Dr Seshasayee Narasimhan

Dr Seshasayee Narasimhan

Conjoint Senior Lecturer

School of Medicine and Public Health

Career Summary

Biography

Dr. Seshasayee Narasimhan is the current Chair of Manning Hospital Medical Staff Council and the Director of Medicine at Manning Base Hospital. Besides HNEAH in NSW, he is a Visiting Interventional cardiologist at The Gold Coast University Hospital in QLD. He is a Conjoint Senior Lecturer at University of Newcastle and an Adjunct Senior Lecturer at the School of Rural Medicine, UNE. He teaches year 4 & 5 medical students clinical skills and contributes to the Joint Medical Program. In addition to his commitments to students, he is actively involved in training registrars for the FRACP examinations and is a visiting instructor in Interventional Cardiology with the Jillin University in China.

Dr. Narasimhan completed his General Cardiology training at John Hunter Hospital. During his training period, he wrote the orientation manual for the cardiology-advanced training. He consolidated his Rural Cardiology experience at Tamworth Hospital where he helped establish the inpatient Transthoracic Echocardiography Services, Cardiac Rehabilitation and Heart Failure Outreach Clinics. Further to this, he has completed 2 years of invasive cardiology fellowships in both the USA and Canada and has settled with his family in the Taree area. Whilst having a broad interest in general cardiology, Dr. Narasimhan's area of expertise is invasive cardiology which includes complex coronary angioplasty of ischemic heart disease, percutaneous management of adult congenital and structural disease including ASD/PFO closures, assessment and management of valvular heart disease, pulmonary hypertension assessment and management, cardiac transplant work up including right heart catheterization and basic diagnostic and interventional vascular medicine.He lives with his wife Katrina and their children, Zeke and Matilda in Taree.


Qualifications

  • Bachelor of Medicine, Bachelor of Surgery, University of Madras

Fields of Research

Code Description Percentage
110201 Cardiology (incl. Cardiovascular Diseases) 100

Professional Experience

Professional appointment

Dates Title Organisation / Department
21/10/2012 -  Cardiologist Hunter New England Health
Internal Medicine
Australia
1/10/2012 -  Director of Medicine


Hunter New England Health
Internal Medicine
Australia

Teaching appointment

Dates Title Organisation / Department
21/10/2012 -  Conjoint Senior Lecturer Hunter New England Health
Internal Medicine
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (41 outputs)

Year Citation Altmetrics Link
2019 Nirthanakumaran DR, Cheung MH, Braude P, Narasimhan S, 'Piranha in a Goldfish Suit', EC Cardiology, 6 876-880 (2019)
2019 Cheah A, Narasimhan S, Gupta K, 'A Complex Cardio-Hematological Case', EC Cardiology, 6 3-7 (2019)
2019 Narasimhan S, Shanks M, Meyer S, Tyrrell B, Taylor D, Welsh RC, 'Success Begins With Failure: An Alternative Approach in Transfemoral Transcatheter Aortic Valve Replacement Using an Antegrade Wire Crossing Technique', CJC Open, 1 150-152 (2019)

© 2019 Canadian Cardiovascular Society Transcatheter aortic valve replacement has transitioned from an experimental procedure to an important alternative therapy for patients with... [more]

© 2019 Canadian Cardiovascular Society Transcatheter aortic valve replacement has transitioned from an experimental procedure to an important alternative therapy for patients with symptomatic aortic stenosis and high surgical risk. We present a case outlining an approach to deal with the issue of ¿failure to cross¿ the aortic valve in transcatheter aortic valve replacement from the transfemoral retrograde approach.

