Volume 26

Xiaohong Zhu1, Lu Lu1, Mei Huang1, Guohui Xiong1, Bingqing Tian1, Xiaohui Fu1, Lijun Song2,*. 1, Department of Ophthalmology, Minda Hospital Affiliated to Hubei University for Nationalities, Enshi, Hubei, 445000, China. 2, Department of Nursing, Minda Hospital Affiliated to Hubei University for Nationalities, Enshi, Hubei, 445000, China. 13607246512@163.com The First Author：Xiaohong Zhu; zxh89892002@163.com(ORCID: 0009-0002-0487-6424) The Second Author：Lu Lu; 13402726523@163.com(ORCID: 0009-0005-7521-9837) The Third Author: Mei Huang; 15826686007@163.com(ORCID: 0009-0003-7604-6304) The Fourth Author: Guohui Xiong; 13257181650@163.com(ORCID: 0009-0004-4513-3779) The Fifth Author: Bingqing Tian; 13477236926@163.com(ORCID: 0009-0002-5811-4089) The Sixth Author: Xiaohui Fu; 15027221260@163.com(ORCID: 0009-0000-8418-8132) Corresponding Author: Lijun Song;  13607246512@163.com(ORCID: 0009-0007-9325-9634) Abstract Introduction: One sort of visual issue that impairs vision clarity is refractive errors. It occurs when an eye’s morphology prevents light from properly concentrating on the retina. Predicting a child’s refractive error with accuracy is essential for identifying amblyopia, a condition that can cause irreversible vision loss but may be treated if caught early. Objective: The most crucial elements for effective screening are a precise prediction algorithm and simple access to photo screening applications. Method: In this study, we proposed a novel Kookaburra-optimized lightweight dense convolutional neural network (KO-LDCNN) to forecast children’s refractive error range. We are utilizing data from eccentric photorefraction images that were taken using a smartphone. Using cycloplegic refraction to quantify spherical values, photorefraction images were classified into several groups. The collected data noise reduction using min-max normalization. It improves the quality and clarity of the images. Data segmentation using Regions of Interest (ROI) involves identifying specific image areas. Subsequent to the segmentation process, the data was extract from the features using linear discriminate analysis (LDA). Result: The proposed method is compared to the other traditional algorithms. According to these result, our suggested approach work efficiently sufficient to be correct. Conclusion: The importance of early photo screening intervention in controlling refractive errors and fostering the best possible visual outcomes in children. Keywords:  Photo Screening, Refractive Errors, Photorefraction Images, Regions of Interest (ROI), Smartphone, Amblyopia, Kookaburra optimized lightweight dense convolutional neural network (KO-LDCNN) 1. Introduction Clinical evaluation, which provides necessary information in sequence about the circumstances of a patient, their reaction to therapy, and overall well-being, is the basis of useful healthcare. A clinical evaluation is mostly crucial for early screening and indicative method for child myopic disorder [1]. Particular techniques counting autorefraction, visual acuity testing, retinoscopy, and ocular health assessment are part of the clinical assessment practice for pediatric eye care. These approaches are tailored to the stage of development and level of support of young patients to detect refractive issue early on, supply suitable treatment, and ensure optimal visual outcome [2]. Clinical assessment must be precise and complete for the regimen to be effective. For this reason, clinical consideration is a crucial tool for pediatric ophthalmologists and healthcare administrators in general. Since myopia maculopathy, a disorder in which detached retinas cause and persistent vision loss carries such a high risk of everlasting loss of vision, it has been labeled a serious worldwide health concern. It is well known that the percentage of people with severe myopia increases with increasing onset age [3]. Consequently, using a myopia preventive approach is essential to lessen or postpone the earliest signs of myopia. In addition to refractive abnormalities, strabismus, and anisometropia are other visual issues that can hinder a child’s normal growth of vision. These changes are a frequent reason for either unilateral or bilateral loss of vision associated with an eye disease [4]. Amblyopia caused by refractive problems can occasionally be treated with glasses. To prevent vision problems in children and enhance the quality of life for adults, early detection and management of