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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 launches new Chinese publishing portal: Q&A with David Wang and Huili Chen

17 Nov, 15 | by aaldcroft


Recently BMJ launched a publishing portal intended to help Chinese authors publish in BMJ’s portfolio of more than 60 journals, including BMJ Open. To help understand the motivations surrounding the portal, along with some of its content, we asked BMJ China’s Business Development Manager Huili Chen and the Deputy Editor of BMJ’s new journal Stroke and Vascular Neurology, David Wang, a few questions.

Q: David, how do you think the portal might benefit Stroke and Vascular Neurology?

DW: As the newest journal of the BMJ family and the official English journal for the Chinese Stroke AssociationSVN would like to be a successful journal in the area of cerebrovascular disease. To be successful requires quality papers. Chinese scholars are always seeking journals for their work and SVN hopefully can benefit from that need. The new portal is the only such kind of service from a major publisher that offers the authors a “one stop shopping” convenience. Authors can easily find the journal to submit their work in one portal. SVN can certainly benefit from the portal since Chinese authors can enjoy the wonderful services provided by BMJ publishing, easily identify our journal, and send in their work.

Q: What information on the portal do you think will be most useful to potential authors in SVN?

DW: SVN would like to provide a user-friendly and state-of-art platform for the authors to submit their manuscripts and track their submission. BMJ portal is the right place to get started. It offers quality information and instructions to potential authors on how to complete the submission. As a new journal that has just been launched, our potential authors can find themselves at ease when they submit their work through the portal.

Q: Huili, what was the motivation behind the portal?

HC: There were a few driving elements. Firstly, BMJ and The BMJ have strong reputations in China, but we’ve not had the chance to promote the journals in a systematic way, directly to authors. Secondly, there is a lot of misinformation about publishing in China, much of it taking the form of comments on websites. We wanted to communicate the correct information, and a portal seemed a good way to do this. Finally, several publishers have initiatives in China, and we want to be competitive and demonstrate that BMJ values work from Chinese authors. The portal seemed like a good starting point.

DW: As China is increasingly becoming a powerhouse in biomedical research, there are greater needs needs for Chinese scholars to publish their work. However, Chinese authors often struggle in finding the best journal for their papers. BMJ has over 60 journals–and growing–but some of the journals are not well-known to Chinese scholars. By having such a portal, it helps to educate the authors about all the journals published by BMJ and offer them a very convenient way to submit their work. Such ease of use will certainly benefit new journals, such as SVN, since authors will recognise that they can submit their work just as easily as they could to other BMJ journals.

Q: Who do you expect will use the portal?

HC: The portal was designed for all Chinese speaking doctors and medical researchers who have an interest in publishing papers in international journals. The portal is available internationally, but we expect that most of the users will be based in China.

DW: The portal is in Chinese. Therefore, any authors who reads Chinese can find it easy to use. It is certainly not limited to the scholars in China but anywhere in the world who understand Chinese

Q: What information is available on the portal?

HC: There is an overview of BMJ’s journal portfolio, with each journal having a page containing key information intended to help authors decide whether the journal is suitable for their work. There is also a page outlining The BMJ, highlighting its criteria for research articles, article requirements, and peer review process. There are regular updates on research articles published in The BMJ and Open Access articles published in all journals, highlighting strong articles from Chinese researchers. We have recently added a Chinese blog by editors from the Journal of Medical Genetics–this can be done for any journal that is interested.

In addition there is an author center where authors can read about journals’ editorial policies and publishing processes. We have included resources that authors might find useful, such as an introduction to the Research to Publication e-learning course. Finally, we highlight Chinese experts who are editors and board members on BMJ journals

Q: What impact do you hope the portal will have?

HC: Ideally, we’d like all medical researchers and doctors to know about the portal and use it whenever they want to publish a new piece of work. We want it to be a tool to establish loyalty and trust. It will, of course, take time to accomplish, but with BMJ’s growing portfolio of journals, we think the portal is an important starting point.

