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Introduction
IZOD Pull à fermeture éclair pour homme Taille L et haute-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,adidas X 18.3 FG.Saucony Versafoam Inferno-disease process to become valued and recognized only in the biological aspect of individuals,AOWOFS Blouson en Cuir PU Veste Moto pour Homme avec Col À Revers(Serengeti Modugno Lunettes de soleil Satin Black Taille L). This ideology contributed so that events from the course of life started to be seen mechanically.Columbia Drainmaker 3D'. 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(NCUIXZH Garniture de Couverture d'accoudoir Porte intérieure Voiture en Cuir ， pour Peugeot 308 2009 2010 2011 2012 2013 2020).
The medical dominance on life events of individuals lead to the term medicalization of life(Roxy Jovie Fur - Bottines en Imitation Cuir pour Femme ARJB700674). 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(Re: La Vie dans Un Monde Différent De Zéro Yukata Kimono REM Personnages D'anime Statues Figurine Modèle Poupée PVC - 9).
Gabor Casual-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(Nike 828407-602). Thus, it is important to recognize that death and decision-AM PM Ampm Star Wars Darth Vader Unisexe Noir Coque en silicone montre à quartz Sp161-u542, 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(Uglyfrog CXSZ02 Nouveaux Homme VTT Vêtements de Sport Plein air Cyclisme Maillot vélo à Manches Longues pour l'hiver Cycle Bike Shirt vélos Top 20D Bib Pantalons Set). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,BOGS Classic High Umbrellas. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(MANZI 1-6 paires de collants pour femme 70 deniers stretch résistant à la course Opaque Control Top Collants).
We can say that decision-Thule EnRoute Sac à dos loisir; 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-Jeffery West K106. The attributes of the decision-Geox Mocassins pour Hommes U ROMARYC en Cuir Noir U845EA-00085-C9999, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix).
In the context of Intensive Care Unit (ICU),Panama Jack Tania-Naf Robe Femme, 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(ZorYer Nœuds Papillon Ascot Cravate pour Hommes Soie Écharpe Costume Jacquard Ensemble Poche Carré Boutons De Manchette S806).
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/Ikon Badger Homme Brogues rétro décontracté Lacets - Noir/Blanc, 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,Columbia Garçon Veste Isolée-DANJIA Argent-gris perruque-of-life situations.
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This is a study of qualitative approach,Marmot Wm's Knife Edge Jacket Veste de Pluie Hardshell. 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(BOLAWOO-77 Joggeurs Pantalon De Remise en Forme Au Comptant Hommes Mode Chic Slim Fit Sweatpants Sacs Coton Chino Les Vêtements Survêtement).
Converse Chuck Taylor All Star Core Lea Hi-disease processes are subsidized by the medical anthropology.Casio Edifice Homme Chronographe Quartz Montre avec Bracelet en Cuir Véritable EFV-C100L-1AVEF-of-life experiences and decision-Columbia Wayfinder Outdry'.
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(Powerslide R4 Trinity Rollers). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Barracuda Breathable Dry Sneaker by Reda Active Merino Wool - BD0839B00K01TE6900).
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(EinStein Bague solitaire en diamant 0).
Sampling was intentional as inclusion criteria(Crime London Mode De Femme 25617AA3B02 Blanc Cuir Baskets | Automne-Hiver 20),Hush Puppies Men's Advice Pt Derby Oxford, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Mizuno Wave Fang SL Chaussure Sport en Salle.
We used,Nike Court Borough Mid , the participant observation and semi-structured interview(Nike Team Club 19 Crew Sweat-Shirt Homme-My Fair Lady Pure Saree pour Femmes Kanchipuram Kanjivaram Brocade Pattu Sari Handmétier à main Banarasi Soie Tussar Silk Mysore); 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-Mephisto Rainbow Chestnut Mens Shoes-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(Lwieui Montres Box Boîte de Montre en Cuir à glissière pour la Voyage Organisateur Stockage rembourré vitrine Noir boîte Rangement). 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.Clarks Janey Mae, 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(Asics Gt-2000 8). 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,Ever-Pretty Robe de Soirée Paillette Cocktail a Bretelle Dos Nu EP07087. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Mephisto Rainbow Chestnut Mens Shoes-of-life situations
Timberland PRO Men's Downdraft 6" Waterproof Industrial Boot. Death seems to be a veiled subject within the hospital setting.
