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Health professionals for a new century: Ttransforming education to strengthen health systems in an interdependent world

Show simple item record Frenk J. Chen L. Bhutta Z.A. Cohen J. Crisp N. Evans T. Fineberg H. Garcia P. Ke Y. Kelley P. Kistnasamy B. Meleis A. Naylor D. Pablos-Mendez A. Reddy S. Scrimshaw S. Sepulveda J. Serwadda D. Zurayk H.
dc.contributor.editor 2010 2017-10-18T13:30:54Z 2017-10-18T13:30:54Z 2010
dc.identifier 10.1016/S0140-6736(10)61854-5
dc.identifier.issn 1406736
dc.description.abstract Background Activation of renal sympathetic nerves is key to pathogenesis of essential hypertension. We aimed to assess eff ectiveness and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension. Methods In this multicentre, prospective, randomised trial, patients who had a baseline systolic blood pressure of 160 mm Hg or more (?150 mm Hg for patients with type 2 diabetes), despite taking three or more antihypertensive drugs, were randomly allocated in a one-to-one ratio to undergo renal denervation with previous treatment or to maintain previous treatment alone (control group) at 24 participating centres. Randomisation was done with sealed envelopes. Data analysers were not masked to treatment assignment. The primary eff ectiveness endpoint was change in seated offi ce-based measurement of systolic blood pressure at 6 months. Primary analysis included all patients remaining in follow-up at 6 months. This trial is registered with, number NCT00888433. Findings 106 (56percent) of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010. 49 (94percent) of 52 patients who underwent renal denervation and 51 (94percent) of 54 controls were assessed for the primary endpoint at 6 months. Offi ce-based blood pressure measurements in the renal denervation group reduced by 32-12 mm Hg (SD 23-11, baseline of 178-96 mm Hg, p0?0001), whereas they did not diff er from baseline in the control group (change of 1-0 mm Hg [21-10], baseline of 178-97 mm Hg, p=0?77 systolic and p=0?83 diastolic). Between-group diff erences in blood pressure at 6 months were 33-11 mm Hg (p0?0001). At 6 months, 41 (84percent) of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 18 (35percent) of 51 controls (p0?0001). We noted no serious procedure-related or device-related complications and occurrence of adverse events did not diff er between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment. Interpretation Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatmentresistant hypertensive patients. Funding Ardian.
dc.format.extent Pages: (1923-1958)
dc.language English
dc.publisher NEW YORK
dc.relation.ispartof Publication Name: The Lancet; Publication Year: 2010; Volume: 376; no. 9756; Pages: (1923-1958);
dc.source Scopus
dc.title Health professionals for a new century: Ttransforming education to strengthen health systems in an interdependent world
dc.type Review
dc.contributor.affiliation Frenk, J., Harvard School of Public Health, Office of the Dean, Kresge Building, 677 Huntington Avenue, Boston, MA 02115, United States
dc.contributor.affiliation Chen, L., China Medical Board, Cambridge, MA, United States
dc.contributor.affiliation Bhutta, Z.A., Aga Khan University, Karachi, Pakistan
dc.contributor.affiliation Cohen, J., George Washington University, Medical Center, Washington, DC, United States
dc.contributor.affiliation Crisp, N., Independent Member of House of Lords, London, United Kingdom
dc.contributor.affiliation Evans, T., James P Grant School of Public Health, Dhaka, Bangladesh
dc.contributor.affiliation Fineberg, H., US Institute of Medicine, Washington, DC, United States
dc.contributor.affiliation Garcia, P., School of Public Health, Universidad Peruana Cayetano, Heredia, Lima, Peru
dc.contributor.affiliation Ke, Y., Peking University, Health Science Centre, Beijing, China
dc.contributor.affiliation Kelley, P., US Institute of Medicine, Washington, DC, United States
dc.contributor.affiliation Kistnasamy, B., National Health Laboratory Service, Johannesburg, South Africa
dc.contributor.affiliation Meleis, A., School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
dc.contributor.affiliation Naylor, D., University of Toronto, Toronto, ON, Canada
dc.contributor.affiliation Pablos-Mendez, A., Rockefeller Foundation, New York, NY, United States
dc.contributor.affiliation Reddy, S., Public Health Foundation of India, New Delhi, India
dc.contributor.affiliation Scrimshaw, S., Sage Colleges, Troy, MI, United States
dc.contributor.affiliation Sepulveda, J., Bill and Melinda Gates Foundation, Seattle, WA, United States
