{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:02:22Z","timestamp":1784718142363,"version":"3.55.0"},"reference-count":69,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Stichting Kitty","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,26]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Treatment with bevacizumab achieves both tumour stabilisation or regression and preservation or improvement of hearing. However, the efficacy of bevacizumab varies between patients and within patients. Side effects due to bevacizumab treatment are also common. It would be of value to predict therapeutic response prior to initiating therapy to prevent unnecessary exposure in patients unlikely to benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We aim to recruit 25 patients with\n                      <jats:italic>NF2<\/jats:italic>\n                      -related schwannomatosis (NF2) with bilateral vestibular schwannomas. Patients will receive an intravenous injection of 37 MBq [\n                      <jats:sup>89<\/jats:sup>\n                      Zr]bevacizumab followed by positron emission tomography (PET)\/CT imaging 4\u2009days later. After clinical evaluation at baseline, patients undergo bevacizumab treatment and are followed up at 3 and 6\u2009months. The primary objective is to examine associations between pretreatment [\n                      <jats:sup>89<\/jats:sup>\n                      Zr]bevacizumab uptake on PET\/CT and changes in multiple hearing outcomes and radiological characteristics of the target tumour following treatment. Secondary outcome measures include vestibular functioning, patient reported outcome measures, cranial nerve functionality, peripheral neurology, non-target schwannoma response and renal function. Given the explorative nature of the study, associations between PET-derived metrics and clinical and radiological outcomes will be examined without formal hypothesis testing, using generalised estimating equations to account for within-patient correlation. Pairwise associations will be summarised in an association matrix with multiplicity addressed using an all-resolutions inference approach, and findings will be considered hypothesis generating.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was submitted via the Clinical Trials Information System reviewed and approved by the Medical Research Ethics Committee Leiden\u2013The Hague\u2013Delft Delft. The study findings will be disseminated through publication in peer-reviewed scientific journals and by presentation at national and international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      The trial is registered at ClinicalTrials.gov Protocol Registration and Results System under the registration ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05685836\">NCT05685836<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114812","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:55:29Z","timestamp":1775645729000},"page":"e114812","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["[\n                    <sup>89<\/sup>\n                    Zr]bevacizumab PET\/CT imaging of vestibular schwannomas for the prediction of bevacizumab treatment effect in patients with symptomatic\n                    <i>NF2<\/i>\n                    -related schwannomatosis: a study protocol for a phase II single centre, prospective, feasibility trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05685836","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8232-576X","authenticated-orcid":false,"given":"Jules P J","family":"Douwes","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemijn L","family":"Tops","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Dibbets-Schneider","sequence":"additional","affiliation":[{"name":"Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berit M","family":"Verbist","sequence":"additional","affiliation":[{"name":"Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanza A","family":"Fuentealba Bassaletti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen C","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim S","family":"Koetsier","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor S","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radboud W","family":"Koot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris H P","family":"van Velden","sequence":"additional","affiliation":[{"name":"Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Pool","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani\u00eblle","family":"Vugts","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefine E","family":"Schopman","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle J","family":"Goeman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lioe-Fee","family":"De Geus-Oei","sequence":"additional","affiliation":[{"name":"Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Biomedical Photonic Imaging Group, University of Twente Faculty of Science and Technology, Enschede, The Netherlands"},{"name":"Department of Radiation Science and Technology, Faculty of Science and Technology, Delft University of Technology, Delft, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik F","family":"Hensen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Gelderblom","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026072203202121000_16.4.e114812.1","doi-asserted-by":"crossref","DOI":"10.1186\/1750-1172-4-16","article-title":"Neurofibromatosis type 2 (NF2): a clinical and molecular review","volume":"4","author":"Evans","year":"2009","journal-title":"Orphanet J Rare Dis"},{"key":"2026072203202121000_16.4.e114812.2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/B978-0-444-62702-5.00005-6","article-title":"Chapter 5 - Neurofibromatosis type 2","volume":"132","author":"Evans","year":"2015","journal-title":"Handb Clin Neurol"},{"key":"2026072203202121000_16.4.e114812.3","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.1.71"},{"key":"2026072203202121000_16.4.e114812.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41436-019-0598-7"},{"key":"2026072203202121000_16.4.e114812.5","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.qjmed.a068699"},{"key":"2026072203202121000_16.4.e114812.