Expert Advice Research Articles

Arthroplasty registries at a glance: an initiative of the International Society of Arthroplasty Registries (ISAR) to facilitate access, understanding, and reporting of registry data from an international perspective

Background and purpose: The amount of information publicly available from arthroplasty registries is large but could be used more effectively. This project aims to improve the knowledge concerning existing registries to facilitate access, transparency, harmonization, and reporting.Methods: Within the International Society of Arthroplasty Registries (ISAR) we aimed at developing, testing, adopting, and making publicly available a short, standardized registry description with items considered relevant for stakeholders using a cross-sectional study survey. Items were chosen based on a literature review and expert advice, selected by 9 ISAR working group members, tested iteratively in 3 registries, and commented upon by 4 external experts. All 29 ISAR member registries as of July 2023 were invited to participate in the project.Results: Included items covered general descriptive information regarding registries, information related to governance, outcomes, data quality, data access, and registry production. The template was adopted, completed, and made publicly available by 25 of the 29 registries. Of those, 2/3 were national registries. 23 captured both hip and knee arthroplasties and 10 captured shoulder arthroplasties. Most registries had public reporting of data quality, methods, and results. Data was accessible in all but 2 registries, mainly as aggregated data. Important items relevant to registry quality for researchers to consistently indicate in scientific papers include scope, inclusion criteria, outcomes definitions, coverage/completeness, and validation processes.Conclusion: This ISAR initiative implemented a short, standardized description to facilitate appropriate use of orthopedic registry data worldwide relevant for a diverse group of stakeholders including researchers, industry, public health and regulatory agencies.

Leveraging EdTech to drive AgriTech innovation for farmers in India

This case study examines the convergence of educational technology (EdTech) with agricultural technology (AgriTech) to tackle the issues encountered by small-scale farmers in India. This method seeks to augment farmers’ understanding of contemporary agricultural techniques, boost production, and promote market access via the integration of digital learning platforms and novel farming technology. The case examines the creation and execution of FarmED, a mobile learning platform that offers farmers tailored lessons, expert advice, and real-time information on agricultural methods, weather predictions, and market rates. Students will examine the business model of FarmED, investigate the obstacles to EdTech implementation in rural regions, and evaluate the social and economic ramifications of this effort. The teaching case promotes dialogue on the integration of digital education and AgriTech to enhance the livelihoods of smallholder farmers, as well as the obstacles encountered in scaling these innovations in areas with limited digital literacy and infrastructural constraints. The example provides significant insights for students examining company strategy, technological management, and rural development.

Strengthening National Immunization Technical Advisory Groups: Twelve Years of Progress (2012-2023).

Well-functioning National Immunization Technical Advisory Groups (NITAGs) are valuable contributors to decision-making processes in the complex immunization policy arena. This paper describes the progress made globally on the establishment and strengthening of these key advisory groups and discusses some of their strengths, challenges, and opportunities. The data submitted annually by countries to the World Health Organization (WHO) via the WHO/UNICEF Joint Reporting Form (JRF) were analyzed, comparing the NITAG functionality criteria in 2012 and 2023. In 2023 and 2012, 88% and 61% of countries, respectively, reported having a NITAG. A total of 77% of NITAGs met all six NITAG process criteria in 2023 compared to 33% in 2012. This progress was most notable in the WHO African Region, increasing from 7% (2012) to 77% (2023), and the South-East Asia Region, increasing from 45% (2012) to 91% (2023). In 2023, 84% of NITAGs issued a vaccine-policy recommendation that was adopted by decision-makers. Marked progress has been made since 2012 on establishing and maintaining NITAGs, with a small number of countries yet to form an advisory committee. Supporting and sustaining NITAG functions remains an important means for countries to foster independent and transparent expert advice on vaccine and immunization policy. Setbacks in countries facing instability or political turmoil are a reminder of the reversibility of progress. WHO and partners play an important role in supporting countries in strengthening these advisory committees. Continuous commitment by countries to the function and involvement of NITAGs in policy recommendations is essential for enhancing the strength and resilience of immunization programs.

Usefulness of a TDM-Guided Approach for Optimizing Teicoplanin Exposure in the Treatment of Secondary Bloodstream Infections Caused by Glycopeptide-Susceptible Enterococcus faecium.

