In 2011, we reported the usefulness of a database（DB）that was established by the members of a palliative care team（PCT）. Since then, we updated DB depending on the requests of PCT. We revised DB mentioned below. We developed a form for keeping a record of PCT members’care for patients, their family members or others, and a record of recommendation for each problem list. We also updated another form so that the evaluation of Support Team Assessment Schedule of Japan（STAS-J）had been showed sequentially, added an entry form of Palliative Prognostic Index, and extracted data required by Japan Society for Palliative Medicine in order to evaluate the activity of PCT. The database could be used by many hospitals, because it was created by the commercially available software.

Purpose: We developed a database that can be shared by the members of our palliative care team (PCT) before the conference and ward round (CR) to make these activities more efficient. Methods: The database was developed using Microsoft Access®. The condition of patients was evaluated using a Japanese version of the Support Team Assessment Schedule (STAS-J). The database allows any member of the team to input patient information. We also developed a form that allows us not only to share the information but to continuously observe the progress of the patients. To evaluate the advantages of the database on CR, we compared the number of patients observed in one CR and the number of CR's per patient before and after the introduction of the database. Results: The number of patients observed in one CR and the number of CR's per patient were significantly increased after the introduction of the database. Conclusion: The database had positive effects on CR by making the patient information available in advance and by allowing continuous evaluation of patients. Palliat Care Res 2011; 6(1): 209-215

The patient was a 74-year-old man with a history of previous aorto-coronary bypass grafting 14 years previously. Echocardiography showed severe aortic valve stenosis. Computed tomography showed severe circumferential aortic calcification of the whole aorta, including the aortic root. Coronary cineangiography showed patency of the endoric graft. Avoiding graft injury and aortic cross clamping, we performed apicoaortic conduit. His postoperative course was uneventful, he was discharged very much improved on the 11th postoperative day. This procedure is useful in high risk patients with aortic valve stenosis.

A 60-year-old man, who underwent repair of ventricular septal defect (VSD) 40 years previously, presented with dyspnea on effort and leg edema. Further examination showed residual VSD, mitral and tricuspid valve insufficiency, atrial flutter and pulmonary hypertension. We performed repair of the residual VSD, mitral valve replacement, tricuspid valve annuloplasty, and the Maze procedure. After surgery, systolic pulmonary arterial pressure decreased from 70 to 39 mmHg. On the 4th postoperative day, his hemodynamic state was stable and he weaned from ventilator. He showed hypoxia with sticky excretions, and reintubation was done 10 h after extubation. After intubation, pulmonary hypertension continued, nitroglycerine administration was not effective but inhaleted nitric oxide (NO) improved pulmonary hypertension. On the 15th postoperative day, sildenafil administration from nasogastric tube was started the day before extubation. On postoperative echocardiogram on the 35th postoperative day, the systolic pulmonary arterial pressure was 30-40 mmHg and left ventricular function was severely impaired because of the paradoxical movement of the ventricular septum after repair VSD. Sildenafil was safely used for the patient with heart failure and secondary pulmonary hypertension associated with congenital heart disease.

Objective: This study intended to clarify whether healthcare professionals provide palliative care and the factors associated with such care. Methods: An anonymous self-administered questionnaire survey was conducted of healthcare professionals in in an acute care hospital in order to investigate their practice and understanding of palliative care as well as their personal attributes. A multivariate logistic regression analysis was conducted to identify factors associated with their palliative care practice. Results: 605 of 955 respondents (response rate: 63%) answered. Twenty-three percent of all respondents answered that they were involved in palliative care practice. A multivariate logistic regression analysis revealed understanding the concept and practical components of palliative care, including the functions of palliative care, differences between primary and specialized palliative care, and advance care planning, were factors associated with palliative care practice. Conclusion: Palliative care specialists should provide the educational support for healthcare professionals to enable them to deepen their understanding of palliative care. Such support from the palliative care specialist may promote the health care professionals’ awareness of their own roles in palliative care.