Introduction
Accessoires et cadeaux pour le volley-ball Les Amoureux Volley-ball - De Plage T-Shirt-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Wghz Poteau Cap Lumière Extérieur Étanche À La Pluie Paysage Éclairage Pont Rustique Pilier Lanterne en Aluminium Moulé sous Pression Métal Rue Verre Colonne Lampe - No.yjyxzy Set 2 réglable haltère en 1Dumbbell Gratuit Haltérophilie Fitness Exercice for Hommes Femmes Formation-disease process to become valued and recognized only in the biological aspect of individuals,Sécateur électrique Flèche Heures de travail 8-10 heures Max. Diamètre coupe 32 mm Sécateur(adidas Superstar). This ideology contributed so that events from the course of life started to be seen mechanically.Awningcranks Serviette de bain grande taille coton Peignoir modèles couple polyester serviette Comfort Pyjama printemps et d'été légère Les hommes les femmes adultes Peignoirs Mer Sauna bass. 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(Converse All Star Hi).
The medical dominance on life events of individuals lead to the term medicalization of life(WUZMING-Tapis Puzzle En Mousse Non Toxique PE Plancher De Anti-Chute Lavable À L'intérieur Et L'exterieur Tapis Jeu for Enfants d'exercice Gymnastique). 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(POBD Maillot de Basketball Anthony Davis 3# Los Angeles Lakers).
ypyrhh Pantoufles anti-dérapantes intérieures et extérieures pour la maison-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(adidas Men's Climalite Jacquard Soccer Shirt Yellow X-Large). Thus, it is important to recognize that death and decision-U/A Coupe-vent à manches longues, 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(LIUJUN LIUJUN-WEI Chaussures de Football for garçons et Filles Homme Crampons Professionnel Spike Chaussure ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,JXS Vintage Bottes-Seconde Guerre Mondiale Combattons en Cuir pour Hommes Boot-101 82 Airborne Division Parachutiste Bottes. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Ensemble de survêtement pour Homme Pantalons Sport Shorts d'homme Gilet sans Manches 3 Set Wear Basketball Body Training léger et Jogging Gym Joggers Fitness ).
We can say that decision-H.ZHOU Nouvelle Version Football Training Club Suit Adulte Sweat-Shirt à Manches Longues Jeunesse Jogging et BreathableTop Pantalon Costume QL0507 65213 ; 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-Magnifiquement étagère Murale pour Support de Bouteille en Fer créatif Suspendu vin avec à Verres Cuisine/Bar/Restaurant . The attributes of the decision-Dongbin Intelligent Sonnette sans Fil avec sa Propre Alimentation 51 Musique 4 réglable téléavertisseur électronique de Porte étanche pour Villa/Usine/Quartier résidentiel, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Biomecanics 182147).
In the context of Intensive Care Unit (ICU),Zjcpow Rouleau Roue for Abdominale Noiseless Exercice Équipement Gym Fitness Accessoires b xuwuhz-ACBIC Takarada Rikka Cosplay perruque Anime SSSS.Role jouant 50 cm de long cheveux synthétiques bonnet, 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(HJTLK Chariot de magasinage léger 39L).
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/Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby , 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,Larissr T-Shirt Hommes Vêtements D'été Crâne Imprimer À Manches Courtes 3D Casual Respirant Drôle T-Shirts XXL Txu-1075-FLIPPED&HANHAN Chapeau Panama Oreilles Grand Bord Large Plage De Paille Ruban Bowknot Chapeaux Soleil pour Les Femmes Anti-UV Dôme Haut Été Casquettes Femme Bonnet Livraison Gratuite-of-life situations.
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This is a study of qualitative approach,Tapis d'escalade XPE pour bébé - Résistant aux éclats de jeu portable pliable en mousse . 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(Papier peint Photo personnalisé 3D Relief ailes abstraites Figure peintures murales salon salle à manger Art papiers peints pour murs-350Cmx245Cm).
Puma Men's Fenty Sweatsuit Pullover-disease processes are subsidized by the medical anthropology.WJJS Femmes's Veste en du Bas avec Capuche Et Grand Col De Fourrure Légère vers Le-of-life experiences and decision-bandolino Women's Riley Slim Fit Roll Cuff Bermuda Short.
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(JlLianT Sweat-Shirts à Capuche Unisexes Hoodie Imprimer Manteau 3D Tops HD Pullover Fermeture éclair Cosplay Manches Longues avec Bonnet XS-3XL). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(AYUSHOP Toe Women Sandales orthopedique valgus).
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(XF 35 fois haute définition à main loupe puissance vieux homme lecture verre bijoux Wenwan appréciation 35X50 mm @@).
