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Open access

Celebrating International Nurses Day #IND2016

12 May, 16 | by Emma Gray


International Nurses Day, celebrated on 12th May each year and coinciding with Florence Nightingale’s birthday, marks the important contributions nurses make to society. As the single largest group of health professionals, nurses care from the first moments of life right through to the final days. To show our appreciation of the work that nurses do, BMJ Open are joining in the celebrations today with a round-up of some of our most popular papers on nursing.

Published in 2015, Dall’Ora et al surveyed registered nurses across 12 European countries to find associations between working 12 hour shifts and job satisfaction, burnout and intention to leave. Receiving over 10,000 downloads since publication, this paper has some important conclusions, finding that longer work hours were indeed associated with adverse outcomes – not only for nurses but potentially for patients as well.

Also published last year was a cross-sectional study into the prevalence of workplace violence that nurses have encountered in Chinese hospitals. The authors, Jiao et al, found that a total of 7.8% of the nurses interviewed for the study had experienced physical violence at work in the previous year, and 71.9% reported experiencing non-physical violence. They aimed to identify risk factors and provide a basis for future interventions, concluding that preplacement education for high-risk groups should take place to reduce workplace violence, and increased awareness from the public as well as policymakers is necessary to develop effective control strategies at individual, hospital and national levels.

One of our most popular papers this year, receiving a press release and over 7,000 downloads since its publication in February, is the paper ‘Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study’ by Griffiths et al.  Aiming to examine associations between mortality and registered nurse staffing in English hospital trusts, the authors found that ward-based registered nurse staffing is significantly associated with reduced patient mortality, as are higher doctor staffing levels. They conclude by saying that current policies and practices on the staffing in hospital wards should be reviewed in line with the evidence, to reduce risks to patients.

A paper by Schlicht et al published back in 2013 sought to determine the safety and acceptability of the Australian TrueBlue model of nurse-managed care of depression in patients with diabetes or heart disease in the primary healthcare setting. Using a mixed methods study involving a clinical record audit as well as focus groups and interviews with nurses, the study found that nurses were able to identify, assess and manage mental health risks in patients with diabetes or heart disease.  The nurse consultations also meant that there was an opportunity for patients to set goals, as they received scheduled follow-up visits and were monitored regularly, leading to stepped care when appropriate.

The final paper in this short overview of our content on nursing is a review of the cost-effectiveness of nurse practitioners in primary and specialised ambulatory care. A systematic review of randomised controlled trials, conducted by Martin-Misener et al, found that nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. This evidence is promising, but there are few studies contributing to this evidence base at the moment: the authors conclude that while some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

More on International Nurses Day:

BMJ is offering free content and discounts on resources for nursing professionals until 12th June: 

To join in with the celebrations, tweet today to show appreciation of nurses using the hashtags #thankanurse #IND2016 and #InternationalNursesDay

OA Journals and Wikipedia: Open for collaboration

16 Oct, 15 | by aaldcroft

The theme of this year’s Open Access week is Open for Collaboration, with the aim of highlighting “the ways in which collaboration both inspires and advances the Open Access movement”. Recently BMJ Open published an article by Samy Azer and colleagues investigating whether articles in Wikipedia relating to cardiovascular disease were accurate enough to function as a suitable learning resource for medical students. The conclusions point to the limitations of Wikipedia, making us wonder, “How can scientists, editors, and non-expert readers work together to improve our open knowledge resources?”

Evolving connections

One of the key advantages of Open Access is that it enables an endless opportunity to collaborate. Openly available knowledge that can be connected via hyperlinks means that all participants in the Open Access community are free to work together to create a richer, more meaningful information landscape. One of the great achievements of the connected, online environment is, of course, Wikipedia. Currently the seventh most visited site on the internet, Wikipedia makes knowledge previously only available to those with the means to purchase it, available to anyone with an internet connection. But what is perhaps even more revolutionary is that the articles are not necessarily written by experts, but by anyone who has the desire to participate in the project. Known as Wikipedians, they are the driving force, and they strive to make Wikipedia more accurate, consistent, and complete. 

