Conflicts of interest (COI) among the UpToDate oncology management authors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13573-e13573
Author(s):  
Madhuri Chengappa ◽  
Aakash Desai ◽  
Ronald S. Go ◽  
Thejaswi K. Poonacha
Keyword(s):  
Clinical Practice ◽  
Clinical Management ◽  
Expert Witness ◽  
Conflicts Of Interest ◽  
Utilization Distribution ◽  
Potential Conflict ◽  
Advisory Boards ◽  
Clinical Resource ◽  
Management Recommendations ◽  
The Impact

e13573 Background: UpToDate is an evidence based clinical resource designed to provide current clinical information. It is a widely used clinical practice tool providing evidenced based recommendations for diagnosis, management, and therapy. The extent of COI among the UpToDate authors has not been well studied. Our study evaluated the extent of COI of UpToDate authors involved in medical management recommendations for the 10 most common cancers in United States. Methods: We examined the latest November 2020 version of the UpToDate clinical management recommendations for 10 most common cancers. Using disclosure lists, we catalogued COIs for participants in each work group. The categories included: Category I- Grant/Research/Clinical Trial Support; Category II- Consultant/Scientific Advisory Boards/Expert witness; Category III- Speakers Bureau; Category IV- Equity Ownership/Stock Options/Patent holder/Employment/Other Financial Interest; and Category V- Spouse/Domestic Partner/Dependent Potential Conflict. We cataloged the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of an individual in 1 company in 1 category for each cancer section. Results: There was a total of 207 authors including section and deputy editors of oncology management section. All authors completed their COI disclosures (100%). 128 (62%) of a total of 207 individuals reported COIs. A total of 1343 episodes were disclosed. We found that each author had an average of 10.49 episodes overall. Authors involved in Category I, II, III, IV & V were 6.3%, 13.5%, 3.2%, 4.7% and 1.6% respectively. 29.36% authors were involved both in Category I and II. A total of 672 company affiliations were associated with COI disclosure. AstraZeneca (6.10%), Merck (4.31%) and Novartis (2.68%) were the companies most frequently reported. The guideline with the maximum episodes (223) was prostate cancer. Conclusions: COIs are prevalent among authors of UpToDate clinical management recommendations. More than ½ of the participants disclosed at least 1 COI, but there appears to be a substantial number of experienced experts without COIs. Further research studies are necessary to determine the impact of these COIs on clinical practice patterns and resource utilization. Distribution of COI and total episodes.[Table: see text]

Financial conflicts of interest among the National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (CPG) Panelists in 2019.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 15-15
Author(s):  
Aakash Desai ◽  
Madhuri Chengappa ◽  
Ronald S. Go ◽  
Thejaswi Poonacha
Keyword(s):  
Expert Witness ◽  
Conflicts Of Interest ◽  
Standard Of Care ◽  
Nccn Guidelines ◽  
Non Hodgkin Lymphoma ◽  
Advisory Boards ◽  
The Us ◽  
Financial Conflicts Of Interest ◽  
Cancer Network ◽  
The Impact

15 Background: CPG are evidence-based guidelines, which serve as a standard of care in practice, quality improvement, and reimbursement. The extent of financial conflicts of Interest (FCOI) in NCCN guidelines has not been recently evaluated. Our study evaluated the extent of FCOI in the NCCN CPG among the 10 most common malignancies in the US. Methods: We examined the latest 2019 version of the NCCN CPG for the 10 most common cancers by incidence in the US. Using disclosure lists, we catalogued the FCOIs for the panelists under various categories outlined in the CPG. We also tabulated the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. “Affiliation” describes a commercial, industry, or institute affiliation reported by a panelist in each episode. Results: Of the 491 panelists on the CPG, 483 (98.3%) completed FCOI disclosures. 224 (46.38%) reported at least 1 FCOI. A total of 1,103 episodes were disclosed with an average of 4.9 episodes per panelist with FCOI. Being a part of scientific advisory boards, consultant, or expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1,103 episodes of FCOI. The top companies were Bristol Myers Squibb, Merck, Genentech and AstraZeneca. Among the top 10 cancers, the prevalence of FCOI were lung (56%), bladder (52%), pancreatic (52%), non-Hodgkin lymphoma (50%), kidney (49%), colorectal (43%), breast (42%), melanoma (40%), prostate (38%), and uterine (32%). Among the panelists with FCOI, 26%, 17%, and 57% reported 1, 2, and > 3 episodes, respectively. There were 127 episodes among the CPG chairs/vice chairs who reported FCOI (mean 6.4). The chairs/vice chairs of uterine, pancreatic, melanoma, and prostate cancer CPG did not have any FCOI. Conclusions: FCOI are very prevalent among the top 10 NCCN CPG panelists. In almost half of the CPG, the majority of the panelists had at least 1 FCOI. Over half of the CPG chairs/vice chairs reported multiple FCOI. Further studies are necessary to determine the impact of these FCOI.

