Biomedical subjects

J Boldt

Publications and source records attributed to J Boldt.

At least 37 records · Page 2Linked to original sources

PubMed2004

Do we necessarily need local anaesthetics for venous cannulation? A comparison of different cannula sizes.

BACKGROUND AND OBJECTIVE: This randomized, prospective study was performed to evaluate the efficacy of a subcutaneous local anaesthetic infiltration prior to venepuncture using different cannula sizes. METHODS: Three-hundred-and-one patients were included in the study, 150 received mepivacaine 1% (0.25 mL) subcutaneously, 151 were cannulated without local analgesia. Patients were further allocated to one of five cannula size groups (standard wire gauge (G)): 20-, 18-, 17-, 16- and 14-G. They were asked to quantify the pain experienced using a four-point rating scale. RESULTS: In the group without local anaesthetics, 28.8% complained about pain compared to 12% receiving local analgesia. The incidence of pain for 14-G (10%) and 16-G (12.9%) cannulae was significantly reduced in the local analgesia group (P < 0.01) compared to no local analgesia (77.4% and 45.1%). Other cannula sizes showed no difference in pain whether using local analgesia or not. CONCLUSIONS: Patients profit from a subcutaneous infiltration with mepivacaine 1% prior to intravenous cathetherization only when cannulae of size > or = 16-G are inserted.

Anesthetics, Local↗

PubMed2004

[ProSeal-laryngeal mask versus endotracheal intubation in patients undergoing gynaecologic laparoscopy].

BACKGROUND: The aim of this study was to assess the practicality of the ProSeal laryngeal mask (PS-LMA) airway during laparoscopic surgery with capnoperitoneum compared to endotracheal intubation (ET). METHODS: Prospective, randomized study. 104 patients undergoing gynaecologic, laparoscopic surgery were allocated randomly to two groups: 1. ET-group (n = 50). 2. PS-LMA-group (n = 54). Total intravenous anaesthesia was performed by the same anaesthesiologist. MEASUREMENTS: Mean arterial pressure, heart rate, at 4 and circuit pressure at 2 measurement points, and the incidences of coughing and sore throat. Insertion of the ET and the PS-LMA was scored by using a four-point scale. Ease of placing the gastric tube was judged by measuring the number of attempts at insertion and the insertion times. A p-value of < 0.05 was considered as significant. RESULTS: There were no differences between PS-LMA and ET concerning circuit pressure at any measurement point. At the end of anaesthesia, mean arterial pressure (92 +/- 13 vs. 100 +/- 14 mmHg; p < 0.01) and heart rate (66 +/- 13 vs. 76 +/- 14 beats/min; p < 0.01) were lower in the PS-LMA-group compared to the ET-group. At the end of anaesthesia 25 patients of the ET-group coughed but nobody in the PS-LMA-group (p < 0.00001). There was no difference with regard to postoperative sore throat. The insertion of the PS-LMA was easier compared to ET (p < 0.05), but we found no significant difference concerning insertion times. Fewer attempts at insertion of the gastric tube were necessary in the PS-LMA-group than in the ET-group (p < 0.01), whereas insertion times did not differ. CONCLUSION: The PS-LMA is a convenient and practicable approach for anaesthesia in patients undergoing laparoscopic surgery.

Adult↗

PubMed2004

[A comparison of the Arndt endobronchial blocker with a double lumen tube in robotic cardiac surgery].

