Search Results (441)

Background: The persistent challenge of not having a physician or nurse practitioner for ongoing care for millions of residents imposes a burden on the health economy in Canada and demands a shift in focus from mere system registry to the value-based concept of attachment readiness. With a hypothesis that true attachment is a function of attachment readiness, a relational process shaped by the intersection of patients’ preparation, providers’ capacity, and systemic support, this study aims to investigate the challenges of attachment-creating barriers to meaningful healthcare relationships. Methods: This sequential mixed-methods study was designed to integrate a comprehensive scoping review of academic librarian-guided databases, search engines, grey literature, and snowballing, followed by 360-degree qualitative interviews with experts, service providers, and clients. Qualitative data was analyzed by thematic coding to answer the research questions. Results: Attachment is a function of a multitude of factors from patients and physicians’ “attachment readiness” is a multilevel, process-oriented condition shaped by patient preparedness, provider capacity, and system design more than a single episodic event or individual attribute. Facilitators such as team-based care, patient navigation, culturally responsive outreach, and structured onboarding reinforce readiness as a system-enabled condition. However, persistent system-level barriers delay attachment among motivated patients (readiness decay), leading to frustration, disengagement, and reduced trust. Findings further suggest that attachment is constrained not only by physician supply but also by time-sensitive readiness conditions. Conclusions: This study suggests that attachment to primary care is one leg of a three-legged stool, upheld and sustained by the two others- equity and access. To facilitate true attachment and to move beyond fragmented care and reliance on high-cost emergency departments, Canadian healthcare policy must consider attachment readiness through standardizing onboarding (implementing uniform digital intake processes to reduce repetitive data entry and administrative friction), an equity lens for prioritizing vulnerability (refining centralized waitlist algorithms to account for clinical urgency and social determinants of health), and supporting provider capacity (providing financial and administrative incentives that recognize the labour involved in establishing new longitudinal relationships for patients with complex needs). Full article

Background/Objectives: Hypercapnic respiratory failure (HRF) is a serious complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity, mortality, and healthcare utilisation. National HRF trends among patients with COPD remain poorly characterised in Lithuania, and the knowledge of prehospital emergency-care professionals regarding oxygen therapy and hypercapnia has not been evaluated. Methods: This study comprised two components. First, a cross-sectional online survey assessed knowledge of COPD, hypercapnia, and oxygen therapy among prehospital emergency-care professionals (EMS physicians, emergency nurses, EMS paramedics, and paramedics); three questionnaire items whose designated correct answers could not be unambiguously supported were excluded from the knowledge score, and the original 10-item score was retained as a sensitivity analysis. Second, nationwide electronic health record data from the Lithuanian national health record system (ESPBI IS, 2020–2023) were analysed retrospectively: patients with COPD and concomitant chronic HRF were identified using ICD-10-AM diagnostic codes, and the number of patients with a recorded J96.11 diagnosis irrespective of underlying disease was obtained as a national denominator. Proportions are reported with 95% confidence intervals and temporal trends as absolute changes in percentage points; multivariable logistic regression was used to estimate odds ratios adjusted for age group and sex. Between-year differences were tested using the χ² test with Holm-adjusted pairwise comparisons, and the association between sex and chronic HRF was expressed as an odds ratio. All tests were two-sided, and p < 0.05 was considered significant. Results: Among the 65 prehospital emergency-care professionals surveyed, knowledge of hypercapnia was relatively high: 78.5% (95% CI 67.0–86.7) correctly defined it and 72.3% (95% CI 60.4–81.7) identified its symptoms, whereas 58.5% (95% CI 46.3–69.6) identified the recommended SpO₂ target range of 88–92%. Respondents answered a median of 5 of the 7 scored knowledge items correctly (IQR 4–6). Total knowledge scores differed by professional role (p = 0.034) but not by years of experience, sex, or frequency of COPD contact; the sensitivity analysis using the original 10-item score gave the same pattern (p = 0.006). In the national electronic health record data, the COPD population increased from 27,239 to 32,446 (+19.1%) between 2020 and 2023, while the number of COPD patients with a recorded chronic HRF diagnosis rose from 160 to 291 (+81.9%). The proportion rose from 0.59% (95% CI 0.50–0.69) to 0.90% (95% CI 0.80–1.01), an absolute increase of 0.31 percentage points (95% CI 0.17–0.45; risk ratio 1.53, 95% CI 1.26–1.85). Men had higher odds than women after adjustment for age (adjusted OR 1.55, 95% CI 1.28–1.88), and adjusted odds were lowest in patients aged 80 years or older. Across the four annual cross-sections, COPD accounted for 41.5% of patient-year observations with a recorded J96.11 diagnosis nationally. Conclusions: Knowledge of COPD, hypercapnia, and oxygen therapy varied among the prehospital emergency-care professionals surveyed, with one of the lowest proportions of correct responses observed for the recommended target oxygen saturation range. National electronic health record data showed an increase in the proportion of patients with COPD who had a recorded diagnosis of chronic HRF between 2020 and 2023. These components were analysed independently, and no relationship between professional knowledge and temporal trends in recorded diagnoses was assessed. The electronic health record findings support continued monitoring and recognition of chronic HRF in COPD, whereas the survey findings support further evaluation of targeted education on oxygen therapy in the prehospital setting. Full article

