Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease.

Although chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling illness, few empirical studies have evaluated the impact of the disease on symptom distress, functional status, and quality of life. These outcomes were explored in a prospective survey of 100 patients with advanced COPD. Patients were recruited from two academic centers.

Merging cultures: palliative care specialists in the medical intensive care unit.

We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork.