Consistency assessment and visualization of recommendations on gastroesophageal reflux disease: a scoping review of clinical practice guidelines.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder that causes diverse esophageal and extraesophageal symptoms. Many clinical practice guidelines (CPGs) have been issued around the world to provide practical evidence regarding GERD management. However, some of the recommendations discussed in various CPGs are inconsistent across individual documents. OBJECTIVES: We aimed to summarize the evidence from CPGs on GERD and assess the consistency of the recommendations. PATIENTS AND METHODS: In this scoping review, we identified current CPGs on the clinical management of GERD, which were comprehensively searched for in electronic databases and on relevant scientific websites. The recommendations were extracted using the population­intervention­comparison framework and were subsequently categorized into tables. RESULTS: Ultimately, 24 CPGs were identified. They included 86 recommendations, which were classified into 5 categories: definition, epidemiology, diagnosis, treatment, and complications. Among the identified recommendations, 68 were proposed in at least 2 CPGs, and they were assessed for the consistency of direction and strength. Overall, 32.4% of the recommendations (22/68) were consistent in direction and strength, whereas 60.3% (41/68) were consistent in direction but inconsistent in strength. Moreover, 7.4% (5/68) were inconsistent in direction. These referred to the relationship between GERD and tobacco consumption, Helicobacter pylori infection, diagnostic utility of the 2­week proton pump inhibitor test, cessation of special food, and antireflux surgery for GERD with extraesophageal symptoms. CONCLUSIONS: Most CPG recommendations regarding GERD were consistent in direction, except for 5 discrepancies, for which further well­designed, large­scale research is required to explain the inconsistency.

Impact of Diagnosis-Related Groups on Inpatient Quality of Health Care: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to comprehensively evaluate the effectiveness of Diagnosis-related group (DRG) based payment on inpatient quality of care. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science from their inception to December 30, 2022. Included studies reported associations between DRGs-based payment and length of stay (LOS), re-admission within 30 days and mortality. Two reviewers screened the studies independently, extracted data of interest and assessed the risk of bias of eligible studies. Stata 13.0 was used in the meta-analysis. A total of 29 studies with 36 214 219 enrolled patients were analyzed. Meta-analysis showed that DRG-based payment was effective in LOS decrease (pooled effect: SMD = -0.25, 95% CI = -0.37 to -0.12, Z = 3.81, P < .001), but showed no significant overall effect in re-admission within 30 days (RR = 0.79, 95% CI = 0.62-1.01, Z = 1.89, P = .058) and mortality (RR = 0.91, 95% CI = 0.72-1.15, Z = 0.82, P = .411). DRG-based payment demonstrated statistically significant superiority over cost-based payment in terms of LOS reduction. However, owing to limitations in the quantity and quality of the included studies, an adequately powered study is necessary to consolidate these findings.

How do inpatients' costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis.

CONTEXT: A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. OBJECTIVE: This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age. METHODS: An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18-64 years) and an older group (≥ 65 years), further stratified into young-old (65-79 years) and oldest-old (≥ 80 years) groups. RESULTS: The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups. CONCLUSION: Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.

[Surface water change characteristics of Taihu Lake from 1984-2018 based on Google Earth Engine]. / 基于Google Earth Engine平台的1984­2018年太湖水域变化特征.

Lakes are important fresh water resources. Accurate understanding of lake dynamic changes benefits the sustainable development of water resources and socio-economic development. Based on the Google Earth Engine (GEE), we analyzed the dynamics of Taihu Lake from 1984 to 2018 by adopting the dataset of Joint Research Centre's Global Surface Water and Landsat imagery. The modified normalized difference water index (MNDWI) was used to explore the changes in the area of Taihu Lake in recent 35 years. The results showed that the area of Taihu Lake increased during 1984-2018, with a total increase of 45.31 km2. The area in spring and winter was larger than that in summer. Eastern Taihu Lake was the main part of Taihu Lake showing area change. Compared with 1984, 88.9% of the water area of Taihu Lake in 2018 did not change, and 0.3% of the water area disappeared permanently. Lake area changes were affected by both natural and anthropogenic factors. Agricultural irrigation, fish farming, reclamation of surrounding lakes, water conservancy engineering facilities, and the transformation of land-use types caused the reduction in lake area. Increased annual precipitation and the implementation of environmental protection policies were the main factors for the increases in lake area. The results provide reference for effective sustainable water resource management and verify the feasibility of monitoring long-term surface water change based on the GEE platform.

Observed and projected trends in paediatric health resources and services in China between 2003 and 2030: a time-series study.