DOI 10.1016/j.cjco.2019.01.008
2018 Connolly SJ, Eikelboom JW, Bosch J, Dagenais G, Dyal L, Lanas F, et al., 'Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial', The Lancet, 391 205-218 (2018)

© 2018 Elsevier Ltd Background: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation... [more]

© 2018 Elsevier Ltd Background: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stable coronary artery disease. Methods: In this multicentre, double-blind, randomised, placebo-controlled, outpatient trial, patients with stable coronary artery disease or peripheral artery disease were recruited at 602 hospitals, clinics, or community centres in 33 countries. This paper reports on patients with coronary artery disease. Eligible patients with coronary artery disease had to have had a myocardial infarction in the past 20 years, multi-vessel coronary artery disease, history of stable or unstable angina, previous multi-vessel percutaneous coronary intervention, or previous multi-vessel coronary artery bypass graft surgery. After a 30-day run in period, patients were randomly assigned (1:1:1) to receive rivaroxaban (2·5 mg orally twice a day) plus aspirin (100 mg once a day), rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg orally once a day). Randomisation was computer generated. Each treatment group was double dummy, and the patients, investigators, and central study staff were masked to treatment allocation. The primary outcome of the COMPASS trial was the occurrence of myocardial infarction, stroke, or cardiovascular death. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. Findings: Between March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the COMPASS trial, of whom 24 824 patients had stable coronary artery disease from 558 centres. The combination of rivaroxaban plus aspirin reduced the primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of 8261; hazard ratio [HR] 0·74, 95% CI 0·65¿0·86, p<0·0001). By comparison, treatment with rivaroxaban alone did not significantly improve the primary outcome when compared with treatment with aspirin alone (411 [5%] of 8250 vs 460 [6%] of 8261; HR 0·89, 95% CI 0·78¿1·02, p=0·094). Combined rivaroxaban plus aspirin treatment resulted in more major bleeds than treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR 1·66, 95% CI 1·37¿2·03, p<0·0001), and similarly, more bleeds were seen in the rivaroxaban alone group than in the aspirin alone group (236 [3%] of 8250 vs 158 [2%] of 8261; HR 1·51, 95% CI 1·23¿1·84, p<0·0001). The most common site of major bleeding was gastrointestinal, occurring in 130 [2%] patients who received combined rivaroxaban plus aspirin, in 84 [1%] patients who received rivaroxaban alone, and in 61 [1%] patients who received aspirin alone. Rivaroxaban plus aspirin reduced mortality when compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR 0·77, 95% CI 0·65¿0·90, p=0·0012). Interpretation: In patients with stable coronary artery disease, addition of rivaroxaban to aspirin lowered major vascular events, but increased major bleeding. There was no significant increase in intracranial bleeding or other critical organ bleeding. There was also a significant net benefit in favour of rivaroxaban plus aspirin and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin has the potential to substantially reduce morbidity and mortality from coronary artery disease worldwide. Funding: Bayer AG.

DOI 10.1016/S0140-6736(17)32458-3
Citations Scopus - 79
2018 Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P, et al., 'Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial', The Lancet, 391 219-229 (2018)

© 2018 Elsevier Ltd Background: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to re... [more]

© 2018 Elsevier Ltd Background: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. Methods: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle¿brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. Findings: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57¿0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35¿0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69¿1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45¿1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12¿2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17¿2·40; p=0·0043). Interpretation: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. Funding: Bayer AG.

DOI 10.1016/S0140-6736(17)32409-1
Citations Scopus - 147
2018 Cormican D, Jayaraman AL, Sheu R, Peterson C, Narasimhan S, Shaefi S, et al., 'Coronary Artery Bypass Grafting Versus Percutaneous Transcatheter Coronary Interventions: Analysis of Outcomes in Myocardial Revascularization.', Journal of cardiothoracic and vascular anesthesia, 33 2569-2588 (2018) [C1]
DOI 10.1053/j.jvca.2018.09.019
2018 Stawiarski K, Kataria R, Bravo CA, Villablanca P, Mohananey D, Narasimhan S, Ramakrishna H, 'Dual Antiplatelet Therapy Guidelines and Implications for Perioperative Management', Journal of Cardiothoracic and Vascular Anesthesia, 32 1072-1080 (2018) [C1]
DOI 10.1053/j.jvca.2017.06.033
Citations Scopus - 3Web of Science - 3
2018 Narasimhan S, 'Cold Agglutinin Disease and Cardiac Surgery: Pitfalls to Avoid', EC Cardiology, 5 950-954 (2018)
2018 Narasimhan S, Lim J, Narasimhan K, 'Characterizing Heart Failure with Reduced Left Ventricular Ejection Fraction Management in Regional Australia', EC Cardiology, 5 293-296 (2018)
2018 Narasimhan S, 'Success Begins with Failure: A Novel Approach in Transfemoral Transcatheter Aortic Valve Implantation', EC Cardiology, 7 404-408 (2018)
2018 Narasimhan S, Chard C, 'Acute Pharyngitis with Synovial and Extra-Synovial Complications', EC Cardiology, 5 733-737 (2018)
2018 Narasimhan S, Lim J, Braude P, Williams E, 'Congestive Heart Failure: Think Outside the Box', EC Cardiology, 5 326-330 (2018)
2017 Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al., 'Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease', NEW ENGLAND JOURNAL OF MEDICINE, 377 1319-1330 (2017)
DOI 10.1056/NEJMoa1709118
Citations Scopus - 448Web of Science - 392
2017 Saraswat A, Narasimhan S, 'Lex parsimoniae', Journal of Cardiology Cases, 15 187-189 (2017)

