Search Results (184)

Background/Objectives: The rapid expansion of social media platforms has profoundly changed the way adolescents access reproductive health information. While digital environments increase accessibility to contraceptive content, they also facilitate the dissemination of misinformation, potentially influencing both contraceptive literacy and psychological well-being. The present study aimed to evaluate the relationship between sources of contraceptive information, contraceptive misinformation endorsement, contraceptive knowledge, and mental health indicators among Romanian adolescents and young adults. Methods: A cross-sectional observational study was conducted in a cohort of 210 Romanian adolescents and young adults. Participants completed a structured self-administered questionnaire assessing demographic characteristics, contraceptive information sources, digital health behaviors, contraceptive misconceptions, and contraceptive knowledge. Anxiety and depressive symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Correlation analyses and multivariable logistic regression models were performed to identify factors associated with poor contraceptive knowledge and moderate-to-severe anxiety. Results: Social media represented the primary source of contraceptive information for 58.1% of participants. Individuals relying predominantly on social media demonstrated significantly lower contraceptive knowledge questionnaire (CKQ) scores compared to those obtaining information from healthcare professionals (5.9 ± 1.8 vs. 8.1 ± 1.7, p < 0.001). Contraceptive misinformation endorsement was inversely correlated with CKQ scores (r = −0.44, p < 0.001) and positively associated with anxiety (r = 0.47, p < 0.001) and depressive symptoms (r = 0.41, p < 0.001). In multivariable analyses, primary reliance on social media (OR 2.21, 95% CI 1.12–4.34, p = 0.022) and low digital health literacy (OR 2.94, 95% CI 1.51–5.71, p = 0.001) were independently associated with poor contraceptive knowledge. Higher misinformation endorsement, infertility-related fears, and high social media exposure were independently associated with moderate-to-severe anxiety. Conclusions: Contraceptive misinformation endorsement was associated with lower contraceptive literacy and poorer psychological outcomes among adolescents and young adults. These findings highlight the growing importance of digital health literacy. However, given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects, and longitudinal studies are required to clarify their directionality. Full article

Background/Objectives: Obesity is an increasing challenge among people living with HIV (PLWH). This study aimed to assess the prevalence of general and abdominal obesity and its association with lifestyle in adult Romanian PLWH, providing the first national data. Methods: A single-center, cross-sectional study involved 106 adult PLWH. Eating behavior was assessed using the Rapid Eating Assessment for Participants—Short Version (REAP-S) and physical activity with the General Practice Physical Activity Questionnaire (GPPAQ), both standardized and validated. Anthropometric, clinical, and virological data were collected from medical records and direct measurement. Results: Median age was 36 years [IQR 33–42], 83.3% were male, and 73.6% lived in urban areas. Median time since HIV diagnosis was 11 years, and 60.4% had AIDS-defining illness. General obesity (BMI ≥ 30 kg/m²) occurred in 17.9%, overweight in 29.2%, and high-risk abdominal obesity in 22.6%. Physical inactivity was reported by 20.8%. Multivariable analysis showed that being moderately or physically active was the only independent predictor of abdominal obesity (OR 0.19; 95% CI, 0.07–0.51; p = 0.001). Conclusions: In this young Romanian cohort of PLWH, physical activity reduces the risk of abdominal obesity, underscoring the need to integrate such interventions into the standard of care to reduce metabolic risk associated with HIV. Full article

