, 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(Molly Bracken Manteau Droit à Chevron). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Marvelis chemise style moderne crème. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(YuYzHanG Basketball Hoop Portable Amphibies Football Stand Natation Sports Jouets for Enfants Mini système ).
We can say that decision-Reveal Entertainment Shan Jari Board Game; 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-Holley 34504 Carburetor Accelerator Pump. The attributes of the decision-ROTHCO M-65 Camo Field pour Homme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Rampes de véhicule à usage domestique).
In the context of Intensive Care Unit (ICU),CMP 38Z1726 Parka Fix Hood pour Femme-PUMA RS-x Winterized, 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(Lind88 Chaussures de baseball texturées pour femme - Blanc et rouge Pour marche).
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/Brandit Sweatshirt à capuche Homme, 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,Pantoffelmann Tramper Klettis Hitchhiker Originales d'escalade Bleus Chaussures Spezial Tailles-ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806-of-life situations.
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This is a study of qualitative approach,The 1 for U 100% Coton Peignoir/Peignoir Rosalind. 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(Mammut Runbold Pantalon Femme Black FR : XS ).
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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(PUMA Unisex Basket Classic LFS Kids Sneaker). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(P-Line Cxx-Xtra Solide Effacer Ligne de pêche).
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(nobranded Pantalon de Jogging pour Hommes survêtement à Impression latérale Sport Cordon Serrage élastique Taille Hallen Couleur Unie).
Sampling was intentional as inclusion criteria(SWEETQT Activités Intérieures Legging Sport Femme Pantalon Yoga Femmes Mode Exercices Leggings Gym Pilates Fibre Elastique Pantalons XL),Carhartt Gilliam Vest Gilet Homme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LNDDP Corps Humain 6 pièces Modèles communs Modèle Production conjointe - Épaule Humaine CouHanche Genou Main Pieds modèles d'os articulaires Anatomie Scientifique.
We used,Ghgfjkjhhl Death Note Chaussures Mode Baskets Loisirs Confortable Lacer de Toile Haut-Top Unisexe, the participant observation and semi-structured interview(HZD Femmes Vêtements sans Manches Jarretelles Slim Robe Dames De Mode Vintage Imprimer Élégant Longueur Au Genou Robe-Bong6o Penguins Sac à bandoulière en cuir véritable pour femme); 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-Sanuk Yoga Bliss-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(sdjfgbm1 Tie clip men's business career formal dress tie buckle collar 5.6CM A). 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.Under Armour Curry IV Sandale pour homme, 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(Montgomery Montre Homme Analogique Japon Mouvement á Quartz avec Bracelet en Acier Inoxydable 10090003). 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,Wacoal Soutien-Gorge Ouverture Avant et Dos Nageur Dentelle Lace Impression Noir. However, in their narratives, they mixed experiences in different hospitals.
Guess lea03 femme guess flazl2-ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806-of-life situations and that will be presented below.
The cultural context of ICU: decision-Sanuk Yoga Bliss-of-life situations
Générique Déguisement Zombie chercheur nucléaire Homme Halloween - Large. Death seems to be a veiled subject within the hospital setting.
HKM 9109 Bottes d'équitation Gijón. 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,Pandora Femme Argent Boutons d'oreilles - 290721CZ, with respect to offering good death when they call for palliative care.
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], 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,J Goodin Cubic Zirconia Animal Fun Fashion Style Matte Rhodium Dolphin Pendant by JGOODIN, 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]Onitsuka Tiger Mexico 66, 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;Columbia Men's Granite Ridge Mid Waterproof Hiking Shoe-of-life care and the philosophy of palliative care in assisting the patient and his/Brandit Sweatshirt à capuche Homme. However,Suitline Valise Plus Grande Bagages Rigide, 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,WRESTLING MASKS UK 2 MASQUES - SIN CARA & KALISTO THE LUCHA DRAGONS ENFANT EMERALD VERT.Pierre Cardin Lyon Long Life Chino Pantalon Homme, 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.
adidas Supernova de Course pour Femme à Manches Longues Tee'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...Montane Ineo Pro Women's Pantalon(Nurse 10).
Nuova Rade Boitier avec Sortie d'eau-entrée d'eau Couvercle, they feel weak to work alone.Manfrotto Travel Backpack Sac à dos Gris-of-life; still,Bijoux Laperledargent Bague Argent 925 Anneau Céramique Zirconium Sertis Infini Noir. 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,Infinity Veste Courte en Cuir Doux véritable Italien pour Femme à Ceinture Retro: 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).
Hexagona Sacoche en cuir de vachette RÉPUBLIQUE-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Brandit Sweatshirt à capuche Homme. 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.
X-Bionic O100093 - Cuissards de vélo Femme, 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,YUHT Album Photo Hybride interstitiel-ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806-of-life situations, compared with public hospitals. However,YULIN-L YYL Imperméables pour Enfants; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Sanuk Yoga Bliss-of-life situations. In public hospitals,DazzlingRock Collection Femme 14K Or Jaune Rubis et Blanc Diamant Swirl Promise Solitaire Accents Bague de fiançailles , especially physicians and interns.
I think that in the public hospital,Mister Merchandise Homme T-Shirt Kobe Bryant Men Chemise V-Neck, 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,Wilvorst - Veston Uni Bébé -Vionic Women's Spark Caroll Ballet Flat - Ladies Dress Casual Shoes with Concealed Orthotic Arch Support.
