'You feel like you've been duped': is the current system for health professionals declaring potential conflicts of interest in the UK fit for purpose? A mixed methods study.

OBJECTIVE: To understand: if professionals, citizens and patients can locate UK healthcare professionals' statements of declarations of interests, and what citizens understand by these. DESIGN: The study sample included two groups of participants in three phases. First, healthcare professionals working in the public domain (health professional participants, HPP) were invited to participate. Their conflicts and declarations of interest were searched for in publicly available data, which the HPP checked and confirmed as the 'gold standard'. In the second phase, laypeople, other healthcare professionals and healthcare students were invited to complete three online tasks. The first task was a questionnaire about their own demographics. The second task was questions about doctors' conflicts of interest in clinical vignette scenarios. The third task was a request for each participant to locate and describe the declarations of interest of one of the named healthcare professionals identified in the first phase, randomly assigned. At the end of this task, all lay participants were asked to indicate willingness to be interviewed at a later date. In the third phase, each lay respondent who was willing to be contacted was invited to a qualitative interview to obtain their views on the conflicts and declaration of interest they found and their meaning. SETTING: Online, based in the UK. PARTICIPANTS: 13 public-facing health professionals, 379 participants (healthcare professionals, students and laypeople), 21 lay interviewees. OUTCOME MEASURES: (1) Participants' level of trust in professionals with variable conflicts of interest, as expressed in vignettes, (2) participants' ability to locate the declarations of interest of a given well-known healthcare professional and (3) laypeoples' understanding of healthcare professionals declarations and conflicts of interest. RESULTS: In the first phase, 13 health professionals (HPP) participated and agreed on a 'gold standard' of their declarations. In the second phase, 379 citizens, patients, other healthcare professionals and students participated. Not all completed all aspects of the research. 85% of participants thought that knowing about professional declarations was definitely or probably important, but 76.8% were not confident they had found all relevant information after searching. As conflicts of interest increased in the vignettes, participants trusted doctors less. Least trust was associated with doctors who had not disclosed their conflicts of interest. 297 participants agreed to search for the HPP 'gold standard' declaration of interest, and 169 reported some data. Of those reporting any findings, 61 (36%) located a relevant link to some information deemed fit for purpose, and 5 (3%) participants found all the information contained in the 'gold standard'. In the third phase, qualitative interviews with 21 participants highlighted the importance of transparency but raised serious concerns about how useful declarations were in their current format, and whether they could improve patient care. Unintended consequences, such as the burden for patients and professionals to use declarations were identified, with participants additionally expressing concerns about professional bias and a lack of insight over conflicts. Suggestions for improvements included better regulation and organisation, but also second opinions and independent advice where conflicts of interest were suspected. CONCLUSION: Declarations of interest are important and conflicts of interest concern patients and professionals, particularly in regard to trust in decision-making. If declarations, as currently made, are intended to improve transparency, they do not achieve this, due to difficulties in locating and interpreting them. Unintended consequences may arise if transparency alone is assumed to provide management of conflicts. Increased trust resulting from transparency may be misplaced, given the evidence on the hazards associated with conflicts of interest. Clarity about the purposes of transparency is required. Future policies may be more successful if focused on reducing the potential for negative impacts of conflicts of interest, rather than relying on individuals to locate declarations and interpret them. TRIAL REGISTRATION NUMBER: The protocol was pre-registered at https://osf.io/e7gtq.

Investigation into financial conflicts of interest and screening for atrial fibrillation in the UK: a cross-sectional study.

OBJECTIVE: To understand the relationship between financial conflicts of interest and recommendations for atrial fibrillation (AF) screening in the UK, via examining (1) if the UK media recommend for or against screening for AF, and (2) the financial conflicts of interests of AF screening commentators. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: References in UK mainstream media, Twitter, the UK's National Health Service (NHS), patient information websites and major UK heart-related charities regarding screening for AF between1 January 2018 and 31 July 2021. OUTCOME MEASURES: Proportion of references advocating for, against and presenting balanced/neutral views on screening. Proportion of references citing commentators with financial conflicts of interest. RESULTS: 217 media stories were identified, containing 284 comments about screening for AF. 185/217 (85.3%) of articles were in favour, 9 (4.1%) were against and 23 (10.6%) were balanced. Quotations within were located from 194 commentators; 44 were quoted more than once. 41/44 (93.2%) were in favour of screening. Of these 41, 37 (90.2%) had a direct or indirect financial conflict of interest, including that due to a work role. Two were balanced and one was negative. 2553 tweets using 3 hashtags promoting screening were analysed. 2119 (83%) of the most impactful tweets promoting AF screening were by industry or organisations with industry funding. Of 23 NHS organisations holding information about funding and promoting AF screening online, 22 (96%) had industry funding. 9 (90%) of the top 10 patient information websites promoting AF screening had industry funding. Four main UK patient charities in this sector promoting screening received industry funding. CONCLUSIONS: The vast majority of UK media promotes screening for AF, in contrast to the position of the independent UK National Screening Committee, which recommends against screening. Most commentators, internal NHS organisations and UK charities promoting screening had a direct or indirect financial conflict of interest. Independent information was rare. The reasons for this are unknown. Readers should consider the potential for the impact of financial conflicts on recommendations to screen.

How are declarations of interest working? A cross-sectional study in declarations of interest in healthcare practice in Scotland and England in 2020/2021.