Background/Objectives: Dementia with Lewy bodies (DLB) is a clinically heterogeneous neurodegenerative disorder characterized by cognitive, neuropsychiatric, motor, and autonomic manifestations. Reduced striatal dopamine transporter availability on ¹²³I-ioflupane single-photon emission computed tomography (SPECT) is an established indicative biomarker of DLB. However, the associations among expert visual interpretation, regional semiquantitative dopamine transporter measurements, autonomic manifestations, and dementia severity remain incompletely characterized. This study aimed to evaluate the relationship between visual ¹²³I-ioflupane SPECT classification and regional DaTQUANT z-scores in patients with clinically probable DLB and to explore their associations with autonomic manifestations and dementia severity. Methods: This retrospective, cross-sectional study included 30 patients who received a clinical diagnosis of probable DLB according to the 2017 DLB Consortium criteria before the ¹²³I-ioflupane SPECT results became available. SPECT images were assessed visually by experienced nuclear medicine physicians and semiquantitatively using DaTQUANT software. Bilateral striatal, putaminal, caudate, and putamen-to-caudate ratio z-scores were analyzed in relation to visual scan classification, Clinical Dementia Rating (CDR) scores, and retrospectively ascertained autonomic manifestations, including orthostatic hypotension, delayed orthostatic hypotension, supine hypertension, postprandial hypotension, constipation, and urinary incontinence. Results: Scans were visually classified as supportive of nigrostriatal dopaminergic degeneration in 23 of 30 patients (76.7%) and as non-supportive in seven (23.3%). Bilateral striatal, putaminal, and caudate z-scores were significantly lower in visually supportive scans than in non-supportive scans (all p < 0.001), whereas putamen-to-caudate ratio z-scores did not differ significantly between the groups. None of the evaluated autonomic manifestations was significantly associated with either visual scan classification or regional DaTQUANT measurements. No regional DaTQUANT measurement was significantly associated with dementia severity. A modest positive correlation was observed between the left putamen-to-caudate ratio z-score and CDR (Spearman’s ρ = 0.373, nominal p = 0.050); however, given the small sample size and multiple regional comparisons, this borderline finding was considered exploratory. Conclusions: Regional DaTQUANT measurements were consistent with expert visual interpretation of ¹²³I-ioflupane SPECT in patients with clinically probable DLB. Associations of dopaminergic imaging measurements with autonomic manifestations and dementia severity were limited. Semiquantitative analysis may complement visual interpretation, but its findings should be interpreted within the broader clinical and biomarker context. Larger prospective studies incorporating standardized autonomic testing, appropriate control groups, longitudinal follow-up, and complementary biomarkers are warranted. Full article