When considering Open Access collaboration, the origins of Wikipedia are noteworthy. Before Wikipedia, there was Nupedia–an abandoned project involving the founders of Wikipedia, Jimmy Wales and Larry Sanger, with Sanger acting as Editor-in-Chief. Like Wikipedia, the knowledge in Nupedia was openly available, but unlike Wikipedia, the knowledge was written by experts and underwent peer review prior to publication. In fact, the seven-stage editorial process of Nupedia closely resembles that used in BMJ Open and other scientific journals, with peer review as a crucial element:

  1. Assignment
  2. Finding a lead reviewer
  3. Lead review
  4. Open review
  5. Lead copyediting
  6. Open copyediting
  7. Final approval and markup

Ultimately, the strict control over quality made Nupedia unsustainable. Authors and reviewers often reached an impasse, and only a small number of articles were ever published. It did, however, blaze the trail for Wikipedia. Initially viewed by experts as unreliable, it was not long before there was evidence indicating that the accuracy of information in Wikipedia was as trustworthy as that in traditional encyclopedias.

Putting it all together

The evidence, however, also reveals the limits of Wikipedia. The study by Azer et al, for example, demonstrates that while Wikipedia presents an accurate overall picture of cardiovascular diseases, more detailed information, such as the pathophysiology, signs and symptoms, diagnostic approach, and treatment, are incomplete. Similar conclusions have been reached in studies investigating content on pathology, osteosarcoma, and drugs. Many caution that Wikipedia should not be used as a substitute for peer-reviewed material written by subject matter experts. These finding are, of course, not surprising. For a broad overview–or as a way to settle family disputes–Wikipedia is brilliant, but as a resource for expert medical knowledge, readers need to be more critical.

Despite the limitations, Wikipedia should not be sold short. Wikipedia offers a number of advantages over traditional learning resources, such as textbooks, because it enables self-directed learning and active engagement with knowledge–critical skills in today’s digitized world. For someone new to an area of study, Wikipedia is the perfect entry point.

So how can we put it all together?

We can’t expect Wikipedians to do everything. Instead, it is important for all of us–scientists, journal publishers, and readers–to collaborate. Experts–and particularly authors–should ensure that when work that is close to them is cited in Wikipedia, it is discussed accurately–and if it’s not, then they have a responsibility to edit it (and are free to do so). Similarly, non-experts whose interest is sparked by an entry in Wikipedia should have the opportunity to read the primary material, ideally in a source that is Open Access. For all parties involved, we must accept that knowledge will always be a work in progress and that what we can achieve through open collaboration is much more than we could achieve alone.

Thank you to our reviewers – 2014

18 Feb, 15 | by Fay Pearson

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.

Erik Martin: Author Profile

21 Nov, 14 | by flee

We are happy to introduce a new feature called Author Profiles where we interview BMJ Open authors to find out more about them and their work.

For our first author profile, we spoke to Erik Martin from Deakin University, Australia, to find out more about his research and his thoughts on Open Access. Erik is first author of the article ‘Exploring the implementation of the framework convention on tobacco control in four small island developing states of the Pacific: a qualitative study‘ which has recently won the CAPHIA 2014 Team Award for Excellence and Innovation in Public Health Research.

We welcome our readers’ thoughts and suggestions on this new feature. If you wish to suggest any questions to ask for future profiles you can do so by commenting at the end of the post.

-Tell us about yourself 

I started my career in science to pursue a career which involved making positive changes for society. I chose public health and health promotion as it is a discipline where there is great need and it is possible to make a difference for the betterment of quality of life for people at a population level. Tobacco control always interested me due to the sheer numbers of people it affects despite the fact that it is a human creation and evidence of its harms dates back many decades.

-What are the messages we should take from your paper?

There are a few:

– Tobacco as a public health issue is very far from being over.

– There are many ways in which tobacco control policies can be shaped, from the downstream in terms of legislation and its enforcement, to the upstream in terms of a country’s social, political, economic and cultural environment – just like health itself.

– As a result of the previous point, there are many potential points in which there can be a deviation from what a government says it will do (or what it intends to do) and what can happen on the ground once implemented.

– The Pacific Islands, despite having challenging environments for health policy, are making strong progress towards implementing tobacco control policies and thereby reducing the harm associated with the tobacco epidemic in the region.

