Out of 104 patients with perimembranous or infundibular-isolated ventricular septal defect (VSD), causative factors of Prol and AR, and the operative indication were studied in 17 with prolapse of the aortic cusp (Prol) and 10 with aortic valve regurgitation (AR). The left to right shunt ratio and the size of VSD were smaller in patients with Prol or AR than in those with the normal aortic cusp, suggesting that hemodynamics might take part in the cause of Prol or AR. Twenty-two patients underwent VSD closure only, four valvuloplasty and one aortic valve replacement. Residual AR was occurred in three out of ten patients. After surgery, AR was disappeared in six out of seven patients with the first grade preoperative AR, but AR remained in all two patients with the second grade preoperative AR. Careful preoperative observation and early operation before the appearance of AR are the important factors for avoiding residual regurgitation after aortic valvuloplasty.

Objective: To clarify the barriers pharmacists face in handling patients with adverse drug events at community pharmacies and to propose solutions.
Design: Cross-sectional study.
Methods: One hundred-twenty-one pharmacists, who worked and experienced to work at community pharmacies (76.0%), hospitals (22.3%), or elsewhere, participated in this study.  All of them were divided into 12 groups and asked to note the barriers, and abstract and structure them through discussion in each group according to the KJ-method.  On the other hand, workers at community pharmacies including people with experience were also asked to fill out a prepared questionnaire on barriers.
Results: Six groups structured the barriers from the perspective of professional flow as pharmacists and the other groups structured them from the perspective of a medical care team.  The barriers emerging from both structures were (a) difficulty in identifying adverse drug reaction and assessing its grade at community pharmacies, (b) lack of standardized protocols for informing physicians from community pharmacies, (c) not being informed about a physician’s assessment of suspicious adverse drug reactions, and (d) difficulty in explaining adverse events to patients and their families.  Those barriers were reported by a high percentage of respondents to the questionnaire.
Conclusion: The barriers are all crucial in order to avoid health damage caused by medication at community pharmacies and should be urgently solved.