Potentially toxic elements (PTE) are persistent contaminants in coastal systems and may accumulate in marine organisms, with relevance for both environmental monitoring and seafood safety assessment. This study provides an exploratory cross-biota assessment of Cd, Cr, Cu, Ni, and Pb in fishery resources from the Romanian Black Sea in 2024. The dataset included 24 composite samples and 120 analyte-level observations across bivalves, gastropods, pelagic fish, and demersal fish. Tissue concentrations were integrated with regulatory maximum levels, bioconcentration factors (BCF), biota–sediment accumulation factors (BSAF), and adult dietary risk indices, including estimated daily intake (EDI), target hazard quotient (THQ), and total target hazard quotient (TTHQ). Within the limits of this single-year dataset, Cd and Pb concentrations were generally higher in bivalves than in fish and gastropods, whereas Cr showed higher values in several fish samples, particularly pelagic fish. Cd was the main element of concern, with regulatory exceedances occurring mainly in bivalves and fewer exceedances in pelagic fish, while Pb exceedance was isolated. BCF and BSAF supported the relevance of Cd as a priority element but were interpreted only as descriptive tissue–water and tissue–sediment ratios, not as evidence of specific uptake pathways. Low abiotic Cd concentrations may have inflated some ratio-based values, and Cr interpretation remains limited by the absence of Cr speciation and dissolved/particulate partitioning data. The adult dietary risk assessment did not indicate substantial non-carcinogenic concern, as all individual THQ values and cumulative TTHQ values remained below 1. Overall, the findings support continued PTE monitoring in the Romanian Black Sea, using sessile bivalves as indicators of local environmental contamination and including gastropods and representative pelagic and demersal fish species of ecological and fisheries relevance to capture contaminant patterns across benthic and mobile fishery resources. Future monitoring should improve species-level replication, integrate metal partitioning in abiotic matrices, and include additional contaminants of seafood safety relevance, particularly Hg and As. Full article

Evidence on the interplay between perceived stress, dietary behaviour, and weight-related psychosocial burden in Romanian young adults remains scarce. This cross-sectional study assessed associations between BMI, perceived stress, multi-system somatic symptom severity, and psychosocial burden in 117 participants aged 16 to 20 years (89.7% female; mean age 19.23 ± 0.74 years; mean BMI 22.66 ± 3.85 kg/m²), recruited by convenience sampling in Târgu Mureș, Romania, during June 2025. Non-parametric methods were used throughout. Female participants scored significantly higher than males across digestive (p < 0.001), neurological (p = 0.001), cutaneous (p = 0.014), and total symptom domains (p < 0.001), with a median total symptom score of 21.0 versus 3.0 in males. Perceived stress correlated positively with neurological (rS = 0.445), cardiovascular (rS = 0.350), digestive (rS = 0.316), and total symptom scores (rS = 0.401; all p < 0.001). BMI was not associated with somatic symptoms but correlated with weight-related stigma (rS = 0.391, p < 0.001). Emotional distress was prevalent regardless of weight status: 60.7% reported food-related guilt and 59.8% reduced self-confidence, yet only 6.0% had consulted a mental health professional. Stress management, nutritional counselling, and body image support should target young adults across all BMI categories. Full article

The rapid proliferation of artificial intelligence (AI) in digital advertising has fundamentally transformed how brands communicate with consumers, shifting from generic mass messaging toward highly personalised, emotionally targeted experiences. Despite growing interest in AI-driven marketing, limited empirical research has examined how consumers’ socio-emotional processing mechanisms, particularly perceived empathy and social cognition, mediate the relationship between AI-powered ad personalisation and downstream consumer decision-making outcomes. This study addresses this gap by investigating the emotional and cognitive responses triggered by AI-personalised advertising among Romanian consumers. Using a quantitative survey design, data were collected from a sample of 234 adult respondents (18–65 years) in Romania, broadly aligned with key Romanian demographic distributions across age, gender, and residential area. Structural equation modelling using the Partial Least Squares (PLS-SEM) approach was employed to test the proposed conceptual model, which integrates constructs of AI-powered ad personalisation, trust in AI, perceived AI empathy, emotional arousal, cognitive elaboration, social cognition, consumer engagement, and purchase intention. The results reveal that perceived empathy toward AI-generated advertising positively influences emotional arousal and cognitive elaboration, which in turn significantly predict consumer engagement and purchase intention. Trust in AI emerged as a critical sequential mediator, while social cognition moderated the personalisation-to-trust pathway. The study yields a validated marketing model that captures the socio-emotional dynamics underlying consumer responses to AI advertising. These findings contribute to the theoretical understanding of human–AI interaction through a social cognition and emotions lens, while offering practical implications for the design of emotionally intelligent, AI-driven advertising strategies. Limitations and future research directions are discussed. Full article