OBJECTIVES: The two-child policy took effect in China on 1 January 2016, thus officially ending the one-child policy. The resultant growth in the population will create a considerable demand for public services such as paediatric healthcare, even while there are limited paediatric resources. We estimated the relationship between paediatric health resources and services and child mortality to determine the degree of the deficiency of such resources in China. Projecting the quantity of paediatric health resource allocation and service supply through 2030 will help provide data reference for future policy decision making. DESIGN: Time-series study. SETTING: The People's Republic of China. PARTICIPANTS: Paediatric patients whose data were recorded between 2003 and 2012 from the National Health and Family Planning Commission of the People's Republic of China. PRIMARY AND SECONDARY OUTCOME MEASURES: Child mortality and paediatric health resources and services data were entered into a cubic polynomial regression model to project paediatric health resources and services to 2030. RESULTS: Child mortality decreased throughout the past decade. Furthermore, the number of paediatric beds, paediatricians and nurses increased between 2003 and 2012, although the proportions increased rather slowly. Both the number and proportion of paediatric outpatients and inpatients increased rapidly. The observed and model-predicted values matched well (adjusted R2=93.8% for paediatric beds; adjusted R2=96.6% for paediatric outpatient visits). Overall, the projection indicated that paediatric beds, paediatricians and nurses will reach 460 148, 233 884 and 184 059 by 2030, respectively. Regarding paediatric services, the number of paediatric outpatient visits and inpatients is expected to reach upwards of 449.95 million and 21.83 million by 2030, respectively. CONCLUSIONS: Despite implementation of the two-child policy, resource allocation in paediatrics has many deficiencies. Proper measures should be taken to actively respond to the demand for paediatric health services.

Tissue-specific distribution of fatty acids, polychlorinated biphenyls and polybrominated diphenyl ethers in fish from Taihu Lake, China, and the benefit-risk assessment of their co-ingestion.

The fish tissues from four species collected from Taihu Lake, China, were analyzed including dorsal, ventral, and tail muscles, heart, liver, and kidney. The highest and lowest concentrations of fatty acids were respectively observed in livers and muscles. There were significant intraspecies and interspecies differences in the compositions of most fatty acids among muscle, heart, liver, and kidney. All the tissues were generally beneficial for consumption considering fatty acids. People mainly consume the muscle. Hence, the benefits from two polyunsaturated fatty acids, i.e., eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and risks from PCBs and PBDEs via fish consumption were evaluated by calculating the benefit-risk quotient (BFQ) for the intake of fish muscle containing EPA+DHA vs. PCBs or PBDEs. The BFQ values considering carcinogenic and noncarcinogenic effects for PCBs were ∼3000 and 10 times higher than those of PBDEs via fish consumption to achieve the recommended EPA+DHA intake of 250 mg d(-1), respectively. The results also suggested that the risk consuming the dorsal muscle was generally lower than the ventral and tail muscles.

Polybrominated diphenyl ethers in food and associated human daily intake assessment considering bioaccessibility measured by simulated gastrointestinal digestion.

The concentrations of PBDEs in 299 vegetable and animal-based food samples of 31 species, collected in Shanghai, China, and the bioaccessibility of PBDEs in part of the samples were determined. The PBDE concentrations ranged from 0 to 1245.4pgg(-1) with animal-based food containing more PBDEs than vegetables. The bioaccessibility of PBDEs, determined by a method simulating human gastrointestinal digestion process, were from 2.6% to 39.9% in vegetables, and from 5.2% to 105.3% in animal-based food. For animal-based food, good correlations were observed between the bioaccessibility of PBDEs and the fat content, thus the fat content in animal-based food was able to be used to estimate the bioaccessibility of PBDEs. The total daily intake of PBDEs via ingestion of vegetables and animal-based food for an average Shanghai resident was estimated as 13235.7 and 13668.0pg d(-1), respectively, but the amounts available for human absorption were reduced to 2674.4 and 4316.6pgd(-1) after the PBDE bioaccessibility was considered. Finally, the contributions of different food groups to the total daily intake of PBDEs were evaluated. The results revealed that, when not considering the bioaccessibility of PBDEs, vegetables were the leading contributor (49.2%), followed by fish (34.0%). However, the sequence was reversed after the PBDE bioaccessibility was taken into account. The results indicated that human exposure to PBDEs via food ingestion might have been significantly overestimated and the exposure assessment could be misleading if the bioaccessibility of PBDEs was not considered.

[Assessment of shallow groundwater nitrate concentrations in typical terrestrial ecosystems of Chinese Ecosystem Research Network (CERN) during 2004-2009].

