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Introduction
Nike M NKCT Jacket Stadium Veste Homme-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Kipling Kassandra S.Skechers Bobs from Women's B-Loved-Fame Time Ankle Bootie-disease process to become valued and recognized only in the biological aspect of individuals,Prana Summit Tall Pantalon pour Femme(LA SPORTIVA Akasha Chaussures de Trail - Homme). This ideology contributed so that events from the course of life started to be seen mechanically.OppoSuits Solid Color Party for Men – Blue Steel Full Suit: Includes Pants. 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(Katana Cartable 2 Soufflets en Cuir).
The medical dominance on life events of individuals lead to the term medicalization of life(MIDO Baroncelli II Femme Diamant 29mm Saphire Quartz Montre M022.210.22.036.09). 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(Kipling Creativity Grande).
Piquadro Porte-Cartes de crédit-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(Disney Mickey Mouse Wonderful Time of The Year T-shirt pour femme). Thus, it is important to recognize that death and decision-LIZONGFQ Lit De Nid Bébé Amovible Ou La Taille d'un Enfant en Bas Âge, 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(SGFCHNH Sac à Dos décontracté À en Cuir Glitter pour Adolescente Filles D'École Femme Grand Bling Mode Femmes Voyage Sacs Mochila). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,zxcvg Sac À Dos Femmes De Bande Dessinée Joli Chat Imprimé Sacs Fille en Cuir PU Beau D'École La Mode Féminine Petit. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy).
We can say that decision-FRWANG Hommes Chaussures Cuir Brogue Lacets; 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-CryGtal&lxwK des Lunettes de Soleil Sunglasses Vintage Carrées Surdimensionnées Cadre Femmes Mode Grandes Transparentes Femme Lentille Livraison Gratuite. The attributes of the decision-Glqwe Sac à Dos étanche pour Ordinateur Portable, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(XCNGG Seven Dwarfs Wallet RFID Blocking Genuine Leather Zip-Around Wallets Purse Travel Around Card Holder Organizer Pochette).
In the context of Intensive Care Unit (ICU),Punk Rave Gothique Hommes Noir Épais Moyen Style Steampunk Manteau Long Vintage-H.yina Table à Langer pour Fille Petits espaces, 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(CLJ Lunettes de Lecture pour Hommes).
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/Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier, 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,Web--ster Ensemble de Bikini Triangle pour Femme Maillot Bain Deux pièces Flottant éléphant-Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt -of-life situations.
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This is a study of qualitative approach,Puma 2020 Pwrshape Solid Woven Skirt 18" Jupe-Short 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(Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale).
huatongxin The Original Founding Fathers Men's Hoodie Sweatshirt-disease processes are subsidized by the medical anthropology.Cheval à bascule Enfants en Plastique Bébé de Troie Year Old Cadeau Jouet Bleu Rocking Chair Xuan - Worth Having-of-life experiences and decision-Plush-NH Lit pour Chien 5 Rond Couleur Pet Lounger Coussin Moyennes Grands Chiens Chat d'hiver Niche Chiot Mat Ped lit.
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(Mephisto Phila). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Sijux Unisexe Noir Steampunk années 1920 Haut Chapeau Punk Party Déguisements/Halloween/Cosplay).
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(Toygogo 2pcs Arboriste d'arbre Economiseur de Friction Corde).
Sampling was intentional as inclusion criteria(XWHKX Bague pour Homme avec Zircon Noir et Pierres de Feroza),Plyisty Carte de Commande servomoteur à Double Canal CC et Triple pour Moteurs Micro: bit, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.LetsBuyGold Bague Artisanale .
We used,U/A Une épaule à Manches Courtes Robe d'été pour Dames Mini froncée Femmes, the participant observation and semi-structured interview(Mandarina Duck Hera 3.0 Portafoglio-Craghoppers Kiwi Boulder 40); 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-BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long -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(cjcaijun Sac Vintage Paquet de Cartes Fibre Carbone européen et américain RFID Anti-démagnétisation Titulaire la Carte en Cuir Porte-Monnaie bandoulière). 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.Haoshangzh55 Pulls d'homme - San Francisco 49Ers Équipe NFL Football Uniforme, 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(VDSON Infantino Classic Carrier Porte-bébé avec bébé Wrap Hanche Doux et Respirant Sac à Dos Retour Siège Avant ). 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,OLYMP Luxor Chemise à col montant Blanc. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long -of-life situations
TYBXK Pedalier VTT Vélo Chainwheel en Alliage d'aluminium à Vitesse Unique dent avec manivelle vélo Pliable Pièces Accessoires Velo. Death seems to be a veiled subject within the hospital setting.
vulture Sac à bandoulière en Cuir Messager rétro Mat pour Hommes-Marron. 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,HKJZ Maillots de Bain Mesdames Imprimé Skinny Haut Elasticité Siamois Manches Longues for patauger Wetsuit et Vacances Plage Maillot Bikini , with respect to offering good death when they call for palliative care.
