Explore the vast range of titles available.

In this paper, we examine whether patient narratives alter the impact of stereotyping on choice of primary care clinicians: in this case, the common presumption that female doctors will be more attentive to empathic relationships with patients. 1052 individuals were selected from a nationally representative Internet panel to participate in a survey experiment. Participants were given performance data about 12 fictitious primary care physicians, including a randomized set of narrative feedback from patients. We compared the choice of clinician made by participants who value bedside manner and were exposed to narratives in the experiment, compared to those valuing bedside manner who had not had this exposure. We estimated multivariate logistic regressions to assess whether exposure to patient comments that “disrupt” stereotypes influenced choice of physicians. Participants who saw patient comments and had previously reported caring about bedside manner had a 67% higher odds of choosing a female physician than those participants that did not see a patient comments, controlling for the content of the narratives themselves. When participants were exposed to patient comments that disrupt gendered stereotypes, they had a 40% lower odds of choosing a female physician. Simple exposure to patient narratives that do not clearly disrupt gendered stereotypes increased the likelihood of choosing a female clinician by priming attention to relational aspects of care. However, when the content of a sufficient proportion of patient comments runs counter stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.

This book provides fully updated coverage of the copper production process encompassing topics as diverse as environmental technology for wind and solar energy transmission, treatment of waste byproducts, and recycling of electronic scrap for potential alternative technology implementation. The authors examine industrially-grounded treatments of process fundamentals and the beneficiation of raw materials, smelting and converting, hydrometallurgical processes, and refining technology for a mine-to-market perspective, from primary and secondary raw materials extraction to shipping of rod or billet to customers. The modern coverage of the work includes bath smelting processes such as Ausmelt and Isasmelt which have become state-of-the-art in sulfide concentrate smelting and converting.

Popular support for the welfare state varies greatly across nations and policy domains. We argue that these variations—vital to understanding the politics of the welfare state—reflect in part the degree to which economic disadvantage (low income) and economic insecurity (high risk) are correlated. When the disadvantaged and insecure are mostly one and the same, the base of popular support for the welfare state is narrow. When the disadvantaged and insecure represent two distinct groups, popular support is broader and opinion less polarized. We test these predictions both across nations within a single policy area (unemployment insurance) and across policy domains within a single polity (the United States, using a new survey). Results are consistent with our predictions and are robust to myriad controls and specifications. When disadvantage and insecurity are more correlated, the welfare state is more contested.

In this article we consider how an online resource that publishes the findings and video, audio and written extracts from narrative interview studies has developed as an international collaboration, currently including 14 countries worldwide. In the two decades since the initiative was founded, the robust, national qualitative studies for DIPEx International have branched out from patient information and support to learning and teaching, insights and service improvement and cross-national comparisons. Embracing the challenge to reflect plural discourses of illness, health and care in societies that appear increasingly polarised, the DIPEx collaboration presents polyphonic perspectives that stand as potential counters to reductive dualities. As a result the collaboration has established a collection of unique, international resources that can be leveraged to promote understanding and learning from people’s experiences of illness and care.

BackgroundHow openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, healthcare avoidance and loss of trust.MethodsCross-sectional 2018 recontact survey assessing experience with medical error in a 2017 random digit dial survey of Massachusetts residents. Two hundred and fifty-three respondents self-reported medical error. Respondents were similar to non-respondents in sociodemographics confirming minimal response bias. Time since error was categorised as <1, 1–2 or 3–6 years before interview. Open communication was measured with six questions assessing different communication elements. Persistent impacts included emotional (eg, sadness, anger), healthcare avoidance (specific providers or all medical care) and loss of trust in healthcare. Logistic regressions examined the association between open communication and long-term impacts.ResultsOf respondents self-reporting a medical error 3–6 years ago, 51% reported at least one current emotional impact; 57% reported avoiding doctor/facilities involved in error; 67% reported loss of trust. Open communication varied: 34% reported no communication and 24% reported ≥5 elements. Controlling for error severity, respondents reporting the most open communication had significantly lower odds of persisting sadness (OR=0.17, 95% CI 0.05 to 0.60, p=0.006), depression (OR=0.16, 95% CI 0.03 to 0.77, p=0.022) or feeling abandoned/betrayed (OR=0.10, 95% CI 0.02 to 0.48, p=0.004) compared with respondents reporting no communication. Open communication significantly predicted less doctor/facility avoidance, but was not associated with medical care avoidance or healthcare trust.ConclusionsNegative emotional impacts from medical error can persist for years. Open communication is associated with reduced emotional impacts and decreased avoidance of doctors/facilities involved in the error. Communication and resolution programmes could facilitate transparent conversations and reduce some of the negative impacts of medical error.

