***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES : Inadequate follow-up of abnormal fecal occult blood test ( FOBT ) results occurs in several types of practice setting s. Our institution implemented multifaceted quality improvement ( QI ) activities in 2004–2005 to improve follow-up of FOBT-positive results . Activities addressed precolonoscopy referral processes and system-level factors such as electronic communication , provider education , and feedback . We evaluated their effects on timeliness and appropriateness of positive-FOBT follow-up and identified factors that affect colonoscopy performance . METHODS : Retrospective electronic medical record review was used to determine outcomes before and after QI activities in a multispecialty ambulatory clinic of a tertiary care Veterans Affairs facility and its affiliated satellite clinics . From 1869 FOBT-positive cases , 800 were r and omly selected from time periods before and after QI activities . Two review ers used a pretested st and ardized data collection form to determine whether colonoscopy was appropriate or indicated based on predetermined criteria and if so , the timeliness of colonoscopy referral and performance before and after QI activities . RESULTS : In cases where a colonoscopy was indicated , the proportion of patients who received a timely colonoscopy referral and performance were significantly higher post-implementation ( 60.5 % vs. 31.7 % , P<0.0001 and 11.4 % vs. 3.4 % , P=0.0005 ) . A significant decrease also result ed in median times to referral and performance ( 6 vs. 19 days , P<0.0001 and 96.5 vs. 190 days , P<0.0001 ) and in the proportion of positive-FOBT test results that had received no follow-up by the time of chart review ( 24.3 % vs. 35.9 % , P=0.0045 ) . Significant predictors of absence of the performance of an indicated colonoscopy included performance of a non-colonoscopy procedure such as barium enema or flexible sigmoidoscopy ( OR=16.9 ; 95 % CI , 1.9–145.1 ) , patient non-adherence ( OR=33.9 ; 95 % CI , 17.3–66.6 ) , not providing an appropriate provisional diagnosis on the consultation ( OR=17.9 ; 95 % CI , 11.3–28.1 ) , and gastroenterology service not rescheduling colonoscopies after an initial cancellation ( OR=11.0 ; 95 % CI , 5.1–23.7 ) . CONCLUSIONS : Multifaceted QI activities improved rates of timely colonoscopy referral and performance in an electronic medical record system . However , colonoscopy was not indicated in over one third of patients with positive FOBTs , raising concerns about current screening practice s and the appropriate denominator used for performance measurement st and ards related to colon cancer screening Background The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test ( FIT ) . Although , colorectal cancer ( CRC ) screening with biannual ( FIT ) has shown to reduce CRC mortality , the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy , and thus , harms related to false results might not be underestimated . Current CRC screening programmes use a single faecal haemoglobin concentration ( f-Hb ) cut-off for colonoscopy referral for both sexes and all ages . We aim ed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion . Methods Prospect i ve cohort study using a single- sample faecal immunochemical test ( FIT ) on 444,582 invited average-risk subjects aged 50–69 years . A result was considered positive at ≥20 μg Hb/g faeces . Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs . Results We analysed 17,387 positive participants in the programme who underwent colonoscopy . Participation rate was 66.5 % . Men had a positivity rate for f-Hb of 8.3 % and women 4.8 % ( p < 0.0001 ) . The detection rate for advanced neoplasia ( cancer plus advanced adenoma ) was 44.0‰ for men and 15.9‰ for women ( p < 0.0001 ) . The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off . However , the loss in CRC detection increased by up to 28.1 % in men and 22.9 % in women . CRC missed were generally at early stages ( Stage I-II : from 70.2 % in men to 66.3 % in women ) . Conclusions This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs . We found differences in positivity rates , neoplasia detection rate , number needed to screen , and interval cancers in men and women and in younger and older groups . However , there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off Objective Colorectal cancer screening programmes are implemented worldwide ; many are based on faecal immunochemical testing ( FIT ) . The aim of this study was to evaluate two frequently used FITs on participation , usability , positivity rate and diagnostic yield in population -based FIT screening . Design Comparison of two FITs was performed in a fourth round population -based FIT-screening cohort . R and omly selected individuals aged 50–74 were invited for FIT screening  and were r and omly allocated to receive an OC -Sensor ( Eiken , Japan ) or faecal occult blood (FOB)-Gold ( Sentinel , Italy ) test ( March – December 2014 ) . A cut-off of 10 µg haemoglobin (Hb)/g faeces ( ie , 50 ng Hb/mL buffer for OC-Sensor and 59 ng Hb for FOB-Gold ) was used for both FITs . Results In total , 19 291 eligible invitees were included ( median age 61 , IQR 57–67 ; 48 % males ) : 9669 invitees received OC-Sensor and 9622 FOB-Gold ; both tests were returned by 63 % of invitees ( p=0.96 ) . Tests were non-analysable in 0.7 % of participants using OC-Sensor vs 2.0 % using FOB-Gold ( p<0.001 ) . Positivity rate was 7.9 % for OC-Sensor , and 6.5 % for FOB-Gold ( p=0.002 ) . There was no significant difference in diagnostic yield of advanced neoplasia ( 1.4 % for OC-Sensor vs 1.2 % for FOB-Gold ; p=0.15 ) or positive predictive value ( PPV ; 31 % vs 32 % ; p=0.80 ) . When comparing both tests at the same positivity rate instead of cut-off , they yielded similar PPV and detection rates . Conclusions The OC-Sensor and FOB-Gold were equally acceptable to a screening population . However , FOB-Gold was prone to more non-analysable tests . Comparison between FIT br and s is usually done at the same Hb stool concentration . Our findings imply that for a fair comparison on diagnostic yield between FIT 's positivity rate rather than Hb concentration should be used . Trial registration number NTR5385 ; Results IMPORTANCE Although some countries have implemented widespread colonoscopy screening , most European countries have not introduced it because of uncertainty regarding participation rates , procedure-related pain and discomfort , endoscopist performance , and effectiveness . To our knowledge , no r and omized trials on colonoscopy screening currently exist . OBJECTIVE To investigate participation rate , adenoma yield , performance , and adverse events of population -based colonoscopy screening  in several European countries . DESIGN , SETTING , AND POPULATION A population -based r and omized clinical trial was conducted among 94 959 men and women aged 55 to 64 years of average risk for colon cancer in Pol and , Norway , the Netherl and s , and Sweden from June 8 , 2009 , to June 23 , 2014 . INTERVENTIONS Colonoscopy screening or no screening . MAIN OUTCOMES AND MEASURES Participation in colonoscopy screening , cancer and adenoma yield , and participant experience . Study outcomes were compared by country and endoscopist . RESULTS Of 31 420 eligible participants r and omized to the colonoscopy group , 12 574 ( 40.0 % ) underwent screening .  Participation rates were 60.7 % in Norway ( 5354 of 8816 ) , 39.8 % in Sweden ( 486 of 1222 ) , 33.0 % in Pol and ( 6004 of 18 188 ) , and 22.9 % in the Netherl and s ( 730 of 3194 ) ( P < .001 ) . The cecum intubation rate was 97.2 % ( 12 217 of 12 574 ) , with 9726 participants ( 77.4 % ) not receiving sedation . Of the 12 574 participants undergoing colonoscopy screening , we observed 1 perforation ( 0.01 % ) , 2 postpolypectomy serosal burns ( 0.02 % ) , and 18 cases of bleeding owing to polypectomy ( 0.14 % ) . Sixty-two individuals ( 0.5 % ) were diagnosed with colorectal cancer and 3861 ( 30.7 % ) had adenomas , of which 1304 ( 10.4 % ) were high-risk adenomas . Detection rates were similar in the proximal and distal colon . Performance differed significantly between endoscopists ; recommended benchmarks for cecal intubation ( 95 % ) and adenoma detection ( 25 % ) were not met by 6 ( 17.1 % ) and 10 of 35 endoscopists ( 28.6 % ) , respectively . Moderate or severe abdominal pain after colonoscopy was reported by 601 of 3611 participants ( 16.7 % ) examined with st and ard air insufflation vs 214 of 5144 participants ( 4.2 % ) examined with carbon dioxide ( CO2 ) insufflation ( P < .001 ) . CONCLUSIONS AND RELEVANCE Colonoscopy screening entails high detection rates in the proximal and distal colon . Participation rates and endoscopist performance vary significantly . Postprocedure abdominal pain is common with st and ard air insufflation and can be significantly reduced by using CO2 . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00883792 Immunochemical fecal occult blood test ( FIT ) is a new colorectal cancer ( CRC ) screening method already recommended by the American screening guidelines . We aim ed to test the feasibility of FIT as compared to guaiac fecal occult blood test ( G‐FOBT ) in a large urban population of Tel Aviv . Average‐risk persons , aged 50–75 years , were offered FIT or G‐FOBT after r and omization according to the socioeconomic status of their clinics . Participants with positive tests underwent colonoscopy . Participants were followed through the Cancer Registry 2 years after the study . Hemoccult SENSA ™ and OC‐MICRO ™ ( three sample s , 70 ng/ml threshold ) were used . FIT was offered to 4,657 persons ( Group A ) and G‐FOBT to 7,880 persons ( Group B ) . Participation rate was 25.9 % and 28.8 % in Group A and B , respectively ( p < 0.001 ) . Positivity rate in Group A and B was 12.7 % and 3.9 % , respectively ( p < 0.001 ) . Cancer found in six ( 0.49 % ) and eight ( 0.35 % ) patients of Group A and B , respectively ( NS ) . Cancer registry follow‐up found missed cancer in five ( 0.22 % ) cases of Group B and none in Group A ( NS ) . The sensitivity , specificity , negative and positive predictive value for cancer in Group A and B were 100 % , 85.9 % , 100 % , 3.9 % and 61.5 % , 96.4 % , 99.8 % , 9.1 % , respectively . There was increased detection of advanced adenomatous polyp ( AAP )  by FIT , irrespective of age , gender , and socioeconomic status ( Per Protocol : odds ratio 2.69 , 95 % confidence interval 1.6–4.5 ; Intention to Screen : odds ratio 3.16 , 95 % confidence interval 1.8–5.4 ) . FIT is feasible in urban , average‐risk population , which significantly improved performance for detection of AAP and CRC , despite reduced participation Background Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction . This study evaluates the effectiveness of two ongoing interventions design ed to improve colonoscopy uptake after a positive fecal occult blood test ( FOBT ) result within Ontario ’s population -wide ColonCancerCheck program . The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonos 
    Output:
    
Discussion Compliance with diagnostic evaluation after a positive FOBT is still suboptimal .