Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rate in population-based screening program. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis and socioeconomic burden. In addition, harmful effect of colonoscopy may increase with age and comorbidity. As the adverse event risk in population-based colonoscopy screening may offset benefit of the screening colonoscopy, the adverse events associated with screening colonoscopy should be well managed and monitored. To adopt population-based colonoscopy screening, consensus for the risk and benefits of screening colonoscopy should be formed for its potential harms, patient preference, socioeconomic considerations, quality improvement of colonoscopy as well as its efficacy for CRC prevention. As the suboptimal colonoscopy quality is a major pitfall of population-based colonoscopy screening, adequate training and provider regulation for screening colonoscopists should be the first step to minimize the variation of quality between colonoscopists. Gastroenterologists should lead quality improvement, auditing, and training associated with colonoscopy in a population-based colonoscopy screening program.
Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Comorbidity ; Consensus ; Mass Screening ; Methods ; Patient Harm ; Quality Improvement

patient harm.TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0004172]]>
Arm ; Information Services ; Infusion Pumps ; Medication Errors ; Methods ; Patient Harm ; Prospective Studies ; Syringes

Central venous catheterization is common in the emergency department for monitoring of CVP (central venous pressure), fluid administration, and drug infusions. However, the insertion of a central venous catheter is a technically challenging procedure with known risks and complications. A 94-year-old woman was transferred to an emergency department due to difficulties in removing the guidewire during central catheter insertion through the right subclavian vein. A focused bedside ultrasound showed that the guidewire was improperly positioned in the right internal jugular vein. Upon computed tomographic evaluation, the guidewire perforated the right subclavian vein, looped in the mediastinum, reentered the right internal jugular vein toward the right jugular foramen, and was removed by surgery. In conclusion, as catheter and guidewire entrapment are well-known potential complications of central venous catheterization, when resistance is encountered at any stage of central venous catheterization (especially when removing the entrapped catheter or guidewire) the procedure should be stopped and evaluated with imaging assistance. Clinicians should be aware of more complicated sequelae caused by blunt removal of an entrapped catheter and guidewire, despite its low probability.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Emergencies ; Female ; Humans ; Jugular Veins ; Mediastinum ; Patient Harm ; Subclavian Vein ; Ultrasonography