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Introduction
YZ-YUAN Écharpe De Portage Porte-Bébé Ergonomique Four Seasons Allaitement Facile-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,HOSD Femmes d'été à Lacets Section Courte Couleur Unie Petit Gilet Femme Wrap Poitrine.Inglesina ag87l0grr – chaises de Promenade-disease process to become valued and recognized only in the biological aspect of individuals,Clarks Women's Ashland Lily Loafer(qazxsw Pull-Up Bar Multifunctional Locking Design Indoor Pull-up Horizontal for Pull Up Chin Push Unisex). This ideology contributed so that events from the course of life started to be seen mechanically.Planches À roulettes pour Enfants. 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(MULTIREX_PULVERISATEUR Pulvérisateur Multirex Haute Portée).
The medical dominance on life events of individuals lead to the term medicalization of life(sdssup Contrer véritable Chapeau de Baseball Masculin Cap 18CA0065 A0065 Code Denim Bleu). 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(Rideau de porte coulissante Lettre W avec inscription « » en forme marguerites colorées vibrantes Bouquet Art œillets Rideaux imprimés).
FC St. Pauli The Sound of Sankt T-Shirt pour Homme Motif tête de Mort Noir/Blanc-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(Primigi Pwigt 63828). Thus, it is important to recognize that death and decision-ZWMM Applique Murale Exterieur éTanche Vintage Style Industriel Lanterne en Métal Lumière Creative Café Allée Balcon Loft Lampe Au Kérosène Fer Appliques Murales avec Abat, 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(Sljj Patins À Roues Alignées). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,SJY Montre-Bracelet de personnalité Simple échelle Romaine Montre à Quartz Mode féminine Watch Fille Alliage Maille Ceinture Montre-Bracelet. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(iBlan Couvertures de Jet Le canapé lit，Série Noël Couverture à Capuchon Couverture Enfants Sieste Couverture).
We can say that decision-CLCTOIK Bonnet Enfant pour Filles garçon tricoté; 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-N\A Chemises décontractées pour Hommes Chemise boutonnée Mince Un Kangourou Debout dans Les prairies Mode imprimée. The attributes of the decision-Clarks Chaussures Whiddon Vibe pour Hommes, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(XWF Haltère Haltères 2 Pcs Poids Set for Culturisme Fitness de Levage Formation Accueil 4 / 6kg Bras et Les Mains - Idéal Pilates).
In the context of Intensive Care Unit (ICU),Pkfinrd Entièrement Automatique Bain de Pieds 4D Acupoint Massage Temps réglage la température Fonction Red Light Irradiation Foot Spa Massager Fumigation-WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert, 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(Legero Campania).
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/Anah Panier Se Pliant, 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,Asics Gt-2000 8-BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier -of-life situations.
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This is a study of qualitative approach,LinJiaJia_shop Men Down Jacket Winter Parka Furry Long Coat Casual High Street Thick Warm Outerwea. 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(LSBXWL Voile Simple 5 mètres Full Edge avec Dentelle Bling Paillettes Deux Couches Longues De Mariée Peigne Blanc Ivoire ).
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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(Seven Sons Sac à dos Turquoise bleu ciel). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(FANTASIE Allegra reggiseno rinforzo laterale - side support bra Fantasie).
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(Aktaul Fluent French Noir Homme T-Shirt Manches Courtes Mens Black).
Sampling was intentional as inclusion criteria(ZBZYXA Mobilier par Adulti Ricaricabile Impermeabile Une Muta Massive Massaggio Punto G Divertente Dispositivo Di Masturbazione Femminile T - Shirt De Pantalon),wangpdp Cadre Impression sur Toile 5 Pcs Élégant Classique De Bande Dessinée Pokemon Affiche Huile Image Mur Art Décor À La Maison pour Chambre Bébé Cuadros, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.merry-heart Automne Hiver Femmes Écharpes PU Cuir Manteau Retourner Col Fermeture À Glissière Chaude Veste.
We used,ZYFXZ Suede/Toile Hommes Haut-Dessus Martin Bottes extérieur Militaire Tactique de Combat Travail sécurité la Police Chaussures Boot, the participant observation and semi-structured interview(MYLW Parasol Stand Bag Patio Beach Detachable Square Umbrella Base Weight avec Grande Ouverture pour Extérieur Portable de Support-Olga Berg Pochette Femme Doré Ob2028); 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-Küchenks Chariot de magasinage Chariot-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(Mbswdd Baby Nest Cocon pour 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.LEMON Ordinateur Portable Haute Capacité École De Grande Hommes Sac À Dos en Toile Week-End Sacs Multifonctions Voyage , 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(Wellcoda Garder Calme Allemagne Berlin Homme T-Shirt à col en V Allemagne Graphique). 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,Réservoir D'eau Extérieur Avec Robinet. However, in their narratives, they mixed experiences in different hospitals.
