Biosimilar ESAs: a comparative review.

BACKGROUND: The management of anaemia in patients with chronic kidney disease has been transformed by development of erythropoiesis-stimulating agents (ESAs). Following expiry of the patent of the originator epoetin alfa in Europe, a number of biosimilar ESAs have been licensed for use in the nephrology setting. Biosimilars are biological medicines that are approved via stringently defined regulatory pathways on the basis that they have demonstrated comparable safety, efficacy and quality to their reference product. OBJECTIVES: As nurses have a pivotal role in patient care, not only administering medications but also educating patients about their treatment options, it is important that nurses understand the differences between biosimilar medicines and their reference products and appreciate the stringent regulatory requirements for approval of biosimilars. METHODS: In this review, we use epoetin zeta as a case study to highlight practical considerations of using biosimilar ESAs in the management of patients with kidney disease. RESULTS AND CONCLUSION: Biosimilar products, such as epoetin zeta, may offer a range of features to patients, nurses and physicians, such as greater flexibility over dose and route of administration, in addition to greater access to biological medicines through cost savings. APPLICATION TO PRACTICE: Renal nurses play a significant role in the management of patients with kidney disease and anaemia, not only having an important role in the delivery of medicine but also in the education of patients. This review discusses some of the practical aspects associated with the use of biosimilar medicines to assist nurses in making informed decisions over their use.

Effectiveness of a steam cleaning unit for disinfection in a veterinary hospital.

OBJECTIVE: To evaluate whether the application of steam to a variety of surface types in a veterinary hospital would effectively reduce the number of bacteria. SAMPLE: 5 surface types. PROCEDURES: Steam was applied as a surface treatment for disinfection to 18 test sites of 5 surface types in a veterinary hospital. A pretreatment sample was obtained by collection of a swab specimen from the left side of each defined test surface. Steam disinfection was performed on the right side of each test surface, and a posttreatment sample was then collected in the same manner from the treated (right) side of each test surface. Total bacteria for pretreatment and posttreatment samples were quantified by heterotrophic plate counts and for Staphylococcus aureus, Pseudomonas spp, and total coliforms by counts on selective media. RESULTS: Significant reductions were observed in heterotrophic plate counts after steam application to dog runs and dog kennel floors. A significant reduction in counts of Pseudomonas spp was observed after steam application to tub sinks. Bacterial counts were reduced, but not significantly, on most other test surfaces that had adequate pretreatment counts for quantification. CONCLUSIONS AND CLINICAL RELEVANCE: Development of health-care-associated infections is of increasing concern in human and veterinary medicine. The application of steam significantly reduced bacterial numbers on a variety of surfaces within a veterinary facility. Steam disinfection may prove to be an alternative or adjunct to chemical disinfection within veterinary practices.

Improving the accuracy of intraocular pressure readings.

AIM: To discover whether a protocol for calibration can improve the accuracy of intraocular pressure measuerements. METHOD: A protocol for checking the calibration of equipment was implemented in an ophthalmic outpatient department. After seven months, calibration checks were compared with those done on equipment in other ophthalmic areas that were not following a protocol. RESULTS: There was a statistically significant association between errors and areas not following the protocol (p = 0.02). In comparing errors found in the area using the protocol with all other areas, a significant difference was evident at the test point of 20 mmHg (p = 0.003). CONCLUSION: Using a protocol significantly reduces calibration errors.