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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.

The importance of reviewers – 2015

23 Dec, 15 | by Emma Gray


The peer review process is central to scholarly research, a critical part of the publishing process and a method of quality control for the scientific community. While peer review can seem like a daunting, never-ending task at times, without it journals would not survive and continue to publish the important, accurate findings they do today.

At BMJ Open, we rely on our large bank of reviewers to help us ensure that the papers we publish are useful and of good quality. A good review can often require a great deal of work, and the continued success of the journal in the past year would not have been possible without the help of reviewers who provided us with their time, expertise and detailed comments. Our transparent, open peer review process is part of our aim to provide a home to sound medical research, making as much research available to the scientific community as possible while still upholding the BMJ’s core standards for research conduct.

It is important to recognise the contribution that reviewers make to the journal, and the essential nature of their work. BMJ Open would like to thank all those reviewers who have worked with us this year – we hope that you will continue to work with us in the year ahead! We are pleased to be able to continue with our reviewer discount of 25% for reviewers who submit manuscripts to us within 12 months of completing their review, and we would like to remind you that CME points are available for those who submit detailed comments within the given timeframe. Existing reviewers for the journal are encouraged to update their profiles on our submission system with their areas of expertise, so we can more easily allocate you appropriate papers – and, of course, we always encourage new reviewers to come forward and join our growing bank of referees.

We look forward to seeing what the next 12 months will hold for BMJ Open. With our fifth birthday on 23rd February 2016, we hope that the journal will continue to go from strength to strength, with the help of our reviewers and authors.

Certain antidepressants linked to heightened risk of mania and bipolar disorder

16 Dec, 15 | by Emma Gray

Strongest association found for SSRIs and venlafaxine

Taking certain antidepressants for depression is linked to a heightened risk of subsequent mania and bipolar disorder, reveals research published in the online journal BMJ Open.

The strongest association seemed to be for serotonin reuptake inhibitors, or SSRIs for short, and the dual action antidepressant venlafaxine, the analysis indicated.

The researchers base their findings on the anonymised medical records of more than 21,000 adults in receipt of treatment for major (unipolar) depression between 2006 and 2013 at a large provider of inpatient and community mental healthcare in London.

The research team looked at subsequent diagnoses of bipolar disorder or mania following an original diagnosis of unipolar depression, so-called because it lacks the ‘highs’ typical of bipolar disorder.

The analysis revealed that the overall yearly risk of a new diagnosis of mania and bipolar disorder between 2006 and 2013 was 1.1% (10.9/1000 patient years).

The peak age for diagnosis was seen among patients aged 26 to 35, among whom the yearly risk was 1.2% (12.3/1000 patient years).

The most commonly prescribed antidepressants were SSRIs (35.5%); mirtazapine (9.4%); venlafaxine (5.6%) and tricyclics (4.7%).

Previous treatment with certain antidepressants was associated with a heightened risk of a subsequent diagnosis of bipolar disorder and/or mania, the yearly risk of which ranged from 1.3% to 1.9% (13.1 to 19.1/1000 patient years).

Further analysis revealed that this heightened risk was particularly associated with treatment with SSRIs and venlafaxine. These drugs were associated with a 34-35% increased risk of being diagnosed with bipolar disorder and/or mania.

These findings held true even after taking account of potentially influential factors.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the researchers point out that their findings may be explained by latent bipolar disorder rather than any effects of drug treatment. Furthermore, they were unable to obtain information on important risk factors.

“However, regardless of underlying diagnosis or aetiology the association of antidepressant therapy with mania demonstrated in the present and previous studies highlights the importance of considering whether an individual who presents with depression could be at high risk of future episodes of mania,” say the researchers.

Pertinent risk factors include a family history of bipolar disorder, a depressive episode with psychotic symptoms, young age at first diagnosis of depression, and depression that is unresponsive to treatment.

“Our findings also highlight an ongoing need to develop better ways to predict future risk of mania in people with no prior history of bipolar disorder who present with an episode of depression,” they write.

