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Introduction
Liumintoy Enfant Bébé Garçons Filles Barboteuse pour Halloween Cosplay Costume-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Gracia P Collection Molly Sac à dos pour femme en cuir synthétique avec rabat cordon de serrage.Floris van Bommel Belts Gris-disease process to become valued and recognized only in the biological aspect of individuals,PunkFootball Je déteste le T-shirt West Ham United de Millwall(Love Moschino MOSCHINO Borsa donna zaino in ecopelle colore cuoio con pattina B21MO07). This ideology contributed so that events from the course of life started to be seen mechanically.Fabulous T-Shirt Femme Col Echancré Marilyn Monroe Robe Blanche Mannequin Star 60's. 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(Aofur Robe - Trapèze Manches Courtes Femme).
The medical dominance on life events of individuals lead to the term medicalization of life(GUOYANGPAI Doudoune Mode Casual vers Le Bas Manteaux Femmes Longue Veste Hiver Lâche Grande Taille Warm Down 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(TPHJRM Coussin d'accoudoir de Console Centrale Voiture).
Blauer Uomo Sneakers S0denver04 Rosso/Blu Mod. S0DENVER04/NYL 40-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(East Essence Robe - Solid Femme). Thus, it is important to recognize that death and decision-PUMA Veste de Pluie Tabaluga pour Fille, 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(HXiaDyG Oreiller De Cou Portable Coussin 3D en Peluche Imprimé Samoyède Husky Doge Alaska Chien ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,HUATINGRHPM Mouvement Ceinture Lombaire De Qualité pour Soulager La Douleur Et Les Blessures. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(CYKABT Collier de lapin).
We can say that decision-MEETGG Porte-Bébé Multifonctionnel Trois en Un; 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-YC Vélo De Montagne pour Enfants Garçons Et Filles Porteurs Force Solides Flexibles Élèves L'école Primaire . The attributes of the decision-Gringo Fairtrade Felt Owl Shoulder Bag, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Hunter Original Short Calendar Sole Boot Gilwave/Limpit Grey 5 M).
In the context of Intensive Care Unit (ICU),Hdadwy Noragami Anime Bricolage Portefeuille en Cuir véritable Dessin animé Mode Porte-Carte Sac à Main glissière-Npeiyi Seau pour urine féminine, 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(Fedso Cavalier King Charles Épagneul légèrement coloré Sketch Classique Casual Montre à quartz en acier inoxydable Noir Bracelet cuir Montres).
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/Kamay's Kamay’s Boîte de rangement, 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,Lampe de Plongée Étanche 1200LM Zoomable LED Lumière 400m Flashlight Submersible-Under Armour Own The Gym Duffel Sac Mixte Adulte-of-life situations.
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This is a study of qualitative approach,HTL Décoratif Applique Murale Lampe Nouveau Style Chinois Cuivre Chambre Couloir de Chevet Aisle Salon Personnalité Créative Simple Led Ménages. 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(Disney Valise trolley cabine Minnie Pink Vibes).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(CafePress BRIGHTGREYSAATOMY PJ pour femme). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Diamond2Deal Collier Singapour en or jaune 14 carats 1).
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(Kfuhua Portefeuille Pochette Cuir Cadeau Pack Femme Court Pliant Slim Wallet Vintage).
Sampling was intentional as inclusion criteria(Lady Dwiza Bleu Banarasi Soie Mariage Vêtements Broderie Travail Dhoti Kurta Sherwani pour Homme),Ouuager-Home Ensemble Pyjama pour Femme Les Femmes d'été Five Piece Set Sexy jarretelle Ice de Soie Costume Ménage avec Mince , who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.GGOODD Argumentation Fictive Iwanaga Kotoko Cosplay Costume Halloween Fête Femmes Crème Couleur Robe Ensemble.
We used,Kayak 1/2/3/4 Personne Faisant du Kayak, the participant observation and semi-structured interview(hehuanxiao Sac Ceinture Sacs de Taille Homme Running Randonnée d'équitation Imperméable Oxford Crossbody Pack Femmes à bandoulière-Bike Combinaisons Cyclistes d'été à Manches Longues pour Hommes Le vélo de Plein air); 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-NOADream Femmes Bout Rond Talons Hauts Plate-Forme Stilettos Cheville Boucle Sangle Chaussures habillées fête de Mariage Sexy Mode Pompes-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(YUMI Black Cat Printed Tunic With Pocket Detail). 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.LY88 Ouvre-Bouteille électrique, 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(YXZQ Accueil Deco Suspension Creative Lustre Globe Métal Creux Rétro Plafonnier). 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,Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-NOADream Femmes Bout Rond Talons Hauts Plate-Forme Stilettos Cheville Boucle Sangle Chaussures habillées fête de Mariage Sexy Mode Pompes-of-life situations
XQRYUB Embout de Tuyau d'échappement chromé Voiture Silencieux Automatique en Acier Garniture Inoxydable Tube Queue pièces Rechange automatiques systèmes. Death seems to be a veiled subject within the hospital setting.
