Fecal calprotectin as a biomarker of intestinal inflammation in ICU patients with diarrhea - testing the pipette method against the collection pin and weighing methods.

Fecal calprotectin is an established biomarker in inflammatory bowel disease, but its role in assessment of intestinal inflammation in ICU patients is yet to be explored. ICU patients tend to acquire diarrhea, which complicates the extraction of fecal calprotectin using a collection pin for stool sampling. Pipetting is an alternative sampling method. The aim of the study was to compare the collection pin method with the pipette method for measurement of fecal calprotectin in ICU patients with diarrhea. Stool samples were collected from fecal bags used in the patients and then analyzed for calprotectin using an extraction device and a piston pipette, respectively. In addition, a validation test for the pipette method of extraction was conducted on liquid stool samples. Eleven stool samples were collected from five randomly selected ICU patients. Calprotectin was detectable in all fecal samples. On average the collection pin measured 45% lower than the pipette method with a 95% confidence interval (30 - 59%). The coefficient of variation when using the pipette method was 13% in low calprotectin concentrations and 39% in high concentrations. In conclusion, the pipette method seems to be appropriate for measuring calprotectin in liquid feces, due to practicalities and a greater precision.

Analytical perspectives on performance-based management: an outline of theoretical assumptions in the existing literature.

Performance-based management (PBM) has become a dominant form of governance in health care and there is a need for careful assessment of its function and effects. This article contains a cross-disciplinary literature synthesis of current studies of PBM. Literature was retrieved by database searches and categorized according to analytical differences and similarities concerning (1) purpose and (2) governance mechanism of PBM. The literature could be grouped into three approaches to the study of PBM, which we termed: the 'functionalist', the 'interpretive' and the 'post-modern' perspective. In the functionalist perspective, PBM is perceived as a management tool aimed at improving health care services by means of market-based mechanisms. In the interpretive perspective, the adoption of PBM is understood as consequence of institutional and individual agents striving for public legitimacy. In the post-modern perspective, PBM is analysed as a form of governance, which has become so ingrained in Western culture that health care professionals internalize and understand their own behaviour and goals according to the values expressed in these governance systems. The recognition of differences in analytical perspectives allows appreciation of otherwise implicit assumptions and potential implications of PBM. Reflections on such differences are important to ensure vigilant appropriation of shifting management tools in health quality governance.