Background and Objectives: Multidrug-resistant (MDR) uropathogens are reshaping the empirical management of acute pyelonephritis, particularly in Eastern European centers. We aimed to describe MDR patterns, identify admission-level predictors, including renal impairment/renal-failure status at presentation and major healthcare exposure variables, and derive a bedside risk score (PYELO-MDR-Risk) for adult pyelonephritis at a Romanian tertiary hospital. Methods: We retrospectively analyzed 129 consecutive culture-confirmed acute pyelonephritis admissions at “Victor Babeș” University Hospital, Timișoara (March 2022–March 2025). MDR was defined as non-susceptibility to ≥1 agent in ≥3 antimicrobial categories. We compared MDR and non-MDR cases on demographics, microbiology, time-to-effective therapy (TTE), and outcomes; multivariable logistic regression identified independent predictors and was the basis for a points-based score with bootstrap-based internal validation (1000 resamples). Results: Fifty-four patients (41.9%) had MDR pyelonephritis. Escherichia coli remained the dominant uropathogen (55.8%) but was less prevalent in the MDR group (40.7% vs. 66.7%; p = 0.003), whereas Klebsiella pneumoniae and Pseudomonas aeruginosa were enriched. Independent predictors of MDR were antibiotic exposure ≤90 days (aOR 5.7, 95% CI 2.4–13.6), recurrent UTI (aOR 3.4, 1.4–8.2), recent hospitalization (aOR 3.1, 1.2–8.0), and renal impairment/renal-failure status at admission (aOR 2.4, 1.0–6.2). Immunosuppression, prior urinary tract instrumentation, and nephrolithiasis/urolithiasis were evaluated as candidate predictors but did not independently improve the final point score after adjustment. MDR was associated with delayed effective therapy (28.4 vs. 9.7 h; p < 0.001), longer hospitalization (13.7 vs. 8.9 days; p < 0.001), and higher 30-day readmission (20.4% vs. 8.0%; p = 0.038). The PYELO-MDR-Risk score (range 0–12) achieved an optimism-corrected AUC of 0.84 with adequate calibration (Hosmer–Lemeshow p = 0.624). Conclusions: MDR drives a substantial fraction of pyelonephritis admissions in Western Romania and tracks closely with prior antibiotic and healthcare exposure. The PYELO-MDR-Risk score offers a transparent bedside tool for empirical-therapy decisions in the local setting, pending national and international external validation. Full article

Background/Objectives: Oral behaviors are increasingly considered relevant within the biopsychosocial framework of temporomandibular disorders, yet their relationship with emotional symptoms remains insufficiently characterized in general adult populations. This study investigated the association between the frequency of oral behaviors and the severity of anxiety and depression symptoms in adults. Methods: This observational, cross-sectional, multicenter study included 460 adults recruited from private dental practices. Oral behaviors were assessed using the Oral Behaviors Checklist (OBC-21), while anxiety and depression were evaluated using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Associations were examined using Spearman correlations and generalized linear models with negative binomial distributions, adjusted for age, sex, and area of residence. Results: OBC-21 scores were positively associated with GAD-7 (R = 0.469, p < 0.001) and PHQ-9 (R = 0.432, p < 0.001). In adjusted models, OBC-21 remained significantly associated with anxiety symptoms (IRR = 1.0292, 95% CI: 1.0187–1.0399, p < 0.001) and depressive symptoms (IRR = 1.0293, 95% CI: 1.0187–1.0400, p < 0.001). Male sex was associated with lower anxiety scores, while age and area of residence were not significant. GAD-7 and PHQ-9 scores were strongly correlated. Conclusions: In this sample of adults attending private dental practices, a higher frequency of oral behaviors was associated with increased anxiety and depression symptoms, independently of age, sex, and area of residence. These findings support the clinical relevance of assessing oral behaviors as part of a biopsychosocial evaluation in dental practice. Full article