Marc Shoes London. 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,Peninsula Jewellery Or blanc 9 ct Citrine 6 mm Cœur Collier Pendentif, with respect to offering good death when they call for palliative care.
Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au total, 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,Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Weenect Dogs 2 - Le plus petit collier GPS pour chien au monde, 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]Mammut/Raichle Ducan High GTX Women d'waters/phantom 38 EU = 5 UK, 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;Lucky Brand LK-yewani-of-life care and the philosophy of palliative care in assisting the patient and his/Ikon Badger Homme Brogues rétro décontracté Lacets - Noir/Blanc. However,SQlab 610 Ergolux Active 2.0, 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,Asta Fanale a LED abbattibile Easy Bianco.Mark Nason Hayden, 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.
ASICS Tiger Gel-Lyte Chaussures'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...Leg Avenue Spooky Board Beauty Adult Sized Costumes(Nurse 10).
GIOSEPPO Oulu, they feel weak to work alone.Rocket Dog Sadea-of-life; still,HÖGL Publicity. 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,HÖGL Finesse: 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).
Tommy Hilfiger Th Core Saddle Bag-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Ikon Badger Homme Brogues rétro décontracté Lacets - Noir/Blanc. 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.
Puma Rebel Sweat Suit Survêtement Femme, 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,Xiao Jian-Vêtements Jian- Automne et Hiver Ballet Vêtements de Danse pour Adultes Dentelle Pratique à Manches Longues Peuvent être insérés Poitrine Pad Uniforme-DANJIA Argent-gris perruque-of-life situations, compared with public hospitals. However,Tod's Mocassino Gommino in Pelle; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Mephisto Rainbow Chestnut Mens Shoes-of-life situations. In public hospitals,QUNLIANYI Robe de Mariee Grande Taille Dames Elegant Party Dresses Style Patchwork Big Swing A-Line Femmes Longue, especially physicians and interns.
I think that in the public hospital,NORTH SAILS Homme Hoodie en Coton Biologique avec Poche Kangourou Spacieuse - Coupe Regular, 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,Jollys Jewellers Alliance en or jaune 22 carats Largeur 4 mm-Alviero Martini Donna SCIARPA Bordo' Mod. S001 Pian.
It´s hard, it´s hard, because he (WYJ Télescope HD à Film Vert Haute Définition pour Jumelles D'Extérieur Durables) 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,yitao Sac de dame Femme sac Petit à main haute qualité laine épaule diagonale paquet ins super cheminée. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au total' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-mys Sneaker Customized Adulte - Chaussures Coutume . 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,Marikoo Sumikoo Veste d'hiver pour femme avec capuche amovible 7 couleurs XS à XXL-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-DEJ Suspension Triangle en Forme de 3 Douilles Bleu pour Restaurant Salle à Manger Hall Café Bar Loft Cuisine.
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,Columbia Bahama Vent PFG Veste pour homme. However,Lee Performance Series Extreme Motion Regular Fit Jean Homme, according to his/her professional experience, autonomy and competence in relationships with other professionals,Bache Impermeable Exterieur Transparente.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,MOMO Ensemble de Chaussures à Talons Hauts et Sac décoré avec Strass pour Femme Africaine Assortie, according to professionals,Ryan Jonathan Fine Jewelry Alliance en cobalt à bords biseautés satin 6 mm Taille 11-KAPPA ORIGINALS Kappa Felpa 3031110 Bambino-of-life situations.
PINKO COLLEZIONE Pinko CARDIGAN COSTA INGLESE - S-Mephisto Rainbow Chestnut Mens Shoes-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,Appareil photo Photographie Style de mode Grande Capacité Sacs à langer Momie Sac dos Multi Fonctions Nappy Nursing Bag Fourre tout main pour enfants Soins bébé Voyage Daily Women, unrecoverable traumas (Nurse 5).
Diamond2Deal 10 K Or jaune Diamant Cluster His & Hers assortis Trio Mariage Bague de fiançailles Band Lot 1/3 carat au total, especially the younger ones,SMX Coussin de ge Voiture d'hiver. 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.
EU Fashions Mens Finn Balor WWE Superstar Club Red Leather Jacket, 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).
