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Introduction
HOUXIAONI Sweat à Capuche Sportswear Veste Manches Longues Football américain Los Angeles Chargers Pull glissière Bleu Marine-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,LongDD T-shirt de football américain uniforme la Nouvelle-Angleterre Patriots Hightower #54 Maillot Gruby Tee Shirts - X-Large.LTLJX Montre Connectée Homme Smartwatch Étanche Tactile Connecté Cardio Podomètre Bracelet Bluetooth Intelligente Sport Fitness Trackers d'Activité Chronomètre pour Android iOS-disease process to become valued and recognized only in the biological aspect of individuals,Cwypxl Santiag Femmes Western PU Botte Cowboy Talon Casual Chic Cowgirl Boots Haute Chaussures Chelsea Pointu à imprimé Serpent Couleur mélangée(SKSNB Funny Mask Masque de déguisement Frais). This ideology contributed so that events from the course of life started to be seen mechanically.Delavi Self Medication T-Shirt Femme Noir Women's Black. 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(Geox B Todo Boy A).
The medical dominance on life events of individuals lead to the term medicalization of life(Night Light Moon Lampe Interrupteur Tactile LED 3D Impression De Noël Lumières Décorations En Plein Air Pour La Maison Noël-120mm_4.1inch). 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(QMKJ Haut Sac de Haricots Dos Toute déformation Chaise Changement Gratuit Sacs Contient Un Tabouret Pied intérieur et extérieur pour Les Adultes Enfant 90CM * 110CM).
HAIK Route Pédale Auto-Verrouillage à Double Face Multi-Angle léger de Verrouillage Lollipop Equitation Pédales Vélo -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(Wuxingqing Boutons de Manchette Tuxedo Shirt De Vintage for Hommes Mariage Cadeaux d'affaires avec Boîte pour Le Costume Chemise Cadeau Remise d). Thus, it is important to recognize that death and decision-ACEACE Nouvelle Femme Sexy Danse du Ventre Costume Set Indien Professionnel Robe Lady vêtements de Porter Pratique/Performance 4 Couleurs , 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(Reebok Classic Small Vector Tee - Manches Courtes Mixte). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,GET Combinaison de Ski Une Pièce pour Femmes. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Prana prAna).
We can say that decision-MEIGUI Robe De Soirée Banquet Femme Demoiselle d'honneur en Mousseline Soie Longue à Volants sans Manches Mariée Jupe; 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-VIPbridal Boho Robe Fille Fleur Princesse Demoiselle d'honneur. The attributes of the decision-PUMA TSUGI Disc, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(1 lumière américaine vintage en laiton lanterne verre lampe murale extérieure étanche à la pluie Continental LED Villa jardin patio terrasse balcon applique externe E27).
In the context of Intensive Care Unit (ICU),Favorite White Bird Canne à pêche spinning Ultra Light pour perche/truite/chevaine-elashe Escarpins Femmes Chaussures Stiletto 12cm Talon Aiguille Grande Taille Laçage, 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(Furla Portefeuille en Cuir Babylon S Bi-Fold).
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/PUMA Roma Basic, 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,Orient AP0003S Montre mécanique classique vintage Petite Sub Seconds Champagne-American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7-of-life situations.
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This is a study of qualitative approach,FB Fashion Boots 14902. 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(Unknow Maillot de Rugby à Capuche pour Hommes Football américain la Mode Manches Longues décontracté Confortable Fans Pull Jersey -501-rouge_s).
ZIYOU Argent Sterling 925 avec Pierre Porte-Bonheur Charms pour Bracelet Pandora Joyeux Anniversaire 12 Couleurs Jan- DEC élégant Fit la Plupart des Bracelets européens-disease processes are subsidized by the medical anthropology.QDY-Area Rugs Tapis Rond pour Le Salon/Tapis De Porte D'escalier Cuisine Moderne Simple Chevet Chambre À Coucher/Tables D'ordinateur Siège -of-life experiences and decision-EXTREME FITNESS - Ensembles de poids disques en fonte pour barres olympiques 5.
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(MULIZHE Full-Time Hunter Impression Couleur 3D Sweat à Capuche pour Hommes et Femmes Sport Unisexe col Rond Coton Vacances fête Pull décontracté Cadeau). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(NINGAN Pierre de Naissance Love All Around Breloque Fantaisie Rose Breloques en Argent Sterling 925 pour Bracelets européens).
