Transporte aéreo e passageiros com deficiência auditiva: barreiras e facilitadores / Air transport and passengers with hearing impairments: barriers and facilitators

Este estudo teve como objetivo compreender as barreiras e facilitadores para a participação das pessoas com deficiência auditiva em viagens aéreas. Fundamentou-se na abordagem da ergonomia da atividade. Os dados foram coletados por meio de questionário, observações diretas durante as viagens e entrevistas de autoconfrontação com passageiros com deficiência auditiva. Constatou-se a existência de barreiras relacionadas a fatores sociais, como comunicação, e ambientais, como sinalização nos aeroportos. Entre os facilitadores das viagens destacaram-se a comunicação com trabalhadores que têm conhecimento da língua de sinais e legendas nos conteúdos de entretenimento a bordo. Este estudo espera dar visibilidade às experiências de viagens de passageiros com deficiência auditiva e, a partir disso, contribuir para a melhoria das condições e procedimentos do transporte aéreo e orientar a formação de pessoal visando prestar serviços adequados aos diversos passageiros

This study aims to understand the barriers and facilitators to the participation of persons with hearing disability in air travel. This study was based on the assumptions of activity-centered ergonomics. Data was collected by means of a questionnaire, direct observations during trips and self-confrontation interviews with passengers with hearing disability. The study findings include barriers related to social factors, such as communication, and environmental factors, such as airport signage. Air travel facilitators included communication in sign language with workers and closed-captioned in-flight entertainment for passengers. This study hopes to give visibility to travel experiences of passengers with hearing disability, and from that to contribute to the improvement of air transport conditions and procedures and to guide staff training aiming to provide adequate services to diverse passengers

Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms.

BACKGROUND: Type 2 endoleaks after the endovascular treatment (EVAR) of abdominal aorta aneurysms (AAAs) remain a concern for vascular surgeons, especially when they are associated with an enlargement of the persistent aneurysmal sac. The purpose of this study is to evaluate the effectiveness of secondary reinterventions for type 2 endoleaks associated with enlargement of the aneurysmal sac after EVAR. METHODS: The incidence of endoleaks, aneurysmal sac diameters, and reinterventions were collected from the clinical and radiologic data of the patients treated by EVAR for AAA with >1 year of follow-up. Patients with a type II endoleak associated with an enlargement of the aneurysmal sac were identified; their operative data and the results of the secondary procedures were recorded. The principal criterion of evaluation was the effectiveness of these reinterventions on the evolution of the diameter of the AAA. The secondary criteria were death rate related to aneurysm and the average costs of these additional procedures. RESULTS: In 232 patients treated by EVAR with an average of 2 years of follow-up (23 ± 30 months), 15 type I (6.5%), 94 type II (40.5%), and 8 type III (3.5%) endoleaks were identified. Among the 94 AAAs with a type II endoleak, 21 had a regression of the aneurysmal sac (22.5%), 46 were stable (49.5%), and 27 continued to grow (28%), including 9 because of another type of endoleak. Among the 18 patients presenting with a type II endoleak linked with an enlargement of the aneurysmal sac, 14 were treated with endovascular embolization, 1 was treated by conventional aneurysmectomy, and 3 patients were followed-up only. Among 14 patients treated by embolization, 9 (60%) presented with persistent enlargement of the aneurysmal sac after embolization, of which 5 were finally treated by conventional treatment with 1 postoperative death. The average cost per patient that required a reintervention for a type II endoleaks was €28,096 ± €30,490 ($37,530 ± $40,728). CONCLUSION: Endovascular reinterventions for type II endoleaks associated with an enlargement of the aneurysmal sac after EVAR have a poor effectiveness on the stabilization of the diameter of the AAA. These procedures involve an high cost and high rates of morbidity, which should be taken into account in their use.

A budget impact model for paclitaxel-eluting stent in femoropopliteal disease in France.

PURPOSE: The Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent. METHODS: A model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payer perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only. RESULTS: The model estimated a net cumulative 5-year budget reduction of 6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses. CONCLUSION: Adoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.