Quantity and quality of conflict of interest policies at German medical schools: a cross-sectional study and survey

ObjectivesTo assess the quantity and evaluate the quality of policies and curricula focusing on conflicts of interests (COI) at medical schools across Germany.DesignCross-sectional study, survey of medical schools, standardised web search.SettingMedical schools, Germany.Participants38 German medical schools.InterventionsWe collected relevant COI policies, including teaching activities, by conducting a search of the websites of all 38 German medical schools using standardised keywords for COI policies and teaching. Further, we surveyed all medical schools’ dean’s offices. Finally, we adapted a scoring system for results we obtained with 13 categories based on prior similar studies.Main outcomes and measuresPresence or absence of COI-related policies, including teaching activities at medical school. The secondary outcome was the achieved score on a scale from 0 to 26, with high scores representing restrictive policies and sufficient teaching activities.ResultsWe identified relevant policies for one medical school via the web search. The response rate of the deans’ survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI.ConclusionsOur results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at the respective school and only two schools had policies in place. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools, there is still a long way to go.

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Quality of life among adult patients living with diabetes in Rwanda: a cross-sectional study in outpatient clinics

BMJ Open ◽

10.1136/bmjopen-2020-043997 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043997

Author(s):

Charilaos Lygidakis ◽

Jean Paul Uwizihiwe ◽

Michela Bia ◽

Francois Uwinkindi ◽

Per Kallestrup ◽

...

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Cross Sectional Study ◽

Diabetes Control ◽

Outpatient Clinics ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Social Burden

ObjectivesTo report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors.DesignCross-sectional study, part of the baseline assessment of a cluster-randomised controlled trial.SettingOutpatient clinics for non-communicable diseases of nine hospitals across Rwanda.ParticipantsBetween January and August 2019, 206 patients were recruited as part of the clinical trial. Eligible participants were those aged 21–80 years and with a diagnosis of diabetes mellitus for at least 6 months. Illiterate patients, those with severe hearing or visual impairments, those with severe mental health conditions, terminally ill, and those pregnant or in the postpartum period were excludedPrimary and secondary outcome measuresDisease-specific quality of life was measured with the Kinyarwanda version of the Diabetes-39 (D-39) questionnaire. A glycated haemoglobin (HbA1c) test was performed on all patients. Sociodemographic and clinical data were collected, including medical history, disease-related complications and comorbidities.ResultsThe worst affected dimensions of the D-39 were ‘anxiety and worry’ (mean=51.63, SD=25.51), ‘sexual functioning’ (mean=44.58, SD=37.02), and ‘energy and mobility’ (mean=42.71, SD=20.69). Duration of the disease and HbA1c values were not correlated with any of the D-39 dimensions. A moderating effect was identified between use of insulin and achieving a target HbA1c of 7% in the ‘diabetes control’ scale. The most frequent comorbidity was hypertension (49.0% of participants), which had a greater negative effect on the ‘diabetes control’ and ‘social burden’ scales in women. Higher education was a predictor of less impact on the ‘social burden’ and ‘energy and mobility’ scales.ConclusionsSeveral variables were identified as predictors for the five dimensions of quality of life that were studied, providing opportunities for tailored preventive programmes. Further prospective studies are needed to determine causal relationships.Trial registration numberNCT03376607.

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Nursing students’ interprofessional educational experiences in the clinical context: findings from an Italian cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-025575 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025575 ◽

Cited By ~ 1

Author(s):

Alvisa Palese ◽

Silvia Gonella ◽

Anna Brugnolli ◽

Irene Mansutti ◽

Luisa Saiani ◽

...

Keyword(s):

Nursing Students ◽

Learning Environment ◽

Linear Mixed Model ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Clinical Rotation ◽

Sectional Study ◽

Cross Sectional ◽

Generalised Linear Mixed Model

ObjectiveTo explore nursing students’ interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences.DesignNational cross-sectional study on data collected in 2016.Setting95 Bachelor of Nursing Sciences programmes; 27 Italian Universities.ParticipantsStudents who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study.Primary and secondary outcomesFirst to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence.MeasuresThe primary outcome was measured using questions based on a 4-point Likert scale (from 0=‘never’ to 3=‘always’). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire.Results9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities ‘only a little’, to ‘some extent’ or ‘always’, respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences.ConclusionsA large number of nursing students experienced either ‘never’ or ‘only a little’ IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students’ interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels.

