Systematic reviews of diagnostic test accuracy (DTA) studies are fundamental to the decision-making process in evidence-based medicine. Although such studies are regarded as high-level evidence, these reviews are not always reported completely and transparently. Sub-optimal reporting of DTA systematic reviews compromises their validity, generalizability, and value to key stakeholders. This thesis evaluates the completeness of reporting of published DTA systematic reviews based on the PRISMA-DTA checklist and provides an explanation for the new and modified items (relative to PRISMA), along with their meaning and rationale. Our results demonstrate that recently published reports of DTA systematic reviews are not fully informative, when evaluated against the PRISMA-DTA guidelines: mean reported items=18.6/26(71%, SD=1.9) for PRISMA-DTA; 5.5/11(50%, SD=1.2) for PRISMA-DTA for abstracts. The PRISMA-DTA statement, this document, and the associated website (http://www. prisma-statement.org/Extensions/DTA) are meant to be helpful resources to support the transparent reporting of DTA systematic reviews and guide knowledge translation strategies.

The sustainability of the REIPPP programme was as yet unknown. Through this study control drivers critical for the sustainability of the REIPPP programme were identified and prioritised. As background sustainability was investigated on an international level and within the South African context. Control drivers are drivers that have a significant impact on the sustainability of the REIPPP programme and also have some level of controllability. These drivers were obtained and compiled based on appropriate literature. The Global Reporting Guideline (GRI) for sustainability was used as baseline for identifying control drivers. To further obtain and verify the relevant sustainability control drivers, input from the REIPPP programme’s key stakeholders were included in the research. The key stakeholders provided an impact and controllability rating via a questionnaire, which was used to prioritise the identified control drivers. Selected key stakeholder where requested to review control drivers that were identified and prioritised, providing the researcher a means of verifying the preliminary proposed control drivers. Obtaining a final list of prioritised control drivers critical for the sustainability of the REIPPP programme was achieved by integrating the drivers identified by the researcher, stakeholder selected alternative drivers and their self-suggested control drivers. The prioritised control drivers could be used to promote or control the sustainability of the REIPPP programme by addressing and/or supporting the control drivers having the most significant impact. The top 5 prioritised control drivers were selected to be used in an interview with high level key stakeholders. The interviewees provided their input on how these drivers could be supported or addressed to control or even promote the sustainability of the REIPPP programme. From the interview it was clear that the final list of prioritised control drivers was relevant and could influence the long-term sustainability of the REIPPP programme. Many insights were obtained which could provide significant role players, or even the South African Government, the guidance they need to take the REIPPP programme forward. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2015

The sustainability of the REIPPP programme was as yet unknown. Through this study control drivers critical for the sustainability of the REIPPP programme were identified and prioritised. As background sustainability was investigated on an international level and within the South African context. Control drivers are drivers that have a significant impact on the sustainability of the REIPPP programme and also have some level of controllability. These drivers were obtained and compiled based on appropriate literature. The Global Reporting Guideline (GRI) for sustainability was used as baseline for identifying control drivers. To further obtain and verify the relevant sustainability control drivers, input from the REIPPP programme’s key stakeholders were included in the research. The key stakeholders provided an impact and controllability rating via a questionnaire, which was used to prioritise the identified control drivers. Selected key stakeholder where requested to review control drivers that were identified and prioritised, providing the researcher a means of verifying the preliminary proposed control drivers. Obtaining a final list of prioritised control drivers critical for the sustainability of the REIPPP programme was achieved by integrating the drivers identified by the researcher, stakeholder selected alternative drivers and their self-suggested control drivers. The prioritised control drivers could be used to promote or control the sustainability of the REIPPP programme by addressing and/or supporting the control drivers having the most significant impact. The top 5 prioritised control drivers were selected to be used in an interview with high level key stakeholders. The interviewees provided their input on how these drivers could be supported or addressed to control or even promote the sustainability of the REIPPP programme. From the interview it was clear that the final list of prioritised control drivers was relevant and could influence the long-term sustainability of the REIPPP programme. Many insights were obtained which could provide significant role players, or even the South African Government, the guidance they need to take the REIPPP programme forward. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2015

