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Introduction
Montane Dyno Stretch Outdoor Short-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,mys Original Chaussures Personnalisé et Imprimés .Festina Femme Analogique Quartz Montre avec Bracelet en Acier Inoxydable F16868-2-disease process to become valued and recognized only in the biological aspect of individuals,WILSON Youth Classic Relaxed Fit Baseball Pant(Weichuang Literie de bébé 7PCS Broderie for Lit Nouveau-né Linge lit Bear Amovible). This ideology contributed so that events from the course of life started to be seen mechanically.Quadra Sac de Voyage à Roulettes Tungsten - Noir / Gris Foncé. 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(Décoration de fête Lampe projecteur Fille Garçon Chambre Projecteur étoile Night Light ).
The medical dominance on life events of individuals lead to the term medicalization of life(Hush Puppies Girls' Jesse Sneaker). 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(steve madden Sandales pour Femme Argent 38 EU).
Nike Air Force 1 Mid 07-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(Dare 2b Femmes acquérir II T-Shirt). Thus, it is important to recognize that death and decision-Dr. Martens 1460, 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(Mickey Mouse Sac à Dos Enfant Garçon Noir Noir/Rouge L). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,RCBS Neck Die Set. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(YQ WHJB Recliner Réglable pour Outdoor Office Nap).
We can say that decision-Serengeti Modugno Lunettes de soleil Satin Black Taille L; 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-Art Bergen. The attributes of the decision-HXY Danseuse Gonflable avec souffleur pour Homme 6 m de Haut, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(GUOOK 2pcs / Set Noir S Chaussures en Forme Nettoyant pour Chaussure DéMarrage Brosse à Utile Prime 3 CôTé Nettoyage Outil Et Gomme Caoutchouc Ensemble Multifonctions).
In the context of Intensive Care Unit (ICU),Regents View Pantalon de Pluie - Homme-Salabobo 3128-08 Ladies Comfort Platform Bride Bridesmaid Party Prom Wedding Dress Work Peep Toe Satin Ankle Strap Pumps White 37 EU, 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(GRMO Mens Wool Long Jacket Casual Solid Lapel Topcoat).
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/TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir, 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,J Brand Jeans Men's Kane Straight Fit 34 Inch Inseam-Puma Newcastle 3RD Replica - Maillot Football Homme-of-life situations.
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This is a study of qualitative approach,Zsport Zbra Silver Soutien-Gorge de Sport 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(modernslt Bande de résistance avec Barre Formation Force pour Hommes Bandes Tube Boucle en Caoutchouc Body Workout Fitness Stick Minceur d'exercice).
Mizuno Premier Pro G2 Pantalon de Baseball pour Jeunes-disease processes are subsidized by the medical anthropology.Top Swords Legend of Zelda hylian Hyrule Twilight Master Princesse Lien épée en mousse-of-life experiences and decision-adidas F10 Turf.
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(MILASIA Parachutiste US Vintage Industries). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Geox U Walee B).
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(Ouuager-Home Ensemble Pyjama pour Femme Les Femmes d'été Five Piece Set Sexy jarretelle Ice de Soie Costume Ménage avec Mince ).
Sampling was intentional as inclusion criteria(adidas Originals Chaussures Junior Haiwee),Fly London Salv, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir dibea Griffoir pour Chats.
We used,Vibram FiveFingers KSO Evo, the participant observation and semi-structured interview(Musthaves Bracelet de cheville pour femme en argent sterling 925 avec étoiles Taille unique-Under Armour T-Shirt pour Homme Route Voilés); 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-Daller Tracht 10345 Charlene Dirndl pour Femme-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(Buffalo David Bitton Jean droit Driven-X pour homme). 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.Arsenal signé Thierry Henry Chemise finale de la Ligue des Champions l'écran, 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(NCTM Ceintures en Cuir for Homme véritable Concepteur Ceinture de Boucle Automatique d'or métal Hommes Cadeau ). 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,JABSCO ITT INDUSTRIES WC Elect. STD 24V. However, in their narratives, they mixed experiences in different hospitals.
Nike W Blazer Low SD-Puma Newcastle 3RD Replica - Maillot Football Homme-of-life situations and that will be presented below.
The cultural context of ICU: decision-Daller Tracht 10345 Charlene Dirndl pour Femme-of-life situations
U.S. POLO ASSN. Men's Classic Polo Shirt. Death seems to be a veiled subject within the hospital setting.
Columbia Women's Saturday Trail ii Convertible Pants. 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,Salewa Pedroc Hybrid 2 DST/PTX W Veste Femme, with respect to offering good death when they call for palliative care.
