{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T22:14:58Z","timestamp":1785190498396,"version":"3.55.0"},"reference-count":50,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"French Society of Physiology and Subaquatic and Hyperbaric Medicine","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100006388","name":"Geneva University Hospitals","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100006388","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,5]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sickle cell disease (SCD) is one of the most common genetic diseases in the world, annually affecting approximately 310\u2009000 births and causing &gt;100\u2009000 deaths. Vaso-occlusive crisis (VOC) is the most frequent complication of SCD, leading to bone pain, thoracic pain (acute chest syndrome) and\/or abdominal spasms. It is the main cause of mortality in patients with SCD, reducing life expectancy. Hyperbaric oxygen therapy (HBOT) is a safe and well-established method of increasing tissue oxygen delivery immediately by up to 10-fold to 20-fold. In the context of VOC, HBOT has the potential to limit sickling. A previous pilot study of nine patients showed the safety and potential benefits of HBOT on VOC-induced pain. Our study aimed to assess the clinical safety and effectiveness of HBOT for treating VOC, its biological mechanisms of actions and its cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This is a multicentric, triple-blinded, randomised controlled trial. Patients aged 8 years or above with a diagnosed major form of SCD, presenting at one of the participating centres\u2019 emergency departments (EDs) with a VOC requiring level 3 analgesia (according to WHO definition), will be eligible. Exclusion criteria are pregnancy, mechanical ventilation, previous history of stroke or prior transcranial Doppler ultrasound anomaly, contraindication to HBOT and the need for above 2\u2009L\/min of oxygen. All patients will receive the usual care for VOCs, including hydration, analgesics, normobaric oxygen therapy and when medically indicated, antibiotic therapy and\/or transfusions. Within 24 hours of their arrival in the ED (or longer in specific cases), and after obtaining informed consent, patients will be randomised into the HBOT intervention group (2.0 atmosphere absolute (ATA), 90\u2009min, FIO\n                      <jats:sub>2<\/jats:sub>\n                      =1) or the sham group (1.3 ATA, 90\u2009min, FIO\n                      <jats:sub>2<\/jats:sub>\n                      =0.21). After their first HBOT session, patients will return to their acute-care ward. Patients in both arms will undergo a second and third session within 24\u201336\u2009hours of the first, unless their Visual Analogue Scale (VAS)-pain is \u22642 without use of level 3 analgesics. The difference in the pain-VAS before and after HBOT and other outcomes will be compared between the intervention and sham groups. Our composite primary outcome will be (1) the change in global VAS-pain 6\u2009hours after initiation of HBOT; (2) the number of patients with a VAS-pain score &gt;4 and\/or a morphine dosage &gt;1\u2009mg\/hour intravenous after the HBOT\/sham session. Other outcomes to be reported are morphine usage, length of stay, biological parameters, satisfaction, complications and cost.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval CER Geneva 2019-01707 (last submission V.5.1, 06.15.2023). The results of the studies will be disseminated by several media, including publications in peer-reviewed international medical journals, and presentations at national and\/or international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04978116\">NCT04978116<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-084825","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T02:05:43Z","timestamp":1732845943000},"page":"e084825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Protocol for a multicentric, double-blind, randomised controlled trial of hyperbaric oxygen therapy (HBOT) versus sham for treating vaso-occlusive crisis (VOC) in sickle cell disease (SCD) in patients aged 8 years or older (HBOT-SCD study)"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct04978116","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4452","authenticated-orcid":false,"given":"Jerome","family":"Stirnemann","sequence":"first","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Serratrice","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Louge","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Combescure","family":"Christophe","sequence":"additional","affiliation":[{"name":"Diagnostic of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaveh","family":"Samii","sequence":"additional","affiliation":[{"name":"Division of Haematology, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigue","family":"Pignel","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Agoritsas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ansari","sequence":"additional","affiliation":[{"name":"CANSEARCH Research Platform in Paediatric Oncology and Haematology of the University of Geneva, University of Geneva, Geneva, Switzerland"},{"name":"Division of Paediatric Oncology and Haematology, University Hospitals of Geneva Department of Women-Children-Teenagers, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Cannas","sequence":"additional","affiliation":[{"name":"Sickle-Cell Disease Reference Center, Hospices Civils de Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Chalandon","sequence":"additional","affiliation":[{"name":"Hematology Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Cimasoni","sequence":"additional","affiliation":[{"name":"Division of Paediatric Oncology and