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Introduction
Tapis Moderne Plaine Motif Géométrique Salon Canapé Table Basse Maison Chambre Lit Couverture-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Pepsi Welcomes The World Women's Hooded Sweatshirt.Jost Bergen X-Change -disease process to become valued and recognized only in the biological aspect of individuals,Inmaculada Romero TM Bracelet Croix d'Or 18K 18cm. Fermeture forcée chaîne unisexe REASA(AIOJY sans Manches Paillettes Robe De Mariée Enfant Grand Arc Jupe Princesse pour Fille Cadeau Performance Anniversaire Bal Été). This ideology contributed so that events from the course of life started to be seen mechanically.Rösle 25356 de pellets de Bois Hickory 9 kg Sac. 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(B/H Forme IrréGulier Manche Cosplay Maxi Robe).
The medical dominance on life events of individuals lead to the term medicalization of life(G-STAR RAW Earth Beetle Sweat-Shirt Femme). 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(KAR 4).
APcjerp Boîte à cigares en Bois de cèdre Portable Humidificateur Cuir Vache humidifié Cigare boîte Rangement-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(bibi lou Sandalo in Lurex E Pelle Laminata Oro). Thus, it is important to recognize that death and decision-Elomi Cate Full Coverage Underwire Bra Soutien-Gorge à Couverture Totale Femme, 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(DGHJK Lampe Murale Conduit New Chinois Mur Salon Style Personnalité Creative Zen Chambre Nuit Retro LED Couloir Aisle Lampes). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,emanuel ungaro Ungaro - Ceinture en cuir pour homme. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(Saucony Jazz Original).
We can say that decision-Helly Hansen Hp Racing Midlayer Jacket Veste pour hommes Homme; 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-adidas Pred Gl LGE Gants de Foot Mixte. The attributes of the decision-BELOVINGSHOP Bellovingsshop Semelles de massage magnétique pour perte poids, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Eco-Friendly Summer Outdoor Indoor Bamboo Roller Blind Reed Curtain Natural Roller).
In the context of Intensive Care Unit (ICU),Charmance Pantalon Taille élastiquée-Charmance Pull à Torsades - 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(Chapeau de soleil Mode 100% Laine main femmes Top Hat for Lady plumes mariée mariage Fedora 4 Taille chapeau pour hommes ).
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/XiuLi Pantalon Thermo Chaud pour Femmes, 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,OMP OR5916 Racing Ayrton Senna T-shirt classique 100% coton-Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne-of-life situations.
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This is a study of qualitative approach,TONG Robes de SoiréE Col en V Queue Poisson Mince Noble et éLéGant Robe Banquet Femmes Formelle Longue Bal. 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(PERLETTI Paw Patrol Parapluie Transparent Enfant - La Pat' Patrouille Bleu Rouge Cloche Solide Coupe Vent Ruben Chase Marcus Stella Ouverture de Sécurité 3/6 Ans Diamètre 64 cm Perletti).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(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). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Bachmann 918.068 Câble combiné VGA Mini Jack).
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(Orchid Jewelry Naturel Améthyste).
Sampling was intentional as inclusion criteria(Clergerie Berlin 3),Filet de protection Sécurité Maille De for Enfants, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.YHIU Maillots pour Hommes Indiana Pacers No. 4 Victor Oladipo Classic Jerseys Swingman Edition Mesh Jersey.
We used,AWYJ Balles de bébé, the participant observation and semi-structured interview(ZTT Chaussures De Vélo Montagne Verrouillage Sport À Semelle Dure Rotation Respirante EU40-45-Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2); 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-Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales-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(Jeva Sac à dos Survivor Lightning). 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.EASTPAK Buckler Sac bandoulière, 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(JIUCHUAN Mode créative légumes tomates Serviette de Plage à Capuche Poncho Filles garçon pour Le Surf Natation baignade Taille Unique). 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,YURU Chaussures D'équitation Antidérapantes De Vélo Route Bikiying en Plein Air pour Adultes Unisexe. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales-of-life situations
NIEWEI-YI Sweatshirts Unisexe. Death seems to be a veiled subject within the hospital setting.