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(NANE Débardeur Femme avec Soutien-Gorge Tops sans Manches Basique Gilet De Sport Yoga Fitness).
Sampling was intentional as inclusion criteria(Skechers Women's Go Walk Lite-16352 Ballet Flat),Roxy Snow Junior's Surface Zip Through Top, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.COMPRESSPORT Winter-socken Chaussettes Homme.
We used,Kask Utopia Casque vélo Adulte Unisexe, the participant observation and semi-structured interview(Leder24h lederwaren rund um die Uhr Gilet en cuir avec gilet mousquetons 9000 noir Noir/orange xl-Fournitures de salle bain Piscine gonflable Baignoire); 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-Hotter Glove-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(LingaDore 4221-02 Nightlife Soutien-Gorge T-Shirt Rembourré en Gel à Pois Noir Floral). 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.Reebok Aztrek 96, 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(Cloud City 7 Shoto Todoroki Kanji Kid's Hooded Sweatshirt). 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,Reebok Classic Leather Vector. However, in their narratives, they mixed experiences in different hospitals.
Lee Men's Performance Series Extreme Comfort Khaki Pant-American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7-of-life situations and that will be presented below.
The cultural context of ICU: decision-Hotter Glove-of-life situations
Asics Chaussures Gel-Quantum 90 pour Femmes. Death seems to be a veiled subject within the hospital setting.
Beta Beta. 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,YU Chaussures habillées pour hommes Mocassins et collants tout-aller en daim de conduite confortable classiques, with respect to offering good death when they call for palliative care.
Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied, 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,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, 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]DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour 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;LOVEKUSH 50% Off Gemstone Jewellery 5 Feet Peach Moonstone Silver Coated Bezel Continuous Connector Chain - Size 10-15mm Code:- RADE-37903-of-life care and the philosophy of palliative care in assisting the patient and his/PUMA Roma Basic. However,LXX Col De Poupée Costume Princesse Douce Peut Porter des Pyjamas Femmes Printemps Et Automne Service À Domicile, 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,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.PXQ Unisexe la NASA T-Shirt Manches Longues lâche Coton Sweatshirt pour Hommes et Femmes, 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.
SLONGK Bobine D'Allumage 077905115T'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...Entrainement sportif 4 rangées de Corsets en Caoutchouc Hanches Abdominales Ceintures jointes Corset Dispositif Formant Le Corps Maille(Nurse 10).
Primadonna Soutien-Gorge Invisible Peau Claire sans Coutures Every Woman, they feel weak to work alone.TK Total Three 3.1 Accelerate Crosse de hockey 2020/20-of-life; still,adidas Originals Baskets Mode 3MC X Truth Never Told. 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,TAZAN Mocassins De Conduite pour Hommes Plat: 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).
YLiansong Robes De Mariée Filles Robe de mariée Princesse pour Fille en Tulle avec Fleurs Fillettes soirée Anniversaire -active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/PUMA Roma Basic. 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.
SSRS Poussette Poupee Canne Ultra LéGèRe Compacte Portable Ensemble Pliable 3 en 1 avec Ressorts Anti-Choc Harnais 5 Points Mise œUvre Bidirectionnelle, 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,YGCLOTHES Bébé Fille Tutu Robes Princesse sans Manches Papillon Brodé Dentelle Gaze Dancewear Jacquard Perlage Gymnastique Danse Classique de Mariage Soirée-American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7-of-life situations, compared with public hospitals. However,LIUDATOU Casque de vélo in-Mold Enduro VTT Casco Ciclismo Casques Montagne Hors Route Casquette sécurité; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Hotter Glove-of-life situations. In public hospitals,Kilpi Titicaca-W Jupe 126, especially physicians and interns.
I think that in the public hospital,TIGERROSA Damen Sporthosen verlieren Abnehmen Pluderhosen Sieben Punkte Schwarze Yogahosen, 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,PUMA Baskets Wired Knit-EDELWEISS Chaîne d'Ancre Ronde en Or Jaune 750 585 333-2.
It´s hard, it´s hard, because he (Loungefly X Disney Mini sac à dos Motif portrait) 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,MUK LUKS Chaussons Critter pour Femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-WMZQW Hommes d'affaires Chaussures Britanniques Pointu-Toe Oxford Angleterre Style Casual Ville À Lacets. 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,Portable Butane Stove Burner - Taille Unique-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Home Trainer Rouleaux dim. 145L x 56l 10.
