{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:41:31Z","timestamp":1792215691332,"version":"4.4.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with Crohn\u2019s disease (CD) may be predisposed to mesh-related complications such as impaired wound healing and fistula formation following hernia repair. With limited evidence and no established guidelines for hernia repair in CD, this Delphi study aimed to establish a hernia expert consensus on elective inguinal, incisional, and parastomal hernia repair in patients with CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-round Delphi process including 21 hernia experts from Europe and the USA was conducted between 24 April and 15 October 2025. The primary outcome of interest was a consensus \u2265 75% among participants. Near consensus was defined as \u2265 70% agreement. Statements were developed from participant comments and questionnaire responses. Experts evaluated statements on timing, surgical approach, and mesh selection (synthetic non-absorbable, synthetic absorbable, biosynthetic, biological, and non-mesh) across different CD subtypes in elective inguinal, incisional, and parastomal hernia repair. Patients were categorized into three CD subtypes, namely abdominal fistulizing Crohn's disease (FCD), isolated perianal FCD, and non-FCD, with each assessed in both active and non-active inflammatory disease states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus or near consensus was achieved for 12 of 20 items (60%) in Round 1, 17 of 33 items (52%) in Round 2, and 13 of 29 items (45%) in Round 3. Overall, 42 of 72 unique items reached consensus (34 items) or near consensus (8 items). It was suggested that elective hernia repair should be avoided in CD patients with active inflammation, regardless of abdominal FCD or non-FCD. In non-active CD, synthetic non-absorbable mesh was suggested for inguinal, incisional, and parastomal hernia repair. Standard mesh placement was recommended for inguinal hernias, whereas retromuscular or preperitoneal mesh placement was recommended for incisional and parastomal hernias. No consensus was reached to avoid elective repair in isolated perianal FCD with active inflammation. The use of non-mesh repair, synthetic absorbable, biological, or biosynthetic mesh was generally not recommended in the elective setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consensus was reached that CD with non-active inflammation does not require deviation from standard hernia repair principles provided that the mesh is positioned in extraperitoneal positions. However, patients with CD may have an increased perioperative risk and the surgical management should be guided by shared decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag172","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:39:40Z","timestamp":1788867580000},"source":"Crossref","is-referenced-by-count":0,"title":["International expert consensus on managing elective hernia repair in patients with Crohn\u2019s disease using the Delphi method"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7887-3579","authenticated-orcid":false,"given":"Hans","family":"Lov\u00e9n","sequence":"first","affiliation":[{"name":"Center for Surgical Science, Zealand University Hospital , K\u00f8ge ,","place":["Denmark"]},{"name":"Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5702-8352","authenticated-orcid":false,"given":"Frederik","family":"Helgstrand","sequence":"additional","affiliation":[{"name":"Center for Surgical Science, Zealand University Hospital , K\u00f8ge ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Friis-Andersen","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Aarhus University Hospital, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Ballecer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dignity Health St. Joseph\u2019s Hospital and Medical Center, Creighton University School of Medicine\u2014Phoenix Division , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3575-5345","authenticated-orcid":false,"given":"Frederik","family":"Berrevoet","sequence":"additional","affiliation":[{"name":"Department for General and HPB Surgery and Liver Transplantation, Ghent University Hospital , Ghent ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-8105","authenticated-orcid":false,"given":"Marja","family":"Boermeester","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam University Medical Center , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-7162","authenticated-orcid":false,"given":"Hanna","family":"de la Croix","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]},{"name":"Department of Surgery, Inflammatory Bowel Disease Surgical Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Gaarder","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Faculty of Medicine, Oslo University Hospital Ulleval, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3753-268X","authenticated-orcid":false,"given":"Ismail","family":"G\u00f6genur","sequence":"additional","affiliation":[{"name":"Center for Surgical Science, Zealand University Hospital , K\u00f8ge ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1805-9866","authenticated-orcid":false,"given":"Nadia","family":"Henriksen","sequence":"additional","affiliation":[{"name":"Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8636-9949","authenticated-orcid":false,"given":"William","family":"Hope","sequence":"additional","affiliation":[{"name":"Department of Surgery, Novant Health New Hanover Regional Medical Center , Wilmington, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Itani","sequence":"additional","affiliation":[{"name":"Department of Surgery, VA Boston Healthcare System , Boston, Massachusetts ,","place":["USA"]},{"name":"Department of Surgery, Boston University School of Medicine, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-5374","authenticated-orcid":false,"given":"Lars","family":"N. J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3470-7322","authenticated-orcid":false,"given":"Ferdinand","family":"K\u00f6ckerling","sequence":"additional","affiliation":[{"name":"Berlin Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charit\u00e9 University Medicine , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4387-1773","authenticated-orcid":false,"given":"Jan Roland","family":"Lambrecht","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust , Hamar ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7047-6114","authenticated-orcid":false,"given":"Marc","family":"Miserez","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Hospitals KU Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Petersson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Sk\u00e5ne University Hospital Malm\u00f6, Lund University , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-6673","authenticated-orcid":false,"given":"Thomas","family":"Pinkney","sequence":"additional","affiliation":[{"name":"Academic Department of Surgery, University of Birmingham , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1192-6311","authenticated-orcid":false,"given":"Benjamin K","family":"Poulose","sequence":"additional","affiliation":[{"name":"MPH Center for Abdominal Core Health, Department of Surgery, The Ohio State University, Wexner Medical Center , Columbus, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rosen","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0063-1086","authenticated-orcid":false,"given":"Jacob","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, Herlev Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L","family":"Sanders","sequence":"additional","affiliation":[{"name":"Academic Department of Abdominal Wall Surgery, Royal Devon University Foundation Healthcare Trust, North Devon District Hospital , Barnstaple ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6032-8580","authenticated-orcid":false,"given":"Dominic","family":"Slade","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Salford Royal Hospitals NHS Foundation Trust , Salford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3554-1628","authenticated-orcid":false,"given":"Bj\u00f6rn","family":"T\u00f6rnqvist","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-3611","authenticated-orcid":false,"given":"Thue","family":"Bisgaard","sequence":"additional","affiliation":[{"name":"Center for Surgical Science, Zealand University Hospital , K\u00f8ge ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"2026101701050786800_zrag172-B1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.smim.2007.11.004","article-title":"Foreign body reaction to biomaterials","volume":"20","author":"Anderson","year":"2008","journal-title":"Semin Immunol"},{"key":"2026101701050786800_zrag172-B2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/s41572-020-0156-2","article-title":"Crohn's disease","volume":"6","author":"Roda","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2026101701050786800_zrag172-B3","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1007\/s00423-022-02638-x","article-title":"Abdominal hernia mesh repair in patients with inflammatory bowel disease: a systematic review","volume":"407","author":"El Boghdady","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"2026101701050786800_zrag172-B4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s10029-024-03228-0","article-title":"Mesh-related complications and recurrence after incisional hernia repair in patients with fistulizing versus non-fistulizing Crohn's disease","volume":"29","author":"Lov\u00e9n","year":"2024","journal-title":"Hernia"},{"key":"2026101701050786800_zrag172-B5","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1093\/ibd\/izz056","article-title":"Prevalence of fistulizing Crohn's disease in the United States: estimate from a systematic literature review attempt and population-based database analysis","volume":"25","author":"Schwartz","year":"2019","journal-title":"Inflamm Bowel Dis"},{"key":"2026101701050786800_zrag172-B6","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.3390\/jcm11113045","article-title":"The optimal management of fistulizing Crohn's disease: evidence beyond randomized clinical trials","volume":"11","author":"Wetwittayakhlang","year":"2022","journal-title":"J Clin Med"},{"key":"2026101701050786800_zrag172-B7","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology"},{"key":"2026101701050786800_zrag172-B8","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1177\/2050640613487194","article-title":"Fistulizing Crohn's disease: diagnosis and management","volume":"1","author":"Gecse","year":"2013","journal-title":"United European Gastroenterol J"},{"key":"2026101701050786800_zrag172-B9","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/MEG.0000000000001936","article-title":"Postoperative outcomes following inguinal hernia repair in inflammatory bowel disease patients compared to matched controls","volume":"33","author":"Horesh","year":"2021","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2026101701050786800_zrag172-B10","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10029-025-03362-3","article-title":"Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease","volume":"29","author":"Lov\u00e9n","year":"2025","journal-title":"Hernia"},{"key":"2026101701050786800_zrag172-B11","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/978-3-031-25110-8_66","volume-title":"Handbook of Social Sciences and Global Public Health","author":"Ismail","year":"2023"},{"key":"2026101701050786800_zrag172-B12","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1576\/toag.7.2.120.27071","article-title":"The Delphi technique","volume":"7","author":"Thangaratinam","year":"2005","journal-title":"Obstet Gynaecol"},{"key":"2026101701050786800_zrag172-B13","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review","volume":"31","author":"J\u00fcnger","year":"2017","journal-title":"Palliat Med"},{"key":"2026101701050786800_zrag172-B14","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10029-009-0518-x","article-title":"Classification of primary and incisional abdominal wall hernias","volume":"13","author":"Muysoms","year":"2009","journal-title":"Hernia"},{"key":"2026101701050786800_zrag172-B15","doi-asserted-by":"crossref","first-page":"13840","DOI":"10.3389\/jaws.2024.13840","article-title":"Acceptance of open preperitoneal repair in inguinal hernia surgery Delphi-consensus after an anonymous