Individual(s) Ethan Kung1, Allessandro Giardini2, T-Y Hsia2, Alison Marsden1, MOCHA Investigators2
Institution(s) 1UCSD, La Jolla, CA; 2Great Ormond Street Hospital for Children, London, United Kingdom

ACCME - DISCLOSURE REQUIREMENT:
CME Activity Conflict of Interest Policy with Disclosure and Acceptance of Responsibility Form

Policy and Definitions

The Cine-Med is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Also, Cine-Med designates educational activities for AMA PRA Category 1 Credit™. As such, the Cine-Med, has the obligation to ensure the delivery of education that is balanced, independent from commercial interests, free of commercial bias, objective, and scientifically rigorous.

Learners participating in all formats of CME activities sponsored, co-sponsored, or jointly provided by the Cine-Med must be provided the opportunity to properly evaluate the objectivity of the information, analysis, and recommendations presented during an activity. It is important that the learners be informed of any aspect of personal or professional circumstance, originating with anyone in a position to control educational content, out of which a perception of a conflict of interest would arise.

A commercial interest is defined by the ACCME as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, with some exceptions, such as, eligible non-profit or government organizations, non-health care related companies, and providers of clinical service directly to patients. Circumstances calling for disclosure include, but are not limited to: receipt of financial support from a commercial interest, as defined above, for research activities or other scientific work reported on during the program, or, a personal financial or proprietary interest in, or consultant relationship to, a company that is a commercial supporter of the activity or whose product or service is discussed as part of the subject matter of the activity. Specifically, any financial relationship in any amount occurring in the last twelve (12) months (even if the relationship has been divested), including those of a spouse/partner, must be disclosed.

A conflict of interest exists wherein an individual has or uses the opportunity to inject bias based on the held financial interest into the educational content or dissemination of related information. According to the ACCME, financial relationships create actual conflicts of interest in CME when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest, as defined above.

Based on the above, ALL CME-related persons involved with content, including committee members, activity chairs/co-chairs, reviewers, presenters, moderators, authors, editors, staff, and others as applicable, must:

Disclose any aspect of his/her personal or professional circumstances which might reasonably be related to the educational activity content or material being presented or disseminated OR indicate that they have nothing to disclose.

Confirm that any financial relationship/affiliation disclosed will in no way influence the content of material being presented or disseminated. For persons with oversight responsibility, recusal from the formulation process is required for any CME activity or activity segment which is directly related to the held financial relationship.

Confirm that the above submitted disclosure statement must, and will, be stated verbally from the podium prior to presentation and included in print on any audio/visual or handout material. Cine-Med will additionally publish the submitted disclosure information in related activity materials, in print and/or online, as applicable.

Presenters/Authors: Confirm that the presentation/educational materials will contain absolutely NO recommendations or promotion regarding any products or services for which a financial relationship exists. ANY mention of a product or device within the verbal presentation, visuals or handout material MUST be technique/procedure oriented only; must be based on peer reviewed, best available evidence/independent unbiased scientific research, and will relate to content in a way that conforms to the standards of medical care published within generally accepted literature.

Confirm that all educational materials submitted (slides, handouts, articles, etc.) will contain and will be reviewed for the proper disclosure statement(s) and references to the best available evidence.

Confirm that no commercial support or honoraria will be accepted from outside sources for participation in CME activity content formulation, approval, individual presentation, publication, or attendance at a program.

Presenters/Authors: Confirm that the guidelines outlined in the disclosure/Acceptance of Responsibility/ Form will be followed, including but not limited to presentation, handout and audio-visual content, verbal and written disclosures, identification and resolution of conflict of interest, and honoraria policies.

Acknowledge that if reasonable information is obtained by the accredited provider which results in doubt as to the validity of the confirmations above, that participation in the related activity formulation will be revoked; a replacement may be assigned and/or the material substituted, or other action taken, as appropriate.

Please provide info in table for the last 12 months and use actual corporate names. (Trade names or product group messages will not be published, therefore only component or generic names may be used, IF needed to clarify a financial relationship or affiliation.

NOTE: ACCME does NOT require disclosure of CME speaker/author honoraria if it is from an accredited provider.

* Royalty recipient, grant recipient, employee, intellectual property rights holder, independent contractor, board member, review panel member, patent holder, expert witness, speakers’ bureau member, etc. are examples of other terminology used to describe the nature of a financial relationship with a commercial interest.

If you have disclosed a financial interest please review the following, which lists the mechanisms have been identified for resolving conflict of interest. If a real or apparent conflict of interest is disclosed above, please check all that apply:

* Have you disclosed a financial interest?
Yes    No

Actions to be taken for final resolution of conflict of interest (COI) will be approved or directed by the CME Planning Committee/Program Chairs, etc. responsible for oversight of the CME activity. Alternate suggestions for resolving specific conflicts of interest may be discussed with the appropriate persons responsible for planning the activity.

Acceptance of Responsibility

All the recommendations involving clinical medicine in a CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindication in the care of patients. All scientific research referred to, reported or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis. Within my role(s) in this activity, I will ensure balance, independence, objectivity, and scientific rigor.

I attest that I have read the above responsibilities and will comply; the information I submit is accurate.
Required Signature (First and Last Name): *