OBJECTIVE: In this prospective, randomised study a double lumen tube (DLT) or an Arndt bronchial blocker (BB) was used for one lung ventilation (OLV). Intraoperative oxygenation, ventilation, haemodynamics, and ease of placement were compared. METHODS: In 32 patients undergoing robotic harvesting of the left internal thoracic artery (ITA) a left-sided DLT or a BB controlled by bronchoscopy was used for OLV of the right lung. In 2 patients randomised for DLT, a single lumen tube and BB was used for difficult visualisation of the larynx. These 2 patients were excluded from the study. RESULTS: Correct placement of DLT (8.8 +/- 5.4 min, 87.5 % of the patients) as well as BB (6.5 +/- 4.0 min; n. s.; 100 % of the patients) was achieved rapidly. The Cormack-Lehane score for visualisation of the larynx was 2, 1 - 3 (median, range) in group DLT and 3, 1 - 4 (median, range) in group BB (p < 0.05). OLV lasted for 93 +/- 29 min in group DLT and 88 +/- 34 min in group BB (n. s.). Satisfactory conditions for harvesting ITA were achieved in all patients of both groups. There was no difference in any haemodynamic parameter at any time between the two groups. Mean pulmonary arterial pressure and pulmonary vascular resistance were increased without significant differences between the two groups during thoracoscopy for robotic preparation of left ITA. During OLV, index of paO (2)/FiO (2) was significantly (p < 0.05) lower in DLT patients compared to BB patients. Time to extubation did not differ between the two groups (DLT 14.3 +/- 4.6 h; BB 11.8 +/- 3.8 h). CONCLUSION: OLV in patients undergoing robotic cardiac surgery was safely achieved either by BB or by left-sided DLT. Positioning of the BB was easier than that of a DLT when intubation was difficult and tube exchange at the end of surgery is avoided. Therefore, we prefer a BB in patients undergoing robotic harvesting of left ITA.

Aged↗

PubMed2004

[Volume replacement with hydroxyethyl starch: is there an influence on kidney function?].

Hydroxyethyl starch (HES) solutions are synthetic colloids with the pharmacological properties that are closest to natural colloids. In Germany, numerous types of HES preparations with different combinations of concentration, weight-averaged mean molecular weight (Mw), and hydroxyethylation pattern are available. They differ with regard to their volume-supporting capacity, intravascular half-life, and side effect profile. The elimination of HES molecules varies with the Mw and degree of substitution (DS). Large HES molecules undergo hydrolytic cleavage by alpha-amylase and are excreted in the urine, or they are phagocytosed by the reticuloendothelial system. The smaller HES molecules are eliminated by glomerular filtration. The higher the DS, the slower the metabolism and elimination of the molecule. Although HES can be used safely even in large doses in patients without altered kidney function, renal dysfunction and acute renal failure after HES infusion have been reported in patients who share several risk factors, such as preexisting renal disease, advanced age in combination with dehydration, or treatment with high doses of slow degradable HES solutions. Since there is no direct chemical toxicity of HES, the most likely mechanism for HES-induced renal dysfunction may be swelling and vacuolization of tubular cells ("osmotic nephrosis-like lesions") and tubular obstruction due to the production of hyperviscous urine. Considering this pathogenesis, it can be hypothesized that all hyperoncotic colloid solutions can induce renal impairment. In the case of HES, the risk of high plasma colloid osmotic pressure and thus the risk of acute renal failure are probably increased by high concentrations of the colloid or repeated administration of slowly degradable HES with a high Mw and DS. With adequate hydration, using sufficient amounts of crystalloids, HES has little if any adverse effects on renal function. Furthermore, modern -rapidly degradable HES solutions with a low Mw and DS, such as HES 130/0.4, do not increase the risk for renal dysfunction even when used in large amounts perioperatively.

Animals↗

PubMed2004

A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study.

Postanaesthetic shivering is a frequent complication following general anaesthesia. The aim of this study was to compare the effectiveness of three doses of nefopam with clonidine and placebo in the prevention of postanaesthetic shivering. We studied 371 patients undergoing abdominal or orthopaedic surgery. Patients were allocated to one of five groups: Group A (n = 73) received 0.2 mg x kg(-1) nefopam, Group B (n = 75) 0.1 mg x kg(-1) nefopam, Group C (n = 76) 0.05 mg x kg(-1) nefopam, Group D (n = 73) 1.5 microg x kg(-1) clonidine, and Group E (n = 74) saline 0.9% as placebo. We found a significant reduction in the incidence of shivering in Group A compared to Group C and clonidine as well as to the placebo group. All active treatments reduced the incidence and the severity of shivering compared to placebo. At 5 min postoperatively clonidine-treated patients showed a significant decrease in MAP and a significantly lower Aldrete score compared to all other groups. No haemodynamic or sedative adverse events were observed in the nefopam-treated patients. The results of our study indicate that nefopam (0.2 mg x kg(-1)) is superior to clonidine (1.5 microg x kg(-1)) in the prophylaxis of postanaesthetic shivering and not accompanied by sedative or haemodynamic side-effects.

Adult↗

PubMed2003

[Prevention of post-operative nausea and vomiting. Randomised comparison of dolasetron versus dolasetron plus dexamethasone].

