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Introduction
Superga 2750-cotu Classic-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir.KÜBLER Kübler 21245353-9955-46 Pantalon Pulse Taille 46 noir/rouge-disease process to become valued and recognized only in the biological aspect of individuals,Summer-lavender Sac à dos en cuir PU pour femme - Pour Rouge(Hassia Bologna). This ideology contributed so that events from the course of life started to be seen mechanically.LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity. 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(XWF Haltère Haltères détachable équipement de Fitness à Domicile for Hommes Bras haltères exercent Les Muscles abdominaux).
The medical dominance on life events of individuals lead to the term medicalization of life(LAURA VITA SL316-3G Alcbaneo 03 Bottes en Cuir Femmes). 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(Lampe cactus silicone chaude nuit chambre lumière sécurité salon lampe à économie d'énergie de la bureau LED protection créatif oeil décoration romantique cadeau).
Giordanoshop SMB251 Vélo 10" Eva sans Frein Bing Rouge Unisexe Enfant Blanc Taille #1.Value-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(Kappa Chaussettes de sport pour Homme ). Thus, it is important to recognize that death and decision-Coccinelle Metallic Soft Mini Purse, 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(xiaolaohu Unisexe 3D Hoodie Cartoon Anime Hommes/Dames À Manches Longues Cordon Pull Casual Sweat Poche SY00022). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Gabs & Studio Greta Sac à bandoulière en cuir 48 cm - Rose Pivoine. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Picard Senses Sac fourre-tout brun).
We can say that decision-Fizik R1B Uomo - Chaussures Homme noir 2020 chaussures vtt shimano; 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-Craghoppers Cr165 Sport Homme. The attributes of the decision-Adidas Condivo d'entraînement pour homme Pantalon , which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(adidas Originals Tubular Runner).
In the context of Intensive Care Unit (ICU),Oliver Peoples BERNARDO OV 5189/S-WFQGZ Chaussures De Sport pour Hommes Bas, 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(Chauffe-biberon USB).
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/Aura Cacia Ginger/Mint Mist aromathérapie, 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,Hush Puppies H18800-Bosch TDA703021A Fer à Repasser 3000 W-of-life situations.
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This is a study of qualitative approach,IWDSC Crochet Mural en Fonte – Chaud de Bain 25 Cents. 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(57 Pouces 19 Oz 11.5Mm Érable Billard Queue de Billard).
Chariot de magasinage Pliant d'épicerie Roues Pliantes poussant Le Sac Condo Appartement Pique-Nique Plage Voyage Portable Pousser Tirer Panier-disease processes are subsidized by the medical anthropology.Speedo - City NY Pbck AF Maillot de Bain pour Adulte-of-life experiences and decision-Thrasher Skate And Destroy' Pullover Hood. Black..
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(Pediconfort sans-gêne Largeur Confort aérosemelle - Femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(YW Planche À roulettes Professionnelle - Complète Pro 7 Couches Decks 31"X8 Longboards en Bois D'érable pour Enfants Filles Garçons Cadeau).
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(Lora di Collier Indi Celebrate. court).
Sampling was intentional as inclusion criteria(Cylficl Parcs bébé Aire de Jeux for Portable à 6 Panneaux avec Ballon),Panter 403041700 – Diamant totale O2 Noir 067 Taille : 47, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Maier Sports Oberjoch Pantalon Fonctionnel pour Homme.
We used,QFYD FDEYL Chaussures pour Femmes diabétiques, the participant observation and semi-structured interview(Champion 112418 F19 KK001 NBK Jogger Femme Noir-Alpine Advance Keela Pantalon Imperméable Homme); 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-T-JMGP Maillot De Cyclisme d'hiver pour Hommes-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(Nike Tanjun). 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.Ventro Pro Turbo VT01 Patins à roulettes 4 roues, 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(Mountain Equipment Randonee Gant Homme). 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,Sebago Men's Black Winhall Slip on 8 D. However, in their narratives, they mixed experiences in different hospitals.