refractive imperfections and the condition were essential. Since childhood eye issues usually don’t have any symptoms, they often go organic and receive incorrect conduct. Schools must regulate vision screening programs during a child’s growing period to guard against potential harms at school brought by untreated refractive defects [5]. Somewhat more than identifying or treating degrees, such eye tests aim to promptly identify refractive defects or vision issues [6]. By using these diagnostic measures, healthcare providers could more effectively diagnose, treat, and monitor children’s refractive issues, ultimately contributing to the greatest possible visual health and wellness [7]. To accurately assess a child’s visual acuity and identify refractive irregularities in situations of refractive errors, a range of specialized methods are employed in the diagnostic process. The primary screening technique for astigmatism, hyperopia, and myopia is visual acuity screening, which uses standardized eye charts. Autorefraction offers computerized estimates of refractive errors, while retinoscopy provides a human evaluation that is particularly useful for younger children [8]. Cycloplegic refraction gives events that are more precise since the edition is uninvolved by completely freezing the ocular muscle. Ocular health examination, in addition to corrective exams, detects the original medical environment that may affect vision [9]. These screening techniques, which are tailored to the unique needs and stage of growth conversant by every child, are central for the early detection, accurate diagnosis, and competent dealing that ultimately support the optimal state of visual health and console in children and adolescents [10]. The aim of this study is to expand and evaluate a precise prediction approach for the spectrum of refractive errors among kids whose smartphone-captured eccentric photorefraction pictures are used. The method employs a novel  Kookaburra-optimized lightweight dense convolutional neural network (KO-LDCNN).  Contributions of the study The study is organized as follows: section II lists relevant works; section III outlines the recommended methodology; section IV addresses the findings and section V wraps up the conclusion. 2. Related Works When doing close tasks, convergent insufficiency (CI) [11] common monocular vision impairment, frequently produces symptoms. It was uncertain, yet, which screening test was optimal for CI. This study set out to determine if standard measures of compensatory and binocular function might reliably identify kids who have CI in a school screen context [12]. These digital technologies, which tackle COVID-19 and other difficulties, comprise artificial intelligence (AI), the Internet of Things (IoT), and fifth-generation (5G) telecommunication networks [13]. Together, they form an

The Efficacy of Interventional Therapy and Collaborative Nursing in Postoperative Pain Management for Orthopedic Surgery Patients Ming Zhang, Lining Xue* Tongchuan People’s Hospital, Shaanxi Province 727000 China. 343794741@qq.com Author’s details The First Author: Ming Zhang, Female, Bachelor’s degree, Nurse in Charge, 1966778783@qq.com Corresponding author: Lining Xue, Female, Bachelor’s degree, Nurse in Charge, 343794741@qq.com Abstract Research motivation: Orthopedic surgery (OS) results in significant postoperative pain, which could recovery and quality of life (QoL). Effective pain management is crucial for optimal patient outcomes. This investigation seeks to determine whether combining interventional therapy with collaborative nursing (CN) can improve postoperative pain management compared to interventional therapy alone. Introduction:OS is a medical field that diagnoses, treats, prevents, and rehabilitates musculoskeletal disorders and injuries, affecting mobility and functionality. It uses surgical and non-surgical techniques to address fractures, arthritis, sports injuries, congenital deformities, and spinal disorders. Through advanced technology and comprehensive care, it improves patients’ QoL. Objective: The purpose of investigations to assess and compare the efficacy of individual physical therapy (PT) and PT combined with CN (PT+CN) for the management of postoperative pain in OS patients. Methods: We investigated 169 OS patients. For conducting a randomized controlled trial nurses were divided into two teams including PT and PT+CN.The intervention involved introducing a pain management