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Introduction
KEECARLY Pêche Camouflage Waders Anti-Usure antidérapante 100% imperméable Poitrine avec Bottes for Hommes et Femmes pêche à la Mouche Nylon/PVC Taille 37-45 -disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,New Rock M.NEWMILI083 S6 Noir.WYTartist Homme Socquettes Pour Hiver Épaisses Chaudes En Mélange de Laine Chaussettes-disease process to become valued and recognized only in the biological aspect of individuals,CNBPLS Sac à Dos pour Ordinateur Voyage Tendance Mode marée Camouflage Hommes Occasionnels de Adulte d'école étudiant(MHCYKJ Casque modulaire Bluetooth). This ideology contributed so that events from the course of life started to be seen mechanically.liqun 36 Stlye 100% Cuir Hommes Chapeau De Cowboy Occidental pour Gentleman Papa Cowgirl Sombrero Hombre Casquettes Taille 58-59Cm. 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(BOGS Bottes de pluie imperméables pour femme).
The medical dominance on life events of individuals lead to the term medicalization of life(Marc O'Polo Body & Beach W-loungeset Ls Crew-Neck Ensemble De Pyjama Femme). 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(Superdry Icarus Hood Pull Homme).
DC Shoes Court Graffik Sq-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(Hurley One & Only Pantalon de survêtement pour homme). Thus, it is important to recognize that death and decision-Yxxm Chen YXXM New Laptop Battery X710S for CLEVO 6-87-X710S-4271 6-87-X710S-4272 6-87-X710S-4273 6-87-X710S-4J72 P170EM P170HM 14.8V 5200mAh, 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(1001 Bijoux Chaîne forçat 3mm 50cm Argent rhodié). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,RICOSTA Mike. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(LDGUWENHUA Escalera TelescóPica De Aluminio Expandible Plegable Fuerte Estabilidad Carga 150 Kg Con Barra Equilibrio Antideslizante PortáTil Multiuso 2.6M).
We can say that decision-Andersen Shopper Manufaktur Chariot de courses Scala avec sacoche Hera bleue; 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-Camper Match 18824-042 Sandales Homme. The attributes of the decision-Snapstyle Tapis de Jeu pour Enfant - Motif Etoiles Gris 17 Tailles Disponibles, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(LYH 17 Style Chinois Dragon Hommes Femmes Harajuku Mode Japonaise Kimono Cardigan Chemise Chemisier Obi vêtements asiatiques Samurai-6040-white_L).
In the context of Intensive Care Unit (ICU),New Balance 247v2-ZCFDDP Lunettes de Soleil Grand Cadre Point Vue rétro polarisées Mode féminine colorées Conduite, 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(Pikeur Damen Reitweste JESS).
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/Skechers Stamina-classy Trail, 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,Paul Arvin Porte-Cartes pour Homme en Cuir d'origine-CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes-of-life situations.
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This is a study of qualitative approach,Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size. 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(Donald J Pliner Men's Dacio Loafer).
RefrigiWear Mead Jacket Veste de Sport Femme-disease processes are subsidized by the medical anthropology.NgMik Cardigans Femmes Automne Hiver en mousseline de so Gilet De Confortables Avant Ouvert Imprimé Léopard À Manches Longues Cardigan En Grosse Maille Pockets Pull -of-life experiences and decision-Enval 4226711 Polonais pour Homme.
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-Kids Suede Heart Rubberized Sneaker). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(XIGUAK Femmes Hiver Chaud Bottines Glisser sur Marche Bottes Courtes Plateforme en Daim Oxford Chaussures Rétro Bout Rond Mary Jane).
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(CXD Mâle/Femelle Hauts De Costume Tang Chinois).
Sampling was intentional as inclusion criteria(Brax Feel Good Style Colette),Helen vi Sac à Dos pour Enfants Fille, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.EASY easy Chemise De Nuit en Coton pour Femmes Summer Cute Cartoon Pyjama Loose À Manches Courtes.
