Publications by authors named "Sashiananthan Ganesananthan"
Background: Placebo-controlled evidence from ORBITA-2 (Objective Randomised Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina-2) found that percutaneous coronary intervention (PCI) in stable coronary artery disease with little or no antianginal medication relieved angina, but residual symptoms persisted in many patients. The reason for this was unclear.
Objectives: This ORBITA-2 secondary analysis investigates the relationship between presenting symptoms and disease severity (anatomic, noninvasive, and invasive ischemia) and the ability of symptoms to predict the placebo-controlled efficacy of PCI.
Background: In stable coronary artery disease, 30% to 60% of patients remain symptomatic despite successful revascularization. Perhaps not all symptoms reported by a patient with myocardial ischemia are, in fact, angina.
Objectives: This study sought to determine whether independent symptom verification using a placebo-controlled ischemic stimulus could distinguish which patients achieve greatest symptom relief from percutaneous coronary intervention (PCI).
Importance: Unlike medications, procedural interventions are rarely trialed against placebo prior to becoming accepted in clinical practice. When placebo-controlled trials are eventually conducted, procedural interventions may be less effective than previously believed.
Objective: To investigate the importance of including a placebo arm in trials of surgical and interventional procedures by comparing effect sizes from trials of the same procedure that do and do not include a placebo arm.
Article Synopsis
- A study was done to see if a procedure called PCI helps people with stable angina (chest pain) feel better than a fake (placebo) procedure.
- 301 patients were divided into two groups: one had the PCI and the other had the fake procedure for 12 weeks.
- The results showed that those who had PCI had better scores for their angina symptoms, meaning they felt less pain compared to the placebo group.
Article Synopsis
- - ATTR-CM is a form of heart failure linked to a specific TTR gene mutation (p.(V142I)) prevalent in 3-4% of individuals of African descent, potentially affecting 1.6 million people in the U.S.
- - A study analyzed 413 patients with this mutation, finding that they had significant heart functional impairment and lower 5-year survival rates compared to patients with wild-type ATTR-CM, emphasizing the seriousness of the condition.
- - The aggressive nature of p.(V142I)-ATTRv-CM was highlighted by findings of myocyte loss and widespread infiltration in the heart muscle, indicating a high risk for biventricular failure and poor patient outcomes.
Purpose: Objective Structured Clinical Examination (OSCE) is a vital examination that must be passed to graduate as a qualified doctor. The delivery of OSCE teaching was changed to an online format to accommodate COVID-19 restrictions. Therefore, this study evaluates factors that students perceive to affect their virtual learning of clinical skills for OSCE.
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- - The study investigates international medical students' perceptions of the financial cost and value of obtaining a medical degree in the UK, highlighting the significant differences in tuition fees compared to domestic students.
- - A questionnaire survey of 352 responses revealed that factors like clinical and academic opportunities (96%) and quality of life (88%) are key motivations for studying medicine in the UK, while family reasons were less influential.
- - Results indicated that 54% of international students considered a UK degree to be value for money, with premedical students expressing a higher belief in its value compared to current students and graduates, suggesting varying perceptions based on education stages.
Background: Recent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit.
Study Design: Cross-sectional study.
Enhancing medical students` confidence and performance in integrated structured clinical examinations (ISCE) through a novel near-peer, mixed model approach during the COVID-19 pandemic.
BMC Med Educ
February 2023
Background: Near-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor.
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- * Expert endocrinologists reviewed thyroid event cases and found that the majority were autoimmune conditions, with 39.5% diagnosed as Graves' disease.
- * Despite the high incidence of thyroid issues, these events were manageable and did not impact the progression of multiple sclerosis in patients.
Article Synopsis
- Smart devices like smartphones and fitness trackers play a crucial role in collecting and analyzing digital health data, especially in clinical trials for conditions like angina.
- There is significant variability in how patients report angina symptoms, which impacts their daily activities and overall quality of life, highlighting the need for more patient-centered outcomes in clinical research.
- This article shares insights from the authors' experiences with incorporating smart devices into their clinical trials, discussing the advantages, challenges, and workflows that can enhance understanding of how angina affects patients' lives.
Introduction: Conferences are an important avenue for dissemination of knowledge, research and provide networking opportunities for career development. The COVID-19 pandemic has prompted adoption of virtual platforms for delivery of these conferences. The aim of the study was to determine the utility and educational impact of a student-led virtual webinar to deliver an undergraduate cardiovascular conference compared to a traditional in-person conference.
View Article and Find Full Text PDFPurpose: The COVID-19 pandemic caused significant disruption to higher education, including medical studies. Online learner support became urgently necessary, and peer-support of learning was needed to supplement formal teaching. This study evaluates the impact and delivery media of OSCEazy, a student-led initiative supporting formal teaching across institutional and national boundaries.
View Article and Find Full Text PDFAims: Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI).
Methods And Results: Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial.
Graves' orbitopathy (GO) has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia, and improve aesthetics. We sought to quantify the effect of different surgical approaches on quality of life.
View Article and Find Full Text PDFBackground: Retrievable stents and aspiration catheters have been developed to provide more effective arterial recanalisation in acute ischaemic stroke.
Aims: The aim of this analysis was to test the effect of mechanical thrombectomy on mortality and long-term neurological outcome in patients presenting with acute large-vessel anterior circulation ischaemic stroke.
Methods: A structured search identified randomised controlled trials of thrombectomy (using a retrievable stent or aspiration catheter) versus control on a background of medical therapy which included intravenous thrombolysis if appropriate.
Background: The COVID-19 pandemic has created a hiatus in in-person clinical assessments due to safety and logistical concerns. We aimed to evaluate student perception and utility of an online Integrated Structured Clinical Examinations (ISCEs) during the pandemic.
Methods: Final-year medical students from a single institution were offered an online mock ISCE through a student-to-student ("near-peer") teaching-programme.
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation.
View Article and Find Full Text PDFObjective: Revision to cardiac resynchronisation therapy (CRT) in patients with existing pacemakers with worsening heart failure (HF) can improve symptoms and cardiac function. We identify factors that predict improvement in left ventricular ejection fraction (LVEF) within a year of CRT revision.
Methods: We performed a retrospective study of 146 consecutive patients (16% female, mean age 73 ± 11 years, mean LVEF 27 ± 8%) undergoing revision to CRT (January 2012 to May 2018) in a single tertiary centre.
Background In stable coronary artery disease, medications are used for 2 purposes: cardiovascular risk reduction and symptom improvement. In clinical trials and clinical practice, medication use is often not optimal. The ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trial was the first placebo-controlled trial of percutaneous coronary intervention.
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