Influence of end-stage renal disease on long-term survival after major amputation.

Background: To analyze long-term outcomes and possible influencing factors in patients with endstage renal disease (ESRD) and critical limb ischemia (CLI) after major amputation compared to patients with normal renal function and non-dialysis-dependent chronic kidney disease. Patients and methods: Abstraction of single-center medical records of patients undergoing above knee (AKA) and below knee (BKA) amputation over a 10 years period (n = 436; 2009-2018). Excluded were amputations due to trauma or tumor. Patients were subdivided according to renal function in three categories: ESRD patients (n = 98), non-dialysis dependent chronic kidney disease (CKD, n = 98) and normal renal function (NF, n = 240). Predefined endpoints were survival and postoperative complications. Cox-regression models were built to analyze independent risk factors for outcome parameters. Results: In total, 298 AKA, 133 BKA and 5 knee joint exarticulations were performed. ESRD patients showed inferior in-hospital results as to death (ESRD 36.7 % vs. CKD 19.4 % and NF 20.0 %, P = .002). Similarly, long-term survival rates (6 months: ESRD 55.0 % vs. CKD 69.4 %, NF 67.9 % 1 year: ESRD 48.6 %, CKD 60.2 %, NF 60.8 % 5 years: ESRD 9.9 %, CKD 31.8 %, NF 37.1 %, P < .001) were significantly decreased for ESRD patients. Median postoperative survival was 10 months in ERSD, and 22 months in CKD and NF, respectively. Analysis of postoperative surgical complications revealed no differences between groups (ESRD 19.4 %, CKD 17.3 %, NF 17.0 %; P = 0.433). Cox regression analysis indicated that dialysis (HR 1.63; 95 % CI 1.22-2.16; P = .001), hypertension (HR 1.59; 95 % CI 0.99-2.54) and smoking (HR 1.22; 95 % CI 1.03-1.44; P = .022) was associated with increased risk of death during follow-up. Conclusions: Mortality after limb amputation in ERSD patients remains high. Survival of ERSD patients is lower in relation to chronic kidney disease and patients with normal renal function. Due to poor in hospital outcomes and absent long-term survival, benefit of primary amputation in ERSD seems scarce.

Interprofessional education in Erlangen: A needs analysis and the conceptual work of a student working group.

INTRODUCTION: Interprofessional education (IPE) is receiving growing significance both nationally and internationally. Despite this, organizational and curricular changes are posing challenges. The level of need for IPE and how changes can be made to curricula and infrastructure were investigated at the University of Erlangen in Germany. METHOD: The student working group for interprofessional teaching (AGIL) has turned its attention to these issues. This group is composed of students from medicine, dentistry, molecular medicine, medical technology and speech therapy. In June, 2015, a needs analysis was carried out among the students in the study programs represented in the working group to assess the actual and target situation concerning IPE (n=1,105). In the search for answers and to better measure any needs, contact was sought with instructors. RESULTS: The majority of students feel that they are insufficiently educated in terms of interprofessional skills. A large proportion of the students wish to see expansion of the IPE offerings. Students also expressed a desire for additional spaces and welcomed the idea of an interprofessional learning center. AGIL began establishing interprofessional electives in October 2015. A concept for an interprofessional learning center was developed. DISCUSSION: Based on the survey results, a need for improvements to curricula and infrastructure can be seen; however, the results are limited to the student point of view. AGIL would like to establish more interprofessional electives. These courses would then facilitate curricular implementation. Modern ideas about study environments could be applied to IPE, in particular to promote informal forms of learning. Contact with instructors was crucial for the project work and should be expanded. Realizing and financing the learning center in Erlangen are now the future goals of AGIL. The aim is to create a foundation for this purpose.