© 2017 Japanese College of Cardiology We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From co... [more]

© 2017 Japanese College of Cardiology We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From computed tomography coronary angiography, a left anterior descending artery lesion was identified and successfully revascularized with a drug-eluting stent. Due to persistent chest pain, further investigation revealed a descending aortic dissection, which was conservatively managed. This case highlights the potential challenges of diagnosis in dual pathologies and emphasizes initiating appropriate investigations. <Learning objectives: It is important to consider all differential diagnoses in atypical presentations of possible acute coronary syndrome. As clinical presentations and risk factors may be similar, initiating appropriate diagnostic and management pathways are crucial to avoid misdiagnosis.>

DOI 10.1016/j.jccase.2017.02.001
2016 Baker D, Wilsmore B, Narasimhan S, 'Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation', Internal Medicine Journal, 46 792-797 (2016) [C1]

© 2016 Royal Australasian College of Physicians Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and... [more]

© 2016 Royal Australasian College of Physicians Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. Aims: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. Methods: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013¿2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. Result: Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38¿34%, 22¿20%), and those prescribed no medication declined (17¿8%, P < 0.001). DOAC were prescribed to patients with lower CHA2DS2VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). Conclusion: DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA2DS2VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.

DOI 10.1111/imj.13088
Citations Scopus - 12Web of Science - 10
2014 Sebastianski M, Narasimhan S, Graham MM, Toleva O, Shavadia J, Abualnaja S, et al., 'Usefulness of the ankle-brachial index to predict high coronary syntax scores, myocardium at risk, and incomplete coronary revascularization', American Journal of Cardiology, 114 1745-1749 (2014)

© 2014 Elsevier Inc. Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study ... [more]

© 2014 Elsevier Inc. Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study was to test the hypothesis that patients with PAD diagnosed by a low ankle-brachial index (ABI; =0.90) have more complex coronary artery disease and more myocardium at risk than patients with normal ABIs (1.00 to 1.40) and that subsequent coronary revascularization is less complete. Adults referred for coronary angiography underwent ABI measurement using a standard Doppler ultrasound technique. Blinded reviewers calculated SYNTAX scores and Duke jeopardy scores at baseline and 3 months after angiography. Of 814 patients, 8% had PAD (ABI =;0.90), 9% had borderline PAD (ABI 0.91 to 0.99), 77% were normal (ABI 1.00 to 1.40), and 7% had vascular calcification artifact (ABI >1.40). Patients with PAD were more likely to have high SYNTAX scores (=33), with an odds ratio of 4.3 (95% confidence interval 1.2 to 14.9), compared with those with normal ABIs after adjustment for traditional cardiovascular risk factors. Similarly, there was a positive association between baseline high Duke jeopardy score (=8) and PAD (adjusted odds ratio 3.5, 95% confidence interval 1.7 to 7.1). Postrevascularization high Duke jeopardy scores (=5) were also positively associated with PAD (adjusted odds ratio 3.0, 95% confidence interval 1.1 to 8.8). In conclusion, PAD is associated with higher SYNTAX scores, more myocardium at risk, and less complete coronary revascularization than in patients with normal ABIs. More complex coronary artery disease and incomplete revascularization may contribute to worse cardiovascular outcomes in patients with PAD.

