You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Welcome to the BMJ Open blog. BMJ Open is an open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas.

Find out more about the journal here.

We will be updating the blog with news about the journal, highly accessed papers, press coverage, events and matters of interest in the open access and publishing world, and anything else that catches our eye.

Should we stop talking about ‘negative’ results?

22 May, 15 | by Richard Sands, Managing Editor

 

BMJ Open recently published the results of a major EU-funded project (OPEN) investigating the problem of dissemination bias. Also know as publication bias, this is the distortion of the evidence base caused by selective or non-reporting of results. The authors concluded:

‘Despite various recent examples of dissemination bias and several initiatives to reduce it, the problem of dissemination bias has not been resolved.’

Many journals, including BMJ Open, have peer review processes that don’t judge importance, novelty or impact, making publishing so-called negative studies easier.

Still, the perception remains that authors find it harder to publish these studies or remain reluctant to do so. If this is true, how important is the terminology we use? Would more ‘negative’ results be published if we called them something else?

The term ‘negative result’ is used widely.  The EU OPEN project used it (OPEN Stands for ‘Overcome failure to Publish nEgative findings’). It appears in journal titles, such as the Journal of Negative Results in Biomedicine. There’s a PLOS negative results collection. Professor Stephen Curry from Imperial College wrote about the importance of negative results for UK newspaper The Guardian.

BMJ Open encourages researchers to publish their studies, especially trials, regardless of results. It’s a premise of the AllTrials campaign, initiated by BMJ. In this spirit, we recently promoted this paper on Twitter. In it, Andrew Wilson and colleagues at the University of East Anglia report a randomised controlled study of maintenance sessions following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. They concluded “We do not recommend that our maintenance programme is adopted.”

To promote the paper and our willingness to consider this kind of study, we tweeted the paper with the comment that it was great that the authors were publishing their RCT ‘despite [a] negative result’.

The feedback from researchers was interesting. “Don’t talk about ‘negative results’ in trials” said Ruairidh Milne (@ruairidhm). “Best not to talk about ‘negative’ and ‘positive’ results in trials” said Shaun Treweek (@shauntreweek); “An important result rather than negative.” Andrew Cook (@ajcook) commented “I meet people who think trials which show now [sic] effect are a waste – calling them negative doesn’t help arguing how useful they are”.

All good points and we haven’t even covered that there are different types of ‘negative’ result (papers showing evidence of the absence of an effect or papers reporting an absence of evidence can both be labelled ‘negative’).

So – should we be thinking about what we call studies like these? Is the term ‘negative result’ just too… negative? Could it be influencing authors (or editors) unduly and if so what should we be calling these studies?

Increasing the value of health research, e-cigarettes and the role of hospital managers in patient safety: Most read articles in April

7 May, 15 | by flee

April’s Top 10 Most Read includes a selection of new entries; including a bibliometric analysis on increasing the value of health research in the WHO African Region by Uthman et al and an article on non-health decision-makers’ use of evidence on the social determinants of health written by McGill et al. Parand et al’s systematic review on the role of hospital managers in quality and patient safety has made it’s way back up to the top of the table.

Rank Author(s) Title
1 Parand et al. The role of hospital managers in quality and patient safety: a systematic review
2 Uthman et al. Increasing the value of health research in the WHO African Region beyond 2015—reflecting on the past, celebrating the present and building the future: a bibliometric analysis
3 Parsons et al. What the public knows and wants to know about medicines research and development: a survey of the general public in six European countries
4 Moore et al. Electronic-cigarette use among young people in Wales: evidence from two cross-sectional surveys
5 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
6 Hubble et al. Trunk muscle exercises as a means of improving postural stability in people with Parkinson’s disease: a protocol for a randomised controlled trial
7 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
8 Cripton et al. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics
9 Rachiotis et al. What has happened to suicides during the Greek economic crisis? Findings from an ecological study of suicides and their determinants
10 McGill et al. Trading quality for relevance: non-health decision-makers’ use of evidence on the social determinants of health

Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

UK doctors unlikely to be able to repay student loans

20 Apr, 15 | by fpearson

UK doctors are unlikely to be able to repay their student loans over the course of their working lives, amassing debts of more than £80,000 by the time they graduate, in some cases, finds research published in the online journal BMJ Open.

What’s more, there are clear gender differences in the amount of cash required to service these debts, the analysis shows, with women paying more in interest, despite earning less than men.

The researchers base their findings on the average earnings of 4286 doctors working more than 30 hours a week, who had taken part in national Labour Force Surveys between 1997 and 2014.

Annual tuition fees amount to £9000 for English students attending UK universities, and most medical degrees take five years to complete.

