Internal Medicine Journal最新文献

{"title":"Back-up arteriovenous fistula in peritoneal dialysis patients: a retrospective cohort study of long-term meaningful outcomes","authors":"Hicham I. Cheikh Hassan,&nbsp;Karumathil M. Murali,&nbsp;Jenny H. C. Chen,&nbsp;Judy Mullan","doi":"10.1111/imj.70493","DOIUrl":"10.1111/imj.70493","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Back-up arteriovenous fistula (bAVF) is used in peritoneal dialysis (PD) to avoid haemodialysis transfer via a central venous catheter (CVC). However, no previous study examined mortality or complications associated with bAVF creation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Comparing mortality, haemodialysis transfer overall or with a CVC and vascular access complications (bAVF or CVC) between patients with a bVF and those with no bAVF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of adult PD patients within an Australian Local Health District (2017–2023). Cox regression models were used for hazard ratios (HR) and 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 115 patents followed up (median of 1.9 years (interquartile range 0.9, 3.5)), 50 (44%) had a bAVF of which 31 (62%) matured. The bAVF group had 56 procedures (1.1/patient), including 32 assisted interventions (0.6/patient). There was no associated difference in mortality between bAVF and no bAVF group (HR 0.8, 95% CI 0.4–1.6, <i>P</i> = 0.6) or haemodialysis transfer (HR 1.0, 95% CI 0.5–2.0, <i>P</i> = 0.9). A bAVF was associated with a lower haemodialysis transfer risk with a CVC (HR 0.4, 95% CI 0.1–0.9, <i>P</i> = 0.04). Complications between the bAVF and no bAVF group were similar (28% vs 14%, <i>P</i> =  0.06).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>bAVF were associated with lower risk of haemodialysis transfer to haemodialysis with a CVC, compared to those with no bAVF. However, there was no difference in mortality, risk of transferring to haemodialysis or complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1528-1535"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When to consider an inborn error of immunity: clues for physicians","authors":"Meera Thangarajah,&nbsp;Lucinda J. Berglund","doi":"10.1111/imj.70505","DOIUrl":"10.1111/imj.70505","url":null,"abstract":"<p>The term inborn errors of immunity (IEIs) refers to the rapidly expanding group of genetic disorders causing dysregulation of the immune system. With improved genetic testing in recent years, the number of defined IEIs and their range of phenotypic presentations has grown vastly, with more than 550 IEIs now described. IEIs cause diverse clinical manifestations, including infection, autoimmunity, lymphoproliferation, allergy and malignancy, with initial manifestations often appearing long before the diagnosis of an IEI is made. Furthermore, IEIs are increasingly diagnosed in adulthood, and a family history of disease is not always apparent. Physicians in all specialties are likely to encounter patients with IEIs, often before a formal diagnosis of an IEI is made or immunology consultation sought. Early diagnosis of an IEI improves patient outcomes through access to specialist immunology services and the potential for more specific, targeted treatment options. All physicians, therefore, need an understanding of IEIs and presenting manifestations in order to identify these patients early. This review outlines common clinical presentations of IEIs in adulthood across different specialties, including guidelines regarding when an underlying IEI should be considered.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1488-1499"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter aortic valve implantation: contemporary management from first valve choice to reintervention","authors":"Malanka Lankaputhra,&nbsp;Nay Min Htun,&nbsp;Dion Stub","doi":"10.1111/imj.70546","DOIUrl":"10.1111/imj.70546","url":null,"abstract":"<p>Transcatheter aortic valve implantation (TAVI) has evolved from a last resort for inoperable aortic stenosis into the preferred bioprosthetic strategy across much of the surgical-risk spectrum for anatomically suitable patients. As it expands into younger and lower-risk populations, the central question is no longer whether TAVI can be performed, but how to choose the first valve intervention so that future options remain open. This clinical perspective focuses on practical decision-making: which patients are better served by TAVI or surgical aortic valve replacement (SAVR), how computed tomography planning influences both immediate and lifetime outcomes, how to manage common early issues such as conduction disease and coronary access, and how to recognise valve dysfunction and plan reintervention. Rather than treating the choice between TAVI and SAVR as a single episode, we consider it as the first step in a treatment sequence. After implantation, ongoing outcomes are shaped by rhythm surveillance, optimisation of antithrombotic and heart failure therapy and early detection of leaflet thrombosis, endocarditis or structural valve degeneration. Contemporary aortic valve replacement practice therefore requires choosing the first procedure with the likely next procedure already in mind.