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Mejia, Nicte

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Mejia

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Nicte

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Mejia, Nicte

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2016 - 20173

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Author's Publications: search.filters.isAuthorOfPublication.2b96d7ef-8124-4779-bd51-5a150c6504a1

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    Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English
    (John Wiley and Sons Inc., 2017) Luan Erfe, Betty M.; Siddiqui, Khawja A.; Schwamm, Lee; Kirwan, Chris; Nunes, Anabela; Mejia, Nicte
    Background: The inability to communicate effectively in a common language can jeopardize clinicians’ efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English. Methods and Results: We analyzed data from 259 non–English‐preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines–Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients’ receipt of defect‐free stroke care. A total of 147 of 259 (57%) non–English‐preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect‐free stroke care (odds ratio: 0.52; P=0.04). Conclusions: Our findings suggest that PMIs may influence the quality of acute ischemic stroke care.
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    Relationship Between Language Preference and Intravenous Thrombolysis Among Acute Ischemic Stroke Patients
    (John Wiley and Sons Inc., 2016) Luan Erfe, Betty; Siddiqui, Khawja Ahmeruddin; Schwamm, Lee; Mejia, Nicte
    Background: Approximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients’ receipt of intravenous (IV) thrombolysis. Methods and Results: We analyzed data from 3894 AIS patients who participated in the American Heart Association “Get With The Guidelines®—Stroke” program at our hospital from January 1, 2003 to April 30, 2014. Information included patients’ language in which they preferred to receive medical care. We used descriptive statistics and stepwise logistic regression models to examine associations between patients’ language preference and receipt of IV thrombolysis, adjusting for relevant covariates. A total of 306/3295 (9.3%) AIS patients preferred to speak a non‐English language and represented 25 different languages. Multivariable analyses adjusting for other socioeconomic factors showed that non‐English‐preferring patients were more likely than English‐preferring patients to receive IV thrombolysis (OR=1.64; CI=1.09‐2.48; P=0.02). However, in models that also included age, sex, and initial NIH Stroke Scale, patients’ language preference was no longer significant (OR 1.38; CI=0.88‐2.15; P=0.16), but NIH Stroke Scale was strongly associated with receiving IV thrombolysis (OR=1.15 per point; CI=1.13‐1.16; P<0.0001). Conclusions: Contrary to our hypothesis, non‐English‐preferring was not associated with lower rates of IV thrombolysis among AIS patients once initial stroke severity was accounted for.
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    Phase IIa trial of fingolimod for amyotrophic lateral sclerosis demonstrates acceptable acute safety and tolerability
    (John Wiley and Sons Inc., 2017) Berry, James; Paganoni, Sabrina; Atassi, Nazem; Macklin, Eric; Goyal, Namita; Rivner, Michael; Simpson, Ericka; Appel, Stanley; Grasso, Daniela L.; Mejia, Nicte; Mateen, Farrah; Gill, Alan; Vieira, Fernando; Tassinari, Valerie; Perrin, Steven
    ABSTRACT Introduction: Immune activation has been implicated in progression of amytrophic lateral sclerosis (ALS). Oral fingolimod reduces circulating lymphocytes. The objective of this phase IIa, randomized, controlled trial was to test the short‐term safety, tolerability, and target engagement of fingolimod in ALS. Methods: Randomization was 2:1 (fingolimod:placebo). Treatment duration was 4 weeks. Primary outcomes were safety and tolerability. Secondary outcomes included circulating lymphocytes and whole‐blood gene expression. Results: Thirty participants were randomized; 28 were administered a drug (fingolimod 18, placebo 10). No serious adverse events occurred. Adverse events were similar by treatment arm, as was study discontinuation (2 fingolimod vs. 0 placebo, with no statistical difference). Forced expiratory volume in 1 second (FEV1) and FEV1/slow vital capacity changes were similar in the fingolimod and placebo arms. Circulating lymphocytes decreased significantly in the fingolimod arm (P < 0.001). Nine immune‐related genes were significantly downregulated in the fingolimod arm, including forkhead box P3 (P < 0.001) and CD40 ligand (P = 0.003). Discussion Fingolimod is safe and well‐tolerated and can reduce circulating lymphocytes in ALS patients. Muscle Nerve 56: 1077–1084, 2017