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The authors report an association between perioperative dexamethasone administration and improved survival in human pancreatic adenocarcinoma patients. An association between use of epidural anesthesia during primary pancreatic cancer surgery and prolonged survival was also observed. Previously identified associations between perioperative blood transfusions and poor tumor histologic grade and decreased survival were confirmed. Further investigations regarding the use of perioperative dexamethasone and neuraxial anesthesia in this patient population are warranted.

BACKGROUND Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. METHODS Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. RESULTS Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillus spp. not anthracis, three (7.5%) α-hemolytic Streptococcus spp., and one each (2.5%) of Enterococcus spp., Staphylococcus aureus (S. aureus), and Corynebacterium spp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. CONCLUSION We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.

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Psychological well-being was found to be an important factor in health promotion. Various therapeutic models consider dysfunctional cognitions and beliefs as a source of mental distress. They propose a rational and objective process of questioning the stressevoking thoughts in order to achieve therapeutic change and psychological well-being. Inquiry-Based Stress Reduction (IBSR, 'The Work') meditation technique offers a different approach for questioning stressful thoughts by including emotional and authentic insight. It consists of two stages: a systematic and comprehensive identification of stressful thoughts followed by questioning of these thoughts by a fixed set of questions and turnarounds. The aim of the current article is to review the IBSR technique, its unique format and therapeutic process. It summarizes the clinical evidence regarding its efficacy as a tool of improving various psychological parameters. Despite several limitations of the technique, the findings demonstrated its effectiveness as a tool for enhancing psychological well-being and promoting mental health. Randomized controlled trials are warranted in order to further examine the technique's potential contribution to psychological well-being.