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Background In intensive care settings, doctors face low-frequency and high-stakes events such as tracheostomy-related emergencies. Junior doctors must learn to manage these situations to ensure patient safety, yet they often lack clinical exposure to such critical events. Clinical teachers should develop methods that provide enough learning opportunities while remaining feasible in terms of workload. This study compared three strategies for teaching junior doctors to manage tracheostomy-related emergencies in intensive care unit (ICU). Method In this pilot study, conducted in the ICU of Lausanne University Hospital, twenty-four junior doctors were randomized into three groups: Group A: Access to a printed algorithm; Group B: E-learning, including the algorithm with access to a toolbox; Group C: Flipped classroom course, including a short low-fidelity simulation. Performance was assessed through pre- and post-intervention sessions consisting of three tracheostomy-related simulation scenarios. A modified Delphi method was used to develop a performance assessment tool consisting of an evaluation scale for each scenario. Knowledge was also assessed before and after the intervention through a multiple-choice questionnaire. The primary outcome was the Global Performance Score (GPS), calculated for each teaching method by summing the performance scale scores across the three simulation scenarios as the total score across all scenarios, after the intervention. Results The GPS significantly improved after the intervention in the three groups (Group A: M  = 141, SD  = 22 vs. M  = 116, SD  = 16.7 p  = 0.008; Group B: M  = 157, SD  = 14 vs. M  = 110.1, SD  = 17.3 p  = 0.008; Group C: M  = 171.9, SD  = 20.1 vs. M  = 99.4, SD  = 16 p  = 0.008). There was a trend for a higher post-intervention GPS in Group B as compared to Group A ( p  = 0.105), and in Group C as compared to Group B ( p  = 0.279). By contrast, post-intervention GPS was significantly higher in Group C as compared to Group A ( p  = 0.021). Conclusion The flipped classroom strategy, combined with a brief simulation, yielded the highest post-intervention score. This strategy appears promising for junior doctors learning to manage low-frequency critical events, such as tracheostomy-related emergencies. Further research should explore its feasibility at larger scale, confirm the results in a larger population of learners with adequately powered studies and the applicability of such a teaching approach to other critical events.

Saliva sampling could serve as an alternative non-invasive sample for SARS-CoV-2 diagnosis while rapid antigen tests (RATs) might help to mitigate the shortage of reagents sporadically encountered with RT-PCR. Thus, in the RESTART study we compared antigen and RT-PCR testing methods on nasopharyngeal (NP) swabs and salivary samples. We conducted a prospective observational study among COVID-19 hospitalized patients between 10 December 2020 and 1 February 2021. Paired saliva and NP samples were investigated by RT-PCR (Cobas 6800, Roche-Switzerland, Basel, Switzerland) and by two rapid antigen tests: One Step Immunoassay Exdia® COVID-19 Ag (Precision Biosensor, Daejeon, Korea) and Standard Q® COVID-19 Rapid Antigen Test (Roche-Switzerland). A total of 58 paired NP-saliva specimens were collected. A total of 32 of 58 (55%) patients were hospitalized in the intensive care unit, and the median duration of symptoms was 11 days (IQR 5-19). NP and salivary RT-PCR exhibited sensitivity of 98% and 69% respectively, whereas the specificity of these RT-PCRs assays was 100%. The NP RATs exhibited much lower diagnostic performance, with sensitivities of 35% and 41% for the Standard Q® and Exdia® assays, respectively, when a wet-swab approach was used (i.e., when the swab was diluted in the viral transport medium (VTM) before testing). The sensitivity of the dry-swab approach was slightly better (47%). These antigen tests exhibited very low sensitivity (4% and 8%) when applied to salivary swabs. Nasopharyngeal RT-PCR is the most accurate test for COVID-19 diagnosis in hospitalized patients. RT-PCR on salivary samples may be used when nasopharyngeal swabs are contraindicated. RATs are not appropriate for hospitalized patients.

The aim of this study was to determine the influence of heat processing on denaturation and digestibility properties of protein isolates obtained from sweet quinoa ( Chenopodium quinoa Willd) at various extraction pH values (8, 9, 10 and 11). Pretreatment of suspensions of protein isolates at 60, 90 and 120 °C for 30 min led to protein denaturation and aggregation, which was enhanced at higher treatment temperatures. The in vitro gastric digestibility measured during 6 h was lower for protein extracts pre-treated at 90 and 120 °C compared to 60 °C. The digestibility decreased with increasing extraction pH, which could be ascribed to protein aggregation. Protein digestibility of the quinoa protein isolates was higher compared to wholemeal quinoa flour. We conclude that an interactive effect of processing temperature and extraction pH on in vitro gastric digestibility of quinoa protein isolates obtained at various extraction pH is observed. This gives a first indication of how the nutritional value of quinoa protein could be influenced by heat processing, protein extraction conditions and other grain components.