scholarly journals The Defeat Depression Campaign

1997 ◽  
Vol 21 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Ann Macaskill ◽  
Norman Macaskill ◽  
A. Nicol
Keyword(s):  
Clinical Practice ◽  
Royal College ◽  
Questionnaire Survey ◽  
Clinical Management ◽  
The Public ◽  
Health Practitioners ◽  
The Impact

The Royal College of Psychiatrists launched a five year campaign in 1992 to better inform health practitioners and the public about depression. A questionnaire survey of Sheffield general practitoners (GPs) to assess the impact of the Defeat Depression Campaign on their knowledge and clinical management of depression was carried out in May 1994, half way through the campaign. Overall, 75% of GPs who responded indicated that the Defeat Depression Campaign had had little or no impact on their clinical practice. It would appear that at its mid-point the Defeat Depression Campaign failed to achieve its main goals in relation to educating GPs about depression and its management.

Nature and extent of financial conflicts of interest among National Comprehensive Cancer Network (NCCN) clinical practice guidelines panel members.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16555-e16555
Author(s):  
Anusha Reddy Madadi ◽  
Ronald S. Go
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Expert Witness ◽  
Conflicts Of Interest ◽  
Research Support ◽  
Expert Opinions ◽  
Non Hodgkin Lymphoma ◽  
Financial Conflicts Of Interest ◽  
Cancer Network

e16555 Background: NCCN Clinical Practice Guidelines are the most widely recognized and comprehensive clinical policies used in oncology written by multidisciplinary panels of expert physicians from NCCN member institutions. However, the recommendations are largely developed from lower levels of evidence or expert opinions, and therefore, potentially vulnerable to influence by financial conflicts of interest (FCOIs) (Poonacha T, et al. J Clin Oncol 2011;29:186-191). Objective: We performed this study to describe the nature and extent of self-reported FCOIs of NCCN panel members among the 10 most common cancers in the US. Methods: We obtained the disclosures from the NCCN website (accessed December 1, 2011). FCOIs are reported under 4 categories: clinical research support (research), advisory board/speaker bureau/expert witness/consultant (honoraria), patent/equity/royalty (equity), and other remunerations. Results: There are 330 panel members with a mean of 33 per panel. Most (94%), but not all, disclosures are up to date as of 2011. 141 (43%) panel members reported FCOIs. The extent of FCOIs among panel members according to disease sites are as follows: non-Hodgkin lymphoma (60%), breast (52%), kidney (49%), colorectal (48%), lung (47%), prostate (41%), bladder (40%), melanoma (29%), thyroid (28%), and uterine (25%) cancers. 74% (n=23) of writing committee members and 83% of panel chairs have FCOIs. Among the panel members with FCOIs, 51%, 48 %, 1%, and 1% of the FCOIs are related to research, honoraria, equity, and other remunerations, respectively. Of those with non-research FCOIs (n=109), 38%, 29%, and 33%, reported 1, 2-3, and >4 disclosures, respectively Conclusions: ASubstantial proportions of NCCN panel members as well as the majority of panel chairs and writing committee members have FCOIs. Nearly half of the FCOIs are unrelated to research support. While the actual impact of FCOIs on the NCCN recommendations cannot be determined from our study, the potential for such influence can be considerable.

