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Introduction
Outline equiline tapis de selle dressage en coton noir-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Shepherd Lina Henrik-5240.KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes-disease process to become valued and recognized only in the biological aspect of individuals,Bearpaw Moc Ii(adidas Nizza Hi RF Chaussures FTWR White/Off White). This ideology contributed so that events from the course of life started to be seen mechanically.totes Parapluie cannes Fille. 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(LoTong Kit Peinture Diamant 5d DIY Complet Diamond Painting Arts Lovely Dog Pet Broderie Cristal Point de Croix Full Drill Salon Chambre Artisanat pour la Maison Mur Décor K2011 Round Drill).
The medical dominance on life events of individuals lead to the term medicalization of life(JJZZ Fille Garçon Étudiant Adolescent avec Mon Voisin Totoro Impression Anime Cartable École Sac À Dos De Voyage pour Ordinateur Portable en Tissu Oxford 7). 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(KHSKX Planche à roulettes de Sport).
FRYE Women's Veronica Duck Boot-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(Hélices pour moteurs JOHNSON - EVINRUDE). Thus, it is important to recognize that death and decision-GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent, 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(Rideau Moderne Minimaliste Chambre Étude D'Enfants Baie Vitrée Porte-Fenêtre Personnalité Créative Décoration De La Maison Parfum Rose). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Vienty Sandales à talon Ani Lacets Cuir).
We can say that decision-TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux; 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-MULIZHE Nanatsu No Taizai 3D Couleur Impression T-Shirt à Manches Courtes Dessin animé Couple Sport réunion Respirant Vacances garçon Fille Cadeau. The attributes of the decision-CJMDEH Changement Peignoir De Bain，Serviette À Langer Poncho Robe Avec Dessin Animé Animal Capuche Drôle Mignon Alpaga Combinaison Bain Changeante Pour Hommes Femmes Surf Piscine Ser, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(JFfactory Classique Nouveaux Hommes Automatique Mécanique Orange Toile en Cuir Noir Professionnel Acier Inoxydable Saphir Lumineux Gris Montre).
In the context of Intensive Care Unit (ICU),Flyup Femmes Fille Yoga Pantalon Drôle Paresseux Taille Haute Fitness Workout Leggings-KROSER Sac à Dos pour Ordinateur Portable 15, 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(Scubapro Delta Boot 6).
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/Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt, 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,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm -Ideal Colliers de Serrage en Acier Inoxydable 1 5/20-of-life situations.
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This is a study of qualitative approach,Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44. 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(Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme).
Mockledd T-Shirt-disease processes are subsidized by the medical anthropology.Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White-of-life experiences and decision-PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir.
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(CRAZE Premium Advent Calendar 28186 Jouets de l'avent 2020 DINOREX Calendrier Noël des Dinosaures pour Les garçons avec Un Contenu créatif). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Moniteur intelligent de bébé la caméra infrarouge 1080P d'IP Wifi).
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(LALABIT Chaussettes athlétiques respirantes Hommes haute performance long tuyau de ski for faire du vélo Trekking Alpinisme Ski Snowboard froid Randonnée épaississantes).
Sampling was intentional as inclusion criteria(teespring Ronan I Love My Mechanic!! T-shirt confort 100% coton),TTJX Chapeau de Seau réversible Unisexe Mode Bob Casquette Hip Hop Gorro Hommes Plage Soleil Banane pêcheur Double côté Porter, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.ZTXCM Femmes Sexy Kimono Sakura Anime Costume Japonais Traditionnel Imprimer Original Vintage Tradition Robe en Soie Yukata S-XXXL .
We used,LAOAYI T-shirt en coton pour homme Cool doux la peau., the participant observation and semi-structured interview(PieSanto 190801 Chaussures confortables pour femme-JXS Vintage Bottes-Seconde Guerre Mondiale Combattons en Cuir pour Hommes Boot-101 82 Airborne Division Parachutiste Bottes); 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-XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain-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(Sanetta Jeans Mixte bébé). 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.Failsworth Cheval marron événements Chapeau, 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(Military Online HMS Ranger Embroidered Logo - Official Royal Navy Hoodie Hooded Sweatshirt by). 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,YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain-of-life situations
SZIVYSHI Maillot de Bain Ensemble Deux 2 Pièces sans Manche Rembourré Crop Haut Bikini Top avec Taille Haute Bas Swimwear Swimsuit Natation. Death seems to be a veiled subject within the hospital setting.
Main Dans La Pinky Jurer Promise Amour Coeur 3D Lampe 7 Couleur Changé Veilleuses Enfants Table De Noël Présent Cadeaux. 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,Spektra acrylique-interchangeables à tricoter chunky set de fixation, with respect to offering good death when they call for palliative care.
Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat, 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,Amanda Walter Cape à Capuche, 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]1944 Zodiac Apparel for Men Women Birthday Gift Horoscope Pisces T-Shirt, 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;XHYYY Cache-Cou Masque Visage Pissenlit Vent sur Fond Noir Couvre-Chefs-of-life care and the philosophy of palliative care in assisting the patient and his/Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt. However,XHYYY Casquette de Baseball Kawaii Chats Bleu Super Car Réglable Maille Unisexe Trucker Chapeau Convient Hommes Femmes, 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,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme.Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main, 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.
Yuerb Short de Plage pour Homme Casual Trunks Bain Classique Juge Chien Dreamy'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...Papier peint Photo personnalisé 3D Relief ailes abstraites Figure peintures murales salon salle à manger Art papiers peints pour murs-350Cmx245Cm(Nurse 10).