DOI 10.1016/j.amjcard.2014.09.010
Citations Scopus - 11Web of Science - 11
2014 Jayasinghe R, Narasimhan S, Tran TH, Paskaranandavadivel A, 'Rapid rule out of myocardial infarction with the use of copeptin as a biomarker for cardiac injury', Internal Medicine Journal, 44 921-924 (2014)

© 2014 The Authors. Internal Medicine Journal. © 2014 Royal Australasian College of Physicians. Copeptin is a non-specific marker of an endogenous stress response. A dual biomarke... [more]

© 2014 The Authors. Internal Medicine Journal. © 2014 Royal Australasian College of Physicians. Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist early exclusion of acute coronary syndrome in Australian emergency departments. The utility and limitations of this approach are discussed.

DOI 10.1111/imj.12526
Citations Scopus - 5Web of Science - 8
2013 Narasimhan S, 'Coronary Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention of Chronic Total Occlusion', Case Reports in Vascular Medicine, 2013 1-3 (2013)
DOI 10.1155/2013/706820
2012 Anastacio MM, Lee AM, Lawton JS, 'Congenital fistula from the left main coronary artery to the left atrium presenting with an acute myocardial infarction', The Journal of Thoracic and Cardiovascular Surgery, 144 e147-e148 (2012)
DOI 10.1016/j.jtcvs.2012.09.015
2012 Nanna GJ, Nanna MG, Muchnik D, DeRose JJ, Narasimhan S, 'A Rare Case of Isolated Congenital Right Ventricular Inflow Obstruction due to the Presence of an Intraventricular Muscular Shelf', TEXAS HEART INSTITUTE JOURNAL, 39 557-559 (2012)
2012 Narasimhan S, Krim NR, Silverman G, Monrad ES, 'Simultaneous Very Late Stent Thrombosis in Multiple Coronary Arteries', TEXAS HEART INSTITUTE JOURNAL, 39 630-634 (2012)
Citations Scopus - 4Web of Science - 4
2012 Krim NR, Narasimhan S, Monrad ES, 'Severe Multivessel Coronary Vasospasm Presenting as Acute ST-Segment Elevation Myocardial Infarction', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 60 1429-1429 (2012)
DOI 10.1016/j.jacc.2012.02.087
Citations Scopus - 5Web of Science - 5
2012 Narasimhan S, McKay K, Bainey KR, 'Coronary Artery Disease in South Asians', CARDIOLOGY IN REVIEW, 20 304-311 (2012)
DOI 10.1097/CRD.0b013e3182532286
Citations Scopus - 2Web of Science - 1
2012 Narasimhan S, 'A Rare Case of Isolated Congenital Right Ventricular Inflow Obstruction', Texas Heart Institute Journal, 39 558-560 (2012)
2011 Narasimhan S, Gabriel PP, 'Location, Location, Location: Is the Star Really Close?', JOURNAL OF INVASIVE CARDIOLOGY, 23 200-201 (2011)
2011 Narasimhan S, Srinivas VS, DeRose JJ, 'Hybrid Coronary Revascularization A Review', CARDIOLOGY IN REVIEW, 19 101-107 (2011)
DOI 10.1097/CRD.0b013e3182140330
Citations Scopus - 22Web of Science - 15
2011 Srinivas VS, Narasimhan S, 'Coronary artery surgery for multivessel coronary artery disease reduces 10-year risk of myocardial infarction compared with medical treatment or percutaneous coronary intervention', Evidence-Based Medicine, 16 50-51 (2011)
DOI 10.1136/ebm1162
Citations Scopus - 1
2010 Hiew C, Williams T, Hatton R, Narasimhan S, O'Connor S, Baker F, et al., 'Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial infarction', Journal of Invasive Cardiology, 22 273-277 (2010) [C1]
Citations Scopus - 9Web of Science - 7
Co-authors Patrick Mcelduff, John Attia
2009 Haddard R, Narasimhan S, Williams T, Savage L, 'Chest Pain Management in a Rural Hospital', Heart, Lung and Circulation, 18 S110-S110 (2009)
DOI 10.1016/j.hlc.2009.05.249
2009 Narasimhan S, McKay K, Attia JR, 'Staff perspectives of a cardiac short stay unit', Australian Journal of Advanced Nursing, 26 23-28 (2009) [C1]
Citations Scopus - 1Web of Science - 1
Co-authors John Attia
2009 Narasimhan S, Clausen D, 'Heterophile antibodies and troponin results: Implications in rural setting', New Zealand Medical Journal, 122 130-132 (2009)
Citations Scopus - 5
2008 Narasimhan S, McKay K, Savage L, Attia J, Bellamy G, 'The Usefulness of a Short Stay Unit in Cardiology', Heart, Lung and Circulation, 17 S74-S75 (2008)
DOI 10.1016/j.hlc.2008.05.175
2008 Scott IA, Thomson PL, Narasimhan S, 'Comparing risk-prediction methods using administrative or clinical data in assessing excess in-hospital mortality in patients with acute myocardial infarction', MEDICAL JOURNAL OF AUSTRALIA, 188 332-336 (2008)
DOI 10.5694/j.1326-5377.2008.tb01648.x
Citations Scopus - 9Web of Science - 9
2008 Narasimhan S, 'Electroconvulsive therapy and electrocardiograph changes', JOURNAL OF POSTGRADUATE MEDICINE, 54 228-229 (2008)
DOI 10.4103/0022-3859.41810
Citations Scopus - 1Web of Science - 2
2007 Robinson G, Narasimhan S, Weatherall M, Beasley R, 'Hemochromatosis gene mutations, liver function tests and iron status in alcohol-dependent patients admitted for detoxification', JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 22 852-854 (2007)
DOI 10.1111/j.1440-1746.2006.04519.x
Citations Scopus - 7Web of Science - 5
2006 Narasimhan S, Ranchord A, Weatherall M, 'International medical graduates' training needs: Perceptions of New Zealand hospital staff', New Zealand Medical Journal, 119 (2006)

