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Godara K, Phakey N, Garg D, Sharma S, Das RR. Interventions to Improve Medication Adherence in Children With Epilepsy: A Systematic Review. Cureus 2024; 16:e54680. [PMID: 38523977 PMCID: PMC10960523 DOI: 10.7759/cureus.54680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Low medication adherence remains a major challenge in the treatment of epilepsy, particularly in children. In recent years, several approaches and interventions have been employed to promote medication adherence in children with epilepsy (CWE). In this study, we aimed to summarize the evidence on these interventions. In this systematic review, major medical electronic databases were searched for relevant literature from January 2005 till July 2023, including PsycINFO, Medline (via PubMed), Google Scholar, Taylor & Francis databases, and CENTRAL by the Cochrane Library. We planned to include observational studies (with a control arm) and clinical trials involving children/adolescents (<19 years) with epilepsy and/or their caregivers/families who underwent any intervention to improve adherence to anti-seizure medications. Out of 536 articles searched, eight (six randomized trials and two non-randomized intervention studies) were included in the systematic review. A total of 2,685 children/adolescents along with their caregivers participated in these studies. Six studies used educational and two used behavioral interventions to improve adherence to anti-seizure medications. Four studies showed variable levels of adherence improvement, ranging from 2-20% up to 73.9% post-intervention. To conclude, the findings suggest the potential for educational interventions to promote medication adherence in CWE. The class of evidence was II to III among the included studies, as per American Academy of Neurology guidelines.
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Affiliation(s)
- Karishma Godara
- Psychology, Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, IND
| | - Nisha Phakey
- Psychology, Chitkara School of Psychology & Counselling, Chitkara University, Rajpura, IND
| | - Divyani Garg
- Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Suvasini Sharma
- Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, IND
| | - Rashmi R Das
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Thorn JC, Davies CF, Brookes ST, Noble SM, Dritsaki M, Gray E, Hughes DA, Mihaylova B, Petrou S, Ridyard C, Sach T, Wilson ECF, Wordsworth S, Hollingworth W. Content of Health Economics Analysis Plans (HEAPs) for Trial-Based Economic Evaluations: Expert Delphi Consensus Survey. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:539-547. [PMID: 33840432 PMCID: PMC8024512 DOI: 10.1016/j.jval.2020.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/23/2020] [Accepted: 09/12/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Health economics analysis plans (HEAPs) currently lack consistency, with uncertainty surrounding appropriate content. We aimed to develop a list of essential items that should be included in HEAPs for economic evaluations conducted alongside randomized trials. METHODS A list of potential items for inclusion was developed by examining existing HEAPs. An electronic Delphi survey was conducted among professional health economists. Respondents were asked to rate potential items from 1 (least important) to 9 (most important), suggest additional items, and comment on proposed items (round 1). A second survey (round 2) was emailed to participants, including the participant's own scores from round 1 along with summary results from the whole panel; participants were asked to rerate each item. Consensus criteria for inclusion in the final list were predefined as >70% of participants rating an item 7-9 and <15% rating it 1-3 after round 2. A final item selection meeting was held to scrutinize the results and adjudicate on items lacking consensus. RESULTS 62 participants completed round 1 of the survey. The initial list included 72 potential items; all 72 were carried forward to round 2, and no new items were added. 48 round 1 respondents (77.4%) completed round 2 and reached consensus on 53 items. At the final meeting, the expert panel (n = 9) agreed that 58 items should be included in the essential list, moved 9 items to an optional list, and dropped 5 items. CONCLUSIONS Via expert consensus opinion, this study identified 58 items that are considered essential in a HEAP.
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Affiliation(s)
- Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Charlotte F Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sara T Brookes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian M Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ewan Gray
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Oxford National Institute for Health Research Biomedical Research Centre, The Joint Research Office, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK & Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, The Joint Research Office, Oxford, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Al-Aqeel S, Gershuni O, Al-Sabhan J, Hiligsmann M. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database Syst Rev 2020; 10:CD008312. [PMID: 33089492 PMCID: PMC8092477 DOI: 10.1002/14651858.cd008312.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017. OBJECTIVES To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. SEARCH METHODS For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles. SELECTION CRITERIA RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. MAIN RESULTS We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention. AUTHORS' CONCLUSIONS Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Olga Gershuni
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jawza Al-Sabhan
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Ragazzo J, Cesta A, Jassal SV, Chiang N, Battistella M. Development and Validation of a Uremic Pruritus Treatment Algorithm and Patient Information Toolkit in Patients With Chronic Kidney Disease and End Stage Kidney Disease. J Pain Symptom Manage 2020; 59:279-292.e5. [PMID: 31610269 DOI: 10.1016/j.jpainsymman.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/04/2023]
Abstract
CONTEXT Uremic pruritus (UP) affects up to half of all patients with kidney disease and has been independently associated with poor patient outcomes. UP is a challenging symptom for clinicians to manage as there are no validated guidelines for its treatment. OBJECTIVES The study aimed to develop and validate an algorithm and patient information toolkit for the treatment of UP in patients with kidney disease. METHODS The study involved a literature search and development of an initial draft algorithm, followed by content and face validation of this algorithm. Validation entailed three rounds of interviews with six nephrology clinicians per round. Participants assessed the relevance of each component of the algorithm and then rated a series of statements on a scale of 1-5 to assess face validity of the algorithm. After each round, the content validity index (CVI) of each algorithm component was calculated, and the algorithm was revised by the study team in response to findings. This process was followed by a second study that developed and validated a patient information pamphlet and video. RESULTS Algorithm validation participants were affiliated with three institutions and included seven physicians, four registered nurses, three nurse practitioners, three pharmacists, and a dietician. The average CVI of the algorithm components across all three rounds was 0.89, with 0.80 commonly cited as the lower acceptable limit for content validation. More than 78% of participants rated each face validity statement as "Agree" or "Strongly Agree". For the patient information tools, five clinicians and 15 patients were included in validation. The average CVI was 1.00 for both tools, and the average face validity was 92%. CONCLUSION A treatment algorithm and patient information toolkit for managing UP in patients with kidney disease were developed and validated through expert review. Further research will be conducted on implementation of the treatment algorithm and evaluating patient-reported outcomes.
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Affiliation(s)
- Jessica Ragazzo
- University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - S Vanita Jassal
- University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada.
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Ridsdale L, McKinlay A, Wojewodka G, Robinson EJ, Mosweu I, Feehan SJ, Noble AJ, Morgan M, Taylor SJ, McCrone P, Landau S, Richardson M, Baker G, Goldstein LH. Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial. Health Technol Assess 2019; 22:1-142. [PMID: 29717699 DOI: 10.3310/hta22210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN A parallel pragmatic randomised controlled trial. SETTING Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Feehan
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie Jc Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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McKinlay AR, Ridsdale LL. Views of People With Epilepsy About Web-Based Self-Presentation: A Qualitative Study. Interact J Med Res 2018; 7:e10349. [PMID: 30578229 PMCID: PMC6320425 DOI: 10.2196/10349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Web-based media, particularly social networking sites (SNSs), are a source of support for people with long-term conditions, like epilepsy. Living with epilepsy can reduce opportunities for accessing information and social support owing to transportation difficulties and stigma leading to self-isolation. However, some people with epilepsy (PWE) overcome these barriers using SNSs and other Web-based media. At present, little is known about Web-based identity and self-presentation of PWE; this study aims to address this gap. Objective This study aims to describe how the use of digital technologies, such as SNSs, impacts sense of identity in PWE. Methods We used qualitative research methods to examine Web-based media use and self-presentation in a group of 14 PWE (age range: 33-73 years; 7 men and 7 women). The median diagnosis duration was 25 years. Semistructured interviews ranged from 40 to 120 minutes, held at participants’ homes or in a public place of their choice, in the United Kingdom. QSR Nvivo 11 software was used to perform an inductive thematic analysis. Results In this study, 9 participants used Web-based media to “silently” learn from other PWE by reading user posts on SNSs and epilepsy-related forums. When asked about self-presentation, 7 participants described feeling cautious about disclosing their epilepsy to others online. Six participants presented themselves in the same manner irrespective of the situation and described their identity as being presented in the same way both online and offline. Conclusions PWE can deploy SNSs and Web-based media to manage aspects of their condition by learning from others and obtaining social support that may otherwise be difficult to access. Some PWE share openly, whereas others silently observe, without posting. Both benefit from the shared experiences of others. Privacy concerns and stigma can act as a barrier to sharing using Web-based media and SNSs. For some, Web-based media offers a chance to experiment with identity and change self-presentation, leading to gradually “coming out” and feeling more comfortable discussing epilepsy with others.
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Affiliation(s)
- Alison Ruth McKinlay
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Leone Lorna Ridsdale
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Wijnen BFM, Mosweu I, Majoie MHJM, Ridsdale L, de Kinderen RJA, Evers SMAA, McCrone P. A comparison of the responsiveness of EQ-5D-5L and the QOLIE-31P and mapping of QOLIE-31P to EQ-5D-5L in epilepsy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:861-870. [PMID: 28871490 PMCID: PMC6008365 DOI: 10.1007/s10198-017-0928-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/25/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To investigate the responsiveness of and correlation between the EQ-5D-5L and the QOLIE-31P in patients with epilepsy, and develop a mapping function to predict EQ-5D-5L values based on the QOLIE-31P for use in economic evaluations. METHODS The dataset was derived from two clinical trials, the ZMILE study in the Netherlands and the SMILE study in the UK. In both studies, patients' quality of life using the EQ-5D-5L and QOLIE-31P was measured at baseline and 12 months follow-up. Spearman's correlations, effect sizes (EF) and standardized response means (SRM) were calculated for both the EQ-5D-5L and QOLIE-31P domains and sub scores. Mapping functions were derived using ordinary least square (OLS) and censored least absolute deviations models. RESULTS A total of 509 patients were included in this study. Low to moderately strong significant correlations were found between both instruments. The EQ-5D-5L showed high ceiling effects and small EFs and SRMs, whereas the QOLIE-31P did not show ceiling effects and also showed small to moderate EFs and SRMs. Results of the different mapping functions indicate that the highest adjusted R 2 we were able to regress was 0.265 using an OLS model with squared terms, leading to a mean absolute error of 0.103. CONCLUSIONS Results presented in this study emphasize the shortcomings of the EQ-5D-5L in epilepsy and the importance of the development of condition-specific preference-based instruments which can be used within the QALY framework. In addition, the usefulness of the constructed mapping function in economic evaluations is questionable.
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Affiliation(s)
- Ben F M Wijnen
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
- , Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
| | - Iris Mosweu
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Marian H J M Majoie
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
- Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe and Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Reina J A de Kinderen
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Paul McCrone
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
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Ridsdale L, Wojewodka G, Robinson EJ, Noble AJ, Morgan M, Taylor SJC, McCrone P, Richardson MP, Baker G, Landau S, Goldstein LH. The effectiveness of a group self-management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial. Epilepsia 2018; 59:1048-1061. [PMID: 29658989 PMCID: PMC5969309 DOI: 10.1111/epi.14073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Epilepsy is one of the most common neurological conditions affecting about 1% of adults. Up to 40% of people with epilepsy (PWE) report recurring seizures while on medication. And optimal functioning requires good self-management. Our objective was to evaluate a group self-management education courses for people with epilepsy and drug-resistant seizures by means of a multicenter, pragmatic, parallel group, randomized controlled trial. METHODS We recruited adults with epilepsy, having ≥2 seizures in the prior 12 months, from specialist clinics. Consenting participants were randomized 1:1 to a group course or treatment as usual. The primary outcome measure was quality of life 12 months after randomization using Quality of Life 31-P (QOLIE-31-P). Secondary outcome measures were seizure frequency and recency, psychological distress, impact and stigma of epilepsy, self-mastery, medication adherence, and adverse effects. Analysis of outcomes followed the intention-to-treat principle using mixed-effects regression models. RESULTS We enrolled 404 participants (intervention: n = 205, control: n = 199) with 331 (82%) completing 12-month follow-up (intervention: n = 163, control: n = 168). Mean age was 41.7 years, ranging from 16 to 85, 54% were female and 75% were white. From the intervention arm, 73.7% attended all or some of the course. At 12-month follow-up, there were no statistically significant differences between trial arms in QOLIE-31-P (intervention mean: 67.4, standard deviation [SD]: 13.5; control mean: 69.5, SD 14.8) or in secondary outcome measures. SIGNIFICANCE This is the first pragmatic trial of group education for people with poorly controlled epilepsy. Recruitment, course attendance, and follow-up rates were higher than expected. The results show that the primary outcome and quality of life did not differ between the trial arms after 12 months. We found a high prevalence of felt-stigma and psychological distress in this group of people with drug-resistant seizures. To address this, social and psychological interventions require evaluation, and may be necessary before or alongside self-management-education courses.
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Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Waterloo Campus, King's College London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Sabine Landau
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Modi AC, Wagner J, Smith AW, Kellermann TS, Michaelis R. Implementation of psychological clinical trials in epilepsy: Review and guide. Epilepsy Behav 2017; 74:104-113. [PMID: 28734195 DOI: 10.1016/j.yebeh.2017.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 01/15/2023]
Abstract
The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
| | - Janelle Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Comprehensive Epilepsy Program, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee W Smith
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Tanja S Kellermann
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rosa Michaelis
- Department of Psychiatry, St. Marien-Hospital, Hamm, Germany; Integrative Curriculum for Anthroposophic Medicine (ICURAM), University Witten/Herdecke, Witten, Germany
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10
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Wojewodka G, Hurley S, Taylor SJC, Noble AJ, Ridsdale L, Goldstein LH. Implementation fidelity of a self-management course for epilepsy: method and assessment. BMC Med Res Methodol 2017; 17:100. [PMID: 28697723 PMCID: PMC5504680 DOI: 10.1186/s12874-017-0373-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complex interventions such as self-management courses are difficult to evaluate due to the many interacting components. The way complex interventions are delivered can influence the effect they have for patients, and can impact the interpretation of outcomes of clinical trials. Implementation fidelity evaluates whether complex interventions are delivered according to protocol. Such assessments have been used for one-to-one psychological interventions; however, the science is still developing for group interventions. METHODS We developed and tested an instrument to measure implementation fidelity of a two-day self-management course for people with epilepsy, SMILE(UK). Using audio recordings, we looked at adherence and competence of course facilitators. Adherence was assessed by checklists. Competence was measured by scoring group interaction, an overall impression score and facilitator "didacticism". To measure "didacticism", we developed a novel way to calculate facilitator speech using computer software. Using this new instrument, implementation fidelity of SMILE(UK) was assessed on three modules of the course, for 28% of all courses delivered. RESULTS Using the instrument for adherence, scores from two independent raters showed substantial agreement with weighted Kappa of 0.67 and high percent agreement of 81.2%. For didacticism, the results from both raters were highly correlated with an intraclass coefficient of 0.97 (p < 0.0001). We found that the courses were delivered with a good level of adherence (> 50% of scored items received the maximum of 2 points) and high competence. Groups were interactive (mean score: 1.9-2.0 out of 2) and the overall impression was on average assessed as "good". Didacticism varied from 42% to 93% of total module time and was not associated with the other competence scores. CONCLUSION The instrument devised to measure implementation fidelity was reproducible and easy to use. The courses for the SMILE(UK) study were delivered with a good level of adherence to protocol while not compromising facilitator competence. TRIAL REGISTRATION ISRCTN57937389 .
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Affiliation(s)
- G Wojewodka
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - S Hurley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - S J C Taylor
- Centre for Primary Care and Public Health, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A J Noble
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - L Ridsdale
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - L H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK. .,King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO 77, The Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.
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11
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Characteristics associated with quality of life among people with drug-resistant epilepsy. J Neurol 2017; 264:1174-1184. [PMID: 28550480 PMCID: PMC5486549 DOI: 10.1007/s00415-017-8512-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/19/2017] [Accepted: 05/06/2017] [Indexed: 12/02/2022]
Abstract
Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy.
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12
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Ridsdale L, Philpott SJ, Krooupa AM, Morgan M. People with epilepsy obtain added value from education in groups: results of a qualitative study. Eur J Neurol 2017; 24:609-616. [PMID: 28181344 PMCID: PMC5396134 DOI: 10.1111/ene.13253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Background and purpose Having epilepsy requires individuals to learn about self‐management. So far, trials of self‐management courses have not included in‐depth qualitative evaluations of how the learning method influences participants’ perceptions and behaviour. We aimed to interview participants who had attended a course, as part of a randomized controlled trial, to examine: (i) their perceptions of what they valued and negative aspects of the intervention, and (ii) whether and in what ways they continued to make use of the training. Methods Twenty participants were selected within 6 months of undertaking a course from the larger randomized controlled trial conducted in England. Semi‐structured interviews were based on a topic guide. Results Participants’ characteristics were representative of the clinical and demographic characteristics of the trial group. Their mean age was 44 years, half were male, and three‐quarters had had epilepsy for over 10 years and had experienced one or more seizures in the previous month. Participants valued the opportunity to meet ‘people like them’. Structured learning methods encouraged them to share and compare feelings and experience. Specific benefits included: overcoming the sense of ‘being alone’ and improving self‐acceptance through meeting people with similar experience. Over half reported that this, and comparison of attitudes and experience, helped them to improve their confidence to talk openly, and make changes in health behaviours. Conclusions People feel socially isolated in long‐term poorly controlled epilepsy. They gain confidence and self‐acceptance from interactive groups. Expert‐facilitated courses that encourage experiential learning can help people learn from each other, and this may enhance self‐efficacy and behaviour change.