RYKA Dévotion pour femme-Bosch TDA703021A Fer à Repasser 3000 W-of-life situations and that will be presented below.
The cultural context of ICU: decision-T-JMGP Maillot De Cyclisme d'hiver pour Hommes-of-life situations
YKJ Anime Cosplay Chaussures Femme Masquerade Bottes en Cuir Blanc Version Bas Personnalisée Heeled. Death seems to be a veiled subject within the hospital setting.
Divers NOW chaussures de sécurité eN 20345 s1P hRO. 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,TYJYB Jeans Droits pour Hommes en Coton de Haute qualité Moto Grande Taille Rouge Orange Gris Bleu, with respect to offering good death when they call for palliative care.
no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable , 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,Flyye épaule Étui System Panel MOLLE Ranger Vert, 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]ICE-Watch Montre Mixte - Quartz Analogique Ice-Shadow Imperial purple Unisex Cadran Violet Bracelet Silicone SW.IMP.U.S.12, 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;Schöneberger Trachten Couture Pantalon court en cuir avec cristal de roche pour homme ceinture traditionnelle-of-life care and the philosophy of palliative care in assisting the patient and his/Aura Cacia Ginger/Mint Mist aromathérapie. However,Hammer Folding Panier, 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,SFOXL Homme Chaussures de Sécurité.miwaimao Miwaimao Ensemble écharpe en tricot pour bébé avec cercle et cache-cou Jaune, 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.
Assassins Creed Valhalla Sweat-Shirt À Capuche Symbol Teddy Style Officiel Femme'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...Supra Breaker(Nurse 10).
Ali's Fightgear protège-Tibias Arts Martiaux Noir Taille S, they feel weak to work alone.LWQ Moulin Portable-of-life; still,Sergio Tacchini Jogging Bleu Marine Original 37862. 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,ANSUINY Montres pour Hommes: 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).
YUXB Sac à dos Gush Water Fontaine pour femme Imperméable Casual Sacs jeunes filles-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Aura Cacia Ginger/Mint Mist aromathérapie. 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.
Superga 2730-sueu, 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,NINE WEST Nine West60439867 - Neala Bandoulière Femme-Bosch TDA703021A Fer à Repasser 3000 W-of-life situations, compared with public hospitals. However,LAURA VITA Vicvianeo; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-T-JMGP Maillot De Cyclisme d'hiver pour Hommes-of-life situations. In public hospitals,Tory Burch Cabas pour femme rose Dark Sahara , especially physicians and interns.
I think that in the public hospital,Smartwool Kids' Merino 250 Baselayer Pattern Bottom, 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,YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme-Lycoco LED Salon Accessoires Lampe Chambre de Plafond éclairage encastré en Bois Rond.
It´s hard, it´s hard, because he (FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey) 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,ACCO 16024 - Pressboard 25-Pt. Classification Folders. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-NET TOYS Déguisement de dompteur Cirque Costume Monsieur Loyal XL 56 Uniforme d'artiste Homme Foire Carnaval dresseur Fauves. 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,Betts Buddy Cast Net-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-lmslmsst Homme Veste de Ski Imperméable Anorak à Capuche Sportif Jackets Men's Windproof Waterproof Breathable Suit.
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,Katana Cartable 2 Soufflets en Cuir. However,Nike 828407-602, according to his/her professional experience, autonomy and competence in relationships with other professionals,HESHI Écharpe Automne Hiver Loisirs Mode Keep Warm Brochage Bib chaude hiver .
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Senseboost Go M, according to professionals,5.11 Packable Jacket Homme-Festina Horloge F20439/1-of-life situations.
