The use of finger-stick blood to assess lactate in critically ill surgical patients

Background

Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock.

Methods

Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an “investigational use only” study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods.

Results

40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired.

Conclusion

Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock.

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Finger-stick capillary lactate correlates with blood gas and core lab values.

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Capillary lactate trends closely over time with arterial lactate.

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Rising or falling capillary lactate reflects the adequacy of global perfusion.

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Capillary lactate measurements require a fraction of the time and blood to process.

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Preliminary results imply capillary lactate may be used in lieu of invasive methods.

Influence of vitamin a on cervical dysplasia and carcinomain situ

A case-control study was undertaken to determine the dietary intake of vitamin A in women having abnormal uterocervical cytology. The study groups (87 cases and 82 controls) were drawn from a population of women who received a screening Pap test in the ambulatory health care section of a large municipal hospital center. A subset of cases (with abnormal cytology) were matched to controls for age, ethnicity, socioeconomic status, and parity. Nutrient intake and retinol binding protein concentrations were determined; epidemiological data were also obtained. It was found that the subset of cases with severe dysplasia or carcinoma in situ (CIS) were more likely to have a total dietary vitamin A intake below the pooled median (3,450 IU) and/or a beta-carotene intake below the pooled median (2,072 IU) than were normal controls (p less than 0.05 and p less than 0.025, respectively). Odds ratios revealed approximately a 3-fold greater risk for severe dysplasia or CIS in women with lowered vitamin A or beta-carotene intake. In addition, retinol binding protein was either absent or undetectable in 78.8% of the dysplastic tissue samples, versus 23.5% of the normal tissue samples (p less than 0.005).

Lay people's and health care personnel's perceptions of cancer, AIDS, cardiac, and diabetic patients

Although some writers assume that negative attitudes toward cancer and other chronic disease patients are prevalent, systematic data have been scarce. Perceptions of patients and their illnesses were assessed for college students, nurses, medical students, and chiropractic students. Subjects rated cancer, AIDS, diabetes, and heart disease patients, as well as the nonill, on 21 bipolar trait items, selected to measure competence, moral worth, dependence, depression, and morbidity. There were also measures of social distance, cancer anxiety, disease beliefs, and ascribed illness responsibility. With minor exceptions, all subsamples perceived cancer victims less favorably than diabetics, heart patients, and the nonill on competence, dependence, depression, and morbidity. Cancer patients were always seen as even more depressed than AIDS sufferers but were rated just as favorably as well people on moral worth. People with AIDS were generally the most negatively evaluated and most rejected group. Cancer was consistently described as the most painful condition and, next to AIDS, the least understood medically and most deadly. Cancer anxiety was moderately predictive of perceptions of cancer victims, and ratings of illness responsibility were moderately predictive of moral worth ratings for the cancer and AIDS groups. Theoretical and practical implications were discussed.