{'fraction_non_alphanumeric': 0.01625526791089705, 'fraction_numerical': 0.0012040939193257074, 'mean_word_length': 4.8936170212765955, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Shared care-is it worth it for the patient?

For any specialized medical service there is a fundamental tension between the demands for quality, access and sustainability, with affordability an ever more important factor. For cystic fibrosis (CF) services, patients ideally want their care from a high quality specialist CF centre, delivered on their door step with no limitation on the services provided. In practice this may be available only to those who live in close proximity to a CF centre, and the further a patient lives from a CF centre the more difficult it may be to offer optimal care. For patients who do not live close to a CF centre, compromises will have to be made between quality and access. The ideal should be to deliver specialized services as close as possible to the patient's home without compromising quality. 
 
Underpinning the construction of guidelines for specialized medical services is the belief that specialized care is better than non-specialized care, and that there is a minimum number of patients who need to be cared for within that service to maintain expertise. Although there is considerable evidence of such effects in adult specialities, there is less evidence in children's specialities. It is arguable that this is a reflection of the difficulty with outcome measures for paediatric practice compared to adult practice – mortality is frequently used in adult studies, but in the 21st century is applicable to few paediatric diseases. This review will assess the evidence for specialized services for adults and children, and specifically the evidence for specialist and shared care for adults and children with CF.