Hippocampal Subfield Volumetry and Navigation in Congenital Blindness.

As the U.S. population ages and becomes increasingly medically complex, the need for palliative care far exceeds the availability of subspecialty-trained palliative care physicians. The emergency department (ED) remains a frequent point of contact for these patients. Half of those living in the United States visit the ED in their last month of life and 75% in the prior six months, with frequent repeat visits. Most adults do not have advance directives completed at the time of ED visits. Because many patients present to the ED while critically ill and requiring urgent interventions, it is imperative that emergency physicians be able to quickly align with patients and families to determine values and offer recommendations for further medical treatment. A systematic review completed in 2019 found that palliative care in the ED (most often delivered by palliative care specialists) improved quality of life, reduced hospital length of stay, and did not decrease survival rate compared with usual care.– Having early and effective goals-of-care conversations can improve symptoms, reduce suffering, and decrease healthcare costs.– Implementing palliative care in the ED for actively dying patients has been shown to improve patient care, optimize comfort measures and emotional support, increase patient satisfaction, and reduce overall hospital admissions. Emergency physicians often practice in environments without readily available palliative care specialists and, therefore, need to have primary palliative skills to provide excellent and holistic care to patients with chronic and/or terminal illnesses. Emergency physicians have reported that palliative care is an important competence in their practice, yet they feel they are not adequately educated in providing such care. They report discomfort regarding physician orders for life-sustaining treatment forms and navigating conflict around withholding life-prolonging treatment.– A needs assessment of emergency medicine (EM) residents showed specific areas in which there were self-reported knowledge gaps, including managing hospice patients, withdrawal of life support, prognostication, and pain management.