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For the individual clustering a cut-off rc of 0.4 was used and the level of overclustering was set to 10 clusters, being over twice the expected number of clusters, similar to the procedure followed in the main analysis (Stage A: Individual clustering, step A2).
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We implemented a 3-stage analysis whereby stage-1 and −2 analyses were conducted to inform the interpretation of results of the main analysis in stage 3.
For the main analysis, one-stage individual participant data meta-analyses taking into account experiment clustering using binary logistic regression models (no analogue flashbacks vs. analogue flashbacks) were performed.
One author (MS) undertook the main analysis and during stages 4 (reviewing themes) and 5 (defining and naming themes) of the thematic analysis process [ 26] the analysis and relevant audit trail for each section were discussed with the co-authors (SH and AJ).
The main analysis used all relevant stage data from NCRS (see Additional file 1: appendix 1 for description of collection of stage data).
Although 768 patients were found to be diagnosed and treated between January 1973 and December 2002, after a careful data-cleaning, only 745 patients were taken into the analysis stage (the main exclusion was deaths occurring within one week of diagnosis).
The main analysis was confined to patients with known stage (complete case analysis).
In a few instances, heterogeneity was estimated and reported from a two-stage approach; even when a one-stage approach was used for the main analysis.
We did not include GOLD staging or infarct severity in the main analysis as data were not available in all patients.
There were 4 categories for stage (I, II, III and IV) in the initial main analysis (Table 2).
In the second sensitivity analysis restricted to patients with stage I III disease, stronger associations than in the main analysis were observed (Table 3).
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