To assess the clinical usefulness of teicoplanin optimized by means of a therapeutic drug monitoring (TDM)-guided approach for treating secondary bloodstream infections (BSIs) caused by Enterococcus faecium. Hospitalized patients having in the period 1 March 2021-31 October 2024 a documented BSI caused by glycopeptide-susceptible Enterococcus faecium being treated with teicoplanin as definitive targeted therapy optimized by means of a real-time TDM-guided expert clinical pharmacological advice (ECPA) program were retrospectively included. Teicoplanin trough concentrations (Cmin) ranging from 20 to 30 mg/L were defined as the desired target of efficacy based on international guidelines. Univariate analysis was performed for assessing variables potentially associated with microbiological failure (defined as persistence at the infection site of the index Enterococcus faecium strain after more than 7 days from starting treatment as documented by follow-up blood cultures). Overall, 67 patients (median age 70 years; male 55.2%) were included. Catheter-related BSIs (50.7%) and intrabdominal/biliary tract (29.9%) infections were the main sources of Enterococcus faecium BSI. The desired target of teicoplanin Cmin was attained in 62.7% of patients at the first TDM assessment and significantly increased to 85.1% (p = 0.003) at subsequent TDM-guided ECPA instances during the overall treatment course. Microbiological eradication was obtained in 95% of cases (63/67). In the univariate analysis, failing effective source control was the only variable associated with an increased risk of microbiological failure (75.0% vs. 12.7%; p = 0.01). Targeted TDM-guided teicoplanin therapy, coupled with effective source control of the primary infection site by granting microbiological eradication in the vast majority of cases, may be considered a reasonable strategy for managing glycopeptide-susceptible Enterococcus faecium secondary BSIs.

Making expert advice public in a time of emergency: Independent SAGE and the contestation of science during the Covid pandemic in the UK.

This article presents a situational analysis of the expert advice offered by Independent SAGE, a group of scientists that formed in May 2020 in the UK to provide advice on the Covid response. Based on interviews with the group's members and partners, we argue that through its interventions Indie SAGE demonstrated an important alternative approach to linking science and politics in a time of emergency. They showed that the only way to ensure that policy and decision-making on Covid-19 was grounded in knowledge was by making expert advice public. Indie SAGE's decision to 'go public' was a response to the political situation in the UK, one in which scientific advice, in particular public health expertise, was being ignored, sidelined and contested as such. We identify four rationales for making expert advice public: openness, calling out, translation, and responsive engagement. We describe associated modes of intervention that Indie SAGE adopted in relation to different critical situations of Covid-19. Distinctive about their advice, we argue, is its prioritization of situational adequacy. Much of it was explicitly oriented towards addressing practical and existential challenges experienced by particular social groups, professions and everyday publics. We argue that this way of making science public in an 'ontological' register acquires critical importance in a political situation like the UK Covid response, which was marked not just by disagreements about science but growing contestation of science as such. In this respect, our study holds a wider lesson for the understanding of the role of evidence in public politics. To advocate for evidence-based governance, as Indie SAGE did, is not necessarily to endorse a post-political vision of government. When science is contested in a time of emergency, making evidence public becomes a key means for responding to the demands of situations. It is not only pragmatic but a critical accomplishment.

Role, function, and expectations of research funding committees: Perspectives from committee members

Research funding committees play an integral role in the research funding process, consisting of a range of skills, knowledge, and expertise (e.g., professional, and public contributors). Although there is some evidence that has explored the efficiency and effectiveness of funding committees in terms of the funding process, there is a lack of published evidence about the purpose, role, and function of funding committees, from the perspective of committee members. A subset of survey data from a cohort of six National Institute for Health and Care Research (NIHR) research programmes, exploring the purpose of a funding committee, and the expectations and role of a funding committee member between October 2020 to December 2021. All committee members were eligible to participate in the survey. Using an inductive approach, 50 completed responses (22.5% response rate) were analysed, focusing on the role of a funding committee member and the functions of a funding committee. Participants highlighted seven key areas for the purpose of a funding committee: prioritising and recommending what research to fund (n=36) and assessment of quality (n=24) being the most common responses. Four areas were considered important to the expectations and role of funding committee members, with reviewing, critically appraising, and discussing applications (n=44); and being fair, objective, and unbiased (n=27) being the most common responses. The findings offer a unique insight into committee members’ expectations about the role, purpose and function of a funding committee and their contribution to the funding recommendation process. There was high agreement that the purpose and role of committees and their members was to offer expert advice to make fair, impartial decisions on which research should be prioritised. Exploring the purpose, role, and function of funding committees has relevance and importance for funding organisations seeking to enhance and optimise the decision-making practice of funding committees.

