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702.3±60.0 °C at 760 mmHg
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To report a case of increased intraocular pressure (IOP) associated with blood in Schlemm’s canal following strabismus surgery.
A 43-year-old female presented with acquired comitant esotropia. The patient had undergone an uneventful bilateral medial rectus recession and right lateral rectus resection operation under general anesthesia. Routine post-operative follow-up at day 3 detected a marked chemosis at the temporal side of the conjunctiva, an elevated IOP of 30 mmHg, and the presence of blood in Schlemm’s canal in the temporal angle of the right eye. Episcleral venous outflow impairment was hypothesized to be the cause of secondary ocular hypertension in this patient. IOP was controlled with anti-glaucoma drops. Conjunctival chemosis, IOP, and blood in Schlemm’s canal gradually decreased, and all topical medications were ceased at 11 weeks after the surgery.
Conclusion and importance
An IOP elevation can be an early complication after strabismus surgery. The presence of blood in Schlemm’s canal suggests that the cause is impairment of episcleral venous flow. Although the episode can be transient, this report underlines the importance of IOP examination during the early post-operative period.
Glaucoma, Episcleral venous pressure, Secondary ocular hypertension, Strabismus surgery
Intraocular pressure elevation associated with blood in Schlemm's canal after strabismus surgery
Wisaruta Wutthayakorn,a,b Kidakarn Meethongkam,c Parnchat Pukrushpan,c and Sunee Chansangpetcha,c,∗∗
Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support.
To explore clients’ perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH).
We searched MEDLINE (OvidSP), MEDLINE In‐Process & Other Non‐Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3‐6 July 2017 dependant on the database (See appendix 2).
We included studies that used qualitative methods for data collection and analysis; that explored clients’ perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally.
Data collection and analysis
We used maximum variation purposive sampling for data synthesis, employing a three‐step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE‐CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness.
We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low‐ and middle‐income settings and sixteen in high‐income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.
Our synthesis showed that clients’ experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).
However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).
Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).
Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients’ views about who sent the digital health communication could influence their views of the programme (moderate confidence).
For an overview of the findings and our confidence in the evidence, please see the ‘Summary of qualitative findings’ tables.
Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue.
Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
Clients’ perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis
Monitoring Editor: Heather MR Ames,corresponding author Claire Glenton, Simon Lewin, Tigest Tamrat, Eliud Akama, Natalie Leon, and Cochrane Consumers and Communication Group
Breast neoplasms, Drug therapy, Estrogen receptors, Prognosis
Young Patients with Hormone Receptor-Positive Breast Cancer Have a Higher Long-Term Risk of Breast Cancer Specific Death
Jianfei Fu,1,* Chenhan Zhong,2,3,* Lunpo Wu,4,5 Dan Li,2,3 Tiantian Xu,6 Ting Jiang,7 Jiao Yang,8 and Jinlin Ducorresponding author9