female patients with fecal incontinence research

This data is based on a survey that was filled by family medicine physicians and geriatricians. The physicians included in the study are those who reported that they did manage female patients with fecal incontinence. The outcome of interest is whether these physicians never referred or did refer any of these females for specialist care.

Referred: (0) if physician has never referred female patients that present to him with fecal incontinence and (1) if physician did refer

Referred Not Referred Total P-value
Number Proportion N % N %
Total physicians 93 91.18 9 8.82 102 100

PHYSICIAN CHARACTERISTICS

Age of provider (Age) 93 9 0.208
25-35 (0) 24 25.81 3 33.33 27 26.47
36-45 (1) 32 34.41 1 11.11 33 32.35
46-55 (2) 15 16.13 3 33.33 18 17.65
56-65 (3) 19 20.43 1 11.11 20 19.61
>60 (4) 3 3.23 1 11.11 4 3.92
Gender (Gender) 0.466
Male (0) 29 31.18 4 44.44 33 32.35
Female (1) 64 68.82 5 55.56 69 67.65
Specialty (Specialty) 0.011
Family medicine (0) 54 58.06 1 11.11 55 53.92
Geriatrics (1) 39 41.94 8 88.89 47 46.08

PHYSICIAN EXPERIENCE

Level of training (training) 0.401
In Training (0) 19 20.43 3 33.33 22 21.57
In Practice (1) 74 79.57 6 66.67 80 78.43

Number of patients (both males and females) per week – Mean (SD) (Number_of_Pts)
45.80 (36.23)
41.11 (30.29)
45.38 (35.64)
0.709

Percentage of female patients per week (female)
0.657
0 to 50% (0) 16 17.2 2 22.22 18 17.65
More than 50% (1) 77 82.8 7 77.78 84 82.35

Percentage of patients referred (to any specialty) (TotalRef)
0.861
Less than 10% (0) 49 52.69 6 66.67 55 53.92
More than 10% (1) 44 47.31 3 33.33 47 46.08

Number of gynecological exam per week – Mean (SD) (GynExam_weekly)
8.04 (13.03)

1.28(1.66)

7.45 (12.6)

0.124

PHYSICIAN KNOWLEDGE, ATTITUDE AND BELIEF

How does fecal incontinence come up?
Patient complaint (FIHow_PtComplain) (No: 0, Yes: 1) 80 86.02 5 55.56 85 83.33 0.040
Elicited from history (FIHow_PhysicianEli~t) (No: 0, Yes: 1) 46 49.46 5 55.56 51 50 1.000
Physical exam (FIHow_PE) (No: 0, Yes: 1) 18 19.35 2 22.22 20 19.61 1.000

What do you think the prevalence of FI is? (PrevFI)

0.215
Less than 1% (0) 25 26.88 2 22.22 27 26.47
1 – 5 % (1) 47 50.54 3 33.33 50 49.02
5 – 15% (2) 16 17.2 2 22.22 18 17.65
15 – 30% (3) 3 3.23 1 11.11 4 3.92
Don’t Know (4) 2 2.15 1 11.11 3 2.94
Comfort level in managing FI (comfort) 0.728
Comfortable (1) 41 44.09 5 55.56 46 45.1
Uncomfortable (0) 52 55.91 4 44.44 56 54.9

HOSPITAL CHARACTERISTICS

Ease of referral to a specialist for FI (ease) 0.060
Easy (1) 64 68.82 3 33.33 67 65.69
Difficult (0) 29 31.18 6 66.67 35 34.31

Setting (Setting)
1.000
Urban (0) 64 68.82 6 66.67 70 68.63
Not Urban (1) 29 31.18 3 33.33 32 31.37

Practice (practice)
0.716
Academic (0) 63 67.74 7 77.78 70 68.63
Non-academic (1) 30 32.26 2 22.22 32 31.37

Availability of gynecologists in institution

0.355
Yes 79 84.95 9 100 88 86.27
No 14 15.05 0 0 14 13.73

Geographic Region

0.848
Mid-Atlantic 39 41.94 5 55.56 44 43.14
North-East 11 11.83 2 22.22 13 12.75
South 14 15.05 1 11.11 15 14.71
Mid-West 12 12.9 0 0.00 12 11.76
South-West 3 3.23 0 0.00 3 2.94
West 14 15.05 1 11.11 15 14.71

referred Odds Ratio Std. Err. z P>z [95% Conf. Interval]

