{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:34:10Z","timestamp":1778502850897,"version":"3.51.4"},"reference-count":53,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["10070022010001"],"award-info":[{"award-number":["10070022010001"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"M\u00e1xima MC Research and Innovation Fund"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,23]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women with high-risk pregnancies (eg, pre-eclampsia, imminent preterm birth) are often hospitalised due to the need for foetal and maternal monitoring. They are monitored for 30\u201345\u2009min up to three times a day with conventional cardiotocography (CTG). In the meantime, they reside at the hospital, but the foetal status is not monitored. Continuous foetal monitoring is currently not recommended using CTG, due to the potential temperature rise from consistent exposure to ultrasound waves. For safe 24\/7 monitoring, newly developed devices using non-invasive electrophysiological cardiotocography (eCTG) instead of conventional CTG offer a promising alternative. Previous research into eCTG has shown favourable results in monitoring foetal heart rate throughout both pregnancy and labour. This study aims to investigate the effect of implementing continuous antepartum eCTG monitoring in hospitalised high-risk pregnancies on perinatal and maternal outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this single centre prospective cohort intervention random sampling study, eligible women will be included on the Obstetric High Care of M\u00e1xima MC Veldhoven, the Netherlands. In total, 511 pregnant women with a singleton pregnancy between 23+0\u2009and 32+0 weeks of gestation requiring hospitalisation will be recruited. Eligible women will be prospectively included in the cohort receiving standard treatment: intermittent CTG monitoring. From these women, a random sample of the prospective cohort will be offered a new monitoring method: 24\/7 eCTG monitoring. For the eCTG monitoring, a wireless abdominal electrode patch, the Nemo Foetal Monitoring System will be used. Additional data from a historical cohort (2014\u20132019) of 1400\u2009women receiving standard treatment will be included. Perinatal and maternal outcome, along with satisfaction levels of both patient and caregivers, will be compared between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      The study is registered on 18 October 2022 to the Central Committee on Research Involving Human Subjects (NL82869.015.22) via\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.toetsingonline.nl\/to\/ccmo_monitor.nsf\/conceptabr?OpenForm\">https:\/\/www.toetsingonline.nl\/to\/ccmo_monitor.nsf\/conceptabr?OpenForm<\/jats:ext-link>\n                      and approved by the Medical Ethics Committee of M\u00e1xima MC (W22.070) on 7 November 2023. Results of the study will be disseminated in peer-reviewed scientific journals and conference presentations.\n                    <\/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=\"NCT06151613\">NCT06151613<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102732","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T11:25:20Z","timestamp":1762946720000},"page":"e102732","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Continuous non-invasive electrophysiological monitoring in high-risk pregnancies: study protocol of a cohort intervention random sampling study in a tertiary obstetrical care centre in the Netherlands (NIEM-O study)"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06151613","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3861-9330","authenticated-orcid":false,"given":"Nadine D","family":"de Klerk","sequence":"first","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7909-3795","authenticated-orcid":false,"given":"Phebe B Q","family":"Berben","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivar R","family":"de Vries","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hendrik","family":"Niemarkt","sequence":"additional","affiliation":[{"name":"Pediatrics, Maxima Medical Centre, Veldhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rik","family":"Vullings","sequence":"additional","affiliation":[{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin R","family":"van den Heuvel","sequence":"additional","affiliation":[{"name":"Mathematics & Computer Science, Technische Universiteit Eindhoven, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myrthe","family":"van der Ven","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"},{"name":"Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annemarie