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      Conflict of Interest Policies at Medical Schools and Teaching Hospitals: A Systematic Review of Cross-sectional Studies

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          Abstract

          Background: This systematic review aims to estimate the proportion of medical schools and teaching hospitals with conflicts of interest (COI) policies for health research and education, to describe the provisions included in the policies and their impact on research outputs and educational quality or content.

          Methods: Experimental and observational studies reporting at least one of the above mentioned aims were included irrespective of language, publication type or geographical setting. MEDLINE, Scopus, Embase and the Cochrane Methodology Register were searched from inception to March 2020. Methodological study quality was assessed using an amended version of the Joanna Briggs Institute’s checklist for prevalence studies.

          Results: Twenty-two cross-sectional studies were included; all were conducted in high-income countries. Of these, 20 studies estimated the prevalence of COI policies, which ranged from 5% to 100% (median: 85%). Twenty studies assessed the provisions included in COI policies with different assessment methods. Of these, nine analysed the strength of the content of medical schools’ COI policies using various assessment tools that looked at a range of policy domains. The mean standardised summary score of policy strength ranged from 2% to 73% (median: 30%), with a low score indicating a weak policy. North American institutions more frequently had COI policies and their content was rated as stronger than policies from European institutions. None of the included studies assessed the impact of COI policies on research outputs or educational quality or content.

          Conclusion: Prevalence of COI policies at medical schools and teaching hospitals varied greatly in high-income countries. No studies estimated the prevalence of policies in low to middle-income countries. The content of COI policies varied widely and while most European institutions ranked poorly, in North America more medical schools had strong policies. No studies were identified on impact of COI policies on research outputs and educational quality or content.

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          Most cited references37

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          Meta-analysis in clinical trials

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            Two-sided confidence intervals for the single proportion: comparison of seven methods.

            Simple interval estimate methods for proportions exhibit poor coverage and can produce evidently inappropriate intervals. Criteria appropriate to the evaluation of various proposed methods include: closeness of the achieved coverage probability to its nominal value; whether intervals are located too close to or too distant from the middle of the scale; expected interval width; avoidance of aberrations such as limits outside [0,1] or zero width intervals; and ease of use, whether by tables, software or formulae. Seven methods for the single proportion are evaluated on 96,000 parameter space points. Intervals based on tail areas and the simpler score methods are recommended for use. In each case, methods are available that aim to align either the minimum or the mean coverage with the nominal 1 -alpha.
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              Transformations Related to the Angular and the Square Root

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                Author and article information

                Journal
                Int J Health Policy Manag
                Int J Health Policy Manag
                Kerman University of Medical Sciences
                International Journal of Health Policy and Management
                Kerman University of Medical Sciences
                2322-5939
                August 2022
                03 March 2021
                : 11
                : 8
                : 1274-1285
                Affiliations
                1Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark and Odense University Hospital, Odense, Denmark.
                2Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom.
                3Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
                4Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.
                5Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark.
                Author notes
                [* ]Correspondence to: Alice Fabbri Email: af987@ 123456bath.ac.uk
                Author information
                https://orcid.org/0000-0001-8413-0440
                Article
                10.34172/ijhpm.2021.12
                9808354
                33812349
                610fee27-f761-4c50-843e-8a9ae1ed4420
                © 2022 The Author(s); Published by Kerman University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 December 2020
                : 06 February 2021
                Page count
                Figures: 3, Tables: 2, References: 45, Pages: 12
                Categories
                Systematic Review

                conflict of interest,policies,industry,medical schools,teaching hospitals

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