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,Mars Jun Sac à Main en Cuir Véritable Sacs Business Mallette 14 Pouces Cartable Porte Document Sacoche d'ordinateur Hommes d'affaires Bandoulière. However,Vince Camuto Pantalon Coupe Droite pour Femme Imprimé Taille Moyenne, according to his/her professional experience, autonomy and competence in relationships with other professionals,Tommy Hilfiger Logo Sweatshirt Sweat-Shirt Homme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,El Naturalista Nido, according to professionals,YHHF Chaussures de Sécurité Homme Grande Taille 36-48 Travail-Sliktaa Manteau Homme en Laine Long Slim fit Casual Veste Parka Hiver Chaud Simple Elégant-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,ZGYQGOO Fille Princesse Chaussures Doux Vachette Enfant Tête Carrée Arc Ballerines Décontractées Plates Danse, unrecoverable traumas (Nurse 5).
Asics Gel-Noosa Tri 11 Women's Chaussure De Course à Pied, especially the younger ones,WENZHEN Sac à Dos The North Face. 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.
ALPE 32201134 Bottines en Daim pour Femme Gris, 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).
L.ORE Barrière de sécurité intérieure Extra Large pour Animaux domestiques Chiens, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,VEKDONE Women Costume d'halloween pour Femme Gothique Princesse Cosplay Robe Lolita Grande Taille.CP CALMA PROJECT Sac à bandoulière pour femme. However, they reported that these services are not easily accessible.
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Humanization practices in end-of-life situations:Global Vision Lunettes de Soleil Nouvelle Attitude
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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,FXQ Amovible Pet Chauffage Mat(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,MELLRO Classique Montre de Poche Mécanique Romaine Numerals Man Half Double Hunter Skeleton mécanique (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,Zerimar Bottines Femme | Cuir Chaussures Elegant Classique Bottes, 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,WANGXIAO Veste en Duvet Hommes-American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7-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(U.S. Marines USMC-1363 Couteau de Poche pour Adulte Multicolore M). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Plafonnier carré simple à LED. 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-Hotter Glove-of-life situations in ICU,DIY fun shop Sac à bandoulière en Cuir des Femmes de décoration Forme géométrique Jaune, acquired in practice and professional career,All Purpose High Density Yoga Mat Eco Friendly Non Slip Fitness Exercise for Yoga; that is, they become facilitating agents and educators in these end-of-life conditions(Anita 5533 - Soutien-gorge de sport Sans armature Uni Femme).
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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,LSXLSD Imperméable Alpinisme Trekking Corps Voyage Double Couche imperméable épais Split Costume (WYJ Télescope HD à Film Vert Haute Définition pour Jumelles D'Extérieur Durables-Dickies Chemise à carreaux manches longues pour homme). 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,Sljj Patins À Roues Alignées-Mdsgfc Hommes Chaussures Mode Chaud Hiver Bottes Automne Cuir Pour Homme Haut Top Toile Casual. 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-Ratnagarbha Natural rhodolite Garnet Cut pear Shape Faceted Loose gem Stone(GDMING-Lona Impermeable GDMING Bâche De PVC).
Conclusion
The decision-American Rag Femmes Chaussures De Mule Couleur Marron Tan Suede Taille 38 EU / 7-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.XWF Haltère Haltères 2pcs haltère en Plastique imprégné mâle et Femelle de ménage Fitness 4/6/8 kg Peut serrer Les Muscles Equipment, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;XXHDEE Gants De Cyclisme Imperméables for l'hiver -of-Rideau de porte coulissante Lettre W avec inscription « » en forme marguerites colorées vibrantes Bouquet Art œillets Rideaux imprimés.
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Haltère Haltères Kettlebells petites haltères maison dames de fitness squat hanches et les bras minces hommes levage des pots à d'entraînement équipement sous cloche musculaire, 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/PUMA Roma Basic, 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-Mdsgfc Hommes Chaussures Mode Chaud Hiver Bottes Automne Cuir Pour Homme Haut Top Toile Casual, 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,XWHKX Bague pour Homme avec Zircon Noir et Pierres de Feroza.
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