Since 2012, students have been able to borrow the annual fees and get a maintenance loan to cover living costs from the Student Loan Company.

Repayments are charged at an annual interest rate of 3% plus annual inflation rate (Retail Price Index) and based on 9% of salary earned above £21,000 gross income. Debts are automatically written off after 30 years, irrespective of the sums outstanding.

A medical student graduating in 2014 would have clocked up a debt of £40,000 for tuition fees.
If maintenance loans are factored in, this would add £24,000 for a student living at home; an additional £30,000 for a student living away from home; and £42,000 for a student living away from home in London, amounting to a total of between £64,000 and £82,000 by the time of graduation.

The survey responses showed that average full time salaries rose with age, but then gradually fell after the age of 55, with a wide gap in earnings starting to emerge between men and women from the age of 30 onwards.

At the age of 55, male doctors earned 35% more than their female colleagues, which was mainly attributable to hourly wage rates rather than the number of hours worked.

The researchers used the average age-salary profiles, projected future repayments, and cumulative debt levels to calculate the total sums required to service the loans.

For those borrowing against tuition fees alone, full time male doctors would have to stump up £57,303 to clear their debts over 20 years, while their female colleagues would need to find just short of £62,000 over a period of 26 years.

When maintenance loans were factored in, the researchers calculated that the total sums to be repaid added up to £75,786 for an initial debt above £46,000 for women doctors and £110,644 for an initial debt above £65,145 for their male colleagues.

For initial debts below £50,000, women repay more, despite earning less, because their debt lasts longer and accrues more interest. But for initial debts above £50,000, men repay more because their average yearly salaries are higher.

The researchers point out for those able to repay their loans within the 30 year timeframe, a higher yearly salary is advantageous because an early repayment means less interest. But for those unable to pay off their loans, a lower salary is advantageous, because it means lower yearly repayments and the writing off of the residual debt.

“It seems reasonable that these repayment variations may actually exist across many graduate careers in the UK,” write the researchers. “It is also apparent that at the current level of fees, even small changes in the student loan contract will have substantial implications for lifetime wealth across different income groups, across male and female graduates, and on the sustainability of the student loans system.”

Many teens try e-cigarettes, but few become regular users

15 Apr, 15 | by fpearson

E-cigarettes are popular with teens, including those who have never smoked, but few of those who try them become regular users, while most of those who do so are also smokers, finds research published in the online journal BMJ Open.

The researchers base their findings on the results of two nationally representative surveys of primary and secondary schoolchildren (CHETS Wales 2 and the Welsh Health Behaviour in School aged Children) from more than 150 schools in Wales carried out in 2013 and 2014.

In all, 1601 children aged 10-11 and 9055 11-16 year olds were quizzed about their use of e-cigarettes.

Use of e-cigarettes at least once was more common than having smoked a conventional cigarette among all age groups, except the oldest (15-16 year olds).

Some 5.8% of 10-11 year olds had tried e-cigarettes—far more than had tried tobacco (1.6%)—while a sizeable proportion (12.3%) of 11-16 year olds said they had used e-cigarettes, irrespective of gender, ethnic background, or family affluence.

This contrasts with the patterning seen in smoking, where all these factors come into play, suggesting that e-cigarettes may have wider appeal among all sectors of the teen population, say the researchers.

Similarly, the proportion of teens who had used e-cigarettes, but who had never smoked, rose from 5.3% among 10-11 year olds, to 8% among 15-16 year olds.

But only 1.5% (125) of those aged 11-16 said they used e-cigarettes regularly—defined as at least once a month. This included 0.3% of those who claimed they had never smoked conventional cigarettes.

These figures suggest that “e-cigarettes are unlikely to make a major direct contribution to adolescent nicotine addiction at present,” write the researchers, who point out that the World Health Organization has recognised that there is little evidence on whether e-cigarettes may or may not act as a gateway to conventional smoking.

The odds of regular e-cigarette use were 100 times higher among current weekly smokers than among non-smokers, and 50 times higher among those who had smoked cannabis

The strong link between current smoking and e-cigarette use suggests that teens are not using these products to help them quit smoking, say the researchers.

They admit that a lack of consensus about what constitutes ‘use’ of an e-cigarette presents something of a challenge for research in this area, and suggest that further much longer term studies to include the generation of young people who have grown up with e-cigarettes are needed before firmer conclusions can be drawn.

UK research cash for dementia and stroke still way too low

14 Apr, 15 | by flee

The amount of government money pumped into dementia and stroke research in the UK has risen significantly in recent years, but it is still way too low when compared with the economic and personal impact these conditions have, finds a study published in BMJ Open.