BACKGROUND: Postoperative nausea and vomiting (PONV) are frequent complications after operations. The aim of this study was to assess the efficacy of combined dolasetron plus dexamethasone versus dolasetron alone with respect to the incidence and severity of emetic symptoms and patients satisfaction. METHODS: In a prospective, randomised, double-blind study, 150 patients scheduled for hysterectomy or breast surgery were allocated to one of the following two groups: group A received 50 mg dolasetron orally and group B 50 mg dolasetron orally plus 8 mg dexamethasone intravenously. The follow-up was for 24 h after surgery. RESULTS: In group A PONV was significantly more frequent (28%) compared to group B (12.0%). The incidence of vomiting was significantly lower in patients receiving dolasetron plus dexamethasone (0%) in comparison to patients receiving dolasetron (8.0%). Furthermore,patients satisfaction was significantly higher in group B compared to group A. About 6 or 7 patients need to be treated with additional dexamethasone instead of a placebo for one patient to benefit from this intervention (i.e. to stay free from PONV) who otherwise would have suffered from PONV. CONCLUSIONS: Combining oral dolasetron with intravenous dexamethasone further improves the antiemetic efficacy of dolasetron. With a number-needed-to-treat of about 6 the additional benefit might be considered clinically relevant.

Administration, Oral↗

PubMed2003

[Rehabilitation guidelines after total knee arthroplasty].

Rehabilitation programs after total knee arthroplasty vary as much as do the surgical procedures employed. The postoperative range of motion of the knee is considered to be one of the primary indicators of the success of arthroplasty surgery. Protocols focusing on improving range of motion have been widely investigated: the end result does not seem to depend on using specific devices or exercises. There are no prospective randomized clinical trials evaluating the differences in outcome after total knee arthroplasty between patients following different rehabilitation programs. What are the needs of the patient after this surgery? Rehabilitation should focus on physical and functional limitations, and guidance of the patient during this process is important. The patient follows an individual program comprising a sensorimotor progression in weight-bearing positions to allow for improved functional knee stabilization. In knee osteoarthritis, and also after total knee arthroplasty, the neuromuscular system undergoes various adaptations during gait and other activities. Because of this, rehabilitation should not attempt to achieve hypothetical norms, but to help the patient in the motor learning process of acquiring improved motion patterns and stabilization strategies.

Arthroplasty, Replacement, Knee↗

PubMed2003

Prevention of propofol-induced injection pain by remifentanil: a placebo-controlled comparison with lidocaine.

In a randomised, double-blind study we compared the efficacy of continuous remifentanil infusion (0.25 microg x kg(-1) x min(-1) with 40 mg lidocaine and placebo in the prevention of injection pain due to intravenous propofol administration (1.5-2 mg x kg(-1)) in 155 patients scheduled for elective surgery. Pain severity was evaluated using a four-point scale. The incidence of injection pain was 62% in the placebo group and could be reduced significantly by using remifentanil (30%; p < 0.0015) or lidocaine (33%; p < 0.005). Analysis of the pain scores showed a significant difference between remifentanil and placebo (p < 0.00005) as well as between lidocaine and placebo (p < 0.0002). There was no significant difference between remifentanil and lidocaine. Remifentanil provided effective pain relief, comparable with lidocaine, and is an alternative as part of an intravenous anaesthesia regimen to using another concomitant drug.

Adolescent↗

PubMed2003

[Current status of non-invasive ventilation in German ICU's -- a postal survey].

