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Prior to commencing the study in 2023, administrative permission and operational authorization for clinical data collection and patient telephone interviews were obtained from Yantai Yuhuangding Hospital. Subsequently, retrospective ethical approval for the analysis and publication of these anonymized data and follow-up records was formally reviewed and approved by the Ethics Committee of Yantai Yuhuangding Hospital (Approval number: K2026-209). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Since the retrospective phase involved anonymized health records, the requirement for written informed consent was waived by the Ethics Committee. For the prospective pilot evaluation phase, verbal informed consent was obtained from all participating patients prior to the structured telephone interviews, which was explicitly approved by the Ethics Committee. The interview questionnaire and scoring protocol are detailed in Supplementary Table S3.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"27402"}}