{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:56:00Z","timestamp":1782496560286,"version":"3.54.5"},"reference-count":64,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,22]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The number of people living with obesity is increasing rapidly worldwide, and the WHO estimates approximately 5\u2009million deaths yearly from non-communicable diseases related to elevated body mass index (BMI). The most effective treatment for weight loss is bariatric surgery, but due to the associated risks and the need for lifelong care, this is not a viable treatment for every patient. With the advent of gut-hormone-based medications to treat obesity, the effectiveness of non-surgical treatment is approaching that of surgical interventions. We therefore aim to investigate the beneficial and harmful effects of laparoscopic bariatric surgery versus any non-surgical treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We will conduct a systematic review with meta-analysis applying our eight-step procedure to assess thresholds for clinical significance and trial sequential analysis to mitigate the risk of random errors. To identify relevant trials, we will search for both published and unpublished trials, without any language restriction, in major medical databases (CENTRAL, MEDLINE, EMBASE, LILACS, SCI-EXPANDED and CPCI-S) and trial registries. The date range covered by the search is from database inception until final search date\u2014within 3\u2009months prior to submission of final results manuscript. Two review authors will independently screen references, extract data and perform risk-of-bias assessment using the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations. We will include randomised clinical trials comparing laparoscopic surgery currently in use with any non-surgical comparator in adults or adolescents with BMI &gt;30\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Quasi-randomised studies or non-randomised studies will not be included. Our critical outcomes are all-cause mortality, serious adverse events and quality of life, and our important outcomes are major cardiovascular events, weight at follow-up, physical function and glycaemic control. In addition, we have two explorative outcomes: metabolic syndrome or Z-score and reported incident of alcohol abuse or other addictive disorder or self-inflicted harm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This review will collect and perform secondary analysis of data from publicly available sources and ethical approval is therefore not required. The findings will be published in peer-reviewed journals and presented at relevant scientific conferences. We will strive to publish with open access. Awareness will be made through social media platforms. This review aims to help clinicians in identifying best practices in the wide-spanning field of obesity treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251135341.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111336","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T15:45:34Z","timestamp":1770651934000},"page":"e111336","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic bariatric surgery versus any non-surgical intervention for adolescents or adults with obesity: protocol for a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4748-0437","authenticated-orcid":false,"given":"Olivia","family":"Duun","sequence":"first","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Louise","family":"Dichman","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Lindschou","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital \u2013 Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadine","family":"Scragg","sequence":"additional","affiliation":[{"name":"Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9837-1958","authenticated-orcid":false,"given":"Johanne Juul","family":"Petersen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital \u2013 Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstine Nyvold","family":"Bojsen-M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9190-2920","authenticated-orcid":false,"given":"Susan A","family":"Jebb","sequence":"additional","affiliation":[{"name":"Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Gluud","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital \u2013 Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Dirksen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"2026062610412998000_16.2.e111336.1","unstructured":"World Health Organization . Obesity and Overweight, 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"key":"2026062610412998000_16.2.e111336.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000973"},{"key":"2026062610412998000_16.2.e111336.3","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14421"},{"key":"2026062610412998000_16.2.e111336.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2009.08.010"},{"key":"2026062610412998000_16.2.e111336.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-067516","article-title":"Anthropometric and adiposity indicators and risk of type 2 diabetes: systematic review and dose-response meta-analysis of cohort studies","volume":"376","author":"Jayedi","year":"2022","journal-title":"BMJ"},{"key":"2026062610412998000_16.2.e111336.6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S2468-1253(22)00317-X","article-title":"Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis","volume":"8","author":"Quek","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026062610412998000_16.2.e111336.7","doi-asserted-by":"crossref","first-page":"485","DOI":"10.3390\/cancers15020485","article-title":"Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management","volume":"15","author":"Pati","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2026062610412998000_16.2.e111336.