Death and grief literacy are increasingly recognised as crucial public health resources for responding to serious illness, dying, death, and bereavement. This critical essay summarises key discussions from a three-day international symposium, “ Fostering Connection in Existential Phases of Life: How Do We Enhance Death and Grief Literacy? ” (July 2025), which brought together experts from palliative care, caring communities, LGBTQ+ advocacy, migration studies, social work, volunteering, and psychosocial support. The symposium did not include members of the general public but focused on academic, clinical, and practice-based expertise. The symposium explored how enhancing death and grief literacy can improve individual and collective responses to loneliness, particularly among marginalised and vulnerable populations who are at higher risk of experiencing loneliness and poorer outcomes in the context of serious illness, dying, and bereavement, and foster deeper connections during life’s existential phases. Discussions addressed the relational, communal, and practical dimensions of death and grief literacy; the entanglement of loneliness and desire to die in severe illness; experiences of grief-related loneliness; and the potential of compassionate communities. Outcomes included concrete recommendations for policy, practice, and education, emphasising community-based support, cultural humility, public engagement, and the integration of death and grief literacy into curricula across multiple educational and professional settings, including school curricula, university education, and relevant workplace training programmes. Overall, we argue that strengthening death and grief literacy can shift societies from pathologising loneliness towards shared responsibility, solidarity, and compassionate care at the end of life and during bereavement.
Computed tomography (CT) plays an essential role in clinical workflow to improve patient outcomes. However, access to CT imaging and specialist interpretation remains limited, particularly in rural, regional, remote (RRR), and other resource-limited settings. Recent advances in mobile CT, telehealth, and artificial intelligence (AI) provide opportunities to extend advanced imaging services to populations in RRR settings. This review examines: 1) mobile CT systems deployed in trucks, trailers, ambulances, and other mobile platforms; 2) telehealth technologies supporting CT-based healthcare; and 3) AI for CT that has received regulatory authorisation or is currently deployed in clinical practice. Applications are evaluated across four clinical functions: screening and diagnosis, patient monitoring, risk prediction, and intervention or therapeutic decision support. The review covers neurological, thoracic, cardiovascular, abdominal, oncological, musculoskeletal, and interventional imaging, with particular attention to stroke, cancer, and other image-guided treatment. Other factors such as regulatory status, deployment status, and estimated technology readiness (TRL) level are compared. Current evidence indicates that mobile CT, telehealth, and AI for conventional CT are individually relatively mature, but fully integration of these technologies remains less widely deployed and validated in the clinical settings. Key barriers include regulatory variation, domain shift, connectivity requirements, cost, workflow integration, cybersecurity, and limited evidence of patient-level benefit. Future research should prioritise prospective, multicentre evaluation of integrated CT systems in real-world and underserved clinical settings.
BACKGROUND:The COVID-19 pandemic accelerated implementation of virtual care models to enhance rural intensive care capacity. However, rigorous evaluation of such models during routine critical care operations remains limited. LOCAL PROBLEM:Two regional level 4 intensive care units (ICUs) in New South Wales, Australia required sustainable capacity enhancement to manage critically ill patients while addressing workforce limitations and geographic isolation. METHODS:We implemented a multiphase virtual intensive care support model progressing from daily videoconference rounds to 24/7 remote monitoring by experienced ICU nurses with specialist physician backup. Using a controlled quasi-experimental design, we compared two intervention sites with two matched control sites across four time periods (January 2019-June 2022). Segmented interrupted time series and difference-in-differences analyses evaluated effectiveness (standardised mortality ratios, length of stay, and adverse events) and efficiency (admission rates and transfer rates). Economic evaluation followed Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 guidelines. Qualitative methods explored clinician and patient experiences following consolidated criteria for reporting qualitative research standards. INTERVENTIONS:The virtual support model included continuous remote patient monitoring, daily multidisciplinary videoconference rounds, tiered escalation protocols, bidirectional staff education, and formal governance structures with defined accountability frameworks. RESULTS:Standardised mortality ratios remained within 95% confidence limits throughout (range: 0.72-1.18). The interrupted time series analysis demonstrated significant level changes in transfers following 24/7 implementation (site 1: -2.8 transfers/month, p = 0.003; site 2: -2.1 transfers/month, p = 0.01). Difference-in-differences estimates confirmed intervention effects independent of concurrent care model changes. An economic analysis revealed cost-benefit ratios of 1:7.1 and 1:5.9 (per AUD invested). Twenty-one clinicians described enhanced collaboration, improved access to expertise, and increased confidence managing complex patients. Implementation fidelity exceeded 92% across monitored components. CONCLUSIONS:Virtual intensive care unit support model represents a safe, cost-beneficial model for enhancing regional ICU capacity during routine operations. Benefits extend beyond pandemic response to sustainable improvements in rural critical care delivery. Implementation requires robust governance, reliable technology, dedicated staffing, and systematic fidelity monitoring.