Background: The recently published Thirst study showed that prolonged preoperative fasting for liquids remains an unresolved issue across multiple European countries despite clear guideline recommendations. In-depth analyses of national practices could help the development of targeted interventions. The aim of our study was to provide a national overview of fluid fasting in Romania, highlighting institutional factors that could prolong two distinct fasting times: true fluid fasting time and fasting time until the last sips. Methods: This was a secondary analysis of the recently published Thirst study, a prospective, observational, multicenter study. Twenty-one Romanian centers recruited a total of 2185 adult patients undergoing elective procedures between 25 and 29 November 2024. The main outcomes were: the median value of self-reported fasting time to the last sips (SIPS) and true fluid fasting time for larger amounts (NOT SIPS) across centers and procedures; SIPS and NOT SIPS times across hospital level of care and fluid fasting protocols; and the independent predictive value of hospital level of care, fluid fasting protocols and workload for prolonged fasting. The secondary outcomes were the frequency of prolonged fasting (>4 h) and fasting for 2–4 h across centers, procedures, level of care, protocol and afternoon scheduling. The Kruskal–Wallis test with pairwise comparisons was used to compare differences in median times depending on the studied subgroup. Results: The median fluid fasting times for SIPS and true fluid fasting were 8 h [3:30–13:00] and 12 h [10:00–14:55], respectively, and varied significantly across centers, specialties, levels of care and protocol in place (p < 0.001). Prolonged SIPS and true fluid fasting times were observed in 67.3% and 95% of the patients, respectively. Both times varied significantly across the procedure types (p < 0.05), with ophthalmology having the shortest fasting times. Reduced fluid fasting times were independently associated with moderate-competence centers, lower emergency case load and guideline-based fasting protocols. Conclusions: This secondary analysis shows that non-adherence to fluid fasting guidelines is frequent in most Romanian regions and centers. Further research is needed to develop individualized strategies based on institutional and geographical policies as well as on physiologic effects of fluid fasting. Full article

Introduction: Problematic internet use has been increasingly associated with depression, anxiety and other psychiatric symptoms; however, its impact on attentional functioning has not been thoroughly researched. This cross-sectional study was conducted in Târgu Mureș, Romania, and aimed to examine the associations between problematic internet use, attentional control, and symptoms of depression and anxiety in adults, and to determine whether problematic internet use independently predicts attentional control after accounting for emotional symptoms. Methods: A cross-sectional study was conducted on 224 adults who completed an anonymous online survey between 1 January 2026 and 1 April 2026. Problematic internet use was assessed using the Compulsive Internet Use Scale-14 (CIUS-14), attentional control using the Attentional Control Scale (ACS), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 scale (GAD-7), and eating disorder risk using the SCOFF questionnaire. Descriptive statistics, internal consistency analyses, Pearson correlations, group comparisons according to the CIUS-14 screening threshold, and multiple linear regression analyses were performed. Results: Problematic internet use was significantly associated with lower attentional control (r = −0.493, p < 0.001), higher depressive symptoms (r = 0.408, p < 0.001), and higher anxiety symptoms (r = 0.467, p < 0.001). In the regression model, problematic internet use remained the only significant independent predictor of attentional control (B = −0.597, p < 0.001), whereas depressive and anxiety symptoms were not significant after adjustment. Participants above the CIUS-14 screening threshold reported significantly lower attentional control and higher depression and anxiety scores than those below the threshold. Conclusions: Problematic internet use was associated with poorer attentional control and greater emotional symptom severity in Romanian adults. These findings suggest that problematic internet use may be linked to a broader cognitive–emotional vulnerability profile. However, because of the cross-sectional design, self-report measures, convenience sampling, and lack of detailed information on specific online activities, the findings should be interpreted cautiously. Longitudinal studies using objective cognitive measures and more detailed assessment of digital behaviors are needed. Full article

Background and Objectives: Access to medicines is a fundamental determinant of health equity and a core pillar of universal health coverage, encompassing the timely availability, affordability, and appropriate use of essential medicines. Socioeconomic disparities may limit actual and timely access to pharmacological treatment, particularly in healthcare systems characterized by mixed public–private financing and significant out-of-pocket expenditures. This study aimed to evaluate socioeconomic determinants of access to medicines among Romanian patients with chronic diseases, focusing on income level, prescription reimbursement, perceived affordability, and substitution behavior during medicine shortages. Materials and Methods: A cross-sectional study was conducted between October and December 2024 using a structured online questionnaire administered to 200 adult patients diagnosed with cardiovascular diseases, diabetes mellitus, chronic hepatitis B and C, or oncological conditions, recruited at the “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania. Associations between income and access-related variables were assessed using Spearman’s rank correlation coefficients with 95% confidence intervals. Binary logistic regression identified independent predictors of perceived difficulty in accessing medicines (p < 0.05). Results: Lower income was significantly associated with greater reliance on reimbursed prescriptions (r_s = −0.241, 95% CI: −0.37 to −0.10, p = 0.001) and fully reimbursed prescriptions (r_s = −0.305, 95% CI: −0.43 to −0.17, p < 0.001). Income was strongly correlated with perceived affordability of treatment (r_s = 0.601, 95% CI: 0.50–0.69, p < 0.001). In multivariate logistic regression analysis, income below 3000 RON/month (adjusted OR = 1.94, 95% CI: 1.05–3.58, p = 0.034) and insufficient affordability (adjusted OR = 4.12, 95% CI: 2.15–7.89, p < 0.001) were independently associated with perceived difficult access to treatment. Additionally, 80% of respondents reported purchasing substitute medicines when prescribed medicines were unavailable. Conclusions: This cross-sectional study indicates that socioeconomic status and perceived affordability are significant determinants of access to medicines among Romanian patients with chronic diseases attending a tertiary ENT centre. Financial vulnerability remains a major barrier despite existing reimbursement mechanisms. Policy interventions aimed at strengthening income-sensitive reimbursement strategies and ensuring consistent pharmaceutical availability may improve equitable access and therapeutic continuity. Full article

