title: Implementing flexible bronchoscopy in least developed countries according to international guidelines is feasible and sustainable: example from Phnom-Penh, Cambodia.
abstract: Flexible bronchoscopy is pivotal for the diagnosis of most respiratory diseases. A flexible bronchoscopy unit (FBU) was created in 2008 in the Preah Kossamak university hospital (Phnom Penh, Cambodia) through a cooperation program between a French and a Cambodian team. In 2009 we conducted an assessment of the compliance of the FBU to international standards and found that most of French and British guidelines were fully applied or adapted to local practice. The aim of the current work was to assess FBU again 6 years later, in order to determine if compliance to international guidelines was sustainable.
  
  
  
  The 2015 evaluation was conducted identically to 2009. All recommendation items from the French and the British Thoracic Societies guidelines were assessed individually. Each recommendation was assigned a status expressing the level at which it was respected in Cambodia: applied, adapted, not applied and not evaluable. An endoscope microbial sampling was performed as recommended by the French Ministry of Health.
  
  
  
  Between 2009 and 2015, the pattern of international recommendations in the Cambodian FBU did not change. Notably the rates of applied French evaluable recommendations remained stable: respectively 58% vs 57%. Main changes in French guidelines occurred in adapted items that became applied (n = 5/15) while 4 previously adapted/applied items became not applied. Furthermore, all microbial analyses showed sterile results.
  
  
  
  Our results show that implementation of a high quality FBU in a least-developed country is feasible. In addition, the performance is maintained in the long-term.
authors.affiliation: Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, 69495, Pierre Bénite, France.|Association PRUPET, Centre Hospitalier de Moulin Yzeure, Moulins, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Veaudor
authors.affiliation: Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, 69495, Pierre Bénite, France. sebastien.couraud@chu-lyon.fr.|Association PRUPET, Centre Hospitalier de Moulin Yzeure, Moulins, France. sebastien.couraud@chu-lyon.fr.|EMR 3738 Ciblage thérapeutique en oncologie, Faculté de médecine et de maïeutique Lyon Sud Charles Mérieux, Université Lyon 1, Villeurbanne, France. sebastien.couraud@chu-lyon.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Couraud
authors.affiliation: Service de pneumologie, Hôpital Preah Kossamak, Phnom Penh, Cambodia.
authors.forename: Sophors
authors.initials: S
authors.lastname: Chan
authors.affiliation: Service de pneumologie, Hôpital Preah Kossamak, Phnom Penh, Cambodia.
authors.forename: Chanraksmey
authors.initials: C
authors.lastname: Choun
authors.affiliation: Service de pneumologie, Hôpital Preah Kossamak, Phnom Penh, Cambodia.
authors.forename: Pisethmorokoth
authors.initials: P
authors.lastname: Keo
authors.affiliation: Association PRUPET, Centre Hospitalier de Moulin Yzeure, Moulins, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Avrillon
authors.affiliation: Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, 69495, Pierre Bénite, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.affiliation: Service de pneumologie, Hôpital Preah Kossamak, Phnom Penh, Cambodia.
authors.forename: Chanty
authors.initials: C
authors.lastname: Ny
mesh_terms: D001999:Bronchoscopy / Q000379:methods / Q000592:standards*; D002160:Cambodia; D003906:Developing Countries; D005602:France; D019983:Guideline Adherence; D006801:Humans; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000592:standards*; D012955:Societies, Medical
keywords: Bronchoscopy; Cambodia; Guidelines; Least Developed Countries; Pulmonary medicine