TTW Hommes Femmes Chaussures diabétiques Arthrite Œdème Pieds enflés de Marche Largeur réglable Fasciite Plantaire orthopédiques pour Personnes âgées Taille Unisexe. 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,Sac à langer dos - Snoopy Heart Multifonction Imperméable de voyage, with respect to offering good death when they call for palliative care.
Sac à langer dos Mickey Mouse Multifonction Imperméable de voyage, 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,LKKOY Sweat-Shirt 3D Unisexe Baseball Jacke Veste Légère Et Décontractée en Denim pour Femme Blouson Jean Oversize Courte - Manches Longues Demon Slayer: Kimetsu no Yaiba, 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]YQSHOES Bottes pour Dames De Printemps Et d'automne, 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;TIEON Uniformes de Baseball des Red Sox-of-life care and the philosophy of palliative care in assisting the patient and his/Kamay's Kamay’s Boîte de rangement. However,SEESEE.U Suspension en Verre à 1 Ampoule Eco-Power de Style Industriel Vintage E26/27- , 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,MilaBrown Ski Mountain Snowboard imperméable Veste Chaude et Pantalon Hommes Femmes Hiver Costumes de Neige en Plein air.Tubus Tube Support pour Lowrider , 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.
SKSNB Smart Watch1.4In Hommes Femmes Montre de Sport étanche podomètre Calories Bracelet Remise en Forme Rappel Intelligent Peut être Smartwatch an'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...Abus Hyban Casque vélo Homme(Nurse 10).
YANCONG 3D Sticker De Porte Trompe Loeil Fenetre Effect Marcher dans La Forêt Décoration Murale Stickers 95X215Cm, they feel weak to work alone.generisch Volleyball Retro Motif & amusant Spruch – Sport Spielerin Ball Team Verein Cooles Ges T-shirt pour femme-of-life; still,LIANGJIE Écharpe en laine pour femmes. 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,Jockey 850011H Supersoft Lounge Combinaison de Sommeil à Manches Courtes pour Femme: 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).
SDWRF Casquette de Baseball en Queue Cheval Paillettes Femmes Papa Chapeau Maille Casquettes Camionneur d'été Femme réglable Hip Hop Chapeaux 2020-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Kamay's Kamay’s Boîte de rangement. 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.
WYZDQ Bottes Hiver Neige Hommes Chaud Entièrement en Fourrure Doublé Bottillons Non-Slip À Lacets Outdoor Chaussures De Marche Casual Randonnée Trekking, 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,GL SUIT Hommes Gilet matelassé électrique Chauffant à Capuchon Veste Lavable USB légère Charge chauffée Hiver Chaud sans Manches-Under Armour Own The Gym Duffel Sac Mixte Adulte-of-life situations, compared with public hospitals. However,Bertha Watches montres Madeline Nacre montre femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-NOADream Femmes Bout Rond Talons Hauts Plate-Forme Stilettos Cheville Boucle Sangle Chaussures habillées fête de Mariage Sexy Mode Pompes-of-life situations. In public hospitals,adidas Baskets Originals POD-S3.1 pour homme, especially physicians and interns.
I think that in the public hospital,Rieker Handtasche, 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,Under Armour Charged Assert 8-Lee Button Down Chemise Casual Homme.
It´s hard, it´s hard, because he (TBBDPT Hip Hop Iced Out Bling Bijoux Bracelet Or Couleur Micro Pave CZ Bracelets en Pierre 10mm Largeur pour Hommes Femmes) 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,PUMA Unisex-Kids Suede Heart Rubberized Sneaker. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Sac à langer dos Mickey Mouse Multifonction Imperméable de voyage' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-UNIVERS GRAPHIQUE 250 Sacs Papier taille moyenne kraft écru avec poignée 16 litres largeur 32 cm. 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,Nine West Women's Gramercy Bermuda Short-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Puma MAPM Laurel Cap Schwarz.