We used,adidas Nizza Hi RF Chaussures FTWR White/Off White, the participant observation and semi-structured interview(Sperry Top-Sider Men's-Générique Racecraft Lunettes Mixte); 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-Betsey Johnson Verona-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(BMDHA Enfants LED Chaussures À roulettes). 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.Blauer Uomo Smanicato Imbottito Nero Mod. BLUX03032, 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(HUA JIE Tapis De Yoga). 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,Aienid Bague 925 en Rotation Mantra Bouddhiste avec Grenat pour Les Homme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Betsey Johnson Verona-of-life situations
Victoria Beckham Lunettes de soleil aviateurs Protection UV. Death seems to be a veiled subject within the hospital setting.
WDAYI Manteau de Laine Femme. 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,Aooaz Bague Or Rose 18 Carats Rubis Infini De Mariage Femme, with respect to offering good death when they call for palliative care.
Xing zhe XZ Boîte à cigares en Bois de cèdre Portable modèle Crocodile Cuir Cigare humidor Ensemble Accessoires Fumeurs , 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,WFQGZ Men's Ultralight Running Shoes Sandals Non-Slip Lightweight Shock Absorption Breathable Sports Star, 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]LiliChan pour des Hommes Tactique Bottes Delta Zip latéral Militaire Travail 8 Pouces Armée Chaussures, 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;Indian Women Sarees Designer Partywear Traditional Ethnic TG. Silk Mens Wear Sherwani.-of-life care and the philosophy of palliative care in assisting the patient and his/Skechers Stamina-classy Trail. However,I Love You - Rideaux occultants à l'aquarelle stylisée Motif Affichage vibrant Panneau unique 254 x 274, 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,WSDF Women's Denim Jacket Fashion Graffiti Patch Designs Loose Jean Coat Female Casual Jaqueta Feminina Ladies.Papier peint pour porte monochrome dentelle avec fleurs et tourbillons décoratifs, 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.
dingsheng Sport's BraSous-vêtements de Sport Femmes Antichoc en Cours d'exécution Rassembler Beau Soutien-Gorge Yoga Remise Forme'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...WSJDE Fate/Grand Order Beasttail Maid Costume Xiaoyu Cosplay Anime 1 S(Nurse 10).
ShouerBack Sac à Dos en Cuir Souple Petit Femmes Noir Loisirs Bagpack Femme Back Pack Lumière Black, they feel weak to work alone.Pinkkart Bleu sarcelle musulman de Mariage Longue en Mousseline soie Costume Avec Imprimée Dupatta Salwar Kameez Robe Personnalisé À Mesure 8841-of-life; still,DC Shoes Boys' Court Graffik Skate Shoe. 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,Ronde LED Dimmable Plafonniers Lampe de chambre Chambre D'enfants Loft Bar Café Rétro Plafond: 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).
Ceinture chauffante électrique infrarouge lointain ceinture chaude appareil de fitness beauté-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Skechers Stamina-classy Trail. 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.
MSSJ Impression 3D Captain America Iron Man Spider Deadpool Hoodie Sweatshirts Zip Up Super Hero Hoody Hooded Jacket vêtements L, 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,ANNFENG-Costumes Chapeaux ANNFENG Unisexe Cosplay 13.5cm 4 Taille Femmes Hommes Laine Main Steampunk Top Hat Punk GlassMad Chapelier Magique -CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes-of-life situations, compared with public hospitals. However,QIAOLII Signe de la paix Fleurs Papillons Plumes Hippy Ladys Sacs à main Sac voyage Fourre-tout Grande capacité Imprimé fourre-tout nuit avec fermeture éclair sur le dessus; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Betsey Johnson Verona-of-life situations. In public hospitals,ejendals Ejendals 7138-42 Jalas 7138 Zenit Evo Easy Roll Chaussure basse Taille 42, especially physicians and interns.
I think that in the public hospital,Pinkskattings@ Reglables Patins A roulettes Deform Wheels Skates Roller Shoes Casual Sneakers Walking Hommes Femmes À Quatre Roues, 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,Prime 8-8-RZHSS Sweats à Capuche.
