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Background: Building research capacity, culture and capability (RCCC) among healthcare practitioners is essential for evidence-informed care. No umbrella review has synthesised review-level evidence on RCCC across professions and settings.

Objective: To synthesise and critically appraise systematic reviews on documented factors influencing RCCC among healthcare practitioners, and to identify strategies that strengthen these factors within healthcare settings.

Methods: MEDLINE, Embase, CINAHL, Scopus and Cochrane (2005-2025; English) were searched for systematic reviews on RCCC among healthcare practitioners. Reviews underwent two-stage screening and were then appraised using the Joanna Briggs Institute checklist. Data were synthesised thematically and mapped to an ecological model (individual, interpersonal, organisational, community/network, policy/system).

Results: Nineteen reviews were included; most were high quality. Barriers included time constraints, limited skills, lack of mentorship, infrastructure gaps, and short-term funding. Strategies spanned multiple levels: education, mentoring, protected time, dedicated roles, partnerships, practice-based research networks, and policy supports such as multi-year funding and streamlined ethics. Evidence on long-term implementation of research capacity building interventions and low-resource settings was limited.

Conclusions: RCCC in healthcare settings is shaped by multi-level and interconnected factors, requiring coordinated and context-sensitive strategies to overcome persistent challenges and harness key enablers. Viewing these factors through an ecological lens is a valuable reference for understanding and organising the information gathered about research support initiatives to align them with established research in healthcare frameworks. To ensure sustainable impact, rigorous evaluation systems must be applied to demonstrate the successful adoption of research facilitators and their contribution to strengthening evidence-based practice.

Registration: PROSPERO: CRD420251007398.

Background: Difficulties in accessing healthcare services represent a major preoccupation in many countries. These difficulties have been shown to negatively affect the well-being and quality of life of people living with physical disabilities. Nonetheless, research on access to services within rehabilitation remains limited, especially regarding strategies for improvement.

Objectives: To identify and characterize innovations implemented to improve access to publicly funded outpatient rehabilitation services for people experiencing physical disabilities, and to explore main barriers and facilitators to implementation.

Design: An environmental scan was conducted in the province of Québec (Canada), combining an online search and semi-structured interviews with key informants.

Methods: Innovations were identified through searching grey literature. For each identified innovation, data on implementation context, targeted access issue(s), and indicators used to measure impact were extracted and analyzed descriptively. Interviews were carried out to provide complementary data on the innovations and to identify barriers and facilitators. They were transcribed and then analyzed using a mixed inductive/deductive thematic approach.

Results: Twenty-seven innovations, implemented in various regions and settings, were identified. Most of these targeted individuals with musculoskeletal disorders and addressed issues such as long wait times, geographical inequalities, and inappropriate care. Interviews were conducted with informants (n = 26) involved in 20 of the innovations. Main barriers to implementation included divergences between actors' perspectives on the relevance of innovations, their complexity and insufficient resources. Main facilitators were having strong planification and individual's engagement in the implementation.

Conclusions: This study enhances our understanding of the nature and purpose of innovations aimed at improving access to outpatient rehabilitation for people with physical disabilities. Implementation is a complex process that requires careful consideration of multiple factors.

Background: Arthritis impacts approximately one in five Canadians, with hip and knee osteoarthritis being the most prevalent and can require total joint replacement (TJR) surgeries. In Saskatchewan, patients access pre-surgical assessments for hip and knee replacements at urban multidisciplinary clinics, and rural and remote residents face significant barriers to accessing these services. Indigenous Peoples experience disproportionally higher rates of arthritis and additional barriers accessing appropriate care.

Objectives: The objective of this project was to identify the unique needs, strengths, and preferences of First Nation and Métis Peoples in accessing and receiving care for TJR.

Design: An explorative qualitative approach.

Methods: This study involved semi-structured qualitative interviews with 7 First Nation and Métis community members who have had or are awaiting hip or knee TJR and 6 orthopedic health care providers who have experience working with First Nation and Métis patients undergoing TJR. Health care providers included men and women, Indigenous and non-Indigenous participants. Community member participants completed a demographic and health questionnaire prior to the interview, with descriptive statistics used to determine participant characteristics. Ages of First Nation and Métis community members ranged from 43 to 75 years old (M = 59.57, SD = 10.66). Iterative thematic analysis and consensus building strategies were used to analyze data using NVivo 14 software.

