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Statistical analysisTo minimise the potential of bias, we combined data on individual patients and aggregate data in a very two stage approach. Data on individual patients were reduced to aggregate data to permit studies with only aggregate data for being combined with individuals with data on individual patients. Unless specifically stated, all estimates shown are from all available data. Point estimates and 95% confidence intervals were calculated for individual studies at each and every time point. Differences in effect estimates between trials as well as the predefined subgroups of patients are displayed with odds ratio plots, with heterogeneity investigated through the use of Cochran's and I2 statistics. Subgroup analyses to look around the causes of heterogeneity were undertaken should the P values of such tests were and, for continuous variables, calculated weighted mean differences30 at every time point. Data under 12 months were combined and are also described as results at 6 months.The primary outcome measure of dissatisfaction was investigated comprehensively by employing received data. Results at 1 year, when most studies had collected data, were put to use as the focus for analysis. When responses are not available at now point, data were substituted, firstly, from couple of years and failing that few months. Estimates of dissatisfaction any time were also examined, in addition to an analysis enabling the correlation from the repeated measurements using generalised estimating equations.If we can't directly compare treatments, we made indirect estimates having a logistic regression model making it possible for trial and treatment.
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For example, we estimated the effects for the comparison of hysterectomy versus second generation endometrial destruction with all the common comparators of first generation endometrial destruction and Mirena. It should be noted that with this particular analysis we assumed there are no systematic differences relating to the sets of trials that can bias the indirect measure. Access to data from individual patients also allowed the inclusion of patient level covariates to analyze possible predictors of dissatisfaction. Firstly, we considered covariates individually, while making it possible for differences between trial estimates by including this parameter inside model. If considered statistically important. ResultsTrials and patientsWe identified 556 potentially relevant citations by electronic searches. After detailed evaluation, trials were qualified to receive inclusion from the review. Of these trials, seven compared hysterectomy with endometrial destruction techniques. Six of the studies involved first generation techniques.The seventh study used a variety of first and second generation in equal proportions and was included here as an initial generation comparison, having a sensitivity analysis performed with no trial. Data coming from a further five studies, which involved comparisons within second and third generation endometrial destruction, were also received. IPD=individual patient data. IPD=individual patient data.
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Study was comparison of second generation endometrial destruction techniques and wouldn't contribute to meta analysis.Open in new tab.Trials that compared hysterectomy with endometrial destruction and those that compared second and third generation endometrial destruction involved women of your similar age, with average ages of 40.6 and 41.0, respectively. Women in trials comparing Mirena with endometrial destruction were slightly older, by having an average chronilogical age of 43.6. Eligibility criteria for female with uterine pathology varied between trials; inclusion of ladies with fibroids was generally tied to size or number from the fibroids. When affected women were included, they amounted with a maximum of 30% in the women in each one study. Overall, we received some data on individual patients from 65% of ladies involved from the trials, although only eight studies had the ability to provide all requested variables. The remaining studies had some missing information, with limited information on follow up of patients covering subsequent operations . Details on the way you used data from studies providing data from individual patients are within the section on statistical analysis. More than half the studies neglected to give adequate specifics of their randomisation procedure and information on allocation concealment. There was an overall lack of true intention to take care of analysis, by studies proclaiming that an intention to manage had been performed yet analysing solely those women who had received treatment. For four studies that reported per protocol analyses,intention to deal with analyses were undertaken with all the available data on individual patients, though it was not always clear if patients who deviated from protocol were followed up correctly in such cases. Small sample sizes often lacked a smart justification, specially in studies involving Mirena. In the nine trials involving Mirena, only four had a lot more than 80% of girls with Mirena in situ twelve months after randomisation.