procedure and conducting training sessions for nurses. The PT Team received standard pain management, while the CN Team received additional CN support. Pre- and post-intervention, nurses’ knowledge, attitudes, and pain management practices were assessed using questionnaires. Patient-reported outcomes on pain intensity and interference with activities were collected through surveys. Results and Conclusion: The obtained questionnaires were assessed using the SPSS analytical tool. Data analysis was performed using chi-square and t-tests to compare variations within and between Teams.The PT+CNTeam demonstrated superior outcomes compared to the PT team. Nurses in the PT+CNTeam showedconsiderably improved knowledge and attitudes about pain management. Additionally, patients in this Team reported lower pain intensity, less interference with activities, and better overall pain management. Keywords: Orthopaedic Surgery (OS), Physical Therapy (PT), Collaborative Nursing (CN), Statistical Analysis, Pain Management Orthopedic procedures are widely known to cause significant discomfort for patients. According to various studies, trauma or orthopedic procedures affecting the extremities rank among the highest in terms of postoperative pain [1]. Effective pain management is critical in the postoperative treatment of these patients as severe pain can delay recovery, increase the risk of complications, and lead to longer hospital stays and higher re-admission rates. Consequently, the management of analgesic needs following OS involves a variety of pain control techniques [2]. Orthopedic physicians are noted for prescribing more opioids than any other medical specialty, while orthopedic nurses play a vital role in providing post-operative care and pain management. Despite the known efficacy of alternative therapies in reducing procedural or post-operative pain, their application specifically for orthopedic patients remains under-researched [3]. Figure 1 depicts various types of orthopedic aspects occurred. Figure 1:  overview of orthopedic occurred parts Post-surgical pain can be complex and multifaceted, stemming from both neuropathic and nociceptive sources. Nociceptive pain arises from tissue damage, which activates nociceptive receptors present in terminal nerve fibers. Higher neuronal regions in the brain receive these impulses via ascending pathways, which affect pain perception [4]. An individual’s experience of pain is influenced by several elements, such as feelings, sex, personality, and cultural origin. Conversely, neuropathic pain is caused by actual harm to the neurological system and is characterized by the activation of bigger nerve fibers [5]. When tissue is injured, chemicals like bradykinin, prostaglandins, and serotonin are released, which increases neural activation and causes pain [6]. Central sensitization, a condition that makes pain management more difficult, can be brought on by persistent simulation.Medication and non-pharmacological techniques are employed to effectively control pain after surgery in patients with OS. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs,) opioids, nerve blocks, and local anesthetic infiltration are a few of the often used medicinal methods [7]. Orthopedic nurses are crucial when it comes to administering these medications and providing care. In addition, it employs complementary therapies such as guided imagery, music therapy, media diversion, and relaxation training to address pain and anxiety [8]. In a number of medical situations, supplemental treatments have demonstrated potential in lowering pain. Opioids have been the go-to medication for treating postoperative pain for a long time. In addition to having a high risk of addiction, its usage is restricted by adverse effects such as ileus, pruritus, nausea and vomiting, respiratory depression, and urine retention [9-11]. Drugs such as these are mostly used as life-saving drugs when other methods of pain management are ineffective when combined with effective no-opioid usage. Table 1 presents the maximum frequently prescribed treatments in OSs. Table 1: Types of opioid analgesics and their classification   Types of Drug Dosage Duration of Analgesia (hours)   process of metabolism     Remarks     Immediate-release opioid medication administered orally   Codeine 15to 60 mg 4to 6 CYP2D6 Protect in young children as it raises intracranial pressure Hydrocodone 2.5to 10 mg 4to 6 CYP3A4 and CYP2D6 Steer clear of adolescents.An increase in brain pressure. Oxycodone 5to 10 mg 3to 6 CYP2D6 and CYP3A Avoid CYP3A4 inhibitors.This leads to a rise in cerebral pressure Tramadol 50to 100 mg 3to 6 CYP2D6 and CYP3A4 Avoid CYP3A4 inhibitors.   