***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 : In 2006 , the National Health Service Bowel Cancer Screening Programme in Engl and ( NHSBCSP ) began offering routine population -based biennial faecal occult blood testing ( FOBt ) at ages 60–69 . There is , however , limited information on how characteristics of individuals affect participation and outcomes of screening , and we studied this association by linking NHSBCSP data to a large prospect i ve cohort of women . Methods : Electronic linkage of the NHSBCSP and Million Women Study records identified 899 166 women in the study cohort with at least one invitation for screening . NHSBCSP provided information on screening acceptance , FOBt results , screen-detected colorectal cancer and other outcomes . The Million Women Study provided prospect ively collected information on personal and lifestyle factors . Multiple regression was used to estimate relative risks ( RRs ) of factors associated with acceptance and outcomes of screening . Results : Overall , 70 % of women ( 628 976/899 166 ) accepted their first invitation for bowel cancer screening , of whom 9133 ( 1.5 % ) were FOBt-positive , 743 ( 0.1 % ) had screen-detected colorectal cancer and 3056 ( 0.5 % ) had screen-detected colorectal adenoma . Acceptance was lower in women from the most than the least deprived tertile , in South Asians and in Blacks than in Whites , in current than in never smokers and in obese than in normal weight women : adjusted RRs ( 95 % confidence interval ) for acceptance vs not , 0.90 ( 0.90–0.90 ) ; 0.77 ( 0.75–79 ) ; 0.94 ( 0.92–0.96 ) ; 0.78 ( 0.77–0.78 ) ; and 0.88 ( 0.88–0.89 ) , respectively : P<0.001 for each . These factors were also associated with an increased risk of being FOBt-positive and of having screen-detected adenoma , but were not strongly associated with the risk of screen-detected colorectal cancer . Relative risks for screen-detected adenoma were 1.22 ( 1.12–1.34 ) , 2.46 ( 1.75–3.45 ) , 1.61 ( 1.05–2.48 ) , 1.53 ( 1.38–1.68 ) and 1.77 ( 1.60–1.95 ) , respectively ( P<0.001 for all , except for Blacks vs Whites P=0.03 ) . Use of hormone therapy for menopause was associated with reduced risk of screen-detected adenoma , RR ever vs never use , 0.87 ( 0.81–0.93 ) , P<0.001 and colorectal cancer , 0.78 ( 0.68–0.91 ) , P=0.001.Interpretation : Among women in Engl and , socioeconomic and lifestyle factors strongly affect participation in routine bowel cancer screening , risk of being FOBt-positive and risk of having screen-detected colorectal adenoma . However , screen-detected colorectal cancer risk is not strongly related to these factors BACKGROUND Complete diagnostic evaluation or CDE ( i.e. , colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray ) is often not performed for persons with an abnormal screening fecal occult blood test ( FOBT+ ) result . METHOD This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates . Four hundred seventy primary care physicians ( PCPs ) in 318 practice s participated in the study . Patients were mailed an FOBT kit annually as part of a screening program . Practice s were r and omly assigned to a Control Group ( N = 198 ) or an Intervention Group ( N = 120 ) . During an 18-month pre-r and omization period and a 9-month post-r and omization period , 2992 screening FOBT+ patients were identified . Intervention practice s received the screening program and the intervention . Control practice s received only the screening program . Study outcomes were baseline-adjusted CDE recommendation and performance rates . RESULTS At baseline , about two-thirds of FOBT+ patients received a CDE recommendation , and about half had a CDE performed . At endpoint , CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practice s ( OR = 2.28 ; 95 % CI : 1.37 , 3.78 , and OR = 1.63 ; 95 % CI : 1.06 , 2.50 , respectively ) . CONCLUSIONS The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance Background Population -based colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK . Despite evidence that older age , male sex and deprivation are associated with an increased incidence of colorectal cancer , uptake of bowel cancer screening varies across demographic groups . The aim of this study was to assess the impact of age , sex and deprivation on outcomes throughout the screening process . Methods A prospect ively maintained data base , encompassing the first screening round of a faecal occult blood test screening programme in a single geographical area , was analysed . Results Overall , 395 096 individuals were invited to screening , 204 139 ( 52 % ) participated and 6 079 ( 3 % ) tested positive . Of the positive tests , 4 625 ( 76 % ) attended for  colonoscopy  and cancer was detected in 396 individuals ( 9 % ) . Lower uptake of screening  was associated with younger age , male sex and deprivation ( all p<0.001 ) . Only deprivation was associated with failure to proceed to colonoscopy  following a positive test ( p<0.001 ) . Despite higher positivity rates in those that were more deprived ( p<0.001 ) , the likelihood of detecting cancer in those attending for colonoscopy was lower ( 8 % most deprived vs 10 % least deprived , p = 0.003 ) . Conclusion Individuals who are deprived are less likely to participate in screening  , less likely to undergo colonoscopy  and less likely to have cancer identified as a result of a positive test . Therefore , this study suggests that strategies aim ed at improving participation of deprived individuals in colorectal cancer screening should be directed at all stages of the screening process and not just uptake of the test 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 colonoscopy . The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up . Methods Prospect i ve cohort study using Ontario ’s ColonCancerCheck program data sets ( 2008–2011 ) , linked to provincial administrative health data bases .  Crude rate ratios were calculated to assess determinants of colonoscopy uptake among an Ontario-wide FOBT-positive cohort with rolling enrolment , followed from October 2008 through February 2011 . Segmented time-series regression was used to assess the average additional change in colonoscopy uptake after FOBT-positive status following the introduction of two ongoing interventions among the same cohort . Results A notification mailed directly to FOBT-positive screening participants was observed to increase colonoscopy uptake , beyond the modest average underlying increase throughout the study period , by an average of 3 % per month ( multivariable-adjusted RR : 1.03 , 95 % CI : 1.00–1.06 ) . However , revision of the existing FOBT result notification to physicians was observed to have no effect . Conclusions Direct participant notification of a positive FOBT result improved adherence with follow-up colonoscopy in Ontario ’s population -wide ColonCancerCheck program . Further participant-directed interventions may be effective means of maximizing adherence in population -wide screening Background Delayed diagnosis of cancer can lead to patient harm , and strategies are needed to proactively and efficiently detect such delays in care . We aim ed to develop and evaluate ‘ trigger ’ algorithms to electronically flag medical records of patients with potential delays in prostate and colorectal cancer ( CRC ) diagnosis . Methods We mined retrospective data from two large integrated health systems with comprehensive electronic health records ( EHR ) to iteratively develop triggers . Data mining algorithms identified all patient records with specific demographics and a lack of appropriate and timely follow-up actions on four diagnostic clues that were newly documented in the EHR : abnormal prostate-specific antigen ( PSA ) , positive faecal occult blood test ( FOBT ) , iron-deficiency anaemia ( IDA ) , and haematochezia . Triggers subsequently excluded patients not needing follow-up ( eg , terminal illness ) or who had already received appropriate and timely care . Each of the four final triggers was applied to a test cohort , and chart review s of r and omly selected records identified by the triggers were used to calculate positive predictive values ( PPV ) . Results The PSA trigger was applied to records of 292 587 patients seen between 1 January 2009 and 31 December 2009 , and the CRC triggers were applied to 291 773 patients seen between 1 March 2009 and 28 February 2010 . Overall , 1564 trigger positive patients were identified ( 426 PSA , 355 FOBT , 610 IDA and 173 haematochezia ) . Record review s revealed PPVs of 70.2 % , 66.7 % , 67.5 % , and 58.3 % for the PSA , FOBT , IDA and haematochezia triggers , respectively . Use of all four triggers at the study sites could detect an estimated 1048 instances of delayed or missed follow-up of abnormal findings annually and 47 high- grade cancers . Conclusions EHR-based triggers can be used successfully to flag patient records lacking follow-up of abnormal clinical findings suspicious for cancer Introduction The Bowel Cancer Screening Programme in Engl and began operating in 2006 with the aim of full roll out across Engl and by December 2009 . Subjects aged 60–69 are being invited to complete three guaiac faecal occult blood tests ( 6 windows ) every 2 years . The programme aims to reduce mort 
    Output:
    
There is evidence of disparities in uptake by socioeconomic position and ethnicity , as well as geographic remoteness .
Positive health beliefs , health knowledge and CRC screening attendance history are associated with increased diagnostic testing .
Facets of organised screening , including performance feedback and funding improve follow-up-whilst guidelines increase diagnostic testing and reduce inappropriate exclusions .
Interventions , notably a screening specialist to aid the patient journey , as well as tracking and reminder systems , can increase diagnostic testing .
Conclusions Although rates of non-attendance in those eligible are low , this represents a group with health care need .
Organised , screening can reduce incomplete diagnostic testing , as can accessible health information