The effect of statins, obesity-related behaviours in Europe and the accuracy of Wikipedia content: Most read articles in October

9 Nov, 15 | by Emma Gray

Statins, obesity-related behaviours, and the accuracy of Wikipedia


by Panoramix303

Lovastatin, from Wikipedia

Several papers have entered the Top 10 Most Read this month, including Kristensen et al‘s systematic review on statins and survival in randomised trials, which tops the list. In our tenth most read article, Azer et al assess the accuracy of content of Wikipedia articles on cardiovascular diseases, and at number nine, Lakerveld et al provide the first results of the SPOTLIGHT survey of obesity-related behaviours and body mass index in adults in Europe. Previously featured papers on the list include Deane et al‘s identification of the top priorities for the management of Parkinson’s disease and Dall’Ora et al‘s study on the association of long shifts for nurses and job dissatisfaction.

Rank Author(s) Title
1 Kristensen et al. The effect of statins on average survival in randomised trials, an analysis of end point postponement
2 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
3 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
4 Dall’Ora et al. Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries
5 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
6 Bernacki et al. Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention
7 Plouvier et al. Transitions in Parkinson’s disease in primary care: protocol of a longitudinal mixed methods study
8 Lakerveld et al. Obesity-related behaviours and BMI in five urban regions across Europe: sampling design and results from the SPOTLIGHT cross-sectional survey
9 Kowalczuk et al. Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models
10 Azer et al. Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?

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

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.

E-cigarette use, abortion legislation and mortality in marginally housed adults: Most read articles in September

9 Oct, 15 | by Emma Gray

Entering the Top 10 Most Read this month is Shiplo et al‘s paper on the prevalence and patterns of use of e-cigarettes in a sample of both smokers and non-smokers in Canada, measured via a cross-sectional survey. Also new are Hysing et al‘s paper on the relationship between adolescent use of electronic devices and sleep deficiency and Jones et al‘s paper, which evaluates the impact of treatable illnesses on mortality in adults living in marginal conditions. Returning to the list this month are a few popular papers, including Koch et al‘s paper published earlier this year on the association between abortion legislation and maternal mortality.

Rank Author(s) Title
1 Dall’Ora et al. Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries
2 Thienpont et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive stud
3 Shiplo et al. E-cigarette use in Canada: prevalence and patterns of use in a regulated market
4 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
5 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
6 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
7 Mills et al. Quantitative systematic review of the associations between short-term exposure to nitrogen dioxide and mortality and hospital admissions
8 Koch et al. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states
9 Lee et al. Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study
10 Jones et al. Mortality from treatable illnesses in marginally housed adults: a prospective cohort study

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

Peer Review Week: An analysis of peer review style and quality

30 Sep, 15 | by Fay Pearson

This week celebrates the first ever Peer Review Week; a collaborative concept from ORCID, Wiley, Sense About Science and ScienceOpen, to highlight and celebrate the invaluable role peer review plays in scientific and medical publishing.

Here at BMJ Open we are, of course, advocates of open peer review and as such are pleased to be publishing a timely research article by our friends at Biomed Central.

The paper, from Maria Kowalczuk et al., is a retrospective analysis of the quality of referee reports from author-suggested and non-author-suggested reviewers in open or single blind peer review journals.

Their objective was to elucidate whether reviews from peers suggested by authors would show bias in quality and decision recommendation compared to reviewers selected by other means. They also aimed to assess whether open review vs. single blind review had an impact on quality and recommendation. To achieve this, the study looked at 200 reviewer reports submitted in 2010-2011 to BMC Microbiology, 200 submitted to BMC Infectious Diseases, and 400 that were submitted to the Journal of Inflammation, these journals use single blind peer review, open peer review and a combination of the two, due to policy change, respectively. Comparisons were made by assessing the quality of report (using the Review Quality Instrument), by analysing the editorial recommendation made, and with author surveys. After statistical analysis of the data, they could conclude that the reports from reviewers suggested by the authors were of comparable quality but were more likely to suggest publication.