F","family":"Fransen","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S Guid","family":"Oei","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith O E H","family":"van Laar","sequence":"additional","affiliation":[{"name":"Gynaecology and Obstetrics, Maxima Medical Centre, Veldhoven, Netherlands"},{"name":"Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"2025120413263156000_15.11.e102732.1","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1007\/s00404-012-2413-4","article-title":"Intrapartum signal quality with external fetal heart rate monitoring: a two way trial of external Doppler CTG ultrasound and the abdominal fetal electrocardiogram","volume":"286","author":"Reinhard","year":"2012","journal-title":"Arch Gynecol Obstet"},{"key":"2025120413263156000_15.11.e102732.2","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1111\/aogs.12387","article-title":"Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques","volume":"93","author":"Cohen","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025120413263156000_15.11.e102732.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000258799.24496.93"},{"key":"2025120413263156000_15.11.e102732.4","first-page":"197","article-title":"The quality of intrapartum uterine activity monitoring","volume":"36","author":"Bakker","year":"2008","journal-title":"J Perinat Med"},{"key":"2025120413263156000_15.11.e102732.5","doi-asserted-by":"crossref","unstructured":"Haws RA , Yakoob MY , Soomro T , et al . Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth 2009;9. doi:10.1186\/1471-2393-9-S1-S5","DOI":"10.1186\/1471-2393-9-S1-S5"},{"key":"2025120413263156000_15.11.e102732.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.6021.1305"},{"key":"2025120413263156000_15.11.e102732.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.gyobfe.2005.07.041"},{"key":"2025120413263156000_15.11.e102732.8","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.110697"},{"key":"2025120413263156000_15.11.e102732.9","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00404-006-0278-0","article-title":"Twenty-four-hour CTG monitoring: comparison of normal pregnancies of 25-30 weeks of gestation versus 36-42 weeks of gestation","volume":"275","author":"K\u00fchnert","year":"2007","journal-title":"Arch Gynecol Obstet"},{"key":"2025120413263156000_15.11.e102732.10","doi-asserted-by":"crossref","unstructured":"Helmy S , Bader Y , Koch M , et al . Measurement of thermal effects of doppler ultrasound: an in vitro study. PLoS One 2015;10. doi:10.1371\/journal.pone.0135717","DOI":"10.1371\/journal.pone.0135717"},{"key":"2025120413263156000_15.11.e102732.11","unstructured":"Nicolaides K , Rizzo G , Hecher K , et al . Doppler in obstetrics. 2002."},{"key":"2025120413263156000_15.11.e102732.12","doi-asserted-by":"crossref","unstructured":"Vullings R , van Laar J . Non-invasive fetal electrocardiography for intrapartum cardiotocography. Front Pediatr 2020;8. doi:10.3389\/fped.2020.599049","DOI":"10.3389\/fped.2020.599049"},{"key":"2025120413263156000_15.11.e102732.13","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ejogrb.2017.05.027","article-title":"Electrohysterography for uterine monitoring during term labour compared to external tocodynamometry and intra-uterine pressure catheter","volume":"215","author":"Vlemminx","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025120413263156000_15.11.e102732.14","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1111\/aogs.13873","article-title":"Intrapartum non-invasive electrophysiological monitoring: A prospective observational study","volume":"99","author":"Lempersz","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025120413263156000_15.11.e102732.15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/OGX.0000000000000560","article-title":"Clinical use of electrohysterography during term labor: a systematic review on diagnostic value, advantages, and limitations","volume":"73","author":"Vlemminx","year":"2018","journal-title":"Obstet Gynecol Surv"},{"key":"2025120413263156000_15.11.e102732.16","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/s41372-018-0065-3","article-title":"Could electrohysterography be the solution for external uterine monitoring in obese women?","volume":"38","author":"Vlemminx","year":"2018","journal-title":"J Perinatol"},{"key":"2025120413263156000_15.11.e102732.17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ajog.2012.10.873","article-title":"Monitoring uterine activity during labor: a comparison of 3 methods","volume":"208","author":"Euliano","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"2025120413263156000_15.11.e102732.18","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/j.1471-0528.2008.01951.x","article-title":"Fetal electrocardiography: feasibility of long-term fetal heart rate recordings","volume":"116","author":"Graatsma","year":"2009","journal-title":"BJOG"},{"key":"2025120413263156000_15.11.e102732.19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/aogs.12286","article-title":"Fetal heart rate variability during pregnancy, obtained from non-invasive electrocardiogram recordings","volume":"93","author":"van Laar","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025120413263156000_15.11.e102732.20","unstructured":"Perinatal death. 