Concerns about medication and medication adherence in patients with chronic pain recruited from general practice

This study examines the concerns and beliefs about medication reported by patients with nonmalignant chronic pain encountered within general practice. Two hundred thirty-nine patients with chronic pain took part in this research. Patients completed the Pain Medication Attitudes Questionnaire, a measure of patient concerns and beliefs relating to addiction, withdrawal, side effects, mistrust in doctors, perceived need of medication, scrutiny from others, and tolerance. The data revealed that patient concerns and beliefs predicted general medication nonadherence. In addition, concerns were related to the direction of nonadherence: overuse of medication was related to increased perceived need for medication and greater concern over side effects; underuse was related to decreased concerns over withdrawal and increased mistrust in the prescribing doctor. Analyses also indicated that patient attitudes and concerns about medication were more predictive of nonadherence than both level of pain and the reported frequency of experienced side effects. This research contributes to the increasing evidence that patient attitudes and beliefs about pain medication are associated with adherence behavior. Training general practitioners to identify and address these concerns may reduce concerns, improve adherence, and facilitate the doctor-patient relationship

Paxos Consensus, Deconstructed and Abstracted (Extended Version)

Lamport's Paxos algorithm is a classic consensus protocol for state machine replication in environments that admit crash failures. Many versions of Paxos exploit the protocol's intrinsic properties for the sake of gaining better run-time performance, thus widening the gap between the original description of the algorithm, which was proven correct, and its real-world implementations. In this work, we address the challenge of specifying and verifying complex Paxos-based systems by (a) devising composable specifications for implementations of Paxos's single-decree version, and (b) engineering disciplines to reason about protocol-aware, semantics-preserving optimisations to single-decree Paxos. In a nutshell, our approach elaborates on the deconstruction of single-decree Paxos by Boichat et al. We provide novel non-deterministic specifications for each module in the deconstruction and prove that the implementations refine the corresponding specifications, such that the proofs of the modules that remain unchanged can be reused across different implementations. We further reuse this result and show how to obtain a verified implementation of Multi-Paxos from a verified implementation of single-decree Paxos, by a series of novel protocol-aware transformations of the network semantics, which we prove to be behaviour-preserving.Comment: Accepted for publication in the 27th European Symposium on Programming (ESOP'18

Training for General Practitioners in opioid prescribing for chronic pain based on practice guidelines: a randomized pilot and feasibility trial

This study is a pilot and feasibility study that compares 2 training experiences to improve appropriate opioid prescribing for chronic pain. Both training conditions included education in relation to opioid guidelines. Following education, 1 condition included training aimed at improving psychological flexibility and the other included training in practical knowledge and skills related to pain management. Eighty-one general practitioners (GPs) took part in the study, each having been randomly assigned to 1 of the training conditions. It proved easy to recruit GPs to the training. Overall, GPs demonstrated increased knowledge of opioid prescribing for chronic pain and decreases in concerns related to prescribing following training. However, there were no changes observed in reported prescribing practices or in secondary measures of well-being. There were also no significant differences between the training conditions, other than a greater increase in intention to use prescribing guidelines in the psychological flexibility condition. Feasibility and acceptability of the training methods were generally rated high. The psychological flexibility condition was rated higher than the comparison condition in terms of interest and satisfaction. Finally, processes of psychological flexibility before and after training significantly correlated with measures of GP well-being, providing partial support for the relevance of these processes as a focus in GP training

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Using the nominal group technique to engage people with chronic pain in health service development

In this methodological paper, we discuss the use of the nominal group technique to facilitate the involvement of people with chronic pain and other stakeholder groups in the design of a community‐based pain management programme. On the basis of our experiences of using the technique in a study conducted in the south‐west region of the UK, we explore conceptual and logistical issues relating to patient involvement in health service development, discuss political issues relating to the articulation and synthesis of different stakeholder perspectives, and provide a description of how the technique can be applied in the aforementioned context. We conclude that although the nominal group technique is not a panacea for the difficulties encountered in patient involvement, it does offer advantages over other approaches

Asynchronous Lease-based Replication of Software Transactional Memory ⋆

Abstract. Software Transactional Memory (STM) systems have emerged as a powerful middleware paradigm for parallel programming. At current date, however, the problem of how to leverage replication to enhance dependability and scalability of STMs is still largely unexplored. In this paper we present Asynchronous Lease Certification (ALC), an innovative STM replication scheme that exploits the notion of asynchronous lease to reduce the replica coordination overhead and shelter transactions from repeated abortions due to conflicts originated on remote nodes. These features allow ALC to achieve up to a tenfold reduction of the commit latency phase in scenarios of low contention when compared with state of the art faulttolerant replication schemes, and to boost the throughput of long-running transactions by a 4x factor in high conflict scenarios