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INTRODUCTION: There is no formal education or training course about daily progress note writing in Iranian medical interns' curriculum. The current study aimed to assess the effectiveness of a training intervention on daily progress note writing by Iranian medical interns. METHODS: This quasi-experimental study (pre- and post-test) was conducted on 150 medical interns selected through the census method at Razi Hospital of Rasht, north of Iran from October-2018 to May-2019. In the baseline, daily progress notes written by 150 medical interns were assessed using a Subjective, Objective, Assessment, and Plan (SOAP)-based questionnaire by the expert panel. Content validity of the questionnaire was confirmed by experts and internal consistency was determined using Cronbach's alpha coefficient. In the intervention phase, training sessions (4 one-hour sessions) on how to write the daily progress note, based on SOAP format and its importance, were held for the interns. All medical interns were given a week to meet the SOAP standards. Then, the same expert panel reviewed and assessed the newly written daily progress notes of the same medical interns. Finally, the scores from the evaluation of progress note writing, before and after the intervention, were compared with paired sample t-test. RESULTS: The mean age of the medical interns was 23.1±5.2 years. The majority of them were male (56%). There was a significant improvement in all SOAP notes' components written by medical interns between the pre- and post-intervention periods (general rules: 52.7±24.5 vs. 85.4±18.2, P<0.001; subjective: 21.2±18.3 vs. 61.7±24.3, P<0.001; objective: 25.3±18.3 vs. 71.3±25.2, P<0.001; assessment: 10.7±13.0 vs. 51.4±29.6, P<0.001; plan: 11.2±15.2 vs. 49.6±27.5, P<0.001; total: 21.9±13.0 vs. 61.8±23.0, P<0.001). But the scores were still far from the desirable level after the training intervention. CONCLUSION: The finding of the present research suggests that a training intervention can lead to some improvements in the daily progress notes written by Iranian medical interns.
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INTRODUCTION: There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in COVID-19 patients. METHODS: We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250â mg·day-1 for 3â days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population. RESULTS: 68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1% versus 57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9% versus 42.9%; p<0.001). We demonstrated that patients in the methylprednisolone group had a significantly increased survival time compared with patients in the standard care group (log-rank test: p<0.001; hazard ratio 0.293, 95% CI 0.154-0.556). Two patients (5.8%) in the methylprednisolone group and two patients (7.1%) in the standard care group showed severe adverse events between initiation of treatment and the end of the study. CONCLUSIONS: Our results suggest that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase.
