A review of patient safety incidents reported as 'severe' or 'death' from critical care units in England and Wales between 2004 and 2014.

We analysed 1743 patient safety incidents reported between 2004 and 2014 from critical care units in England and Wales where the harm had been classified as 'severe' (1346, 77%) or 'death' (397, 23%). We classified 593 (34%) of these incidents as resulting in temporary harm, and 782 (45%) as more than temporary harm, of which 389 (22%) may have contributed to the patient's death. We found no described harm in 368 (21%) incidents. We classified 1555 (89%) of the incidents as being avoidable or potentially avoidable. There were changes over time for some incident types (pressure sores: 10 incidents in 2007, 64 in 2012; infections: 60 incidents in 2007, 10 in 2012) and some changes in response to national guidance. We made a comparison with a dataset of all incidents reported from units in North-West England, and this confirmed that the search strategy identified more severe incidents, but did not identify all incidents that contributed to mortality.

The weight debate.

Therapeutic interventions administered on Critical Care are often dosed on the basis of patient body size, to ensure treatments are effective in achieving their goals and to prevent harm from overdose. Many treatment modalities use predicted weights estimated from descriptors such as sex, weight and height to reduce error that is associated with using total body weight in critically ill patients. In this article we review the size descriptors that have been described, their origin and calculation. We then examine the role they play in dosing of common therapies utilised in Critical Care and potential areas of research for the future.

Primary health care as an educational process: a model and a freirean perspective.

This is a discussion that attempts to open up to reflection some of the deeper aspects of Primary Health Care. A model originally derived to assist reflection on philosophies of education is drawn on and illustrated with the very pertinent ideas of Paulo Freire. The article aims at assisting that deeper level of deliberation which is especially important to a comprehensively conceived Primary Health Care.

GC box binding induces phosphorylation of Sp1 by a DNA-dependent protein kinase.

Efficient transcription of SV40 early genes requires transcription factor Sp1. Here, we report that SV40 infection induces Sp1 phosphorylation. While characterizing this modification, we discovered that Sp1 becomes quantitatively phosphorylated in an in vitro transcription extract. Multiple processive phosphorylation of Sp1 depends on binding of Sp1 to GC box-containing DNA. Cell fractionation and column chromatography reveal that the Sp1 kinase is a nuclear DNA binding protein that corresponds to a previously identified DNA-dependent protein kinase. Because only some trans-activators are phosphorylated by this kinase, Sp1 belongs to a specific subgroup of factors that are phosphorylated upon binding to promoter sequences. Finally, efficient phosphorylation of Sp1 requires both a functional DNA binding domain and a region containing the transcriptional activation domains. Coupling of phosphorylation to DNA binding may represent a novel mechanism for regulating transcriptional initiation.