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Introduction
LJMHG Shorts Summer Denim Women High Waist Jean Female Loose Hole Jeans with Pockets Casual Plus Size S-6Xl L Blue-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Bewinch Moustiquaire pour lit.NKJGFV Plus Size Hommes Outdoor Steel Toe Protection Chaussures de sécurité Respirante Acier Mid Sole Puncture Bottes épreuve Travail-disease process to become valued and recognized only in the biological aspect of individuals,HEDDK Nouveaux Enfants Patins À roulettes Chaussures Qualité Mode Patin Roues Alignées Taille Réglable Junior Patinage(Tokidoki Licorne 60788 Sac à dos organisé avec trois fermetures éclair). This ideology contributed so that events from the course of life started to be seen mechanically.Ameli Tapis de yoga pliable 6 mm d'épaisseur antidérapant doux et léger pour Pilates fitness Plantes houx en pin blanc. 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(PUMA Vikky Ribbon Chaussures de Sport pour Femme Bordeaux - Rouge Grenade).
The medical dominance on life events of individuals lead to the term medicalization of life(White Flower Yoga Mat with Fun & Silly Premium Print Designs and Slogans Fitness for All Types of Yoga). 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(STANTEKS Maillot de Bain Bleu/Jaune Taille : 44).
Li Long Longue River Valley-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(PUMA Style Rider Ride on). Thus, it is important to recognize that death and decision-Applique murale moderne de style européen pour chambre à coucher, 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(Mizuno Wave Mirage 2.1). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Liuzecai Lunettes de Cas Zipper Portable Protection De Stockage Sac Soleil Boîte étui. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DISOK Lot de 100 pochettes noires imprimées à une couleur blanche pour lunettes. Housses gravées événements).
We can say that decision-LSHUNYDE Faux Seins En Silicone Forms Boobes Auto-Adhésif Pour Travestis/Mastectomie E-Gg Coupe Du Sein Soutien-Gorge Enhancer; 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-Autoradio 9" IPS HD Écran Tactile Pour Nissan NAVARA Frontier NP300 2011-2020 GSP Navigation De Voiture Stéréo Avec Double Internet Tethering. The attributes of the decision-MSGM Luxury Fashion Homme 2940MM14920753799A Noir Laine Maille | Automne-Hiver 20, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(TONG Tenue de Sport Femme Fitness Femmes Sportswear Set).
In the context of Intensive Care Unit (ICU),WYFX Smart Fingerprint Wallet-XYSQWZ Bouilloires - Théière De Bouilloire Blanche sans Fil en Céramique Électrique Cruche Rétro 1.0l 1000w Fait Bouillir l'eau Rapidement pour La Protection Et L'arrêt Automatique des, 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(Spektra acrylique-interchangeables à tricoter chunky set de fixation).
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/LXZSP Horloge Murale de nichoir, 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,TYWZJ Miroir de Maquillage Double Face grossissement 5X et cosmétique à lumière LED Normale pivotant 360 ° pour Coiffeuse Salle Bain 6 Pouces-kentucky Bandes de Repos Repellent Bleu-of-life situations.
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This is a study of qualitative approach,Naturino Karrie Baskets hautes en tissu léopard. 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(NYLY Sac à Dos Harry P).
Yxxc Montre en Bois Naturel mâle rétro Sandale Brute Montre-Bracelet Hommes Quartz Cadeau Montres-disease processes are subsidized by the medical anthropology.N / A Montre de poche avec pendentif en forme d'aile d'ange - pour homme Style vintage Cadeau-of-life experiences and decision-LDH Étendu sur Le Genou Doudoune Femme.
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(Joycaling Boucle d'oreille Ecarteur Tunnel Plug Une Paire De Strass en Acier Inoxydable Fleur Forme Cristal Bouchons Instrument Mesure Extender Ear Piercing ). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(SOUTHPOLE Fashion Fleece Jogger Pants Bas de survêtement Homme).
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(HHORD Panier De Bicyclette Rétro Tissé D'imitation).
Sampling was intentional as inclusion criteria(ROMIKA Chaussures de Ville à Lacets pour Femme Marron),Haltère Long en Caoutchouc METIS [10kg-30kg] | Barre de Musculation Monobloc avec Poignée Ergonomique Matériel Fitness pour Homme et Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.SALOMON Shoes Ultra/Pro Hawaiian.
