Glucocorticoids are highly effective in the treatment of allergy and asthma and inhibit the synthesis of IL‐4, IL‐5 and IL‐13 by disease‐promoting CD4+ Th2 cells. CD8+ T cells also synthesize these cytokines, and the aim of this study was to investigate how glucocorticoids effect cytokine production by these cells. When CD8+ T cells are stimulated with anti‐CD3 and IL‐2 plus IL‐4 or dexamethasone, production of the anti‐inflammatory cytokine IL‐10 is low in both primary and secondary cultures restimulated with anti‐CD3 and IL‐2 alone. However, when both are present, a synergistic effect on IL‐10 synthesis is observed. The additional presence of antigen‐presenting cells (APC) in the priming culture maintains IL‐10 levels, but inhibits IL‐4 and IL‐5 production. CD4+ T cells develop a similar glucocorticoid‐induced phenotype. These cells demonstrate regulatory activity and inhibit CD4+ T cell activation in an IL‐10‐dependent manner. Earlier reports show glucocorticoids promote a Th2 phenotype by effects on purified naive T cells or pretreatment of APC. This study demonstrates, more critically, that when APC are present, glucocorticoids induce CD4 and CD8 T cell populations synthesizing high levels of IL‐10, but greatly reduced amounts of disease‐promoting IL‐4 and IL‐5.

Objective: To review inferior vena cava (IVC) filter retrieval practice at our institution, the Royal London Hospital, and measure changes following a quality improvement intervention. IVC filters are a preventive treatment for pulmonary embolism when anticoagulation is ineffective/contraindicated. Unless permanent filtration is required, all filters should undergo attempted retrieval within manufacturer’s recommendations with a success rate of ≥80 %. Methods: Retrospective audit of filters inserted between 2011 and 2014, followed by a quality improvement intervention and a second audit between 2015 and 2017. Clinical–radiological data were analysed using the Picture Archiving and Communication System and electronic patient records. Results: During the first audit, filter retrieval was attempted in 92% of cases, of which 82% underwent the procedure within manufacturer's recommendations and 86% were successful. During the second audit, an improvement across indicators was seen. Retrieval increased by 3% and was attempted in 95% of cases (92% of which were within manufacturer’s guidelines). Rate of retrievals within manufacturer’s guidelines increased by 10%. Filter retrieval success rate increased by 11% - to 97%. Conclusions: IVC filter retrieval practice at a single institution can be improved by implementing a simple audit intervention. Advances in knowledge: Filter retrieval practice has clinical and medicolegal implications. A simple quality intervention can substantially improve overall practice.