BRITISH JOURNAL OF ANAESTHESIA
Disclosure of Interests
The British Journal of Anaesthesia requires disclosure of interests by all authors so
that the editors and readers of the journal may determine whether any conflict of
interest exists. A conflict of interest does not preclude the authors from contributing
to the journal but it is essential that this is clearly and openly stated in the
manuscript. This form must be completed with details for ALL authors. The
completed form must be submitted through ScholarOne along with the initial
submission of your manuscript.
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Authors’ Names: Click here to enter text.
Manuscript Title: Click here to enter text.
Date of completion: Click here to enter a date.
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In each of the questions that follow, for every author, text must be entered. If no
competing interest exists then please type “No interest declared”; if any potential
competing interest does exist, then enter details, including the value of any financial
involvement and any aspect that may represent a conflict of interest in your
contribution to the journal. Example of response to question 1:
AB Smith: No interest declared.
CD Harbor: CDH has received payments and travel funding for overseas lectures from ABZ
Pharmaceuticals Inc. Total funding approximately £15,000.
EF Lancer: EFL has received £25,000 to perform clinical studies from IOLabs Ltd.
GH Mansori: No interest declared.
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1.
Commercial organisations: within the past 5 years, have you or a member
of your household* had any involvement with commercial organisations whose
business or financial interests may be affected by the activities of the British Journal
of Anaesthesia or the publication of your manuscript? This includes the receipt of
funding from commercial companies, the conduct of contracted research, and
industry-supplied funding for lectures, travel and department support.
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2.
Consultancy / board activity: within the past 5 years, have you or a
member of your household* advised or acted as a consultant for any organisations
whose activities affect or compete with the British Journal of Anaesthesia or whose
activities may be affected by the publication of your contribution? This includes
membership of editorial boards of journals publishing in anaesthesia, critical care
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and pain medicine, consulting for equipment or pharmaceutical manufacturers, or
membership of national/international committees relating to the subject matter of
the manuscript.
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3.
Personal financial gain: do you or a member of your household* have any
personal financial interests (e.g. ownership of stocks/shares) that may be affected
by the activities of the British Journal of Anaesthesia or the publication of your
contribution? Do you or a member of your household* have any patents (received or
pending) whose success or commercial viability may be affected by the activities of
the British Journal of Anaesthesia or the publication of your contribution?
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By selecting YES in the field below, I confirm that:
1. I provide this information to the British Journal of Anaesthesia with my full
consent
2. I attest that the information I have provided in this form is correct.
3. That all authors have seen this completed form and approve of its contents.
NO
Signed:
Typed Name
Signature
Date
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CORRESPONDING AUTHOR’S ADDRESS
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Tel. no.
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Fax no.
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E-mail address:
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*For the purposes of the declaration of interests, we define “your household” as your dependants, your spouse/partner and any
close relatives.
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