The place of numbers 13-14(star) and numbers 20:2-12(star) in the priestly narrative (Pg)

Among scholars who adhere to an originally independent or once separate Priestly narrative (Pg) there is an emerging debate as to whether Numbers 13-14* and 20:2-12* (1) are to be included in Pg. Traditionally these texts have been incorporated as part of pg. (2) Recently, however, this has been questioned, with several scholars advocating that Pg concludes in the Sinai material, either in Exodus (3) or in Leviticus. (4) Moreover, this latter position, which excludes Num 13-14*; 20:2-12* from Pg is interrelated with the view that the establishment of the sanctuary and/or its cult within the Sinai material is the climax of Pg, where Pg's overall purpose is to be found, and therefore forms its conclusion. (5) This is an understandable development since there is a tendency among those scholars who incorporate Num 13-14*; 20:2-12* into Pg but see the primary concern of Pg to reside in the setting up of the cultic community at Sinai to have little success in accounting adequately for Num 13-14*; 20:2-12* within the theological horizon of Pg as a whole. (6) In this article, therefore, I will address the issue of whether Num 13-14* and 20:2-12* are to be seen as part of Pg. I will seek to show that these texts form an integral part of Pg. This will be argued primarily on the grounds of the correspondences and interplay of motifs and themes between these texts and Pg texts preceding them; and, since conceptions regarding which texts belong to Pg are intimately connected with the attempt to make sense of Pg as a whole, I will argue that these texts interact with preceding Pg texts in such a way that they can be seen to play an integral role within Pg's theological horizon

IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study

BACKGROUND: Frailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We assessed if, in older care home residents, particularly those with severe frailty, i-CGA could improve access to advance care planning discussions and reduce unplanned hospitalisations. METHOD: As a quality improvement project we progressively incorporated our i-CGA process into routine primary care for older care home residents, and used a quasi-experimental approach to assess its interim impact. Residents were assessed for frailty by General Practitioners. Proactive i-CGAs were completed, including consideration of traditional CGA domains, deprescribing and ACP discussions. Interim analysis was conducted at 1 year: documented completion, preferences and adherence to ACPs, unplanned hospital admissions, and mortality rates were compared for i-CGA and control (usual care) groups, 1-year post-i-CGA or post-frailty diagnosis respectively. Documented ACP preferences and place of death were compared using the Chi-Square Test. Unplanned hospital admissions and bed days were analysed using the Mann-Whitney U test. Survival was estimated using Kaplan-Meier survival curves. RESULTS: At one year, the i-CGA group comprised 196 residents (severe frailty 111, 57%); the control group 100 (severe frailty 56, 56%). ACP was documented in 100% of the i-CGA group, vs. 72% of control group, p < 0.0001. 85% (94/111) of severely frail i-CGA residents preferred not to be hospitalised if they became acutely unwell. For those with severe frailty, mean unplanned admissions in the control (usual care) group increased from 0.87 (95% confidence interval ± 0.25) per person year alive to 2.05 ± 1.37, while in the i-CGA group they fell from 0.86 ± 0.24 to 0.68 ± 0.37, p = 0.22. Preferred place of death was largely adhered to in both groups, where documented. Of those with severe frailty, 55% (62/111) of the i-CGA group died, vs. 77% (43/56) of the control group, p = 0.0013. CONCLUSIONS: Proactive, community-based i-CGA can improve documentation of care home residents' ACP preferences, and may reduce unplanned hospital admissions. In severely frail residents, a mortality reduction was seen in those who received an i-CGA.Published version, accepted versionThe article is available via Open Access. Click on the 'Additional link' above to access the full-text