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Introduction: With the availability of direct-acting antiviral (DAA) therapy in primary care, Australia is in a unique position to eradicate chronic hepatitis C (CHC). Success of this initiative is dependent on uptake and monitoring of efficacy (sustained virological response at 12 weeks [SVR12]). The treatment of CHC has previously been protocol-based and required significant resources and careful patient selection to optimize adherence. Treatment in primary care will remove many of these barriers; however, the effect on adherence to treatment and follow-up is unknown. We aim to study the adherence to DAA treatment protocols and assess outcomes in primary and tertiary care settings. Method(s): Participants with CHC were prospectively recruited between October 2014 and November 2016 from 12 primary care practices and compared with patients prospectively recruited and managed solely at specialist centers. All patients underwent clinical, biochemical, virological, and liver stiffness measurement (LSM) assessment. Individuals initially assessed in primary care with an LSM >= 12.5 kPa or dual infection were referred to specialist centers. DAA efficacy and adherence to SVR12 testing were monitored in both the primary and specialist centers. Follow-up was censored on 1 April 2017. Result(s): Overall, there were 1044 participants with CHC recruited. DAA therapy was commenced in 503: 40.6% in primary care (n = 204) and 59.4% in specialist centers (n = 299). At time of analysis, 337 patients had reached their SVR12 date, but only 75% (n = 253) had completed SVR12 polymerase chain reaction testing. In patients with SVR12 data available, cure rates were equivalent between tertiary center and primary care treatment groups (96.2% vs 97.3%, P = 0.668). Treatment failures were seen in genotype 1a and 3 with equal frequency (1.1% vs 1.3%, P = 1.00). LSM >= 12.5 kPA was not associated with treatment failure (5.5% vs 2.9%, P = 0.406). Participants commenced on DAA therapy at tertiary

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.Copyright © 2017 John Wiley & Sons Ltd

Introduction: Many developed countries have identified the increasing incidence and mortality of hepatocellular carcinoma (HCC) as targets for intervention, with various preventive, early detection, and therapeutic options available. Current cost-benefit analyses that inform reimbursement of new therapeutic agents have been derived from administrative databases. We provide real-world costing for a clinical population of patients with HCC. Method(s): Patients were prospectively recruited over a 1-year period, in a previously published population-based clinical cohort from Melbourne, Australia. Direct costings were derived from hospitals for admissions, outpatients, and emergency attendance for 24 months of follow-up. Analysis was performed by phases of disease: initial phase (3 months before to 1 month after diagnosis), terminal phase (6 months before death), and continuing phase (time in between). Result(s): There were 136 patients from three tertiary hospitals, including the state liver transplant unit, representing 50% of the original cohort included in the costings. The total cost of treatment was $6 663 149 over 24 months, with a median total cost of $6046 in the initial phase, $33 737 in the continuing phase, and $19 395 in the terminal phase. The majority of costs were incurred by inpatient episodes (69%), with emergency attendance 22%, and outpatients 9%. Liver transplantation was most expensive overall, with best overall survival (21% of total costs, eight patients, median cost, $199 924; median survival, 24 months), followed by local ablation (19%, 20 patients, $31 011; 19 months), transarterial chemoembolization (15%, 24 patients, $41 576; 18 months), best supportive care (14%, 29 patients, $19 856; 3 months), resection (11%, 19 patients, $43 908; 20 months), and sorafenib (6%, 17 patients, $16 216; 13 months). Treatment received and Child-Pugh score at diagnosis were significant (P < 0.001) predictors of high cost on multivariate analysis. Tumor stage did

BACKGROUND AND AIM: Proton pump inhibitors (PPIs) are among the most widely used medications worldwide. Dementia is an increasingly common cause of disability in older populations. Recent studies have suggested an increased risk of cognitive impairment and dementia diagnosis among people who consume PPIs. This systematic review explores dementia, cognitive impairment, and the use of PPIs. METHODS: Systematic searches were conducted in the databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PSYCinfo, Scopus, Web of Science, and ClinicalTrials.gov for articles published from inception to June 30, 2016. Primary outcomes of interest were the use of PPIs and diagnosis of dementia or acute cognitive impairment. Studies conducted on people aged less than 18 years old were excluded. All study designs were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from included studies. RESULTS: The systematic search strategy and screening process yielded 11 studies for inclusion in the systematic review. Four studies explored PPI use and dementia, and seven studies explored PPI use and acute cognitive impairment. Three of the four studies exploring dementia identified a positive association with PPI use. A positive association was also observed in the majority of studies exploring acute cognitive impairment. CONCLUSIONS: Based on the current published literature, this systematic review has identified that the reported association between PPI use and dementia is limited by methodological issues and conflicting results. Further longitudinal studies with robust bias limitation are required to explore the use of PPIs and dementia or acute cognitive impairment, and to ascertain the existence of any causal relationships.

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.