British Medical Bulletin Journal Impact Factor & Information

Publisher: British Council. Medical Dept, Oxford University Press (OUP)

Journal description

This series of expert reviews on selected health topics in fields where significant new developments are occurring is aimed at non-specialists and postgraduate medics and serves as an invaluable reference source. It also allows those working in other specialities and younger clinicians and scientists to update their knowledge in important and well-defined subject areas. Each issue offers an authoritative and concise overview of the current state of knowledge in a specific area.

Current impact factor: 3.95

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 3.953
2012 Impact Factor 4.363
2011 Impact Factor 4.543
2010 Impact Factor 3.211
2009 Impact Factor 2.9
2008 Impact Factor 3.277
2007 Impact Factor 2.545
2006 Impact Factor 1.881
2005 Impact Factor 3.179
2004 Impact Factor 2.165
2003 Impact Factor 2.25
2002 Impact Factor 1.708
2001 Impact Factor 1.246
2000 Impact Factor 1.869
1999 Impact Factor 3.381
1998 Impact Factor 2
1997 Impact Factor 2.092
1996 Impact Factor 2
1995 Impact Factor 2.188
1994 Impact Factor 1.577
1993 Impact Factor 1.677
1992 Impact Factor 2.023

Impact factor over time

Impact factor

Additional details

5-year impact 4.73
Cited half-life 10.00
Immediacy index 0.41
Eigenfactor 0.01
Article influence 1.51
Website British Medical Bulletin website
ISSN 1471-8391
OCLC 165840904
Material type Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Oxford University Press (OUP)