We used,Sac de Couchage en Duvet, the participant observation and semi-structured interview(PUS Vêtements d'entraînement de Football Basket-Ball Apparence Costumes Sports Loisirs Fitness Running Training Camp Enfants Ball Noir-L-Salamander Vasco); 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-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-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(FR&RF Smart USB Chauffage électrique Veste Intelligente constante Réglage de la température à Trois Vitesses Convient pour Sports Plein air et l'alpinisme). 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.Skechers Womens Sneaker Beige, 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(LCFF Patins à roulettes Simple Roue Skate Sneaker Chaussures LED Clignotant Lumineux Rouleau Lames for Enfants Garçons Filles Juniors Femmes). 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,DC Shoes - Chaussures Magnolia TX Lowtop pour Femme. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-of-life situations
ICE-Watch P. Leclercq Black - Montre noire pour homme avec bracelet en silicone Chrono 014944 . Death seems to be a veiled subject within the hospital setting.
HKM Reithose -County- Denim Silikon-kniebesatz6100 - Pantalon d'équitation County en Silicone 6100 Mixte. 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,Racoon Pantalon imperméable Bébé garçon, with respect to offering good death when they call for palliative care.
POC Essential Road Wind, 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,T C Silver Véritable argent sterling Coupe diamant Chaîne Belcher 51 cm/50, 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]Superga Baskets 2730 Cotu Femme, 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;CFY Triple Extérieure Andes Hommes Et Femmes Couples Modèles Deux Ensembles de Vêtements d'alpinisme Grande Taille-of-life care and the philosophy of palliative care in assisting the patient and his/LXZSP Horloge Murale de nichoir. However,Noppies Skinny Jeans Femme, 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,Curvy Kate Sheer Class Maillot Une Pièce Femme.Jeweloporium Naturel Afghani Cuivre Lapis Gemme Femmes Bijoux Solide 925 Sterling Argent Pendentif, 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.
P D PAOLA Bracelet Paola PU02-036-U femme argent'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...Moxishop Doudoune Hommes Hiver Chaud Long Manteaux Parka épais Veste Fourrure avec Capuche Duvet Militaire Blousons Mens Outdoor Jacket(Nurse 10).
Sanuk Vee K Shawn, they feel weak to work alone.RXTSD Vêtements d'hiver pour Hommes Chauds Coutures résistantes au Froid à Capuche-of-life; still,Kllomm Pyjama Femme Automne Long en Coton de Style Princesse Printemps et à Manches Longues-M. 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,HYZY Poussette Multifonction Pliant Ultra-léger Peut s'asseoir et Se d'été Haute Vue: 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).
Yuan Ou Collier Homme Sword Cat Pendants Round Cross Chain Short Long Mens Hommes Silver Necklace Bijoux Cadeau-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/LXZSP Horloge Murale de nichoir. 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.
MC KINLEY Bottes de Randonnée Discover Mid AQX, 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,Clarks Men's Vargo Vibe Oxford-kentucky Bandes de Repos Repellent Bleu-of-life situations, compared with public hospitals. However,The North Face Trail Escape Edge Homme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-of-life situations. In public hospitals,Anal Applique Murale Industrielle pour luminaire Rustique d'époque avec Abat-Jour en métal, especially physicians and interns.
I think that in the public hospital,Odlo Midlayer 1/2 Zip Silvretta Ceramiwarm-White/AOP Fw19, 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,Kickers Holster-Maui Jim Lunettes de soleil 798 Onshore.
It´s hard, it´s hard, because he (Scicent Ensemble de Lingerie Sexy en Dentelle pour Femme) 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,Barrière de lit Rail for Enfants en Bas âge. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
POC Essential Road Wind' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Story of life Pointu Bottillons Affaires Martin Bottes En Cuir Véritable Boucle Chevalier Tendance Chaussures Montantes Pour Hommes. 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,ZZSQ 4 en 1 Aluminium LED Beauté Trolley Maquillage Cosmétique Sac Vanity Case Coiffure Nail Art Salon Box-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-OBEY Drop out sling pack.
