Preoperative stent placement decreases cost of ureteroscopy.

OBJECTIVES: To examine the effect of preoperative stent placement on total cost of ureteroscopic stone intervention. Passive ureteral dilation with a preoperative ureteral stent has been proposed as a method to facilitate both upper tract access and stone removal. METHODS: We retrospectively reviewed the records of patients who underwent ureteroscopic stone intervention at our institution from 2005 to 2009. A sample of patients who had undergone stenting before ureteroscopy was selected and nonstented matched controls were used as a comparison group. A cost model was used to compare the total healthcare costs for the prestented and nonstented patients with a large (>1 cm) and small (≤1 cm) stone burden using the actual cost accrued for each patient. Sensitivity analyses were used to examine the robustness of the cost model. RESULTS: A total of 104 patients were included in the present study (45 prestented, 59 not prestented). The median stone size was 1 cm (range 0.3-4). The overall stone clearance rate was 95.8%. The median number of procedures was 1. Pre-stenting significantly decreased the total healthcare cost in patients with stones >1 cm. The median cost for the prestented and nonstented cohorts was $17,706 and $27,806, respectively (P < .01). However, prestenting increased the total cost for smaller stones of ≤1 cm, although not significantly. The median cost for the prestented and nonstented cohorts was $10,872 and $12,344, respectively (P = .70). Sensitivity analysis confirmed that the model conclusions are robust. CONCLUSIONS: Preoperative stent placement is cost-effective for successful ureteroscopic treatment of stones >1 cm.

A condom skill scale: assessing condom skills among female drug users.

Use of latex condoms is a primary form of sexual risk reduction, and consequently many intervention programs have focused efforts on increasing condom use among high-risk populations. Use alone, however, will not fully protect the individual if condoms are not used correctly. The objective of this study was to describe the development and properties of a scale measuring demonstrated condom use skill using a sample of 261 drug-using women. Guttman's coefficient of reproducibility and Jackson's Plus Percentage Ratio (PPR) were used to determine the scalability of the Condom Skill Scale (CSS). Analysis of scale scores revealed high levels of condom skill among the population, although there was reduced performance for three items. Preliminary analysis suggests that the CSS is a potentially valid and reliable instrument, and may have application as a tool assessing condom skill level.

Social isolation and domestic violence among female drug users.

The objective of this study was to examine the association between social isolation, domestic violence, and substance dependence among street-recruited female drug users. Hierarchical logistic regression was used to assess the independent contribution of social isolation and substance dependence to the likelihood that women will experience physical abuse. One hundred women (38.2%. N = 262) reported at least one incident of physical violence perpetrated by her most-recent sexual partner. Controlling for substance dependence and relationship status (the only significantly associated demographic variable), women reporting indicators of social isolation were more likely to have been physically abused by their most-recent sexual partners than nonisolated women. Substance dependence was not related significantly to domestic violence. Providers who have contact with female drug users should be aware of the high domestic violence rates and work to counterbalance the isolation these women may experience.