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‘Well-being paradox’ revisited: a cross-sectional study of quality of life in over 4000 adults with congenital heart disease

BMJ Open ◽

10.1136/bmjopen-2021-049531 ◽

2021 ◽

Vol 11 (6) ◽

pp. e049531

Author(s):

Caroline Sophie Andonian ◽

Sebastian Freilinger ◽

Stephan Achenbach ◽

Peter Ewert ◽

Ulrike Gundlach ◽

...

Keyword(s):

Quality Of Life ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Patient Reported

ObjectiveThe present cross-sectional study investigated quality of life (QOL) in a large cohort of German adults with congenital heart disease (ACHDs) in association with patient-related and clinical variables.DesignCross-sectional survey.ParticipantsBetween 2016 and 2019, a representative sample of 4014 adults with various forms of congenital heart defect (CHD) was retrospectively analysed. Inclusion criteria were confirmed diagnosis of CHD; participant aged 18 years and older; and necessary physical, cognitive and language capabilities to complete self-report questionnaires.Primary and secondary outcome measuresQOL was assessed using the 5-level EQ-5D version (EQ-5D-5L). Sociodemographic and medical information was obtained by a self-devised questionnaire. Associations of QOL with patient-reported clinical and sociodemographic variables were quantified using multiple regression analysis and multiple ordinal logit models.ResultsOverall, ACHDs (41.8±17.2 years, 46.5% female) reported a good QOL comparable to German population norms. The most frequently reported complaints occurred in the dimensions pain/discomfort (mean: 16.3, SD: p<0.001) and anxiety/depression (mean: 14.3, p<0.001). QOL differed significantly within ACHD subgroups, with patients affected by pretricuspid shunt lesions indicating the most significant impairments (p<0.001). Older age, female sex, medication intake and the presence of comorbidities were associated with significant reductions in QOL (p<0.001). CHD severity was positively associated with QOL within the dimensions of self-care (OR 0.148, 95% CI 0.04 to 0.58) and mobility (OR 0.384, 95% CI 0.19 to 0.76).ConclusionCurrent findings temper widely held assumptions among clinicians and confirm that ACHDs experience a generally good QOL. However, specific subgroups may require additional support to cope with disease-related challenges. The negative correlation of QOL with age is especially alarming as the population of ACHDs is expected to grow older in the future.Trial registration numberDRKS00017699; Results.

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Conflict of Interest Policies at German medical schools - A long way to go

10.1101/809723 ◽

2019 ◽

Cited By ~ 1

Author(s):

Peter Grabitz ◽

Zoe Friedmann ◽

Sophie Gepp ◽

Leonard U. Hess ◽

Lisa Specht ◽

...

Keyword(s):

Medical Students ◽

Medical School ◽

Web Search ◽

Response Rate ◽

Conflicts Of Interest ◽

Medical Schools ◽

Pharmaceutical Marketing ◽

Maximum Score ◽

Prescribing Behaviour

AbstractBackgroundMost medical students are in contact with the pharmaceutical or medical device industry during their studies. Medical schools play an important role in protecting students from undue commercial influence and educating them about pharmaceutical marketing practices. Such influence has been shown to affect later prescribing behaviour with potential adverse effects for patient care. While in North America, many medical schools formulated and implemented conflicts of interest (COI) policies, only few such institutional policies have been reported in Germany. We aimed to analyze the quantity and quality of policies and curricula on COI at medical schools across Germany.MethodsWe collected relevant COI policies and teaching activities by conducting a search of the websites of all 38 German medical schools using standardized keywords for COI policies and teaching. Further, we surveyed all medical schools’ dean’s offices and adapted a scoring system for obtained results with 13 categories based on prior similar studies.ResultsWe identified relevant policies for one medical school via the web-search. The response rate of the deans’ survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI.ConclusionOur results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at their respective school. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools there is still a long way to go.