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Pre-print can only be posted prior to acceptance
    • Pre-print must be accompanied by set statement (see link)
    • Pre-print must not be replaced with post-print, instead a link to published version with amended set statement should be made
    • Pre-print on author's personal website, employer website, free public server or pre-prints in subject area
    • Post-print in Institutional repositories or Central repositories
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany archived copy (see policy)
    • Eligible authors may deposit in OpenDepot
    • The publisher will deposit in PubMed Central on behalf of NIH authors
    • This policy is an exception to the default policies of 'Oxford University Press (OUP)'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Orthostatic hypotension (OH) is very common, particularly in older populations. Diagnostic criteria exist but appear to be arbitrary rather than evidence based. This review will visit the evidence for diagnostic strategies for OH. Medline (OvidSP), EMBASE (OvidSP), ISI Web of Science, the Health Technology Assessments Database and the Cochrane Library. A 5-min rest is required before measuring baseline. An active stand with continuous blood pressure (BP) monitoring is preferable to a tilt test to identify initial OH in particular. At least 2 min in the upright position is required. A systolic drop of 20 or a diastolic drop of 10 is supported by the evidence. Reproducibility when testing for OH is poor. Is the active stand preferable to the tilt test to diagnose classical OH? Although continuous BP monitoring increases diagnostic rates, does it improve clinical outcomes? Should symptoms be used to inform diagnosis? Establishing the long-term clinical outcomes for transient drops in BP detected on continuous, non-invasive monitoring. Evaluating the different patterns of BP drop to aid diagnosis and direct treatment. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 05/2015; DOI:10.1093/bmb/ldv025
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    ABSTRACT: Autoimmune hepatitis is a chronic immune-mediated liver injury, frequently associated with progression to end-stage liver disease if untreated. Patients commonly present with hepatitis, positive immune serology, elevated immunoglobulins and compatible liver histology, in the absence of an alternative aetiology. Data for this review were obtained using PubMed. Disease usually responds to steroids and azathioprine, and appears to be a manifestation of autoimmune predisposition triggered in genetically susceptible individuals exposed to likely environmental challenges. We provide an up-to-date approach to disease understanding and management along with the clinical approach to diagnosis and current treatment suggestions. Controversies such as second line therapies and novel markers of disease activity are introduced. Increased understanding of the immunoregulatory mechanisms behind autoimmune hepatitis has led to opportunities for new therapies. These are developed including a discussion of timely research studies relevant to future therapies for patients. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 05/2015; DOI:10.1093/bmb/ldv021
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    ABSTRACT: The V(D)J recombination is a DNA rearrangement process that generates the diversity of T and B lymphocyte immune repertoire. It proceeds through the generation of a DNA double-strand break (DNA-DSB) by the Rag1/2 lymphoid-specific factors, which is repaired by the non-homologous end joining (NHEJ) DNA repair pathway. V(D)J recombination also constitutes a checkpoint in the lymphoid development. V(D)J recombination defect results in severe combined immune deficiency (SCID) with a lack of T and B lymphocytes. The V(D)J recombination represents one of the few programmed molecular events leading to DNA-DSBs that strictly relies on NHEJ. Two NHEJ factors, Artemis and XLF/Cernunnos, were identified through the molecular studies of SCID patients. Mutations in PRKDC and DNA Ligase IV genes also result in SCID. Studies in mice have demonstrated that XLF/Cernunnos is dispensable for V(D)J recombination in lymphoid cells but not for the repair of genotoxic-induced DNA-DSBs, which raises the question of the implication of Rag1/2 factors in the DNA repair phase of V(D)J recombination. New factors of NHEJ, such as PAXX, are being identified. Patients with NHEJ deficiency (XRCC4) without immune deficiency were recently reported. We, therefore, may not have yet the complete picture of DNA-DSB repair in the context of V(D)J recombination. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 05/2015; DOI:10.1093/bmb/ldv020
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    ABSTRACT: The current report reviews the data from the series Accidental Death and Suicide in India published by India's National Crime Records Bureau (NCRB) reporting official suicide rates based on police reports over the period of 10 years from 2004 to 2013. A reference to wider literature is made to present a comprehensive picture. Suicide in India is more prevalent in young, is likely to involve hanging and ingestion of pesticides and is related to social and economic causes. Reducing alcohol consumption, unemployment, poverty, social inequities, domestic violence and improving social justice are essential to reduce suicide in India. NCRB data might underreport suicide. Discrepancy in farmers' suicide rate between reports suggests that this might be overrepresented in NCRB data. An integrated suicide prevention programme with a multidimensional approach is needed. Mental health care bill and the recent launch of first national mental health policy are welcome measures. Decriminalization of suicide is likely to positively influence mental health practice and policy in India. Nationally representative studies investigating fatal and non-fatal suicidal behaviours, evaluation of models of service delivery for the vulnerable population, investigating suicide following different treatment services and effects of decriminalization of suicide on suicide rates should be the focus of future research. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 05/2015; DOI:10.1093/bmb/ldv018