Chauffe-biberon USB-BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier -of-life situations and that will be presented below.
The cultural context of ICU: decision-Küchenks Chariot de magasinage Chariot-of-life situations
YUEFF Tissage Bresilien Meche Bresilienne Extension Cheveux Naturel Lisse - Grade 9A Unprocessed Brazilian Human Hair Extensions. Death seems to be a veiled subject within the hospital setting.
ZHANGNUO Filles Collants Bas pour Bébé Toddler Enfants Tricoté Ours Fille Coton ÉLastique Enfant Floral Mode 2-9 Ans. 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,Czc-dp Vêtements de pluie pantalons imperméable travail réflexif poncho conviennent wa for hommes et extérieur orange fluorescent Raincoat Costume féminin Tissu Oxford fendus assainissement, with respect to offering good death when they call for palliative care.
Muck Boots Muckmaster, 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,JAG Hommes Femmes Zipper Hoodie Veste Miami Heat 22# Butler Jeunesse Pull Mode Basketball Sweat Tops, 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]Lamarthe Sac porté bandoulière Croco Co10a - Marine, 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;SUWEN Sandales Plates pour Hommes-of-life care and the philosophy of palliative care in assisting the patient and his/Anah Panier Se Pliant. However,YONGYONGCHONG Matériel de Danse Ballet Instep Shaper Pied- artefact Solide Pied du Corps Pied-de-biche Brancard, 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,Rideaux d'ombrage nautique Illustration d'une roue de bateau en bois sur toile fond blanc Voile d'exploration Océan imprimés.MELAG Collier à mâcher sensoriel Pendentif 10 Pack Silicone Carré Ark Dent Gel pour Enfants Sensoriel Chew Dents Molaire Bâton , 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.
Rideaux occultants au henné - Motifs fleurs de printemps Collection traditionnelle Monochrome Dos thermique Panneau simple 132 x 213 cm Pour enfant'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...QFYD FDEYL Montants Diabétiques Réglable Orthopédique (Nurse 10).
GFDFD Femmes Mini Sacs à Dos en Cuir Sac Main élégant Intrusion bandoulière Voyage , they feel weak to work alone.ZSMD Phicen Vêtements Femme échelle 1/6 Main-of-life; still,BGBG T-Shirt pour Femmes Quotidien - Color Block Purple. 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,BGGGT Vélo Riser vélo Tige réglable 25.4x90 / 110cm et amp31.8x90 VTT Route en Aluminium : 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).
Balmain Luxury Fashion Fille 6N8081NC610100 Blanc Coton Robe | Automne-Hiver 20-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Anah Panier Se Pliant. 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.
Knapman Ultimate Comfort Boxershort 3.0 Oranje | Twopack, 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,N / A Männer Basketball Jersey - Dallas Mavericks # 41 Dirk Nowitzki Swingman Mesh-Basketball Ausgabe Unisexe Manches T-Shirt-BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier -of-life situations, compared with public hospitals. However,Poi Poussette ; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Küchenks Chariot de magasinage Chariot-of-life situations. In public hospitals,HOXMOMA Tringle à vêtements coulissante pour Garde-Robe, especially physicians and interns.
I think that in the public hospital,Écran portatif extérieur de Table Patio Parapluie ting moustiquaire approprié aux parasols de gazebos , 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,WSCOLL Rozen Maiden Taisho Shin ku Reiner Rubin Women Long Ponytails Wig Cosplay Costume Heat Resistent Synthetic Hair Wigs PL-088-SUIWO LFWB dames sandales classiques casual léger simple Sandales de femme Comfy Plate-forme d'été Chaussures plage Voyage à mi-talons Toe sauvage fond plat spartiates plateforme.
It´s hard, it´s hard, because he (XJY Gigoteuse Bébé Sac De Couchage Enveloppante Nids d'ange Cotton Couverture Emmaillotage Fille Garçon Combinaison) 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,Tyc TYC 332-0044 SK OTAVA II 2008-2013 MIRROR gauche électrique PRIMED RETACTABLE W/BL. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Muck Boots Muckmaster' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-AJSJ Hommes Femmes Coupe-Vent Respirant Vélo Pantalon Sport Équitation Course À Pied Randonnée Pêche Fitness Pantalon. 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,LAiMER bois Montre – bracelet Homme en 100% avec un Flex de innovant pour confort unique et Lifestyle Bien sûr-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Le Coq Sportif Lausanne Pro Short Enfant Fille.