Background/Objectives: Overweight and obesity are increasing globally. However, structured contemporary data on lifestyle behaviors and adiposity in Romanian young adults remain limited. Therefore, this study aimed to describe dietary and lifestyle habits, BMI, and overweight/obesity prevalence in Romanian adults aged 18–30 years and to examine associations between these variables. Methods: This cross-sectional online questionnaire study included 1202 young Romanian adults. BMI was calculated from self-reported height and weight and analyzed continuously, as well as for overweight/obesity (BMI ≥ 25 kg/m²). Pre-specified exposures were compulsive eating, soft-drink intake, breakfast frequency, physical activity, and sleep duration. Multivariable linear regression with heteroscedasticity-consistent standard errors was used for BMI, and modified Poisson regression with robust variance was used for overweight/obesity. Composite dietary score, sex-interaction, and sensitivity analyses were also performed. Results: Mean age was 23.2 ± 3.3 years, mean BMI was 23.8 ± 4.2 kg/m², and 32.4% of participants had overweight/obesity. Men had higher BMI and a higher prevalence of overweight/obesity than women. Compulsive eating and soft-drink intake showed dose-dependent associations with higher BMI and higher overweight/obesity prevalence. Short sleep duration (≤5 h/night) and daily breakfast consumption were associated with a higher and, respectively, lower prevalence of overweight/obesity. Physical activity showed no independent association after full adjustment, although this finding may be influenced by the use of a single self-reported item. Composite-score analyses supported the main findings. Conclusions: In Romanian young adults, compulsive eating and soft-drink intake were the most consistent behavioral correlates of adiposity, while breakfast regularity and short sleep showed threshold-type associations with overweight/obesity. These findings may inform the design of multicomponent prevention strategies, although longitudinal confirmation is needed. Full article

Objective: We examined the psychological mechanisms underlying cyberchondria by testing whether rumination mediates the association between intolerance of uncertainty and cyberchondria and whether this indirect effect is moderated by prior medical experiences and perceived access to healthcare. Methods and Measures: A cross-sectional design was employed with a non-clinical sample of 96 Romanian adults. Participants completed validated self-report measures of intolerance of uncertainty (IUS-12), rumination (Ruminative Responses Scale), and cyberchondria (Cyberchondria Severity Scale). Additional items assessed medical history and perceived access to healthcare. Moderated mediation analyses with bootstrapped confidence intervals were conducted, controlling for relevant sociodemographic variables. Results: Higher intolerance of uncertainty was associated with higher cyberchondria both directly and indirectly through rumination, which accounted for more than half of the total effect. The rumination–cyberchondria association, and the indirect effect of IU, were significantly stronger among individuals who had experienced a recent acute medical episode, whereas chronic illness did not significantly moderate this pathway. Cyberchondria levels were lowest among participants reporting very good access to healthcare. Conclusions: Cyberchondria appears to arise from the interaction of intolerance of uncertainty, ruminative thinking, and contextual health experiences. Targeting rumination and uncertainty tolerance may be particularly important following acute medical events. Full article

