Tumor boards may add little to VA cancer care

NEW YORK (Reuters Health) – Getting doctors together to discuss the best treatments for cancer patients in U.S. Veterans Affairs hospitals was only linked to a minor improvement in care in a large new study.

Analyzing the records of 138 VA medical centers, researchers found that the presence of a so-called tumor board – a group of cancer treatment experts – only affected seven out of 27 measures of quality and processes in patient care, and not always for the better.

“This does not support the hypothesis that tumor boards are doing a lot to improve care,” said Dr. Nancy Keating from Boston’s Harvard Medical School and Brigham and Women’s Hospital, the study’s senior author.

Tumor boards are a standard part of medical care in the U.S. and are generally made up of several different types of doctors, including surgeons and radiation oncologists, who review patients’ cases and make recommendations for their treatment.

The study’s authors write in the Journal of the National Cancer Institute that previous research found hospitals dedicate about 50 hours per month of their doctors’ time to participation in tumor boards.

“It is interesting that despite the fact that tumor boards seem like a good thing and they are so well established, there is so little literature on them,” said Keating.

She and her colleagues wanted to know whether tumor boards actually made a difference.

To do that, they linked together information and records from the VA’s 138 medical centers on cancer patients treated between 2001 and 2004.

The team found that 75 percent of the medical centers had at least one tumor board that discussed most of the conditions the researchers were interested in: colorectal, lung, prostate, breast and blood cancers.

Then, using established national guidelines, the researchers developed a list of 27 markers for the quality and type of care patients received.

For example, the researchers checked whether patients with stage II or III rectal cancer got the recommended dose of chemotherapy and radiation before surgery to remove the cancer.

Overall, the researchers found the presence of a tumor board was only linked with differences in seven of the 27 markers.

“And some of those seven were actually a situation where the tumor board was associated with worse care,” Keating said.

In addition, recommended care for specific types of malignancies, such as blood cell cancers, was more often seen in centers with no tumor board (56 percent) or only a general tumor board (61 percent) than in centers with tumor boards specializing in blood cancers (39 percent).

“This is a little bit off-putting because it challenges the conventional wisdom that tumor boards are a good thing,” said Dr. Douglas Blayney, a professor of medicine at the Stanford School of Medicine in California.

“I think the main issue that remains to be answered: Did the recommendations of the tumor boards actually get carried out?” added Blayney, who wrote an editorial accompanying the study.

“We think patients benefit from having their cases reviewed at the outset, but we leave it to the medical system to get acted upon,” he said.

Keating said researchers need to do a “deep dive” into tumor boards to find out more. She said they still need to know how the tumor boards are structured, and what types of cases are discussed.

Until then, “I do think that people and centers who are investing time and energy in their tumor boards should really think about how they are structured, and if they’re set up in a way to improve patient care,” she said.

Blayney told Reuters Health that he doesn’t think hospitals should scrap their tumor boards based on these findings, because there are new possibilities with new technology.

“The promise of telemedicine technology makes extra use of academic centers available to patients who may live in rural locations and doctors who are remote from the academic centers,” he said.

For example, the rural doctors of a woman with breast cancer can conference with a tumor board that specializes in breast cancer at a large, urban academic center.

“Again it’s tapping into the knowledge and experience of a broad range of physicians,” Blayney said.

SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online December 28, 2012.

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Obama ‘optimistic’ Senate leaders will reach ‘fiscal cliff’ deal this weekend

(Reuters/Jonathan Ernst)

Following talks with congressional leaders that yielded no news of  a "fiscal cliff" agreement, President Barack Obama on Friday evening pressured lawmakers to reach a deal this weekend as the public's patience wears thin.

"America wonders why it is that in this town for some reason they can't get stuff done in an organized timetable, why everything always has to wait for the last minute," Obama said during a statement delivered in the White House briefing room. "The American people are not going to have any patience for a politically self-inflicted wound to our economy, not right now."

The president confirmed that following his Friday afternoon meeting with congressional leaders, Senate Majority Leader Harry Reid and Senate Minority Leader Mitch McConnell have been tasked to reach an agreement to reduce the deficit and avoid the "fiscal cliff"—automatic spending cuts and tax increases set to go into effect Jan. 1.

But in the absence of a deal, Obama said he will "urge" Reid to "bring to the floor a basic package for an up-or-down vote" that would increase taxes on households earning more than $250,000, extend unemployment insurance and disarm a sequestration—provisions the president has supported.

But Republicans have been rejecting any tax increases, even for the wealthiest earners.

