Situated generosity in clinical care: A mixed-methods study of STI services in China

by Ke Zhou, Dorian Ho, Suzanne Day, Thomas Fitzpatrick, Katherine T. Li, Takhona Grace Hlatshwako, Danyang Luo, Zhuoheng Yin, Gifty Marley, Ligang Yang, Weiming Tang, C. Micha Belden, Joseph D. Tucker, Ruby Congjiang Wang

Generosity is a critical yet understudied dimension of prosocial behavior in healthcare. Existing research has focused on individual traits or professional values, with limited attention to how generosity is shaped in everyday clinical contexts. This study examines how healthcare professionals in China understand and enact generosity in sexually transmitted infection (STI) services, and how it is shaped by relational and organizational conditions.

We conducted semi-structured interviews with 27 healthcare professionals and a focus group with four participants across five hospitals in Guangdong Province, China. Thematic analysis explored clinicians’ understandings and experiences of generosity. Crisp-set Qualitative Comparative Analysis (csQCA) examined configurations of relational and organizational conditions associated with reported generous practices. Data were analyzed using NVivo 12 and csQCA 4.0. Given uniform outcome presence, findings are interpreted as descriptive configurational patterns rather than causal effects.

Participants described generosity as discretionary practices beyond formal duties, including emotional support, flexible scheduling, and financial accommodations. These practices were associated with patient trust and collegial support, but also with emotional strain and boundary tensions in resource-constrained settings. Generosity was more often described in accounts involving clinicians’ engagement with patients’ broader social circumstances and experiences of supportive team environments. Overall, generosity appeared as a context-dependent practice shaped by interacting relational and organizational conditions.

Generosity in STI care appears as a relationally embedded practice shaped by interactions among clinicians, patients, and organizational environments. It reflects the coupling of relational dynamics and institutional conditions that simultaneously enable and constrain discretionary care. Sustaining situated generosity therefore depends less on individual motivation than on organizational infrastructures that structure relational work in clinical settings.

Capturing the Work of Nurses in General Practice: Development and Testing of the OCEAN‐GPN Tools

ABSTRACT

Aim

To provide a worked example of the process used in developing data collection tools to measure the profile and practice of Australian general practice nurses (GPNs).

Design

Methodological discussion.

Methods

An iterative design process encompassing the steps of sandpit development, alpha, beta and pilot (field) testing, alongside stakeholder consultations, was used to develop the Occasions of Care Explained and Analysed (OCEAN)-GPN tools. At each stage, the ‘think-aloud’ method was used to collect qualitative data and a user survey measured satisfaction with tool development.

Results

The application of user-centred design principles shows how the data collection tools were developed for this major national study. Examples of iterative testing strategies illustrate how participants' experiences can inform data-collection processes.

Conclusion

The OCEAN-GPN tools have been rigorously developed to capture Australian GPNs' profile and clinical activity. The iterative processes and extensive consultation ensured that the tools were fit for purpose and met user needs. Collection of study data using these tools will enable evaluation to inform policy, research, education and clinical practice.

Correlation study of brain function changes after chemotherapy in breast cancer patients by automated fiber quantification based on diffusion tensor imaging

by Yun Feng, Wei Chen, Yang Lu, Haifei Zhou

The aim of this study is to evaluate the changes of white matter microstructure in breast cancer patients before and after chemotherapy based on automated fiber quantification (AFQ),as well as determine if these dispersion indexes are significantly correlated with clinical data.

Twenty-four breast cancer patients scheduled for chemotherapy were enrolled. Diffusion tensor imaging (DTI), neuropsychological tests and self-report measures, and hematological tests were conducted before chemotherapy(time 0,T0) and within one week after chemotherapy(time 1,T1). AFQ was used to track 20 fiber tracts in the brain. The correlation between average abnormal tracts and changes in neuropsychological tests and self-report measures and blood indicators was analyzed.

Compared to T0, subjects at T1 showed decreased scores on the verbal fluency test; increased scores on the self-rating anxiety scale(SAS)and self-rating depression scale (SDS). Estrogen concentration was lower while luteinizing hormone(LH), follicle-stimulating hormone, and triglyceride levels were higher. Mean fractional anisotropy (FA) value decreased in the right cingulum cingulate(CGC)while mean radial diffusivity (RD) increased in the right CGC; mean axial diffusivity (AD) value decreased in callosum forceps major and callosum forceps minor. Changes in FA with in the right CGC were positively correlated with changes in SDS and LH, while changes in RD with in the right CGC were negatively correlated with changes in SDS and LH.

Early changes observed in brain white matter fiber tracts, along with persistent hormone and triglyceride metabolism disorders, could potentially serve as neurobiological markers for monitoring chemotherapy-induced cognitive impairment.