Oxymorphone 5to 10 mg 3to 6   Glucuronidation –   Intrauterine Opioids   Hydromorphone 0.5 to 1 mg 2 to 4 Glucuronidation, Renal clearance Useful for people with reduced kidney functionAvoid individuals with hypovolemic shock. Genitourinary obstructions should not be treated with this medication. Meperidine 50to 150 mg 2to 3 CYP3A4 and CYP3A5 Seizures can be brought on by normeperidine, an active metabolite.Not recommended when using monoamine oxidase inhibitorsThe elimination rate is slower in the elderly. Fentanyl 1to 2 mcg 30 min–1 CYP3A4 andCYP3A5 A hundred times as potent than morphineSuitable for people with compromised kidney function.Suitable for individuals with bronchospasm or hemodynamic instability Morphine 2to 4 mg 3to 4 Glucuronidation, Renal clearance. Histamine release can cause Bradycardia, hypotension, and vagally mediated vasodilation. Research objective: This study evaluates and

Feiling Lin1, Yuan Fui2, Lei Huo3, fang Yuhn3,*. 1, Department of Interventional Medicine, Zhangye People’s Hospital Affiliated to Hexi University, 734000, China. 2, Department of Orthopedics, Zhangye People’s Hospital Affiliated to Hexi University, 734000, China. 3, Department of Gastroenterology, Zhangye People’s Hospital Affiliated to Hexi University, 734000, China. 13993686972@163.com Abstract Introduction: Acute Pancreatitis (AP) is an acute clinical concern, which affects the patients’ condition in a severe manner due to inflammation. Some of the many problems associated with acute or chronic pancreatitis include gastrointestinal, metabolic, and psychological issues. Objective: To investigate the effects on the psychological state, quality of life (QoL), and medical results of patients with AP of comprehensive nursing treatments in conjunction with stress awareness programs Methods: Overall, 153 patients with AP were randomly separated into two groups over two years: Group A acknowledged systematic nursing interventions and mindfulness-based stress reduction training, while Group B acknowledged routine care. Stress, depression, and four domains (environmental, social connections, and wellness of psychological and physical) of QoL were considered as key outcome indicators. Data were examined with SPSS software. Results: Results showed that compared with Group B, Group A experienced significantly shorter recovery times for bowel sounds, abdominal pain, and complications. Psychological assessments revealed that Group A had lower anxiety and depression scores. In addition, the complication rate in Group A was lower. QoL scores in Group A showed significant improvement across all domains, with notable differences including their physical, psychological, and social interactive capabilities. Conclusion: The integration of systematic nursing interventions with stress awareness training advanced the QoL, psychological state, and medical results of patients with AP. Keywords: Systematic nursing interventions, stress awareness training, acute pancreatitis, quality of life (QoL), psychological status With an increasing speed of lifestyle and an extensive food supply, the overall incidence of acute pancreatitis (AP) has increased annually, varying from 4.8 to 74.1 per 10, 000 individuals [1]. AP is a frequent but multifactorial disorder, associated with inflammation of the pancreas, and symptoms and complications can vary. This condition presents clinical symptoms like abdominal pain, bloating, and lower indigestion, lack of appetite, and rapid pulse, which leads to a poor quality of life (QoL) among the patients [2]. Various factors contribute to the development of acute pancreatitis, including gallstones, alcohol consumption, and other causes such as trauma, medication use, and hyperlipidemia (Figure 1). The condition has a fast beginning and speedy development. It is commonly followed by repercussions such as peritonitis, infections, and unbelief, any of which can endanger patients’ lives if not treated immediately [3]. Figure 1: Symptoms and Causes of Acute Pancreatitis (AP)  The therapeutic procedure can result in several dangerous consequences, and patients are vulnerable to stress, depression, and other feelings, so treatments must involve treatments using a methodological and suitable nursing approach [4]. Through