A major question in L1 attrition research is whether cross-linguistic influence from a speaker’s second language onto their first constitutes only a temporary, superficial effect or whether it can also lead to a structural change, often discussed as a distinction between effects on language processing as opposed to changes to the mental representation of grammatical properties. Some have argued that L1 grammars of adult L2 speakers are entirely impervious to change, while others stated that some of the available findings can be interpreted as grammatical representations themselves being vulnerable. This paper contributes to the question of how we can distinguish between these two types of attrition. I argue that it is challenging to use behavioral differences across tasks as well as experimental results showing optionality between L1 and L2 options to distinguish between a superficial and a structural change. Instead, situations where properties of an attriter’s L1 grammar converge on the L2 constitute the clearest case of structural change as these cannot be explained as temporary effects of L2 influence. Using data from an earlier study on attrition found in Romanian native speakers living in Italy, I furthermore challenge the claim that L2 convergence only occurs in rare situations where attriters lose contact with the L1. To better understand the contexts in which attrition at the level of representation may be possible, I suggest that future studies focus on (1) a variety of linguistic properties where the L1 allows a grammatical construction or interpretation also in situations where it is not used in the L2, (2) properties where options from both the L1 and the L2 are less likely to co-exist in an attritred grammar and (3) consistently include analyses of individual response patterns. Full article

Healthcare-associated infections (HAIs) are clinically relevant complications in critically ill stroke patients, particularly in neurological intensive care settings, where severe neurological injury, dysphagia, immobilization, invasive device exposure, and prolonged hospitalization increase infection susceptibility. Romanian data focused on deceased stroke patients admitted to neurological intensive care units remain limited. This retrospective descriptive single-center hospital-based study, supported by focused literature contextualization, was conducted in the Neurological Intensive Care Unit of the Brașov County Emergency Clinical Hospital, Romania. Adult stroke patients who died during hospitalization over a six-year observation period were included. Clinical data were extracted from a working hospital database and analyzed descriptively after data cleaning and harmonization. The final cohort comprised 190 deceased stroke patients; ischemic stroke was documented in 69.5% and hemorrhagic stroke in 28.9%. Hypertension (73.7%) and ischemic heart disease and/or previous myocardial infarction (60.0%) were the most frequently recorded comorbidities. Pneumonia was the dominant documented infectious complication, recorded in 52.6% of patients, followed by urinary tract infection (11.6%), pressure sore-related infection (4.7%), and sepsis-related coding (6.8%). The median in-hospital survival interval was 6 days (IQR 3.0–10.75). Because year-by-year stratification was not sufficiently robust, the temporal component was interpreted only in aggregate form. These findings provide a descriptive hospital-based profile of documented infectious complications in a fatal stroke ICU cohort and support the need for more standardized infection documentation and better linkage between clinical and microbiological data in neurocritical care settings. Full article

Background and Objectives: Infective endocarditis (IE) remains associated with high mortality, and real-world (RW) patients often differ from trial populations. We evaluated predictors of complications and mortality, the trial-eligibility gap, and temporal trends in guideline adherence across two periods (Period 1 [P1]: 2011–2016 vs. Period 2 [P2]: 2017–2025) in a Romanian county hospital. Materials and Methods: We conducted a retrospective analysis of consecutive adult patients with definite IE. Patients were categorized as trial-eligible (TE) or RW according to predefined criteria. The composite endpoint included acute heart failure, cardiogenic or septic shock, embolic events, infectious complications, need for renal replacement therapy, and in-hospital mortality. We evaluated guideline adherence using a predefined quality indicator (QI) score ≥ 3. We identified independent predictors of outcome using multivariable logistic regression. Results: Among 206 patients (mean age 63.0 ± 14.8 years; 70.4% male), blood cultures were positive in 64.1%, with Staphylococcus aureus accounting for 14.1%. Vegetations were documented in 72.8%, and cardiac surgery was performed in 26.2%. Overall, at least one event from the composite endpoint occurred in 61.6%, and mortality was 32.5%. TE patients represented 63.1% of the cohort. Guideline adherence improved over time (QI ≥ 3: from 18.3% in P1 to 25.4% in P2, p = 0.32). In P2, the composite endpoint (66.8% vs. 42.9%, p = 0.002) and embolic events (31.8% vs. 8.2%, p < 0.001) were more frequent, whereas mortality remained unchanged (31.8% vs. 34.7%, p = 0.844). Sepsis at admission and left ventricular ejection fraction (LVEF) < 50% independently predicted adverse outcomes; model discrimination was acceptable, with an area under the curve (AUC) of 0.77. Conclusions: RW IE showed high complication rates and a persistent trial gap; improved guideline adherence was offset by greater clinical severity. Full article