Haemoglobin for Fall Risk Screening in Gynaecological and Obstetric Wards: Retrospective Survey and Delphi Validation.

The objective of this study is to ascertain the suitability of haemoglobin as a screening factor for falls among obstetrics and gynaecology inpatients and to formulate a stratified scheme for assessing fall risk based on haemoglobin. A retrospective analysis and Delphi surveys were employed for this investigation. Initially, a retrospective survey analysed falls among obstetrics and gynaecology inpatients in two hospitals from January 1, 2020, to July 10, 2022. Descriptive statistics, receiver operating characteristic (ROC) curve analysis, Youden index, sensitivity and specificity were utilised for data examination. The conclusions drawn were subsequently validated by Delphi surveys, featuring 21 experts participating in five rounds of consultation. The Kappa value and the coefficient of variation (CV) were employed to assess expert advice. The area under the Receiver Operating Characteristic curve (AUC) of haemoglobin was 0.762 ± 0.030, 95% CI (0.703, 0.821). The highest Youden index was 0.425, with sensitivity at 0.705 and specificity at 0.720 when haemoglobin was 107.5 g/L. Two consensuses were reached by experts: anaemia was important in causing falls in obstetrics and gynaecology wards, and haemoglobin should be employed as a screening factor for falls. The stratification of anaemia was developed as follows: ≥ 110; 90-109; 60-89; and < 60 g/L. Approval for the final results was unanimous among all experts. The Kappa value (K*) was 1, and the CV of expert advice ranged from 0.092 to 0.219. Haemoglobin could potentially be used as a predictor of fall risk in Gynaecological and Obstetric Wards. The recommended stratified scheme for anaemia in fall risk assessment is as follows: ≥ 110; 90-109; 60-89; and < 60 g/L. What problem did the study address? The study revealed a relationship between falls and haemoglobin in obstetrics and gynaecology inpatients. It also proposed a stratification scheme for assessing fall risk based on haemoglobin levels. What were the main findings? Haemoglobin has a good performance on fall risk prediction in Gynaecological and Obstetric Wards. The stratified scheme of anaemia for fall risk assessment was suggested as follows: ≥ 110; 90-109; 60-89; and < 60 g/L. Where and on whom will the research have an impact? Nurses and inpatients in obstetrics and gynaecology wards will be affected by the results of this study, and it provided a reference for fall prevention. This study has adhered to relevant EQUATOR guidelines and named the reporting method. No Patient or Public Contribution.

Impact of Information Disorders in Librarians’ Community

Objective. Librarians' role is crucial in combating information disorders. Their ability to identify false information is a core professional competency. As librarians refine their professional identities, they also cultivate a robust knowledge practice. This paper delves into the impact of information disorders on the librarian community. Methods. A group of Filipino public librarians were interviewed to understand the librarians' perceptions of the severity and impact of information disorders on their communities. Results. After careful analysis of qualitative data, five themes emerged including credibility threat, detrimental information, unfounded claims, manipulation of information, and promotion of truthful information. Conclusions. Information disorders pose a serious threat to librarians and the public. Malicious actors exploit these to manipulate public opinion, leading to fraud and false expertise. Librarians can counter these threats by sharing credible resources. They can also address the crisis of credibility by sharing expert advice and advocating for the value of accurate information

Virtual reality simulations in robotic surgery training: a systematic review and meta-analysis.

To compare VR simulations with other training methods regarding improvements in objective assessment scores and task completion times. A database search was conducted on 20 May 2024 across Central, MEDLINE, EMBASE, Web of Science, and Scopus. Included were randomised controlled trials comparing VR simulations to other training methods, assessing objective scores and task times. The Risk of Bias-2 tool was used for bias assessment. Eighteen studies were included. VR significantly improved objective scores (n = 339, SMD 1.04, 95% CI 0.40-1.69, P = 0.002) and reduced task completion times (n = 357, SMD of -1.08, 95% CI of as -2.05 to -0.12, P = 0.03) compared to no additional training. VR was as effective as dry lab training for improving scores (n = 213, SMD -0.47, 95% CI -1.34 to 0.41, P = 0.30) and task times (n = 98, SMD -0.37, 95% CI -1.51 to 0.78, P = 0.53). However, one study found wet lab training significantly reduced task times compared to VR (n = 20, SMD of 1.7, 95% CI of 0.65-2.76, P = 0.002). No significant differences were found when VR alone was compared to VR with expert advice. VR is more effective than no additional training and is as effective as dry lab training in robotic skill acquisitions. Therefore, VR is effective in enhancing robotic surgery skills and warrants an expanded role in surgical training programmes.

Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya’s social health insurance model

ObjectivesTo analyse the potential of the Social Health Insurance (SHI) model to support the achievement of Universal Health Coverage (UHC) in Low and Middle-Income Countries (LMICs) through a policy analysis...

Historical aspect of the european understanding of the rule of law

Purpose. The article analyzes potential ways to improve Ukraine’s legal system using European standards and practices. The study analyzes the history of the rule of law in Europe, compares legal systems, studies legal reforms in Ukraine, analyzes statistical data, and identifies the main problems of the Ukrainian legal system. It was determined that although Ukraine has taken significant steps to prevent corruption since independence, the country’s legal system still requires significant changes.It is also found that the current state of the European rule of law shows mixed trends. In addition, leading European countries not only demonstrate successful models of the rule of law, but also actively support Ukraine in implementing such standards through various technical assistance programs and expert advice. Methodology. In order to achieve the set goal, a comprehensive analysis of the available information regarding the analyzed problem was carried out and conclusions and proposals were formed on their basis. The following methods of scientific knowledge were used during the research: dialectical, systemic-structural, terminological, systemic-functional, historical, normativedogmatic, generalization method. Originality. As a result of the research, it was found that the concept of the rule of law creates a platform, a basis for uniting all branches of law, especially given that different branches of our law are developed separately. The constitutional enshrinement of the rule of law and the rule of law principle determine the scope of activities of all branches of government and the methods of their operation. The state should not go beyond the boundaries of the legal field, crossing which the rule of law turns into its antithesis. The state cannot use methods in its activities that contradict the principles of the rule of law and the rule of law. Scientific novelty. The author establishes that the principle of the rule of law is, in fact, the only effective means of ensuring the inviolability of democracy, as well as one of its main features, and its enforcement and control is a guarantee of human rights to the extent that decent living conditions are created for each person. Practical significance. The analysis proves that the mere formation of a perfect system of legislation that enshrines fundamental human rights and freedoms and defines an effective legislative procedure is not enough to build a democratic society in our country. We need not only to enshrine the principle of the rule of law in the Constitution, but also to implement it in our daily activities.

Selecting a dietary assessment method for a national nutrition survey: a review and evaluation of online 24-h dietary recall tools.

Online 24-h dietary recall tools are commonly used in nationwide nutrition surveys to assess population diets. With a steep rise in the development of new and more advanced 24-h dietary recall tools, the decision of which tool to use for a national nutrition survey becomes increasingly challenging. Therefore, this short communication outlines the process of selecting a 24-h dietary recall tool for a national nutrition survey in New Zealand. To identify suitable 24-h dietary recall tools, a review of peer-reviewed and grey literature was conducted (2019-2022). Data on functionalities, validation, usability and adaptability were extracted for eighteen pre-specified tools, which were used in the subsequent evaluation process. Six of the eighteen tools had new relevant publications since 2019. The fourteen new publications described six validation studies and eight usability studies. Based on pre-selection criteria (e.g. availability, adaptability, previous use in national surveys), three tools were shortlisted: ASA24, Intake24 and MyFood24. These tools were further evaluated, and expert advice was sought to determine the most suitable tool for use in the New Zealand context. A comprehensive yet time- and cost-efficient approach was undertaken to identify the potential use of online 24-h dietary recall tools for a national nutrition survey. The selection process included key evaluation criteria to determine the tools' suitability for adaptation within the New Zealand context and ultimately to select a preferred tool. A similar approach may be useful for other countries when having to select 24-h dietary recall tools for use in national nutrition surveys.