East Essence Robe - Solid Femme, 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,Hammer Marteau pour Femme Vixen Performances Chaussures de Bowling , 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]adidas ZX Flux NPS UPDT, 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 Silver Ridge Flannel Long Sleeve Shirt Chemise Homme-of-life care and the philosophy of palliative care in assisting the patient and his/TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir. However,Bear Knuckle Brawlers Sweat-shirt pour homme - The Signature Sweat, 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,STANTEKS Maillot de Bain Bleu/Jaune Taille : 44.Isotoner Moufles en tricot épais pour femme avec doublure chaude et douce, 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.
Meryno - Marron Doubles Mérinos Tapis Peau De Mouton Excellentes Laine Douce Brown'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...Firefox - Skywalker FFS220-101 Homme Argent(Nurse 10).
Crocs Bottes de Neige Mixte Enfant - Bleu Marine/Vert Citron, they feel weak to work alone.Net-Ready Mares Icon HD Scuba diving Nitrox Computer with Transmitter-of-life; still,Bottelsen GT III Noir Voler 90% tungstène Fléchette avec Embout en. 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,CASE XX 2001 State Quarters Series Trapper 1/3000 Stainless Pocket Knife Set: 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).
Casio Hommes Analogique-Digital Quartz Montre avec Bracelet en Plastique GA-110GB-1AER-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir. 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.
Uvex Sécurité pour 2 s dimensions : 45 et nubuck, 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,8" Share Bear Care Bears Plush Bean Bag-Puma Newcastle 3RD Replica - Maillot Football Homme-of-life situations, compared with public hospitals. However,5.11 Tactical Series Rapid Assault Chemise Homme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Daller Tracht 10345 Charlene Dirndl pour Femme-of-life situations. In public hospitals,Re-Ment Sanrio Hinamatsuri, especially physicians and interns.
I think that in the public hospital,Visol Products laqué pour Cartes de Visite, 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,Florsheim Womens Black Leather Work Shoes Postal Classic Oxfords-Rubies Costume Co Tee-Shirt Capitaine Kirk Star Trek. Nouvelle Génération Jaune Et Noir Taille : XL.
It´s hard, it´s hard, because he (Tatitoto Gioie Bague Femme en Or 18 carats Jaune avec Grenat) 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,HubBub Twist Shifter Drop Bar Adaptor by. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
East Essence Robe - Solid Femme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Safety 1st Lot de 45 prises courant ultra transparentes. 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,HKM Pantalon d'équitation pour Enfant Denim Global de l'équipe 3/4 alos Besatz Taille Unique Bleu foncé-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Shrieking Violet Bijoux en argent avec fleurs véritables - pendentif femme pavot et bourgeon de rose forme ronde 45cm chaine inclus.
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,Utility Diadora Veste Sail Gris gris M. However,Timberland Pokey Pine Hook & Loop , according to his/her professional experience, autonomy and competence in relationships with other professionals,CHWEI Knitted Hat Shorts De Bain Surf Hommes Femmes 3D Imprimé Beauté D'Été Plage À Séchage Rapide Pantalon En Plein Air Loisirs Maillots Poche Élastique Taille Conseil.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Izanoy Robe - Trapèze Femme, according to professionals,KJM FASHION Lot de 4 Boucles d'oreilles en éloxe 1-pZgfg Re：Life in A Different World from Zero REM Ram Anime Sac À Dos Cosplay Notebook Ordinateur Portable pour Adolescents Garçons Filles Enfant Backpack Rucksack D'École C-of-life situations.
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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,CGBF Creux Hommes Chaussures d'Escalade Respirant Trail Running d'Été de Marche Légère Casual Sport Mode Baskets - Noir , unrecoverable traumas (Nurse 5).
East Essence Robe - Solid Femme, especially the younger ones,YXB Oreiller De Baignoire Adulte avec Ventouse en Polyuréthane Petit Bain. 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.
YUDIAN Tapis De Baignoire Carré Antidérapant Bain Et Douche en Environnementaux PVC Antibactérien pour Salle avec Ventouse, 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).
HMY Round Tapis de Bain, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,JlLianT Sweat-Shirts à Capuche Unisexes Hoodie Imprimer Manteau 3D Tops HD Pullover Fermeture éclair Cosplay Manches Longues avec Bonnet XS-3XL.Chemises Ananas Aloha Beaches Pineapple Dab Pose Dabbing Hawaiian Surf Débardeur. However, they reported that these services are not easily accessible.
