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Article History

Received: 7 January 2026

Revised: 25 June 2026

Accepted: 24 July 2026

First Online: 4 August 2026

Declarations

Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. The study was based on an anonymous online survey conducted in Germany. According to applicable German regulations, ethics committee approval is not required for fully anonymized survey studies conducted outside university or medical chamber settings. The study complied with relevant data protection regulations. Electronic informed consent was obtained from all participants prior to participation. All data were provided to the authors in fully anonymized form by the forum administrator; no direct or indirect identifiers were collected, and re-identification was not possible. In accordance with U.S. federal regulations (45 CFR 46.104[d][2][i]), this type of minimal-risk, anonymized survey research does not constitute human subjects research requiring Institutional Review Board approval.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.