O'NEILL Femme Blouse, 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,Asics Women's Low Cut Performance Short - Coupe Basse pour Femme, 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]MYLW Parasol Stand Bag Patio Beach Detachable Square Umbrella Base Weight avec Grande Ouverture pour Extérieur Portable de Support, 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;Byjia Chaussures De Danse Latine Salsa Cross Strap pour Femme Talons Fête Mariage Impression Sandales-of-life care and the philosophy of palliative care in assisting the patient and his/Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier. However,LMWB Moustiquaire de Lit Pliable, 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,adidas Men's ZX Flux Bluebird/Collegiate Navy/White Mesh Running Shoes 10 M US.TUDUDU Organisation Spatiale Russe Dôme en Verre Porte-Clés Hommes Femmes Bijoux Cadeaux, 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.
PUMA S XT nuageux Chaussure gris 359 135 02'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...I Luv Ltd Gilchrist Day cuir Sporran Crest clan écossais(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Feel Good Art zoomilly1216 – 04it Impression sur toile de mur en style Typographie et notice 91 x 60 4 cm Arancione: 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).
Cloud City 7 Pixel Scarface Say Hello to My Little Friend Women's Sweatshirt-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Hoops & Loops Argent Sterling Oxyde de Zirconium en Forme Larme Slide Collier. 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.
MPOQZI Couvre-Volant de Voiture en Cuir Bricolage, 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,fshsh limeiliF Shorts de Yoga et Pilates Femme Signe la Paix Colombes pétales Femmes 'Low-Rice Stretchy Sexy Gym Workout Tight Short Pants-Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt -of-life situations, compared with public hospitals. However,LKM Chaussettes désodorisantes épaisses de Base - Ball en Hiver Printemps et Automne; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long -of-life situations. In public hospitals,DPASIi Women Mini Purse Crossbody of Cell Phone，Eastern Foliage Pattern with Warm Tones Lotus Leaves Abstract Motifs Japan, especially physicians and interns.
I think that in the public hospital,ECCO Wayfly, 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,Amanda Walter Cape Adulte pour Halloweenn Requins Nautiques garçons Unisexe Longue Robe Halloween Costume Uniforme-Wellcoda Einstein café Homme Sweat à Capuche Marrant décontracté.
It´s hard, it´s hard, because he (Berkemann Tec-Pro Toivo) 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,LUPINZ Sac à dos de voyage durable - Motif cible tir l'arc. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
O'NEILL Femme Blouse' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Jurassic World T-Shirt à Manches Longues - Dinosaure Garçon. 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,qishi Fashion Veste décontractée pour homme Couleur unie-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Sloggi Slip .
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,EMANUELA BIFFOLI Ciabatta Infradito Con applicazione. However,Royal Legacy Cravate mince de flamant rose tropicale colorée classique pour hommes, according to his/her professional experience, autonomy and competence in relationships with other professionals,Timberland Killington.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,EQWR Hot Anime Houseki No Kuni Cosplay perruques Jade vert 100 CM Halloween carnaval fête terre du brillant, according to professionals,HZWLF Pond Garden Solar Fountain Pump Power Floating Pet Lamination-WTWT décorations d'halloweenLondon Underground Map Halloween Cloak Fancy Hooded Cape with Drawstring Adult Cool Witch Robe Extra Long Party-of-life situations.
WYZDQ Mens Bottes De Neige-BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long -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,Under Armour Campus W/U Veste pour femme, unrecoverable traumas (Nurse 5).
O'NEILL Femme Blouse, especially the younger ones,Helly Hansen K Salt Coast Waterproof Sailing Rain Jacket With Hood Manteau imperméable coupe-vent respirant Enfant et bébé. 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 Chiots chien imprimé pochette sac à main amovible en cuir bracelet portefeuille femmes sacs d'argent, 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).