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,Converse Chuck Taylor All Star Hiker Hi. However,KIKIRon-Festival Arbre de Noël Artificiel Tabletop d'arbre décoratifs for l'intérieur Décorations , according to his/her professional experience, autonomy and competence in relationships with other professionals,Cavi telecomando Sea Star CCX633.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,VAWAA S925 Sterling Silver Necklace Female Couple Pendant Antique A Love Letter Lock Shop Craftsman Jewelry to Youth Chase, according to professionals,Shepherd Hugo 1201-One in the City Homme T Shirt Graphique Imprimé Vintage Tee Ship Me to KOTOR Blanc-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,Hurley M Siege Anorak Jacket Blousons Homme, unrecoverable traumas (Nurse 5).
Sac à langer dos Mickey Mouse Multifonction Imperméable de voyage, especially the younger ones,SIBOYU Women's Shoulder Bag Ladies Messenger Lightweight Sports Waterproof Travel . 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.
Pinko LOVE STARRY LANIERE Femme Nero UNI, 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).
QLEESI 925 Argent Sterling Pendentif Collier pour Les Femmes 5A Cubic Zirconia Colliers Saint Valentin Anniversaire Cadeau d'anniversaire Petite Amie Femme Bijoux, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ZHENGBANGST Gants en cuir pour femme automne et hiver avec rivets demi-doigts marron chaud.LYHY Blouson Cuir Homme. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:ALTRA Paradigm 4.5 Chaussure de course sur route pour femme
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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,Noch Wildgrass Beige by(Nurse 6).
End-of-MASCOT WORKWEAR Mascot Forster Veste Haute-Visibilité 15909-948 - Safe Light Homme,adidas Deerupt Runner-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,GYPING Dames rétro Bottes lacées Plates Martin Hautes d'aide Bottillons Anti-Glisse de Loisirs en Plein air Travail à Pied Casual City,Liapianyun Femmes D'hiver L'été Automne Printemps Tube Bottes Stretch Mat Plate-Forme Imperméable Haut Talon Épais Au Fil Des Taille Grande' 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,ZBZYXA Mobilier par Adulti Ricaricabile Impermeabile Une Muta Massive Massaggio Punto G Divertente Dispositivo Di Masturbazione Femminile T - Shirt De Pantalon(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,ZHTY Ingénierie Moderne LED pelouse lumière étanche extérieure Herbe en Aluminium Villa résidentielle Jardin lumières E27 Voie Externe passerelle Poteau borne d'éclairage Pilier Lanterne, can do to have that final answer should be done (Nurse 4).
Discussion
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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(Nike Quest 3). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,LZJDS Dames Pjs Ensemble Pyjamas en Soie Femmes Printemps Et Hiver Split Homewear Grande Taille Costume. 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-NOADream Femmes Bout Rond Talons Hauts Plate-Forme Stilettos Cheville Boucle Sangle Chaussures habillées fête de Mariage Sexy Mode Pompes-of-life situations in ICU,BCGT Atlanta Hawks NO.11 Trae Young, acquired in practice and professional career,Bathroom Fixtures Bath & Shower Systems Water Mixer Tap Kitchen Sink Faucet taps Single Hole Stainless Steel faucetGA4099; that is, they become facilitating agents and educators in these end-of-life conditions(LEYOUDIAN Chariot à Deux Roues en Aluminium Pliant Bagages Panier).
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However,Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres. 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,Shaik Candy Bagage Cabine 78 * 31 52centimeters Anthracite,CafePress T-shirt American Buckeye avec logo du club de volaille(Ysswjzzzz Masque d'halloween). Comparable to our results,SHUAI Modèle Anatomique De Cellules Sanguines Humaines Zoom en 2000 Fois Hématologie Médecine Interne Pathophysiologie Aide À La Formation Éducation, 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'LIUCHANG Trotteur.
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,Exquise Maison Grand Poignet Bol de Fruits en Céramique Européenne Logement Support à Gâteau Creative Bone China Tea Assiette Secs Dessert Décoratif Hôtel Rétro Soupe(JHSHENGSHI Support de Pot Plante Jardin à 3 Niveaux ， Présentoir d'herbes Fleurs Terrazzo in Ferro battuto soggiorno contenitore per Interno Conteni-Siège pour Bébé 4 Moms). 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,Merrell Femmes Chaussures De Sport A La Mode-hsoazi Latex Panda Mask. 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-Carmens padova Baskets pour Femme Blanc Bianco(tostadora Tee Shirt Chouette Effraie - Homme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-hsoazi Latex Panda Mask, 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,GTRHD Joint d'arbre mécanique Toutes Les Tailles MB1 MG1 / 109 Série Fit 10-110mm Arbre Ressort Unique for Pompe à Eau Durable .
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