the continual growth of the concept of biopsychosocial medicine, scientists have shown a strong interest in the use of psychological interventions for mindfulness stress management training [5]. Self-control is a function of awareness in which people are aware of thoughts, behaviors, and actions beyond criticism. Mindfulness stress management guidance is a training method based on mindfulness theory that uses extensive meditation events to assist the trainees to manage their feelings and deal with difficulties with the ultimate objective of alleviating mental and physical issues [6]. At present, there is limited research that emphasizes training for awareness managing stress in AP treatment. As a result, it is critical to investigate the efficacy of standard nursing assistance along with the awareness of specialization in decreasing stress for the management of AP [7]. The patient can be aware of the negative effects, but due to reduced ventilator function or apparent disease of the lung, has reduced capacity for down regulation, leading to mood swings and in far advanced stages, normal life impartment in the patients’ and family lives [8]. Focusing on the patient’s emotions, narrative nursing is a micro-level theory linked to the stories that are told within the healthcare process when patients are presented with issues [9]. In the procedure, they help them to address the issues that are concerned by knowing how others feel and evaluating their opinions and paying appropriate, active, and tender concern to patients, altering the perceptions of life and disease narratives [10]. Consequently, nursing is very vital in an improved QoL along with the outcomes and prognosis of diseases in AP patients [11]. Incorporating the content of stress awareness and systematic nursing therapy has some benefits in the treatment of physiological and psychological disorders of patients [12]. Such programs, which rely on mindfulness-based approaches, aim to reduce emotional pain, enhance methods of managing stress, and increase overall mental health [13]. These therapies will be most beneficial to patients with AP who often experience severe psychological stress due to the severity and uncontrolled nature of the situation. Such an extensive treatment plan corresponds with recent tendencies in modern medicine based on patient-centered approaches [14]. This study aims to evaluate the effectiveness of systematic nursing interventions and stress awareness training in patients with AP. The objective of the study is to assess the impact of these interventions on systemic inflammation, nutritional status, recovery time, and psychological well-being, compared to routine nursing care. The study further investigated inflammatory markers, clinical complications, and QoL outcomes. Research Aim · This study demonstrated the effectiveness of systematic nursing interventions and stress training in reducing systemic inflammation. · Highlighted the positive impact of these interventions on nutritional status, including improved food intake and protein consumption. · Provided evidence that nursing interventions contributed to quicker recovery times and better psychological health. · Exhibited improvement in psychological well-being positively influences physical health outcomes, reducing complications and hospital stays. 2. Literature Reviews The author of [15] assessed the mental and physical wellness of patients with recently discovered pancreatic malignancy and found high symptom burden, low well-being, and high distress levels. The study suggested that to enhance patient results and general health, comprehensive care techniques that prioritize symptom treatment and mental wellness could be

        Running title: Baduanjin on Cardiac Rehabilitation After PCI 22      Abstract 23          Background 27          Objective 30          Methods 41          Result 50          Conclusion 53 56 57      Introduction 107 108      Methods 113 114          Inclusion and Exclusion Criteria 129 130          Literature Search Strategy 145 146          Study Selection and Data Extraction 155 156          Quality Assessment 165 166          Certainty of evidence 175 176          Statistical Analysis 194 195      Results 196          Literature Search 203 204      Fig 1. PRISMA flow diagram of the literature selection process. 205 206          Basic Characteristics of the Included Studies 217 218          Quality Assessment 228 229      Fig 2. Risk-of-bias assessment of the included randomized controlled trials. 