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      Bronchoscopy in Nigerian Clinical Practice: A Survey of Medical Doctors' Perception, Use and Associated Challenges

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          Abstract

          Background

          Bronchoscopy is a vital diagnostic and therapeutic procedure in pulmonological practice. The aim of this study was to determine the perception, use and challenges encountered by Nigerian medical doctors involved in this procedure.

          Materials and Methods

          A cross-sectional study was conducted among 250 medical doctors recruited from three major tertiary institutions in Nigeria between September 2013 and June 2014. A semi-structured questionnaire was self-administered to adult physicians, paediatricians, and surgeons as well as their trainees to obtain their perception, use and associated challenges in the use of bronchoscopy in clinical practice.

          Results

          The majority (91.6%) of the respondents perceived bronchoscopy as a beneficial procedure to respiratory medicine. However, 59.2% of them were not aware of the low mortality rate associated with this procedure. The commonest indications for bronchoscopic use were foreign body aspiration (88.8%) and management of lung tumors (75.6%). Only 21 (8.4%) of the respondents had received formal training in bronchoscopy. Very few procedures (1–5 cases per month) were performed. The respondents identified the lack of formal training in the art of bronchoscopy as the foremost challenge facing its practice in Nigeria. In addition, availability of bronchoscopes, level of awareness, knowledge of the procedure among medical doctors and the cost of the procedure were the challenges faced by the medical doctors.

          Conclusion

          There is an urgent need to equip training centers with modern bronchoscopic facilities. In addition,well-structured bronchoscopic training programme is imperative to enhance the trainees' proficiency for the furtherance of bronchoscopic practice.

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          Most cited references23

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          Bronchoscopy in North America: the ACCP survey.

          A mail survey of this type has several inherent drawbacks. First, answers to some of the questions, particularly those pertaining to complication rates, rely on the memory of participants. Second, the wording of certain questions may have imparted different meanings. Third, the format of the questionnaire may have confused some. Fourth, one cannot expect that all questionnaires will be answered fully. Fifth, as indicated by several respondents, several important topics (eg, topical anesthetic agents and mode of their delivery, prophylaxis against infective endocarditis, tracheobronchial stent placement, endobronchial intraluminal radiotherapy) were not included. Many respondents suggested inclusion of these and other questions in future surveys. Nevertheless, in the absence of any survey looking into a large number of bronchoscopy-related practices, mail surveys have the advantage of reflecting nationwide practice rather than results from selected centers, and this report provides some insight into bronchoscopy practices in North America. While the results indicate the present trends in bronchoscopy practices in North America, they do not establish or recommend any standards in bronchoscopy.
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            Foreign body aspiration: clinical utility of flexible bronchoscopy.

            Foreign body aspiration is a worldwide health problem which often results in life threatening complications. More than two thirds of foreign body aspirations occur among children younger than 3 years. Organic materials such as nuts, seeds, and bones are most commonly aspirated. There is a wide range of clinical presentation, and often there is not a reliable witness to supply the clinical history, especially in children. Maintaining a high index of suspicion is therefore necessary for the diagnosis. None of the imaging methods employed in such cases are diagnostic, and bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during diagnostic examination with a fibreoptic bronchoscope under local anaesthesia, which may help to avoid any further invasive procedures with more complications. When diagnosis is delayed, complications of a retained foreign body such as unresolving pneumonia, lung abscess, recurrent haemoptysis, and bronchiectasis may necessitate a surgical resection. However, some of the late complications may resolve completely after the retrieval of the foreign body, therefore, a preoperative flexible bronchoscopy should always be considered in suitable cases.
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              Complications of bronchoscopy: A concise synopsis

              Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding. Systemic complications arise from the procedure itself, medication administration (primarily sedation), or patient comorbidities. Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy. Here we review the complications (classified as mechanical or systemic) of both rigid and flexible bronchoscopy in hope of making practitioners who are operators of these tools, and those who consult others for interventions, aware of potential problems, and pitfalls in order to enhance patient safety and comfort.
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                Author and article information

                Journal
                Ethiop J Health Sci
                Ethiop J Health Sci
                Ethiopian Journal of Health Sciences
                Research and Publications Office of Jimma University (Jimma, Ethiopia )
                1029-1857
                2413-7170
                July 2017
                : 27
                : 4
                : 331-338
                Affiliations
                [1 ]Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
                [2 ]Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
                [3 ]Department of Medicine, University of Nigeria Nsukka Teaching Hospital, Enugu, Nigeria
                Author notes

                Funding: Nil

                Competing Interests: The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists.

                Article
                jEJHS.v27.i4.pg331
                5615022
                b2e58855-626b-4cc2-a2ec-9c8a1f37697f
                Copyright © 2017 Stanley C.O.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 February 2016
                : 24 February 2017
                Categories
                Original Article

                Medicine
                bronchoscopy,nigeria,respiratory medicine,interventional pulmonology,training
                Medicine
                bronchoscopy, nigeria, respiratory medicine, interventional pulmonology, training

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