"If members of the House or Senate want to vote 'no,' they can," Obama said of his plan. "But we should let everybody vote. That's the way this is supposed to work."

The president referred to Friday's meeting, which also included House Speaker John Boehner, House Minority Leader Nancy Pelosi, Vice President Joe Biden and Treasury Secretary Tim Geithner, as "good and constructive" and said he remained "modestly optimistic" about Congress' ability to reach a deal.

But he blamed Congress for the 11th-hour holdup.

"The economy is growing, but sustaining that trend is going to require elected officials to do their jobs," Obama said.

No details on the proposals offered Friday were released by the White House or the lawmakers present.

According to a readout from the speaker's office, Boehner began the meeting by reminding those gathered "that the House has already acted to avert the entire fiscal cliff and is awaiting Senate action." Plan options were discussed and the speaker said the House will consider Senate-amended, House-passed legislation.

Following the meeting, McConnell said on the Senate floor that he was "hopeful and optimistic" about a deal.

"We had a good meeting down at the White House. We are engaged in discussions—the majority leader and myself and the White House—in the hopes that we can come forward as early as Sunday and have a recommendation that I can make to my conference and the majority leader can make to his conference," McConnell said. "And so we’ll be working hard to try to see if we can get there in the next 24 hours."

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750,000 Android apps invade OS X thanks to BlueStacks App Player

Earlier this year, BlueStacks App Player made headlines by allowing Android apps run on Microsoft’s (MSFT) Windows 8 platform. The company announced on Thursday its App Player is now available in beta form for free on Mac, giving OS X users access to 750,000 Android apps normally reserved for smartphones and tablets.

[More from BGR: Google names 12 best Android apps of 2012]

BlueStacks uses patent-pending virtualization software called “Layercake” to allow Android apps to run on other platforms. It works virtually the same as running Windows within OS X using software such as Parallels or VMWare. The Windows 8 version of BlueStacks has been out since March and has been installed on more than 5 million PCs, which is a good sign that people want to run mobile apps on their computers.

[More from BGR: Samsung looks to address its biggest weakness in 2013]

BGR tested BlueStacks on a mid-2011 MacBook Air running OS X 10.8 Mountain Lion and found performance to be hit or miss. Android apps can be searched and it will list which app stores to download them from, but sometimes apps won’t install properly because of missing code, especially from the Google Play store. Downloading apps from the Amazon (AMZN) Appstore seems to be a better bet, though. If it’s any consolation, Jetpack Joyride and Fruit Ninja are perfectly playable.

BlueStacks works as mostly advertised, but honestly, why bother running Android apps on your Mac? A mouse or trackpad isn’t a better substitute for a touchscreen. But if you must do so, it’s reassuring to know BlueStacks is available.

This article was originally published by BGR

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It’s husband No. 3 for actress Kate Winslet

NEW YORK (AP) — Kate Winslet has tied the knot again.

The Oscar-winning actress wed Ned Rocknroll in New York earlier this month. The private ceremony was attended by Winslet‘s two children as well as a few friends and family members, her representative said Thursday.

It is the third marriage for the 37-year-old Winslet. She was previously married to film directors Jim Threapleton and Sam Mendes.

The 34-year-old Rocknroll, who was born Abel Smith, is a nephew of billionaire Virgin Group founder Richard Branson.

The couple had been engaged since last summer.

Winslet won a Best Actress Oscar for her performance in the 2008 film “The Reader.”

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State’s first flu death is Tulsa County resident

A Tulsa County resident between the ages of 19 and 64 is the first person in Oklahoma to die from the flu this season.

Since Sept. 30 there have been 24 hospitalizations due to flu reported in Tulsa County, the most for any county in the state.

Oklahoma County has reported 10, according to the Oklahoma State Department of Health.

There have been 75 flu hospitalizations throughout the state. Twenty-one of those were reported last week. The age range with the most hospitalizations was 65 and older with 28. Children under 4 accounted for 20 cases, according to the department.

Nationally 1,013 people have been hospitalized and eight children have died, according to the Centers for Disease Control and Prevention.

Flu activity has been increasing, particularly in the south central and southeastern regions of the county. Oklahoma reported regional flu activity last week while 29 states had widespread activity, according to the CDC.

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Retired General Norman Schwarzkopf dies

WASHINGTON (AP) — Retired Gen. H. Norman Schwarzkopf, who topped an illustrious military career by commanding the U.S.-led international coalition that drove Saddam Hussein's forces out of Kuwait in 1991 but kept a low public profile in controversies over the second Gulf War against Iraq, died Thursday. He was 78.