The status of non-invasive ventilation (NIV) in intensive care units (ICU) in Germany was analysed by a national survey. Questionnaires consisting of multiple-choice and short-answer questions were sent to ICUs of university hospitals, hospitals with >1000 beds, with 500 - 1000 beds, and hospitals with <500 beds separated with regard to different specialties (anesthesia ICUs, surgical ICUs, cardiac surgical ICUs, neurosurgical ICUs, internal ICUs, interdiscipline ICUs). Of the 716 questionnaires sent 223 (32 %) were returned and analysed. The use of NIV in all specialties increased during the last 3 years. 14 % of ICUs in some specialties treated more than 30 % of patients with NIV. CPAP (88 %), BIPAP (45 %) and ASB/PSV (48 %) were most frequently used as NIV-strategies. 10 % of all ICUs reported to have experience with proportional assist ventilation. NIV was most frequently used for disease states like COPD (82 %), pneumonia (64 %), pulmonary oedema (50 %), bronchial asthma (35 %) and ALI/ARDS (22 %). The use of NIV was considered when clinical signs of ventilation (93 %) and oxygenation [arterial blood gas analysis (92 %) and oxygen saturation (66 %)] were inadequate. Complications observed during NIV were panic reaction (83 %), ulceration of nose (38 %) and aspiration (14 %). The reasons to reject NIV were (total 13 %): lack of ventilators (64 %), expenditure of personnel (57 %) and risk of the procedure (11 %). 38 % of the ventilators used were older than 5 years. 56 % of the ICUs were content with the equipment for NIV. 76 % of the ICUs were interested to buy new equipment of NIV. 99 % of the survey have declined NIV as an alternative method of ventilation. In summary we found NIV as an accepted additional method of ventilatory support in respiratory failure in German ICUs. We found no significant increase in frequency of NIV in the last three years.

Anesthesia↗

PubMed2003

[Point of care (POC) monitoring in anesthesia and intensive care--an overview of available POC systems].

There is an increasing trend to have data rapidly ready at the patient's bedside. The general principle behind point-of-care (POC) testing is that "faster is better" ('from vein to brain'). The entire process for laboratory testing includes withdrawal of blood into special (pre-labelled) tubes, transportation of the sample to the central laboratory where the plasma is separated from the blood cells by centrifugation, carefully pippeting of a defined volume of plasma that is placed in the analyzer. POC instruments provide us with the potential to do old things in new ways. With the help of portable POC analyzers a variety of laboratory parameters including coagulation parameters, blood gas analysis, electrolytes, markers of organ function can be measured next to the patient's bed thus significantly shorting turnaround-time (TAT). Cost analyses of new monitoring devices are necessary in today's climate of cost savings. It is important to capture all costs and not only costs of the test kits. Direct costs (e. g. test cartridges, costs for the analyzers, cost for quality control) may constitute only a small percentage of the true costs. Hidden costs consist of overhead costs (e. g. transportation) and the consequences of delayed results. The present overview summarizes the available POC systems in Germany and may serve as a decision maker for those who are interested in introducing POC monitoring systems.

Anesthesia↗

PubMed2003

[Shortage of anaesthesiologists in Germany].

After the glut of doctors in the past, we find a shortage of doctors in the present time. Approximately only 60% of all doctors would decide to become a doctor again. These alarming news should urge us to improve the situation for the rising generation of doctors especially for young anaesthesiologists. The actual situation in the hospital is rather unattractive and there is increasing risk that we will not have a sufficient number of anaesthesiologists in our hospitals in the near future. Improvement of the financial situation is without doubt important--this must include payment according to performance principle rather than payment with regard to age. Moreover, training programs (e. g. financial support of meetings) of the young anaesthesiologists, working conditions for all staff members (e. g. limitation of overtime), and importance of the role of anaesthesia must be modified to improve motivation and to guarantee high standards of quality of anaesthesia for the future.

Anesthesiology↗

PubMed2003

[Influence of cardiopulmonary bypass (CPB) on the natriuretic peptides ANP and BNP. A comparison between long and short duration of CPB and off pump surgery].

OBJECTIVE: Plasma atrial and brain natriuretic peptide (ANP and BNP) are cardiac hormones secreted mainly due to cardiac overload. The study was designed to assess plasma concentrations of ANP and BNP in patients undergoing coronary bypass grafting (CABG) with long and short duration of cardiopulmonary bypass (CPB) and without CPB (off-pump surgery). METHODS: We studied 45 patients scheduled for elective CABG. Patients were allocated in three groups: group A received CPB with a duration less than 60 minutes, group B more than 60 minutes and patients without CPB were allocated in group C. ANP and BNP were measured after induction of anaesthesia (T0), at the end of surgery (T1), 4 hrs. (T2), 24 hrs. (T3) and 120 hrs. postoperatively (T4). RESULTS: In all groups, ANP-levels increased from T0 to T4 (group A: from 3.7 +/- 2.1 to 8.9 +/- 8.0; group B: from 3.3 +/- 1.7 to 8.0 +/- 6.0; group C: from 3.0 +/- 1.6 to 5.3 +/- 2.3 pg/ml), but there were no significant differences between the groups. BNP-concentrations increased also from T0 to T4 (group A: from 34 +/- 18 to 234 +/- 164; group B: from 33 +/- 26 to 219 +/- 182; group C: from 33 +/- 24 to 77 +/- 55 pg/ml). Furthermore we measured significant higher BNP-levels in group B compared to group C at T3 and T4. No significant differences between group A and B were found. CONCLUSIONS: CPB influenced BNP, but not ANP plasma concentrations. An influence of the duration of CPB on ANP and BNP was not seen.

