Browsing by Author "Zepeda, Isabel"

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    Electric Scooters (e-scooters): Assessing the Threat to Public Health and Safety in Setting Policies: Assessing e-scooter policies
    (Society of Practitioners of Health Impact Assessment, 2020-11) Comer, Amber R.; Apathy, Nate; Waite, Carly; Bestmann, Zoe; Bradshaw, Jacob; Burchfield, Emily; Harmon, Brittany; Legg, Rebekah; Meyer, Star; O'Brien, Patrick; Sabec, Micha; Sayeed, Jami; Weaver, Alexis; D'Cruz, Lynn; Bartlett, Stephanie; Marchand, McKenzi; Zepeda, Isabel; Endri, Katelyn; Finnell, John T.; Grannis, Shaun; Silverman, Ross D.; Embi, Peter J.; Health Sciences, School of Health and Human Sciences
    Objective: To determine self-reported incidences of health and safety hazards among persons who ride rentable electric scooters (e-scooters), knowledge of e-scooter laws, and attitudes and perceptions of the health and safety of e-scooter usage. Methods: A cross-sectional survey of n= 561 e-scooter riders and non-riders was conducted during June of 2019. Results: Almost half of respondents (44%) report that e-scooters pose a threat to the health and safety of riders. Riders and non-riders disagree regarding the hazards that e-scooters pose to pedestrians. Among riders, 15% report crashing or falling off an e-scooter. Only 2.5% of e-scooter riders self-report that they always wear a helmet while riding. Conclusions: E-scooter riders report substantial rates of harmful behavior and injuries. Knowledge of e-scooter laws is limited, and e-scooters introduce threats to the health and safety of riders, pedestrians on sidewalks, and automobile drivers. Enhanced public health interventions are needed to educate about potential health risks and laws associated with e-scooter use and to ensure health in all policies. Additionally, greater consideration should be given to public health, safety, and injury prevention when passing relevant state and local e-scooter laws.
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    Palliative and End-of-Life Care After Severe Stroke.
    (Elsevier, 2022-05) Comer, Amber R.; Williams, Linda S.; Bartlett, Stephanie; D'Cruz, Lynn; Endris, Katlyn; Marchand, McKenzie; Zepeda, Isabel; Toor, Sumeet; Waite, Carly; Jawed, Areeba; Holloway, Robert; Creutzfeldt, Claire J.; Slaven, James E.; Torke, Alexia M.; Health Sciences, School of Health and Human Sciences
    Background and Objectives The distinct illness trajectory after acute ischemic stroke demands a better understanding of the utilization of palliative care consultations (PCC) for this patient cohort. This study sought to determine the prevalence, predictors, and outcomes associated with PCC for patients hospitalized with severe ischemic stroke. Methods This multicenter cohort study was conducted at four hospitals (2 comprehensive and 2 primary stroke centers) between January, 2016 and December, 2019. We included all patients with a discharge diagnosis of ischemic stroke and an initial National Institutes of Health Stroke Scale (NIHSS) of 10 or greater. We compared patient sociodemographic, clinical and care characteristics as well as hospital outcomes between patients who did and did not receive PCC. Results The study included 1297 patients hospitalized with severe ischemic stroke. PCC occurred for 20% of all patients and this proportion varied across institutions from 11.9% to 43%. Less than half (43%) of patients who died in the hospital. In multivaraible analysis, PCC was less likely in female patients (OR .76, 95% CI .59, .99, P=0.04) but more likely in patients with higher NIHSS (OR1.95, 95% CI 1,13, 3.37, P=0.02). Patients with PCC had higher rates of moving to a plan focused on comfort measures (CMO) (P<0.01) and removal of artificial nutrition as part of a move to CMO (P<0.01). In a sub analysis of patients who died in the hospital and received PCC, patients who died on or before hospital day 3 were less likely to receive PCC than patients who died on or after hospital day 4 (24% v. 51%) (P=<0.01). Conclusions Most patients with severe stroke do not receive PCC, even among those who experience in-hospital death. The results of this study indicate there are missed opportunities for PCC to help reduce suffering after severe stroke.
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    Prevalence, Predictors and Outcomes of Documented DNR and/or DNI Orders in COVID-19 Patients (S522)
    (Elsevier, 2022) Comer, Amber; Fettig, Lyle; Bartlett, Stephanie; Schmidt, Amanda; Endris, Katelyn; Zepeda, Isabel; Waite, Carly; Slaven, James; Torke, Alexia; Medicine, School of Medicine
    Outcomes: 1. Understand the prevalence, predictors, and outcomes associated with DNR and DNI orders for hospitalized patients with COVID-19 throughout the pandemic 2. Understand the reasons for differences in code status order utilization for hospitalized patients with COVID-19 throughout the pandemic Original Research Background: The COVID-19 pandemic created complex challenges regarding timing and appropriateness of do not resuscitate (DNR) and do not intubate (DNI) orders. Research Objectives: This study sought to determine the prevalence, predictors, timing, and outcomes associated with having a documented DNR or DNI order for hospitalized patients with COVID-19. Methods: A retrospective multisite chart review of hospitalized patients with COVID-19 was performed to determine characteristics, medical treatments received, and outcomes associated with having a documented DNR or DNI order. Patients were divided into two cohorts (early and late) by timing of hospitalization during the pandemic. Results: Among 1,358 hospitalized patients with COVID-19, 19% (n = 259) had a documented DNR or DNI order. In multivariate analysis, age (older) (p < .01, OR 1.13), race (White) (p = .01, OR 0.55), and hospitalization during the early half of the pandemic (p = .02, OR 1.8) were associated with having a DNR or DNI order. Palliative care consultation occurred more often in the early cohort (p < .01). Medical treatments, including ICU (p = .31) and level of ventilator support (p = .32) did not differ between cohorts. Hospital mortality was similar between the early and late cohorts (p = .27); however, among hospital decedents median hospital day from DNR or DNI order to death differed between cohorts (p < .01) (6 days from order to death in early vs 2 days in the late cohort). Conclusion: More frequent use of DNR orders and orders written farther from death in decedents characterized the early pandemic phase. White patients were more likely to have DNR or DNI orders, consistent with prior research. Implications for Research, Policy, or Practice: Uncertainty in prognosis may have played a role in the frequency and timing of DNR and DNI orders early in the pandemic. Additional factors, such as fear of resource shortage and transmission of COVID-19 to healthcare workers, may have also played a role.