***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 : We evaluated the effect of the use of aspirin , nonsteroidal anti-inflammatory drugs ( NSAIDS ) , and anticoagulants on the performance of immunochemical fecal occult blood test ( I-FOBT ) . METHODS : A prospect i ve , cross-sectional study of 1,221 ambulatory patients having total colonoscopy after preparing three I-FOBTs . Information regarding the use of medications was collected from the health medical organization ( HMO ) data base . I-FOBT was analyzed with the OC-MICRO instrument using both ≥75 and 100 ngHb/ml of buffer thresholds to determine positivity . RESULTS : Colorectal cancer ( CRC ) was found in 17 and advanced adenomatous polyp ( AAP ) in 97 patients . A total of 212 patients were using aspirin/NSAIDS at the time of I-FOBT testing . Qualitative analysis for the detection of AAP/CRC reveals a trend for an increased sensitivity  with aspirin/NSAIDS use . At the threshold 75 ng/ml for positivity , the sensitivity for the detection of AAP/CRC was 66.7 % for aspirin/NSAIDS use vs. 51.2 % for nondrug takers ( P=0.20 ) , and at the threshold of 100 ng/ml , the sensitivity was 66.7 vs. 46.5 % ( P=0.09 ) . The specificity , however , was not affected by the use of aspirin/NSAIDS . At the threshold of 75 ng/ml for positivity , the specificity for the detection of AAP/CRC was 89.5 % for aspirin/NSAIDS use vs. 91.2 % for nondrug takers ( P=0.47 ) , and at the threshold of 100 ng/ml , the specificity was 92.17 vs. 93.0 % ( P=0.69 ) . A total of 33 patients were using antithrombotics/coagulants  at the time of I-FOBT testing . This group was small ; however , it appears that their use was also associated with a trend for increased sensitivity and no change in specificity . CONCLUSIONS : The use of aspirin/NSAIDS and anticoagulants was associated with a trend for increased sensitivity with no change in specificity for the detection of AAP/CRC . This study suggests that there is no need to stop these agents before I-FOBT testing BACKGROUND Low-dose aspirin is commonly used in patients with cardiovascular disease . However , little is known about the effect of aspirin on occult blood loss caused by gastrointestinal injury . Therefore , we studied endoscopic injury and fecal occult blood loss in patients ingesting different quantities of low-dose aspirin .  METHODS Forty healthy volunteers were enrolled in a r and omized , double-blind , prospect i ve , pilot endoscopic study . Each volunteer underwent 30 days of treatment with daily aspirin 30 mg , 81 mg , 325 mg , or placebo . Subjects completed fecal occult blood test cards before and at the end of treatment of two types : guaiac impregnated ( Hemoccult and Hemoccult SENSA ) and immunochemical ( HemeSelect and FlexSure OBT ) . Each volunteer underwent upper endoscopy at baseline and after completing 30 days of study medication . RESULTS Aspirin did not induce significant injury as determined by endoscopy when compared with placebo . Six of 30 volunteers taking aspirin developed erosions , whereas 1 of 10 subjects on placebo developed a new erosion ( p = 0.66 ) . Aspirin ( 325 mg ) was associated with a higher mean symptom score than the lower aspirin dosages and the placebo group ( p = 0.12 ) . Only one subject taking aspirin ( 325 mg ) had fecal occult blood on a single HemeSelect card . No subject had a positive fecal occult blood test with Hemoccult II , Hemoccult II SENSA , or FlexSure OBT cards . CONCLUSIONS Aspirin in dosages commonly used for cardiovascular prophylaxis does not generally cause significant gastric or duodenal mucosal endoscopic lesions . In the absence of frank ulceration , low-dose aspirin does not result in positive fecal occult blood tests . Low-dose aspirin should not interfere with fecal occult blood testing and probably should not be stopped during stool collection BACKGROUND : In clinical practice , some physicians discontinue warfarin prior to fecal occult blood testing ( FOBT ) . Although anticoagulant use is associated with an increased risk of overt gastrointestinal bleeding , the impact of warfarin on the positive predictive value of FOBT is unknown . METHODS : During a 5-yr period , we prospect ively studied all patients taking warfarin who were referred for the evaluation of a positive FOBT . For each patient taking warfarin  , we enrolled one age- and gender-matched control subject with a positive FOBT who was not taking anticoagulants .  