Objective: To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. Design: A ... [more]

Objective: To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. Design: A postal questionnaire sent to hospital doctors and nurses. Methods: All doctors working at Wellington, Kenepuru, and Hutt Hospitals in the greater Wellington region, and nurses working in acute medical wards at the same hospitals, were asked to complete a questionnaire based on the Northern Clinical Training Network and Capital Coast District Health Board resident medical officer assessment forms regarding an overseas-trained doctor they had worked with in the last year. Results: The response rate for the doctor's questionnaires was 68/174 (39.1%), with 51 of these from New Zealand doctors. rating an international medical graduate. The response rate for the nurses was 58/ 60 (96.7%). Areas where the median score of the questionnaire was unsatisfactory (less than three out of five on ordinal scale rating performance) were clinical documentation; communication with patients, families, and other health professionals; knowledge of hospital policies and procedures, and medicolegal matters; and some aspects of patient management. There was no difference in median ratings between doctors and nurses. Conclusions: More specific training may improve the performance of overseas-trained doctors in the New Zealand health system. A further study of the perceived needs of the overseas-trained doctors themselves may be useful. ©NZMA.

Citations Scopus - 12
2006 Burgess C, Blaikie A, Ingham T, Robinson G, Narasimhan S, 'Monitoring the use of amiodarone: Compliance with guidelines', Internal Medicine Journal, 36 289-293 (2006)

Aim: Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at o... [more]