They also conclude that the open peer review reports were of a slightly higher quality than those using single blind review. These findings are in line with those from the randomised trial conducted by The BMJ, after they became one of the first journals to use open peer review in 1999, and similar to another study by the British Journal of Psychiatry.

As BMJ Open is open access with fully open peer review, we are always happy to see further research demonstrating the success of this model.  As we use a combination of both author suggested and non-author suggested reviewers (with an in-house filtering process), we couldn’t help but agree when we spoke to the paper’s authors and they said the following,  ‘It is reassuring that reviewers suggested by the authors provided reports of as good quality as reviewers found by editors using other means. Author-suggested reviewers tended to recommend acceptance of the manuscript more often than other reviewers, which highlights the important role of the editor in making the final decision on the manuscript’ .

The full text of the paper, Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models– Kowalczuk et al., can be found here:

Introducing ‘How to write and publish a Study Protocol’ using BMJ’s new eLearning programme: Research to Publication

22 Sep, 15 | by Ed Sucksmith

Study protocols are an integral part of medical research. They provide a documented record of a researcher’s plan of action, detailing in advance a study’s rationale, methodology and analyses. Publication of study protocols ensures greater transparency in the research process and protects the wider community against a number of damaging research practices. These include the selective publication of positive results, the selective presentation of data or analyses, the failure to adequately calculate statistical power and the failure to distinguish between hypothesis-generating (exploratory) and hypothesis-testing analyses. Publication of protocols also informs the research community about what research activity is currently being carried out in different fields, preventing unnecessary duplication of work and encouraging collaboration between research groups. The many benefits of publishing study protocols helps to ensure that medical research studies are conducted to the highest standards, leading to a stronger evidence base in medicine and ultimately better healthcare for patients.

BMJ Open is committed to improving standards in medical research by supporting the publication of study protocols. Furthermore, BMJ Open’s Editor-in-Chief, Trish Groves, leads an online eLearning programme, Research to Publication, which includes a free module on how to write and publish a study protocol. The aim of the Research to Publication programme is to equip researchers with the basic skills and knowledge needed to understand research designs, write manuscripts and become published authors.

Successful completion of the study protocol module is formally recognized with a certificate from The BMJ’s Editor-in-Chief. If a researcher completes the module and provides the certificate when they submit their study protocol to BMJ Open, then they will receive a 75% reduction on the Article Publishing Charge upon acceptance of their manuscript for publication (usual protocol APC: £1000). The protocol would need to be submitted to BMJ Open within six months of completion of the module and would need to go through the usual editorial and peer review processes, so we cannot promise acceptance.

We hope this combination of training, certification, and publication support will encourage more researchers to publish their study protocols. Further information about the Research to Publication eLearning programme can be found here.

12+ hour hospital nursing shifts linked to heightened risk of burnout and job dissatisfaction

10 Sep, 15 | by Emma Gray

Findings similar across 12 European countries, and run counter to perceived value of longer shifts

Working 12+ hour shifts is linked to a heightened risk of burnout, job dissatisfaction, and intention to leave among hospital nurses in 12 European countries, finds research published in the online journal BMJ Open.

The findings run counter to the perceived value among both nurses and employers of working longer shifts, which are increasingly common practice in England, Ireland, and Poland, say the researchers.

Job satisfaction and burnout are global concerns in the nursing workforce, because of the potential impact they have not only on the quality and safety of patient care, but also on retention.

And nursing shifts have been lengthening, driven by the perception that they boost efficiency and productivity and offer increased flexibility and more full days off work. But these extended working patterns have not been comprehensively evaluated, say the researchers.

They therefore surveyed 31 627 registered hospital nurses (response rate 62%), excluding those in intensive or long term care units, in 488 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, The Netherlands, Norway, Poland, Spain, Switzerland and Sweden, between 2009 and 2010.