-And what limitations should we be aware of?

The main limitation would be that of complexity. Given it is based on the primarily qualitative research on a highly complex issue that is shaped by many forces and is context-dependent and not reproducible in a controlled environment. That being said, this is also a strength as it explores this real world context.

-If you wanted to repeat your study, what would you be looking out for that may have taken you by surprise the first time around?

The time it takes to plan for and conduct research in far away places.

-What impact will your study have on the field?

It adds a level of detail that isn’t common in the public realm, especially in small and developing island nations such as those in the Pacific. It also draws upon political theory, which tends to be under-utilised in public health despite policy often being labelled a barrier to achieving public health goals.

-What still needs to be done in the field?

Many things in many different areas – too many to mention! In tobacco control specifically, there’s a lot more qualitative and quantitative research needed on the implementation and effectiveness of policies that many countries have sought to implement over the last decade.

-What feedback has your article generated?

It has generated positive feedback especially from relevant stakeholders in the region who are interested in and tackling the issues it presents.

-Congratulations on the CAPHIA 2014 Team Award for Excellence and Innovation in Public Health Research award! Tell us about it. How did it feel to win? What does this mean for your research?

The journey of a PhD can sometimes be seen as an insular and quiet one that seldom achieves recognition far beyond the research team, but in this case it was fantastic to receive an award and be recognised amongst some very distinguished peers in public health. It was an honour to receive this award and as well as giving me some great assurance, I believe it brings more welcomed attention to the issues my research aims to address.

-Had you heard of Open Access before submitting to BMJ Open? What are your thoughts about Open Access?

Yes I had – it’s a rather interesting new world for academia which is a field of great tradition. I think Open Access is a great opportunity for earlier career researchers to get their research out there in an increasingly competitive environment. That being said, it also has its challenges as there are several unknowns and it has changed the publishing landscape so rapidly.

-If funding was no object what would be your dream study to run?

I’d like to explore the in-depth experiences of more countries in relation to tobacco control policy. I’d also like to look into what is happening at community levels in extremely remote places that may not have access to the wealth of expertise, resources and information that we do in countries like Australia. Another area that would be interesting (though it’d be more than funding that is the barrier) would be to explore what has gone on behind the closed doors of the tobacco industry in order to shape public health policies.

-What advice would you offer to anyone starting out in the field?

Be patient and diligent and your hard work will be worth it.

-What’s next for you (personally and professionally)?

I’ve recently acquired an Associate Lecturer in Public Health position at the Deakin University School of Medicine, which has been a great experience so far in looking at the teaching side of things and developing my career as an academic. Nonetheless I’m simultaneously interested in continuing my research in tobacco control and perhaps following up on some of the Pacific Island countries I visited in 2011 to see how things have progressed. I’m also interested in exploring tobacco control policy at home in Australia, particularly amongst minority populations which still have very high tobacco use prevalence rates in comparison to the relatively low rate in the general population.


Open Access Week: the next generation

20 Oct, 14 | by sjohar

Open Access Week, a global event now entering its eighth year and running from the 20th – 26th October, is an opportunity for the academic and research community to continue to learn about the potential benefits of Open Access, to share what they’ve learned with colleagues, and to help inspire wider participation in helping to make Open Access a new norm in scholarship and research. BMJ Open takes a closer look at this year’s theme as announced by The Scholarly Publishing and Academic Resources Coalition (SPARC) – “Generation Open”. As explained by SPARC, this theme represents the role of the next generation of Open Access advocates, and also what impact any changes within scholarly publishing have upon the careers of scholars and researchers.

So why do we still need an annual Open Access Week? For a long time, establishing the rules and even the definition of Open Access remained an absolute necessity. The radical departure from traditional publishing models meant that early Open Access advocates had to face legitimate questions over the funding and sustainability of this business model, and address the possibility of its misuse (for example, in so-called ‘vanity publishing’). Such questions do, to a point, remain. Educating the publishing community about Open Access, however, has led to so much support that ideas including Open Access Week (and the Open Access Button) were able to flourish and garner a significant following of their own, enabling future generations to better inform others and build upon these foundations. In fact, the team behind the simple genius of the Open Access Button, where being unable to access a research article because of a paywall can be reported on, are/were largely students – how’s about that for ‘Generation Open’?!

