Preventing species extinctions: A global conservation consortium for Erica

Societal Impact Statement Human-caused habitat destruction and transformation is resulting in a cascade of impacts to biological diversity, of which arguably the most fundamental is species extinctions. The Global Conservation Consortia (GCC) are a means to pool efforts and expertise across national boundaries and between disciplines in the attempt to prevent such losses in focal plant groups. GCC Erica coordinates an international response to extinction threats in one such group, the heaths, or heathers, of which hundreds of species are found only in South Africa's spectacularly diverse Cape Floristic Region. Summary Effectively combating the biodiversity crisis requires coordinated conservation efforts. Botanic Gardens Conservation International (BGCI) and numerous partners have established Global Conservation Consortia (GCC) to collaboratively develop and implement comprehensive conservation strategies for priority threatened plant groups. Through these networks, institutions with specialised collections and staff can leverage ongoing work to optimise impact for threatened plant species. The genus Erica poses a challenge similar in scale to that of the largest other GCC group, Rhododendron, but almost 700 of the around 800 known species of Erica are concentrated in a single biodiversity hotspot, the Cape Floristic Region (CFR) of South Africa. Many species are known to be threatened, suffering the immediate impacts of habitat destruction, invasive species, changes in natural fire regimes and climate change. Efforts to counter these threats face general challenges: disproportionate burden of in situ conservation falling on a minority of the community, limited knowledge of species-rich groups, shortfalls in assessing and monitoring threat, lack of resources for in situ and limitations of knowledge for ex situ conservation efforts and in communicating the value of biological diversity to a public who may never encounter it in the wild. GCC Erica brings together the world's Erica experts, conservationists and the botanical community, including botanic gardens, seed banks and organisations in Africa, Madagascar, Europe, the United States, Australia and beyond. We are collaboratively pooling our unique sets of skills and resources to address these challenges in working groups for conservation prioritisation, conservation in situ, horticulture, seed banking, systematic research and outreach.publishedVersio

Botaniske hager går sammen for å stanse utryddelsen av arter: Global Conservation Consortium for Erica (lyng)

Botanic gardens unite to prevent species extinctions: the Global Conservation Consortium for Erica. Michael Pirie et al. describe an international project to prevent extinctions of species of Erica, the heaths or heathers. The ‘Global Conservation Consortium for Erica’ is coordinated at the Bergen University Gardens under the umbrella of Botanic Gardens Conservation International (BGCI). The authors describe the challenges of understanding and protecting species rich plant groups where much of the diversity is concentrated in biodiversity hotspots. Around 700 Erica species are only found in South Africa’s Cape Floristic Region. They explain how GCC Erica will address those challenges, including through both ‘in situ’ and ‘ex situ’ conservation

World guidelines for falls prevention and management for older adults: a global initiative

Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

304 ED-FASU: A Novel ‘Front Door’ Multidisciplinary Service Assessing Patients with Falls and Syncope in the Emergency Department

Abstract Background Patients with falls/syncope/presyncope frequently present to the emergency department (ED) and many that could be managed safely in an ambulatory care setting are admitted for extensive diagnostic work-up. A pilot intervention commenced in March 2019, with direct access to specialist assessment in the ED for patients presenting with falls/syncope/presyncope, aiming to provide appropriate testing and early diagnosis to reduce unnecessary hospitalizations. This pilot study assessed the feasibility of embedding this service within the ED, as well as the effectiveness of the intervention in terms of admission avoidance. Methods The study was conducted between 25th March and 19th April 2019 in a large urban teaching hospital with a dedicated Falls &amp; Syncope Unit and compared to similar data from March/April 2018. The core ED-FASU team comprised a consultant geriatrician, specialist registrar in geriatric medicine and clinical nurse specialist. Inclusion criteria were those of all ages, presenting with falls/syncope/presyncope/dizziness between 0800-1800 Monday-Friday. Patients were reviewed directly from triage or after referral from the ED team. Results In total, 203 patients were assessed during the pilot, an average of 10 assessments per day. The median age of those seen was 63 (58.0-67.0) years. Almost one third (57/203) were aged ≥75 years. After excluding those who were already admitted to the acute hospital and awaiting a bed when seen in the ED (n=29), 24% (41/174) of those seen were admitted to hospital. This compares to an admission rate of 33% (73/223) for the 2018 comparison group (p = 0.045). Conclusion This pilot study shows that it is feasible to embed specialist assessment for falls/syncope/presyncope in the ED. Initial pilot data suggests a significant reduction in admission rates for those seen by this service but needs to be confirmed over a more prolonged assessment period and alongside data on readmission and length of stay. </jats:sec

298 Falls and Syncope in Older People in the Emergency Department: Prevalence, Clinical Characteristics and Outcomes

Abstract Background Falls, syncope and presyncope comprise a large proportion of emergency department (ED) presentations among older people, however accurate data detailing this is limited. The aim of this study therefore was to ascertain the percentage of ED presentations in older people due to falls/syncope/presyncope, and examine admission rates, length of stay and likely underlying diagnosis. Methods Over 1,300 consecutive presentations of older people (aged ≥60 years) to the ED of a large urban university teaching hospital in March 2018 were examined (electronic and hard-copy notes) to ascertain the prevalence of falls/syncope/presyncope presentations. Data was collected for each presentation with fall/syncope/presyncope on demographics, and relevant clinical characteristics, including admission outcome and length of stay (LOS). Results Falls/syncope/presyncope comprised 19% (250/1,324) of presentations of older people to the ED, with a mean age of 75.3 +/-0.64 years. Almost 60% (158/250) presented during ‘normal’ working hours, i.e. Monday to Friday, 0800-1800. Almost half (121/250) had a Manchester Triage Score (MTS) of 3, indicating a need for urgent care, while one third (93/250) were categorized as requiring very urgent or immediate assessment (MTS 2 or 1 respectively). Over one third (97/250) presented with explained/accidental falls, while 26% (66/250) and 35% (87/250) presented with syncope and unexplained falls respectively. One in two (118/250) older people presenting with falls/syncope/presyncope were admitted to the acute hospital, and this rises to almost two thirds (82/135) of those aged ≥75 years. The median LOS was 15 (9.9 -22.0) days. Conclusion Older people frequently present to the ED with falls/syncope/presyncope. The majority present during working hours and admission rates and LOS are relatively high. Falls/syncope/presyncope therefore represent an appropriate target for structured, multidisciplinary assessment at the ‘front door’ to provide early specialist assessment and management, and reduce complications associated with unnecessary admission to hospital. </jats:sec