Background: Statins are among the most frequently prescribed medications worldwide, with proven benefits in reducing all-cause and cardiovascular mortality, preventing major adverse cardiovascular events (MACEs), and lowering healthcare costs. Despite their well-established safety and effectiveness, discontinuation of statin therapy remains a common problem in both primary and secondary prevention. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines and registered in the PROSPERO database (CRD420261295172). Original studies published since 1 January 2014 were identified through searches of PubMed (MEDLINE) and Google Scholar using predefined keywords. Methodological quality and risk of bias of the included observational studies were evaluated using the Newcastle-–Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Synthesized data from 29 included studies indicate that up to half of patients discontinue statin therapy within the first year (discontinuation rates ranging from 27.1% to 47.0% in primary prevention and 18.5% to 32.4% in secondary prevention), with rates increasing over time. Major factors contributing to non-adherence include fear of side effects, particularly statin-associated muscle symptoms (SAMSs), misinformation, limited patient–physician communication, socioeconomic barriers, and polypharmacy. Discontinuation is associated with significantly higher all-cause and cardiovascular mortality (Hazard Ratios ranging from 1.30 to 4.65), higher rates of cardiovascular and cerebrovascular events, worsening metabolic outcomes, reduced quality of life, and greater healthcare expenditures. Conclusions: Improving adherence requires better patient education, addressing misconceptions, strengthening patient–physician relationships, and optimising treatment regimens. A multidisciplinary approach is needed to prevent unjustified discontinuation and improve long-term clinical outcomes. Full article

Background/Objectives: Empathy is a fundamental component of patient-centered care and plays a critical role in the physician–patient relationship. This study aimed to evaluate empathy levels among undergraduate medical students at a medical university in Romania, examined from a Medical Humanities perspective, and to analyze how these scores are distributed according to gender, academic year, clinical stage, and direct experience with patient contact. Methods: A descriptive, cross-sectional study was conducted among 209 undergraduate medical students across all six academic years. Empathy levels were assessed using the Romanian-language version of the Jefferson Scale of Empathy—Student Version (JSE-S). Differences in empathy scores were analyzed using independent samples t-tests and a one-way analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) post hoc comparisons. Statistical significance was set at an alpha level of less than 0.05. Results: Internal consistency of the JSE-S total scale was good (Cronbach’s α = 0.829). The overall mean total JSE-S score was 107.34 ± 14.34. Female students demonstrated significantly higher empathy scores compared to male students (109.92 ± 13.10 versus 99.37 ± 15.20; t = 4.450; p < 0.001; Cohen’s d = 0.77). No statistically significant differences were found between preclinical and clinical stage students (106.84 ± 14.75 versus 108.98 ± 12.90; p = 0.363; Cohen’s d = −0.15), between students with and without direct patient contact (108.20 ± 14.14 versus 104.48 ± 14.78; p = 0.115; Cohen’s d = 0.26), or across the six academic years (F = 1.614; p = 0.158; partial η² = 0.038). Conclusions: Medical students demonstrated moderate-to-high empathy levels, with gender representing the only statistically significant demographic factor. The absence of major differences across academic-year cohorts and clinical exposure suggests that empathy levels were comparably represented across the different stages of training within this cross-sectional sample. These findings contribute descriptive data on empathy levels among Romanian medical students and highlight gender as the main factor associated with variation in empathy scores in this sample. Full article

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements. Full article

Professional and elite sport represents a high-pressure healthcare environment in which standard principles of patient-centered care, confidentiality, informed consent, shared decision-making, and clinical independence are tested by organizational and performance-related pressures. This narrative review examines reliance management in athlete–physician relationships. Reliance is conceptually distinguished from trust: whereas trust is an interpersonal attitude that can be betrayed, reliance denotes the broader dependence of the athlete-patient on the physician, the care process, and the surrounding governance system—a dependence that may persist even where trust is absent. Reliance management is conceptualized as the deliberate, multi-level design and maintenance of communicative, ethical, and governance conditions under which such reliance is well-placed. A structured, non-systematic literature search of PubMed, Scopus, Web of Science, SPORTDiscus, and Google Scholar, supplemented by backward citation tracking, informed a thematic synthesis organized around three dimensions: clinical ethics, patient-centered care, and governance. The synthesis distinguishes empirical findings, professional consensus guidance, ethical and legal analysis, and illustrative cases, and identifies domains in which evidence remains weak. An integrative conceptual model is proposed that links governance antecedents at the dyadic, clinical, organizational, and system levels to mechanisms of well-placed reliance and to outcomes that require empirical evaluation. Proposed safeguards—independent medical oversight, documented return-to-play pathways, formal data-sharing rules, second-opinion access, and contractual protection of physician autonomy—are intended to protect patient-centered care and patient safety; their effectiveness has, however, rarely been evaluated and should be the object of future intervention research. Full article

