The vast advance in medical knowledge forces us to super specializations. Yet, as we get to know better the tree, we might lose the perspective of the forest. Team work and more specifically, diversity teams, keep us in touch with the different aspects of knowledge. And although diversity has potential to disrupt group functioning, in reality, in both in behavioral and psychological science and in business arena, diverse teams are proven smarter1-2.

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Patient care in Intensive Care Units is characterized by high demanding tasks, which leads in daily high workload. The aim of the study is to evaluate the effect of patient’s sedation level to workload for the certain task. It also examines whether workload lowers over time, as an effect of the experience gained by the repetition of the task. NASA- TLX tool was used as workload assessments method during a complex monitoring task in an adult Intensive Care Unit environment. The latter included monitoring and recording of skin conductance variability, noise level, hemodynamic and respiratory parameters were monitored during 4 hour routine in two groups of patients. The group was defined by the sedation level (Ramsay sedation score); otherwise no major differences were spotted in their characteristics. Both raw and weighted data of the NASA-TLX tool were included in the analysis, which was performed with MS Excel 2007 (Microsoft Co, USA) and Rstudio® IDE v.0.99.903 (Rstudio Inc, Boston, MA, USA). Patients’ sedation level did not affect NASA-TLX measured workload. The former was valid both for raw values and weighted data of the subscales of the NASA-TLX tool.  In the second part of the analysis where the raw values were treated as time series data, it was shown that some subscales (Ment, Phys) had a tendency towards lower values, others (e.g. Temp, Ef) had a relative stability and others  (Per) increased over time. The total workload (OW) did not seem to lower over time. While the patient’s sedation level does not affect workload of the specific task, several subscales of the NASA-TLX index do reveal a tendency over time; a fact that may be used as learning curve/ experience assessment for a given task. However, further studies are needed in order to define its future utility.

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Prehospital emergency medical services (PEMS) are becoming more and more sophisticated as more point-of–care advanced medical technology is available in the field. Yet, the literature around the subject is limited, as data come mainly from Northern Europe, USA, Canada and New Zealand. The aim of this analysiswas to describe time trends of PEMS activity in a region of northern Greece.Use of data retrospectively collected for PEMS usage, in the regional unit of Thessaloniki, Northern Greece from 2006 to 2015. The area of interest represents a little more than 10% of the total population of Greece.Total utilization of PEMS shows an overall l4.03% decrease over the decade; yet with an increase in the 2 last years.The mean rate of use was 69/1000 inhabitants for ambulance services and 1.5/1000 for medical interventions (MICU).

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Contemporary changes in medical science and scientific publishing practices are hard to understand and even harder to follow. In the past it was enough to talk about “medicine” and “announces”/papers written by an author-researcher-doctor. Today one can easily claim that there are constellations of medical fields and publishing practices and still, not describe the reality.

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Trend towards noninvasive, easy to use monitor was always a challenge. Numerous indices have been used to monitor the progress of patients on positive pressure ventilation. The present study compares different indices in a mixed larger intensive care unit (ICU) population. In a prospective observational study Arterial blood gases (ABG) analyses were obtained from 225 patients under mechanical ventilation in a polyvalent adult ICU. Values of ideal body weight (IBW), Body mass index (BMI), PAO2, PaO2/FiO2 ratio (PFr), SpO2/FiO2 ratio (SFr), SpO2/PEEP ratio (SPr), SpO2/PaCO­2 ratio (SPCr), Oxygenation index (OI) and Ventillatory ratio (VR) were calculated; and further correlation analysis was conducted. In Pressure control ventilation mode a relative strong relation between PFr and SFr and OI was found; yet further regression analysis implies that no direct replacement of PFr with SFr can be made without limitations, in clinical setting. In Volume control ventilation mode moderate relation was found between SFr and PFr. In the present study a moderate relation was found between SFr and PFr. The results agree with previous published studies; the differences among them lie in the different design of each one of them. The authors believe that- given the fact that one still considers using broadly PFr as index of oxygenation- SFr can be used safely as a surrogate for PFr only for certain disease states. Larger series are needed in order to define those patients groups and these pathophysiological conditions.

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Dear colleagues,

Traditional publishing is an ex cathedra affair, top down, hierarchical. Electronic publishing is essentially egalitarian1. That’s why the present journal had never adopted printed form.

Here, we would like to underline some of the changes that occurred in the journal. These changes were designed to maintain excellence while improving the efficiency of the review process and taking advantage of new technology. Thus, new features have been added in the article section and feedback surveys are planned to be performed in regular basis. New sections for bibliographic information and editorial board / reviewers’ panel have been added. Organizational changes for a better workflow are also en route. The journal is already accepted in several electronic databases (see “indexing” section), while application for inclusion in several others is also under way. For all the changes, every website visitor is invited to explore these new features.

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Clinical evaluation of pupils is considered as an essential part of neurological examination. The pupillary response to light is controlled by the autonomic nervous system. Numerous factors affect pupils dynamics, like e.g. luminance, visual field area, pain, drug administration, age, the functional integrity of anatomical structures involved, e.t.c. Moreover, pupillometry card method and examination of pupil reaction with the use of a penlight is subjective to a lot of bias. Portable infrared pupillometry allows a more objective and detail evaluation of pupil’s dynamics. That’s why it has already found applications in various clinical areas, like e.g. neurology, psychology, ophthalmology, endocrinology, anesthesia, pain management, intensive care, emergency medicine. This review focuses on physiology of pupil’s dynamics and on applications of infrared pupillometry in perioperative setting.

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The Fontan procedure and its modifications is the definitive therapy for a number of congenital heart diseases. Anesthesia for semi-elective Caeserian section in a pregnant woman with a history of such surgery history can be a real challenge due to probability of high perioperative morbidity and mortality. We present the anesthetic management of a young parturient with a history of a partially repaired complex cyanotic congenital heart disease and perform a literature review.

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The incidence of preeclampsia in the western countries is estimated to range from 2% to 6% in healthy, nulliparous women. In developing nations, the incidence of the disease is reported to be 4- 18%,with hypertensive disorders being the second most common obstetric cause of stillbirths and early neonatal deaths in these countries Etiology of the disease is multifactorial, with risk factors like ma-ternal age, oxidative stress, angiotensin T-235 homozygote having a different role in every case. Moreover, the disease its self is a multisystem expression of a complicated pathophysiology. Many attempts to explain the latter have been made with often controversial results. In the present article we explore the hypothesis of intra-abdominal pressure as possible causative factor of preeclampsia and the role ofthe maternal venous compartment and rennin-angiotensin-anldosterin system in this hypothesis. Continue reading
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