scholarly journals Pharmacogenomics, CYP2D6, and Tamoxifen: A Survey of the Reasons Sustaining European Clinical Practice Paradigms

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 344
Author(s):  
Reis ◽  
Carvalho ◽  
Fernandes
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Clinical Management ◽  
Hospital Setting ◽  
Economic Factors ◽  
Breast Cancer Patients ◽  
Survey Analysis ◽  
Management Board ◽  
The Impact ◽  
Clinical Bias

Tamoxifen is a drug that is often used in the clinical management of breast cancer. CYP2D6 is a key metabolizing enzyme that is involved in the conversion of tamoxifen to its active drug metabolites. CYP2D6 has several alleles that metabolize tamoxifen and other drugs at different rates that can alter therapeutic impact, a characteristic that renders it one of the most studied enzymes in the field of pharmacogenetics. Background and objectives: Portugal has no implemented measures based on pharmacogenomics analysis prior to therapy that might function as a cultural sample control when analyzing the individual and economic factors present in clinical practice paradigms. Therefore, we aim to investigate the impact of CYP2D6 genotyping of the tamoxifen metabolizing enzymes in the clinical management of breast cancer patients. Materials and Methods: Qualitative/quantitative studies regarding the impact of pharmacogenomics in breast cancer; personal interviews in different Portuguese laboratories within hospital setting using a survey. Analysis of data through interviews to management board and/or decision makers from major oncological centers. Results: Reasons for common adoption of pharmacogenomics practice are contradictory and based both in economic factors and cultural/clinical bias. Conclusions: This research study identifies specific cultural and/or clinical bias that act as obstacles to pharmacogenomic implementation and proposes viable courses of action that might bring about change in cultural/medical habits.

scholarly journals The First Registry: Follow-up in Rivaroxaban Patients in the Setting of Venous Thromboembolism

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4737-4737
Author(s):  
Kathryn Jane Lang ◽  
Vicente Solis ◽  
Jignesh Patel ◽  
Julia Czuprynska ◽  
Lara N Roberts ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Treatment Algorithm ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
The Impact

Abstract The direct oral anticoagulants (DOACs) are revolutionising the management of acute venous thromboembolism (VTE). Although favourable short term outcomes have been demonstrated with these agents, there is a growing need to improve our understanding of biological and clinical predictors of longer-term outcomes with all DOACs. In addition to reducing the need for dual anticoagulant coverage, the use of oral rivaroxaban, has accelerated the implementation of outpatient and early discharge treatment protocols for VTE, in particular for pulmonary embolism (PE). Although clinical trials provide evidence of efficacy and safety, there is a need for ongoing assessment of outcomes in unselected populations treated in routine 'real-world' clinical practice. As for most drugs, conditions requiring special attention include advanced age, impaired renal or liver function, extremes of body weight, presence of multiple co-morbidities, and the need for concomitant therapies. Such conditions commonly co-exist, particularly in elderly patients. In clinical practice patients aged 80 years or older and requiring anticoagulation are becoming increasingly common. In addition, trials do not report long-term adverse outcomes after VTE; aside from bleeding, currently there are no long-term data that assess the impact of the DOACs as part of a single-drug treatment algorithm on long-term recurrence. The FIRST registry will assess long-term outcomes of patients with acute VTE treated with rivaroxaban from diagnosis - our hypothesis is that the long-term outcomes for such patients will be favourable due to consistent anticoagulation intensity, particularly during the acute phase of thrombosis. There are currently no data describing post-thrombotic syndrome (PTS) or chronic thromboembolic pulmonary hypertension (CTEPH) incidence rates in patients treated with DOACs. Patients enrolled onto the FIRST registry will be followed up for five years with primary end-points defined as incidence of long-term sequelae (PTS and CTEPH, defined clinically) and secondary endpoints including recurrence, bleeding and anticoagulation related satisfaction and adherence scores. Analysis of these data may also contribute to improved risk stratification strategies to identify patients who have the greatest risk of adverse bleeding events, recurrence and long-term VTE-related morbidity. Recruitment is currently underway at 20 UK hospitals, with a target of 1500 patients, to be achieved by summer 2017. Disclosures No relevant conflicts of interest to declare.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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