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.05.007"},{"key":"2026072203202121000_16.4.e114812.7","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet-2015-103290"},{"key":"2026072203202121000_16.4.e114812.8","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet-2017-104519"},{"key":"2026072203202121000_16.4.e114812.9","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.34359"},{"key":"2026072203202121000_16.4.e114812.10","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1301396"},{"key":"2026072203202121000_16.4.e114812.11","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000239"},{"key":"2026072203202121000_16.4.e114812.12","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nou317"},{"key":"2026072203202121000_16.4.e114812.13","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noz153"},{"key":"2026072203202121000_16.4.e114812.14","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/MAO.0000000000000272","article-title":"Neurofibromatosis Type 2 Vestibular Schwannoma Treatment: A Review of the Literature, Trends, and Outcomes","volume":"35","author":"Maniakas","year":"2014","journal-title":"Otol Neurotol"},{"key":"2026072203202121000_16.4.e114812.15","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s11060-021-03910-8","article-title":"Stereotactic radiosurgery for vestibular schwannomas in neurofibromatosis type 2 patients: a systematic review and meta-analysis","volume":"156","author":"Tosi","year":"2022","journal-title":"J Neurooncol"},{"key":"2026072203202121000_16.4.e114812.16","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2005.036319"},{"key":"2026072203202121000_16.4.e114812.17","article-title":"Radiation treatment of benign tumors in NF2-related-schwannomatosis: A national study of 266 irradiated patients showing a significant increase in malignancy\/malignant progression","volume":"5","author":"Evans","year":"2023","journal-title":"Neurooncol Adv"},{"key":"2026072203202121000_16.4.e114812.18","doi-asserted-by":"publisher","DOI":"10.1080\/00016480310005101"},{"key":"2026072203202121000_16.4.e114812.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902579"},{"key":"2026072203202121000_16.4.e114812.20","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.3817"},{"key":"2026072203202121000_16.4.e114812.21","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-019-03234-8"},{"key":"2026072203202121000_16.4.e114812.22","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.5301\/tj.5000313","article-title":"Bevacizumab treatment for vestibular schwannoma in a patient with neurofibromatosis type 2: hearing improvement and tumor shrinkage","volume":"101","author":"Sponghini","year":"2015","journal-title":"Tumori J"},{"key":"2026072203202121000_16.4.e114812.23","doi-asserted-by":"crossref","DOI":"10.3390\/cancers17030519","article-title":"Efficacy and Toxicity of Bevacizumab in Children with NF2-Related Schwannomatosis: A Systematic Review","volume":"17","author":"Tops","year":"2025","journal-title":"Cancers (Basel)"},{"key":"2026072203202121000_16.4.e114812.24","first-page":"281","article-title":"Bevacizumab in neurofibromatosis type 2 (NF2) related vestibular schwannomas: a nationally coordinated approach to delivery and prospective evaluation","volume":"3","author":"Morris","year":"2016","journal-title":"Neurooncol Pract"},{"key":"2026072203202121000_16.4.e114812.25","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/MAO.0000000000001781","article-title":"Improvement in Patient-reported Hearing After Treatment With Bevacizumab in People With Neurofibromatosis Type 2","volume":"39","author":"Huang","year":"2018","journal-title":"Otol Neurotol"},{"key":"2026072203202121000_16.4.e114812.26","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1177\/0194599818809085","article-title":"Bevacizumab for Hearing Preservation in Neurofibromatosis Type 2: Emphasis on Patient-Reported Outcomes and Toxicities","volume":"160","author":"Sverak","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2026072203202121000_16.4.e114812.27","doi-asserted-by":"crossref","DOI":"10.1093\/noajnl\/vdad099","article-title":"A systematic review of targeted therapy for vestibular schwannoma in patients with NF2-related schwannomatosis","volume":"5","author":"Chiranth","year":"2023","journal-title":"Neuro oncol Adv"},{"key":"2026072203202121000_16.4.e114812.28","doi-asserted-by":"crossref","DOI":"10.3390\/cancers16081479","article-title":"Bevacizumab Treatment for Patients with NF2-Related Schwannomatosis: A Single Center Experience","volume":"16","author":"Douwes","year":"2024","journal-title":"Cancers (Basel)"},{"key":"2026072203202121000_16.4.e114812.29","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.119.239558"},{"key":"2026072203202121000_16.4.e114812.30","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/203601","article-title":"Zirconium-89 labeled antibodies: a new tool for molecular imaging in cancer patients","volume":"2014","author":"van de Watering","year":"2014","journal-title":"Biomed Res Int"},{"key":"2026072203202121000_16.4.e114812.31","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.109.071043"},{"key":"2026072203202121000_16.4.e114812.32","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/RLU.0000000000000329","article-title":"Avastin scintigraphy in surveillance of bevacizumab treatment in a patient with neurofibromatosis type 2: a case report","volume":"39","author":"Versleijen","year":"2014","journal-title":"Clin Nucl Med"},{"key":"2026072203202121000_16.4.e114812.33","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2016.00131","article-title":"Immuno-Positron Emission Tomography with Zirconium-89-Labeled Monoclonal Antibodies in Oncology: What Can We Learn from Initial Clinical Trials?","volume":"7","author":"Jauw","year":"2016","journal-title":"Front Pharmacol"},{"key":"2026072203202121000_16.4.e114812.34","doi-asserted-by":"crossref","first-page":"4309","DOI":"10.3390\/ijms21124309","article-title":"Current Perspectives on 89Zr-PET Imaging","volume":"21","author":"Yoon","year":"2020","journal-title":"Int J Mol