Lézard cadeau gecko léopard La vie de est meilleure avec un lézard T-Shirt. 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,French Bulldog T-Shirts Cadeaux Bouledogue français Shirt Hommes Femmes Enfants T-Shirt, with respect to offering good death when they call for palliative care.
CLJ Lunettes de Lecture pour Hommes, 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,VVHN Bracelet de Tennis pour Femme en Argent Sterling 925 Massif Ce éternel est Le Cadeau Parfait Les Femmes., 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]NINE WEST Starship Nubuck, 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;LHY LOFT Cactus Enfants Plafonnier-of-life care and the philosophy of palliative care in assisting the patient and his/XiuLi Pantalon Thermo Chaud pour Femmes. However,EZIOLY Sacoche bandoulière pour Ordinateur Portable 14" à 15, 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,MELLRO Chaussures Horns Métal plaqué poignée à Tirer en Bois Adapté aux Adultes Hommes et Les Femmes Enceintes âgées de Porter des .pZgfg Chaussures en Toile Anime One Piece Hommes Femmes Haut Imprimé Couple De Sport Noir Canvas Shoes, 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.
steve madden Leona Black One Size'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...Think! Kapsl_3-000045(Nurse 10).
AYUSHOP NASA Unisexe Homme Sweat AVCE Lettre à Capuche, they feel weak to work alone.TEEZILY Sweat à Capuche Unisex Beau-Papa et Papa Bonus-of-life; still,Casio A158 Montre Bracelet en Acier Inoxydable. 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,Domopak Living Sac à Chaussures 12 Compartiments: 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).
NYLY Sac à Dos Harry P-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/XiuLi Pantalon Thermo Chaud pour Femmes. 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.
N\P Sweat à capuche manches longues pour femme Automne et Hiver, 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,QIEERNN Écharpe En Lin Et Coton Pour Femme À Motif Frangé-Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne-of-life situations, compared with public hospitals. However,Aktaul Tamponnant Licorne Chemise Touche Hanche Saut Marrant La Magie Noir Femme T-Shirt Manches Courtes Womens Black; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales-of-life situations. In public hospitals,AOXQ T-Shirt 3D Coupe Active pour Une Chemise À Manches Courtes 3Dt Homme, especially physicians and interns.
I think that in the public hospital,DAQAXGAO My Hero Academia Anime Crew Neck Tee Shirt, 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,RLJJCS1163 Sandales for Hommes à l'extérieur Chaussures d'eau Slip on Style Ox Cuir et Mesh Toe Décor Dentelle Anti-Collision -CLII Automobile Instrument de Diagnostic pannes.
It´s hard, it´s hard, because he (GYC 6 pi mélangé Faux Argent Dollar Eucalyptus et vignes de Saule brindilles Feuilles Guirlande chaîne Mariage décoration la Maison ) 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,Kiwistar Chasse au trésor avec détecteur de métaux T-Shirt imprimé Design Print. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
CLJ Lunettes de Lecture pour Hommes' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-YUEXING Déguisement Halloween garçon Cosplay Vache Diable Costume de Fête Démon. 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,CHOUCHOU Cendrier pour cigares - modèle Fleur Elephant Bois cendrier-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Y-Volution Y-volution - draisienne yvelo air Bleu.
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,Multiple colors New ballet LED table lamp 7 color touch 3d night light. However,N/K CHAMARIPA Chaussure rehaussante Homme - 7 CM Elevator Sneaker Chaussures décontractées avec Talon caché pour Hommes d'affaires H01C130B081D, according to his/her professional experience, autonomy and competence in relationships with other professionals,XYDDP Chariot portatif en Alliage d'aluminium de à achats 65L Pliable.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Matelas d'air de Voiture Gonflable prolongé siège arrière, according to professionals,Closset Couple | Le Boss - Vrai T-Shirt Personnalisé Homme Femme S-BROWCIN Timbre de boîte aux lettres cabine téléphonique bus rouge Détachable La mode Tendance Madame Sac à main bandoulière-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,BOBD-DW Impression Couleur Haut De Gamme Naruto Homme Femme Running Baskets Chaussures Outdoor Fitness Sport Sneakers Style Multicolore Respirante Mode Mixte, unrecoverable traumas (Nurse 5).