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Quality of advertisements for prescription drugs in family practice medical journals published in Australia, Canada and the USA with different regulatory controls: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-034993 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034993 ◽

Cited By ~ 1

Author(s):

Dion Diep ◽

Abnoos Mosleh-Shirazi ◽

Joel Lexchin

Keyword(s):

Risk Reduction ◽

Family Practice ◽

Prescription Drugs ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Number Needed To Treat ◽

Sectional Study ◽

Cross Sectional ◽

The Usa

ObjectiveTo assess if different forms of regulation lead to differences in the quality of journal advertisements.DesignCross-sectional study.ParticipantsThirty advertisements from family practice journals published from 2013 to 2015 were extracted for three countries with distinct regulatory pharmaceutical promotion systems: Australia, Canada and the USA.Primary and secondary outcome measuresAdvertisements under each regulatory system were compared concerning three domains: information included in the advertisement, references to scientific evidence and pictorial appeals and portrayals. An overall ranking for advertisement quality among countries was determined using the first two domains as the information assessed has been associated with more appropriate prescribing.ResultsAdvertisements varied significantly for number of claims with quantitative benefit (Australia: 0.0 (0.0–3.0); Canada: 0.0 (0.0–5.0); USA: 1.0 (0.0–6.0); p=0.01); statistical method used in reporting benefit (relative risk reduction, absolute risk reduction and number needed to treat; Australia: 6.7%, n=2; Canada: 10.0%, n=3; USA: 36.6%, n=11; p=0.02); mention of adverse effects, warnings or contraindications (Australia: 13.3%, n=4; Canada: 23.3%, n=7; USA: 53.3%, n=16; p=0.002); equal prominence between safety and benefit information (Australia: 25.0%, n=1; Canada: 28.6%, n=2; USA: 75.0%, n=12; p=0.04); and methodological quality of references score (Australia: 0.4150 (0.25–0.70); Canada: 0.25 (0.00–0.63); USA: 0.25 (0.00–0.75); p<0.001). The USA ranked first, Canada second and Australia third for overall quality of journal advertisements. Significant differences for humour appeals (Australia: 3.3%, n=1; Canada: 13.3%, n=4; USA: 26.7%, n=8; p=0.04), positive emotional appeals (Australia: 26.7%, n=8; Canada: 60.0%, n=18; USA: 50.0%, n=15; p=0.03), social approval portrayals (Australia: 0.0%, n=0; Canada: 0.0%, n=0; USA: 10.0%, n=3; p=0.04) and lifestyle or work portrayals (Australia: 43.3%, n=13; Canada: 50.0%, n=15; USA: 76.7%, n=23; p=0.02) were found among countries.ConclusionsDifferent regulatory systems influence journal advertisement quality concerning all measured domains. However, differences may also be attributed to other regulatory, legal, cultural or health system factors unique to each country.

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1167 A Cross-Sectional Study of Undergraduate Exposure and Teaching of Trauma and Orthopaedics in The UK

British Journal of Surgery ◽

10.1093/bjs/znab259.896 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S M Choi ◽

S Z Y Ooi ◽

E C Carpenter

Keyword(s):

Medical Students ◽

Medical School ◽

Clinical Teaching ◽

Great Influence ◽

Medical Schools ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Total Length ◽

The Uk

Abstract Aim Research has shown exposure to specialities as a medical student can have a great influence in choice of career. Exposure to potential mentors during this time also has an additive effect on career shaping of medical students. It is important to encourage interest in trauma and orthopaedics (T&O) to ensure the best candidates are selected. Our aim was to establish the compulsory duration of T&O teaching provided by all (non-new) medical schools. This study also aims to identify which other specialities were taught alongside T&O. Method Surveys were distributed to medical students in all 33 (non-new) medical schools, through surgical societies and colleagues met through courses, between June 2019- February 2020. The survey asked the total length of compulsory teaching of T&O in days, and how this was divided into pre-clinical or clinical teaching. Results Data for all 33 UK medical schools were collected. Only 7 medical schools taught T&O as a standalone subject. The other 26 medical schools combined T&O with other specialities, most commonly with Rheumatology (n = 16). The average total length of days of T&O teaching across medical school was 17 days (range 3-60). Majority of this teaching was given in the clinical years of medical school (n = 30). Conclusions Research has shown medical students require enough exposure to increase their interest in pursuing a particular speciality. Currently there is a huge variance on the number of compulsory teaching days for T&O.

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