Background: The clinical significance of inflammatory phenotypes and their temporal relationship with natriuretic peptide dynamics in acute heart failure (AHF) remain poorly defined. We investigated admission inflammatory phenotypes, in-hospital C-reactive protein (CRP) trajectories, and their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP) dynamics. Methods: In this retrospective single-center cohort of 306 patients hospitalized for AHF, patients were stratified according to admission CRP (≤10 vs. >10 mg/L). Among patients with dual biomarker measurements (n = 147), a CRP–procalcitonin (PCT) concordance phenotype was evaluated. Serial CRP measurements were available in 65 patients, and NT-proBNP response (≥30% reduction) was assessed in 42 patients; because these repeat measurements were obtained at the treating physician’s discretion, the corresponding subgroups were older and more severely ill than the full cohort and are treated as exploratory. Results: Elevated admission CRP (>10 mg/L) was associated with higher NT-proBNP levels (3621 vs. 1251 pg/mL, p < 0.001), more severe symptoms (New York Heart Association [NYHA] III–IV: 45.9% vs. 29.8%, p = 0.006), and greater PCT positivity (21.8% vs. 8.7%, p = 0.029), independent of left-ventricular ejection fraction; the association persisted after adjustment for age, sex, and ejection fraction (adjusted odds ratio 2.40, 95% CI 1.27–4.55). The biomarker-defined CRP+/PCT+ phenotype showed the greatest concurrent NT-proBNP burden and the highest prevalence of heart failure with preserved ejection fraction (HFpEF, 70.6%). Despite declining NT-proBNP, CRP increased during hospitalization in 69.2% of patients (median ΔCRP +5.9 mg/L, p < 0.001), and the two changes were uncorrelated, indicating divergent biomarker trajectories. Conclusions: Admission CRP identifies patients with a more severe concurrent inflammatory and hemodynamic profile, while combined CRP–PCT phenotyping further characterizes this profile. Divergent CRP and NT-proBNP trajectories suggest that inflammatory and hemodynamic changes follow distinct time courses during AHF hospitalization. Because no post-discharge outcomes were available, these findings describe concurrent associations rather than prognosis. Full article

Background: Substantial inter-individual variability in imatinib systemic exposure may influence both efficacy and toxicity. Based on recommendations of the International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT), the IRCCS-CRO of Aviano started in 2018 offering physicians the opportunity to monitor plasma concentrations of imatinib and its active metabolite, norimatinib, as part of a diagnostic service for patients with Gastrointestinal Stromal Tumor (GIST). This study aims to evaluate the potential clinical utility of imatinib Therapeutic Drug Monitoring (TDM) in predicting response and toxicity in a real-world cohort of 63 patients with GIST. Methods: Imatinib and its active metabolite norimatinib trough concentrations (C_min) were quantified using a validated LC–MS/MS method. Associations between drug exposure and clinical–demographic characteristics, treatment-related toxicity, and progression-free survival (PFS) were evaluated. Results: A total of 437 plasma samples from 63 patients were collected. Marked inter- and intra-patient variability in imatinib exposure was observed (43% and 31% respectively); 67% of patients receiving 400 mg/day had a C_min below the recommended target concentration (1100 ng/mL). Female sex was significantly associated with higher imatinib exposure (median C_min 1114 vs. 786 ng/mL in males; p = 0.0018). Combined age–sex analysis showed a significant difference between women and men < 60 years (1041 vs. 668 ng/mL; p = 0.0068, Bonferroni-adjusted). A strong exposure–toxicity relationship emerged, with higher imatinib levels in samples collected at toxicity occurrence vs. the others (1728 vs. 927 ng/mL; p < 0.0001), without a direct association between sex and toxicity. No significant association between C_min and PFS was observed; however, disease progression was more frequent in patients with C_min < 500 ng/mL and absent in those with C_min >1500 ng/mL (60% vs. 0%, respectively). Conclusions: TDM was found to be a potentially useful tool for predicting clinically relevant toxicity and outcome. Sex and age significantly influence exposure, supporting tailored dosing strategies. Full article