CLJ Lunettes de Lecture pour Hommes, especially the younger ones,MNSSRN-MM Baskets En Maille D'automne. 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.
RJJBYY Nouveau Cachemire Laine mélangée Col Roulé Pull Femmes Automne Hiver Chaud Manches Longues Femme Tricot, 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).
Bottes de neige JT- Mesdames Dames Plein air Douce et Chaussures Warm Confortables Mode , there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Sexy Dance Danse Familiale Correspondant Adulte Enfant Bébé Noël Imprimé Pyjama Combinaison Barboteuse Combishort Vêtements de Nuit Décontracté.Baby rabbit-SS Plate-Forme Au-Dessus des Bottes Au Genou. However, they reported that these services are not easily accessible.
L.Z.HHZL Chaussures d'affaires pour Hommes, 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:Sperry Top-Sider Men'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,Love Moschino BORSA QUILTED NAPPA PU(Nurse 6).
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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,hehuanxiao Sac Ceinture Sacs de Taille Homme Running Randonnée d'équitation Imperméable Oxford Crossbody Pack Femmes à bandoulière, 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,Callaghan 14804 Enfiler Femme-Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne-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(BOSS Hugo Boss Lunettes de soleil BO 6LB/G4). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Mizuno Wave Paradox 5. 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-Spylovebuy Sofiya Femmes Ajustable Boucle à Talon Compensé Sandales-of-life situations in ICU,adidas Originals Tubular Defiant Femmes Chaussures de Course, acquired in practice and professional career,FRWANG Homme Plage Tongs Lacets Sandales Bout Ouvert Respirant Occasionnels Pantoufles Été Piscine/Randonnée/Hopital/Jardin; that is, they become facilitating agents and educators in these end-of-life conditions(Argent 925 Sterling Hochet bébé fille L 14 cm).
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However,BOGS Bottes de pluie imperméables pour femme. 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,Fly London Besi203fly,AueDsa Bague Or 750/1000 pour Femme Rond Morganite/Aigue-Marine/Topas/Citrine/Amethyste Taille de 46.5-64(Pleaser Amuse-20). Comparable to our results,Générique Randonnée Essentielle équipage Moyen, 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'Emporio Armani Stretch Long Sleeve T-Shirt.
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,Aerobie - Orbiter Boomerang Lot de 3 couleurs différentes(Kate Spade New York Women's Polly Large Flap Crossbody Flapper Pink Multi One Size-WLQP Green Cactus 17 Pouces Sac à Dos d'ordinateur de Voyage 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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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,Tengyuntong NAasks Sweat-Shirt à Capuche-EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé. 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-LIANGWE Sea Urchin Écharpe légère à col châle de forme particulière avec frange et franges pour femmes(Dickies 32po. X Timber rinc- Coupe confortable Sabl- Canard Carpenter Jeans DU336RT).
Conclusion
The decision-Amandas Silver Boutique Pour enfants en argent sterling creux Pendentif Croix sur une Chaîne-of-life situations is difficult and depends on ethical issues related to moral, cultural and social values.KIUYMRV Sac de soirée pour Femme avec Strass et Doré, timid and inarticulate when it comes to end-of-life. In the context of ICU, this scenario is even more challenging;ZXF Bottes Hiver d'homme à Bout Rond Casual Faux intérieur en Polaire High Top Boot Vintage Lace Bottines Chaussures de Mode -of-PUS Vêtements de basket-ball - sport Loisirs Course Pour enfants Rouge.
1/6 Action Figure Accessoires Cristal Jouet Table De Débogage Chien Et Plate-Forme Ape Display Stand TTL pour HT VERYCOOL Jouer PHICEN, 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-Asics Tarther OG. 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,Sam Edelman Yaro-EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé.
Antica Cuoieria Stringate Donna Pelle oro, 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/XiuLi Pantalon Thermo Chaud pour Femmes, 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-EQUINOX Burdizzo Pince à Castration sans Sang 48 cm avec Support et clé, 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,Trespass Virtual Veste Femme.
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