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    ABSTRACT: Desensitization, a term loosely referring to a collection of antibody reduction and B-cell depletional therapies aimed at improving rates of transplantation in highly HLA and ABO-incompatible transplant recipients, has seen significant growth in the last decade. Advancements relate to an increasing unmet medical need for FDA-approved therapies, advancements in antibody detection methodologies and improved renal pathological assessments of antibody-mediated rejection (ABMR). Data reviewed include collective summaries of experience with high-dose intravenous immunoglobulin (IVIG), B-cell depletion with rituximab and the use of plasma exchange with low-dose IVIG. Consensus suggests that these protocols are the most commonly used while experiences with other agents (i.e. bortezomib) are evolving. Controversy exists as to the extent of resources required, expense and outcomes of desensitization protocols. Here we review and synthesize data from evolving protocols and summarize developments of novel biologics aimed at modification of B-cells, antibodies and complement activation which will likely improve desensitization and treatment of ABMR. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 05/2015; DOI:10.1093/bmb/ldv013
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    ABSTRACT: Smoking during pregnancy causes adverse health outcomes. Though the prevalence of smoking among pregnant women has declined, postpartum relapse rates remain high and smoking-related maternal, fetal and infant morbidity and mortality remains a public health burden. A comprehensive literature search on smoking in pregnancy was conducted to provide a practical review for health professionals. Psychosocial support is an effective evidence-based treatment for pregnant women. Bio-psycho-socio factors that influence likelihood of quitting and remaining quit should be addressed. Electronic cigarettes are marketed as a harm reduction tool, but research on safety and effectiveness are lacking for pregnant women. The safety and efficacy of pharmacotherapy for use among pregnant women remains unclear. Clinicians should increase discussions regarding all resources for tobacco use treatment and secondhand smoke (SHS) exposure during pregnancy and postpartum and offer psychosocial support to all pregnant women. Research on developing stronger tobacco control policies in low- and middle-income countries, increasing cessation and relapse prevention among pregnant smokers with mental health conditions and increasing the impact of evidence-based supports, such as the quitline, among pregnant women can decrease consumption of tobacco in pregnancy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 04/2015; DOI:10.1093/bmb/ldv016
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    ABSTRACT: Biobanking refers to the infrastructure, policies and practices involved in collecting, processing, storing and disseminating biological samples. Biospecimen methods research to support biobanking through evidence-based practices is now recognized as critical to the success of biobanking and translational research. Data concerning biospecimen research have appeared in the literature for many years, primarily in journals and textbooks focused on clinical chemistry, epidemiology and pathology. Recently, new efforts have been initiated to support the development of evidence-based biobanking practices. Generally, researchers who are engaged in studies involving biospecimen collection are aware of the effects of pre-analytical variables on their downstream analyses, and they normally take steps to control those variables to publish reproducible results. Knowledge of such biospecimen research data is often unknown in the clinical setting unless the researchers are engaged in a project requiring strict protocols. There is broad agreement of the need to develop evidence-based practices to achieve consistent quality for biospecimens and data. However, due to inconsistencies in the literature, there is some disagreement on whether biospecimens need to be collected according to a 'platinum' standard or local biobank standards for collecting samples as 'fit-for-purpose' will be sufficient. New and expanded efforts, on an international basis where possible, need to be developed to better harmonize biospecimen management practices. Additional biospecimen methods research leading to the development of evidence-based practices is critical to translational research and personalized medicine. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 04/2015; DOI:10.1093/bmb/ldv012
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    ABSTRACT: Most people will experience a traumatic event during their lives. However, not all will develop Post-Traumatic Stress Disorder (PTSD). There have been recent changes in diagnostic criteria for PTSD and there are a number of treatment options available. This review is based on published literature in the field of PTSD, its management and the recently published DSM-V. The most influential risk factors relate to the post-incident environment rather than pre-incident or the incident itself. There are two established and effective psychological therapies; trauma-focussed cognitive behavioural therapy and eye movement desensitization and reprocessing. It is unclear what actually constitutes a traumatic event. Psychological debriefing or counselling interventions, shortly after trauma-exposure are found to be ineffective and may cause harm. Medication, whilst common practice, is not recommended as first line management. Future psychotherapies for PTSD may be just as effective if delivered in carefully considered group settings or through remote means. Research into the most effective ways to prevent individuals at risk of developing PTSD is still at an early stage and development of effective early interventions could substantially reduce the morbidity associated with PTSD. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 04/2015; DOI:10.1093/bmb/ldv014
