Biomedical subjects
William Finn
Publications and source records attributed to William Finn.
Final transitions: family caregiving at the end of life.
BACKGROUND: This study aimed to understand how caregivers make the transition to end-stage caregiving and to illuminate its unique aspects using a stress process model. METHODS: Qualitative in-depth interviews were conducted with 74 caregivers of a family member who had been receiving hospice care for at least 2 weeks. Interviews were tape recorded, transcribed, and coded for emergent themes using constant comparative analysis. RESULTS: End-stage caregiving was characterized in the sample as (1) comprehension of terminality (the interrelationship of information, physical and cognitive decline, and personality change and role losses), (2) near-acute care, (3) executive functions, and (4) final decision making. The comprehension of terminality emerged from three interrelated experiences: receiving and assimilating concrete information about the illness, observing the progression of the disease, and observing the personality change and role loss. The primary stressors (unique end-stage caregiving tasks) were providing near-acute care, assuming an executive function, and beginning and final decision making. The secondary stressors were family role conflict, work conflict, and financial strain. Resources, such as intrinsic and extrinsic religious and faith practices and social support, were identified. Negative outcomes included intense emotional responses, and positive outcomes included heightened development of meaning making. CONCLUSION: The findings suggest that palliative care professionals have important opportunities to provide information and support to family caregivers during the final stages of the patient's terminal illness.
Validation of body fluid analysis on the Coulter LH 750.
The role of the hematology laboratory in the analysis of body fluid has been to provide accurate enumeration of red blood cells (RBCs), total nucleated cells (TNCs), and differentials by manual analysis. Three hospitals (London Health Sciences Centre, University of Pittsburgh Medical Center, and University of Michigan Health System) participated in the assessment of the performance of automated analysis of body fluid by the Beckman Coulter LH 750, an impedance-based hematology analyzer. We evaluated the accuracy of analysis results for both the TNCs and RBCs of 372 samples (158 serous fluid, 148 cerebrospinal fluid [CSF], 66 synovial fluid) run on the LH 750 compared to results obtained from manual chamber counting. Of the 372 samples, 152 were suitable for evaluation of accuracy of the automated TNC. The remaining 220 samples were either flagged for interfering substances or the reference results were < 0.2 x 10(9)/L, below the background limit of the analyzer. Correlation coefficients for serous fluid were 0.895, P = .88; for CSF, 0.993, P = .84; and for synovial fluid, 0.836, P = .94. Of the 372 samples, 106 had RBC counts greater than 0.01 x 10(12)/L and were used for method comparison. Correlation coefficients for serous fluid were 0.957, P = .66; for CSF, 0.849, P = .55; and for synovial fluid, 0.667, P = .81. Linearity and precision studies showed excellent agreement for both TNC and RBC parameters. Low-level sensitivity excluded the majority of cerebrospinal (119) and a small number of peritoneal dialysate fluid samples (8), which require accurate enumeration at clinical decision points between 0 to 100 cells/microliter. In the case of synovial and serous fluids, however, most clinicians are interested in TNC counts above 0.2 x 10(9)/L, and RBC counts are relevant only if they are significantly increased (> or = 0.05 x 10(12)/L). Adopting the criteria of reporting TNC counts as < 0.2 x 10(9)/L or accurate enumeration on counts > or = 0.2 x 10(9)/L, clinically relevant results could be provided by automated analysis in 93.8% of serous fluids and 85.8% of synovial fluids.