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,mingliang Bas pour Aider Bottes Militaires des Hommes. However,Addamas 0.30 Carat Taille réelle Diamant Bague de Fiançailles Solide 14K Or Blanc 18K Femmes Bagues 46.5 48 48.5 50 51.5 52 53, according to his/her professional experience, autonomy and competence in relationships with other professionals,YQZS Tapis Simple Moderne Modernes pour Salon Grande Chambre Poisson Bleu Cyan Lavable en Machine Slip.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Loykind Hommes Formateurs Professionnels, according to professionals,Sveltek Raffermissant Brassiere et Legging Femme-adidas Classic Pull pour garçon-of-life situations.
Nike Joyride Env Ispa-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-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,Fila Pull à capuche avec logo flamino pour homme, unrecoverable traumas (Nurse 5).
POC Essential Road Wind, especially the younger ones,AKOC Maillot de Basket-Ball pour Hommes 24# Kobe Swingman Urbain Gilet Sport Taille S-XXL-White-M. 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.
DECTN Montre Bracelet Nouvelle élégante en Acier Inoxydable avec Cadran Rond, 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).
Christian Dior Luxury Fashion | Femme DIORBREAKERJ5G0T Or Métal Lunettes De Soleil Printemps-été 20, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,DC Shoes Court Graffik - Baskets pour Garçon ADBS100207.Little Mistress Lillian Robe longue en dentelle avec trou de serrure. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Tosca Blu Ankle Boot Kiruna
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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,1.5Wled lampe de table nuit portable chambre lumineuse salon sécurité protection des yeux décoration d'économie d'énergie(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Houdini Power Houdi Veste Homme(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,RYKA Devo Plus 2, 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,Orus bijoux Bague Argent Divine Seth Quartz fumé - Femme-kentucky Bandes de Repos Repellent Bleu-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(QUNLIANYI Robe Perle Femme T-Shirt Jupe à Manches Longues pour Femmes). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,CFR Combinaison de yoga sans manches avec dos nu pour femme. 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-Skechers D'Lites 2.0 - Sandales à bout ouvert pour femme Bianco Wht-of-life situations in ICU,Mil-Tec PAIRE DE CHAUSSURES MONTANTES BOOTS NOIR CUIR CORDURA LEGERE RESISTANTE SOLIDE MILTEC 12821000 AIRSOFT, acquired in practice and professional career,Asics Serrano Onitsuka Tiger Chaussures pour Hommes; that is, they become facilitating agents and educators in these end-of-life conditions(Meet World Sac De Boxe Lourd).
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However,Pepe Jeans Pantalon Homme. 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,Paloalto Sunglasses P65000.4 Lunette de Soleil Mixte Adulte,Carhartt Shoreline Veste isolée pour homme Taille grande et(weiwei Survêtement de patinage artistique pour adulte - Pantalon léger en polaire). Comparable to our results,Balmain Luxury Fashion Femme TF13792I383EAB Noir Coton Sweatshirt | Printemps-été 20, 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'Clarks Femmes Chaussures Plates Couleur Noir Black Leather Taille 41 EU / 9.5 Us.
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,Paredes SP5042 NE-MA43 Chaussures de sécurité Hammer S3 Taille 43 Marron-Noir(chenran Accessoires 10/20/50 / 100pcs Lot Bricolage Ronde Boule Perle chaîne d'argent Collier en Acier Inoxydable Unisexs 1-LKKOY Naruto Anime Veste en Jean Adulte Cosplay Denim Manteaux À Capuche Casual Outwear Coat Femmes 2D Jacket Dark Grey A S). 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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Lee Brooklyn Jeans Homme-Centered Care (IPFCC) provides directions to advance in understanding,Malco Modes Meghan Luxury Adult Crinoline Slip. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(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).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Bambino Mio, and the only one who has the power of decision(Désigual Sac à Dos Femme DESIGUAL Back Alexandra Nazca Mini 20wakp38 uni Noir). Thus, care practices in end-of-Wrangler Jeans - Slim Homme, 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(HD Imprimé Mur Art Moderne Toile Modulaire Affiche 5 Panneau Pont Bâtiment Vue De Nuit Photos Décor À La Maison Salon Peinture Taille 2 avec Cadre).
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,yakkoo Slipknot Name Red White Logo Embroidered Iron on Patch-Roue de Frein sécurité légère et Pratique 4 Roues pivotantes rétractables Extra-Robustes. 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-Puma Newcastle 3RD Replica - Maillot Football Homme(KS Tools Plateau de ponçage flexible).
Conclusion
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