OBJECTIVE: To understand arrangements for healthcare organisations' declarations of staff interest in Scotland and England in the context of current recommendations. DESIGN: Cross-sectional study of a random selection of National Health Service (NHS) hospital registers of interest by two independent observers in England, all NHS Boards in Scotland and a random selection of Clinical Commissioning Groups (CCGs) in England. SETTING: NHS Trusts in England (NHSE), NHS Boards in Scotland, CCGs in England, and private healthcare organisations. PARTICIPANTS: Registers of declarations of interest published in a random sample of 67 of 217 NHS Trusts, a random sample of 15 CCGs of in England, registers held by all 14 NHS Scotland Boards and a purposeful selection of private hospitals/clinics in the UK. MAIN OUTCOME MEASURES: Adherence to NHSE guidelines on declarations of interests, and comparison in Scotland. RESULTS: 76% of registers published by Trusts did not routinely include all declaration of interest categories recommended by NHS England. In NHS Scotland only 14% of Boards published staff registers of interest. Of these employee registers (most obtained under Freedom of Information), 27% contained substantial retractions. In England, 96% of CCGs published a Gifts and Hospitality register, with 67% of CCG staff declaration templates and 53% of governor registers containing full standard NHS England declaration categories. Single organisations often held multiple registers lacking enough information to interpret them. Only 35% of NHS Trust registers were organised to enable searching. None of the private sector organisations studied published a comparable declarations of interest register. CONCLUSION: Despite efforts, the current system of declarations frequently lacks ability to meaningfully obtain complete healthcare professionals' declaration of interests.

Long-term atmospheric deposition of current-use and banned pesticides in Atlantic Canada; 1980-2000.

The occurrence of current-use and banned pesticides is reported in wet-precipitation collected from four sites across Atlantic Canada during the period 1980-2000. The most frequently detected compounds were alpha-HCH, gamma-HCH (lindane), chlorothalonil, pentachlorophenol, atrazine, and endosulfan. Median site concentrations varied between not-detected and 10.2 ng l(-1). Deposition of HCHs (hexachlorocyclohexane), chlorothalonil, and endosulfan at Kejimkujik (Keji) and Jackson, Nova Scotia, were generally similar. Significant spatial differences (p<0.05), however, were found for the HCH isomers and endosulfan at Keji and Gros Morne (Newfoundland and Labrador), areas geographically separated by the northern Gulf of St. Lawrence. Long-term deposition of alpha-HCH decreased (p<0.05) at both Keji (1980-2000) and Gros Morne (1994-2000), with half-lives of 5.9 and 4.5 y, respectively. A decreasing trend was also found for pentachlorophenol with a half-life of 4.9 y at Jackson. Significant negative trends (p<0.05) were observed for alpha-/gamma-HCH ratios during the study at Keji and Jackson, possibly reflecting changes in production and use patterns of technical HCH and lindane on a continental and perhaps hemispheric scale. Seasonal trends for alpha-HCH and gamma-HCH were found to vary over the 20-y study period at Keji, however, spatial trends were generally similar between sites. Seasonal trends were observed with peak deposition generally occurring during the growing period (spring-summer) for the HCHs, chlorothalonil, endosulfan, and atrazine. Bimodal seasonal trends were also observed for these compounds with the exception of endosulfan.

Multiple frontal systems controlling response speed.

This study evaluated a model of attention that postulates several distinct component processes, each mediated by specific neural systems in the human frontal lobes. A series of reaction time (RT) tests (simple, choice, and prepare) examined the hypothesis that different attentional processes are related to distinct regions within the frontal lobes. These tests were given to 38 patients with frontal lesions and 38 age-matched control subjects. Lesions were localized both by general regions (superior medial, inferior medial, left and right lateral) and by individual architectonic areas. Lesions in the superior medial (SM) frontal lobes, particularly involving areas 24 and 32 on the right, were associated with slow RT in all tests and with failure to decrease RT after a warning signal. Lesions in the right lateral (RL) frontal lobe, centred in area 9/46v, prevented the decrease in RT with increasing foreperiod that was seen in normal subjects and in patients with lesions elsewhere in the frontal lobes. The ability to energize a response for rapid RT, either generally or specifically following a warning stimulus, is sensitive to lesions of the right SM. Monitoring of stimulus occurrence and response behaviour in order to enhance the speed of response to upcoming stimuli is sensitive to RL lesions.

Maintaining the Characteristics of Effective Clinical Teachers in Computer Assisted Learning Environments.

There has been a growing trend in medical education to integrate the use of computers into the undergraduate medical curriculum. While it seems intuitively obvious that personal computers and the Internet can be useful learning tools, it is not clear that the perceived advantages of Computer Assisted Instruction (CAI) are warranted. One problem is that computers are too often used in CAI simply as presentation devices for predefined material without ample consideration paid to the pedagogical principles that have informed more conventional teaching practices. The creation of an environment that is conducive to effective learning has often been overlooked in favour of the development and use of increasingly more sophisticated technologies. The current paper represents an attempt to delineate ways in which we might better develop instructional multimedia programs by employing some of the strategies believed to characterise effective clinical teaching. To do so, this paper will briefly review the work of Irby and others in an attempt to draw attention to ways in which the characteristics identified by these researchers might be implemented for the use of CAI.