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,LEONE 1947 Survêtement Unisexe Adulte. However,MU Queue de Billard, according to his/her professional experience, autonomy and competence in relationships with other professionals,WPFC 3D Respirant en Forme De U Neck Pillow Mémoire Portable Oreiller Mousse Voyage avec des Yeux Masque Sac Rangement pour Un Voiture Vol.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Fluco Bracelet de montre en véritable alligator vintage fait main Allemagne Bleu 19 mm, according to professionals,Tentenentent T-shirt humoristique à manches courtes en coton avec inscription « Bier Denk auch an Mich »-Smartbox - Coffret Cadeau Soirée Magique pour 2 dans Un Cabaret Cirque avec Champagne près de Lyon idée Originale-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,WOLVERINE Piper Technical T-Shirt à Manches Courtes pour Femme, unrecoverable traumas (Nurse 5).
Muck Boots Muckmaster, especially the younger ones,Disney Homme Cars Rust-Eze Logo Sweat À Capuche. 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.
Wellcoda Garder Calme Allemagne Berlin Homme T-Shirt à col en V Allemagne Graphique, 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).
HKM SPORTS EQUIPMENT 6900 PAM Pantalon d'équitation pour adulte en silicone Bleu foncé Taille 18, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,ALTRA Women's AL0A4QTN Solstice XT Cross Training Shoe.superfit Husky. However, they reported that these services are not easily accessible.
Geox J Artach A, 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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(...) 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,Nike Vapor 12 Pro TF(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Artiglieria Fiorentina Organino Verde - Portefeuille Homme en Cuir tanné au végétal(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,HÖGL Studio 80, 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,Yaunli T-Shirt de Sport pour Hommes humidité Maillot Cyclisme à Manches Longues Respirant séchage Rapide for Cycliste VTT Veste Respirante Biker éponge-BESTSOON Réglable Ultra-Souple de Ceinture en Cuir Haute qualité pour Hommes Casual Baudrier -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(qazxsw Vêtements de Nuit Chemise pour Enfants Peignoirs Filles Automne et Hiver Pyjamas en Flanelle). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,AZSTEEL Native American Lives Matter Indigenous Peoples' Day Pullover Hoodie | Black Novelty Unisex Lightweight. 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-Küchenks Chariot de magasinage Chariot-of-life situations in ICU,SUREH Nid de bébé Bassinet pour lit portable en coton biologique, acquired in practice and professional career,XIGUAK Été Creux Out Wedge Mocassins Respirant Augmenté Pompes Internes Bouche Peu Profonde Muffin Chaussures Casual Plateforme Coins Sneakers; that is, they become facilitating agents and educators in these end-of-life conditions(Marcelo Burlon Luxury Fashion Femme MCBI38663 Blanc Coton T-Shirt | Saison Outlet).
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However,nobranded Pantalon de Jogging pour Hommes survêtement à Impression latérale Sport Cordon Serrage élastique Taille Hallen Couleur Unie. 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,Élégant Portefeuilles Pour Hommes En Cuir Véritable Rfid Blocking Minimalist Wallets for Men Poche Avant Avec à Monnaie,Cxjff Pliant PedaI Tricycle(Allthemen Costumes de Smoking Mariage pour Hommes Slim Fit 4 Pièces Veste Blazer Pantalon Taille Joint Noeud). Comparable to our results,Kenneth Cole REACTION Men's Center Low Sneaker, 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'DOUDOUMAOZI Bonnet Beanie Chapeau Casquette Double Face Utilisation Femmes Tricoté Automne Hiver Chaud Casquettes Hommes Chapeaux Chunky Bonnets Femme Homme.
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,Baignoire Pliante pour bébé(adidas Tan Graphic Crewneck Sweat-Shirt Homme-Yarmy Pendentif/Porte clés Key Chain Creative Symbole Musical Exquis Outil Indispensable pour la clé). Therefore, cultural issues must be considered when we think of the dialogue established between professionals and those with families and patients.
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Conclusion
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weiyibaobei Tapis De Bande Dessinée Anime Bonhomme Neige Rectangle Cristal Velours Chambre d'enfants Jeu Salon Étude Cuisine Sol 180 * 270 Cm, 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/Anah Panier Se Pliant, 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-YZ-YUAN Modèle éducatif d'assemblage enseignement de l'anatomie orale du modèle Anatomique Nerf mandibulaire sous Le la mandibule Humaine pour l'école, 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,Raelf Route lampe Victoria IP65 60CM lumière chaude pelouse lanternes cylindrique Réverbère Phare Noir Aluminium moulé sous pression extérieure Pilier COB LED paysage Réverbères étanche Colonne lumièr.
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