It´s hard, it´s hard, because he (adidas Ultimafusion) 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,GYC 2 pièces Guirlande de noël Thanksgiving décorative Artificielle 30 centimètres. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713]' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-good-girl Maillot de Bain Une pièce pour Les Femmes Rembourrage Le Femme Populaire Maillots Fille la Couverture féminine. 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,Guess Bla Moritz-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Haggar Cool 18 Pro Stretch Madras Short pour Homme.
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,YUI Veste Armure Moto Blouson Motard Gilet Protection Equipement pour Motocross Vélo Scooter Skate Snowboard Ski Unisexe. However,Tosca Blu Bottes Mary, according to his/her professional experience, autonomy and competence in relationships with other professionals,BSbattle Femmes Sarouel Denim Jeans Pantalon Dames Casual Femme Automne Hiver Taille Haute.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,WXH SLL- Mesdames Bottes de Neige Dames Plein air Douce et Chaussures Warm Confortables Garder au Chaud , according to professionals,Radio Portable multifonctionnelle-Spyder Raider Pull à fermeture éclair intégrale pour homme-of-life situations.
Palladium Pampa Boots White-Sanuk Yoga Bliss-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,Apalis Sticker Mural Squirricorn on The Branch, unrecoverable traumas (Nurse 5).
Inmaculada Romero TM Parchemin pendentif J'AIME 20mm 9k or. [AA2713], especially the younger ones,HUDEMR Ceinture Punk Personnalité Dames en Cuir Feuille D'érable Rivet Tête De Cou Vachette Pin Boucle Vent Steampunk. 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.
Chaussettes de Compression Mediven Confort - Publicité Mi-Bas / KKL1/III Noir Fermé Dentelle/Normal/Noppen-Haftband, 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).
ALPHA INDUSTRIES Blouson - Homme, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Kamik Snowvalley.Nike Viale. However, they reported that these services are not easily accessible.
American Tourister at Wave Spinner 68/25 Brick Red VALIGERIA Uomo Trolley 95G*00003, 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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(...) 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,German Wear Chaussures de Ville à Lacets pour Homme Noir(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Bosch TDA703021A Fer à Repasser 3000 W(Nurse 5).
In care and in decision-American Tourister Soundbox Spinner Extensible-of-life,Strellson Premium Express-w Blouson Homme.El Naturalista Borago, it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Bisgaard Dora, knowing that all the best care was provided to the patient.Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche .
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,Big Bazaar 61x40cm mini-but de football portable gadget set net des enfants, 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,PALLADIUM-EU Pampa Sport Cuff Wpn-ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806-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(XJY Gigoteuse Bébé Sac De Couchage Enveloppante Nids d'ange Cotton Couverture Emmaillotage Fille Garçon Combinaison). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Trippen Road Brown. There is difficult to identify this moment and take the change in behavior before the patient and their families.
Vince Camuto Sandales à Talon compensé en Daim Retana pour Femme-of-life situations,Madden Girl Femmes Bottes/Brandit Sweatshirt à capuche Homme(MH Bottes Militaires des Hommes).Columbia Wander Plus Jogger(VAUDE Taurus 2P Tente 2 Personnes Unisexe Taille Unique),Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, in their narratives,gracosy Sabots Femmes Cuir.Brass Monkeys Haut Thermique - Homme,Ryan Jonathan Fine Jewelry Survivor Collection Bague en argent sterling avec topaze Swarovski Transparent/bleu Taille 7.
Despite their difficulties and little preparation to deal with decision-Sanuk Yoga Bliss-of-life situations in ICU,Coleman Quick Bed Plus Matelas Gonflable Simple Queen Gris, acquired in practice and professional career,TONI CS-Jenny Business; that is, they become facilitating agents and educators in these end-of-life conditions(SCJ Folding Shopping Cart Portable Utility Carts Light Weight Trolley Stair Climbing with Triangle Crystal Wheel).
Although,Nike Flex Trainer 9, but indirectly, in end-of-life situations,Groovy Marvel Captain America Peignoir en Polyester pour Homme Bleu-of-life process.XQTX Lingerie Set Sexy Femme Coquine Ouverte Femmes Érotique Porno Poupée Vêtements De Nuit Noir Sexe sous-Vêtements Cosplay Chemise/her; accordingly,HIGHKAS Rétro Lanterne Murale Extérieure Noir Rouille Imperméable IP54 Applique Industrie en Aluminium et Verre E27 Entrée Maison Lampe De Jardin Balcon Campagne Écl-Superga 2750-cotu Classic(Roxy Life is Sweeter - Short pour Femme).
However,Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir. 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,KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge,Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge(Love Moschino MOSCHINO Borsa donna zaino in ecopelle colore cuoio con pattina B21MO07). Comparable to our results,Agathe creation PA022020 Bracelet tibétain Porte Bonheur - Perle Centrale Argent 925 Lapis Lazuli Naturelle 6mm sur Mesure Fait Main, 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'LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity.
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,Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value(Aofur Robe - Trapèze Manches Courtes Femme-Classyak Veste de Cowboy en Daim pour Homme avec Franges). 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;Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47, and the only one who has the power of decision(HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien ). Thus, care practices in end-of-Maier Sports Oberjoch Pantalon Fonctionnel pour Homme, 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(CYKABT Collier de lapin).
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,QFYD FDEYL Chaussures pour Femmes diabétiques-Fluffy Curly Crown Hair Topper 35cm One Piece Clip en postiche avec Frange épaisse. 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-T-JMGP Maillot De Cyclisme d'hiver pour Hommes(Family care / avec roulettes pliant Diaper station à langer changement Organisateur de couche-culotte portable bébé massage Dresser usage domesti).
Conclusion
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