In an accompanying videocast, the researchers highlight that the absolute risk of developing bipolar disorder is low and antidepressants are safe and effective treatments for depression and anxiety. Patients should not stop their treatment suddenly as this may result in withdrawal symptoms, they advise.

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

Bicycling injury hospitalisation rates, clinical trial registration and women in leadership roles: Most read articles in November

9 Dec, 15 | by Emma Gray

Bicycling injuries, clinical trial registration, and the under-representation of women in leadership roles

This month sees a lot of change in the Top 10 Most Read, with many new papers entering the list. At number one this month is Teschke et al‘s assessment of bicycling injury hospitalisation rates with relation to helmet legislation and mode shares, which has generated a lot of interest both on our site and on Twitter. Our second most read article takes a look at clinical trial registration, reporting and publication rates for new drugs approved by the US Food and Drug Administration. Bismark et al examine the reasons for the under-representation of women in medical leadership roles via a qualitative study at number six, and maintaining its position at number five this month is Hysing et al‘s paper on adolescent use of electronic devices in relation to sleep.

Rank Author(s) Title
1 Teschke et al. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share
2 Miller et al. Clinical trial registration, reporting, publication and FDAAA compliance: a cross-sectional analysis and ranking of new drugs approved by the FDA in 2012
3 Kristensen et al. The effect of statins on average survival in randomised trials, an analysis of end point postponement
4 Tricco et al. Comparative safety and effectiveness of long-acting inhaled agents for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis
5 Hysing et al. Sleep and use of electronic devices in adolescence: results from a large population-based study
6 Bismark et al. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia
7 Bove et al. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol
8 Deane et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease
9 Chaibi et al. Chiropractic spinal manipulative therapy for migraine: a study protocol of a single-blinded placebo-controlled randomised clinical trial
10 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

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

US pedestrian wheelchair users third more likely to die in car crashes than general public

19 Nov, 15 | by Emma Gray

And men’s risk is five times higher than women’s, particularly among 50 to 64 year olds

Pedestrian wheelchair users in the US are a third more likely to be killed in road traffic collisions than the general public, finds research published in the online journal BMJ Open.

And men’s risk is five times higher than women’s, the findings show.

Every year nearly 5000 pedestrians are killed and another 76,000 injured in road traffic collisions on public roads in the US.

But it is not known what the risk of death is among pedestrian wheelchair users, and whether this is higher than that of the general population who don’t use wheelchairs.

The researchers therefore used a technique that mines the overlap between two independent but incomplete data sources (capture-recapture) to estimate the total number of pedestrian deaths caused by car crashes between 2006 and 2012.

These were national news stories on car crash fatalities published on the LexisNexis US newspaper database; and the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS), which is based on police reports of road traffic collisions on US roads.

Based on these data, the researchers calculated that approximately 528 pedestrians using wheelchairs were killed in road traffic collisions in the US between 2006 and 2012.  This equates to a risk of death for a pedestrian wheelchair user that is more than a third higher than for American pedestrians in general.

Furthermore, the risk of a car crash death was over five times higher for men in wheelchairs than for women, particularly among men aged 50 to 64, the analysis showed.

The figures are likely to be an underestimate of the true number of deaths because mobility devices were not always differentiated from recreational scooters and mopeds in news stories.

Around half (47.5%) of the fatal crashes occurred at intersections, and in almost four out of 10 (39%) of these cases, traffic flow was not controlled.

Many fatal crashes occurred at locations with inadequate pedestrian facilities.  For example, crosswalks were unavailable at the site in one in five fatal crashes.

The police reports also indicated that drivers frequently failed to give way to wheelchair users, and that the wheelchair user was not sufficiently visible in 15% of the incidents.

it is important—and often required by the Americans with Disabilities Act—that there should be well-designed curb cuts, ramps, and sidewalks to enable people who use wheelchairs to safely traverse roads, say the researchers.

“[Our] findings underscore the need for policy-makers and planners to fully incorporate disability accommodations into pedestrian infrastructure and for persons who use wheelchairs—and others with disabilities—to remain a salient population when road safety interventions are designed,” they write.

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.