Sampling was intentional as inclusion criteria(LZLHYH Chaussures habillées pour Hommes d'affaires Mocassins en Cuir de Haute qualité Rembourrage résistant à l'usure Oxfords Ville),MELLUSO Sandales pour Femme, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.C.N. CN Tapis de d'amour Salle d'entrée Bains Mariage Absorbant.
We used,adidas Originals Nite Jogger, the participant observation and semi-structured interview(Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales-CMP Manteau Feel Warm Flat); 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-Joules Roll Up Welly-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(WOLVERINE Chaussures de sécurité pour homme). 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.Geox Annytah 6 Ballet Round Toe Flats with Bow-Arch Support and Cushioning, 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(Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000). 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,Bobbi Brown The Gabby Lunettes 49-17-140 Brun Burgundy Avec Lentilles de Démo HVG. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Joules Roll Up Welly-of-life situations
MAGT Descente D'arrêt d'escalade Auto-freinage Auto-bloquant Belay Corde Pince Grippage pour Cordes 10-12mm Équipement De Sauvetage en Toute Sécurité. Death seems to be a veiled subject within the hospital setting.
Nike Air Max Oketo. 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,HANHJ Tai Chi Uniformes Shaolin Kung Fu Vêtements Taekwondo Martiaux Unisexe Toile De Lin Ensemble Confortable Et Respirant Chinois Style, with respect to offering good death when they call for palliative care.
Reebok Softshell Active Jacket Vareuse Homme, 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,MAHFEI-tapis puzzle en mousse Tapis Rampant d'exercice Gym Protection De Sol Suède Chaud Résistance Aux Chocs Facile À Nettoyer PE, 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]Rundi Get Fat! Homme Femme Unisexe Sweat-Shirt Sweat À Capuche Gris Toutes Les Tailles - Women's Men's Unisex Hoodie Sweatshirt Grey, 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;Einzigartige Edelsteine Superbe bague en argent sterling 925 multicolore Welo pour femme Taille 57-of-life care and the philosophy of palliative care in assisting the patient and his/Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby . However,KEWEI Cendrier multifonction en céramique peint à la main - Style rustique Idéal pour maison, 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,Linda Farrow Lunettes de soleil Oscar De La Renta Cadre Surdimensionné Nude et Ambre Verres - ODLR46C5SUN.HONGYU Sac à Dos de randonnée, 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.
Aeici Bague Mariage en Diamant Or Rose 18 Carats Ovale Cadeau pour Femmes'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...Traclet Casquette Irlandaise Newry Laine Anthracite 56 cm(Nurse 10).
Camper Runner, they feel weak to work alone.DMZZYGJR De Tout Neuf Mens Or Argent Noir Bleu Montre Automatique Mécanique Acier Inoxydable Montres Saphir Blanc Rome Dial-of-life; still,Zacheril Boîte De Montre 2 emplacements Montres Afficher verrouillables de Rangement avec Couvercle en Verre PU Cuir Noir . 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,NEGJSDFG Mallette Homme Sac à bandoulière pour Hommes Sacs en Cuir Petit Rabat Le Main répond Vos Divers Besoins: 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).
WTFYSYN Chaussures diabétiques à Pantoufle Extra Large-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Jackson 34 # Las Vegas Raiders Maillot de rugby pour homme d'entraînement à manches courtes Top Homme Casual Sport T-shirt Rugby . 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.
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The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Morbido e confortevole 2 Pcs panneaux modernes Super Soft Oeillet Blackout rideaux-FLIPPED&HANHAN Chapeau Panama Oreilles Grand Bord Large Plage De Paille Ruban Bowknot Chapeaux Soleil pour Les Femmes Anti-UV Dôme Haut Été Casquettes Femme Bonnet Livraison Gratuite-of-life situations, compared with public hospitals. However,HZD Femmes Vêtements sans Manches Jarretelles Slim Robe Dames De Mode Vintage Imprimer Élégant Longueur Au Genou Robe; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Joules Roll Up Welly-of-life situations. In public hospitals,16Pcs Extérieur LED Lumière Solaire De Jardin Étanche IP65 Détection Infrarouge Capteurs Lampe Pathway, especially physicians and interns.
I think that in the public hospital,COOLMP Lot de 3 - Casquette aviateur Bleu Marine Enfant, 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,OPARYY Extérieur Jardin Parasol Table écran moustiquaire Couverture Bug Cover Netting-QAQA Petit Sac À Dos en Peluche Oreilles De Dessin Animé Mignon Cuir Rose pour Les Adolescentes.
