Changing bureaucratic structures and increasing collaboration within public service delivery create new questions for leadership. With formal authority becoming more dispersed and various actors... Show moreChanging bureaucratic structures and increasing collaboration within public service delivery create new questions for leadership. With formal authority becoming more dispersed and various actors increasingly involved, revised expectations as to who contributes to organizational coordination are emerging. We investigate how both managers and non-managerial employees use leadership behaviours and how characteristics of the organizational context affect their engagement in leadership. Analyses of survey data collected among public servants (n = 1,266) in the Netherlands show that employees both with and without formal leadership positions demonstrate more leadership behaviour in situations of higher environmental complexity, but the latter group faces more bureaucratic constraints. Show less
Kempeneers, M.A.; Hemert, A.K.E. van; Hoek, M. van der; Issa, Y.; Hooft, J.E. van; Nio, C.Y.; ... ; Boermeester, M.A. 2022
Background Surgery is the most effective treatment in patients with painful chronic pancreatitis and a dilated pancreatic duct. Studies reporting the outcomes of selected surgical approach... Show moreBackground Surgery is the most effective treatment in patients with painful chronic pancreatitis and a dilated pancreatic duct. Studies reporting the outcomes of selected surgical approach according to the pancreatic head size in these patients are lacking. Method This was a retrospective, observational single-centre study of consecutive patients who underwent either a Frey procedure or extended lateral pancreaticojejunostomy (eLPJ) for pain due to chronic pancreatitis with a dilated main pancreatic duct (5 mm or more) between 2006 and 2017. A Frey procedure was used in patients with pancreatic head enlargement (40 mm or more) and eLPJ (full-length pancreaticojejunostomy, including transection of the gastroduodenal artery) in others. A biliodigestive bypass was added in the case of biliary obstruction. Results Overall, 140 of 220 patients met the eligibility criteria: 70 underwent a Frey procedure and 70 an eLPJ. Hepaticojejunostomy was added in 17.1 per cent of patients (Frey: 24.3 per cent; eLPJ: 10.0 per cent (P = 0.025)). Major morbidity occurred in 15.0 per cent of patients (Frey: 21.4 per cent; eLPJ: 8.6 per cent (P = 0.033)). After a median 7.8 years of follow-up, the mean (s.d.) decrease in Izbicki pain score was 33 (27) points (34 (28) points after a Frey procedure; 32 (26) points after an eLPJ). Pain relief was reported as 'very much' by 87.5 per cent of patients (Frey: 86.1 per cent; eLPJ: 88.9 per cent) and as 'partial' by 11.1 per cent (Frey: 13.8 per cent; eLPJ: 8.3 per cent). Conclusion Selective-use of either a Frey procedure or eLPJ in patients with symptomatic chronic pancreatitis was-associated with low morbidity and long-term pain relief. Adding a-biliodigestive bypass did not increase morbidity.Studies reporting on short- and long-term outcomes of Frey and extended lateral pancreaticojejunostomy (eLPJ) in chronic pancreatitis are lacking. In 140 consecutive patients the rate of major morbidity was 15 per cent (Frey: 21 per cent; eLPJ: 9 per cent). After median follow-up of 7.8 years in 75 patients, mean (s.d.) decrease in Izbicki pain score was 33 (27) points (Frey: 34 (28); eLPJ: 32 (26)) and pain relief was reported as 'very much' by 88 per cent of patients (Frey: 86 per cent; eLPJ: 89 per cent). Show less