Sci"},{"key":"2026072203202121000_16.4.e114812.35","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23095023","article-title":"Radiopharmaceuticals for PET and SPECT Imaging: A Literature Review over the Last Decade","volume":"23","author":"Cri\u0219an","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2026072203202121000_16.4.e114812.36","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.112.117218"},{"key":"2026072203202121000_16.4.e114812.37","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.116.183475"},{"key":"2026072203202121000_16.4.e114812.38","doi-asserted-by":"publisher","DOI":"10.1089\/108497803322287745"},{"key":"2026072203202121000_16.4.e114812.39","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.107.041301"},{"key":"2026072203202121000_16.4.e114812.40","doi-asserted-by":"crossref","DOI":"10.1186\/s13550-014-0035-5","article-title":"Pilot study of (89)Zr-bevacizumab positron emission tomography in patients with advanced non-small cell lung cancer","volume":"4","author":"Bahce","year":"2014","journal-title":"EJNMMI Res"},{"key":"2026072203202121000_16.4.e114812.41","doi-asserted-by":"crossref","DOI":"10.1186\/s40658-017-0179-2","article-title":"Minimum lesion detectability as a measure of PET system performance","volume":"4","author":"Adler","year":"2017","journal-title":"EJNMMI Phys"},{"key":"2026072203202121000_16.4.e114812.42","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s00259-023-06514-8","article-title":"An extended bore length solid-state digital-BGO PET\/CT system: design, preliminary experience, and performance characteristics","volume":"51","author":"Kennedy","year":"2024","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026072203202121000_16.4.e114812.43","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.118.215541"},{"key":"2026072203202121000_16.4.e114812.44","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s00259-006-0131-5","article-title":"How should we analyse FDG PET studies for monitoring tumour response?","volume":"33 Suppl 1","author":"Lammertsma","year":"2006","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026072203202121000_16.4.e114812.45","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-009-1306-7"},{"key":"2026072203202121000_16.4.e114812.46","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.111.093443"},{"key":"2026072203202121000_16.4.e114812.47","doi-asserted-by":"crossref","DOI":"10.1186\/2191-219X-3-77","article-title":"The PET-derived tumor-to-blood standard uptake ratio (SUR) is superior to tumor SUV as a surrogate parameter of the metabolic rate of FDG","volume":"3","author":"van den Hoff","year":"2013","journal-title":"EJNMMI Res"},{"key":"2026072203202121000_16.4.e114812.48","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2020394"},{"key":"2026072203202121000_16.4.e114812.49","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000435744.57038.af"},{"key":"2026072203202121000_16.4.e114812.50","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(95)70138-9"},{"key":"2026072203202121000_16.4.e114812.51","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx510"},{"key":"2026072203202121000_16.4.e114812.52","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200307000-00019"},{"key":"2026072203202121000_16.4.e114812.53","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(95)70101-X"},{"key":"2026072203202121000_16.4.e114812.54","doi-asserted-by":"publisher","DOI":"10.1177\/000348948809700110"},{"key":"2026072203202121000_16.4.e114812.55","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-009-9867-7"},{"key":"2026072203202121000_16.4.e114812.56","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181bacf85"},{"key":"2026072203202121000_16.4.e114812.57","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2017.00258","article-title":"The Video Head Impulse Test","volume":"8","author":"Halmagyi","year":"2017","journal-title":"Front Neurol"},{"key":"2026072203202121000_16.4.e114812.58","doi-asserted-by":"publisher","DOI":"10.1080\/00016489850183089"},{"key":"2026072203202121000_16.4.e114812.59","doi-asserted-by":"crossref","unstructured":"Shepard NT , Jacobson GP . Chapter 9 - the caloric irrigation test. In: Furman JM , Lempert T , eds. Handbook clinical neurology. Elsevier, 2016: 119\u201331.","DOI":"10.1016\/B978-0-444-63437-5.00009-1"},{"key":"2026072203202121000_16.4.e114812.60","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.cnp.2019.01.005","article-title":"Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications","volume":"4","author":"Rosengren","year":"2019","journal-title":"Clin Neurophysiol Pract"},{"key":"2026072203202121000_16.4.e114812.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2009.10.016"},{"key":"2026072203202121000_16.4.e114812.62","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20988"},{"key":"2026072203202121000_16.4.e114812.63","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002092"},{"key":"2026072203202121000_16.4.e114812.64","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1990.01870040046011"},{"key":"2026072203202121000_16.4.e114812.65","first-page":"75","article-title":"Test-retest reliability of the Dutch version of the Dizziness Handicap Inventory","volume":"2","author":"Vereeck","year":"2006","journal-title":"B-ENT"},{"key":"2026072203202121000_16.4.e114812.66","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2012.4"},{"key":"2026072203202121000_16.4.e114812.67","doi-asserted-by":"publisher","DOI":"10.1177\/019459988509300202"},{"key":"2026072203202121000_16.4.e114812.68","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.77"},{"key":"2026072203202121000_16.4.e114812.69","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE). US Department of Health and Human Services, 2017."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-114812","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:20:32Z","timestamp":1784715632000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-114812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":69,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,8]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-114812"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114812","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}