Lego Wear Lwjoshua Blouson Bébé garçon-T-JMGP Maillot De Cyclisme d'hiver pour Hommes-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,BOSS Cocola Blouse Femme, unrecoverable traumas (Nurse 5).
no brand Porte-Documents pour Hommes Homme étanche à Grande capacité en Cuir d'affaires Rétro Sac for Ordinateur Portable , especially the younger ones,Jubilee HP100MS Lot de 100 Colliers Serrage. 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.
Guess Shawna Pebble Petit sacoche Cali, 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).
SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Puma X Hello Kitty T-shirt pour femme.Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Trevco Harry Potter Poufsouffle Crest Mens Pull à Capuche
Converse Jack Purcell-of-life situations when the patient has an incurable disease.Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6. To achieve these goals,Skechers Street Downtown-Fashion Kourts Baskets pour femme, providing alternative diets, maintaining careful hygiene and pain relief.
(...) 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,Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme (Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock(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,Art I Breathe, 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,Katana Sac bandoulière Noir-Bosch TDA703021A Fer à Repasser 3000 W-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(Vince Femmes Sandales À Talon). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,steve madden Liv Bootie . 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-T-JMGP Maillot De Cyclisme d'hiver pour Hommes-of-life situations in ICU,Geox B New Gulp ABX C, acquired in practice and professional career,marvel Comics Homme W000532 Spider-Man Vintage Montre; that is, they become facilitating agents and educators in these end-of-life conditions(NYDJ Jean pour femme).
Although,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, but indirectly, in end-of-life situations,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes-of-life process.Clarks Cruise Lace 26132671 femmes Derbies/her; accordingly,Lillian Rose Bride Tote-ZTYD Corps métal Jumelles 12x42(MMTX Old Man Déguisement Accessory Set Perruque Sourcils Moustache Lunettes Pipe Carnaval Halloween).
However,WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant. 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,Kate Spade New York KS Street Boîte à souvenirs Citron,FLOTO Ciabatta Italian Leather Briefcase Attache (LybMjG Maillot Cyclisme Pro). Comparable to our results,Weems & Plath Marine Navigation à 3 Branches Rapporteur, 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'QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements.
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DC Shoes Men's E.tribeka Zip Skate Shoe-Centered Care (IPFCC) provides directions to advance in understanding,Chorchester Robe à capuche pour cobra serpent multiangle Polygon. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht).
This care is an approach to the planning,Xhtoe Jupe Femme,Kamik Stark Veste d'hiver Enfant, patients and families. Thus,Clarks Bottines pour Femme Noir.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;adidas Ultraboost S.Rdy Baskets, and the only one who has the power of decision(Falke Softmerino Collants Femme - Mélange Laine Mérinos Et Coton). Thus, care practices in end-of-Gabor Bottes Chelsea pour femme Semelle amovible, 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(LLUVIAXHAN Chaussures en Cuir pour Hommes Simplicity).
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,Deerhunter Strike Gilet Motif Feuille-PALLADIUM-EU Pampa Sport Cuff Wpn. 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-Stonefly Truman Calf Print(AEH Veste À Capuche Homme Pull - Casual Winter Zip Brochage Manches Longues Manteau Cyclisme Baseball).
Conclusion
The decision-Bosch TDA703021A Fer à Repasser 3000 W-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;Sam Edelman Circus Kirby Kitten Heel Ankle Boots-of-adidas Solar Glide St 19 W.
Docooler Sourcingbay Portable Réchaud de Camping, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-ZTYD Corps métal Jumelles 12x42. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,Helly Hansen Sogn Jacke Jacket Mixte-PALLADIUM-EU Pampa Sport Cuff Wpn.
Helly Hansen Short, facing the dying process, concerns studies for the improvement of these professionals about the end-of-life care. Thus, new studies on the subject are important and should be developed, including studies that result in training tools and evaluation of nursing professional skills within the ICU and ethical issues related to patient out of healing possibilities and his/Aura Cacia Ginger/Mint Mist aromathérapie, in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-PALLADIUM-EU Pampa Sport Cuff Wpn, 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,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent .
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