ABSTRACT Introduction: Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. Methods: We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. Results: The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). Conclusion: MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied. Introduction setting Methods 20 isolated 201 202 10 (MIAVR CAVR. . (CAVR) differences propensitymatching propensity matching each Results 30day day 30 1.1% 11 1 (1.1 vs 0 P=0.99. P099 P P=0.99 99 P=0.99) 6 ( hours P<0.01. P001 P<0.01 01 P<0.01) 3.3% 33 3 (3.3 132 13 13.2% P=0.03. P003 P=0.03 03 P=0.03) significantly 1.8 18 8 (1. 12 1. 32 3. 14 4 days P<0.01, , 6.7 67 7 (6. 21 2. 72 7. 19 P=0.09, P009 P=0.09 09 P=0.09) Followup Follow up logrank Pvalue value 0.58. 058 0.58 58 0.58) Conclusion postextubation post support denied (CAVR 1.1 P09 P=0.9 P00 P<0.0 3.3 (3. 13.2 P=0.0 (1 6. 05 0.5 5 P0 P=0. P<0. (3 13. 0. P=0 P<0 P= P<

This is an empirical, quanti-qualitative research that aimed to identify and compare ethical problems experienced by nurses and doctors at Primary Care Centers, in São Paulo, Brazil. Data were collected through semi-structured interviews. The participants were asked to tell an ethical problem that they experienced during their work at Primary Care. The problems were analyzed by using an evaluation instrument of ethical problems' occurrence in primary care. The results showed that professionals have difficulty to deal with the ethical issues raised by assistance in a primary care because these problems are broad, diverse and influenced by social and subjective aspects on the caring context. This questions become an obstacle for an effective and comprenhensive healthcare. The quality of healthcare and rare discussion about ethical problems or issues compromises the healh care quality and team work.

Estudio empírico, cuanti-cualitativo, que buscó identificar y comparar problemas éticos vividos por enfermeros y médicos que actúan en la Atención Básica, en el municipio de São Paulo/ Brasil. Por medio de entrevista semiestructurada se pidió a los participantes que contasen algún problema ético que vivieron en su trabajo en la Atención Básica. Los discursos sufrieron análisis de contenido y los problemas encontrados fueron agrupados con el uso del Instrumento para Evaluación de la Ocurrencia del Problema Ético en la Atención Básica. Los resultados mostraron dificultad en lidiar con cuestiones éticas identificadas por ser amplias, diversificadas e influenciadas por el contexto social y subjetivo presentes de forma más intensa en la atención básica. Esto interviene como obstáculo a más para la efectuación de la práctica de una atención integral, muchas veces ya comprometida por la fragmentación en las relaciones profesionales que dificultan el trabajo en equipo y la construcción de espacios para la discusión de problemas éticos.

Estudo empírico, quanti-qualitativo, que buscou identificar e comparar problemas éticos vivenciados por enfermeiros e médicos que atuam na Atenção Básica no município de São Paulo. Por meio de entrevista semi-estruturada pediu-se aos sujeitos que narrassem algum problema ético que tivessem vivido em seu trabalho na Atenção Básica. Os resultados mostraram dificuldade dos profissionais em lidar com questões éticas identificadas por serem amplas, diversificadas e influenciadas pelo contexto social e subjetivo presentes mais intensamente na Atenção Básica. Isto intervém como um obstáculo a mais para a efetivação da prática de uma atenção integral, muitas vezes já comprometida pela fragmentação nas relações profissionais que dificultam o trabalho em equipe e a construção de espaços para discussão de problemas éticos.