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource. Full article

Physician burnout represents a major occupational health concern associated with impaired wellbeing, reduced job satisfaction, and decreased quality of patient care. Although burnout is frequently examined using variable-centered approaches, less is known about distinct burnout profiles among physicians and their associations with professional identification and intellectual humility. The present study investigated relationships between burnout, job satisfaction, professional social identification, and intellectual humility among physicians using both variable-centered and person-centered approaches. A sample of 100 physicians completed measures assessing burnout dimensions, job satisfaction, professional identification, and intellectual humility. Cluster analysis identified four distinct burnout profiles characterized by different combinations of exhaustion, distancing, cognitive dysfunction, and emotional dysfunction. Significant differences between profiles emerged regarding job satisfaction and professional identification, with higher burnout generally associated with lower occupational wellbeing and weaker professional identification. Correlational analyses also indicated negative associations between burnout, job satisfaction, and professional identification. Although global intellectual humility was not significantly associated with burnout severity, exploratory analyses revealed that openness to correction and engagement in debate were negatively associated with cognitive and emotional dysfunction. These findings support the heterogeneous nature of physician burnout and suggest that professional identification and humility-related cognitive openness represent relevant psychological resources in demanding healthcare environments. Full article

Older people are at increased risk of medication-related problems, which may be identified by clinical pharmacists during hospital medication reviews. Some problems are better managed in primary care, where follow-up is possible. Medication-related communication by pharmacists may improve information transfer in care transitions, but this practice remains uncommon in Sweden. This qualitative study explored clinical pharmacists’ experiences and perceptions of writing referrals to primary care. Data were collected through four focus groups and three supplementary interviews with 19 clinical pharmacists from hospitals and primary care, and analysed using qualitative content analysis. Eleven participants had experience writing referrals, although none did so regularly. Four categories emerged: role of the pharmacist, current work procedures, pharmacist–physician relationship and facilitating factors. Pharmacists believe they can contribute to patient safety through involvement in transitions of care. An overall concept of an underused competence permeated the categories. Referrals identifying medication-related problems are hindered by limited pharmacist integration into the healthcare team and limited continuity. Writing referrals was considered a new procedure requiring collaboration with unfamiliar partners. Organisational changes, including increased pharmacist continuity and clearer pharmacist roles, are needed to implement referral practices. Further research is needed to evaluate effects on medication treatment and patient outcomes. Full article

Background/Objectives: Chronic otitis media (COM) in children carries a risk of irreversible sensorineural hearing loss (SNHL), which impairs language development and academic performance, although an objective clinical threshold does not exist to identify patients requiring urgent surgical intervention. Methods: We retrospectively analyzed 60 pediatric patients (aged 5–18 years) who underwent surgery for COM or cholesteatoma and performed linear regression, Pearson’s correlation, and receiver operating characteristic (ROC) curve analyses to quantify the relationship between otorrhea frequency and shifts in bone conduction (BC) threshold at least six months postoperatively. Results: Otorrhea frequency was significantly correlated with BC deterioration (r = 0.327, p = 0.011, R² = 0.107). ROC analysis identified five or more episodes as the optimal cutoff for predicting a clinically significant BC shift of ≥10 dB (area under the curve = 0.712; sensitivity 75.0%, specificity 80.0%). Bacteriological findings, including the presence of non-skin commensal pathogens, did not significantly influence hearing outcomes (p = 0.721). Conclusions: Five or more otorrhea episodes constitute a quantitative, equipment-free red flag for imminent cochlear injury in pediatric COM, and this threshold provides primary care physicians and pediatricians a simple, age-independent criteria for timely surgical referral to prevent lifelong auditory morbidity. Full article

