The Thought of Philip Doddridge in the Context of Early Eighteenth-Century Dissent

Philip Doddridge (1702-51) was pastor of the Independent congregation meeting at Castle Hill, Northampton, and tutor of the Northampton academy from 1729 to his death in 1751. He is regarded as a leader of moderate Dissent during that period and the heir, theologically and pastorally, of Richard Baxter. He has been seen as forming a bridge between the more rational Dissenters, on the one hand, and the more conservative and orthodox wing of Dissent on the other. His thought has not, however, been the subject of a detailed analysis in the context of his time. This thesis sets out to conduct such an analysis in order to examine more closely his position within early eighteenth-century Dissent. Doddridge’s philosophical and theological views are considered in chapters two to five. Chapter two assesses the extent of his indebtedness to the philosophy of John Locke, examining also the views of Isaac Watts and showing how Doddridge and Watts modified Locke’s thought in some areas in order to accommodate Christian beliefs. In chapter three, Doddridge’s views on natural theology, natural law and reason are considered and the influence on him of Samuel Clarke, in particular, is examined. Turning to theology, chapter four looks at the use in early eighteenth-century Dissent of terms such as ‘Baxterian’ and ‘moderate Calvinist’ and then considers Doddridge’s doctrinal positions on a range of subjects which are generally considered to represent Baxterian theology. Chapter five examines Doddridge’s views on the key interconnected areas of confessional subscription, scripture and the doctrine of the Trinity. Practical subjects are then considered in chapters six to eight. Doddridge’s views on Christian piety are examined in chapter six. Chapter seven considers ways in which Doddridge sought to communicate, examining the audiences whom he aimed to reach, the ways in which he attempted to reach them and the content of what he wanted to say. The eighth chapter looks at the subject of identity and argues that Doddridge is to be viewed, not so much as a bridge between different wings of Dissent, but as a leader amongst moderate Calvinists. In conclusion, this thesis argues that Philip Doddridge sought to expound a Calvinist theology in the context of the philosophical and theological debates of his day and to promote an ordered Dissent focused on central evangelical truths and united around the language of scripture

A study to enhance medical students' professional decision-making, using teaching interventions on common medications

Aim To create sustained improvements in medical students' critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training

A novel measure of changes in force applied to the Perruchet Effect.

The reaction time (RT) version of the Perruchet Effect demonstrates a concurrent dissociation between RTs to respond and conscious expectancy of the outcome across runs of repeated trials. Consequently, the Perruchet Effect is considered strong evidence for multiple learning processes. This conclusion, however, relies on the RT trend being driven by associative learning rather than, as some have argued, US recency or priming mechanisms. Recent research examining the mechanisms underlying the RT trend do so by examining motor activity associated with the response. With this aim in mind, the current study developed, and assessed the usefulness of, a novel method to measure changes in the amount of force applied to the response button in an RT Perruchet paradigm. The results obtained could not be explained by a single mechanism, but suggest multiple factors underlying the RT version of the Perruchet effect

The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

Background: There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. Methods: A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. Results: Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. Conclusions: The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

Background: Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods: The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results: Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions: While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured

Bridging the gaps: studying the misconceptions, knowledge gaps and commonly held beliefs about dementia with Aboriginal and Torres Strait Islander communities in Far North Queensland

Aims: Aboriginal and Torres Strait Islanders have lower life expectancy and worse health outcomes than the general Australian population and an increased risk of dementia within these communities has recently been found (Smith et al., 2008). Although studies have shown that dementia is not widely understood within urban Aboriginal Communities (Garvey et al. 2011), knowledge in remote communities and in the Torres Strait, where health inequalities are greatest, has not been investigated. As knowledge of symptoms has been linked to willingness to seek treatment and early diagnosis is crucial for optimal treatment of dementia, the aim of this study was to investigate understanding of Alzheimer's disease and dementia amongst remote Aboriginal and Torres Strait Islander communities and to clarify variables that influence dementia literacy. Methods: A total of 462 adult Aboriginal and Torres Strait Islanders completed the Alzheimer's Disease Knowledge Survey for Indigenous Australians whilst attending three cultural festivals in Far North Queensland. Responses were analyzed to evaluate overall knowledge of Alzheimer's disease and dementia as well as identify commonly held beliefs, misconceptions and knowledge gaps. Results: Consistent with previous research, dementia knowledge was low (mean score = 5.23 (SD 2.9), range 0–13 out of 20) and did not differ significantly between Aboriginal and Torres Strait Islanders. Although there was a commonly held belief that memory loss was a central feature of Alzheimer's disease, there were shared misconceptions about the cause, prevalence and treatment of dementia and how dementia is diagnosed. Conclusion: Results highlighted the importance of developing culturally appropriate interventions to improve dementia literacy amongst Aboriginal and Torres Strait Islanders given the increased risk of dementia within these communities

Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method ‘Harmony in the Bush’ dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive

Community involvement to maximise research success in Torres Strait Islander populations: more than ticking the boxes

Context: Health research is important to effectively address the health disparities between Indigenous and non-Indigenous Australians. However, research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Justifiably then, people may be reticent to welcome researchers into their communities. Genuine commitment to community consultation, the fostering of partnerships and collaborative approaches maximise successful outcomes and research translation in these communities. Issue: Despite guidelines existing to ensure the needs of Aboriginal and Torres Strait Islanders are met through any research involving them, non-Indigenous researchers may not be fully aware of the complexities involved in applying these guidelines. This paper explores how a team of Indigenous and Non-Indigenous researchers understood and applied the guidelines during a three-year dementia prevalence study in the Torres Strait. Their reflections on the practicalities involved in conducting ethically sound and culturally appropriate research are discussed. Lessons learned: Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just ticking the boxes on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice

OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary– secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population