Health plans use selective physician networks to control costs while improving quality. However, narrow (limited) networks raise concerns about reduced access to and continuity of care. In the period 2010-15, the proportion of Medicaid managed care plans in fourteen states with narrow primary care physician networks-that is, the plans that employed 30 percent or less of those physicians in their market-declined from a peak of 42 percent in 2011 to 27 percent in 2015. On average, plans experienced a 12 percent annual turnover rate, with 34 percent of primary care physicians exiting within five years. Turnover was 3 percentage points higher in plans with narrow networks after one year, and 20 percentage points higher after five years, compared to turnover in plans with non-narrow networks. These findings suggest that efforts to maintain adequate physician networks must monitor not only the breadth of the networks, but also the continuity within them.

Background Little is known about the usefulness of online ratings when searching for a hospital. We therefore assess the association between quantitative and qualitative online ratings for US hospitals and clinical quality of care measures. Methods First, we collected a stratified random sample of 1000 quantitative and qualitative online ratings for hospitals from the website RateMDs. We used an integrated iterative approach to develop a categorization scheme to capture both the topics and sentiment in the narrative comments. Next, we matched the online ratings with hospital-level quality measures published by the Centers for Medicare and Medicaid Services. Regarding nominally scaled measures, we checked for differences in the distribution among the online rating categories. For metrically scaled measures, we applied the Spearman rank coefficient of correlation. Results Thirteen of the twenty-nine quality of care measures were significantly associated with the quantitative online ratings (Spearman p  = ±0.143, p  < 0.05 for all). Thereof, eight associations indicated better clinical outcomes for better online ratings. Seven of the twenty-nine clinical measures were significantly associated with the sentiment of patient narratives ( p  = ±0.114, p  < 0.05 for all), whereof four associations indicated worse clinical outcomes in more favorable narrative comments. Conclusions There seems to be some association between quantitative online ratings and clinical performance measures. However, the relatively weak strength and inconsistency of the direction of the association as well as the lack of association with several other clinical measures may not enable the drawing of strong conclusions. Narrative comments also seem to have limited potential to reflect the clinical quality of care in its current form. Thus, online ratings are of limited usefulness in guiding patients towards high-performing hospitals from a clinical point of view. Nevertheless, patients might prefer different aspects of care when choosing a hospital.

Objectives/Goals: Hospital mergers have proliferated in the USA, yet a comprehensive understanding of how mergers affect nurses’ well-being and their ability to provide safe, high-quality care is lacking. We examined the associations among hospital mergers, nursing, nurse well-being, and patient safety and quality of care to guide policy or hospital interventions. Methods/Study Population: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews reporting guidelines, we conducted a scoping review by systematically searching 10 databases comprised of both business and healthcare literature up to January 2025. Eligible studies met the following inclusion criteria: (1) US-based sample, (2) specify a hospital merger and one nursing-related criteria, (3) use empirical data, (4) peer-reviewed, and (5) in English. Conference abstracts, protocols, interventions, non-empirical studies, theses or dissertations, quality improvement, and systematic review articles were excluded. Two reviewers independently screened articles and extracted data to focus on empirical research that examined hospital mergers and nursing. Results/Anticipated Results: Our search yielded 1,772 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, and 2 multi-methods. Only three studies analyzed data from 2003 or later. Although the data were sparse and older, we found that hospital mergers introduced organizational changes among the nursing workforce – nurse staffing, leadership, and operations. Nurse-sensitive patient safety and quality of care outcomes may not improve post-merger. Qualitatively, nurses described poor communication, a perceived lack of trust in leadership, a loss of identity and unity, decreased morale, increased fear or uncertainty, and issues with equal and/or respectful treatment. The identified study methods were unable to draw strong causal and/or detailed conclusions, and few variables were examined. Discussion/Significance of Impact: This review highlights potential links between US hospital mergers and nursing, nurse well-being, and patient safety and quality of care and emphasizes the lack of robust, up-to-date studies to guide policymakers and hospital administrators in making informed decisions – potentially leading to negative consequences.

For two decades, various initiatives have encouraged Americans to consider quality when choosing clinicians, both to enhance informed choice and to reduce disparities in access to high-quality providers. The literature portrays these efforts as largely ineffective. But this depiction overlooks two factors: the dramatic expansion since 2010 in the availability of patients' narratives about care and the growth of information seeking among consumers. Using surveys fielded in 2010, 2014, and 2015, we assessed the impact of these changes on consumers' awareness of quality information and sociodemographic differences. Public exposure to any quality information doubled between 2010 and 2015, while exposure to patient narratives and experience surveys tripled. Reflecting a greater propensity to seek quality metrics, minority consumers remained better informed than whites over time, albeit with differences across subgroups in the types of information encountered. An education-related gradient in quality awareness also emerged over the past decade. Public policy should respond to emerging trends in information exposure, establish standards for rigorous elicitation of narratives, and assist consumers' learning from a combination of narratives and quantified metrics on clinician quality.