a 186 praticiens exerçant dans les hôpitaux universitaires de France m etropolitaine. Deux groupes d'enfants ont et e etudi es : enfants dits « a ne pas intuber » et enfants b en eficiant uniquement de mesures de confort.

ObjectiveTo determine the clinical stage (stable, unstable, deteriorating or dying) for children and young people (CYP) aged 0-25 years in Scotland with a life limiting condition (LLC). DesignNational cohort of CYP with a LLC using linked routinely collected healthcare data. SettingScotland. Patients Main OutcomeClinical stage based on emergency inpatient and intensive care unit admissions and date of death. ResultsOver 2200 CYP with a LLC in Scotland were unstable, deteriorating or dying in each year. Compared to 1-5 year olds, under 1s had highest risk of instability (OR 6.4, 95% CI 5.7-7.1); all older age groups had lower risk. Girls were more likely to be unstable than boys (OR 1.15, 95% CI 1.06-1.24). CYP of South Asian (OR 1.61, 95% CI 1.28-2.01), Black (OR 1.58, 95% CI 1.04-2.41) and Other (OR 1.33, 95% 3 CI 1.02-1.74) ethnicity were more likely to experience instability than White CYP. Deprivation was not a significant predictor of instability. Compared to congenital abnormalities, CYP with most other primary diagnoses had a higher risk of instability, only CYP with a primary Perinatal diagnosis had significantly lower risk (OR 0.23, 95% CI 0.19-0.29). ConclusionsThe large number of CYP with a LLC who are unstable, deteriorating or dying may benefit from input from specialist pediatric palliative care. The under 1 age group and CYP of South Asian, Black and Other ethnicities should be priority groups. WHAT IS ALREADY KNOWN?National prevalence of children and young people with Life-Limiting Conditions is rising in England.Children and young people with Life-Limiting Conditions have complex health care needs often with repeated hospital admissions, particularly at end of life.

The process and outcomes were presented to the Scottish Teaching Deans, with a view to their inclusion in undergraduate and foundation year curricula. It is through a strong commitment to achieving these learning outcomes that we will prepare all doctors for providing palliative care to the increasing numbers of patients and families that require it.

Background:Care of young adults with life-limiting illnesses can often be complex due to the fact that they are growing and developing within the continuing presence of their illness. There is little research conducted nationally and internationally, which has examined the life issues of young adults or taken a longitudinal approach to understand such issues over a period of time.Aim:To gain clear understanding of one particular and pertinent life issue—relationship transition—occurring in the context of being a young adult with a life-limiting illness and the clinical needs arising from this.Design:This was a triangulated, longitudinal, qualitative study involving young adults with life-limiting illnesses and their significant others, namely, family members and healthcare professionals. Semi-structured interviews were conducted with participants and analysed using thematic analysis. Clinical case note reviews were also carried out.Setting/participants:A total of 12 young adults (aged between 17 and 23 years) from 2 hospices and 22 nominated significant others participated in a total of 58 interviews.Results:Thematic analysis revealed 4 main themes and 11 subthemes. The main themes were ‘Dependence dichotomy’, ‘In it together’, ‘Biographical uncertainty’, and ‘Conserving integrity’. These themes helped to establish the nature of relationship transitions that the young adult participants from the study experienced and additionally allowed insight into their possible needs at their end of life.Conclusion:This study has identified the nature of relationship transitions pertinent to young adults and has highlighted associated end of life clinical needs. This study can influence further research into the transitions and end of life needs of this particular patient group receiving palliative care, while informing the lacking evidence base which exists internationally.

In this chapter we consider what is meant by a team and by team-working. We explore the issues that arise in teams in paediatric palliative care and some of the key challenges of team working. We look at ways of tackling these challenges, so teams develop and function in healthy and creative ways, and so members are able to recognize when there are difficulties and have ways to resolve them, irrespective of the particular composition of the team. Teams are often used to address these various aspects of care, as no one professional can cover all aspects, or meet the diverse range of needs of these children and their families.