Background/Objectives: Intensive Care Unit (ICU) patients with pneumothorax face an elevated risk of developing Acute Kidney Injury (AKI) due to compromised hemodynamics and increased intrathoracic pressure. Early identification is crucial but challenging. This study aimed to develop and externally validate an interpretable machine learning (ML) framework to predict pneumothorax-associated AKI. Methods: This multicenter retrospective study utilized data from the MIMIC-IV database (development), alongside a temporal validation cohort (MIMIC-III) and an independent external validation cohort (eICU). A tri-algorithm intersection strategy—comprising Boruta, Least Absolute Shrinkage and Selection Operator (LASSO), and Recursive Feature Elimination (RFE)—was applied to extract optimal predictors. We systematically evaluated nine supervised ML algorithms. Shapley Additive exPlanations (SHAP) and Restricted Cubic Spline (RCS) analyses were integrated to unveil decision-making mechanics and non-linear dynamics. The optimal model was deployed as a web-based dynamic nomogram. Results: The hybrid feature selection strategy identified a parsimonious consensus of 7 core predictors (BUN, SOFA score, CKD, PEEP, Heart Failure, Albumin, and Age). Following comprehensive evaluation, the Logistic Regression model demonstrated favorable discriminative performance [Area Under the Curve (AUC) = 0.839 (95% CI: 0.786–0.891), Sensitivity = 81.5%, Specificity = 76.0%] and external generalizability (eICU AUC = 0.869; MIMIC-III AUC = 0.854). SHAP analysis delineated the individual contribution of each feature. RCS analysis revealed significant non-linear, dose–response relationships, highlighting an exponential AKI risk escalation driven by elevated BUN and higher PEEP levels. Decision Curve Analysis (DCA) suggested the potential net clinical benefit of the model across all validation cohorts. Conclusions: We developed a transparent, externally validated ML framework for predicting pneumothorax-associated AKI. The resulting web-based nomogram provides intensive care physicians with a practical, data-driven bedside tool to assist in personalized risk stratification. However, given the substantial calibration drift observed in the external cohort, local recalibration is essential prior to its use outside the MIMIC-derived population, and prospective cohort validation remains necessary before routine clinical implementation. Full article

Introduction: Chronic dermatological diseases that appear in adolescence, such as acne vulgaris, atopic dermatitis, alopecia areata and psoriasis vulgaris, not only cause physical symptoms but also significantly affect young people’s quality of life, mental state, self-esteem and social relationships. Social media, especially information spread by influencers, significantly influences adolescents’ body image, health-related attitudes and even the quality of the physician-patient relationship. The aim of our study was to explore the relationships between dermatology-related quality of life, media use, health values, body image and self-esteem among adolescents with chronic dermatological diseases. Methods: In our cross-sectional, quantitative study, we used validated questionnaires (DLQI, EQ-5D-5L, IRVS, Attitude Scale, STAI-Y2, SWLS-H, Rosenberg Scale, BAT), which we supplemented with a media consumption questionnaire of our own design. Structured data collection took place between October 2024 and March 2025, with the participation of 208 adolescents aged 11–18. Data analysis was performed using SPSS 26.0 (Spearman’s correlation, Mann–Whitney test). Differences were considered significant at p < 0.05. Ethical approval: BM/22429-1/2024. Results: Acne vulgaris was the most common diagnosis (65%), followed by atopic dermatitis (22%) and psoriasis (11%). Over a quarter of the adolescents (27%) followed influencers who provided skincare advice. The mean daily screen time was 4.5 h, with 3.7 h on smartphones. A longer screen time was significantly correlated with poorer dermatological quality of life. Greater dermatology-related quality of life impairment (higher DLQI scores) was associated with poorer general quality of life (EQ-5D-5L). Following skincare-related influencers was significantly associated with dermatology-related quality of life and anxiety. Conversely, stronger health values were significantly linked to more favourable health behaviors. Conclusions: In this sample, greater dermatology-related quality-of-life impairment was associated with poorer psychosocial outcomes. Longer screen time was associated with poorer dermatology-related quality of life and less favourable psychosocial outcomes. The novelty of our study lies in the use of a self-developed media consumption questionnaire, which is suitable for the complex mapping of psychological and quality-of-life factors in adolescents. Full article