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    ABSTRACT: Phenoxy herbicides have been used widely in agriculture, forestry, parks and domestic gardens. Early studies linked them with soft-tissue sarcoma (STS) and non-Hodgkin lymphoma (NHL), but when last reviewed by the International Agency for Research on Cancer in 1986, the evidence for human carcinogenicity was limited. We searched Medline and Embase, looking for cohort or case-control studies that provided data on risk of STS and/or NHL in relation to phenoxy herbicides, and checked the reference lists of relevant publications for papers that had been missed. The extensive evidence is not entirely consistent, and a hazard of STS or NHL cannot firmly be ruled out. However, if there is a hazard, then absolute risks must be small. Extended follow-up of previously assembled cohorts may be the most efficient way of further reducing uncertainties. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 03/2015; DOI:10.1093/bmb/ldv008
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    ABSTRACT: Women now outnumber men in British medical schools. This paper charts the history of women in medicine and provides current demographic trends. A historical literature review and routinely collected data from Department of Health and the Health and Social Care Information Centre. Clear gender differences are apparent in working practices, including greater likelihood of working part time and specializing in certain areas of medicine. The increasing need to increase activity among the existing medical workforce is timely amidst a changing workforce demographic. Workforce planners, policymakers and Royal Colleges should continue to develop interventions that may reduce disparities in career choices, as well as considering ways to increase participation and activity. Further research is needed to explore the cost-effectiveness of existing and future interventions in this field. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 03/2015; DOI:10.1093/bmb/ldv007
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    ABSTRACT: This review aims to provide information on the time taken to resume sport following tibial diaphyseal stress fractures (TDSFs). A systematic search of Medline, EMBASE, CINHAL, Cochrane, Web of Science, PEDro, Sports Discus, Scopus and Google Scholar was performed using the keywords 'tibial', 'tibia', 'stress', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. Twenty-seven studies were included: 16 reported specifically on anterior TDSFs and 5 on posterior TDSFs. The general principles were to primarily attempt non-operative management for all TDSFs and to consider operative intervention for anterior TDSFs that remained symptomatic after 3-6 months. Anterior TDSFs showed a prolonged return to sport. The best time to return to sport and the optimal management modalities for TDSFs remain undefined. Management of TDSFs should include a full assessment of training methods, equipment and diet to modify pre-disposing factors. Future prospective studies should aim to establish the optimal treatment modalities for TDSFs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 02/2015; DOI:10.1093/bmb/ldv006
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    ABSTRACT: Tuberculous meningitis (TBM) is the most severe form of infection caused by Mycobacterium tuberculosis, causing death or disability in more than half of those affected. The aim of this review is to examine recent advances in our understanding of TBM, focussing on the diagnosis and treatment of this devastating condition. Papers on TBM published between 1891 and 2014 and indexed in the NCBI Pubmed. The following search terms were used: TBM, diagnosis, treatment and outcome. The diagnosis of TBM remains difficult as its presentation is non-specific and may mimic other causes of chronic meningoencephalitis. Rapid recognition of TBM is crucial, however, as delays in initiating treatment are associated with poor outcome. The laboratory diagnosis of TBM is hampered by the low sensitivity of cerebrospinal fluid microscopy and the slow growth of M. tuberculosis in conventional culture systems. The current therapy of TBM is based on the treatment of pulmonary tuberculosis, which may not be ideal. The combination of TBM and HIV infection poses additional management challenges because of the need to treat both infections and the complications associated with them. The pathogenesis of TBM remains incompletely understood limiting the development of interventions to improve outcome. The optimal therapy of TBM has not been established in clinical trials, and increasing antimicrobial resistance threatens successful treatment of this condition. The use of adjunctive anti-inflammatory agents remains controversial, and their mechanism of action remains incompletely understood. The role of surgical intervention is uncertain and may not be available in areas where TBM is common. Laboratory methods to improve the rapid diagnosis of TBM are urgently required. Clinical trials of examining the use of high-dose rifampicin and/or fluoroquinolones are likely to report in the near future. The use of biomarkers to improve the rapid diagnosis of TBM warrants further investigation. The role of novel antituberculosis drugs, such as bedaquiline and PA-824, in the treatment of TBM remains to be explored. Human genetic polymorphisms may explain the heterogeneity of response to anti-inflammatory therapies and could potentially be used to tailor therapy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 02/2015; 113(1). DOI:10.1093/bmb/ldv003