Les objectifs de cette thèse étaient de produire des connaissances nouvelles sur les méthodologies d’évaluation de l’optimalité des soins avec l’exemple des délais diagnostiques et des infections bactériennes sévères de l’enfant (IBS). Nous avons mis en évidence, dans deux revues systématiques de la littérature, que les points méthodologiques potentiellement associés à des risques de biais et d’obstacles à la transportabilité des résultats étaient rarement rapportés dans les études primaires sur les délais diagnostiques ou rarement évalués par les auteurs de méta-analyses. Nous avons donc construit et validé internationalement une reporting guideline pour aider les scientifiques à prendre en compte ces points méthodologiques critiques. Nous avons montré par une enquête confidentielle avec comité d’experts en population que : (i) les prises en charge étaient suboptimales pour 76% des enfants décédés d’IBS, (ii) un retard au recours médical, une sous-évaluation de la gravité ou un retard à l’antibiothérapie étaient retrouvés dans la prise en charge de respectivement 20%, 20% et 24% des enfants atteints d’IBS, (iii) les soins suboptimaux étaient indépendamment et fortement associés au risque de décès et (iv) les soins suboptimaux étaient plus fréquents chez les enfants de moins d’un an ou lorsque qu’ils n’étaient pas administrés par un médecin spécifiquement formé. La minimisation des biais dans la sélection des participants et la mesure de l’optimalité et la prise en compte de facteurs de confusion comme la sévérité intrinsèque de la maladie sont des éléments clefs de l’évaluation de l’optimalité des soins afin de produire des messages cliniques correctifs valides. / The aim of this thesis was to product new knowledge about the methodology on how to assess the optimality of care with the examples of time to diagnosis and serious bacterial infection (SBI). In two systematic reviews, we found that the key methodological points potentially related to risks of bias or threats to transportability were rarely reported in the primary studies and rarely evaluated by authors of systematic reviews. Then, we developed and internationally validated a reporting guideline to help scientists to better take into consideration these critical methodological points. In a population-based confidential inquiry, we found that: (i) care was suboptimal in 76% of the initial management of children who died from SBI, (ii) delayed first medical contact, undervaluation of severity or delayed antibiotic administration were detected in the management of 20%, 20% and 24% of children admitted to intensive care for a SBI, respectively, (iii) the total number of suboptimal cares delivered during the management was independently associated with death, and (iv) suboptimal cares were more frequent in children younger than one year old and if the care was delivered by a non specialist physician. Minimizing the risks of bias both in the selection process of the study population and in the assessment of the optimality of care, and taking into account confounding factors such as the intrinsic severity of the disease are keys elements to ensure a reliable evaluation of optimality of care in order to produce effective corrective clinical messages.

<b>Background:</b> Defined by their mechanisms, social and psychological interventions are those interventions that work through mental processes and social phenomena. They are often complex and challenging to evaluate, so understanding randomised controlled trials (RCTs) of these interventions requires detailed reports of the interventions tested and the methods used to assess them. However, reports of these RCTs often omit important information. Poor reporting hinders critical appraisal and synthesis of RCTs in systematic reviews, thereby impeding the effective transfer of research evidence to policy and practice. The Consolidated Standards for Reporting Trials (CONSORT) Statement is a reporting guideline that has contributed to improvements in the quality of RCT manuscripts in journals publishing medical research. However, studies have shown persistent deficiencies in the reporting quality of social and psychological intervention trials. A new CONSORT extension for these interventions may be needed given their distinct and complex features. This DPhil thesis reports on a project to develop and disseminate an official CONSORT Extension for Social and Psychological Interventions: CONSORT-SPI. <b>Structure:</b> Following a preface, this DPhil thesis includes eight chapters. Chapter 1 provides an overview of the conceptual rationale that prompted the CONSORT-SPI project. Chapter 2 details the project protocol, which consists of a five-phase methodology that follows current best practices for reporting guideline development and dissemination. Chapter 3 discusses systematic literature reviews to assess reporting guidelines for and the reporting quality of publications of social and psychological intervention RCTs. Chapter 4 discusses an online, international Delphi process to generate a prioritised list of possible items to include in the CONSORT-SPI extension. Chapter 5 discusses a formal consensus meeting to select reporting items to add to or modify for the CONSORT-SPI Extension checklist. Chapter 6 involves drafts of the CONSORT-SPI checklist as well as a template for the Explanation and Elaboration (E&E) document providing detailed advice and examples of good reporting for each checklist item. These drafts have not yet been circulated to co-authors or other members of the project team; their purpose in this thesis is to give an indication of how previous project phases have led into initial prototypes of the checklist and E&E, which will undergo further development and revision by the project team before publication. Chapter 7 proposes a coordinated dissemination and implementation strategy informed by theoretical frameworks and tools used to guide the implementation of clinical guidelines and empirically-supported interventions. The final chapter summarises the information gained from the CONSORT-SPI project to date, assesses strengths and limitations of the project methodology, and discusses implications for future research. <b>Conclusion:</b> A CONSORT-SPI Extension could improve the reporting quality of social and psychological intervention RCTs. This extension could also facilitate better critical appraisal of this body of research and its use in evidence-based decision-making. With successful dissemination and implementation, the guideline will hopefully contribute to the improvement of intervention evaluations—as well as the methodology underpinning these studies—within the social and behavioural sciences.