The researchers assessed central government and charity research expenditure in 2012 into the UK’s leading causes of death and disability: cancer, coronary heart disease, dementia and stroke.

In 2012, all four conditions accounted for over half (55%) of all UK deaths and for 5.5 million disability adjusted life years (DALYs), which combine the number of years of life lost to early death, ill health, or disability.

The amount of funding was compared with the population impact of the individual conditions: prevalence, the number of years lost to early death, ill health, or disability, and the total health and social care costs.

The combined amount of research funding allocated by the government and charities to all four conditions came to £856 million in 2012, almost two thirds of which (64%; £544 million) was allocated to cancer.

Around one fifth (19%; £166 million) was devoted to coronary heart disease, while just 11% (£90 million) was allocated to dementia and even less (7%; £56 million) to stroke research.

That same year, there were around 2.3 million cases of cancer, the same number of coronary heart disease cases, 0.8 million cases of dementia and 1.2 million of stroke.

In 2012 a total of 2.9 million DALYs were lost to cancer, 1.5 million to coronary heart disease, 0.4 million to dementia and 0.7 million to stroke.

The costs of healthcare were highest for cancer (£4.4 billion) and lowest for dementia at £1.4 billion and for stroke at £1.8 billion.

But the social care costs of dementia outweighed the social care costs of the other three conditions combined. And the combined costs of health and social care for dementia came to £11.6 billion in 2012, the researchers calculated.

This was more than double the equivalent costs for cancer at £5 billion, and significantly more than for stroke (£2.9 billion) and coronary heart disease (£2.5 billion).

This means that for every £10 of health and social care costs attributable to each condition, £1.08 in research funding was spent on cancer, £0.65 on coronary heart disease, £0.19 on stroke, and just £0.08 on dementia, the researchers calculated.

Since 2010, there have been substantial changes in medical research funding policies, particularly by government organisations, which pumped 21% of the total share into dementia research and 12% into stroke research in 2012, with cancer attracting 46% of the total spend.

The equivalent figures in 2008 were 66% for cancer, 21% for coronary heart disease, 9% for dementia, and just 4% for stroke.

But the sums allocated by charities have scarcely budged since 2008, say the researchers. Charities are reliant on public funds so this stasis may be down to public perception of risk or a form of ageism, derived from the belief that stroke and dementia are inevitable only in the elderly, they suggest.

Despite the shift in funding priorities, research into the treatment and prevention of dementia and stroke remains underfunded when compared with the economic and personal impact these conditions have, they conclude.

Children with type 1 diabetes almost 5 times as likely to be admitted to hospital

13 Apr, 15 | by fpearson

Children with type 1 diabetes run almost five times the risk of being admitted to hospital for any reason as their peers, finds research published in the online journal BMJ Open.

Pre-schoolers and those from disadvantaged backgrounds are most at risk, the findings indicate.

The number of new cases of childhood type 1 diabetes has been rising steadily by around 3-4% a year, the evidence shows, and the risk of death among those with the condition under the age of 30 is nine times that of the general public.

The researchers analysed the causes of hospital admission after a diagnosis of type 1 diabetes among 1577 Welsh children up to the age of 15.

All these children had been diagnosed with type 1 diabetes between 1999 and 2009, and their details entered into the Brecon Group Register—a network of healthcare professionals caring for children and young people with diabetes normally resident in Wales.

Around one in five children had been diagnosed with type 1 diabetes before the age of 5; two in five had been diagnosed after the age of 10.

Their hospital records were compared with those of 7800 children admitted to hospital up to May 2012, who had been randomly selected from the Patient Episode Database for Wales (PEDW), and matched for birth date, sex, and residential area.

The results showed that children with type 1 diabetes were almost five times as likely to be admitted to hospital for any cause as their peers.

Pre-schoolers were at highest risk of admission. After the age of 5 the risk fell by more than 15% for every five year rise in age at diagnosis.

Although there was no gender difference in risk, coming from a disadvantaged background was associated with an increased risk of hospital admission.

And those whose outpatient care was delivered at large centres were 16% less likely to be admitted to hospital as those treated in small centres. Most (78%) of those treated at large centres lived in urban areas.

“It is unsurprising that complications of suboptimal management, such as hypoglycaemia [low blood sugar] and ketoacidosis [excess sugar and acid in the blood] occur, leading to hospitalisation,” write the researchers.

But the personal costs to the individual and their families, and the financial toll on the NHS are considerable, they say.

They add: “This is an area of great clinical importance as patients admitted to hospital with diabetes aged under 30 years have a death rate nine times that of the general population.”