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002449"},{"key":"2026062610412998000_16.2.e111336.9","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S2213-8587(15)00334-4","article-title":"Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study","volume":"3","author":"Eliasson","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026062610412998000_16.2.e111336.10","article-title":"Surgery for weight loss in adults","volume":"2014","author":"Colquitt","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062610412998000_16.2.e111336.11","unstructured":"Dwyer JT , Melanson KJ , Sriprachy-anunt U , et al . Dietary Treatment of Obesity. Endotext 2015."},{"key":"2026062610412998000_16.2.e111336.12","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2028198"},{"key":"2026062610412998000_16.2.e111336.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.10397"},{"key":"2026062610412998000_16.2.e111336.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1212914"},{"key":"2026062610412998000_16.2.e111336.15","doi-asserted-by":"crossref","unstructured":"Noronha JC , Thom G , Lean MEJ . Total Diet Replacement Within an Integrated Intensive Lifestyle Intervention for Remission of Type 2 Diabetes: Lessons From DiRECT. Front Endocrinol 2022;13. doi:10.3389\/fendo.2022.888557","DOI":"10.3389\/fendo.2022.888557"},{"key":"2026062610412998000_16.2.e111336.16","unstructured":"Sherman MM , Ungureanu S , Rey JA . Naltrexone\/Bupropion ER (Contrave). Pharmacol Ther 2016;41."},{"key":"2026062610412998000_16.2.e111336.17","unstructured":"Bansal AB , Patel P , Al Khalili Y . Orlistat, 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK542202\/"},{"key":"2026062610412998000_16.2.e111336.18","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2011.330"},{"key":"2026062610412998000_16.2.e111336.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.3224"},{"key":"2026062610412998000_16.2.e111336.20","doi-asserted-by":"crossref","unstructured":"Trapp S , Brierley DI . Brain GLP-1 and the regulation of food intake: GLP-1 action in the brain and its implications for GLP-1 receptor agonists in obesity treatment, 2021. Available: https:\/\/doi.org\/10.1111\/bph.v179.4\/issuetoc","DOI":"10.1111\/bph.15638"},{"key":"2026062610412998000_16.2.e111336.21","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14280"},{"key":"2026062610412998000_16.2.e111336.22","doi-asserted-by":"crossref","first-page":"846","DOI":"10.2337\/dc24-1533","article-title":"Cardiovascular and Kidney Outcomes and Mortality With Long-Acting Injectable and Oral Glucagon-Like Peptide 1 Receptor Agonists in Individuals With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Trials","volume":"48","author":"Lee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026062610412998000_16.2.e111336.23","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2307563"},{"key":"2026062610412998000_16.2.e111336.24","doi-asserted-by":"crossref","unstructured":"Aronne L , Horn DB , Roux C , et al . Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med 2025. doi:10.1056\/NEJMOA2416394\/SUPPL_FILE\/NEJMOA2416394_DATA-SHARING.PDF","DOI":"10.1056\/NEJMoa2416394"},{"key":"2026062610412998000_16.2.e111336.25","doi-asserted-by":"publisher","DOI":"10.1080\/13543784.2025.2472408"},{"key":"2026062610412998000_16.2.e111336.26","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12012"},{"key":"2026062610412998000_16.2.e111336.27","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.53141","article-title":"Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass: A Randomized Clinical Trial","volume":"7","author":"Hedberg","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026062610412998000_16.2.e111336.28","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.tgie.2016.11.003","article-title":"Review of multimodal therapies for obesity treatment: Including dietary, counseling strategies, and pharmacologic interventions","volume":"19","author":"Kumar","year":"2017","journal-title":"Tech Gastrointest Endosc"},{"key":"2026062610412998000_16.2.e111336.29","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.suc.2020.12.013","article-title":"Laparoscopic Gastric Bypass Still the Gold Standard? Surg","volume":"101","author":"Maclellan","year":"2021","journal-title":"Clin North Am"},{"key":"2026062610412998000_16.2.e111336.30","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-2654"},{"key":"2026062610412998000_16.2.e111336.31","unstructured":"Brown -Chair W . 8 th global registry report international federation for surgery for obesity and metabolic disorders members of the ifso global registry committee 1."},{"key":"2026062610412998000_16.2.e111336.32","doi-asserted-by":"crossref","unstructured":"Barreto SG , Kow L . Laparoscopic adjustable gastric banding \u2013 mechanism of action. obesity, bariatric and metabolic surgery: a comprehensive guide: second edition.2023:665\u201370.","DOI":"10.1007\/978-3-030-60596-4_97"},{"key":"2026062610412998000_16.2.e111336.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(03)00392-1"},{"key":"2026062610412998000_16.2.e111336.34","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-018-3525-0"},{"key":"2026062610412998000_16.2.e111336.35","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/S2213-8587(25)00025-7","article-title":"Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial","volume":"13","author":"Abbott","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026062610412998000_16.2.e111336.36","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1210\/clinem\/dgaa849","article-title":"Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study","volume":"106","author":"Purnell","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2026062610412998000_16.2.e111336.37","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1001\/jamasurg.2022.2229","article-title":"Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial","volume":"157","author":"Salminen","year":"2022","journal-title":"JAMA Surg"},{"key":"2026062610412998000_16.2.e111336.38","doi-asserted-by":"crossref","first-page":"29","DOI":"10.20517\/2574-1225.2021.130","article-title":"Nutritional deficiencies following metabolic surgery","volume":"6","author":"Basishvili","year":"2022","journal-title":"Mini-invasive Surg"},{"key":"2026062610412998000_16.2.e111336.39","first-page":"170","article-title":"Long-term nutritional deficiencies following