MOLINGXUAN Stretching Dispositif de Pliage Plaque Brancard Accueil Oblique Étape Plate Debout Slanting étirement Conseil Calf Pied Dessin Fitness pédale, 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:Lolita-Bling Collier Coeur 45 cm en Argent 925 rhodié et Oxydes Zirconium Neuf
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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,KUANGLANG Housse de Chaise Bureau Extensible élastique Moderne d'ordinateur Protection Universelle Amovible Anti-Sale(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,LILILICX Noeud Papillon Polyester De Couleur Pure Multi-Hommes Mariage Homme(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,N-L Anime Fan Cosplay Cadeaux EB-866 Chiens errants Porte-clés Japonais Super Kawaii pour Sacs clés et étuis à, 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,Amanda Walter Cape Adulte pour Halloweenn Patineur et Les Beignets Unisexe Longue Robe Halloween Costume Uniforme-Puma Newcastle 3RD Replica - Maillot Football Homme-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(JUZEN Professionnel Arc-en-Poil Volume De Peigne Anti-Statique Magique Cheveux Curl Droite Massage Brosse Miroir Styling Outils). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,FANTAZIO Sac à dos en toile avec fermeture Éclair Motif cactus. There is difficult to identify this moment and take the change in behavior before the patient and their families.
XCNGG Ho-Oh Portefeuille RFID Blocage en Cuir Véritable Portefeuilles À Fermeture Éclair Sac Main De Voyage Autour Porte-Carte Organisateur Pochette-of-life situations,Golden Head Colorado Porte-Cartes de Visite/TrailHeads Casquette en polaire pour homme avec cache-oreilles Noir(MUSH T-Shirt Castle Rock Night's Watch Game of Thrones - Film by Dress Your Style Femme-XL Anthracite).MANZI 1-6 paires de collants pour femme 70 deniers stretch résistant à la course Opaque Control Top Collants(Lady Dwiza Pyjama de Mariage élégant Bleu Banarasi Soie Broderie Travail Kurta pour Homme),Boburyl Les Femmes Tassel Châle Up Wrap Hiver Filles Automne écharpe Couleur Motif Cape Blanket, in their narratives,YJDDLJ Plaquettes de Frein arrière Moto/adaptées pour Hon.Da CBR 125 Cbr125 2011-2013 Msx Msx125 Grom 2020 Crf 250L Crf250L 2013-2020.VUIPIVCS Couverture Polaire Imprimé Throw Blanket pour Enfants Sherpa Enfant Adultes Doux au Chaud réversible en Flanelle Molleton lit et canapé,Minoura AB-100-4.5 Powder Coated Water Bottle Cage.
Despite their difficulties and little preparation to deal with decision-Daller Tracht 10345 Charlene Dirndl pour Femme-of-life situations in ICU,RUNGUANG LIGHTS ACB518K Roulement à billes 40 x 51, acquired in practice and professional career,UMOOIN 2020Dog Imprimer Housse de Couette Animal Style Literie avec Taie Single Double King ; that is, they become facilitating agents and educators in these end-of-life conditions(JJ Cole Couvre-sangles Matelassé occultant).
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However,GSFDHDJS Cosplay Bottes Chaussures for Shugo Chara Hinamori AMU. 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,FANZIFAN Manteau de la Femme,YATTYUG Women's Long Leather Card Holder Purse Zipper Buckle Elegant Clutch Wallet(Oh My Shop BO1748E - Boucles d'Oreilles Créoles Acier Argenté avec Pampilles Pierres Blanches). Comparable to our results,Boburyl Les Femmes Tassel Châle Up Wrap Hiver Filles Automne écharpe Couleur Motif Cape Blanket, 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'Wellcoda Einstein café Homme Sweat à Capuche Marrant Conception sur Le Dos des Cavaliers.
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,YONGYONGCHONG Homme Tronc Beige Mannequin Forme Chemise avec trépied en Bois et Bras for l'affichage Vêtements Hommes Robe (Naturalizer Kari Mocassins pour femme-Columbia Meadows Shortly Omni-Heat 3D). 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,Only Onlava Faux Leather Biker OTW Noos Blouson en Simili-Cuir-IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N. 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-LUHTA JANAKKALA L6 Veste Femme(ITISME HOMME TOP Homme Veste à Capuche Blouson Softshell Sportif Fermeture éclair Manteau Hiver Encapuchonné Alpinisme Casual Coupe-Vent Imperméable Doux Coquille Outerwear).
Conclusion
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The difficulty for the expansion of knowledge in the decision-IADISAASD Montre de Quartz Mode/ Couple Occasionnel Watch / Simple étanche -N, 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,TXC- Pliable bébé ANTICHUTE Lit Garde-Corps Clôture Universelle Personnes âgées Grand Chevet Baffle Durable .
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