Background: Death literacy – the knowledge, skills, and capacity to navigate end-of-life care, advance care planning, dying, and death care – is shaped by cultural, religious, and linguistic factors. The Death Literacy Index (DLI) captures practical, experiential, factual, and community domains. Currently, there is limited evidence about death literacy levels among culturally and linguistically diverse communities in multicultural settings, and little is known about how translated versions of the DLI perform psychometrically in these groups or how culturally tailored, community-delivered interventions can strengthen death literacy. Objectives: (1) To evaluate the impact of culturally adapted, community-designed and delivered interventions on DLI subscale and total scores among Filipino, German, Italian, and Vietnamese communities in South Australia; and (2) to examine the preliminary psychometric properties (factor structure and reliability) of translated DLI instruments in these populations. Design: Pre–post intervention study. Methods: Community leaders in each group co-designed and delivered a community-specific intervention over 3–5 months using culturally familiar channels (workshops, radio/podcasts, social media, and printed/online resources). Thus, four parallel but distinct interventions were implemented, one in each cultural/language community. The DLI was professionally translated (German, Italian, Tagalog, Vietnamese) with community review. Surveys were administered in preferred languages at baseline (T1) and ~6 weeks post-intervention (T2). Psychometrics (T1, n = 242): confirmatory factor analysis (CFA) and reliability. Impact (matched pairs, n = 100): Wilcoxon signed-rank tests. Results: Psychometrics (T1, n = 228): Subscale CFAs supported the translated DLI across groups, while the total-scale fit was poor – reinforcing a multidimensional construct; internal consistency was good–excellent overall, with weaker reliability for Talking Support subscale (Vietnamese) and some variability in Experiential Knowledge. Intervention impact (matched pairs, n = 100): Filipino participants showed significant increases in median scores across all four DLI subscales and the total DLI score (medium–large effects); Vietnamese participants showed significant decreases in Practical Knowledge and total DLI scores, with little change on other subscales; German and Italian groups demonstrated small, mostly non-significant increases on selected DLI subscales (particularly Factual and Community Knowledge), with minimal change in total DLI scores. Across groups, DLI subscales capturing knowledge of resources and supports generally improved. Conclusion: Culturally tailored, community-delivered interventions can strengthen death literacy, but effects vary by cultural/linguistic context. DLI subscales function adequately across groups, whereas total-scale fit is poor. Future work should refine translations (e.g. DLI-R), address weaker domains, and adapt content and delivery to community preferences to enhance cultural responsiveness and equity in end-of-life literacy. The study demonstrates how death literacy can operate as a culturally responsive, community-level public health indicator and provides evidence to guide adaptation of both the DLI and community programs to advance equity in end-of-life literacy and care.
Background The transition of care from the hospital to the home is a period of high risk for medication-related errors. This risk is further increased in hospitals in rural and regional areas, which face unique challenges such as geographical isolation and limited access to healthcare and healthcare providers. Aim To explore the formative perspectives of key stakeholders towards the implementation of a virtual Transitions of Care Stewardship (TOCS) service to improve medication management upon discharge from rural and regional hospitals, including facilitating a home medicines review (HMR). Method An interview guide was developed using the updated Consolidated Framework for Implementation Research. Key stakeholders were identified through professional networks and local healthcare providers and approached to participate. Semi-structured interviews were conducted in person or virtually (videoconference or teleconference) with patients, pharmacists, medical practitioners, nurses and allied health professionals between August and September 2024. Interviews were audio-recorded, transcribed verbatim, and continued until data saturation was reached. Data analysis was conducted using the framework approach to identify themes. Results In total, 37 interviews were conducted with healthcare professionals and patients in rural and regional New South Wales. Three main themes were identified: (1) factors affecting service acceptability (access to primary care, older patient demographic, health literacy, cultural acceptability of First Nations Peoples); (2) utilising existing components of healthcare (virtual pharmacists in rural areas, rural HMR- credentialed pharmacists, improving utilisation of allied health assistants, strategies to improve awareness); and (3) workflow of a TOCS pharmacist (coordination of HMR referral, importance of continuity). Conclusion Overall, a medication-centred discharge service in the form of a virtual TOCS pharmacist and their facilitation of post-discharge HMRs were found to be an acceptable intervention to enhance continuity of medication management for patients discharged from hospital to home in rural and remote areas.