The Impact of Pressure on Risk Evaluation in Decision-Making: A Case Study of Three Major Accidents

Decision-making is critical in organizational and managerial activities, and stress is an important factor influencing decision-making. This study examines how stress affects risk assessment and decision-making by analyzing three major accident cases (the Fukuchiyama Line derailment, the NASA Challenger STS-51L accident, and Boeing 737 Max 8 design problems). In the Fukuchiyama Line accident, the driver ignored the risk of speeding the train for fear of company penalties. In the Challenger accident, NASA ignored the risk of a leaking O-ring due to political, media, and internal cultural pressures. In the Boeing 737 Max 8 accident, Boeing ignored potential risks in the design of the MCAS system and a single sensor in an effort to catch up with competitor Airbus. This study points out that pressure can lead decision makers to ignore risks with disastrous consequences and suggests that the quality of decision making can be improved by information gathering, seeking expert advice and taking known issues seriously.

The Impact of Social Influences on Investment Decision-Making: A Multi-Method Analysis of Vietnamese Investors

This study explores the impact of social influences on investment decision-making, focusing on Vietnamese investors and employing a multi-method approach. Drawing on Social Contagion Theory, Behavioural Finance Theory, and Information Cascade Theory, the research examines how social media, peer pressure, and expert opinions shape investment behaviour. A representative sample of 368 individual investors was analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA), revealing significant direct effects of social influences, moderated by investment self-efficacy and risk perception. Notably, novice investors were more susceptible to peer pressure and social media, while experienced investors relied heavily on expert advice. The findings extend theoretical frameworks by elucidating the mediating and moderating mechanisms of social influences and providing boundary conditions based on investor experience. Methodological contributions include the integration of quantitative and qualitative approaches and advanced analytical techniques. Practical implications highlight the need for investment platforms to provide tailored decision-support tools, financial advisors to enhance investor self-efficacy, and regulators to address misinformation risks in digital platforms. Despite limitations such as reliance on self-reported data and a cross-sectional design, the study offers a robust foundation for future research into the dynamic interaction of social and cognitive factors in financial decision-making.

Development Of Bilingual Getrans Teaching Aids To Understand Geometry Transformation Material

This research aims to develop bilingual getrans teaching aids that can be used to visualise the concept of geometry transformation. The urgency of this research lies in the effort to facilitate students' understanding of abstract concepts in geometric transformations where the development of getrans teaching aids allows students to learn actively, involving physical and visual, which is believed to improve understanding and retention of concepts. Utilizing the 4D model, the Research and Development (R&amp;D) approach is applied. The four phases of the 4D development model are defined, designed, developed, and disseminated. The findings showed that students had trouble grasping the idea of geometric transformation at the define stage. At the design stage, preparation for the development of bilingual getrans teaching aids was carried out. At the development stage, getrans props were made as well as validation of video results by experts and limited trials to students. Then at the dissemination stage, the revised video results were disseminated based on expert advice. The conclusion of this research is that bilingual getrans teaching aids can be used for learning mathematics which students can better understand changes in position, rotation, reflection, or dilation of objects in geometry with better.

Legal obstacles jeopardise research in personalised medicine - experiences from a Nordic collaboration within rheumatology.

Personalised medicine in chronic complex diseases such as rheumatoid arthritis (RA) is within reach but requires international multi-stakeholder collaboration. We exemplify how national implementations of the General Data Protection Regulation (GDPR) have introduced administrative delays and created disincentives for data sharing and collaborative research. Our Danish/Swedish/Norwegian research collaboration (the 3-year NordForsk-funded "NORA" project) aims to develop a personalised medicine approach for the management of RA, built on the exploitation of unique existing data sources: longitudinal data from clinical rheumatology registries, research cohorts, nationwide health care registries, and biobank material from >20 sample collections. Data and results are shared and accessed remotely by collaborators at secure servers. New biomarker assays and patient-centric implementations of the results are to be explored, validated, and disseminated to patients and health care via the development of digital tools. Following the advice of legal experts at the involved academic or public institutions and private companies, GDPR compliance resulted in >20 legal documents to govern the collaboration (consortium-, joint controller-, research collaboration-, data sharing-, and a series of unique two-way data processing-, and material transfer agreements). Lack of agreed-upon templates, policies, procedures, and a shortage of legal resources have caused considerable delays. Thus, our research consortium has spent more time ensuring GDPR compliance than on actual research activities. The current interpretation and implementation of the legal premises (rather than the GDPR per se) for research collaborations caused unnecessary barriers and delays. Our experiences call for Nordic trust-based code-of-conduct-like framework agreements, and for harmonisation of procedures and templates, lest the Nordic advantage in research be lost.

What Giant Data Breaches Mean for You: Expert advice for protecting sensitive data.