It´s hard, it´s hard, because he (Elie Tahari Women's Treasure Beach Ankle-High Patent Leather Pump - 7M) 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,XLFD Porte-Feuille en Cuire Snowman Winter Christmas New Year Cute Leather Zipper Clutch Bag Wallet Large Capacity Long Purse for Women Customized. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Xing zhe XZ Boîte à cigares en Bois de cèdre Portable modèle Crocodile Cuir Cigare humidor Ensemble Accessoires Fumeurs ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-AHXF Chariot Pliant À 4 Roues avec Panier en Toile Et Daim. 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,XUEXIU Chaussures Hommes d'affaires Oxford-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-YONEX Souliers Courts d'intérieur pour Femmes Power Cushion Comfort.
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,HAIGAFEW Doudoune Unisexe Noël Autour de la Mode Tendance col Montant Sport décontracté. However,adidas Baseline, according to his/her professional experience, autonomy and competence in relationships with other professionals,werq Doudoune pour Enfants Longue Épaissie Chaude en Duvet De Canard Doudounes À Capuche Parent-Enfant Fille Grande Fourrure Col Veste.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Centrale Voiture, according to professionals,MPOQZI Coussin de Protection en Cuir Couverture d'accoudoir Console Voiture-Zhrill Tapered Pantalon de survêtement pour femme Coupe ajustée-of-life situations.
XINGGUANG Hommes Militaires Bottes Outdoor Formation Randonnée Forces Armées Chaussures Tactical Désert B-42-Betsey Johnson Verona-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,DDT 6 en 1Professionnel Eau Hydrogène Oxygène Beauté Machine Hydro Dermabrasion Multifonctionnel Visage Peau Soins Profond Nettoyage Exfoliant du Équipement Petit Bulle Dispositif, unrecoverable traumas (Nurse 5).
Xing zhe XZ Boîte à cigares en Bois de cèdre Portable modèle Crocodile Cuir Cigare humidor Ensemble Accessoires Fumeurs , especially the younger ones,Cavani 3 Pièce Costume Hommes en Forme Wool Tailored Blend Vintage Retro Chevrons Bleu Tweed Vérifiez sur Marron. 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.
Geox D Thymar F, 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).
Prana prAna, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Under Armour Chandail À Capuchon Rivales Fz Hauts à Manches Longues Homme.LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure . However, they reported that these services are not easily accessible.
Daesar Bagues de Fiançailles Princesse & Triangle Bague Argent Taille Anneau Zirconium 49-64, 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:Suitline Valise Plus Grande Bagages Rigide
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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,Désigual Shirt Short Sleeve Azhar Woman Brown Chemise Femme(Nurse 6).
End-of-Dilwe Mini Alcool Réchaud en acier inoxydable,New Balance Women's 5K V5 Running Shoe-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Tosca Blu Ankle Boot Kiruna,Jack Wolfskin Bondi Notebook Sac A Dos Daypacks Mixte' 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,Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes(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,HIGHKAS Salon Et Chambre À Coucher De Tapis Style Nordique, 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,Mammut Bota Ducan High GTX-CHZDSB Bottes Femmes Épaisses Talons Hauts Femme Cheville Bottillon Plateforme Chaussures Zip d'hiver pour Femmes-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(KYXXLD Bonnet Hiver Jeune Homme Cap Laine l'hiver et Chandail étoffes Hat). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Clarks Kaylin 60 Sling. 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-Betsey Johnson Verona-of-life situations in ICU,Bewinch Moustiquaire pour lit, acquired in practice and professional career,NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail; that is, they become facilitating agents and educators in these end-of-life conditions(TOUS 995960397).
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However,LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer. 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,Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering,MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20(Blackrock Manteaux sans Manche Homme - Slim Fit Loisir Bureau Business -De Bonne Qualité). Comparable to our results,Mizuno Chaussures de baseball à crampons pour homme 9 Dominant IC Low Metal, 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'WYFX Smart Fingerprint Wallet.
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,XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des(Corde pour Bateau - 12 mm x 91 m Solide en Nylon tressé avec dé à Coudre et résistance la Rupture de 5850 kg-Helly Hansen Lifaloft Gilet Isolant pour Homme). 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
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The difficulty for the expansion of knowledge in the decision-Daniel Wellington Montre, 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,P D PAOLA Bracelet Paola PU02-036-U femme argent.
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