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1510-1517"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing primary ciliary dyskinesia in Australian adults: 10 years of testing","authors":"P. J. Robinson","doi":"10.1111/imj.70487","DOIUrl":"10.1111/imj.70487","url":null,"abstract":"<p>Primary ciliary dyskinesia (PCD) is a rare inherited disorder characterised by impaired ciliary function, leading to chronic upper and lower airway disease from early life. Limited awareness of the condition contributes to delayed diagnosis, with some individuals first diagnosed in adulthood following specialised testing. We describe 91 adults referred to the PCD diagnostic service at the Royal Children's Hospital in Melbourne, Australia over a 10-year period. Twenty-eight adults were diagnosed with PCD (31% referrals). The most common reason for referral was bronchiectasis. These findings highlight the importance of considering PCD in adults presenting with features suggestive of chronic airway disease, particularly bronchiectasis.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1637-1640"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing utilisation of intravenous iron among Australian women of reproductive age, 2013–2024: an Australian population-based study","authors":"Gizat M. Kassie,&nbsp;Hannah Jackson,&nbsp;Lisa Clarke,&nbsp;Kedir Gonete,&nbsp;Jenni Ilomaki,&nbsp;Clare L. Whitehead,&nbsp;Tim Green,&nbsp;Luke E. Grzeskowiak","doi":"10.1111/imj.70494","DOIUrl":"10.1111/imj.70494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Utilisation of intravenous iron is increasingly recognised as a viable option for treating iron deficiency, especially when oral iron is ineffective or intolerable. However, there are no updated data on the longitudinal trends of utilisation of intravenous iron among women of reproductive age (18–44) in Australia</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to assess the longitudinal trends of intravenous iron utilisation among Australian women aged 18–44 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study (2013–2024) using the 10% Pharmaceutical Benefit Scheme dataset. We examined the longitudinal trends in the rate of intravenous iron dispensing and total dose dispensed for unique treatment episodes according to iron type and examined variation according to age group, state/territory, prescriber type and health care concession card status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The rate of dispensed intravenous iron increased from 0.3 in 2013 to 5.0 per 100 women in 2024, with ferric carboxymaltose making up 93.9% of total claims. In 2024, one in 20 Australian women aged 18–44 years was dispensed intravenous iron. Total expenditure on intravenous iron increased from $1.1 million in 2013 to $82.3 million in 2024. Significant variation in type of intravenous iron and total treatment doses dispensed was evident according to age group, state/territory, concession card status and prescriber type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall rates and expenditure on intravenous iron among women of reproductive age have rapidly increased between 2013 and 2024, with high levels of practice variation evident. Identifying the underlying reasons for the observed variation in intravenous iron utilisation is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1536-1543"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty transitions and their association with mortality in older adults","authors":"Evrim Ataca,&nbsp;Mert Can Ataca,&nbsp;Cihan Heybeli,&nbsp;Lee Smith,&nbsp;Nicola Veronese,&nbsp;Irem Tanriverdi,&nbsp;Pinar Soysal","doi":"10.1111/imj.70502","DOIUrl":"10.1111/imj.70502","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Frailty is a dynamic condition in older adults, and transitions between frailty states may occur over time. However, predictors and clinical implications of changes in frailty status, particularly frailty improvement, remain insufficiently understood.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Predictors and clinical implications of changes in frailty status over time have not been studied in detail. This study aimed to evaluate these aspects.