Results: First Nation and Métis patient perspectives highlighted five major themes: 1) Difficulty Accessing Care, 2) Community and Family Support, 3) Pre-Surgical Experience, 4) Quality of Life, and 5) Virtual Care. Health care provider interviews indicated three major themes: 1) Challenges Accessing Care, 2) Education Associated with Total Joint Replacements, and 3) Future Resource and Implementation Needs.

Conclusion: The results indicated a need for increased access to culturally responsive pre-surgical education and informed recommendations for future pre-surgical rehabilitation care interventions.

Background: The management of autism and other comorbidities among children and young adults places a substantial economic and logistical burden on families. Telemedicine offers potential benefits for children and young adults with autism by improving access to care, reducing costs, and supporting families in managing ongoing treatment needs, all highlighted during the COVID-19 pandemic. While telemedicine has shown positive benefits in neurotypical pediatric populations, limited evidence supports and describes the use of telemedicine for children with autism.

Objective: This study examined children and young adults with autism and assessed the association between telemedicine services and annual combined out-of-pocket (OOP) medical costs among children and young adults with autism.

Design: Cross-sectional data from the U.S. nationally representative Medical Expenditure Panel Survey (MEPS) were analyzed. Independent variables included demographics, medical conditions, utilization patterns, and healthcare expenditures. A weighted log-linear regression model estimated combined medical OOP costs, and a binary weighted logistic regression examined factors associated with telemedicine use.

Data: The study cohort included 189 children and young adults with autism aged 1-21 years from 2020 to 2023.

Results: Among them, 62 (32.8%) used telemedicine. By 2023, telemedicine utilization among children and young adults with exceeded those who did not use telemedicine. Telemedicine utilization did not have a significant effect on OOP costs (EXP(β) = 1.30, p = 0.17). Insurance type showed a strong effect, with individuals without Medicaid having much higher odds of incurring OOP costs than those with Medicaid (EXP(β) = 15.91, p < 0.001). Black or African American children had significantly lower odds of telemedicine use compared to non-Hispanic White children (Exp(β) = 0.17, p < 0.05).

Conclusion: Telemedicine use was not significantly associated with combined OOP medical costs among children and young adults with autism. However, differences were observed in telemedicine use and OOP costs.

Background: Individuals with traumatic spinal cord injuries (TSCI) can encounter different experiences when accessing care, especially between individuals receiving care from the Veterans Affair (VA) health care insurance and commercial insurance.

Objectives: The purpose of this study was to explore the barriers and facilitators in access to care among individuals with TSCI receiving care from the VA and commercial insurance.

Design: We used a qualitative descriptive study and interviewed 31 participants (n = 13, receiving care through the VA; n = 18, commercially insured).

Methods: Participants and their caregivers participated in a semi-structured interview. To analyze the data, we used thematic text analysis to identify overarching themes.

Results: We identified four themes: (a) challenges identifying appropriate and adequate specialized care, (b) financial assistance is limited when accessing care, (c) lack of proximity to care leads to social and contextual barriers, and (d) enhancing care through close social support systems. The first three themes were barriers to care while the latter theme was identified as a facilitator. Most participants from the VA noted challenges finding an adequate formal caregiver, whereas individuals receiving care from commercial insurance reported primarily receiving help from informal caregivers. Financial impediments were discussed between both groups, but those receiving care through commercial insurance noted the most challenges. Finally, individuals receiving care from the VA had support from the VA regarding adaptations to their home environment, whereas civilians often asked informal caregivers (e.g., family, friends, community) for help.

Conclusions: The findings from this study illuminate the need for specialized care centers, caregivers, and additional supports for individuals with TSCI.

Background: Clinal Quality Registries (CQRs) often collect patient reported measures (PRMs) for the purpose of reporting these data to clinicians. By incorporating PRM data, CQRs and participating healthcare providers can gain a more comprehensive understanding of patient experiences and outcomes to inform both individual care and broader health service improvements. However, many CQRs do not routinely provide patient access to PRM data or report these data back to patients.

