Chemotherapy safety and severe adverse events in cancer patients: strategies to efficiently avoid chemotherapy errors in in- and outpatient treatment.

To enhance the quality and safety in cancer treatment, and in acknowledgement that medical errors occur, we have established 2 error management systems: one monitors chemotherapy errors, the other records all severe adverse events occurring in chemotherapy-treated cancer patients (SAECTx) in in- and outpatient treatment. These error systems have been implemented by our departmental "Clinical Service Center," a multidisciplinary team which controls all chemotherapy protocols and orders prior to the medication reaching the patient. We performed a prospective cohort study in consecutive cancer patients who received chemotherapies in our department between January 2005 and December 2006. Over this 2-year period, 2,337 patients were treated, with an equal distribution as in- and outpatients: 22,216 consecutive chemotherapy orders were analyzed, of which 83.5% were completely flawless, whereas we detected and corrected medical and administrative errors in 17.1%: in 3.8%, these errors involved the chemotherapy itself, in 4.5% the patient data and in 8.7% missing written informed consent forms. Chemotherapy errors were less frequent in outpatients than inpatients (3.3 vs. 4.5%, respectively). In outpatients, the rate of chemotherapy errors decreased from 4% in 2005 to 2.8% in 2006, but remained stable for inpatients (4.4% 2005 vs. 4.7% 2006). Among a total of 3,792 detected errors, only 3 reached the patient, resulting in an error rate in patients of 0.079%. Therefore, since we detected a substantial number of chemotherapy-related errors and intercepted 99.9%, we recommend our efficient surveillance system as an important safety check, thereby ensuring that chemotherapies are delivered error-free to cancer patients.

IL-10-producing monocytes differentiate to alternatively activated macrophages and are increased in atopic patients.

BACKGROUND: Recently the immune regulatory role of T cell-derived IL-10 in allergic disease has been extensively studied. In contrast, there is mounting evidence that IL-10 might also have a role in the perpetuation of allergic inflammation and fibrotic remodeling. It has been reported that alternatively (IL-4) activated macrophages (aaMPhi) produce large quantities of IL-10 and lack IL-12 production. OBJECTIVE: Bearing this in mind, we hypothesized whether functionally different properties of IL-10-producing monocytes could be identified. METHODS: Intracellular cytokine expression of IL-10, IL-12, and IL-6 in peripheral blood CD14(+) monocytes was measured in 19 atopic patients and 18 healthy control subjects by means of flow cytometry. In addition, IL-10-secreting monocytes were sorted by means of flow cytometry. Capabilities of these cells regarding further differentiation, accessory cell capacity, and surface molecule expression were analyzed. RESULTS: Our data show a dichotomous expression pattern of either IL-10 or IL-12p40/p70 in peripheral blood monocytes after LPS stimulation. Compared with healthy control subjects, the percentage of IL-10-producing monocytes was significantly increased in atopic patients. IL-10-secreting monocytes were isolated by using an IL-10 secretion assay, and functional analysis of these sorted cells revealed that IL-10-secreting monocytes preferentially differentiate into suppressor of cytokine signaling 3 expressing aaMPhi, which perpetuate T(H)2 immune response. CONCLUSION: Our study shows the existence of an IL-10-producing monocyte subset, which is increased in atopic disease and which might facilitate allergic inflammation and fibrotic remodeling by differentiation into aaMPhi. CLINICAL IMPLICATIONS: Controlling aaMPhi in T(H)2-driven inflammatory processes might be a novel target for intervention strategies.