Schwarzkopf died in Tampa, Fla., where he had lived in retirement, according to a U.S. official, who was not authorized to release the information publicly and spoke on condition of anonymity.

A much-decorated combat soldier in Vietnam, Schwarzkopf was known popularly as "Stormin' Norman" for a notoriously explosive temper.

He served in his last military assignment in Tampa as commander-in-chief of U.S. Central Command, the headquarters responsible for U.S. military and security concerns in nearly 20 countries from the eastern Mediterranean and Africa to Pakistan.

Schwarzkopf became "CINC-Centcom" in 1988 and when Saddam Hussein invaded Kuwait three years later to punish it for allegedly stealing Iraqi oil reserves, he commanded Operation Desert Storm, the coalition of some 30 countries organized by then-President George H.W. Bush that succeeded in driving the Iraqis out.

At the peak of his postwar national celebrity, Schwarzkopf — a self-proclaimed political independent — rejected suggestions that he run for office, and remained far more private than other generals, although he did serve briefly as a military commentator for NBC.

While focused primarily in his later years on charitable enterprises, he campaigned for President George W. Bush in 2000 but was ambivalent about the 2003 invasion of Iraq, saying he doubted victory would be as easy as the White House and Pentagon predicted. In early 2003 he told the Washington Post the outcome was an unknown:

"What is postwar Iraq going to look like, with the Kurds and the Sunnis and the Shiites? That's a huge question, to my mind. It really should be part of the overall campaign plan," he said.

Initially Schwarzkopf had endorsed the invasion, saying he was convinced that former Secretary of State Colin Powell had given the United Nations powerful evidence of Iraqi weapons of mass destruction. After that proved false, he said decisions to go to war should depend on what U.N. weapons inspectors found.

He seldom spoke up during the conflict, but in late 2004, he sharply criticized then-Defense Secretary Donald Rumsfeld and the Pentagon for mistakes that included inadequate training for Army reservists sent to Iraq and for erroneous judgments about Iraq.

"In the final analysis I think we are behind schedule. ... I don't think we counted on it turning into jihad (holy war)," he said in an NBC interview.

Schwarzkopf was born Aug. 24, 1934, in Trenton, N.J., where his father, Col. H. Norman Schwarzkopf Jr., founder and commander of the New Jersey State Police, was then leading the investigation of the Lindbergh kidnap case, which ended with the arrest and 1936 execution of German-born carpenter Richard Hauptmann for stealing and murdering the famed aviator's infant son.

The elder Schwarzkopf was named Herbert, but when the son was asked what his "H'' stood for, he would reply, "H." Although reputed to be short-tempered with aides and subordinates, he was a friendly, talkative and even jovial figure who didn't like "Stormin' Norman" and preferred to be known as "the Bear," a sobriquet given him by troops.

He also was outspoken at times, including when he described Gen. William Westmoreland, the U.S. commander in Vietnam, as "a horse's ass" in an Associated Press interview.

As a teenager Norman accompanied his father to Iran, where the elder Schwarzkopf trained the country's national police force and was an adviser to Reza Pahlavi, the young Shah of Iran.

Young Norman studied there and in Switzerland, Germany and Italy, then followed in his father's footsteps to West Point, graduating in 1956 with an engineering degree. After stints in the U.S. and abroad, he earned a master's degree in engineering at the University of Southern California and later taught missile engineering at West Point.

In 1966 he volunteered for Vietnam and served two tours, first as a U.S. adviser to South Vietnamese paratroops and later as a battalion commander in the U.S. Army's Americal Division. He earned three Silver Stars for valor — including one for saving troops from a minefield — plus a Bronze Star, a Purple Heart and three Distinguished Service Medals.

While many career officers left military service embittered by Vietnam, Schwarzkopf was among those who opted to stay and help rebuild the tattered Army into a potent, modernized all-volunteer force.

After Saddam invaded Kuwait in August 1990, Schwarzkopf played a key diplomatic role by helping to persuade Saudi Arabia's King Fahd to allow U.S. and other foreign troops to deploy on Saudi territory as a staging area for the war to come.

On Jan. 17, 1991, a five-month buildup called Desert Shield became Operation Desert Storm as allied aircraft attacked Iraqi bases and Baghdad government facilities. The six-week aerial campaign climaxed with a massive ground offensive on Feb. 24-28, routing the Iraqis from Kuwait in 100 hours before U.S. officials called a halt.