sleeve gastrectomy: a 6-year single-centre retrospective study","volume":"20","author":"Mulita","year":"2021","journal-title":"Prz Menopauzalny"},{"key":"2026062610412998000_16.2.e111336.40","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/j.soard.2020.05.021","article-title":"Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up","volume":"16","author":"Lazzati","year":"2020","journal-title":"Surg Obes Relat Dis"},{"key":"2026062610412998000_16.2.e111336.41","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.20313"},{"key":"2026062610412998000_16.2.e111336.42","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12567"},{"key":"2026062610412998000_16.2.e111336.43","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1016\/j.numecd.2021.06.018","article-title":"Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials","volume":"31","author":"Cosentino","year":"2021","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"2026062610412998000_16.2.e111336.44","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(24)00396-6"},{"key":"2026062610412998000_16.2.e111336.45","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S2213-8587(19)30344-4","article-title":"Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial","volume":"7","author":"Hofs\u00f8","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026062610412998000_16.2.e111336.46","first-page":"417","article-title":"Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review","volume":"86","author":"D\u2019hoedt","year":"2023","journal-title":"Acta Gastroenterol Belg"},{"key":"2026062610412998000_16.2.e111336.47","first-page":"21","article-title":"The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment","volume":"223","author":"Vecht","year":"1997","journal-title":"Scand J Gastroenterol Suppl"},{"key":"2026062610412998000_16.2.e111336.48","doi-asserted-by":"publisher","DOI":"10.1381\/096089202762552430"},{"key":"2026062610412998000_16.2.e111336.49","doi-asserted-by":"crossref","DOI":"10.1155\/2013\/974762","article-title":"Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations","volume":"2013","author":"Anderson","year":"2013","journal-title":"Gastroenterol Res Pract"},{"key":"2026062610412998000_16.2.e111336.50","unstructured":"SF-36 Physical and Mental Health Summary Scales: a User\u2019s Manual, Available: https:\/\/www.researchgate.net\/publication\/292390260_SF-36_Physical_and_Mental_Health_Summary_Scales_a_User%27s_Manual"},{"key":"2026062610412998000_16.2.e111336.51","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1056\/NEJMe2101705","article-title":"STEP 1 for Effective Weight Control - Another First Step?","volume":"384","author":"Ingelfinger","year":"2021","journal-title":"N Engl J Med"},{"key":"2026062610412998000_16.2.e111336.52","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-017-0315-7","article-title":"Trial Sequential Analysis in systematic reviews with meta-analysis","volume":"17","author":"Wetterslev","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2026062610412998000_16.2.e111336.53","doi-asserted-by":"crossref","unstructured":"Moher D , Shamseer L , Clarke M , et al . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4. doi:10.1186\/2046-4053-4-1","DOI":"10.1186\/2046-4053-4-1"},{"key":"2026062610412998000_16.2.e111336.54","unstructured":"FDA . E6(R2) Good Clinical Practice: Integrated Addendum to ICH E6(R1), Available: https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/e6r2-good-clinical-practice-integrated-addendum-ich-e6r1"},{"key":"2026062610412998000_16.2.e111336.55","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2001.13"},{"key":"2026062610412998000_16.2.e111336.56","unstructured":"Higgins J , Thomas J , Chandler J , et al . Cochrane Handbook for Systematic Reviews of Interventions, 2024. Available: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current"},{"key":"2026062610412998000_16.2.e111336.57","unstructured":"Page M , Higgins J , Sterne J , et al . Chapter 13: assessing risk of bias due to missing evidence in a meta-analysis. In: Cochrane. 2024."},{"key":"2026062610412998000_16.2.e111336.58","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-14-120","article-title":"Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods","volume":"14","author":"Jakobsen","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2026062610412998000_16.2.e111336.59","unstructured":"Thorlund K , Engstr\u00f8m J , Wetterslev J , et al . User Manual for Trial Sequential Analysis (TSA), 2017. Available: https:\/\/ctu.dk\/wp-content\/uploads\/2021\/03\/2017-10-10-TSA-Manual-ENG_ER.pdf"},{"key":"2026062610412998000_16.2.e111336.60","unstructured":"FDA . Guidance for Industry Diabetes Mellitus: Developing Drugs and Therapeutic Biologics for Treatment and Prevention, 2008. Available: http:\/\/www.fda.gov\/cder\/guidance\/index.htm"},{"key":"2026062610412998000_16.2.e111336.61","unstructured":"FDA & CDER . Obesity and Overweight: Developing Drugs and Biological Products for Weight Reduction Guidance for Industry DRAFT GUIDANCE, 2025. Available: https:\/\/www.fda.gov\/drugs\/guidance-compliance-regulatory-information\/guidances-drugs"},{"key":"2026062610412998000_16.2.e111336.62","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/cob.12226","article-title":"Improvements in health-related quality of life over 3\u2009years with liraglutide 3.0\u2009mg compared with placebo in participants with overweight or obesity","volume":"8","author":"Kolotkin","year":"2018","journal-title":"Clin Obes"},{"key":"2026062610412998000_16.2.e111336.63","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"2026062610412998000_16.2.e111336.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.09.011"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-111336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:44:16Z","timestamp":1782495856000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-111336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":64,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-111336"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-111336","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}