What Giant Data Breaches Mean for You: Expert advice for protecting sensitive data.

SitFit: A core fitness tracker for improved sit-up accuracy and injury prevention

This study investigated the students’ perceptions of a self-paced fitness program that is integrated with SitFit, a fitness tracker that measures body inclination during sit-up exercises, and their acceptance of digital innovation in physical education. The data was gathered from a survey of 1001 Thai undergraduates. Results revealed that attitudes toward using the technology and the perceived ease of use were important predictors of behavioral intention to use the sit-up fitness tracker. consistent with previous TAM studies. Subsequently, SitFit was developed based on exercise principles and expert advice to enable users to exercise more effectively while reducing injury risk.

Reliable Autism Spectrum Disorder Diagnosis for Pediatrics Using Machine Learning and Explainable AI.

Background: As the demand for early and accurate diagnosis of autism spectrum disorder (ASD) increases, the integration of machine learning (ML) and explainable artificial intelligence (XAI) is emerging as a critical advancement that promises to revolutionize intervention strategies by improving both accuracy and transparency. Methods: This paper presents a method that combines XAI techniques with a rigorous data-preprocessing pipeline to improve the accuracy and interpretability of ML-based diagnostic tools. Our preprocessing pipeline included outlier removal, missing data handling, and selecting pertinent features based on clinical expert advice. Using R and the caret package (version 6.0.94), we developed and compared several ML algorithms, validated using 10-fold cross-validation and optimized by grid search hyperparameter tuning. XAI techniques were employed to improve model transparency, offering insights into how features contribute to predictions, thereby enhancing clinician trust. Results: Rigorous data-preprocessing improved the models' generalizability and real-world applicability across diverse clinical datasets, ensuring a robust performance. Neural networks and extreme gradient boosting models achieved the best performance in terms of accuracy, precision, and recall. XAI techniques demonstrated that behavioral features significantly influenced model predictions, leading to greater interpretability. Conclusions: This study successfully developed highly precise and interpretable ML models for ASD diagnosis, connecting advanced ML methods with practical clinical application and supporting the adoption of AI-driven diagnostic tools by healthcare professionals. This study's findings contribute to personalized intervention strategies and early diagnostic practices, ultimately improving outcomes and quality of life for individuals with ASD.

The experiences of rural generalist occupational therapists in provision of palliative care in rural, regional, and remote Australia: A phenomenological inquiry.

Access to specialist palliative care in rural and remote Australia is limited, resulting in a reliance on generalist health professionals to provide these services. Although literature exists concerning the experiences of some health professions in providing rural generalist palliative care, little is known about the experiences of occupational therapists who fill these roles. This paper aims to address this gap in knowledge by exploring the experiences of rural generalist occupational therapists in the provision of palliative care in rural, regional, and remote Australia. An interpretive phenomenological approach guided this research. Data were collected from eight rural generalist occupational therapists across Australia, using semi-structured, in-depth interviews. Data were thematically analysed to develop a nuanced understanding of lived experience in provision of palliative care. Due to the focus of this research on the practice experiences of occupational therapists, consumer and/or community involvement was not undertaken in its design or implementation. Three key themes were identified: 'community connections - a double-edged sword'; 'frustrations with structural and contextual factors limiting quality palliative care service provision'; and 'education and support as enablers of professional preparedness for palliative care service provision.' Taken collectively, these findings shed light on a variety of challenges and opportunities associated with rural generalist palliative care occupational therapy practice, as well as clues to their effective management. Knowledge of rural generalist occupational therapists' experiences can inform workforce development, promote retention of rural occupational therapists, and improve outcomes for dying persons, their families and caregivers. This study offers new insights into challenges and opportunities for rural generalist occupational therapy practice in palliative care and highlights the way in which both, new and existing support structures may be of value in promoting practice capacity and therapist wellbeing. It can be hard to get expert support for dying people in areas outside of cities in Australia. Health workers in these areas should be helped to provide good care. In this study, we spoke with some health workers in rural and remote areas who occasionally work with people who are dying. They told us that people in these areas were often helpful in supporting people who are dying because they felt close to them. But they also said that this made caring sadder for health workers because, sometimes, they were close to the people who were dying too. Having too much work, not enough experience and long distances made providing good care extra difficult. The health workers said that getting expert advice or using online teaching could help them improve their practice, but finding the time to do this is hard.