Objectives: To understand how PRMs captured in CQRs should be reported to patients, and to develop a guide for reporting registry-collected PRMs to this population.

Methods: First, a targeted literature review was undertaken, involving a structured search of the scientific literature to identify evidence on patient preferences regarding the reporting of PRMs. Data were extracted and managed using Microsoft Excel. Second, focus group discussions were conducted with 15 registry consumers to explore their PRM information needs, and preferences for how registry-collected PRM data should be reported.

Results: The literature review identified 23 studies and found that many patients preferred to receive their own PRM data. Access to these data helped them better understand their health, support discussions with clinicians, and feel more empowered in their care. Graphical displays and lay summaries were most preferred. Focus group participants also valued receiving aggregate reports and being informed about how their data were used and recommended clear terminology and accessible formats for diverse audiences.

Conclusion: Based on the findings from this study, we developed a guide with practical resources, examples, and guidance for CQRs on how to engage with patients in the PRMs' reporting process. The goal of this document is to support transparency in PRMs reporting, patient engagement with CQRs, and the real-world use of this data for improving healthcare quality.

Background: The "code of silence" in healthcare refers to reluctance among professionals to report misconduct or unsafe practice. Prior research in the United States identified tensions between personal ethics, professional standards, and organizational pressures in shaping speaking-up behavior. It remains unclear whether these dynamics extend across institutional and cultural contexts.

Purpose: This study examines whether patterns of awareness and response to inappropriate practice previously identified in a U.S. sample replicate in Romania, and how institutional context may shape interpretations of responsibility and reporting behavior.

Design and method: Using a structured replication design, we administered the same core survey instrument used in the prior U.S. study to all licensed clinical staff at a large Romanian public hospital (N=458 invited; 201 complete responses). Comparative analysis examined descriptive patterns of indirect and direct awareness, actions taken, reasons for inaction, and perceived outcomes.

Results: Reluctance to act following awareness of inappropriate practice was observed in both contexts, suggesting cross-system robustness of silence-related dynamics and raises the possibility of important differences. Exploratory evidence suggests that U.S. respondents appear to report higher awareness levels and greater reliance on formal supervisory reporting channels, whereas Romanian respondents seem to more frequently report direct interpersonal intervention and greater uncertainty about outcomes. Differences appear consistent with variation in regulatory structures, reporting mandates, and hierarchical norms.

Conclusion: The code of silence appears across healthcare systems but may operate through context-specific mechanisms. In more formalized regulatory environments, responsibility may be more often enacted through institutional escalation, whereas in other settings it may be framed as interpersonal correction. The findings also suggest that effective interventions must distinguish between episodic and recurring problems, as well as between clinical error and inappropriate conduct. To clarify these distinctions, we propose a Deming-inspired governance framework indicating that different types of problems require different institutional responses, ranging from learning-oriented process improvement to formal accountability mechanisms.

This study investigated the spatiotemporal variability of fine particulate matter (PM_2.5) in Addis Ababa, Ethiopia and assessed its associated health risks and economic burden using data from January 2022 to December 2023. Hourly PM_2.5 concentrations were collected through a hybrid monitoring network comprising seven low-cost sensors and two Beta Attenuation Monitors (BAM). Spatiotemporal analysis was performed using Python, and health risks were assessed by estimating the Hazard Quotient (HQ) and Excess Lifetime Cancer Risk (ELCR). The economic burden attributable to PM_2.5 exposure was assessed by monetizing disease-specific Disability-Adjusted Life Years (DALYs) using a locally adapted Value of Statistical Life (VSL) approach. Over the two-year periods, mean PM_2.5 concentrations ranged from 15 to 33 μg/m³ across monitoring sites, with an overall a citywide average of 27 μg/m³, exceeding the World Health Organization (WHO) Air Quality Guideline (AQG) of 5 μg/m³ by more than fivefold. Seasonal analysis revealed elevated PM_2.5 concentrations during the wet season (Kiremt), while diurnal patterns showed peaks of 38 µg/m³ at 7:00 AM. The HQ values for all age groups exceeded the acceptable threshold of 1, indicating non-carcinogenic health risks. ELCR estimates calculated using a slope factor of 0.008 exceeded the risk threshold (1 ×10^-4), whereas estimates based on the slope factor of 0.0012 remained within the acceptable limits, highlighting the sensitivity of cancer risk estimates to the toxicity parameter applied. The economic burden attributable to PM_2.5 exposure was estimated at USD 652.95 million over the two-year study period, contributing an external cost share to national GDP of 0.25% in 2022 and 0.25% in 2023. Cardiovascular diseases, particularly ischemic heart disease (IHD), accounted for the largest share of economic losses, significantly exceeding acute respiratory infections and PM_2.5 related cancers. These findings provide evidence to support targeted policies aimed at reducing PM_2.5 related cancers combined.

