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For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of first choice for moderate-to-severe cancer pain.The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group (SIG) guidelines, for the diagnosis and assessment of cancer pain in adults provide a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs of patient population and situations in India. A questionnaire based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that a comprehensive pain assessment of all the patients should be conducted before initiating treatment. The patients should be educated about all the available pain control interventions. For assessing cancer pain, unidimensional tools such as Numeric Rating Scale, Visual Analog Scale, and Visual Rating Scale should always be used routinely. Patients with cancer pain should routinely be screened for distress and other psychological disorders, using the Patient Health Questionnaire-9. The most reliable assessment of pain is patients’ self-reporting.

The coronavirus disease 19 (COVID-19) pandemic has placed significant strains on healthcare resources including staff, theatre, high dependency and intensive care availability. Surgery remains the optimal treatment for the majority of oral malignancies, and primary reconstruction is often necessary to avoid significant morbidity as a result of ablative procedures.

The supraclavicular artery island flap (SCAIF) is increasingly finding a place as an alternative to free flap reconstruction of soft-tissue defects and has several specific advantages when compared to use of a soft-tissue free flap during the COVID-19 pandemic. It can be used for a range of head and neck defects.

We describe our experience with the SCAIF during the pandemic in five patients with a variety of tumour types and locations. All five patients had a successful outcome with none requiring further reconstruction and all had a functional swallow postoperatively, including a patient who underwent a total pharyngeal reconstruction with a SCAIF.

The use of a SCAIF during the current COVID-19 pandemic has significant advantages and is a reliable alternative to a soft tissue free flap.

The use of a SCAIF during the current COVID-19 pandemic has significant advantages and is a reliable alternative to a soft tissue free flap.

Double valve replacement (DVR) with a mechanical prosthesis is associated with a higher risk of mortality. We planned to study the survival rate, early and late mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing DVR for rheumatic heart disease, with various generations of prosthetic valves ranging from ball in cage to bileaflet prosthesis and tilting disc valves.

We followed up 277 patients with rheumatic heart disease who underwent DVR between August 1999 and November 2009, retrospectively, at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. Two hundred and fifty-nine patients were followed up for a minimum period of 10years, and the follow-up period varied between 10 and 20years. Eighteen patients were lost to follow-up after the surgery and could not be contacted. Their data was included till the time they appeared for follow-up last, for survival analysis. Survival analysis was carried out using the life table method to cnctional status following surgery, with good rates of freedom from re-operation and MACCE.Given the unprecedented challenges imposed on the aviation industry by the COVID-19 pandemic, this paper proposes a new perspective on airport user experience as a field of study to unlock its potential as a basis for strategic roadmapping. Through an integrative literature review, this study points out a dominant focus, in practice and research, on customer experience and service quality, as opposed to user experience, to help airports gain a competitive edge in an increasingly commoditized industry. The review highlights several issues with this understanding of experience, as users other than passengers, such as employees, working for the airport and its myriad stakeholders, as well as visitors, are largely omitted from study. Given the complexity of the system, operationally, passengers are generally reduced to smooth flows of a passive mass, which this study argues is both a missed opportunity and a vulnerability exacerbated by the COVID-19 pandemic. Major events apart from COVID-19 are used to show the negative effects this simplification of user experience has had. Based on solutions and models proposed in previous studies, a conceptual model has been developed to illustrate the postulated potential of a deeper and more holistic study of airport user experience to make airport systems generally more agile, flexible and future-proof. As such, the paper advocates to utilize the user experience as a basis for strategic planning to equip airports with the know-how to manage not just daily operations more effectively but also the aftermath of and recovery from major events like the COVID-19 pandemic. Moreover, with the user experience at the center of the strategic roadmap, airports can plan ahead to mitigate the impact of future scenarios. The importance of future research and the use of existing research are discussed.This study examines the short-term impact of the 2019 novel coronavirus (COVID-19) outbreak on 52 listed airline companies around the world by using event study methodology. The results demonstrate that airline stock returns decline more significantly than the market returns after three major COVID-19 announcements were made. Overall, investors react differently during the three selected events. The strongest overreaction is noted in the post-event period of the World Health Organization’s and President Trump’s official announcements. Selleck Dac51 Moreover, the findings confirm that traders in Western countries are more responsive to recent information than the rest of the world. The findings call for immediate policy designs in order to alleviate the impact of the pandemic in the airline industry around the globe.