The survey included a total of 118 questions, relating to the demands and experience of the job itself; the most recent shift worked; and personal details. Burnout was assessed, using an internationally validated three-dimensional measure (MBI), and participants were asked directly about their levels of job satisfaction and intentions to leave.

The average age of the respondents was 38, and most were women. Almost two thirds worked in hi-tech and/or teaching hospitals. Over half (57%) worked in medical units; the remainder worked in surgical units.

The most common shift length was 8 or fewer hours (50%); almost a third (31%) worked 8-10 hours; 4% worked 10 to less than 12 hours; and 14% worked 12-13 hours. Just 1% worked more than 13 hours.

But 12 hour+ shifts were more common in certain countries, with 39% of respondents in England, 79% in Ireland, and 99% in Poland, working this shift length. And more than one in four of the entire sample (27%) had worked overtime on their last shift.

Around one in four (27%) reported high emotional exhaustion, while 10%  said they experienced high depersonalisation and 17% low personal accomplishment—the three dimensions of burnout.

Around one in four expressed dissatisfaction with their job; a similar proportion were equally dissatisfied with their work schedule flexibility, and a third said they planned to leave their current job.

The analysis of the responses showed that shift length of 12+ hours was associated with greater levels of burnout in all three dimensions; job dissatisfaction; working schedule dissatisfaction; and intention to leave.

For example, job dissatisfaction rose to 40% among those clocking up shifts of 12+ hours compared with those working shifts of 8 hours or less, while the intention to leave rose to 31%.

Furthermore, working 8 hour shifts was associated with poorer job satisfaction, while working overtime was linked to unfavourable outcomes in all domains, irrespective of the actual additional hours worked.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. But the findings run counter to perceived wisdom and practice, say the researchers.

“Current literature tends to report that 12 h shifts represent a way to retain nurses in hospital clinical practice because it is believed to be the preferred shift length and that nurses are more satisfied with their jobs: our results suggest the opposite,”  they write.

“Therefore, our findings pose substantial questions for managers, most notably because job satisfaction is a consistent and robust predictor of remaining in a job,” they say.

They add that employers need to be aware of the potential effects of burnout, which include a heightened risk of making a mistake, poorer quality of care, compromised wellbeing, and increased absenteeism and high staff turnover.

Euthanasia requests, the risks of heavy smoking and alcohol use in older people: Most read articles in August

8 Sep, 15 | by Emma Gray

A few new entries are included in August’s Top 10 Most Read as well as some popular articles from previous months. New entries include Thienpont et al‘s paper on euthanasia requests among psychiatric patients and Elwyn et al‘s paper on the motivations of patients to record their clinical encounters, measured by a mixed-methods analysis of survey data. A Mendelian randomisation meta-analysis from Morris et al aimed to investigate whether heavier smoking is associated with abdominal adiposity phenotypes, concluding that smoking in an effort to control weight may lead to accumulation of central adiposity. Rao et al‘s paper on exploring the relationship between alcohol consumption, health, ethnicity and socioeconomic deprivation was also popular this month.

Rank Author(s) Title
1 Thienpont et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study
2 Rao et al. Alcohol use, socioeconomic deprivation and ethnicity in older people
3 Elwyn et al. Patients recording clinical encounters: a path to empowerment? Assessment by mixed methods
4 Parand et al. The role of hospital managers in quality and patient safety: a systematic review
5 Rachiotis et al. What has happened to suicides during the Greek economic crisis? Findings from an ecological study of suicides and their determinants (2003-2012)
6 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
7 Whiting et al. How well do health professionals interpret diagnostic information? A systematic review
8 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
9 Branas et al. The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis
10 Morris et al. Heavier smoking may lead to a relative increase in waist circumference: evidence for a causal relationship from a Mendelian randomisation meta-analysis. The CARTA consortium

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

Forum 2015: Global Forum on Research and Innovation for Health

8 Sep, 15 | by Emma Gray

With the aim of identifying solutions to the world’s unmet health needs through research and innovation, Forum 2015 provided delegates with a unique global platform on which to present ideas for innovation in health and create partnerships for action.

