Introducing Incentives and Reducing Disincentives in Enhancing Deceased Organ Donation and Transplantation.

Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.

Multipronged infection control strategy to achieve zero nosocomial coronavirus disease 2019 (COVID-19) cases among Hong Kong healthcare workers in the first 300 days of the pandemic.

BACKGROUND: Nosocomial outbreaks leading to healthcare worker (HCW) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: We implemented a strategy to reduce nosocomial acquisition. METHODS: We summarized our experience in implementing a multipronged infection control strategy in the first 300 days (December 31, 2019, to October 25, 2020) of the COVID-19 pandemic under the governance of Hospital Authority in Hong Kong. RESULTS: Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first pandemic wave (142 cases), second wave (896 cases), and third wave (3,770 cases) in Hong Kong. With the exception of 1 patient who died before admission, all COVID-19 patients were admitted to the public healthcare system for a total of 78,834 COVID-19 patient days. The median length of stay was 13 days (range, 1-128). Of 81,955 HCWs, 38 HCWs (0.05%; 2 doctors and 11 nurses and 25 nonprofessional staff) acquired COVID-19. With the exception of 5 of 38 HCWs (13.2%) infected by HCW-to-HCW transmission in the nonclinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population; P = .008). The incidence of COVID-19 among professional staff was significantly lower than that of nonprofessional staff (0.30 vs 0.66 per 1,000 full-time equivalent; P = .022). CONCLUSIONS: A hospital-based approach spared our healthcare service from being overloaded. With our multipronged infection control strategy, no nosocomial COVID-19 in was identified among HCWs in the first 300 days of the COVID-19 pandemic in Hong Kong.

Infection control challenges in setting up community isolation and treatment facilities for patients with coronavirus disease 2019 (COVID-19): Implementation of directly observed environmental disinfection.

BACKGROUND: Extensive environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in hospitals during the coronavirus disease 2019 (COVID-19) pandemic. We report our experience with the practice of directly observed environmental disinfection (DOED) in a community isolation facility (CIF) and a community treatment facility (CTF) in Hong Kong. METHODS: The CIF, with 250 single-room bungalows in a holiday camp, opened on July 24, 2020, to receive step-down patients from hospitals. The CTF, with 500 beds in open cubicles inside a convention hall, was activated on August 1, 2020, to admit newly diagnosed COVID-19 patients from the community. Healthcare workers (HCWs) and cleaning staff received infection control training to reinforce donning and doffing of personal protective equipment and to understand the practice of DOED, in which the cleaning staff observed patient and staff activities and then performed environmental disinfection immediately thereafter. Supervisors also observed cleaning staff to ensure the quality of work. In the CTF, air and environmental samples were collected on days 7, 14, 21, and 28 for SARS-CoV-2 detection by RT-PCR. Patient compliance with mask wearing was also recorded. RESULTS: Of 291 HCWs and 54 cleaning staff who managed 243 patients in the CIF and 674 patients in the CTF from July 24 to August 29, 2020, no one acquired COVID-19. All 24 air samples and 520 environmental samples collected in the patient area of the CTF were negative for SARS-CoV-2. Patient compliance with mask wearing was 100%. CONCLUSION: With appropriate infection control measures, zero environmental contamination and nosocomial transmission of SARS-CoV-2 to HCWs and cleaning staff was achieved.

Hyperacute extensive middle cerebral artery territory infarcts. Role of computed tomography in predicting outcome.

OBJECTIVE: To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts. METHODS: The CT features, total CT score, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the 30-day mortality in 16 patients with a hyperacute MCA infarct. RESULTS: Admission NIHSS scores were significantly lower in the survival group (P = 0.016). The extent of infarct, attenuation of corticomedullary differentiation, and total CT score were associated with 30-day mortality (P < 0.05). In prediction of mortality, extent of an infarct > 67% gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 100%, 100%, and 90%, respectively. Attenuation of corticomedullary differentiation gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 89%, 86%, and 89%, respectively. An NIHSS score > 28 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 67%, 67%, and 86%, respectively. A CT score > 4 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 78%, 75%, and 88%, respectively. CONCLUSIONS: Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.