2022. Available: https:\/\/www.peristat.nl\/ [Accessed 29 Mar 2022]."},{"key":"2025120413263156000_15.11.e102732.21","doi-asserted-by":"crossref","unstructured":"Pels A , Derks J , Elvan-Taspinar A , et al . Maternal Sildenafil vs Placebo in pregnant women with severe early-onset fetal growth restriction: a randomized clinical trial. JAMA Netw Open 2020;3. doi:10.1001\/jamanetworkopen.2020.5323","DOI":"10.1001\/jamanetworkopen.2020.5323"},{"key":"2025120413263156000_15.11.e102732.22","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.nicl.2017.08.015","article-title":"Clinical neuroimaging in the preterm infant: Diagnosis and prognosis","volume":"16","author":"Hinojosa-Rodr\u00edguez","year":"2017","journal-title":"Neuroimage Clin"},{"key":"2025120413263156000_15.11.e102732.23","unstructured":"Towbin A . Cerebral intraventricular hemorrhage and subependymal matrix infarction in the fetus and premature newborn. n.d."},{"key":"2025120413263156000_15.11.e102732.24","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-835966"},{"key":"2025120413263156000_15.11.e102732.25","first-page":"6","article-title":"Periventricular leukomalacia complex","volume":"103","author":"Grunnet","year":"1979","journal-title":"Arch Pathol Lab Med"},{"key":"2025120413263156000_15.11.e102732.26","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2006.05.002"},{"key":"2025120413263156000_15.11.e102732.27","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-0204"},{"key":"2025120413263156000_15.11.e102732.28","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7210963"},{"key":"2025120413263156000_15.11.e102732.29","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197801000-00001"},{"key":"2025120413263156000_15.11.e102732.30","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-0569"},{"key":"2025120413263156000_15.11.e102732.31","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/S0140-6736(13)60178-6","article-title":"Retinopathy of prematurity","volume":"382","author":"Hellstr\u00f6m","year":"2013","journal-title":"The Lancet"},{"key":"2025120413263156000_15.11.e102732.32","unstructured":"Cresswell J . Maternal mortality who definition. Available: https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/4622#:~:text=Definition%3A,and%20site%20of%20the%20pregnancy [Accessed 25 Jul 2022]."},{"key":"2025120413263156000_15.11.e102732.33","doi-asserted-by":"publisher","DOI":"10.1080\/14767050410001727404"},{"key":"2025120413263156000_15.11.e102732.34","doi-asserted-by":"crossref","unstructured":"de Klerk ND , Berben PB , der Ven M van , et al . Optimizing clinical scientific research: the cohort intervention random sampling study with historical controls. J Comp Eff Res 2025. doi:10.57264\/cer-2024-0168","DOI":"10.57264\/cer-2024-0168"},{"key":"2025120413263156000_15.11.e102732.35","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1515\/jpm-2021-0214","article-title":"The quality of intrapartum cardiotocography in preterm labour","volume":"50","author":"Faiz","year":"2022","journal-title":"J Perinat Med"},{"key":"2025120413263156000_15.11.e102732.36","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.jval.2016.01.003","article-title":"Dutch tariff for the five-level version of EQ-5D","volume":"19","author":"M. Versteegh","year":"2016","journal-title":"Value Health"},{"key":"2025120413263156000_15.11.e102732.37","doi-asserted-by":"publisher","DOI":"10.1080\/0963828021000031197"},{"key":"2025120413263156000_15.11.e102732.38","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.3109\/14767058.2015.1059808","article-title":"Professionals\u2019 views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing","volume":"29","author":"Brown","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025120413263156000_15.11.e102732.39","doi-asserted-by":"crossref","unstructured":"Rooijakkers MJ , Song S , Rabotti C , et al . Influence of electrode placement on signal quality for ambulatory pregnancy monitoring. Comput