dc.contributor.affiliation Serwadda, D., Makarere University, School of Public Health, Kampala, Uganda
dc.contributor.affiliation Zurayk, H., Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
dc.contributor.authorAddress Frenk, J.; Harvard School of Public Health, Office of the Dean, Kresge Building, 677 Huntington Avenue, Boston, MA 02115, United States; email:
dc.contributor.authorCorporate University: American University of Beirut; Faculty: Faculty of Health Sciences; Department: Center for Research on Population and Health;
dc.contributor.authorDepartment Center for Research on Population and Health
dc.contributor.faculty Faculty of Health Sciences
dc.contributor.authorInitials Frenk, J
dc.contributor.authorInitials Chen, L
dc.contributor.authorInitials Bhutta, ZA
dc.contributor.authorInitials Cohen, J
dc.contributor.authorInitials Crisp, N
dc.contributor.authorInitials Evans, T
dc.contributor.authorInitials Fineberg, H
dc.contributor.authorInitials Garcia, P
dc.contributor.authorInitials Ke, Y
dc.contributor.authorInitials Kelley, P
dc.contributor.authorInitials Kistnasamy, B
dc.contributor.authorInitials Meleis, A
dc.contributor.authorInitials Naylor, D
dc.contributor.authorInitials Pablos-Mendez, A
dc.contributor.authorInitials Reddy, S
dc.contributor.authorInitials Scrimshaw, S
dc.contributor.authorInitials Sepulveda, J
dc.contributor.authorInitials Serwadda, D
dc.contributor.authorInitials Zurayk, H
dc.contributor.authorOrcidID yan, liu-0000-0001-8517-1084
dc.contributor.authorReprintAddress Frenk, J (reprint author), Harvard Univ, Sch Publ Hlth, Off Dean, Kresge Bldg,Room 1005,677 Huntington Ave, Boston, MA 02115 USA.
dc.contributor.authorResearcherID Dharamsi, Shafik-H-3165-2011; yan, liu-A-1822-2015
dc.contributor.authorUniversity American University of Beirut
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dc.description.citedCount 530
dc.description.citedTotWOSCount 526
dc.description.citedWOSCount 500
dc.format.extentCount 36
dc.identifier.coden LANCA
dc.identifier.pubmedID 21112623
dc.identifier.scopusID 78649871039
dc.publisher.address 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
dc.relation.ispartOfISOAbbr Lancet
dc.relation.ispartOfIssue 9756
dc.relation.ispartofPubTitle The Lancet
dc.relation.ispartofPubTitleAbbr Lancet
dc.relation.ispartOfVolume 376
dc.source.ID WOS:000285439800034
dc.type.publication Journal
dc.subject.otherIndex accreditation
dc.subject.otherIndex Africa
dc.subject.otherIndex Asia
dc.subject.otherIndex behavioral risk factor surveillance system
dc.subject.otherIndex cost
dc.subject.otherIndex environmental factor
dc.subject.otherIndex Europe
dc.subject.otherIndex financial management
dc.subject.otherIndex geographic distribution
dc.subject.otherIndex health care availability
dc.subject.otherIndex health care personnel
dc.subject.otherIndex health care policy
dc.subject.otherIndex health care quality
dc.subject.otherIndex health care system
dc.subject.otherIndex health program
dc.subject.otherIndex information technology
dc.subject.otherIndex market
dc.subject.otherIndex medical education
dc.subject.otherIndex medical information system
dc.subject.otherIndex medical practice
dc.subject.otherIndex medical school
dc.subject.otherIndex midwife
dc.subject.otherIndex nurse
dc.subject.otherIndex nursing education
dc.subject.otherIndex physician
dc.subject.otherIndex postgraduate education
dc.subject.otherIndex practice guideline
dc.subject.otherIndex priority journal
dc.subject.otherIndex professional competence
dc.subject.otherIndex professional knowledge
dc.subject.otherIndex public health service
dc.subject.otherIndex review
dc.subject.otherIndex vocational education
dc.subject.otherIndex Western Hemisphere
dc.subject.otherIndex Curriculum
dc.subject.otherIndex Developed Countries
dc.subject.otherIndex Developing Countries
dc.subject.otherIndex Education, Medical
dc.subject.otherIndex Education, Professional
dc.subject.otherIndex Health Care Reform
dc.subject.otherIndex Health Manpower
dc.subject.otherIndex Health Personnel
dc.subject.otherIndex Humans
dc.subject.otherIndex Internationality
dc.subject.otherKeywordPlus MEDICAL-EDUCATION
dc.subject.otherKeywordPlus PUBLIC-HEALTH
dc.subject.otherKeywordPlus HUMAN-RESOURCES
dc.subject.otherKeywordPlus GLOBAL HEALTH
dc.subject.otherKeywordPlus SOCIAL ACCOUNTABILITY
dc.subject.otherKeywordPlus CHRONIC DISEASES
dc.subject.otherKeywordPlus POOR COUNTRIES
dc.subject.otherKeywordPlus FLEXNER REPORT
dc.subject.otherKeywordPlus BRAIN-DRAIN
dc.subject.otherWOS Medicine, General and Internal

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