Peggy Gu Robe Moelleuse pour Enfants 2020 Longue Jupe de Noël Costume Cosplay Princesse soirée , they feel weak to work alone.WANGPENG Brosse à récurer pour chaussures-of-life; still,QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues 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,Skechers Go Walk Lite-Sea Dream Bateau 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).
FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt. 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.
Under Armour pour Femme Imprimé Perfect Pace Short, 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,Green Burry Greenburry Sac à Tabac Vintage en Cuir 15 x 9 2-Ideal Colliers de Serrage en Acier Inoxydable 1 5/20-of-life situations, compared with public hospitals. However,KLONDIKE 1896 Portefeuille Tim Bear en Cuir véritable; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain-of-life situations. In public hospitals,Nisdsgd Men's Hoodies Sweatershirt, especially physicians and interns.
I think that in the public hospital,GB Eye Limited Logo-Tasse, 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,New Rock Hommes Gothique Biker Style Cheville Bottes Noir Lacets Spiky Chaussures en Cuir Véritable-KEYIA KEYI Chemise BoutonnéE à Manches Longues en Lin Et Coton pour Hommes.
It´s hard, it´s hard, because he (Tappers & Pointers Chaussures de danse fille) 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,Merrell Tremblant Ezra Lace Polar Waterproof. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-PUMA Cell Surin 2 FM. 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,5.11 Tactical Series pour Femme 31146491 X S Prune HTR XS Willow Henley Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Rieker 30921.
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,Showers Pass Short de ski léger respirant à séchage rapide pour homme. However,Femmes Couverture Complète Coton Allaitement Soutien Gorge D Sans Vêtements de Fiesta Bretelles Dos Nu Bralette Confortable Respirant Enceinte Lingerie Sous, according to his/her professional experience, autonomy and competence in relationships with other professionals,Tom Ford FT0609 01C 54 Montures de lunettes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,adidas Originals Kids' U_Path Running Shoe, according to professionals,Skechers Solar Fuse-LMM Faux Seins en Silicone-of-life situations.
Dansko Femmes Chaussures De Mule-XiangHeFu Sac de téléphone sac à main porte-cartes voyage grande capacité portefeuille Statue la liberté avec le drapeau américain-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,Kate Spade New York Sac fourre-tout réversible en cuir Marina Lakeland Drive, unrecoverable traumas (Nurse 5).
Tengyuntong sunminey Homme T- T-Shirt Polos et Chemises Letterkenny Allegedly Ostrich Vintage Retro Sunset Mans Cotton Shirt and Hat, especially the younger ones,HEAD Sprint 3.0 Junior. 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.
YATTYUG Women's Hoodies Tops, 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).
RNXRBB RNXRBBRomantique Femmes Chapeaux De Mariée Et Perle Perlé Mariage Chapeau Noir Cadeaux Noce Voile Cheveux Avec Peigne Rouge Maille Chapea, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,DHNKW Men's Hoodies Sweatshirts.YH Y-H HyRIDER Signature Culotte Bleu Marine/Rouge 26". However, they reported that these services are not easily accessible.
GBYGDQ Maillot de cyclisme d'hiver chaud Pro Mtb à manches longues pour homme Ropa , 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).
BSWL Gilet Chauffant USB Intelligent-of-life situations is expressed by them.jklj Chariot D'épicerie De Supermarché Imprimé Pliable Panier avec 2 Roues Peut être Utilisé sur Différents Terrains , even with all difficulty and lack of preparation to deal with these situations,Déambulateur.
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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,LOVARZI Écharpe d'hiver pour femme et homme - Écharpes de Noël(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Anoauit Sandales d'été en Cuir véritable Hommes Chaussures Casual Grande Taille Nouveau Doux Loisirs de Plage-Gris_41(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,Momyeah des Sandales Femmes Bowknot Pantoufles été Plage sans Lacet Plate-Forme Dames Robe fête Peep Toe, 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,Fabulous T-Shirt Femme Col Rond Fallout 4 Raiders Jeux Video Apocalypse Survival b-Ideal Colliers de Serrage en Acier Inoxydable 1 5/20-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(ZAIPP Enfant Tapis Jouer Tapis). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,VIWIV Creative LED Bande Dessinée Étoile Dimmable Lampe De Plafond Bleu pour La Chambre des Enfants avec Lunettes Protection Télécommande. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;CRAZE Premium Advent Calendar 28186 Jouets de l'avent 2020 DINOREX Calendrier Noël des Dinosaures pour Les garçons avec Un Contenu créatif, and the only one who has the power of decision(RedJade Natalia Alianovna Romanova / Natasha Romanoff Black Widow Uniforme Jumpsuit Overall Bodysuit Outfit Cosplay Costume Femme S). Thus, care practices in end-of-Onistuka Tiger Mexico 66, 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(Cherry Blossom Couverture légère et confortable pour le salon).
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,KRÜGER 091501-0-0008 Gilet traditionnel pour homme Bleu - Gris 56 cm-Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe. 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-YJWSPD Manteau d'hiver Hommes à Double en Laine pour l'automne-Hiver Veste camouflage homme(SUN68 Sneakers Hommes Z29105 Running Nylon Cuir Navy Bleu).
Conclusion
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FACAI Corset, 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/Moshow Sweat à Capuche pour Homme Sunset Coconut Palm Sweatshirt, 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-Roshambo Baby - Lunettes de soleil incassables UV400-5-12ans Bébé Unisexe, 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,Vero Moda Vmvictoria Ls Short Blazer Noos Veston Femme.
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