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      Influência do ácido acetilsalicílico na pesquisa de sangue oculto nas fezes: revisão baseada na evidência Translated title: The influence of acetylsalicylic acid on faecal occult blood testing: an evidence-based review

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          Abstract

          Introdução: A pesquisa de sangue oculto nas fezes (PSOF) para rastreio do cancro colorretal (CCR) realiza-se num grupo etário que frequentemente toma ácido acetilsalicílico (AAS). A eficácia do rastreio CCR sob tratamento com AAS não está comprovada. Objetivos: Rever a evidência sobre impacto do AAS profilático no desempenho da PSOF no rastreio do CCR. Metodologia: Em fevereiro de 2013 pesquisaram-se guidelines, meta-análises, artigos de revisão e originais, na PubMed, sítios de Medicina Baseada na Evidência, Index de RMP e referências cruzadas dos artigos elegíveis. Utilizaram-se os termos MeSH “aspirin” e “occult blood” e correspondentes DeCS. As publicações consideraram-se elegíveis se comparavam o desempenho da PSOF de rastreio de CCR no grupo sob AAS versus sem AAS. Aplicou-se a STARD checklist e GATE frame para avaliação crítica dos estudos. Adotou-se a taxonomia de níveis de evidência (NE) do Oxford CEBM. Resultados: Dos 698 artigos obtidos foram elegíveis três estudos originais: um referente à PSOF pelo método guaiaco (NE 4) e dois pelo imunoensaio (NE 2; NE 4). Os estudos referentes ao imunoensaio são qualitativamente concordantes quanto à inexistência de diferenças estatisticamente significativas em termos de valor preditivo positivo (VPP). Um dos estudos analisou outras variáveis de desempenho, tendo detetado aumento da sensibilidade sob AAS mas não do desempenho global. Para o método guaiaco, os resultados sugerem de forma inconclusiva haver redução do VPP sob AAS. Conclusão: Não há evidência suficiente quanto ao impacto do AAS no desempenho global da PSOF pelo método guaiaco, podendo estar diminuído. Quanto ao imunoensaio, o impacto do AAS no desempenho global poderá ser nulo a benéfico.

          Translated abstract

          Introduction: Fecal occult blood test (FOBT) screening for colorectal cancer (CRC) is often performed with patients taking acetylsalicylic acid (ASA). There is doubt about the efficacy of CRC screening with ASA treatment. Objective: To review the evidence for the impact of prophylactic ASA consumption on the diagnostic accuracy of FOBT screening for CRC. Methods: In February 2013, a search for guidelines, meta-analysis, reviews and original articles was conducted on PubMed, EBM databases, Index RMP and in the references in eligible articles. The MeSH terms aspirin and occult blood and corresponding DeCS (Portuguese search terms) were used as keywords. Eligible publications compared the accuracy of FOBT screening for CRC with ASA versus screening without ASA. The STARD checklist and GATE framework were applied for critical appraisal. The Oxford EBMC Levels of Evidence (LE) were used. Results: Of the 698 articles obtained, three original studies matched eligibility criteria. One study examined the guaiac-FOBT (LE 4) and two other studies examined the immunological-FOBT (LE 2 and 4). The latter two studies showed no statistically significant difference in the Positive Predictive Value (PPV) of immunological-FOBT for CRC with or without ASA. One of the studies examined other performance measures and showed increased sensitivity for diagnosis of CRC but no improvement in global accuracy for the immunoassay with ASA treatment. The guaiac-FOBT results may have a reduced PPV but this finding was inconclusive. Conclusion: There is inconclusive evidence regarding the impact of ASA on the accuracy of the guaiac-FOBT. For the immunoassay, ASA consumption might have null or positive effect on its diagnostic accuracy.

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          Low-dose aspirin use and performance of immunochemical fecal occult blood tests.

          Immunochemical fecal occult blood tests (iFOBTs) are potentially promising tools for colorectal cancer screening. Low-dose aspirin use, which increases the likelihood of gastrointestinal bleeding, is common in the target population for colorectal cancer screening. To assess the association of low-dose aspirin use with the performance of 2 quantitative iFOBTs in a large sample of patients undergoing colorectal cancer screening. Diagnostic study conducted from 2005 through 2009 at internal medicine and gastroenterology practices in southern Germany including 1979 patients (mean age, 62.1 years): 233 regular users of low-dose aspirin (167 men, 67 women) and 1746 who never used low-dose aspirin (809 men, 937 women). Sensitivity, specificity, positive and negative predictive values, and area under receiver operating characteristic (ROC) curves in detecting advanced colorectal neoplasms (colorectal cancer or advanced adenoma) with 2 quantitative iFOBTs. Advanced neoplasms were found in 24 users (10.3%) and 181 nonusers (10.4%) of low-dose aspirin. At the cut point recommended by the manufacturer, sensitivities of the 2 tests were 70.8% (95% confidence interval [CI], 48.9%-87.4%) for users compared with 35.9% (95% CI, 28.9%-43.4%) for nonusers and 58.3% (95% CI, 36.6%-77.9%) for users compared with 32.0% (95% CI, 25.3%-39.4%) for nonusers (P = .001 and P = .01, respectively). Specificities were 85.7% (95% CI, 80.2%-90.1%) for users compared with 89.2% (95% CI, 87.6%-90.7%) for nonusers and 85.7% (95% CI, 80.2%-90.1%) for users compared with 91.1% (95% CI, 89.5%-92.4%) for nonusers (P = .13 and P = .01, respectively). The areas under the ROC curve were 0.79 (95% CI, 0.68-0.90) for users compared with 0.67 (95% CI, 0.62-0.71) for nonusers and 0.73 (95% CI, 0.62-0.85) for users compared with 0.65 (95% CI, 0.61-0.69) for nonusers (P = .05 and P = .17, respectively). Among men, who composed the majority of low-dose aspirin users, the areas under the ROC curve were 0.87 (95% CI, 0.76-0.98) for users compared with 0.68 (95% CI, 0.63-0.74) for nonusers and 0.81 (95% CI, 0.68-0.93) for users compared with 0.67 (95% CI, 0.61-0.72) for nonusers (P = .003 and P = .04, respectively). For 2 iFOBTs, use of low-dose aspirin compared with no aspirin was associated with a markedly higher sensitivity for detecting advanced colorectal neoplasms, with only a slightly lower specificity.
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            How to write an evidence-based clinical review article.

            Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Non-quantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician. First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence, or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician, rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.
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              Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.

              To improve the accuracy and completeness of reporting of studies of diagnostic accuracy in order to allow readers to assess the potential for bias in a study and to evaluate the generalisability of its results.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                rpmgf
                Revista Portuguesa de Medicina Geral e Familiar
                Rev Port Med Geral Fam
                Associação Portuguesa de Medicina Geral e Familiar (Lisboa )
                2182-5173
                August 2014
                : 30
                : 4
                : 244-252
                Affiliations
                [1 ] USF Fânzeres
                Article
                S2182-51732014000400006
                7b6f0873-cd8e-4e40-9e23-de21251c2f91

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Portugal

                Self URI (journal page): http://www.scielo.mec.pt/scielo.php?script=sci_serial&pid=2182-5173&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Aspirin,Occult Blood,Diagnostic Performance,Aspirina®,Sangue Oculto,Desempenho Diagnóstico

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