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Browsing by Person "Robertson, Julie"

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    354 To refer or not to refer?: ethical challenges of appropriate patient selection to obtain optimum survival and quality of life post lung transplant
    (ScienceDirect, 2017-06) Robertson, Julie; MacDonald, Kath
    Objectives: We present a case study which raises several ethical issues as to refer or not to refer and seek discussion and debate within this session. Currently in the UK there are 321 patients on the active lung transplant list. With a shortfall of available suitable organs, not all patients will receive a transplant. Up to 1 in 6 patients on the active lung transplant list die or become too sick to receive a graft. Successful transplant can achieve a 60% survival to 5 years. Contraindications to transplant can be physical and or psychosocial. This limited supply highlights the responsibility of CF teams to have consensus on referring candidates that are most likely to benefit from receiving this limited resource. The CF team need to be honest with patients and give a realistic account of process, outcomes and survival before a referral is made.
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    Prevalence of bone loss in a population with cystic fibrosis.
    (2010) Robertson, Julie; MacDonald, Kath
    The adverse effect of an increased life expectancy for people with cystic fibrosis (CF) is the increased risk of complications, such as CF-related low bone mineral density (BMD). Diagnosis of CF-related low BMD is confirmed by a dual-energy X-ray absorptiometry (DXA) scan. This study reports the results of an audit of DXA scans in 108 adults with CF in our clinic. The most common risk factors for bone loss were vitamin D deficiency (89%), CF-related diabetes (53%), low body mass index (39%) and post-lung transplant (25%); half of those with bone loss were genotype homozygous DF508. Overall fracture incidence was 5.5%; low BMD was not associated with high fracture rates. Thus BMD may not be a good predictor of fracture risk. Treatment includes bisphosphonates, which are difficult to take and have uncertain long-term effects. It is unknown whether bisphosphonate therapy is justified in this already overburdened group.