Background: Maryland implemented an all-payer hospital global budget revenue (GBR) model in 2014 to decouple hospital revenue from volume and improve revenue predictability. This study evaluated whether Maryland's 2014 GBR implementation was associated with differential changes in hospital total margins, inpatient revenue per discharge, and COVID-period margin volatility relative to Massachusetts.

Methods: A matched hospital-year panel for Maryland and Massachusetts spanning 2010-2023 (2,261 matched observations) was constructed by merging Medicare cost report-based financial measures with provider characteristics using CMS certification identifiers. Two-way fixed-effects difference-in-differences models with hospital and year fixed effects and hospital-clustered standard errors estimated post-2014 changes in outcomes in Maryland relative to Massachusetts. Identification was assessed using an event-study specification and a placebo test (fake treatment in 2012, restricted to the pre-period). Financial stability under pandemic shock was evaluated using a COVID-period differential effect on margin volatility, defined as the absolute year-over-year change in total margin. An additional restricted sensitivity analysis for 2010-2019 adjusted for available case-mix and payer-mix covariates.

Results: GBR implementation was not associated with a statistically detectable change in total margins (β = 0.021, p = 0.232). In contrast, GBR was associated with higher log inpatient revenue per discharge in Maryland relative to Massachusetts after 2014 (β = 0.287, p = 0.003), consistent with an approximate 33% increase in revenue per discharge (exp[0.287]-1). However, in the restricted 2010-2019 sensitivity analysis adjusting for available case-mix and payer-mix covariates, this association was attenuated and no longer statistically significant (β = 0.030, p = 0.513). Margin volatility during COVID-19 did not differ significantly between states (β = -0.018, p = 0.161). The placebo test showed no spurious effect in the pre-period (β = -0.008, p = 0.801), supporting the validity of the design.

Conclusions: Maryland's all-payer global budgets were associated with higher revenue per discharge in the primary model, but with no detectable change in total margins or in differential margin volatility during COVID-19. The revenue-per-discharge finding was sensitive to adjustment for available case-mix and payer-mix covariates in a restricted sensitivity analysis, supporting a cautious interpretation. These findings are consistent with GBR altering revenue intensity without clear evidence of improved profitability or shock-absorbing effects over 2010-2023.

Background: Best-practice recommendations for stroke care are available worldwide, yet there are challenges implementing these guidelines, contributing to gaps in stroke care. Clinicians delivering stroke services can inform improvements in stroke care delivery and outcomes.

Objectives: We aimed to conduct an in-depth examination of clinicians' perspectives on current gaps in stroke care throughout the entire care continuum, with a specific focus on the context of Ontario, Canada.

Design: This is a qualitative interpretive descriptive study.

Methods: Semi-structured interviews and focus groups were conducted with licensed clinicians who had experience providing stroke care in hospital or community settings in Ontario. The interviews were audio-recorded and transcribed verbatim. Analysis followed Thorne's interpretive description analysis techniques.

Results: Fourteen clinicians from five organizations participated in this study. Clinicians were occupational therapists (n=4), speech-language pathologists (n=5), physiotherapists (n=2), nurses (n=2), and a stroke coordinator (n=1). Clinicians identified the following four overarching gaps in patient- and family-centred stroke care: delays in recognition and response to stroke symptoms (theme 1), challenges in delivering and retaining stroke education (theme 2), variation in stroke care resources, quality, and rehabilitation access (theme 3), and gaps in continuity of care across the stroke care continuum (theme 4).

Conclusion: The findings from this study offer critical insights into current gaps in stroke care. Addressing these patient- and family-centred gaps may improve the quality of stroke care and outcomes for patients and families.