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INTRODUCTION: Renal parenchymal volume loss from standard partial nephrectomy (SPN) is a significant prognosticator for postoperative renal function. Tumor enucleation (TE) minimizes parenchymal loss compared to SPN. Little is known regarding discrete changes in renal function associated with volume loss. We sought to quantify the differences between SPN and TE in preserving parenchymal volume and estimated glomerular filtration rate (eGFR). METHODS: We identified 420 patients who underwent robotic partial nephrectomy (SPN or TE) at our tertiary care center from 2009 to 2022. Parenchymal volumes were calculated using TeraRecon 3D reconstruction software from axial imaging performed preoperatively and within 6 months postoperatively. Renal volume preserved and renal function were evaluated with multivariable linear and logistic regression models. RESULTS: At 1 year, eGFR was 7% lower in patients undergoing SPN compared to TE (P < 0.01). Across both SPN and TE, only volume of preserved parenchyma was predictive of eGFR and chronic kidney disease (CKD) progression (both P < 0.01). TE preserved more healthy parenchymal volume compared to SPN (median percentage 97.6% vs 89.2%; P < 0.001). Each 1% of volumetric loss corresponded to a 0.35% decrease in eGFR at 1 year postoperatively (P < 0.01). CONCLUSIONS: Volume of preserved renal parenchyma was the strongest factor associated with preserved eGFR and reduced odds of CKD progression. TE preserved more parenchyma than SPN, which translated to higher eGFR preservation at 1 year postoperatively.
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Purpose: The purpose of this study was to determine if implementation of a new educational curriculum focusing on Emotional Intelligence (EI) and Resilience improved second year medical student scores in these areas. Methods: Our EI-Resilience curriculum was offered as an elective for second year medical students to voluntarily enroll in. The elective consisted of six 2-hour sessions taught by a single faculty member over eight months. Sessions focused on development of EI skills and teaching a Resilience "PROGRAM" (Positive thinking, Reframing, Optimism, Gratitude, Reflection, Altruism, Meaning). Participants' EI levels were assessed before and after the elective using the Bar-On Emotional Quotient Inventory 2.0 (EQ-i 2.0). Results: Over a period of 2 years, 70 students participated in the elective. The overall mean EI score significantly improved after the educational elective (100.05 ± 12.94 versus 108.14 ±12.36, p < 0.001). Compared to the baseline scores, there was significant improvement in all EI components, including all five composite scales, all fifteen content subscales, and the well-being score (all p < 0.05). In a post-intervention survey assessing student perception of the elective, most students found the elective to be helpful (95%, 64/67), most students felt the elective should continue to be available for future students (95%, 64/67), and most would recommend the elective to other students (93%, 62/67). Conclusion: An EI-Resilience curriculum offered as an elective to second year medical students was well received by students. Our outcomes showed significant improvement in students' EI scores and all sub-scores, including all components of the stress management composite and well-being score. Teaching EI skills and Resilience strategies in the preclinical setting might be an opportune time for this type of educational intervention.