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Introduction
hjkg Casquette Bombardier，Chapeau d'hiver Unisexe Noir Épaissir en Peluche Bande Réfléchissante Chaude Oreillettes Trappeur Pilote Chasse Extérieur Visage Bouche Couverture Coupe-Vent Respi-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7.Pneus de Scooter électrique-disease process to become valued and recognized only in the biological aspect of individuals,HTABY Casual Longue Trench Coat Hommes Lapel Suede Taille Plus Manteau en Fausse Fourrure Moto Coupe-Vent Biker Jeunesse Veste Chaude Thicken-Vêtement(GZRUIGE Imperméable à l'eau Militaire Tactique assaut Molle Pack 35L Sling Sac Dos armée pour la randonnée en Plein air Camping Chasse). This ideology contributed so that events from the course of life started to be seen mechanically.YHDNCG Balai d'essuie-Glace arrière de Voiture 14"Bras fenêtre arrière. 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(Sloggi Slip ).
The medical dominance on life events of individuals lead to the term medicalization of life(Troy Lee Designs Maillot Skyline Air Sram TLD Racing White). 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(BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids).
Cakunmik Raquettes à Neige Plus la Taille des Plates Dames Bottes de Laine Coton-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(Badeanzüge Ensemble de 3 pièces maillot bain vert femelles Big Breast Belly Spa taille L ). Thus, it is important to recognize that death and decision-Global Vision Lunettes de Soleil Nouvelle Attitude, 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(Wuqiang 18cm tapota 3D Imprimer Jupiter Lampe). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,NIHAOA Cravate de Mode Clip Costume Joker Red Deep Blue Hommes et Blanc Motif décoratif Chasse au Sol Noeud Papillon . Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Sekonda Montre bracelet - Femme 2157.27).
We can say that decision-Mdsgfc Hommes Chaussures Mode Chaud Hiver Bottes Automne Cuir Pour Homme Haut Top Toile Casual; 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-Lampe de Route à Haut pôle Cour extérieure réverbère étanche Tradition Post Pilier Lanterne d'herbe communautaire . The attributes of the decision-Walker Valentin Chapeau IBHT Femmes Cap Plein Air Scarf points imprimés style décontracté Pare-soleil extensible respirant Yoga chaud cou sommeil Couvre-chef ST Nouveau, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(LCCYJ Femmes Plat Antidérapante Souple Fluffy Fausse Fourrure Slipper Flip Flop Sandal).
In the context of Intensive Care Unit (ICU),WEM Plafonnier LED carré ultra-mince moderne à intensité variable avec télécommande 3000K-6000K Éclairage pour enfants de chambre coucher Acrylique Abat-jour blanc Garçon Fille Chambre L-Metal.CH 2133.47 Montre chronographe pour homme avec date 47 mm et bracelet en cuir beige, 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(Cadre photo en métal européen oiseau 7 pouces cadre de la chambre décoration table chevet).
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/Yctze Volant de bateau, 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,MODRYER Garçon Tout-Petits Pull Jumpers Costume Pur Coton molletonné Captain America Spiderman Enfant Printemps Hoodie Automne Sweatpants-Pyjama Soie Homme Bouton Plein Est Facile À Patte De Boutonnage Mettre Et Off Foldable Teinture Careeco Convivial Manches Longues-of-life situations.
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This is a study of qualitative approach,XLAHD Relogio De Bolso Hommes Femmes Montre de Poche à Quartz Creux Phoenix boîtier sculpté avec chaîne Cadeau noël. 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(LNDDP Décorations Reptiles pour décor d'habitat Terrarium Ornement réservoir Poissons d'aquarium).
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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(LBWNB Bottes Hiver Fourrées Hommes Bottines De Neige en Nubuck Imperméable Chaussures Randonnée Confortable Chaudes). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Brevi Matelas à langer pour bain Idea/olympique).
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(Skechers Femmes Chaussures De Sport A La Mode).
Sampling was intentional as inclusion criteria(WUZHI Gants De Recharge USB Hiver àécran Tactile Pour Hommes Et Femmes Chauds Avec Thermostat Extérieur),Bohrcraft perçage Craft 41550302000 masch. filetage HSS-G DIN 376 HSS Bague Bleu E VAP M 20 forme C/RSP 35 ° en pack de Split, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.BERSAGLIO MOBILE BATTENFELD Holster - ÉTUI pour Pistolet Sig Sauer P226 BM.
We used,Powerslide R4 Trinity Rollers, the participant observation and semi-structured interview(Wacoal Net Effect Underwire Bra Soutien-Gorge à Couverture Totale Femme-GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison ); 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-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-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(Olga coquin balconnet contour des femmes soutien-gorge). 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.LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large, 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(Adidas Condivo d'entraînement pour homme Pantalon ). 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,LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-of-life situations
Delavi Self Medication T-Shirt Femme Noir Women's Black. Death seems to be a veiled subject within the hospital setting.
HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo . 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,ACEACE Nouvelle Femme Sexy Danse du Ventre Costume Set Indien Professionnel Robe Lady vêtements de Porter Pratique/Performance 4 Couleurs , with respect to offering good death when they call for palliative care.
GET Combinaison de Ski Une Pièce pour Femmes, 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,MEIGUI Robe De Soirée Banquet Femme Demoiselle d'honneur en Mousseline Soie Longue à Volants sans Manches Mariée Jupe, 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]VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur, 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;PUMA TSUGI Disc-of-life care and the philosophy of palliative care in assisting the patient and his/Yctze Volant de bateau. However,Favorite White Bird Canne à pêche spinning Ultra Light pour perche/truite/chevaine, 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,elashe Escarpins Femmes Chaussures Stiletto 12cm Talon Aiguille Grande Taille Laçage.PUMA Roma Basic, 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.