The Council on Health Research for Development (COHRED) partnered with the Philippines for this event, which took place in August 2015, to allow stakeholders in development from around the world (including public, private and non-profit stakeholders) to set an agenda with the ultimate outcome of improving health, equity and socio-economic development in a sustainable way.

Understanding the importance of ongoing research and innovation in health is of growing importance, particularly with the impending 2015 Sustainable Development Goals. With over 4,000 registered delegates representing over 72 countries, this understanding was key to the programme, which featured not only the conference activities onsite in the Philippines but also an online discussion platform to encourage participation from those who were not able to attend in person.

A message from Benigno Simeon S. Aquino III, President of the Philippines, was delivered by Mario G. Montejo, Secretary of the Department of Science and Technology, commenting that this type of constant and pro-active vigilance from the global research community is what is needed to improve and secure the wellbeing of people all over the world, especially those in low- and middle-income countries.

BMJ Open is pleased to support this meeting by publishing Forum 2015 abstracts – all of which can be found online at: With topics ranging from e-health to music therapy and disaster response, there is likely to be something of interest to all professionals working in global health.

Readers may also be interested in the newly launched journal BMJ Global Health – an online, open access journal from the BMJ dedicated to publishing high-quality peer-reviewed content relevant to those involved in global health. Further information on this journal can be found here:

“Substantial” number of NHS hospital staff treat victims of human trafficking

18 Aug, 15 | by Emma Gray

Maternity services most likely to do so; but staff across NHS don’t know how best to respond

A “substantial” proportion of NHS hospital staff—around one in eight, in some places—treat the victims of people trafficking, with maternity services most likely to do so, finds research published in the online journal BMJ Open.

Although understanding of the sorts of health problems trafficked patients are likely to have, is generally high, few NHS staff feel adequately prepared to respond appropriately, the findings suggest.

International law requires that the UK provides victims of human trafficking with whatever medical treatment they require, which includes psychological help, counselling, and further information on support services.

It is thought that around 2.5 million people are trafficked every year, with every country in the world either a source, transit point, or destination.

The researchers wanted to know just how likely it is that NHS hospital staff will encounter patients who have been trafficked, and how well prepared they feel to respond to them.

They therefore quizzed almost 800 NHS staff from a wide range of specialties to gauge their experience and knowledge of people trafficking, as well as their confidence in responding appropriately to it, using a validated questionnaire (PROTECT) between August 2013 and April 2014.

All the healthcare professionals were attending either mandatory training in child protection and vulnerable adult issues at 10 secondary care trusts across England, where at least five victims of human trafficking had been reported to the police the previous year, or were at meetings of the Royal College of Emergency Medicine.

In all, around one in eight (13%) staff said they had treated a patient whom they either knew, or suspected, had been trafficked. In eight trusts, this proportion rose to more than one in 10 of the staff.

Maternity services staff were the most likely to encounter victims of human trafficking, with one in five (20.4%) saying they had treated such patients.

But most staff in every specialty represented said they didn’t know what questions to ask to spot potential victims (just under 89%), while more than three quarters (78%) said they didn’t feel sufficiently trained to enable them to help victims adequately.

Over half said they lacked the confidence to make appropriate referrals, with referrals for men vexing the most staff (71%).

Most participants (over 95%) had no idea of the scale of human trafficking in the UK, and three out of four (76.5%) didn’t realise that without appropriate safeguards, a call to the police could put patients in even more danger.

“In particular [staff] lack knowledge about how to ask about experiences of human trafficking, how and when to contact law enforcement agencies, and how to make referrals to local and national support agencies,” write the researchers.

Three out of four of those surveyed said they would be interested in targeted training around people trafficking, particularly those working in mental health and emergency medicine services.

The researchers caution that their findings may not be applicable to the entire NHS, but suggest that additional training for NHS staff could improve the wellbeing and safety of such a vulnerable group of people.

A video abstract for this manuscript is available to view here: