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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.

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.

Urban cycling, physician attire and the impact of complaints on Doctors: Most Read Articles in January

12 Feb, 15 | by fpearson

Several new papers made the January top 10 most read, including the cross-sectional survey by Bourne et al., on the impact of complaints on doctor’s health and psychological welfare. We also had a popular analysis of cycling injuries and the relationship with personal, trip, route and crash characteristics by Cripton et al. Petrelli et al.‘s paper on the role of physician attire on patient perceptions including trust, satisfaction and confidence and Aboshady et al.’s article on open online training courses for medical students in developing countries were both highly accessed.


Rank Author(s) Title
1 Cripton et al. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

2 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

3 Marston et al. Prescribing of antipsychotics in UK primary care: a cohort study

4 Caulfield et al. Representations of the health value of vitamin D supplementation in newspapers: media content analysis

5 Barnett et al. The impact of a streamlined funding application process on application time: two cross-sectional surveys of Australian researchers

6 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease

7 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

8 Guzman-Castillo et al. The contribution of primary prevention medication and dietary change in coronary mortality reduction in England between 2000 and 2007: a modelling study

9 Aboshady et al. Perception and use of massive open online courses among medical students in a developing country: multicentre cross-sectional study

10 Parand et al. The role of hospital managers in quality and patient safety: a systematic review



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

UCL Qualitative Health Research Symposium 2015

10 Feb, 15 | by flee

The UCL Division of Psychiatry’s Qualitative Researchers Working Group is working together with the UCL Department of Applied Health Research and the UCL Health Behaviour Research Centre on a one day symposium to discuss questions, and to generate constructive commentary on the contributions that qualitative inquiry can make to understandings of health, illness and care.

The symposium will include a keynote paper by Dr Sara Shaw, Queen Mary University of London and a panel discussion featuring Professor Paul Higgs, UCL Division of Psychiatry, Professor Naomi Fulop, UCL Department of Applied Health Research, and Professor Richard Watt, UCL Epidemiology and Public Health and will include oral and poster presentations from the UK and abroad.

The background and context of the day can be found on the blog pages of UCL’s Division of Psychiatry here.

BMJ Open has a track record of publishing high-quality qualitative research in medicine and healthcare and we are delighted to be supporting this conference. Shortly afterwards the abstracts will also be published as a supplement to BMJ Open.

Information about the event and registration details can be found on the UCL Department of Applied Health Research website.

And further details about the symposium programme can be found here.

2014: A year in review

9 Feb, 15 | by flee

2014 proved to be a successful and fruitful year for BMJ Open. We received over 2500 submissions, compared to just over 2000 in 2013. We published over 1100 papers.

BMJ Open has always welcomed research article and protocol submissions, and in 2014, we expanded our scope to include cohort profiles.

In mid year, Thomson Reuters calculated our second impact factor (IF), ‘2.063,’ which was an increase on our 2013 IF (1.583). BMJ Open was also selected to be indexed in MedLine. We are now included in every major database (which also includes Web of Science, PubMed amongst others.)

Last year, you may remember us mentioning that we introduced our institutional memberships, which aim to ease the administrative burden around organising payment of article publishing charges (APCs) as well as providing authors with discounts. Since 2013, the number of institutions who now hold a membership with us has increased. There are now 25 institutions that are a part of our Open Access Membership scheme.

Despite memberships, we understand that some authors still do not have access to funds. We aim to support where we can, and this year we waived over £100k in charges.

Press coverage of BMJ Open articles was considerable, in particular around the following papers ‘The prescribing of antipsychotics in UK primary care‘ and ‘Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones’. We have increased the number of video abstracts to help promote papers that have been press released.

We also published the first trial prompted by the Restoring Invisible and Abandoned Trials (RIAT) initiative. The initiative was previously announced by editors of The BMJ and PLOS Medicine as a way to complete and correct the scientific record, so that doctors and patients have access to accurate information to make decisions about treatments.

It was a busy year for us, but we would like to take the opportunity to thank our reviewers and authors and we look forward to working with you again.

Cumulative daily screen time linked to teen sleep problems

2 Feb, 15 | by flee

Time to update recommendations on healthy use of electronic devices, say researchers

The longer a teen spends on screen time throughout the day before going to bed, the worse quality sleep s/he is likely to have, suggests a large study published in BMJ Open.

It’s time to update the recommendations on the healthy use of electronic devices, and extend them to the latest technology, such as tablets and smartphones, say the researchers.

They base their findings on almost 10,000 16 to 19 year olds, all of whom were part of the Norwegian youth@hordaland study in 2012.

The teens were asked how much screen time they spent outside of school hours, and on what activities, for any of the following electronic devices: computer; smartphone; Mp3 player; tablet; games console; and TV.

They were also asked questions about their sleep routine on weekdays and at weekends: when they normally went to bed and got up; how much sleep they needed to feel rested; and how long it took them get to sleep (sleep onset latency).

Some gender differences emerged in activities and preferred devices. Games console use was more popular among the boys, whereas girls were more likely to use smartphones and Mp3 players. Girls spent significantly longer on their computers chatting online while boys spent longer playing games on consoles and computers.

Almost all of the teens said they used one or more electronic devices shortly (an hour) before going to bed.

Although frequency of use differed among the various devices, use of any device during the day and in the hour before bedtime was linked to a heightened risk of taking longer than 60 minutes to get to sleep.

In particular, use of a computer, smartphone, or Mp3 player in the hour before bedtime was significantly associated with taking longer to fall asleep. A period of more than half an hour is normally defined as long sleep latency in adults, say the researchers.

Total daytime screen use of more than 4 hours was linked to a 49% greater risk of taking longer than 60 minutes to fall asleep.

And a total of more than 2 hours of screen time after school was strongly linked to both longer sleep onset latency and shorter sleep duration.

On average, the teens said they needed 8-9 hours of sleep to feel rested. But those who spent more than 2 hours emailing or chatting online were more than three times as likely to sleep for less than 5 hours. While those who spent more than 4 hours in front of any screen were more than 3.5 times as likely to sleep for less than 5 hours.

When the analysis looked at individual devices, the strongest association for shortened sleep and less sleep than deemed necessary was found for computers, although this technology was one of the most commonly used of all the electronic platforms.

Multi-taskers—those using more than one device—were also more likely to take longer to get to sleep and to sleep for less—than those who used only one device.

Teens who used four or more devices were 26% more likely to take 60 or more minutes to fall asleep than those who used just one.

And teens who used two to three devices were 50% more likely to sleep for less than 5 hours than those who used just one device; teens who used four or more devices were 75% more likely to do so.

Screen use may simply replace sleeping time or may interfere with sleep by stimulating the nervous system, suggest the researchers, in a bid to explain their findings. Alternatively, the light emitted from electronic devices may interfere with the body clock (circadian rhythm).

“The recommendations for healthy media use given to parents and adolescents need updating, and age specific guidelines regarding the quantity and timing of electronic media use should be developed,” write the researchers.

“The current recommendation is not to have a TV in the bedroom. It seems, however, that there may be other electronic devices exerting the same negative influence on sleep, such as PCs and mobile phones. The results confirm recommendations for restricting media use in general,” they conclude.

Sharp and sustained rise in suicides in Greece linked to austerity measures

2 Feb, 15 | by flee

Give greater weight to mental health fall-out of future policies, urge researchers

Suicides in Greece reached a 30 year all-time high in 2012, with a sustained upward trend starting in June 2011, the month that the government introduced further austerity measures to help pay down the country’s debts, reveals a 30 year study, published in BMJ Open.

The researchers tracked the number of suicides recorded in Greece every month between January 1983 and December 2012 to assess the impact of prosperity and austerity on the figures, using national death certification data from the Hellenic Statistical Authority.  Data for later years were not available at the time of study.

The 1997 announcement that Greece would host the 2004 Olympic Games; the country’s admission into the European Union (2000-2002); its adoption of the Euro in 2002; and the Olympic Games in 2004 were classified as prosperity events during this period.

Austerity events, all of which occurred between 2008 and 2012, began with the Greek recession in 2008, through a series of financial bail-out packages, riots, strikes and protests, and the public suicide of a Greek pensioner in the main square of Athens in response to austerity conditions.

Between 1983 and 2012, 11,505 people took their own lives—9079 men and 2426 women.

The introduction of austerity measures in June 2011 marked the start of a significant, sharp, and sustained increase in suicides, to reach a peak in 2012, the figures showed.

The number of total suicides rose by over 35% in June 2011, which was sustained for the rest of the year and into 2012, equivalent to an extra 11.2 suicides every month, on average.

No other prosperity or austerity events over the 30 year period were associated with such a strong shift in the total number of suicides recorded.

The suicide rate in men started rising in 2008, when the Greek recession began, increasing by just over 13%, equivalent to an extra 3.2 suicides a month. The rate then rose by an additional 5.2 suicides every month (18.5%) from June 2011 onwards.

There was a further, but short-lived, rise in April 2012 of just under 30% (9.8 deaths a month), following a public suicide linked to austerity conditions.

This was very widely covered in the news media and included a lot of detail and quotes from the suicide note—factors that may have prompted copycat suicides, say the researchers.

By contrast, the launch of the Euro in Greece in January 2002 marked an abrupt but short-lived fall of 27% fewer suicides among men.

Economic instability in Greece has primarily affected men, who are still the main breadwinners, say the researchers, adding that the trends between 2008 and 2011 reveal the long term and systemic effects that large government austerity programmes can have on national economic stability and public health.

Suicides among women, who accounted for one in four such deaths over the 30 years, also surged by an extra 2.4 a month (just under 36%) in May 2011 following events associated with austerity, an increase that was sustained in 2012.

Further analyses, which included adjustments for potential undercounting of suicide (for religious and other reasons), showed the same sustained increased in June 2011.  This further reinforces the importance of the events during this month, say the researchers.

June 2011 marked the beginning of the first part of a larger austerity plan that was narrowly voted through amidst widespread public opposition, manifest in violent protests and strikes.

“Despite historically having one of the lowest suicide rates in the world, Greece is thought to have been more affected by the global financial downturn than any other European country,” write the researchers.

High unemployment, household debt, comprehensive welfare and benefit cuts, and increasing homelessness prompted by the unrelenting and sizeable economic downturn in Greece are likely to have piled on the stress and created a sense of hopelessness, they say.

“As future austerity measures are considered, greater weight should be given to unintended health consequences of these measures,” they write, adding: “Greater attention should also be paid to the public reporting of austerity measures and any subsequent suicide-related events that may follow.”

Falls in blood pressure and cholesterol have saved 20,000+ lives in England

22 Jan, 15 | by flee

Impact of statins greatest among most affluent but drugs only accounted for 14% of total fall in deaths

Falls in blood pressure and total cholesterol staved off more than 20,000 deaths from coronary heart disease in England between 2000 and 2007, shows a mathematical analysis published in BMJ Open.

The impact of statins was greatest among the most affluent in the population, suggesting that these drugs have helped maintain health inequalities between rich and poor, say the researchers.

The researchers wanted to quantify the contributions made by drug treatment (primary prevention) and changes in population risk factors (blood pressure and total cholesterol) to the falling rates of coronary heart disease deaths, stratified by socioeconomic background.

They used trial data, analyses of published evidence, national surveys, and official statistics to calculate the number of deaths postponed or prevented across the population of England.

The analysis showed that between 2000 and 2007 deaths from coronary heart disease fell by 38,000, of which 20,400 lives were saved as a direct result of reductions in blood pressure and total cholesterol.

In absolute terms, a higher proportion of lives were saved among the least affluent sectors of the population, which is to be expected given their much higher prevalence of risk factors, say the researchers.

The substantial fall in blood pressure accounted for well over half of the total, the calculations indicated, with around 13,000 deaths prevented or postponed.

But only a small proportion (1800) of these were attributable to drug treatment, with the rest accounted for by changes in risk factors at the population level.

Falls in blood pressure prevented almost twice as many deaths among the population’s poorest as among the richest.

Falls in total cholesterol accounted for some 7400 deaths prevented or postponed, of which (5300 or 14% of the total) were attributable to statins, with the remainder attributable to changes in risk factors at the population level.

Statins prevented almost 50% more deaths among the richest compared with the poorest, whereas changes at the population level prevented three times as many deaths among the poorest as among the richest.

The researchers were not able to account for 14% of the total fall in coronary heart disease deaths between 2000 and 2007 (17,600 lives saved). These might be attributable to other risk factors for heart disease, such as stress, they suggest.

They conclude that population-wide approaches, focusing on prevention, such as public health initiatives to curb salt and trans fat levels in processed and take-away foods may have more of an impact than prescribing drugs to individuals.

“Targeting high-risk individuals with medication appears less effective and may also widen socioeconomic inequalities in [coronary heart disease] mortality,” they write.

“Any intervention that requires people to mobilise their own resources (material and psychological) will understandably favour those who have greater resources, and thus widen social inequalities,” they add.

When healthcare budgets are stretched, as now, preventive approaches are a better way to get results, they suggest.

UK doctors facing complaints dogged by severe depression and suicidal thoughts

15 Jan, 15 | by fpearson

UK doctors subject to complaints procedures are at significant risk of becoming severely depressed and suicidal, reveals research published in the online journal BMJ Open.

Those referred to the UK professional regulator, the General Medical Council (GMC), seem to be most at risk of mental ill health, the findings suggest.

The researchers base their findings on an anonymised online survey of more than 95,000 UK doctors in 2012, all of whom were members of the British Medical Association (BMA).

Almost 8000 (8.3%) fully completed the questionnaire and were included in the final analysis. Respondents were broadly representative of the BMA membership in terms of gender mix and place of qualification, although there were some differences in ethnic background and age range.

Respondents were streamed into three groups: those subject to a current/ongoing complaint within the past 6 months (recent); those who had endured a complaint more than 6 months ago (past); and those who had no personal experience of a complaint.

The survey questions were designed to probe attitudes to any type of complaints procedure, ranging from informal through to referral to the GMC, as well as the psychological and professional fall-out of going through the process, and what might be done to improve it.

The survey also included questions about medical history; validated tests of depression and anxiety; and an assessment of life satisfaction.

Around one in five respondents (22.5%) had no personal experience of a complaint; almost half (49%) had faced a complaint in the past; and more than one in four (28.5%) had done so recently.

Around one in six (just under 17%) of those with a recent complaint were moderately to severely depressed, and they were 77% more likely to report these symptoms than doctors in the other two groups, after taking account of influential factors.

And they were twice as likely as those who had no personal experience of a complaint to harbour thoughts of self-harm or suicide.

A similar proportion (15%) of those in the recent/ongoing complaints category were also twice as likely to have clinically significant levels of anxiety as doctors with no personal experience of a complaint.

Lvels of psychological distress paralleled the type of complaint. Doctors who had been referred to the GMC reported the highest levels of depression (more than 26%), anxiety (more than 22%), and thoughts of self-harm (more than 15%).

Doctors subject to a recent/ongoing complaint were also more likely to have poorer health and wellbeing, including gut problems, insomnia, and relationship issues.

Defensive practice was common, with most (80%) of those who had experienced a complaint saying they had changed their clinical practice as a direct result, deploying tactics such as avoidance—not carrying out difficult surgery, for example—or hedging—ordering too many investigations, for example—and in some cases, acting against their professional judgement.

Furthermore, almost three out of four of those who had not been the subject of a complaint said they had also changed their clinical practice after witnessing a colleague’s experience of going through the process.