The nitrate-N (NO3(-) -N) concentrations of 38 shallow groundwater wells from 31 of the typical terrestrial ecosystems on Chinese Ecosystem Research Network (CERN) were assessed using the monitoring data from 2004 to 2009. The results showed that the average values of NO3(-) -N concentrations were significantly higher in the agricultural (4.85 mg x L(-1) +/- 0.42 mg x L(-1)), desert (oasis) (3.72 mg x L(-1) +/- 0.42 mg x L(-1)) and urban ecosystems (3.77 mg x L(-1) 0.51 mg x L(-1)) than in the grass (1.59 mg x L(-1) +/- 0.35 mg L(-1)) and forest ecosystems (0.39 mg x L(-1) +/- 0.03 mg x L(-1)). Nitrate was the major form of nitrogen, with between 56% to 88% of nitrogen in the nitrate-N form in the shallow groundwater of desert (oasis), urban and agricultural ecosystems. Nitrate-N concentrations for some agricultural ecosystems (Ansai, Yanting, Yucheng) and desert (oasis) ecosystems (Cele, Linze, Akesu) analysis exceeded the 10 mg x L(-1) World Health Organization drinking water standards between 14.3% and 84.6%. Significant seasonality was found in Ansai, Fengqiu, Yanting agricultural ecosystems and the Beijing urban ecosystem using the relatively high frequency monitoring data, with the higher nitrate concentrations usually found during summer and winter months. The monitoring results indicated that the shallow groundwater of agricultural ecosystems was contaminated by agricultural management practices, i.e. fertilization, while the shallow groundwater of forest ecosystems was under natural condition with no contamination from human activities.

Assessment of the bioaccessibility of polybrominated diphenyl ethers in foods and the correlations of the bioaccessibility with nutrient contents.

Bioaccessibility of a contaminant in foods is the fraction of the contaminant mobilized from the food matrices during gastrointestinal digestion. In the present paper, the bioaccessibility of polybrominated diphenyl ethers (PBDEs) in 13 types of foods, including fish, meat, rice, flour, and vegetables, was determined using an in vitro digestion method. The bioaccessibility obtained ranged from 2.6% to 41.3%. It was found that the bioaccessibility of PBDEs exhibited positive correlations with fat and carbohydrate contents and negative correlations with protein and dietary fiber contents in the foods. Fat was the most important factor affecting the bioaccessibility of PBDEs. The mechanism underlying the correlations was discussed in view of partition of PBDEs between liquid and solid phases. To our knowledge, this is the first article systematically investigating the bioaccessibility of PBDEs in foods and demonstrating the influence of the food constituents on the bioaccessibility of PBDEs.

[Identification of critical area of phosphorus loss in agricultural areas of Guishui River watershed by phosphorus loss risk assessment].

Agricultural non-point sources pollution is one of severe problems for water environment of agricultural areas in China. Because of the big difficulties, identifying the critical source areas for phosphorus loss becomes the focal point of the non-point sources pollution control. A modified catchment scale phosphorus ranking scheme was developed for agricultural areas in Guishui River watershed. The new scheme included eight assessment factors, which had three phosphorus loss risk ranks respectively and selected quantitative analysis method. The result shows that the phosphorus fertilizer management of the vegetable fields is the most unfit method and has high phosphorus loss probabilities. Most study areas have high soil available phosphorus content and low soil erosion degree. The figure of the assessment result shows that the areas that are categorized as "low" phosphorus loss risk are small. Based on the figure of the result, the critical source areas were confirmed and the management strategies were brought forward according to the analysis on the distribute characteristics of the critical source areas. The result shows that the modified catchment scale phosphorus ranking scheme has operability and practicability to a certain extent.

[Catchment scale risk assessment and critical source area identification of agricultural phosphorus loss].

Agricultural non-point source phosphorus pollution is a severe problem for rural water bodies in China, but hard to control directly because of its special characteristics. In this paper, an approach on the catchment scale risk assessment and critical source area identification of agricultural phosphorus loss in northern China was made, based on the catchment scale phosphorus ranking scheme and the method proposed by Gburek et al. Eight factors were selected and weighed in the modified catchment scale phosphorus ranking scheme, and the phosphorus loss risk rating of each factor was adjusted based on the current professional standards and the actual circumstances in China. The areas with ' high' risk rating of phosphorus loss in definite catchment were the critical source areas for non-point source phosphorous pollution control in that catment. The availability of obtained data and the quantification of the assessment were taken into account in the new scheme, and GIS technique and geostatistics were used for confirming the factors. Therefore, the new scheme had definite operability and practicability.