230 231          Results of Meta-Analysis 232          N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) 243 244      Fig 3. Forest plots for (A) NT-proBNP, (B) LVEF, (C) 6MWT, and (D) LVEDD. 245 246          Left Ventricular Ejection Fraction (LVEF) 261 262          Six-Minute Walk Test (6MWT) 277 278          Left Ventricular End-Diastolic Diameter (LVEDD) 289 290          Quality of Life (QoL) 302 303      Fig 4. Forest plots for (A) QoL, (B) anxiety, (C) depression, and (D) mental health. 304 305          Anxiety 315 316          Depression 326 327          Mental Health 336 337          Physical Functioning 346 349 350          Social Functioning 360 361          Incidence of Adverse Events 371      = 0.16, 95% CI: 0.02 to 1.24). (Fig 5C) 372 373          Meta-Regression 379          (Supplementary File 3) 380 381          GRADE Assessment 389          (Supplementary File 4). 390 391          Sensitivity Analysis and Publication Bias 397 398      Discussion 482 483          Conclusion 488 489      Acknowledgments 490      None. 491 492      Conflict of Interest 493      The authors declare that the research was conducted in the absence of any commercial 494      or financial relationships that could be construed as a potential conflict of interest. 495 496          Author Contributions 502 503      Data Availability Statement 504      Data sharing is not applicable to this article as no datasets were generated or analysed 505      during the current study. 506 507          Reference 687 688      Table 1. Basic Characteristics of the Included Studies.   Study   Year Age   Intervention       Control   N1   Intervention   N2   Control Rehabilitation   Phase Population   category Xuejuan   2021   59.54±14.78   58.65±17.38   40   Baduanjin   40   Standard care   I   AMI after PCI Wang                   Juan Wang 2024 59.96±6.39 60.02±6.38 46 Baduanjin 46 Standard care Ⅰ AMI after PCI Yu Cai 2022 49.58±9.41 49.47±9.32 45 Baduanjin 45 Standard care Ⅰ AMI after PCI Hongmei Hu 2025 47.02±7.34 46.95±7.29 40 Baduanjin 40 Standard care Ⅰ CHD after PCI Liang Kang 2024 52.2±10.9 53.0±10.7 60 Baduanjin 60 Standard care Ⅱ AMI after PCI Xiaoyu   2023   53.8±14.2   52.4±13.6   60   Baduanjin   60   Standard care   Ⅱ   AMI after PCI Zhang                   Guoguo Liu 2022 56.21±10.44 57.32±11.36 30 Baduanjin 30 Standard care Ⅱ AMI after PCI Hongyun 2023 57.44±7.32 56.38±7.31 45 Baduanjin 45 Standard care Ⅱ AMI after PCI Zheng   Xuefei Liang 2022 59.9±11.9 61.2±10.2 24 Baduanjin 24 Standard care II AMI after PCI Panpan Liu 2024 59.37±4.94 58.72±5.51 61 Baduanjin 61 Standard care Ⅱ AMI after PCI Xing Wang 2023 52.0±16.7 52.5±15.5 40 Baduanjin 40 Standard care Ⅱ CHD after PCI Ting Tang 2019 60.02±8.66 61.38±9.21 50 Baduanjin 50 Standard care Ⅱ CHD after PCI Yingchun Du 2023 60.98±6.04 60.39±6.12 53 Baduanjin 53 Standard care Ⅱ CHD after PCI Manzhen Wu 2024 64.27±4.61 64.74±4.57 51 Baduanjin 50 Standard care Ⅱ CHD after PCI Miaomiao   2022   69.88±2.47   69.48±2.47   39   Baduanjin   39   Standard care   II   CHD after PCI Gao                   Yunxiao Cai 2022 58.42±6.61 59.02±6.78 37 Baduanjin 37 Standard care Ⅱ CHD after PCI Tong Sun 2025 53.07±9.81 52.80±11.26 59 Baduanjin 60 Standard care Ⅱ CHD after PCI Kai Zhao 2022 61.63±5.91 61.89±6.02 41 Baduanjin 41 Standard care Ⅱ CHD after PCI Jinxin Zhao 2023 51.37±7.89 52.27±8.95 46 Baduanjin 47 Standard care Ⅱ ACS after PCI Li Hua 2018 NA NA 60 Sitting Baduanjin 60 Standard care I CHD after PCI Jiamei Wang 2020 59.32±15.43 58.82±12.56 171 Sitting Baduanjin 171 Standard care II CHD after PCI Yan Zhang 2021 60.48±13.28 65.53±13.23 40 Sitting Baduanjin 40 Standard care II CHD after PCI Yueyan Yu 2022 61.13±11.06 60.4±11.37 53 Sitting Baduanjin 53 Standard care II AMI after PCI Dan Zhang 2024 61.4±8.5 62.8±7.5 55 Sitting Baduanjin 55 Standard care II AMI after PCI Zeyun Xu 2025 70.68±9.52 70.94±9.14 43 Sitting Baduanjin 43 Standard care II CHD after PCI Yuying   2024   64.25±1.65   64.31±1.71   38   Sitting Baduanjin   38   Standard care   II   AMI after PCI Huang                   Rui Si 2025 59.68±5.93 60.26±6.14 73 Sitting Baduanjin 73 Standard care II AMI after PCI Chenchen Hu 2023 57.16±5.28 56.84±6.27 60 Sitting Baduanjin 60 Standard care II ACS after PCI Jingjing   2019   58.32±9.74   60.32±7.23   55   Sitting Baduanjin   55   Standard care   II   CHD after PCI Wang                   689 690          Supplementary Materials