English Abstract↗

PubMed2003

[Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization?].

Levosimendan, is a new calcium sensitiser with 2 major effects. First, levosimendan acts as a positive inotropic agent by binding calcium dependently to cardiac troponin C. Second, levosimendan activates adenosine triphosphate-regulated potassium (K (ATP)) channels. Thus it has vasodilatory properties and cardioprotective effects at a dose enhancing myocardial contractility. These unique properties of levosimendan might be of great advantage in patients with myocardial ischemia simultaneously requiring inotropic support. The concept of perioperative inoprotection is presented in 6 patients with acute ischemia undergoing emergent cardiac surgery.

ATP-Binding Cassette Transporters↗

PubMed2003

[Injection pain secondary to propofol-MCT/LCT and propofol-LCT--comparison of prophylaxis with lidocaine].

OBJECTIVE: Pain on injection is one of the most described side-effects of the intravenous application of propofol. This study was designed to assess the efficacy of lidocaine 40 mg in preventing incidence and severity of injection pain for two different propofol solvents. METHODS: In a double-blind and prospective study 202 patients were enrolled and randomized to 4 different groups: group A receiving 2 ml NaCl 0.9 % and propofol-LCT (Disoprivan; AstraZeneca), group B 40 mg lidocaine and propofol-LCT, group C received 2 ml NaCl 0.9 % and propofol-MCT/LCT (Propofol-Lipuro, B. Braun Melsungen AG) and group D 40 mg lidocaine and propofol-MCT/LCT. According to the protocol, all patients were cannulated with a 18-G venous cannula at the dorsum of the hand and no other medicament was injected before the study drug. Time interval between test agents and propofol application in a dosage of 2 mg/kg was one minute. Severity of pain was evaluated during propofol injection over 30 seconds until loss of consciousness using a 4-point rating scale. RESULTS: The incidence of injection pain did not differ between propofol-LCT and propofol-MCT/LCT (64 % and 53 %). Propofol-MCT/LCT significantly reduced the severity of pain compared to propofol-LCT (p < 0.05). The application of lidocaine resulted in a significant reduction in incidence (Propofol-MCT/LCT: 16 %; Propofol-LCT: 31 %) and severity of injection pain compared to placebo. CONCLUSION: Propofol-MCT/LCT showed a significant advantage compared to propofol-LCT considering the severity of injection pain, but not in reducing the incidence of pain. The use of lidocaine resulted in a significant reduction of incidence and severity of injection pain for both propofol solvents.

English Abstract↗

PubMed2003

[Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery].

BACKGROUND: Controlled hypotension (CH) is an established method to reduce intraoperative bleeding. The aim of the study was to investigate the influence of CH induced by sodium nitroprusside (SN) or esmolol on hepatocellular integrity. METHODS: Prospective, randomized, controlled study. 45 patients scheduled for elective endonasal sinus surgery were allocated to one of the following three groups: 1. SN-group (n = 15): CH induced by SN. 2. Esmolol-group: CH induced by esmolol. In both groups mean arterial pressure was kept between 50-55 mmHg. 3. Control group (n = 15): no hypotension was performed (MAP > 70 mmHg). The cytosolic liver enzyme alpha-glutathione S-transferase (alpha-GST) and standard liver enzymes (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase) were measured at the following timepoints: preoperative (T0), at the end of surgery (T1), 2 h (T2), 24 h (T3) and 48 h (T4) postoperatively. RESULTS: alpha-GST concentrations were significantly higher in patients receiving CH (SN: 5.9 +/- 3.4; Esmolol: 6.5 +/- 2.8 microg/L) in comparison with controls (2.5 +/- 1.4 microg/L) at T1. Already at T2 there were no significant differences between the three groups. Standard liver enzymes showed a similar course in all groups. CONCLUSION: The small but significant increase of alpha-GST in both hypotension groups suggests that hypotension induces a mild damage of hepatocellular integrity.