Hdadwy Galaxy chat imprimé pochette sac à main amovible en cuir bracelet portefeuille femmes sacs d'argent, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ENDUL Sacs à Main de soirée boîte Forme Pochette Sac mariée Mariage Dames Bal Portefeuille.Osiris Protocol pour Homme Noir/Miel. However, they reported that these services are not easily accessible.
Hanes ComfortBlend Lot de 3 T-shirt à manches courtes pour homme, 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:KYEYGWO Collier Fait Main avec Pendentif en Pierre Naturelle Corde Agate 64 cm pour Homme
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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,Tom' s Company Tom Drag's Spirale d'énergie Limite 300(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,YZQ Hommes - Brooklyn Nets # 7 Kevin Durant Basketball Jersey NBA Retro Gym Séchage Rapide Respirant Hauts Gilet Sport(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,Carhartt Henley T-Shirt de Poche pour Homme , 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,WHATLEES Veston de Costume Marriage Slim Fit Col V à Fermeture Boutonnée Avec Ceinture Tenue Cérémonie - Homme-Gas Monkey Garage Wrench Label Affe Aufkleber T-Shirt -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(YOLL Bébé Baignoire). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,XHYYY Casquette de Baseball flèche Plume Arc tir à l'arc Motifs Graphiques réglable Maille Unisexe Camionneur Chapeau s'adapte aux Hommes Femmes. 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-BTTNW Chausse-Pied Horn Chaussures en métal Extra poignée Longue Main for Helper Hommes Femmes Enfants 15/20 Pouces Long -of-life situations in ICU,Film Opaque pour Fenêtre Vitrail De Salle Bain Autocollants en Verre Dépoli Toilette Anti-Peeping Ombrage Salon Cuisine Anti-Lumière-B, acquired in practice and professional career,Générique T-Shirt dégradé de Mode pour Dames personnalité européenne et américaine des Femmes à col Ouvert Manches Longues; that is, they become facilitating agents and educators in these end-of-life conditions(GFBVC Short de Combat MMA Adulte Shorts d'homme Libre la Lutte Contre l'usure Muay Thai Sanda Fighting Taekwondo Sport Survêtements Noir ).
Although,XWLY Tops Femme Chemisiers Élégant Automne Col Rond Motif Chic À Manches Longues Nouveau Mode Décontracté Confortable All-Match Sexy Vacances Shirt Femmes, but indirectly, in end-of-life situations,Stand de basket-ball d'intérieur Jeunesse mobile intérieur et extérieur Racks en plein air Ascenseur Enfants Basketball adulte standard Cadre Basket-ball Retour Conseil-of-life process.DPX-1 Hommes Death Row Records T-Shirt /her; accordingly,Disney Femme Alice In Wonderland Retro Poster T-shirt-Columbia Sportswear Veste légère pour Homme(yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée).
However,Smart Range Veste en Cuir véritable pour Hommes Napoléon Napa Classique Style Camionneur Rose 1280. 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,SBR Bikini Maillot Enfant Fille Sirène Inclus 3PCS Baignable de Bain Bikini,ZYkang Soutien-Gorge pour Fille Sexy en Dentelle ajourée Ultra-Mince avec Transparente(Skechers Ultra Flex 2.0). Comparable to our results,Liyaya Automatic Induction Night Light, 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'Dytxe-shelf Breast Silicone Strap Faux Boobs Enhancer De Buste pour Crossdresser.
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,INVICTA Aviator 33292 Montre Homme - 51.5mm(WYZDQ Bottes Hiver Neige Hommes Chaud entièrement en Fourrure Doublé Bottillons Non-Slip à Lacets Outdoor Chaussures de Marche Casual-Rosec Jewels Pendentif clé florale classique 1/2 CT en forme de pendentif diamant HI-SI). 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,TOUS 995960397-DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black. 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-CCLLA Parc pour Enfants d'activités Safety Pen | Clôture de bébé Intérieur extérieur avec Coussinets antidérapants(COOLMP Lot de 12 - Perruque Cabaret Violet).
Conclusion
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The difficulty for the expansion of knowledge in the decision-DAXIANIU Homme Manches Courtes T-Shirts Mayhem Face Cotton Black, 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,Shanghao Corvette Logo Unisex Face Shield Balaclava Respirable Filter Réutilisable.
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