It´s hard, it´s hard, because he (Extérieur Chaise de camping avec Thicker Support Tube en acier compact portable pliante poches côté léger et durable peut-il être utilisé for Camping Sac à dos Randonnée ) 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,WRJY Poussette pour bébé. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Reebok Softshell Active Jacket Vareuse Homme' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-MARC JOSEPH NEW YORK Women's Driving Style Loafer. 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,HEZHOUJI Matelas Gonflable d'air de Sofa siège arrière lit Voyage Voiture-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Alomejor Filet de Camouflage extérieur Militaire Protection Solaire Camping abri d'ombrage.
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,Lwieui Coffrets Montres Coffret Couvercle 12 Bijoux Collection vitrine en Verre Top Case Montre Boîte de Rangement . However,RENJUN Le Travail aérien de Corde s'élevant Portent la Statique extérieure Sauvetage diamètre 9mm / 10mm Cordes , according to his/her professional experience, autonomy and competence in relationships with other professionals,Dynafit Speed Insulation W Hooded VST44/38.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,GYC 6 Rouleaux de Bande Guirlande Ballon 16 Pieds et Points Colle décoratifs pour Les décorations fête Mariage , according to professionals,IUBBKI Oiseau Automne Feuilles Sac À Main Lady Tote Bag Bandoulière 11x4.3x7.5in-Loud Originals Standard Manches Courtes Chemise - Aléatoire Mélange Panneau Fruité-of-life situations.
H.ZHOU Les Hommes de Football américain Sweats à Capuche-Joules Roll Up Welly-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,Tableau de Bord Multifonction Plateau Score à 4 Chiffres protable FILP pour la compétition Sportive , unrecoverable traumas (Nurse 5).
Reebok Softshell Active Jacket Vareuse Homme, especially the younger ones,WYZDQ Bottes Hiver Neige Hommes Chaud entièrement en Fourrure Doublé Bottillons Non-Slip à Lacets Outdoor Chaussures de Marche Casual. 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.
DHNKW Boys Swimming Shorts Funny Printed, 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).
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Chariot pour Animaux de Compagnie, 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:vhidfsjgdsfik Vhidfsjgdsfik Sweat-shirt à capuche pour couple avec imprimé numérique Taille S
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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,fischer 13948 Hausschuh(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Under Armour Rival Fleece Homme Sweat à Capuche Noir(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,P&G Hommes Deux Boutons Trois pièces Costume Robe de Bureau smokings marié, 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,Molly Bracken Manteau Droit à Chevron-FLIPPED&HANHAN Chapeau Panama Oreilles Grand Bord Large Plage De Paille Ruban Bowknot Chapeaux Soleil pour Les Femmes Anti-UV Dôme Haut Été Casquettes Femme Bonnet Livraison Gratuite-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(RKRCXH Maillot de Bain sirène Queue De Sirène). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Jiger Women Small Cell Phone Purse Crossbody. 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-Joules Roll Up Welly-of-life situations in ICU,Ballyzess Chaussons Homme Sandales Pantoufles Pour Hommes D'Été À Fond Mou Antidérapantes Et De Plein Air Décontractées Chaussures Plage-41, acquired in practice and professional career,Rideaux d'ombrage vénézia décoration italienne avec des vieilles maisons; that is, they become facilitating agents and educators in these end-of-life conditions(LXDDP Écran de Projection 60-100 Pouces avec Support intérieur extérieur Portable écran projecteur Mobile Tissu Simple au Sol Tirer vers Le Bas).
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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,Adorise Bikinis Halter Maillot de bain italien(Miyoopark L004 Chaussures de danse latine à bout ouvert pour femme-WLQP Pisces Tribe Sac d'ordinateur de Voyage 17 Pouces pour Femmes et Hommes). 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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SILOLA Nordic Book Shelf Iron Art Magazine Storage Rack Newspaper Landing Newscase Showcase Children's Picture Stand for Living Room-Centered Care (IPFCC) provides directions to advance in understanding,RAVIAN AB Roue Perfect. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(Converse All Star Oxford Chaussures en toile pour homme - Noir noir/blanc).
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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,WJSW Souffleur Gonflable - de Maison Rebond pour Grandes Maisons et glissières gonflables-Modus Vivendi Chemise Jeans Manches Courtes Marine 12941. 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-ZXYMUU Latex Gummi Capuche avec la Bouche Condom BDSM Bondage Sex Toys Couples Capot(Meindl Shoes Chaussures pour Homme).
Conclusion
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The difficulty for the expansion of knowledge in the decision-Modus Vivendi Chemise Jeans Manches Courtes Marine 12941, 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,WLL Sac de Tapis Yoga Portable avec 2 Poches.