Doctors, teach your adrenal insufficiency patients well: provide them with a European Emergency Card!

Adrenal insufficiency is a life-threatening condition requiring chronic glucocorticoid replacement therapy, as well as stress adaptation to prevent adrenal crises. To increase patients' self-sustainability, education on how to tackle an adrenal crisis is crucial. All patients should carry the European Emergency Card.

Therapy options for adrenal insufficiency and recommendations for the management of adrenal crisis.

Adrenal insufficiency (AI) is a life-threatening condition requiring life-long glucocorticoid (GC) substitution therapy, as well as stress adaptation to prevent adrenal crises. The number of individuals with primary and secondary adrenal insufficiency in Europe is estimated to be 20-50/100.000.

CPMS-improving patient care in Europe via virtual case discussions.

Purpose: The core task of European Reference Networks (ERNs) is to reduce health care inequalities throughout Europe for all patients with rare and complex conditions. A secure web-based application for virtual consultations, the Clinical Patient Management System (CPMS), was developed by the EU to provide expert specialized care for all these patients. This review analyses the opportunities and difficulties that the implementation of this virtual network implies for physicians as well as for the patients.

The current landscape of European registries for rare endocrine conditions.

Objective To identify cross-border international registries for rare endocrine conditions that are led from Europe and to understand the extent of engagement with these registries within a network of reference centres (RCs) for rare endocrine conditions. Methods Database search of international registries and a survey of RCs in the European Reference Network for rare endocrine conditions (Endo-ERN) with an overall response rate of 82%. Results Of the 42 conditions with orphacodes currently covered within Endo-ERN, international registries exist for 32 (76%).

Electronic healthcare record; a way to empower the patient.

Background: Patients are demanding a bigger role in the management of their own health and health care.

Methods: The Dutch Federation of Patient and Consumer Organizations (NPCF) has initiated several projects in this area. One project started in 2001 and aims at contributing to the development of a nation-wide EPR system.

Poly-beta-hydroxybutyrate metabolism in dynamically fed mixed microbial cultures.

The kinetics of production and degradation of poly-beta-hydroxybutyrate (PHB) by a mixed activated sludge culture growing on acetate was studied in a sequencing batch reactor (SBR). Occasionally a very high amount of acetate was added to the steady state system in order to obtain high PHB concentrations in the cells (fPHB). This made it possible to follow PHB production and degradation over a wide range of fPHB-data (between 0 and 0.

Aerobic granulation in a sequencing batch airlift reactor.

Aerobic granular sludge was cultivated in an intensely mixed sequencing batch airlift reactor (SBAR). A COD loading of 2.5 kg Acetate-COD/(m3 d) was applied.

N-removal in a granular sludge sequencing batch airlift reactor.

The removal of N-compounds in the sequencing batch airlift reactor (SBAR) containing granular sludge was studied under conditions of decreased dissolved oxygen (DO). A simulation model was developed to describe and evaluate the effects of several process conditions in the SBAR on N-removal performance. The model described the experimental data reasonable well.

Simultaneous storage and degradation of PHB and glycogen in activated sludge cultures.

Bacteria in activated sludge are subjected to periods of substrate availability and absence of external substrates. The response of bacteria to such dynamic conditions was studied in a 2 L sequencing batch reactor (SBR) by subjecting a mixed microbial population to successive periods of external substrate availability (feast period) and no external substrate availability (famine period). In previous studies, acetate or glucose was used as single substrate leading to the storage of polyhydroxybutyrate or glycogen, respectively.

Glycogen metabolism in aerobic mixed cultures.

In this study, the metabolism of glycogen storage and consumption in mixed cultures under aerobic conditions is described. The experimental results are used to calibrate a metabolic model, which as sole stoichiometric variables has the efficiency of oxidative phosphorylation (delta) and maintenance requirement in units of adenosine triphosphate (m(ATP)). Using the experimental data and values from the literature we show that delta and m(ATP) are strongly coupled and that the values determined for glycogen and poly-beta-hydroxybutyrate (PHB) metabolism are similar.

Stoichiometry and kinetics of poly-beta-hydroxybutyrate metabolism under denitrifying conditions in activated sludge cultures.

The objective of this research was to obtain a more detailed insight in the kinetics and stoichiometry of poly-beta-hydroxybutyrate (PHB) metabolism in activated sludge cultures. The process of storage and degradation of PHB under denitrifying conditions was studied. Dynamic conditions as occurring in activated sludge processes were simulated in a 2L sequencing batch reactor (SBR) by subjecting a mixed sludge population at a sludge retention time (SRT) of about 6 days to successive periods of external substrate availability (feast period) and no external substrate availability (famine period).

Stoichiometry and kinetics of poly-beta-hydroxybutyrate metabolism in aerobic, slow growing, activated sludge cultures.

This paper discusses the poly-beta-hydroxybutyrate (PHB) metabolism in aerobic, slow growing, activated sludge cultures, based on experimental data and on a metabolic model. The dynamic conditions which occur in activated sludge processes were simulated in a 2-L sequencing batch reactor (SBR) by subjecting a mixed microbial population to successive periods of external substrate availability (feast period) and no external substrate availability (famine period). Under these conditions intracellular storage and consumption of PHB was observed.

The chronically ill patient and the pharmacist. Pharmaceutical care from the patient's perspective.

Dynamic changes in the world also affect the chronically ill patient. Relations with professionals are changing, including the relations with pharmacists. Patients expectations as described in this article, should be rewarded and then patients and pharmacist both will benefit.