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  1. Article ; Online: Clinical and Ethical Dilemmas in the Involuntary Treatment of Anorexia Nervosa.

    Tumba, Jenny / Smith, Megan / Rodenbach, Kyle E

    Harvard review of psychiatry

    2023  Volume 31, Issue 1, Page(s) 14–21

    Abstract: Learning objectives: After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss ... ...

    Abstract Learning objectives: After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN.
    Abstract: Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient's objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.
    MeSH term(s) Humans ; Anorexia Nervosa/therapy ; Inpatients ; Involuntary Treatment
    Language English
    Publishing date 2023-01-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1174775-4
    ISSN 1465-7309 ; 1067-3229
    ISSN (online) 1465-7309
    ISSN 1067-3229
    DOI 10.1097/HRP.0000000000000355
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3888: Show issues Location:
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  2. Article ; Online: Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality.

    Rodenbach, Rachel A / Rodenbach, Kyle E / Tejani, Mohamedtaki A / Epstein, Ronald M

    Patient education and counseling

    2015  Volume 99, Issue 3, Page(s) 356–363

    Abstract: Objective: Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of ... ...

    Abstract Objective: Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them.
    Methods: Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality.
    Results: Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients.
    Conclusion: An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care.
    Practice implications: Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.
    MeSH term(s) Adult ; Attitude of Health Personnel ; Attitude to Death ; Communication ; Death ; Female ; Humans ; Interviews as Topic ; Male ; Medical Oncology ; Middle Aged ; Neoplasms/mortality ; Neoplasms/psychology ; Physician-Patient Relations ; Physicians/psychology ; Qualitative Research ; Terminal Care ; Terminally Ill
    Language English
    Publishing date 2015-10-23
    Publishing country Ireland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605590-4
    ISSN 1873-5134 ; 0738-3991
    ISSN (online) 1873-5134
    ISSN 0738-3991
    DOI 10.1016/j.pec.2015.10.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1465: Show issues Location:
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  3. Article: Use of ECT in Major Vascular Neurocognitive Disorder with Treatment-Resistant Behavioral Disturbance following an Acute Stroke in a Young Patient.

    Rodenbach, Kyle E / Varon, Daniel / Denko, Timothey / Peterson, Ryan / Andreescu, Carmen

    Case reports in psychiatry

    2019  Volume 2019, Page(s) 9694765

    Abstract: The following case describes the utilization of bitemporal ECT as a treatment of last resort in a 47-year-old woman with profoundly treatment-resistant behavioral disturbance poststroke. The use of ECT led to improvement in symptoms sufficient for ... ...

    Abstract The following case describes the utilization of bitemporal ECT as a treatment of last resort in a 47-year-old woman with profoundly treatment-resistant behavioral disturbance poststroke. The use of ECT led to improvement in symptoms sufficient for discharge from an inpatient psychiatric unit to the nursing home. Neuropsychiatric sequelae of stroke include poststroke depression, anxiety, mania, psychosis, apathy, pathological laughter and crying, catastrophic reaction, and mild and major vascular neurocognitive disorders. Behavioral disturbance is common and may pose diagnostic and therapeutic difficulty in the poststroke patient. In most cases, first-line treatment includes pharmacologic intervention tailored to the most likely underlying syndrome. Frequent use of sedating medications is a more drastic option when behaviors prove recalcitrant to first-line approaches and markedly affect quality of life and patient safety. ECT is generally safe, is well tolerated, and may be effective in improving symptoms in treatment-resistant behavioral disturbance secondary to stroke with major neurocognitive impairment, as suggested in this case.
    Language English
    Publishing date 2019-04-21
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2629914-8
    ISSN 2090-6838 ; 2090-682X
    ISSN (online) 2090-6838
    ISSN 2090-682X
    DOI 10.1155/2019/9694765
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  4. Article ; Online: Renal Response to a Protein Load in Healthy Young Adults as Determined by Iohexol Infusion Clearance, Cimetidine-Inhibited Creatinine Clearance, and Cystatin C Estimated Glomerular Filtration Rate.

    Rodenbach, Kyle E / Fuhrman, Dana Y / Maier, Paula S / Schwartz, George J

    Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation

    2017  Volume 27, Issue 4, Page(s) 275–281

    Abstract: Objective: Renal reserve (RR) measures the increase in glomerular filtration rate (GFR) in response to a protein load; lack of RR could indicate subclinical kidney disease but such a test is not routinely used in clinical practice. The purpose of this ... ...