Adrenergic beta-Antagonists↗

PubMed2002

Effects of sodium nitroprusside-induced controlled hypotension on pancreatic function assessed by pancreatitis-associated protein in patients undergoing radical prostatectomy.

BACKGROUND AND OBJECTIVE: Controlled hypotension may alter organ blood flow and tissue oxygenation. The aim of the study was to investigate whether induced hypotension using sodium nitroprusside alters pancreatic function assessed by pancreatitis-associated protein concentrations in the blood. METHODS: Thirty patients undergoing elective radical prostatectomy were allocated randomly into two groups: (a) hypotension group: sodium nitroprusside was administered to lower mean arterial pressure to approximately 50 mmHg; (b) control group: no hypotension was used, mean arterial pressure was kept > 70 mmHg. Pancreatitis-associated protein and lipase were measured in arterial blood samples: after induction of anaesthesia (T1), at the end of surgery (T2), 2 h (T3) and 24 h (T4) postoperatively. RESULTS: Pancreatitis-associated protein plasma concentrations increased significantly in patients in the hypotensive group (from 2.8 +/- 1.1 to 5.5 +/- 2.0 micrograms L-1 at T4) and pancreatitis-associated protein plasma concentrations were significantly higher in comparison with controls (5.5 +/- 2.0 versus 3.5 +/- 2.4 micrograms L-1) at T4. Lipase concentrations showed a similar course in both groups. None of the patients showed clinical signs of pancreatitis. CONCLUSIONS: Controlled hypotension during surgery was associated with a small but significant increase in pancreatitis-associated protein compared with controls. The absence of concomitant elevation in lipase concentrations and a lack of clinical evidence of pancreatitis damage suggest that hypotension induces mild pancreatic stress.

Aged↗

PubMed2002

[Dolasetron reduces pain on injection of propofol].

OBJECTIVE: Pain on injection is a well known side-effect of propofol. The present study was designed to assess the efficacy of dolasetron, a 5-HT 3 -antagonist, in prophylaxis of pain on injection of propofol compared with lidocaine and placebo. METHODS: Prospective, randomised, double-blinded study including 150 patients randomly assigned to one of three groups: Group A received 12.5 mg dolasetron, group B 40 mg lidocaine and group C saline 0.9 % as placebo. After occluding the venous drainage the test medication was given. The occlusion was released after 1 min and 2.0 mg/kg Propofol was administered over a period of 30 sec. The patients were asked whether they felt any pain during the administration. Pain on injection was judged by using a four-point scale. RESULTS: Incidence of pain on injection as well as the severity of pain was significantly reduced by lidocaine (62 % pain free) compared with placebo (28 %). Severity, but not incidence of pain on injection was significantly reduced by dolasetron (50 %) compared with placebo. There was no significant difference between dolasetron and lidocaine. CONCLUSION: Dolasetron and lidocaine were effective in preventing pain of injection secondary to propofol.

English Abstract↗

PubMed2002

[Funding of research projects--the importance of foundations].

OBJECTIVE: Without outside funding, scientific research would widely stagnate. Funding of research projects by German foundations was analysed and specified for different medical disciplines. METHODS: The analysis based on the following sources: Handbuch der Wissenschaftspreise und Forschungsstipendien, Forschungshandbuch "Hochschul- und wissenschaftsfördernde Institutionen und Programme", Deutsches Arzteblatt 2000, the internet and the CD-ROM "Verzeichnis Deutscher Stiftungen". RESULTS: The highest number of research support by foundations was found in internal medicine (n = 70; volume: > 3,6 Mio DM). Other large disciplines, e. g. surgery (number of projects n = 10; financial volume: approximately 130,000 DM) or anesthesia (9 projects), were much less supported by foundations. A smaller discipline, dermatology, was supported much more (n = 13; volume 320,000 DM). CONCLUSIONS: None-industrial, none-governmental supported research is based on foundations. The range of support by foundations is very large, reaching from very high to only very small support. Increase in the foundation-based financial support would help to improve medical research in several disciplines.

Anesthesiology↗