Cycling injuries, the Greek economic crisis and Parkinson’s disease: Most read articles in March

7 Apr, 15 | by flee

March’s Top 10 Most Read includes a selection of new entries; a national survey on the patterns and trends in sources of information about sex among young people in Britain by Tanton et al and an article on the severity of urban cycling injuries and crash characteristics written by Cripton et al. Articles which are still proving to be popular include Koch et al.’s article on abortion legislation, and Parand et al.‘s systematic review of the role of hospital managers in quality and patient safety.

Rank Author(s) Title
1 Koch et al. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states
2 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
3 Parand et al. The role of hospital managers in quality and patient safety: a systematic review
4 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
5 Tanton et al. Patterns and trends in sources of information about sex among young people in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles
6 Cripton et al. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics
7 Hubble et al. Trunk muscle exercises as a means of improving postural stability in people with Parkinson’s disease: a protocol for a randomised controlled trial
8 Rachiotis et al. What has happened to suicides during the Greek economic crisis? Findings from an ecological study of suicides and their determinants
9 Esposito et al. A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 163 patients
10 Hsia et al. Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis

 

Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

The impact of economic austerity, sleep and electronics and abortion leglisation: Most Read Articles in February

5 Mar, 15 | by flee

February’s Top 10 Most Read includes a selection of new entries, including a time-series analysis on the impact of economic austerity on suicide in Greece written by Branas et al and Hysing et al.’s population-based study on sleep and the use of electronic devices. Articles which are still proving to be popular include Petrilli et al.’s article on the role of physician attire on patient perception, and Bourne et al.‘s cross sectional survey on the impact of complaints procedures on the welfare, health and clinical practice of UK doctors.

Rank Author(s) Title
1 Branas et al. The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis
2 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
3 Petrilli et al. Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators
4 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
5 Esposito et al. A nomogram to estimate the HbA1c response to different DPP-4 inhibitors in type 2 diabetes: a systematic review and meta-analysis of 98 trials with 24 163 patients
6 Bourne et al. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey
7 Hubble et al. Trunk muscle exercises as a means of improving postural stability in people with Parkinson’s disease: a protocol for a randomised controlled trial
8 Parand et al. The role of hospital managers in quality and patient safety: a systematic review
9 Rah et al. Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys
10 Koch et al. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states

 

Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

BMJ Open’s fourth anniversary

23 Feb, 15 | by Richard Sands, Managing Editor

Today is the fourth anniversary of BMJ Open publishing its first papers.

Since 23 February 2011 we have published over 3000 open access papers with our open peer review process.

One hundred of these papers have accompanying datasets in the Dryad data repository. We are still one of very few medical journals integrated with Dryad to make linking data to articles as simple as possible.

As well as open review and open data, we try to contribute to open science by publishing research protocols. These are detailed research study plans published in advance of the research being undertaken, keeping the community informed and aiding accountability. Twenty-three percent of the papers we published in 2014 were protocols.

BMJ Open papers are increasingly influential. Ninety-one percent of the papers we published in 2011 have citations recorded in the Web of Science; 76% of 2012’s papers and 60% of 2013’s papers are also already cited there.

Four papers are now classed as ‘Highly cited’ by the Web of Science:

As well as being cited by other researchers, papers from BMJ Open regularly make the news. Click on the ‘In the news’ tag on the right hand side to see some of the papers that have hit the headlines in recent months. Many papers also boast impressive altmetric scores (you can see these by scrolling down below the abstract or article) showing how often they get disseminated through social media or by reference management programs. Most importantly, people read the articles (they are open access, after all). Our website received over 2.7 million page views in 2014.

BMJ Open doesn’t discriminate editorially on grounds of perceived impact but still publishes papers that attract attention, get cited and reach a wide audience.

Thank you to all the reviewers who have helped make BMJ Open the journal it is and to all the authors who have trusted us with their research. We are excited to see what the next 12 months hold.

Thank you to our reviewers – 2014

18 Feb, 15 | by fpearson

After a very busy year at BMJ Open, in which over 1100 papers were published, we would like to say a big thank you to all of our reviewers who contributed in 2014. All that we achieved last year would not have been possible without the help of the many referees who gave thorough and detailed reviews which are essential to our decision making process. The comments and evaluations provided by our reviewers allow us to maintain the quality and scientific validity necessary to the continued success of BMJ Open.

Since its conception BMJ Open has been tirelessly dedicated to provide a home for all properly conducted medical research from all disciplines and therapeutic areas. Our rigorous and transparent peer review process has been crucial to achieving this aim, because of this, we are pleased to be able to continue to offer the 25% reviewers discount to those who submit manuscripts within 12 months of completing their review and also give CME accreditation for the submission of timely and thorough comments.
The BMJ Open team is truly thankful for the continued hard work and support of our peer reviewers and we look forward to the year ahead.