Haematology, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Cougoul","sequence":"additional","affiliation":[{"name":"Sickle-cell Reference Center, Institut Universitaire du Cancer de Toulouse Oncopole CHU Toulouse, Toulouse, Occitanie, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Desgraz","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Gervaix","sequence":"additional","affiliation":[{"name":"Department of Women-Children-Teenagers, Geneva University Hospitalse, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Grosgurin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Joffre","sequence":"additional","affiliation":[{"name":"Hyperbaric Center, Hospices Civils de Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Lae","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Anne","family":"Magnan","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Menager","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Momo Bona","sequence":"additional","affiliation":[{"name":"Emergency Department, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc-Alain","family":"Panchard","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Luc","family":"Reny","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Riu","sequence":"additional","affiliation":[{"name":"Hyperbaric Center, Institut Universitaire du Cancer de Toulouse Oncopole CHU Toulouse, Toulouse, Occitanie, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Sahyoun","sequence":"additional","affiliation":[{"name":"Department of Women-Children-Teenagers, Geneva University Hospitals Children's Hospital, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Boet","sequence":"additional","affiliation":[{"name":"Subaquatic and Hyperbaric Medicine Unit, Emergency Service, Acute Medicine Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"2025120600280641000_14.11.e084825.1","unstructured":"Arnal C , Godeau B . Strat\u00e9gie de La Prise En Charge Des Crises Vaso-Occlusives Non Compliqu\u00e9es de l\u2019adulte Dr\u00e9panocytaire. La dr\u00e9panocytose. Paris: Girot, R, 2003:77\u201383."},{"key":"2025120600280641000_14.11.e084825.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006223422502"},{"key":"2025120600280641000_14.11.e084825.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13045-022-01237-z","article-title":"Advances in the diagnosis and treatment of sickle cell disease","volume":"15","author":"Brandow","year":"2022","journal-title":"J Hematol Oncol"},{"key":"2025120600280641000_14.11.e084825.4","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathmechdis-012418-012838"},{"key":"2025120600280641000_14.11.e084825.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14689-2"},{"key":"2025120600280641000_14.11.e084825.6","doi-asserted-by":"publisher","DOI":"10.1172\/JCI9225"},{"key":"2025120600280641000_14.11.e084825.7","doi-asserted-by":"crossref","first-page":"3548","DOI":"10.1182\/blood.V82.12.3548.3548","article-title":"Integrin alpha 4 beta 1 and glycoprotein IV (CD36) are expressed on circulating reticulocytes in sickle cell anemia","volume":"82","author":"Joneckis","year":"1993","journal-title":"Blood"},{"key":"2025120600280641000_14.11.e084825.8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0925-4439(98)00085-4","article-title":"Mechanism of interaction of thrombospondin with human endothelium and inhibition of sickle erythrocyte adhesion to human endothelial cells by heparin","volume":"1453","author":"Gupta","year":"1999","journal-title":"Biochim Biophys Acta"},{"key":"2025120600280641000_14.11.e084825.9","doi-asserted-by":"publisher","DOI":"10.1172\/JCI1204"},{"key":"2025120600280641000_14.11.e084825.10","doi-asserted-by":"publisher","DOI":"10.1136\/jms.8.1.8"},{"key":"2025120600280641000_14.11.e084825.11","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.6.1955"},{"key":"2025120600280641000_14.11.e084825.12","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1182\/blood.V91.1.266","article-title":"Blood polymorphonuclear leukocytes from the majority of sickle cell patients in the crisis phase of the disease show enhanced adhesion to vascular endothelium and increased expression of CD64","volume":"91","author":"Fadlon","year":"1998","journal-title":"Blood"},{"key":"2025120600280641000_14.11.e084825.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-2143(97)90005-6"},{"key":"2025120600280641000_14.11.e084825.14","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1182\/blood.V84.2.643.643","article-title":"The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease","volume":"84","author":"Castro","year":"1994","journal-title":"Blood"},{"key":"2025120600280641000_14.11.e084825.15","doi-asserted-by":"publisher","DOI":"10.1172\/JCI89741"},{"key":"2025120600280641000_14.11.e084825.16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-11-3422"},{"key":"2025120600280641000_14.11.e084825.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199406093302303"},{"key":"2025120600280641000_14.11.e084825.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711273372203"},{"key":"2025120600280641000_14.11.e084825.19","doi-asserted-by":"publisher","DOI":"10.1172\/JCI62972"},{"key":"2025120600280641000_14.11.e084825.20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-09-529420"},{"key":"2025120600280641000_14.11.e084825.21","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020001851"},{"key":"2025120600280641000_14.11.e084825.