“These behaviours are not in the interest of patients and may cause harm, while they may also potentially increase the cost of healthcare provision,” note the researchers.

The process itself was often an unpleasant experience for the doctors involved. One in five of those who had been subject to a complaint felt victimised for having blown the whistle on poor clinical or managerial practice, and almost four out of 10 (38%) said they felt bullied during the investigation. And around one in four had taken more than a month off work.

Most of the respondents who offered suggestions for ways to improve complaints procedures focused on boosting managerial competence in complaints handling; greater transparency; and disciplinary action for vexatious complaints.

The researchers caution that the overall response rate may mean that these findings are not truly representative of doctors working in the UK, and this is an observational study so no definitive conclusions about cause and effect can be drawn.But as the largest UK study of its kind, they believe the findings are relevant.

They emphasise the importance of protecting patient safety and of enabling complaints to be raised as a way of improving standards of care, but go on to say: “However, a system that is associated with high levels of psychological morbidity among those going through it is not appropriate. Most importantly, a system that leads to so many doctors practising defensive medicine is not good for patients.”

Few UK family doctors seem to be treating obesity/overweight appropriately

12 Jan, 15 | by flee

Patient health records suggest limited evidence of weight management in primary care

Few UK family doctors seem to be treating overweight/obesity appropriately, with some not treating it all, suggests an analysis of patient records published in BMJ Open.

The researchers scrutinised the anonymised health records of more than 90,000 obese and overweight adults, whose data had been entered into the Clinical Practice Research Datalink (CPRD) between 2005 and 2012.

The CPRD is the largest primary care database in the world, and contains the health records of over 5% of the UK population, submitted by 680 general practices.

The researchers looked at all the weight management options provided, including lifestyle advice, specialist referrals, and prescription of obesity drugs.

The average age of the patients was 56. Some 60% were overweight and 40% were obese, including 5% who were morbidly obese with abody mass index (BMI) of 40kg/m2 or more.

Between 2005 and 2012, no weight management intervention was recorded for most (90%) of the overweight patients. Many practices didn’t record any interventions at all for obese patients during this time.

A weight management intervention was more likely to be recorded in the health records of obese patients, but it was still not documented in more than 80% of those with simple obesity.

Patients with severe obesity were more than three times as likely to be offered weight management, but this was still not recorded in the case notes of over half (59%) of them.

Lifestyle change, including dietary advice and exercise, was the most common weight management plan offered in all but the most severely obese patients, for whom drug treatment was the most commonly recorded intervention.

And there was little documented evidence that progress on weight loss had been tracked after an intervention had been introduced.

Monitoring progress on weight loss in the first year after an intervention was most frequently recorded in the case notes of patients who had been referred to specialist services (34%). But it was only recorded for one in five of those given lifestyle advice and one in four of those prescribed an obesity drug.

There was no evidence that outcomes were being monitored for any intervention after five years.

Factors associated with weight loss intervention included older age, type 2 diabetes, and depression, with morbid obesity the strongest predictor of weight management provision. Women, former smokers, and those from disadvantaged backgrounds were also more likely to be treated for overweight/obesity.

The researchers point out that the findings might simply be the result of poor documentation, and that brief advice may have been offered, but not recorded in the patient’s notes.

On the other hand, the findings “might also indicate a lack of patient access to appropriate body weight management interventions in primary care due to a lack of clinician awareness or confidence in treating obesity,” they write.

The reasons for this might include too little time to tackle the issue in consultations, doubts about the success of weight loss attempts, greater use of drugs to treat obesity related risk factors and disease, and possibly ‘normalisation’ of excessive body weight.

Nevertheless, they conclude: “The results of this study suggest that primary care interventions given to patients with the aim of reducing weight are underutilised, and that follow up to determine their success is poor.”

And they emphasise: “The growing burden of obesity on primary healthcare services and lack of long term follow up on the effectiveness of these treatments supports the use of structured recording of interventions for weight management.”