international survey among European Hernia Society members","volume":"3","author":"Lorenz","year":"2024","journal-title":"J Abdom Wall Surg"},{"key":"2026101701050786800_zrag172-B16","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2013.12.002","article-title":"Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies","volume":"67","author":"Diamond","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"2026101701050786800_zrag172-B17","doi-asserted-by":"crossref","first-page":"561103","DOI":"10.3389\/fpubh.2020.00457","article-title":"Delphi technique in health sciences: a map","volume":"8","author":"Niederberger","year":"2020","journal-title":"Front Public Health"},{"key":"2026101701050786800_zrag172-B18","doi-asserted-by":"crossref","first-page":"znad346","DOI":"10.1093\/bjs\/znad346","article-title":"What defines an incisional hernia as \u2018complex\u2019: results from a Delphi consensus endorsed by the European Hernia Society (EHS)","volume":"111","author":"Giovannini","year":"2024","journal-title":"Br J Surg"},{"key":"2026101701050786800_zrag172-B19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jviscsurg.2016.04.009","article-title":"The importance of the Crohn's disease activity index in surgery for small bowel Crohn's disease","volume":"153","author":"Lee","year":"2016","journal-title":"J Visc Surg"},{"key":"2026101701050786800_zrag172-B20","doi-asserted-by":"crossref","first-page":"2845407","DOI":"10.1155\/2020\/2845407","article-title":"The role of active inflammation and surgical therapy in Crohn's disease recurrence","volume":"2020","author":"Ingallinella","year":"2020","journal-title":"Gastroenterol Res Pract"},{"key":"2026101701050786800_zrag172-B21","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1002\/ibd.21917","article-title":"Presence of concomitant inflammatory bowel disease is associated with an increased risk of postcholecystectomy complications","volume":"18","author":"Navaneethan","year":"2012","journal-title":"Inflamm Bowel Dis"},{"key":"2026101701050786800_zrag172-B22","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.4240\/wjgs.v15.i11.2579","article-title":"Risk and management of post-operative infectious complications in inflammatory bowel disease: a systematic review","volume":"15","author":"Mowlah","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"2026101701050786800_zrag172-B23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12876-024-03171-5","article-title":"Clinical features of inflammatory bowel disease unclassified: a case-control study","volume":"24","author":"Shao","year":"2024","journal-title":"BMC Gastroenterol"},{"key":"2026101701050786800_zrag172-B24","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1177\/000313481608200620","article-title":"Outcomes of retromuscular approach for abdominal wall reconstruction in patients with inflammatory bowel disease","volume":"82","author":"Wang","year":"2016","journal-title":"Am Surg"},{"key":"2026101701050786800_zrag172-B25","doi-asserted-by":"crossref","first-page":"101869","DOI":"10.1016\/j.cpsurg.2025.101869","article-title":"Biological vs synthetic mesh in ventral hernia repair; A systematic review and meta-analysis","volume":"72","author":"Addalla","year":"2025","journal-title":"Curr Probl Surg"},{"key":"2026101701050786800_zrag172-B26","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.surg.2022.12.002","article-title":"Biologic versus synthetic mesh in open ventral hernia repair: a systematic review and meta-analysis of randomized controlled trials","volume":"173","author":"Mazzola Poli de Figueiredo","year":"2023","journal-title":"Surgery"},{"key":"2026101701050786800_zrag172-B27","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1097\/AS9.0000000000000366","article-title":"Five-year follow-up of a slowly resorbable biosynthetic P4HB mesh (Phasix) in VHWG grade 3 incisional hernia repair","volume":"4","author":"Van den Dop","year":"2023","journal-title":"Ann Surg Open"},{"key":"2026101701050786800_zrag172-B28","doi-asserted-by":"crossref","first-page":"109579","DOI":"10.1016\/j.surg.2025.109579","article-title":"Biosynthetic compared with synthetic mesh in retrorectus ventral hernia repair: a matched analysis with 3-year outcomes","volume":"186","author":"Khan","year":"2025","journal-title":"Surgery"},{"key":"2026101701050786800_zrag172-B29","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1007\/s00268-020-05436-y","article-title":"Mesh repair in Crohn's disease: a case-matched multicenter study in 234 patients","volume":"44","author":"Beyer-Berjot","year":"2020","journal-title":"World J Surg"},{"key":"2026101701050786800_zrag172-B30","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1097\/01.sla.0000141193.08524.e7","article-title":"Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia","volume":"240","author":"Burger","year":"2004","journal-title":"Ann Surg"},{"key":"2026101701050786800_zrag172-B31","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1056\/NEJM200008103430603","article-title":"A comparison of suture repair with mesh repair for incisional hernia","volume":"343","author":"Luijendijk","year":"2000","journal-title":"N Engl J Med"},{"key":"2026101701050786800_zrag172-B32","doi-asserted-by":"crossref","first-page":"zrad080","DOI":"10.1093\/bjsopen\/zrad080","article-title":"Update of the international HerniaSurge guidelines for groin hernia management","volume":"7","author":"Stabilini","year":"2023","journal-title":"BJS Open"},{"key":"2026101701050786800_zrag172-B33","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1053\/j.gastro.2020.12.031","article-title":"STRIDE-II: an update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD","volume":"160","author":"Turner","year":"2021","journal-title":"Gastroenterology"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag172\/72066014\/zrag172.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag172\/72066014\/zrag172.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:05:17Z","timestamp":1792213517000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag172\/8935233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag172","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,4]]},"article-number":"zrag172"}}