Schwarzkopf said afterward he agreed with Bush's decision to stop the war rather than drive to Baghdad to capture Saddam, as his mission had been only to oust the Iraqis from Kuwait.

But in a desert tent meeting with vanquished Iraqi generals, he allowed a key concession on Iraq's use of helicopters, which later backfired by enabling Saddam to crack down more easily on rebellious Shiites and Kurds.

While he later avoided the public second-guessing by academics and think tank experts over the ambiguous outcome of Gulf War I and its impact on Gulf War II, he told the Washington Post in 2003, "You can't help but... with 20/20 hindsight, go back and say, 'Look, had we done something different, we probably wouldn't be facing what we are facing today.'"

After retiring from the Army in 1992, Schwarzkopf wrote a best-selling autobiography, "It Doesn't Take A Hero." Of his Gulf war role, he said, "I like to say I'm not a hero. I was lucky enough to lead a very successful war." He was knighted by Queen Elizabeth II and honored with decorations from France, Britain, Belgium, Kuwait, Saudi Arabia, United Arab Emirates, Qatar and Bahrain.

Schwarzkopf was a national spokesman for prostate cancer awareness and for Recovery of the Grizzly Bear, served on the Nature Conservancy board of governors and was active in various charities for chronically ill children.

"I may have made my reputation as a general in the Army and I'm very proud of that," he once told the AP. "But I've always felt that I was more than one-dimensional. I'd like to think I'm a caring human being. ... It's nice to feel that you have a purpose."

Schwarzkopf and his wife, Brenda, had three children: Cynthia, Jessica and Christian.

___

Pyle contributed from New York.

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Afghan bomber attacks near major US base

KABUL, Afghanistan (AP) — A vehicle driven by a suicide bomber exploded at the gate of a major U.S. military base in eastern Afghanistan on Wednesday, killing the attacker and three Afghans, Afghan police said. The Taliban claimed responsibility for the attack.

Police Gen. Abdul Qayum Baqizai said a local guard who questioned the vehicle driver at the gate of Camp Chapman was killed along with two civilians and the assailant. The camp is located adjacent to the airport of the capital of Khost province, which borders Pakistan. Chapman and nearby Camp Salerno had been frequently targeted by militants in the past, but violent incidents have decreased considerably in recent months.

Taliban spokesman Zabihullah Mujahid said in an email that the bomber targeted Afghan police manning the gate and Afghans working for the Americans entering the base. He claimed high casualties were inflicted.

NATO operates with more than 100,000 troops in the country, including some 66,000 American forces. It is handing most combat operations over to the Afghans in preparation for a pullout from Afghanistan in 2014. Militant groups, including the Taliban, rarely face NATO troops head-on and rely mainly on roadside bombs and suicide attacks.

NATO forces and foreign civilians have also been increasingly attacked by rogue Afghan military and police, eroding trust between the allies.

On Tuesday, the Interior Ministry said a policewoman who killed an American contractor in Kabul a day earlier was a native Iranian who came to Afghanistan and displayed “unstable behavior” but had no known links to militants.

The policewoman, identified as Sgt. Nargas, shot 49-year-old Joseph Griffin, of Mansfield, Georgia, on Monday, in the first such shooting by a woman in the spate of insider attacks. Nargas walked into a heavily-guarded compound in the heart of Kabul, confronted Griffin and shot him once with her pistol.

The U.S-based security firm DynCorp International said on its website that Griffin was a U.S. military veteran who earlier worked with law enforcement agencies in the United States. In Kabul, he was under contract to the NATO military command to advise the Afghan police force.

The ministry spokesman, Sediq Sediqi, told a news conference that Nargas, who uses one name like many in the country, was born in Tehran, where she married an Afghan. She moved to the country 10 years ago, after her husband obtained fake documents enabling her to live and work there.

A mother of four in her early 30s, she joined the police five years ago, held various positions and had a clean record, he said. Sediqi produced an Iranian passport that he said was found at her home.

No militant group has claimed responsibility for the killing.

The chief investigator of the case, Police Gen. Mohammad Zahir, said that during interrogation, the policewoman said she had plans to kill either the Kabul governor, city police chief or Zahir himself, but when she realized that penetrating the last security cordons to reach them would be too difficult, she saw “a foreigner” and turned her weapon on him.

There have been 60 insider attacks this year against foreign military and civilian personnel, compared to 21 in 2011. This surge presents another looming security issue as NATO prepares to pull out almost all of its forces by 2014, putting the war against the Taliban and other militant groups largely in the hands of the Afghans.

