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.

Purpose: Surgery of the horseshoe fistula is challenging due to its complex configuration and sphincter muscle involvement. Complete deroofing fistulotomy for horseshoe fistula is highly curative with the eradication of all fistulous lesions but has been discredited for its high incontinence rate. It was replaced with the more conservative Hanley’s procedure leaving the lateral tracts intact, despite its issue of recurrence. Our study aimed to report the outcomes of a procedure dividing complete deroofing fistulotomy for horseshoe fistula into 2 stages to avoid impairment of sphincter function. Methods: We retrospectively reviewed 139 patients who underwent surgery for horseshoe fistula using the 2-stage complete deroofing fistulotomy method between 2014 and 2017. The first surgery deroofed the lateral tracts with an arch-like incision severing the anococcygeal ligament. The primary lesion was also drained and curetted. A seton was placed in the primary tract which was laid open in the second surgery after the lateral wound had partially healed. Results: Recurrence was observed in 12 patients. All were superficial recurrences except for 1, in which recurrence was confirmed in the primary lesion. Those with blind intersphincteric upward extensions had a significantly higher recurrence rate. Furthermore, patients who resided far from the hospital and could not make visits for frequent wound inspections also had a significantly higher recurrence rate. No patient had any continence issues at the end of the follow-up period. Conclusion Managing horseshoe fistula with the 2-stage deroofing fistulotomy approach allows for eradication of the fistula tract without compromising anal sphincter function.

Purpose: Surgery of the horseshoe fistula is challenging due to its complex configuration and sphincter muscle involvement. Complete deroofing fistulotomy for horseshoe fistula is highly curative with the eradication of all fistulous lesions but has been discredited for its high incontinence rate. It was replaced with the more conservative Hanley’s procedure leaving the lateral tracts intact, despite its issue of recurrence. Our study aimed to report the outcomes of a procedure dividing complete deroofing fistulotomy for horseshoe fistula into 2 stages to avoid impairment of sphincter function. Methods: We retrospectively reviewed 139 patients who underwent surgery for horseshoe fistula using the 2-stage complete deroofing fistulotomy method between 2014 and 2017. The first surgery deroofed the lateral tracts with an arch-like incision severing the anococcygeal ligament. The primary lesion was also drained and curetted. A seton was placed in the primary tract which was laid open in the second surgery after the lateral wound had partially healed. Results: Recurrence was observed in 12 patients. All were superficial recurrences except for 1, in which recurrence was confirmed in the primary lesion. Those with blind intersphincteric upward extensions had a significantly higher recurrence rate. Furthermore, patients who resided far from the hospital and could not make visits for frequent wound inspections also had a significantly higher recurrence rate. No patient had any continence issues at the end of the follow-up period. Conclusion Managing horseshoe fistula with the 2-stage deroofing fistulotomy approach allows for eradication of the fistula tract without compromising anal sphincter function.