At BMJ Open we welcome submissions from students as well as more established authors. We fully support Open Access Week and as such we’ve created a special landing page with some of our most read Open Access content and are offering a 15% discount on article publishing charges on all our fully open and hybrid titles between the 20th October and the 20th November.

Similarly, the shift by many publishers to Open Access continues unabated with hundreds of Open Access journals launched each year by several global publishers offering gold, green and hybrid Open Access options. Importantly, can and will government and institutional policy reflect this to also benefit future researchers who wish to make their work fully accessible? Well, policies introduced within the last few years are on their side. Relatively recent Open Access mandates from organisations such as Research Councils UK (with grant funding for gold Open Access) and the US government (with mandated deposition in public repositories, i.e. green Open Access) will no doubt be continually revised or perhaps even superseded to accommodate the needs of funders, researchers and publishers.

So, as we enter Open Access Week, what will the future hold for Open Access? Will the benefits still need espousing? Will we even need ‘advocates’ or will the foundations of the movement be so ingrained upon future researchers that the days of defending Open Access be reduced to just memories of a different era? Given initial, and, arguably, continuing scepticism, the fact that we are looking to the next generation of scholars to steer the Open Access movement forward is an achievement in itself. The future milestones they will reach and the innovations they will deliver have not yet been determined. Maybe the foundations will be laid at this year’s Open Access Week, but we wait with anticipation for where the next generation of Open Access leaders will take us.

And we will be ready to support them.

Comparing the results from two surveys of BMJ Open authors

9 May, 14 | by Richard Sands, Managing Editor


BMJ Open authors were among those surveyed by Professor David J Solomon of Michigan State University for a study recently published in the journal PeerJ.

Needless to say we read this with great interest (we were unaware of the survey until the results were published). The survey reported a generally positive response to BMJ Open specifically and open access megajournals in general. The low response rates mean that many of the specific results should be interpreted with caution, though.

The response rate from BMJ Open authors was the lowest in the Solomon study (187/728 respondents; 26%). A possible explanation for this is that we were surveying the same people (authors published in 2013) at what seems to have been around the same time, asking some similar questions. BMJ journals regularly survey authors, readers and reviewers to help us stay in touch with the research community. There were some notable similarities in results and some major differences.

We achieved a 47% response rate (401/849) and thought it might be of interest to summarise our results which were roughly comparable with Professor Solomon’s.

Like Professor Solomon we surveyed our authors about the most important factors behind their decision to submit to BMJ Open. We offered 12 options from which authors could choose three. There was no ranking of these three choices.

The three most important reasons for submitting to BMJ Open in Solomon’s survey were

  • the quality of the journal (28%)
  • reputation of the publisher (18%)
  • the impact factor (IF) (13.5).

In our survey, impact factor was much less important. The three most selected options were

  • open access (59%)
  • BMJ Group branded journal (50%)
  • speed of review (37%).

Reputation of the journal (34%) was the fourth most selected in our survey (the most comparable option we had to Solomon’s ‘quality of the journal’). Impact factor was only the ninth most important reason given (13%). The most popular option in our survey without a rough equivalent in Solomon’s was ‘ease of transfer from another BMJ journal’, selected by 29% of respondents as one of their three most important reasons for submitting.

Although open access was the most-selected reason for submitting to BMJ Open in our survey, 84% of respondents believed publishing in an open access journal was not a requirement of their funder or their institution.

66% of our respondents said BMJ Open was not their first choice for submission, similar to the 68% in Solomon’s paper. The broad scope of the journal was a 35% said they used institutional funds to pay the publishing charge followed by 29% who said they used a direct grant. The number who received a waiver (9%) in our survey was roughly similar to those in Prof. Solomon’s survey (11.4%); the actual figure for 2013 was around 10%.

Further comments
BMJ Open’s IF was announced in July 2013. Many of the authors surveyed may have submitted to and/or published in the journal before it was announced. This may make the answers that relate to its importance when submitting less reliable (in both surveys). Alternatively there may be a balance between authors who didn’t care that no IF had been announced and those that would not have submitted if the journal didn’t have one.