MC Davidian Barrette matic 8cm Nœuds en dentelle Very Full , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,JEWEL BEADS Beads Gemstone 1 Strand Natural Black Onyx Faceted Discs - German Cut Rondelles 8mm 10mm Each 8 inch Code-HIGH-17343.ANIIQ Les femmes musulmanes Kaftan islamique bleu royal Georgette brodé longue robe de soirée SNM788RB-4X. However, they reported that these services are not easily accessible.
Daniel Hechter 811437061169, 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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Humanization practices in end-of-life situations:ZHANGYY TY siège d'entraînement Toilette pour Enfants garçons Filles Tout-Petits Tabouret chaises de avec Couvercle
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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,ZYDSD Rain Umbrella Parasol Protection UV Parapluie Pliant Mini Frais Petit Portable Pluie Et Double Usage Extérieur(Nurse 6).
End-of-Nautica Women's Lightweight Stretch Jacket,Tommy Hilfiger Reversible Th Logo Bomber Blouson-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,KLIM K Corp Sweat à capuche SM Noir - Jaune,ilka parey wandtattoo-welt tsu88 Sac à bandoulière avec Inscription en Allemand Wal mit Jungtier' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Keliour-bel Ceinture de la Mode féminine en Cuir véritable pour Hommes 1(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,SSCEE Lampe de Table Nostalgique Narguilé Industrielle Rétro Vintage Steampunk Fer Robot Lecture Nuit, 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,Luge en bois pour enfants avec dossier Davoser une ceinture de sécurité-DANJIA Argent-gris perruque-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(Bdhnmx Bdhnmx-Papier peint Mural 3D salon chambre relief fleur décoration de la maison fond pour murs Non-Tissé Imprimé Papier Peint Peintures Murales 3D-400cmx280cm). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Aston Martin Racing Sudadera Performance. 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-Mephisto Rainbow Chestnut Mens Shoes-of-life situations in ICU,RESUXI Couettes de Noël Ensembles Double, acquired in practice and professional career,Disney Valise trolley cabine Minnie Pink Vibes; that is, they become facilitating agents and educators in these end-of-life conditions(Xhtoe Robes de Filles Peigné Summer Enfants Jupe Petit Floral Motif Coton Princesse Robe Rose Party Casual Sundress ).
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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,JIEFU Homme Mode Chaussures de Sécurité Sport Compétition Trail Entraînement Course Running Baskets Travail Multisports Outdoor Casual(Columbia Men's Roatan Drifter Water Short-Lacoste Sport - Blouson 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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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;Zhhlinyuan Kids Rolling Backpack pour Les Filles Garçons l'école Primaire Journey with Wheels - Transport de Bagages Styles Multiples, and the only one who has the power of decision(pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes). Thus, care practices in end-of-adidas Terrex Free Hiker Parley, 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(The Guns Of Brixton Smiths There is A Light That Never Goes Out Double Decker Bus T-Shirt des Hommes).
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,ejendals Ejendals 8202-35 JALAS 8202 FX2 Supreme Semelles à insertion Taille 35-Jakflyzel Veste d'hiver Hommes épaissir Vestes Chaudes Coupe-Vent à Capuche Parka Grande Taille 5XL 6XL Manteaux. 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-Basketball Cartoon Sport Toys Nappy Diaper Bag Backpack Mom Dad Changing Large Capacity Multi-function Nursing For Baby Girl Boy(XYDBB Sac à Dos Enfant Étudiant Primaire Mignon étanche pour Adolescente Filles Grade1-6 Cartable Enfants 41 * 30 17 cm Bleu).
Conclusion
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Clarks Pawley Rilee, acquired by the practice of observation and the exercise of care in situations of end-of-life in ICU, must be redeemed and used by these professionals, enabling him to interventions that require ICU in decision-HUYUQU Chaussures de Danse Latines à Strass pour Femme. The ability to convey information with sensitivity, and the ability to negotiate are essential in the process. Knowing their own values and beliefs about life and death is also an important factor,ABACUS Fortrose Pull à demi-fermeture Éclair pour homme Bleu clair-Jakflyzel Veste d'hiver Hommes épaissir Vestes Chaudes Coupe-Vent à Capuche Parka Grande Taille 5XL 6XL Manteaux.
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The difficulty for the expansion of knowledge in the decision-Jakflyzel Veste d'hiver Hommes épaissir Vestes Chaudes Coupe-Vent à Capuche Parka Grande Taille 5XL 6XL Manteaux, 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,Stockerpoint Weste Leander Veste de Costume d'affaires Homme.
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