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Affiliation(s)
- L Ridsdale
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S J Philpott
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - A-M Krooupa
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - M Morgan
- King's College London, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, London, UK
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Ring A, Jacoby A, Baker GA, Marson A, Whitehead MM. Does the concept of resilience contribute to understanding good quality of life in the context of epilepsy? Epilepsy Behav 2016; 56:153-64. [PMID: 26895477 DOI: 10.1016/j.yebeh.2016.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/31/2015] [Accepted: 01/02/2016] [Indexed: 12/15/2022]
Abstract
A significant body of research highlights negative impacts of epilepsy for individual quality of life (QOL). Poor seizure control is frequently associated with reporting of poor QOL and good seizure control with good QOL; however, this is not a universal finding. Evidence suggests that some people enjoy good QOL despite ongoing seizures while others report poor QOL despite good seizure control. Understanding the factors that influence QOL for people with epilepsy and the processes via which such factors exert their influence is central to the development of interventions to support people with epilepsy to experience the best possible QOL. We present findings of a qualitative investigation exploring influences and processes on QOL for people with epilepsy. We describe the clinical, psychological, and social factors contributing to QOL. In particular, we focus on the value of the concept of resilience for understanding quality of life in epilepsy. Based on our analysis, we propose a model of resilience wherein four key component sets of factors interact to determine QOL. This model reflects the fluid nature of resilience that, we suggest, is subject to change based on shifts within the individual components and the interactions between them. The model offers a representation of the complex influences that act and interact to either mitigate or further compound the negative impacts of epilepsy on individual QOL.
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Affiliation(s)
- Adele Ring
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Ann Jacoby
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Gus A Baker
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Anthony Marson
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
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Robertson J, Baines S, Emerson E, Hatton C. Service Responses to People with Intellectual Disabilities and Epilepsy: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 30:1-32. [DOI: 10.1111/jar.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Sydney NSW Australia
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
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15
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Laybourne AH, Morgan M, Watkins SH, Lawton R, Ridsdale L, Goldstein LH. Self-management for people with poorly controlled epilepsy: Participants' views of the UK Self-Management in epILEpsy (SMILE) program. Epilepsy Behav 2015; 52:159-64. [PMID: 26426353 DOI: 10.1016/j.yebeh.2015.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/11/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Epilepsy is a long-term condition that requires self-management, but currently, there is no well-evaluated epilepsy self-education or self-management intervention in the United Kingdom (UK). AIM The aim of this study was to examine the views and experiences of the first participants of the Self-Management in epILEpsy UK (SMILE UK) program to assist the development of a full trial. METHOD In-depth semistructured interviews and group discussions were conducted with 10 people with poorly controlled epilepsy to explore their views and experiences of the self-management program. Interviews were audio-recorded, transcribed, and analyzed thematically. RESULTS All participants viewed the program positively. Three themes emerged: i) peer support was experienced through knowledge sharing, disclosure of experiences, and exchange of contact details; ii) participants felt better equipped to enter discussions with doctors and other health-care professionals about their condition; and iii) participants reported an improvement in their personal life through increased confidence to live with epilepsy and acceptance of their diagnosis. CONCLUSION A brief group self-management intervention increased knowledge and confidence in managing epilepsy.
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Affiliation(s)
- Anne H Laybourne
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Myfanwy Morgan
- King's College London, Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, Addison House, Guy's campus, London SE1 1UL, United Kingdom.
| | - Sarah H Watkins
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Rebecca Lawton
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Leone Ridsdale
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
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