Michael O Ogunlana, Olufemi O Oyewole, Joseph A Aderonmu, Ogochukwu Kelechi Onyeso, Ayobamigbe Y Faloye, Pragashnie Govender
Patterns and predictors of cultural competence practice among Nigerian hospital-based healthcare professionals
BMC medical education
early pregnancies accurately costeffectively diagnosed managed using new medical computerized tool compared standard clinical approach retrospective implementation new medical software gynaecological emergency unit correlated accurate diagnosis costeffective management early pregnancy complications responsible large percentage consultations mostly emergency units guidelines becoming complex poorly knownmisunderstood practitioners total 780 gynaecological emergency consultations 446 patients recorded november 2018 june 2019 tertiary university hospital retrospectively encoded new medical computerized tool inclusion criteria positive hcg test result ultrasonographical visualization gestational sac andor embryo corresponding gestational age 14 weeks less diagnosis management suggested new computerized tool named ediagnoses provided gynaecologist member emergency department staff called meddiagnoses usability primary endpoint accuracy cost reduction respectively secondary tertiary endpoints identical ediagnosesmeddiagnoses considered accurate followup visits updated ediagnoses meddiagnoses became identical previously discrepant ediagnosis meddiagnosis previous ediagnosis meddiagnosis also considered correct four doubleblinded experts reviewed persistent discrepancies determining accurate diagnoses ediagnosesmeddiagnoses accuracies compared using mcnemars chi square test sensitivity specificity predictive values 1 01 780 registered medical records lacked data full encoding 779 remaining consultations 675 ediagnoses identical meddiagnoses 866 104 discrepant 134 104 60 reached agreement followup consultations 59 meddiagnoses ultimately changing initial ediagnoses 98 one discrepant ediagnosis turning later initial meddiagnosis 2 finally 24 remained discrepant subsequent checks 20 reevaluated 44 majority experts agreed 38 ediagnoses 86 5 meddiagnoses 11 including four twin pregnancies whose twinness discrepancy majority reached one discrepant ediagnosismeddiagnosis 2 total accuracy ediagnoses 991 675 59 38 772 ediagnoses 779 versus 874 675 1 5 681 meddiagnoses p 00001 calculating basic costs extra consultations extramedications extrasurgeries extrahospitalizations induced incorrect meddiagnoses versus ediagnoses new medical computerized tool would saved 362375 euros per month retrospectively medical computerized tool usable almost recorded cases 999 globally accurate 991 versus 874 diagnoses except twinning reports costeffective standard clinical approach retrospective study design limitation observed improvements medical software could derive encoding rested andor experienced physician better ultrasound interpretation software cannot replace clinical ultrasonographical skills may improve compliance published guidelines medical computerized tool improving new version considers diagnosis management multiple pregnancies specificities potentially multiple locations chorioamnionicity prospective evaluations required developmental steps planned including software incorporation ultrasound devices integration previously published predictiveprognostic factors eg serum progesterone corpus luteum scoring external funding obtained study fb dg created new medical software nct03993015