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this retrospective cohort study, 2573 patients were screened. After applying exclusion criteria and including only those with longitudinal follow-up, 399 patients were included in the final analysis. Frailty was assessed by the Fried frailty phenotype. Participants were categorised as robust (0), pre-frail (1–2) and frail (3–5). Changes in frailty status from baseline and associations with overall survival were analysed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We included 399 outpatients from a geriatric clinic. The mean age was 83 ± 7 years, and 291 (73%) were women. At baseline, 9.3% (&lt;i&gt;n&lt;/i&gt; = 37) were robust, 34.3% (&lt;i&gt;n&lt;/i&gt; = 137) were pre-frail, and 56.4% (&lt;i&gt;n&lt;/i&gt; = 225) were frail. Over a median follow-up of 14 months (interquartile range 12–23 months and range 6–71 months), 17.8% of participants improved, 16.0% deteriorated and 66.2% remained stable. Compared to baseline, weight loss and handgrip strength improved while walking speed worsened. Younger age (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.88–0.97, &lt;i&gt;P&lt;/i&gt; = 0.003) was independently associated with improvement of frailty status. In the adjusted model, higher glomerular filtration rate was not statistically significant but demonstrated a trend towards association with improvement in overall frailty status (OR 1.02, 95% CI 1.00–1.04, &lt;i&gt;P&lt;/i&gt; = 0.057). Overall, frailty transitions were not significantly associated with survival; however, in pre-frail individuals, progression to frailty was associated with shorter survival (41 vs 65 months, &lt;i&gt;P&lt;/i&gt; = 0.010). Among pre-frail participants, older age (OR 1.08, 95% CI 1.00–1.16, &lt;i&gt;P&lt;/i&gt; = 0.049), higher number of medications (OR 1.25, 95% CI 1.07–1.45, &lt;i&gt;P&lt;/i&gt; = 0.005) and higher vitamin D levels (OR 1.06, 95% CI 1.01–1.10, &lt;i&gt;P&lt;/i&gt; = 0.011) independently predicted transition to frailty.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Frailty is potentially reversible, particularly in the pre-frail stage. Improvements in weight loss and muscle strength contribute to enhanced frailty status. ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1565-1574"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologist review at the time of lung nodule referrals saves clinic appointments and fast tracks investigations: results of the outpatient respiratory nodule management (Ornament) study","authors":"David Fielding,&nbsp;Jung Hwa Son,&nbsp;Jade Simms,&nbsp;Kimberley Ryan,&nbsp;Karin Steinke","doi":"10.1111/imj.70513","DOIUrl":"10.1111/imj.70513","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With increased awareness around the National Lung Cancer Screening Program (NLCSP), there are increased general practitioner (GP) referrals to outpatient clinics for evaluation of incidental computed tomography (CT)-detected lung nodules (ILNs). We studied how expert radiologist review of the referral chest CT could mitigate clinic numbers and expedite urgent cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An Ethics Committee-approved ‘virtual triaging’ of referrals was performed. The radiologist reviewed referral CT scans, blinded to the clinic outcomes. Brock score was calculated before and after radiologist review, and the NLCSP category was assigned to allow ‘virtual’ triaging. NLCSP Category 1–4 cases were ‘virtually’ referred back to the GP. Category 5 and 6 cases were triaged for clinic/procedure as urgent/very urgent respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 6 months of referrals, 101 consecutive cases were reviewed in four half-hour meetings with a radiologist, thoracic physician and clinic nurse. Referrals were 52 males and 49 females, the mean age was 67.0 ± 12.0 years, and the mean Brock score was 13.9 ± 13.8. Fifty-four cases (53%) were deemed Category 1–4, needing no appointment. Thirty-three cases were deemed suspicious of lung cancer (NLCSP Category 6), resulting in early ‘virtual’ appointments saving 37.3 ± 28 days wait time (range 0–89 days). Comparing actual to virtual, clinic numbers saved were 131 (336 vs 205, <i>P</i> &lt; 0.001) and clinic preparation hours saved were 83.4 (170.5 vs 87.1, <i>P</i> &lt; 0.001). Meeting costs including CT retrieval time (AU$2171) were balanced by savings from reduced clinic preparation time (AU$3582).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This cost-effective strategy demonstrates dual benefits of managing rising referral numbers and fast-tracking urgent cases for procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1600-1609"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal fluid orexin testing in Australians with narcolepsy type 1","authors":"Mario Fernando,&nbsp;Gianluca Cotta,&nbsp;Samantha Kung,&nbsp;Grace Garden,&nbsp;Jian Eu Tai,&nbsp;Elie Matar,&nbsp;Brendon Yee,&nbsp;Claire Ellender,&nbsp;Sheila Sivam","doi":"10.1111/imj.70501","DOIUrl":"10.1111/imj.70501","url":null,"abstract":"<p>A clinical diagnosis of narcolepsy type 1 can be challenging, particularly in relation to cataplexy. Despite its specificity, cerebrospinal fluid (CSF) orexin testing is under-utilised in Australasia. We describe the use of CSF orexin testing in 15 clinically indicated patients from two sleep centres, highlighting its utility in the Australasian context.