PrevFI
1 to 5% 2.513507 4.53769 0.51 0.61 0.0730445 86.49139
5 to 15% 0.7663785 1.591936 -0.13 0.898 0.0130711 44.93407
15 to 30% 0.3625486 1.065403 -0.35 0.73 0.0011428 115.0134
Don’t Know 0.1473844 0.5277002 -0.53 0.593 0.0001321 164.4838

ease 52.18946 96.61055 2.14 0.033 1.386374 1964.65
comfort 0.3251792 0.5021416 -0.73 0.467 0.0157651 6.7073
Gender 2.025946 3.0336 0.47 0.637 0.1076614 38.12375
practice 6.658584 13.23788 0.95 0.34 0.135243 327.8302
training 0.911682 1.597096 -0.05 0.958 0.0294237 28.24809
female 3.311432 5.898749 0.67 0.501 0.1008663 108.714
Setting 2.837799 5.849919 0.51 0.613 0.0499219 161.3141
Specialty 0.2557765 0.3407654 -1.02 0.306 0.0187855 3.482552
GynExam_weekly 1.197839 0.3863167 0.56 0.576 0.6366138 2.253827
Number_of_Pts 0.9970729 0.0202015 -0.14 0.885 0.9582545 1.037464
TotalRef 2.629969 3.494612 0.73 0.467 0.1944926 35.56296

Age
36 – 45 yrs 30.4138 64.85385 1.6 0.109 0.4655688 1986.816
46 – 55 yrs 0.95813 1.895747 -0.02 0.983 0.0198265 46.30243
56 – 65 yrs 55.76306 206.4201 1.09 0.277 0.0393934 78934.96
older than 65 yrs 56.07181 174.7047 1.29 0.196 0.1249191 25168.67

FIHow_PtComplain 2.273854 3.378354 0.55 0.58 0.1236229 41.82404
FIHow_PhysicianEli~t 4.84377 7.080369 1.08 0.28 0.2760207 85.00125
FIHow_PE 0.035095 0.0812784 -1.45 0.148 0.0003749 3.285395
_cons 0.1664197 0.9696737 -0.31 0.758 1.83E-06 15166.35

Beneficial Resources Articles from pubmed:
1- Perceptions and practice patterns of general gynecologists regarding urogynecology and pelvic reconstructive surgery.
2- Likelihood of nursing home referral for fecally incontinent elderly patients is influenced by physician views on nursing home care and outpatient management of fecal incontinence.
3- Awareness of investigations and treatment of faecal incontinence among the general practitioners: a postal questionnaire survey
4- Anal incontinence: the role of medical management.
5- Experience with an obstetric perineal clinic.
6- Outcomes and follow-up after obstetric anal sphincter injuries.
7- [Fecal incontinence in community-dwelling elderly: findings from a study of prevalence, consultation of physicians, psychosocial aspects and treatment].
8- Effective and ineffective management of incontinence: issues around illness trajectory and health care.

Title
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Abstracts
Include a structured abstract of no more than 350 words for reports of original data, reviews, and meta-analyses. Abstracts should be prepared in JAMA style-see instructions for preparing abstracts below. For other major manuscripts, include an unstructured abstract of no more than 200 words that summarizes the objective, main points, and conclusions of the article. Abstracts are not required for Editorials, Viewpoints, and some special features. All reports of original data, systematic reviews, and meta-analyses should be submitted with structured abstracts as described below. No information should be reported in the abstract that does not appear in the text of the manuscript.

Abstracts for Reports of Original Data: Reports of original data should include an abstract of no more than 350 words using the headings listed below. For brevity, parts of the abstract may be written as phrases rather than complete sentences. Each section should include the following content:

Importance: The abstract should begin with a sentence or 2 explaining the clinical (or other) importance of the study question.

Objective: State the precise objective or study question addressed in the report (eg, “To determine whether…”). If more than 1 objective is addressed, the main objective should be indicated and only key secondary objectives stated. If an a priori hypothesis was tested, it should be stated.

Design: Describe the basic design of the study. State the years of the study and the duration of follow-up. If applicable, include the name of the study (eg, the Framingham Heart Study). As relevant, indicate whether observers were blinded to patient groupings, particularly for subjective measurements.

Setting: Describe the study setting to assist readers to determine the applicability of the report to other circumstances, for example, general community, a primary care or referral center, private or institutional practice, or ambulatory or hospitalized care.

