The public sector and co-creation in turbulent times: A systematic literature review on robust governance in the COVID-19 emergency.

The capacity of public sector of co-creating with other stakeholders is challenged by the increasing presence of disruptive turbulent events, such as the COVID-19. At this regard, robustness has been identified as a suitable response to deal with this kind of events. Through a systematic literature review, we analyzed how public sector organizations have co-created with other actors during the COVID-19 and what have been the contribution of robust governance strategies. Our findings point firstly to the empirical validity of the robustness concept, providing evidence of the extensive use of robust governance strategies into the co-creation processes. Second, we identified a configurational approach to robustness, with governments co-creating by simultaneously employing several robust strategies. Thirdly, we observed a more active involvement of societal stakeholders, with emergence of proto-institutions and potential threats to the political system.

The public sector and co‐creation in turbulent times: A systematic literature review on robust governance in the COVID‐19 emergency

The capacity of public sector of co‐creating with other stakeholders is challenged by the increasing presence of disruptive turbulent events, such as the COVID‐19. At this regard, robustness has been identified as a suitable response to deal with this kind of events. Through a systematic literature review, we analyzed how public sector organizations have co‐created with other actors during the COVID‐19 and what have been the contribution of robust governance strategies. Our findings point firstly to the empirical validity of the robustness concept, providing evidence of the extensive use of robust governance strategies into the co‐creation processes. Second, we identified a configurational approach to robustness, with governments co‐creating by simultaneously employing several robust strategies. Thirdly, we observed a more active involvement of societal stakeholders, with emergence of proto‐institutions and potential threats to the political system.

Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway.

BACKGROUND: The British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase. AIMS: External validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance. METHODS: A prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed. RESULTS: 1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51-73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7-99.3)% and an NPV of 99.3 (97.8-99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3-99.7)% and NPV of 99.5 (98.1-99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS. CONCLUSIONS: In a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.