Objectives: The purposes of this study are to assess the prevalence and tasks of bereavement services in Japanese hospices/PCUs and to explore these changes through comparison of survey data in 2002 and 2012. Methods: A postal survey of all government-approved hospice and care units in Japan was conducted in 2012. Two hundred twenty-seven questionnaires were dispatched, of which 156 were retuned (response rate, 68.7%). Results: The results of 2012 survey showed that 78% of respondents sent memorial cards, and 73% provided memorial services. The ratios of hospices/PCUs offering diverse bereavement serveces in general decreased over the last decade. “Organizational support” was perceived by 71% of respondents as one of the tasks of bereavement services in 2012 survey. The responses of “caregiver training” and “research on the demands of bereaved individuals” as perceived tasks were declined significantly over the past decade from 2002. Conclusion: These findings in 2012 survey revealed present status of bereavement services in Japanese hospices/PCUs, and suggested that some perceived tasks has been slightly dealt with through comparison with results of 2002 survey.

Objective: To develop and to examine the feasibility of the Japanese version Bereavement Risk Assessment Tool (BRAT-J). Methods: Pilot survey was performed at three palliative care units and one home care clinic. Medical staff performed an assessment by using the Japanese version of BRAT (BRAT-J) to examine bereavement risk among families of cancer patients. Results: 25 individuals who had a cancer patient in their family participated in this survey. Of those 25 participants, 7 (28%) were classified as minimal risk, 8 (32%) were low risk, 9 (36%) were moderate risk and 1 (4 %) was high risk. Chi-square was used to test the association between risk level and each items of BRAT. Two items of BRAT, ‘heightened emotional states (anger, guilt, anxiety) as typical response to stressors’ and ‘lack of social support/social isolation (perceived or real)’ were significantly associated with the family member’s risk level. Conclusion: This was a pilot survey to examine the feasibility of BRAT-J in practice. Further qualitative investigation needs to be conducted to determine the appropriate support required for each risk level among the bereaved individuals.

Objectives: The aim of this study is to explore prevalence and determinants of complicated grief, depressive symptoms, and suicide ideation among the relatives whose family members died in palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), Inventory of Traumatic Grief (ITG), the item concerning suicide ideation, Care Evaluation Scale (CES), and Good Death Inventory (GDI). Results: Of the 653 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 67%). The results showed 10 (2.3%) respondents with complicated grief and 153 (43.8%) with depressive symptoms. Suicide ideation was appeared among 52 (11.9%) respondents. Multiple regression analysis revealed that ITG was signicicantly associated with both CES and GDI. Patiens' age at death and pre-bereavement health contributed to the suicide ideation of the bereaved family members. Conclusion: The prevalence of complicated grief and depressive symptoms among the relatives whose family members died in palliative care units were 2.3% and 43.8%, respectively. The rates of suicide ideation was 11.9% of respondents. The results suggested that the evaluations about structure and process of palliative care, and quality of death contribute to better adjustment of the bereaved.

Objectives: The purpose of this study is to clarify evaluations and needs of bereavement services among the bereaved whose family member died at palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the items concerning bereavement services provided by palliative care units and other resources, and the Center for Epidemiologic Study Depression Scale (CES-D). Results: Of the 661 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 68%). The results revealed that 49% of respondents received "memorial cards". Bereavement services were evaluated positively by 88-94% of respondents. The bereaved relatives with higher level of depressive symptoms signicicantly asked for bereavement services. Conclusion: These findings did not suggest the efficacies of some beravement services provided by a specified unit, but that of each service itself at palliative care units. And this result supported the notion that all the bereaved did not equally want any beravement services.

We report a successfully treated case of double valve replacement for mucopolysaccharosis in a 27-year-old woman. Mucopolysaccharosis had been suspected since she was aged 11. Symptoms of heart failure and chest pain suggested valvular disease and she was referred to us. Echocardiography, aortography and cardioangiography showed aortic regurgitation (grade IV/IV) and mitral regurgitation (grade III/IV). She received double valve replacement and was discharged on the 38th postoperative day with symptom improvement. Although urinalysis was positive for heparan-sulfate, this case could not be diagnosed definitively as mucopolysaccharosis due to normal lymphocytic enzyme-activity. However, large amounts of mucopolysaccharoid deposits were present in her removed aortic and mitral valve leaflets, and her clinical picture corresponded with mucopolysaccharosis. Thus, it was considered that her ultimate diagnosis was combined cardiac valvular disease due to mucopolysaccharosis.

We report a case of coronary artery bypass grafting (CABG) in a patient with systemic lupus erythematosus (SLE). A 24-year-old woman with SLE had been treated with steroids and immunosuppressive agents for 7 years. The patient was admitted to Kumamoto University Hospital for the management of unstable angina. CABG was successfully performed using bilateral internal thoracic arteries and postoperative 3D-CT demonstrated good patency of both arterial grafts. The patient experienced no significant postoperative complications, and has remained well to date (8 months postdischarge).