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1641-1643"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148162769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervising trainee research projects: an interview study of nephrology supervisors in Aotearoa New Zealand","authors":"Natasha Houghton-Jones,&nbsp;Katherine G. Richards,&nbsp;Kalpa Jayanatha,&nbsp;Suetonia C. Green","doi":"10.1111/imj.70510","DOIUrl":"10.1111/imj.70510","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research projects are a mandatory requirement for advanced training in Aotearoa New Zealand, yet trainees and supervisors report challenges in the research process. While barriers and enablers of research have been described internationally, the experience within physician training in New Zealand has not been formally explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to identify barriers and enablers of research conducted by nephrology trainees in New Zealand from the perspective of supervising nephrologists and to inform evidence-based recommendations for addressing challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We carried out semi-structured interviews with nephrologists who had supervised at least one advanced training research project in New Zealand until theoretical sufficiency occurred. Reflexive thematic analysis was conducted on transcribed interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen nephrologists from eight training centres were interviewed. Five themes were identified: (1) perceived value motivates supervisors; (2) research constrained by feasibility, including competing clinical demands with insufficient research time, limited access to specialised research support and bureaucratic delays; (3) trainee engagement and ownership facilitated success; (4) overcoming trainee inexperience with supervisor guidance; and (5) the importance of research infrastructure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Perceived value, trainee ownership, adequate supervision and supportive infrastructure were critical to successful research projects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1584-1592"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application value of the impulse oscillometry system in the airway evaluation of patients with chronic obstructive pulmonary disease in different age groups","authors":"Shan Zhao,&nbsp;Feng Chen,&nbsp;Ziyang Cui","doi":"10.1111/imj.70499","DOIUrl":"10.1111/imj.70499","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impulse oscillometry system (IOS) uses a tidal-breathing method requiring considerably less patient cooperation than conventional spirometry, thereby more accurately reflecting normal respiratory physiology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the application value of the IOS in evaluating the airways of patients with chronic obstructive pulmonary disease (COPD) across different age groups in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study enrolled 115 COPD patients and 103 healthy volunteers, categorised into young/middle-aged (≤60 years) and elderly (&gt;60 years) groups. Participants underwent IOS and conventional pulmonary function tests. Logistic regression and receiver operating characteristic (ROC) curves were used to evaluate the sensitivity, specificity and optimal cut-off values of key IOS parameters – including resonance frequency (Fres), low-frequency reactance area (AX) and resistance percentage (R5–R20%R5) – to distinguish COPD patients within each age stratum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For young and middle-aged patients, the area under the curve (AUC) of AX was 0.838 (95% confidence interval (CI): 0.756–0.921, <i>P</i> &lt; 0.001); a cut-off value of 1.36 kPa/L yielded 83.7% sensitivity and 75.0% specificity. For elderly patients, the AUC of R5–R20%R5 was 0.849 (95% CI: 0.775–0.924, <i>P</i> &lt; 0.001); a cut-off value of 48.68% achieved 76.4% sensitivity and 97.9% specificity. Additionally, the AUC of Fres in the elderly was 0.734 (95% CI: 0.646–0.823, <i>P</i> &lt; 0.001; cut-off: 22.75 Hz; sensitivity: 56.9%; specificity: 87.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Changes in AX are sensitive indicators for early COPD screening in young and middle-aged individuals. Furthermore, R5–R20%R5 and Fres serve as highly specific and reliable diagnostic parameters for elderly patients, particularly those unable to cooperate with conventional spirometry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1553-1564"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}