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2016.05.042"},{"key":"2025120600280641000_14.11.e084825.23","first-page":"122","article-title":"Tenth European Consensus Conference on Hyperbaric Medicine: preliminary report","volume":"46","author":"Mathieu","year":"2016","journal-title":"Diving Hyperb Med"},{"key":"2025120600280641000_14.11.e084825.24","first-page":"247","article-title":"Mechanisms of action of hyperbaric oxygen therapy","volume":"41","author":"Camporesi","year":"2014","journal-title":"Undersea Hyperb Med"},{"key":"2025120600280641000_14.11.e084825.25","doi-asserted-by":"crossref","first-page":"51","DOI":"10.28920\/dhm53.1.51-54","article-title":"Validation of sham treatment in hyperbaric medicine: a randomised trial","volume":"53","author":"Louge","year":"2023","journal-title":"Diving Hyperb Med"},{"key":"2025120600280641000_14.11.e084825.26","first-page":"253","article-title":"Side effects of hyperbaric oxygen therapy","volume":"41","author":"Camporesi","year":"2014","journal-title":"Undersea Hyperb Med"},{"key":"2025120600280641000_14.11.e084825.27","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/01.ASW.0000508712.86959.c9","article-title":"A Retrospective Analysis of Adverse Events in Hyperbaric Oxygen Therapy (2012-2015): Lessons Learned From 1.5 Million Treatments","volume":"30","author":"Jokinen-Gordon","year":"2017","journal-title":"Adv Skin Wound Care"},{"key":"2025120600280641000_14.11.e084825.28","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/j.1600-0676.1998.tb00135.x","article-title":"Hyperbaric oxygen pretreatment attenuates hepatic reperfusion injury","volume":"18","author":"Chen","year":"1998","journal-title":"Liver"},{"key":"2025120600280641000_14.11.e084825.29","doi-asserted-by":"crossref","first-page":"H1799","DOI":"10.1152\/ajpheart.2000.278.6.H1799","article-title":"Impaired nitric oxide-mediated vasodilation in transgenic sickle mouse","volume":"278","author":"Kaul","year":"2000","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"2025120600280641000_14.11.e084825.30","doi-asserted-by":"publisher","DOI":"10.1172\/JCI1932"},{"key":"2025120600280641000_14.11.e084825.31","doi-asserted-by":"crossref","first-page":"C292","DOI":"10.1152\/ajpcell.2000.278.2.C292","article-title":"Hyperbaric oxygen downregulates ICAM-1 expression induced by hypoxia and hypoglycemia: the role of NOS","volume":"278","author":"Buras","year":"2000","journal-title":"Am J Physiol Cell Physiol"},{"key":"2025120600280641000_14.11.e084825.32","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.01096.2005"},{"key":"2025120600280641000_14.11.e084825.33","unstructured":"Mehdaoui H , Drepanocytose DJH . Trait\u00e9 de M\u00e9decine Hyperbarre. Ellipses, 2022:416\u201323."},{"key":"2025120600280641000_14.11.e084825.34","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/S0025-7125(16)33102-9","article-title":"Sickle cell anemia","volume":"50","author":"Desforges","year":"1966","journal-title":"Med Clin North Am"},{"key":"2025120600280641000_14.11.e084825.35","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/00007611-196904000-00018","article-title":"Effects of hyperbaric oxygenation on sickle syndromes","volume":"62","author":"Laszlo","year":"1969","journal-title":"S Med J"},{"key":"2025120600280641000_14.11.e084825.36","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1971.03180380035007"},{"key":"2025120600280641000_14.11.e084825.37","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1973.01000050092002"},{"key":"2025120600280641000_14.11.e084825.38","article-title":"Oxyg\u00e9noth\u00e9rapie hyperbare des crises douloureuses osseuses rebelles de la dr\u00e9panocytose homozygote","volume":"4","author":"Coeur","year":"1975","journal-title":"Nouv Presse Med"},{"key":"2025120600280641000_14.11.e084825.39","first-page":"368","article-title":"Long-term follow-up of scleral buckling procedures with sickle cell disease and retinal detachment treated with the use of hyperbaric oxygen","volume":"18","author":"Freilich","year":"1977","journal-title":"Mod Probl Ophthalmol"},{"key":"2025120600280641000_14.11.e084825.40","unstructured":"Perrimond H . M\u00e9decine Hyperbare. La Dr\u00e9panocytose, 1992:131\u20136."},{"key":"2025120600280641000_14.11.e084825.41","unstructured":"Mehdaoui H , Letellier E . L\u2019oxyg\u00e9noth\u00e9rapie hyperbare pour les dr\u00e9panocytaires. Universit\u00e9 de Lille: m\u00e9moire de DIU, 1994."},{"key":"2025120600280641000_14.11.e084825.42","unstructured":"Dubois B . Dr\u00e9panocytose et Hyperbarie. Universit\u00e9 de Lilles, 2001."},{"key":"2025120600280641000_14.11.e084825.43","unstructured":"Huang E . Hyperbaric Oxygen Therapy Indications 15th Edition. Undersea and Hyperbaric Medical Society, 2023."},{"key":"2025120600280641000_14.11.e084825.44","first-page":"82","article-title":"Hyperbaric oxygen therapy for vaso-occlusive crises in nine patients with sickle-cell disease","volume":"42","author":"Stirnemann","year":"2012","journal-title":"Diving Hyperb Med"},{"key":"2025120600280641000_14.11.e084825.45","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.118863"},{"key":"2025120600280641000_14.11.e084825.46","doi-asserted-by":"publisher","DOI":"10.1080\/03630260701587810"},{"key":"2025120600280641000_14.11.e084825.47","unstructured":"Gawdi R , Cooper J . Jeffrey cooper declares no relevant financial relationships with ineligible companies. In: Hyperbaric Contraindications. Treasure Island (FL) ineligible companies: StatPearls, 2024."},{"key":"2025120600280641000_14.11.e084825.48","doi-asserted-by":"publisher","DOI":"10.1177\/1740774513475850"},{"key":"2025120600280641000_14.11.e084825.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2007.09.005"},{"key":"2025120600280641000_14.11.e084825.50","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-06-227330"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-084825","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:28:14Z","timestamp":1765009694000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-084825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":50,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,28]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-084825"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-084825","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}