Participants: State the clinical disorders, important eligibility criteria, and key sociodemographic features of patients. The numbers of participants and how they were selected should be provided (see below), including the number of otherwise eligible individuals who were approached but refused. If matching is used for comparison groups, characteristics that are matched should be specified. In follow-up studies, the proportion of participants who completed the study must be indicated. In intervention studies, the number of patients withdrawn because of adverse effects should be given. For selection procedures, these terms should be used, if appropriate: random sample (where random refers to a formal, randomized selection in which all eligible individuals have a fixed and usually equal chance of selection); population-based sample; referred sample; consecutive sample; volunteer sample; convenience sample. Note: the preceding 3 sections are usually combined for accepted papers during the editing process as “Design, Setting, and Participants,” but for manuscript submission these sections should be kept separate.

Intervention(s) for clinical trials or Exposure(s) for observational studies: The essential features of any interventions, or exposures, should be described, including their method and duration. The intervention, or exposure, should be named by its most common clinical name, and nonproprietary drug names should be used.

Main Outcome(s) and Measure(s): Indicate the primary study outcome measurement(s) as planned before data collection began. If the manuscript does not report the main planned outcomes of a study, this fact should be stated and the reason indicated. State clearly if the hypothesis being tested was formulated during or after data collection. Explain outcomes or measurements unfamiliar to a general medical readership.

Results: The main outcomes of the study should be reported and quantified, including baseline characteristics and final included/analyzed sample. Include absolute numbers and measures of absolute risks (such as increase/decrease or absolute differences between groups), along with confidence intervals (for example, 95%) or P values. Approaches such as number needed to treat to achieve a unit of benefit may be included when appropriate. Measures of relative risk also may be reported (eg, relative risk, hazard ratios) and should include confidence intervals. Studies of screening and diagnostic tests should report sensitivity, specificity, and likelihood ratio. If predictive value or accuracy is reported, prevalence or pretest likelihood should be given as well. All randomized controlled trials should include the results of intention-to-treat analysis, and all surveys should include response rates.

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Trial Registration: For clinical trials, the name of the trial registry, registration number, and URL of the registry must be included.

Abstracts for Meta-analyses and The Rational Clinical Examination: Manuscripts reporting the results of meta-analyses should include an abstract of no more than 350 words using the headings listed below. The text of the manuscript should also include a section describing the methods used for data sources, study selection, data extraction, and data synthesis. Each heading should be followed by a brief description:

Importance: A sentence or 2 explaining the importance of the review question.

Objective: State the precise primary objective of the review. Indicate whether the review emphasizes factors such as cause, diagnosis, prognosis, therapy, or prevention and include information about the specific population, intervention, exposure, and tests or outcomes that are being reviewed.

Data Sources: Succinctly summarize data sources, including years searched. The search should include the most current information possible, ideally with the search being conducted within several months before the date of manuscript submission. Potential sources include computerized databases and published indexes, registries, abstract booklets, conference proceedings, references identified from bibliographies of pertinent articles and books, experts or research institutions active in the field, and companies or manufacturers of tests or agents being reviewed. If a bibliographic database is used, state the exact indexing terms used for article retrieval, including any constraints (for example, English language or human study participants). If abstract space does not permit this level of detail, summarize sources in the abstract including databases and years searched, and place the remainder of the information in the Methods section.

Study Selection: Describe inclusion and exclusion criteria used to select studies for detailed review from among studies identified as relevant to the topic. Details of selection should include particular populations, interventions, outcomes, or methodological designs. The method used to apply these criteria should be specified (for example, blinded review, consensus, multiple reviewers). State the proportion of initially identified studies that met selection criteria.

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Main Outcome(s) and Measure(s): Indicate the primary study outcome(s) and measurement(s) as planned before data collection began. If the manuscript does not report the main planned outcomes of a study, this fact should be stated and the reason indicated. State clearly if the hypothesis being tested was formulated during or after data collection. Explain outcomes or measurement unfamiliar to a general medical readership.

Results: State the main quantitative results of the review, including baseline characteristics and final included/analyzed studies and/or sample(s). Include absolute risks whenever possible (such as increase/decrease or absolute differences between groups), along with confidence intervals (for example, 95%) or Pvalues. Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. Numerical results should be accompanied by confidence intervals, if applicable, and exact levels of statistical significance. Evaluations of screening and diagnostic tests should include sensitivity, specificity, likelihood ratios, receiver operating characteristic curves, and predictive values. Assessments of prognosis should summarize survival characteristics and related variables. Major identified sources of variation between studies should be stated, including differences in treatment protocols, co-interventions, confounders, outcome measures, length of follow-up, and dropout rates.

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