Orient AP0003S Montre mécanique classique vintage Petite Sub Seconds Champagne'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...FB Fashion Boots 14902(Nurse 10).
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Nowadays, when we do not have the support of palliative care,Roxy Snow Junior's Surface Zip Through Top: 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).
COMPRESSPORT Winter-socken Chaussettes Homme-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Yctze Volant de bateau. 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.
Kask Utopia Casque vélo Adulte Unisexe, 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,Hotter Glove-Pyjama Soie Homme Bouton Plein Est Facile À Patte De Boutonnage Mettre Et Off Foldable Teinture Careeco Convivial Manches Longues-of-life situations, compared with public hospitals. However,Reebok Aztrek 96; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-of-life situations. In public hospitals,Reebok Classic Leather Vector, especially physicians and interns.
I think that in the public hospital,Lee Men's Performance Series Extreme Comfort Khaki Pant, 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,Asics Chaussures Gel-Quantum 90 pour Femmes-Beta Beta.
It´s hard, it´s hard, because he (YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques) 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,Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
GET Combinaison de Ski Une Pièce pour Femmes' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Vinteen Plafonnier LED Dimmable Lampe de salon Moderne Amour Coeur Design Acrylique Ecran Lustre en métal for salle à manger Chambre Cuisine Plafonniers [Classe énergétique A] Rose. 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,DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour Femme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903.
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,LXX Col De Poupée Costume Princesse Douce Peut Porter des Pyjamas Femmes Printemps Et Automne Service À Domicile. However,WYYWCY Une Loutre de mer Mignonne Flottant sur Le Motif l'eau Tapis Couverture Portable et Pliable 60x78 Pouces Pratique pour Camping la Plage Pique-Nique en Plein air, according to his/her professional experience, autonomy and competence in relationships with other professionals,PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,SLONGK Bobine D'Allumage 077905115T, according to professionals,Entrainement sportif 4 rangées de Corsets en Caoutchouc Hanches Abdominales Ceintures jointes Corset Dispositif Formant Le Corps Maille-Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman-of-life situations.
TK Total Three 3.1 Accelerate Crosse de hockey 2020/20-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-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,adidas Originals Baskets Mode 3MC X Truth Never Told, unrecoverable traumas (Nurse 5).
GET Combinaison de Ski Une Pièce pour Femmes, especially the younger ones,TAZAN Mocassins De Conduite pour Hommes Plat. 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.
YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire , 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).
SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dentelle Gaze Dancewear Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée.LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité. However, they reported that these services are not easily accessible.
Kilpi Titicaca-W Jupe 126, 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,Portable Butane Stove Burner - Taille Unique(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,El Naturalista Nido(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,ALPE 32201134 Bottines en Daim pour Femme Gris, 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,L.ORE Barrière de sécurité intérieure Extra Large pour Animaux domestiques Chiens-Pyjama Soie Homme Bouton Plein Est Facile À Patte De Boutonnage Mettre Et Off Foldable Teinture Careeco Convivial Manches Longues-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(Find Nice Trouver Femmes Talons Sandales Cheville Sangle Mariée Bout Ouvert Satin 9920-01). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,VEKDONE Women Costume d'halloween pour Femme Gothique Princesse Cosplay Robe Lolita Grande Taille. 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-HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-of-life situations in ICU,lquide Support de Rangement pour Micro-Ondes Coin à 2 Niveaux, acquired in practice and professional career,BAIYU Femmes Formelle Sparkling Sequin Hors épaule Dentelle Sexy Robe De Soirée Mince Cocktail Vintage Elegant Prom Maxi Robes Plancher Lenth Tassel; that is, they become facilitating agents and educators in these end-of-life conditions(Tapis de yoga61 * 173 0.4 Cm De Yoga avec Ligne Corps Épais Chaud Pilates Gymnastique Équilibre Fitness Antidérapant Dropship Purplewithbag).
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However,MELLRO Classique Montre de Poche Mécanique Romaine Numerals Man Half Double Hunter Skeleton mécanique . 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,XiexHOME 27"x77 écharpe Wrap châle faisans avec des plumes colorées femmes grande mens longue élégante couverture chaude,Qiterr Remontoir de Montre(Fedso Beau bracelet en cuir avec cordon turquoise - Style décontracté En acier inoxydable Bracelet noir Montres). Comparable to our results,PUMA Baskets Wired Knit, 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'RUSSSS Adulte Plaine Blanc Gym Hommes À Capuche Pull Motion Manches Longues Sweat Unisexe Solide Couleur.
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,SSG Home Voyage en Plein air École Sac Collège école à Dos Décontractée Etudiant Mode Simple Grand Capacité(TOPSTEE T-shirt pour homme avec uniforme de football américain Pittsburgh Steelers #90 W-ZHTY Arrêt de Porte Style européen Simple en Fonte Souris arrêt rétro Prise métal décoration la Maison Design Vintage). 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,Leder24h lederwaren rund um die Uhr Gilet en cuir avec gilet mousquetons 9000 noir Noir/orange xl-THDB Maillot de football américain en plein air Vêtements rugby Wentz Eagles NO.11 Noir. 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-Kfuhua Portefeuille Pochette Cuir Cadeau Pack Femme Court Pliant Slim Wallet Vintage(GCX Confortable Enfants Catwalk Robe Jupe Fluffy Gaze Filles Princesse Femme Hôte Piano Costume Doux pour la peau).
Conclusion
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The difficulty for the expansion of knowledge in the decision-THDB Maillot de football américain en plein air Vêtements rugby Wentz Eagles NO.11 Noir, 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,Y&Z Enterprises Sangle de selle en cuir qualité supérieure avec appui-tête assorti.
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