Though omitted as an option from the Solomon survey BMJ also has institutional membership schemes that cover APCs and you can read more about them here.

With regard to publishing preliminary findings, BMJ Open publishes research protocols as well as results papers. So some of the authors surveyed would not have been publishing any research findings in BMJ Open.

It was nice to see that Professor Solomon opted to make the peer review comments open. We use open review and are glad to see more journals bringing transparency into the review process.

We’ll gloss over BMJ Open being referred to as BMC Open. Twice …


Thank you to our reviewers – 2013

16 Jan, 14 | by sjohar

Peer review is a fundamental part of publishing. Perhaps nowhere more so than in the open access field, which is often more scrutinised than other traditional publishing routes. Recognising this, the BMJ Open team would like to thank all 2725 peer reviewers who refereed for the journal in 2013 – your advice and considered remarks were essential in ensuring the quality and scientific validity of our articles.

At BMJ Open, we are pleased to have several policies in place that highlight the importance of peer review. For example, our open peer review policy allows complete transparency over the history of an article, and gives credit to specific referees through the disclosure of their names and the publication of their comments. We also provide reviewers with a 25% discount on the article-publishing charge of any manuscript they subsequently submit as an author and give CME accreditation for the submission of timely and thorough comments.

BMJ Open appreciates the support and hard work of all the peer reviewers who gave their valuable time in contributing to the journal throughout 2013. We hope to work with you again and look forward to forging new relationships in 2014. Given our continued success since our launch, we cannot wait to see what this forthcoming year will bring.

Exploring open access in higher education

27 Oct, 11 | by Richard Sands, Managing Editor


BMJ Open will be taking part in the The Guardian’s Higher Education Network’s live blog/debate tomorrow on Exploring open access in higher education.

Discussion kicks off at noon, BST and will run until 2 pm. There is a large panel, drawn from publishing, academia, industry and policy.

The event will ‘consider the various ways in which higher education can become – and is becoming – more open. We will consider what the challenges ahead might be and what policy shifts, as well as cultural shifts are needed’.

If you can’t follow the discussion then, you can leave a comment or question in advance. Comments made during the chat will be shared on Twitter. The hashtag is #HElivechat

Open Access Week is here

25 Oct, 11 | by Richard Sands, Managing Editor


BMJ Open is proudly sponsoring Open Access Week 2011.

A global event, now in its fifth year, Open Access Week promotes open access as a new norm in scholarship and research. The website currently lists 119 upcoming events so have a look to see what is happening near you or browse their back catalogue of presentations and videos.

BMJ Open is the BMJ Group’s latest involvement with open access publishing, following the BMJ’s long-standing commitment to making its research open access and our specialty journals’ well-established Unlocked programme.

All BMJ Open articles are open access under a Creative Commons licence. As well as Open Access Week, BMJ Open and the BMJ Group also supports the Open Access Scholarly Publishers Association (OASPA) and deposits all its open access content with PubMed Central.

UK universities minister helps UK research councils affirm OA commitments

6 Jun, 11 | by Richard Sands, Managing Editor


The Higher Education Funding Council (HEFCE) and Research Councils UK (RCUK) – which includes the Medical Research Council – recently put out a joint statement reinforcing their open access commitments (here).

This announcement came in a speech by David Willetts, Minister for Universities and Science, showing the extent to which the principles of open access are gaining ground.

The RCUK position on open access specifically mentions their support for the author-pays model.

‘Research Councils UK and HEFCE have a shared commitment to maintaining and improving the capacity of the UK research base to undertake research activity of world leading quality, and to ensuring that significant outputs from this activity are made available as widely as possible both within and beyond the research community. Open access to published research supports this commitment and, if widely implemented, can benefit the research base, higher education, and the UK economy and society more broadly. To achieve this, open access needs to be implemented with clear licensing agreements, sustainable business models, and working with the grain of established research cultures and practices.

HEFCE and the Research Councils will work together and with other interested bodies to support a managed transition to open access over the medium term, and welcome the work of the UK Open Access Implementation Group in support of this aim.’