More than 50 Afghan members of the government’s security forces also have died this year in attacks by their own colleagues. The Taliban claims such incidents reflect a growing popular opposition to the foreign military presence and the Kabul government.

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Natalie Portman, Kristen Stewart most bankable Hollywood stars

NEW YORK (Reuters) – Actresses Natalie Portman and Kristen Stewart are Hollywood’s most bankable stars and provide studios with the highest average returns for their films, according to Forbes.com.

Academy award winner Portman topped the list of best actors for the buck, providing about $ 42.70 for every dollar she earns.

“Black Swan,” for which she won her best actress Oscar, was produced for an estimated $ 13 million and earned $ 329 million in global box office sales.

“We estimate that for every dollar Portman is paid by the studios, she returns $ 42.70. Compare that to Eddie Murphy, our most overpaid star, who returns $ 2.30 for every dollar he gets paid,” Forbes.com said.

“Twilight” star Stewart was not far behind, bringing in $ 40.60. She also topped the Forbes list of highest-earning actresses with an estimated $ 34.5 million in salary in 2012.

“Stewart was able to earn a ton over the last three years and offer a healthy return thanks to ‘Twilight,’” according to Forbes.com. “Even though she was paid $ 25 million to star in the last two films, she was clearly worth the money.”

Forbes.com analyzed salaries, estimated box office grosses from the actor’s last three films over the previous three years to calculate the studio’s return on investment. The most bankable stars tended to be featured in the most profitable films.

Stewart’s two co-stars in the “Twilight” films were also good investments for the studio. Robert Pattinson came in fourth with a return of $ 31.70 and Taylor Lautner was No. 6, making $ 29.50 for the studio for every dollar he was paid.

(This story was refiled to correct spelling of Kristen)

(Editing by Steve Orlofsky)

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Ex-U.S. President George H.W. Bush in intensive care

AUSTIN, Texas (Reuters) – Former President George H.W. Bush is in the intensive care unit of a Houston hospital and is in “guarded condition,” family spokesman Jim McGrath said Wednesday.

“The president is alert and conversing with medical staff, and is surrounded by family,” McGrath said in a statement.

“Following a series of setbacks including a persistent fever, President Bush was admitted to the intensive care unit at Methodist Hospital on Sunday where he remains in guarded condition,” McGrath said.

Doctors at Methodist Hospital “continue to be cautiously optimistic about the current course of treatment,” McGrath said.

The 88-year-old was admitted to the hospital November 23 for bronchitis.

Bush, the 41st U.S. president and a Republican, took office in 1989 and served one term in the White House. The father of former President George W. Bush, he also served as a congressman, ambassador to the United Nations, envoy to China, CIA director and vice president for two terms under Ronald Reagan.

(Reporting by Corrie MacLaggan; Editing by Paul Thomasch and Phil Berlowitz)

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Former President George H.W. Bush in intensive care

HOUSTON (AP) — Former President George H.W. Bush has been admitted to the intensive care unit at a Houston hospital "following a series of setbacks including a persistent fever," but he is alert and talking to medical staff, his spokesman said Wednesday.

Jim McGrath, Bush's spokesman in Houston, said in a brief email that Bush was admitted to the ICU at Methodist Hospital on Sunday. He said doctors are cautiously optimistic about his treatment and that the former president "remains in guarded condition."

No other details were released about his medical condition, but McGrath said Bush is surrounded by family. Bush has been hospitalized since Nov. 23.

Earlier Wednesday, McGrath said a fever that kept Bush in the hospital over Christmas had gotten worse and that doctors had put him on a liquids-only diet.

"It's an elevated fever, so it's actually gone up in the last day or two," McGrath told The Associated Press earlier in the day. "It's a stubborn fever that won't go away."

But he said the bronchitis-like cough that initially brought the 88-year-old to the hospital has improved.

Bush was visited on Christmas by his wife, Barbara, his son, Neil, and Neil's wife, Maria, and a grandson, McGrath said. Bush's daughter, Dorothy, was expected to arrive Wednesday in Houston from Bethesda, Md. The 41st president has also been visited twice by his sons, George W. Bush, the 43rd president, and Jeb Bush, the former governor of Florida.

Bush and his wife live in Houston during the winter and spend their summers at a home in Kennebunkport, Maine.

The former president was a naval aviator in World War II — at one point the youngest in the Navy — and was shot down over the Pacific. He achieved notoriety in retirement for skydiving on at least three of his birthdays since leaving the White House in 1992.

___

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