A detailed clinical history was obtained , and all subjects underwent colonoscopy and esophagogastroduodenoscopy . RESULTS : Lesions consistent with occult bleeding were identified in 59.0 % of the 210 patients in the warfarin group and 53.8 % of the 210 control subjects ( p= 0.27 ) . Although more lesions were identified by colonoscopy in the warfarin group than in control subjects ( 36.2%vs 25.7 % , p= 0.02 ) , there was no difference in the frequency of lesions identified by esophagogastroduodenoscopy ( 35.2%vs 39.5 % , p= 0.43 ) . Overall , adenomas ≥1 cm in diameter ( 16.2 % ) and colorectal carcinoma ( 9.5 % ) were the most common lesions identified by colonoscopy , while erosive gastritis ( 15.5 % ) and erosive duodenitis ( 11.0 % ) were the most frequent lesions found by esophagogastroduodenoscopy . Among individuals with colorectal cancer , 83.3 % of patients in the warfarin group had early cancers ( Dukes ' stage A or B ) compared with 50.0 % of control subjects ( p= 0.046 ) . CONCLUSIONS : Warfarin use did not decrease the positive predictive value of FOBT . These findings suggest that warfarin should not be discontinued prior to FOBT BACKGROUND Although colorectal cancer is the third most common cancer in women , little is known about predictors of adherence to screening . METHODS A r and omly selected sample of 202 predominantly low-income and African-American women were interviewed .  Knowledge of , attitudes and beliefs about , and practice s related to flexible sigmoidoscopy ( FS ) screening were assessed . RESULTS The majority of participants were in the precontemplation stage of adoption ( 56 % ) . There were significant differences by stage of adoption for FS beliefs , FS barriers , risk of developing colorectal cancer , worry about getting colorectal cancer , and physician recommendation to get a FS . Predictors of adherence to FS guidelines were perceiving fewer barriers to getting a FS and having a physician recommend a FS . CONCLUSION Seventy-two percent of the women in this study were nonadherent to FS screening guidelines . Psychosocial factors play an important role in screening for colorectal cancer . Ways of reducing barriers and increasing physician recommendations should be explored Ibuprofen ( CAS 15687 - 27 - 1 ) is a nonsteroidal antiinflammatory drug endowed with analgesic , antiinflammatory and antipyretic activity . The main side effect of ibuprofen and nonsteroidal antiinflammatory agents is addressed to disturbances of the gastrointestinal tract , like gastric pyrosis , gastric and intestinal damage . A pharmaceutical formulation of ibuprofen in fast melting tablets consisting in gastroprotected microgranules to be ingested without concomitant water intake ( Cibalginadue Fast , hereinafter referred to as test ) was compared in this trial with a formulation of ibuprofen in tablets ( reference ) on 18 healthy volunteers in terms of gastrointestinal and general tolerability . Both the formulations are present on the market . The two formulations were administered according to a two-period , two-formulation , two-sequence , cross-over design in repeated dose regimen to steady state with wash-out . The dose was 400 mg ( 2 strengths ) b.i.d . over 7 days . Before , during and after each study period general tolerability was carefully checked from blood/urine biochemical parameters , adverse events experienced and vital signs . The target parameters were the gastric permeability to sucrose and the intestinal permeability to lactulose and mannitol , which were administered orally and assayed in the urine excreted during a 6-h period . Urinary excretion > 0.15 % of sucrose and > 0.04 of the lactulose to mannitol ratio are considered expression of increased gastric and intestinal permeability , respectively . Three volunteers treated with the reference showed an increased gastric permeability > 0.15 % . Neither other gastric nor intestinal increased permeability was detected . Occult blood in faeces was negative in all the cases . The incidence of adverse effects experienced was higher with the reference ( 9 volunteers ) than with the test ( 5 volunteers ) . In details gastric pyrosis was experienced by six volunteers treated with the reference and only by two volunteers treated with the test . The whole tolerability was better with the test formulation than with the reference , even if these differences did not reach any statistically significant degree . The better tolerability of the test was attributed to its gastroprotection OBJECTIVE To determine whether low-dose aspirin or warfarin induces fecal occult blood loss . PATIENTS AND METHODS A prospect i ve , cross-over study , of 100 participants over 40 years of age in 1 of 3 groups , taking : ( 1 ) no aspirin or warfarin , ( 2 ) daily aspirin ( either 81 or 325 mg ) , or ( 3 ) warfarin , but no aspirin .  Stool sample s were collected and analyzed for the presence of occult blood using HemoQuant and Hemoccult II . After collection of baseline sample s , patients initially taking no aspirin ( group 1 ) were asked to take regular aspirin ( 325 mg daily ) for 2 months . Patients initially taking aspirin 81 mg daily ( group 2 ) were switched to 325 mg daily for 2 months , and vice versa . RESULTS Patients taking no aspirin  had mean fecal blood of 0.68 + /- 0.05 mg hemoglobin/g stool , which increased to 1.41 + /- 0.36 mg/g after taking 325 mg of aspirin daily ( P = 0.02 ) . In contrast , patients in group 2 , taking 81 mg and 325 mg of aspirin , had mean fecal blood of 0.82 + /- 0.08 mg/g ( P = 0.57 ) and 1.04 + /- 0.23 mg/g ( P = 0.13 ) , respectively ( comparisons with patients taking no aspirin ) . The mean blood loss in patients taking warfarin was 0.51 + /- 0.04 mg/g ( P = 0.55 ) , and fecal blood was not related to the degree of anticoagulation . There was no increase over normal in the rate of Hemoccult II-positive stool tests with aspirin or warfarin therapy . CONCLUSION Aspirin , but not warfarin , caused a small but clinical ly insignificant increase in occult fecal blood . The small blood loss in patients taking aspirin or warfarin  is unlikely to interfere with fecal occult blood test . Therefore , positive fecal occult blood tests , in patients taking either low-dose aspirin or warfarin , should be managed in the same fashion as patients not taking these medications BACKGROUND Developing effective programs to promote colorectal cancer ( CRC ) screening requires underst and ing of the effect of healthcare system factors on access to screening and adherence to guidelines . METHODS This study assessed the role of insurance status , type of plan , the frequency of preventive health visits , and provider recommendation on utilization of CRC screening tests using a cross-sectional , r and om-digit-dial survey of 1002 Massachusetts residents aged > or = 50 . RESULTS A broad definition of CRC screening status included colonoscopy or barium enema ( screening or diagnostic ) within 10 years , flexible sigmoidoscopy ( FSIG ) within 5 years , and fecal occult blood testing ( FOBT ) in the past year as options ; 51.7 % of subjects aged 50 to 64 and 61.5 % of older subjects were current . The uninsured had the lowest current testing rate . Among insured participants , type of insurance had little impact on CRC testing ; older subjects enrolled in HMOs had marginally higher rates , although not statistically significant . Increased frequency of preventive health visits and ever receiving a physician 's recommendation for FSIG or ever receiving FOBT cards were associated with higher rates of CRC screening among both age groups . CONCLUSIONS Even when broad criteria are used to define current CRC screening status , a substantial proportion of the age-eligible population remains underscreened . Obtain 
    Output:
    
SYNTHESIS No studies addressed the effects of medication interventions on the sensitivity or specificity of FOBT screening .
R and omized controlled trials , however , showed no increase in the rate of positive results among those taking NSAIDs .
The literature is mixed regarding the effect of NSAIDs on the positive predictive value of a positive FOBT result , although no change in positive predictive value has been shown for warfarin .
Iron will not affect FOBT results in vivo .
Available evidence , however , does not suggest a benefit from withholding NSAIDs , anticoagulant medications , or iron during the screening period .