Aim: Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at our hospitals with the current international guidelines for the use of this drug. Methods: A retrospective audit was carried out on all patients aged 15 years or older, with a primary discharge diagnosis of tachyarrhythmia and who were commenced and discharged alive on amiodarone between 1 January 2000 and 30 June 2002 from Wellington and Kenepuru Hospitals, Capital and Coast District Health Board, Wellington, New Zealand. The medical records were examined for baseline measurements of renal, liver, thyroid and pulmonary function, the electrocardiogram and chest X-ray. Follow-up arrangements were sought postdischarge. A questionnaire was sent to the general practitioner requesting information on follow-up testing. Results: During the trial period, 743 patients were admitted with a primary diagnosis of tachyarrhythmia. Eighty-six patients satisfied the entry criteria, and of these 58 were followed for at least 1 year postdischarge. Baseline testing of the electrocardiogram, full blood count and renal function testing was excellent (95-100%). Chest X-rays were carried out in 80% of patients. Baseline testing of thyroid (61%) and liver (44%) function was suboptimal. Two percent of patients had pulmonary function testing and no patient had a formal eye examination. At 6 months, only 32% had thyroid function tests and 41% had liver function tests. At 1 year, of those still on treatment, 35% had both liver and thyroid function tests. Conclusion: Monitoring of thyroid, liver and pulmonary function tests in patients on amiodarone is less than ideal. This is probably because of lack of awareness of current guidelines. © 2006 Royal Australasian College of Physicians.

DOI 10.1111/j.1445-5994.2006.01068.x
Citations Scopus - 15
2005 Robinson GM, Narasimhan S, Weatherall M, Beasley R, 'Raised plasma homocysteine levels in alcoholism: Increasing the risk of heart disease and dementia?', New Zealand Medical Journal, 118 (2005)

Background: Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in ... [more]

Background: Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in alcohol-dependent male subjects. Methods: In this study, we measured plasma homocysteine levels in 20 female and 31 male alcoholic subjects admitted to hospital for detoxification. Nutritional status and clinical factors that might predict plasma homocysteine levels were assessed by measurement of red cell folate, vitamin B12, blood alcohol, and liver function tests. Results: The median (interquartile range) plasma homocysteine level on admission was 15.4 µmol/L (11.1 to 19.7), with 27 (53%) subjects having a raised homocysteine level, greater than 15 µmol/L. There was no difference in admission plasma homocysteine levels between the male and female subjects (difference, male versus female 1.9 µmol/L, 95% CI=2.4 to 6.0, p=0.4). Red cell folate, vitamin B12 levels, and blood alcohol level on admission were not significant predictors of admission homocysteine level. Conclusion: Severe alcohol dependence is associated with markedly raised plasma homocysteine levels in both females and males. The common condition of alcohol dependence may be an under-recognised risk factor contributing to raised plasma homocysteine levels and the associated risk of vascular and intellectual impairment. © NZMA.

Citations Scopus - 9
2004 Narasimhan S, Robinson GM, 'Wellens syndrome: A combined variant', Journal of Postgraduate Medicine, 50 73-74 (2004)
Citations Scopus - 3
2004 Narasimhan S, 'Spontaneous coronary artery dissection (SCAD)', Indian Journal of Thoracic and Cardiovascular Surgery, 20 189-191 (2004)
DOI 10.1007/s12055-004-0084-x
Citations Scopus - 3
McKay KA, Narasimhan S, 'Bridging the gap between doctors and nurses', Journal of Nursing Education and Practice, 2
DOI 10.5430/jnep.v2n4p52
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Conference (4 outputs)

Year Citation Altmetrics Link
2016 Lim J, Sarwar G, Narasimhan S, 'Characterising Heart Failure with Reduced Ejection Fraction and its Management in Regional New South Wales', Heart, Lung and Circulation (2016)
DOI 10.1016/j.hlc.2016.06.242
2013 McMurtry MS, Sebastianski M, Narasimhan S, Toleva O, Shavadia J, Abdualnaja S, et al., 'Low ABI predicts higher coronary syntax scores and myocardium at risk, but not incomplete coronary revascularization', VASCULAR MEDICINE (2013)
2011 Gabriel PP, Aggarwal V, Narasimhan S, Krim N, Srinivas VS, Scheuer J, 'Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio on Admission as a Predictor of Impaired Reperfusion in Patients Presenting with ST-Segment Elevation Myocardial Infarction', CIRCULATION (2011)
2011 van't Veer C, Bakhtiari K, Fikrig E, Daffre S, van der Poll T, DePonte K, et al., 'Tick salivary protein P23 inhibits coagulation by postponing factor v activation and plays a crucial role in tick feeding', JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2011)
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Dr Seshasayee Narasimhan

Position

Conjoint Senior Lecturer
School of Medicine and Public Health
Faculty of Health and Medicine

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