Adopting the digital platform model for citizen services - proposed waves towards a government platform organization

Following the rise of digital platform models, governments also start deploying this model for certain citizen services such as employment, education, care, health, or social services. This paper presents an exploratory case study of VDAB, Flanders’ (BE) regional government agency for labour services and its journey in adopting a platform model for employment services to citizens. Research suggests a new wave of e-government evolution focusing on digital platform technology adoption and ecosystems to deliver citizen services. We observed the need for VDAB to adapt its IT governance approach as a critical driver for success. We come up with a suggested roadmap to describe VDAB\u27s transition to a platform organization, linked to the waves of e-government evolution. We reflect on this using extant IT governance literature. Further research will focus on how governance of government platform models can be organized and what governance mechanisms can be employed for success

Adopting the digital platform model for citizen services:proposed waves towards a government platform organization

Following the rise of digital platform models, governments also start deploying this model for certain citizen services such as employment, education, care, health, or social services. This paper presents an exploratory case study of VDAB, Flanders’ (BE) regional government agency for labour services and its journey in adopting a platform model for employment services to citizens. Research suggests a new wave of e-government evolution focusing on digital platform technology adoption and ecosystems to deliver citizen services. We observed the need for VDAB to adapt its IT governance approach as a critical driver for success. We come up with a suggested roadmap to describe VDAB's transition to a platform organization, linked to the waves of e-government evolution. We reflect on this using extant IT governance literature. Further research will focus on how governance of government platform models can be organized and what governance mechanisms can be employed for success

Adopting the digital platform model for citizen services:proposed waves towards a government platform organization

Following the rise of digital platform models, governments also start deploying this model for certain citizen services such as employment, education, care, health, or social services. This paper presents an exploratory case study of VDAB, Flanders’ (BE) regional government agency for labour services and its journey in adopting a platform model for employment services to citizens. Research suggests a new wave of e-government evolution focusing on digital platform technology adoption and ecosystems to deliver citizen services. We observed the need for VDAB to adapt its IT governance approach as a critical driver for success. We come up with a suggested roadmap to describe VDAB's transition to a platform organization, linked to the waves of e-government evolution. We reflect on this using extant IT governance literature. Further research will focus on how governance of government platform models can be organized and what governance mechanisms can be employed for success

Impact of Neoadjuvant Chemoradiotherapy on Postoperative Outcomes After Esophageal Cancer Resection

International audienceObjectives: To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection.Background: Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL.Methods: Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n = 593) were compared with those treated by primary surgery (n = 1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics.Results: Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P = 0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P = 0.110) and 33.4% versus 32.1% (P = 0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P = 0.291), whereas chylothorax (2.5% vs 1.2%; P = 0.020), cardiovascular complications (8.6% vs 0.1%; P = 0.037), and thromboembolic events (8.6% vs 6.0%; P = 0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P = 0.228), with more chylothorax (2.5% vs 0.7%; P = 0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P = 0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT.Conclusions: Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016)

Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study

International audienceAims: The aims of this study were to compare short-and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.Methods: Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short-and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.Results: No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short-or long-term outcomes.Conclusion: The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery

Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer

International audienc