Math Methods Med 2014;2014. doi:10.1155\/2014\/960980","DOI":"10.1155\/2014\/960980"},{"key":"2025120413263156000_15.11.e102732.40","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1007\/s00381-018-3897-4","article-title":"Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study","volume":"34","author":"Han","year":"2018","journal-title":"Childs Nerv Syst"},{"key":"2025120413263156000_15.11.e102732.41","doi-asserted-by":"crossref","first-page":"495","DOI":"10.32677\/IJCH.2020.v07.i12.006","article-title":"Incidence of periventricular leukomalacia in preterm very low birth neonates \u2013 A tertiary care experience","volume":"7","author":"Mohd","year":"2020","journal-title":"Indian J Child Health"},{"key":"2025120413263156000_15.11.e102732.42","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1038\/s41372-021-01095-6","article-title":"New BPD-prevalence and risk factors for bronchopulmonary dysplasia\/mortality in extremely low gestational age infants \u226428 weeks","volume":"41","author":"Geetha","year":"2021","journal-title":"J Perinatol"},{"key":"2025120413263156000_15.11.e102732.43","doi-asserted-by":"publisher","DOI":"10.1177\/1535370219891971"},{"key":"2025120413263156000_15.11.e102732.44","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/uog.22088","article-title":"Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review","volume":"56","author":"Juan","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025120413263156000_15.11.e102732.45","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.bpobgyn.2020.02.004","article-title":"The future of electronic fetal monitoring","volume":"67","author":"Knupp","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025120413263156000_15.11.e102732.46","doi-asserted-by":"crossref","unstructured":"Hurtado-S\u00e1nchez MF , P\u00e9rez-Melero D , Pinto-Ib\u00e1\u00f1ez A , et al . Characteristics of heart rate tracings in preterm fetus. Medicina (Kaunas) 2021;57. doi:10.3390\/medicina57060528","DOI":"10.3390\/medicina57060528"},{"key":"2025120413263156000_15.11.e102732.47","doi-asserted-by":"crossref","unstructured":"Tamber KK , Hayes DJL , Carey SJ , et al . A systematic scoping review to identify the design and assess the performance of devices for antenatal continuous fetal monitoring. PLoS ONE 2020;15. doi:10.1371\/journal.pone.0242983","DOI":"10.1371\/journal.pone.0242983"},{"key":"2025120413263156000_15.11.e102732.48","doi-asserted-by":"crossref","unstructured":"Berben PBQ , de Klerk ND , van der Ven M , et al . Non-invasive electrophysiological monitoring vs conventional monitoring during labour in a tertiary obstetric care centre in the Netherlands: study protocol of a cohort intervention random sampling study (NIEM-II study). BMJ Open 2025;15. doi:10.1136\/bmjopen-2025-102901","DOI":"10.1136\/bmjopen-2025-102901"},{"key":"2025120413263156000_15.11.e102732.49","doi-asserted-by":"crossref","unstructured":"Afors K , Chandraharan E . Use of continuous electronic fetal monitoring in a preterm fetus: clinical dilemmas and recommendations for practice. J Pregnancy 2011;2011. doi:10.1155\/2011\/848794","DOI":"10.1155\/2011\/848794"},{"key":"2025120413263156000_15.11.e102732.50","unstructured":"Freeman R , Garite T , Nageotte M , et al . Foetal Heart Rate MonitoringL. 4th edn. 2012."},{"key":"2025120413263156000_15.11.e102732.51","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1038\/s41372-019-0342-9","article-title":"Foetal heart rate, heart rate variability, and heart rate\/movement coupling in the Safe Passage Study","volume":"39","author":"Shuffrey","year":"2019","journal-title":"J Perinatol"},{"key":"2025120413263156000_15.11.e102732.52","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/00005721-200411000-00008","article-title":"Monitoring the preterm fetus during labor","volume":"29","author":"Simpson","year":"2004","journal-title":"MCN Am J Matern Child Nurs"},{"key":"2025120413263156000_15.11.e102732.53","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/0002-9378(82)90812-2","article-title":"The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks\u2019 gestation","volume":"143","author":"Sorokin","year":"1982","journal-title":"Am J Obstet Gynecol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-102732","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:27:57Z","timestamp":1764883677000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-102732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,12]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-102732"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-102732","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}