    Abstract Objective: Renal reserve (RR) measures the increase in glomerular filtration rate (GFR) in response to a protein load; lack of RR could indicate subclinical kidney disease but such a test is not routinely used in clinical practice. The purpose of this study was to compare a meat versus liquid protein load in a cystatin C-based (Cys-C) RR test using cimetidine-inhibited creatinine clearance (Cr Cl) and iohexol infusion clearance (Io Cl) for validation. The design was cross-sectional analysis and the setting was a Clinical Research Center.
    Subjects: Participants (N = 16), mean (standard deviation [SD]) age 22 (2) years, had normal health and blood pressure without proteinuria.
    Intervention: Participants 1 to 8 received a beef burger (1 g/kg protein) and participants 9 to 16 received a ProCel shake (1-1.5 g/kg protein).
    Main outcome measure: RR defined as the difference in stimulated versus baseline GFR.
    Results: Baseline GFR (SD) in mL/minute/1.73 m
    Conclusion: Protein loading stimulates Io Cl and Cr Cl after a beef or milk-based protein load. The change in Cys-C eGFR is significant but smaller for the shake and burger group, which may be due to the dilutional effect of water loading or the length of Cys-C half-life in the blood.
    MeSH term(s) Biomarkers/blood ; Cimetidine/administration & dosage ; Creatinine/blood ; Cross-Sectional Studies ; Cystatin C/blood ; Female ; Glomerular Filtration Rate ; Humans ; Iohexol/administration & dosage ; Kidney/drug effects ; Kidney/metabolism ; Kidney Diseases/drug therapy ; Male ; Young Adult
    Chemical Substances Biomarkers ; CST3 protein, human ; Cystatin C ; Iohexol (4419T9MX03) ; Cimetidine (80061L1WGD) ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2017-04-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1080003-7
    ISSN 1532-8503 ; 1051-2276
    ISSN (online) 1532-8503
    ISSN 1051-2276
    DOI 10.1053/j.jrn.2017.01.021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3273: Show issues Location:
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  5. Article ; Online: Hyperuricemia and Progression of CKD in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort Study.

    Rodenbach, Kyle E / Schneider, Michael F / Furth, Susan L / Moxey-Mims, Marva M / Mitsnefes, Mark M / Weaver, Donald J / Warady, Bradley A / Schwartz, George J

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2015  Volume 66, Issue 6, Page(s) 984–992

    Abstract: Background: Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children.: Study design: Prospective observational ... ...

    Abstract Background: Hyperuricemia is associated with essential hypertension in children. No previous studies have evaluated the effect of hyperuricemia on progression of chronic kidney disease (CKD) in children.
    Study design: Prospective observational cohort study.
    Setting & participants: Children and adolescents (n=678 cross-sectional; n=627 longitudinal) with a median age of 12.3 (IQR, 8.6-15.6) years enrolled at 52 North American sites of the CKiD (CKD in Children) Study.
    Predictor: Serum uric acid level (<5.5, 5.5-7.5, and >7.5mg/dL).
    Outcomes: Composite end point of either >30% decline in glomerular filtration rate (GFR) or initiation of renal replacement therapy.
    Measurements: Age, sex, race, blood pressure status, GFR, CKD cause, urine protein-creatinine ratio (<0.5, 0.5-<2.0, and ≥2.0mg/mg), age- and sex-specific body mass index > 95th percentile, use of diuretics, and serum uric acid level.
    Results: Older age, male sex, lower GFR, and body mass index > 95th percentile were associated with higher uric acid levels. 162, 294, and 171 participants had initial uric acid levels < 5.5, 5.5 to 7.5, or >7.5 mg/dL, respectively. We observed 225 instances of the composite end point over 5 years. In a multivariable parametric time-to-event analysis, compared with participants with initial uric acid levels < 5.5mg/dL, those with uric acid levels of 5.5 to 7.5 or >7.5mg/dL had 17% shorter (relative time, 0.83; 95% CI, 0.62-1.11) or 38% shorter (relative time, 0.62; 95% CI, 0.45-0.85) times to event, respectively. Hypertension, lower GFR, glomerular CKD cause, and elevated urine protein-creatinine ratio were also associated with faster times to the composite end point.
    Limitations: The study lacked sufficient data to examine how use of specific medications might influence serum uric acid levels and CKD progression.
    Conclusions: Hyperuricemia is a previously undescribed independent risk factor for faster progression of CKD in children and adolescents. It is possible that treatment of children and adolescents with CKD with urate-lowering therapy could slow disease progression.
    MeSH term(s) Adolescent ; Child ; Cohort Studies ; Cross-Sectional Studies ; Disease Progression ; Female ; Humans ; Hyperuricemia/blood ; Hyperuricemia/diagnosis ; Hyperuricemia/epidemiology ; Longitudinal Studies ; Male ; Prospective Studies ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/epidemiology ; Uric Acid/blood
    Chemical Substances Uric Acid (268B43MJ25)
    Language English
    Publishing date 2015-07-21
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2015.06.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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