December 1, 2023

Exploring Interconnections Between Music, Art, Physics and Medicine

 A new article titled "The Beholder - A Symphony of Life in Medicine" traces the author's journey integrating artistic, scientific, and humanistic perspectives. It reveals striking symmetries between music, visual art, quantum physics, and medicine, illuminating an interconnected reality. As a holistic musician drawn to medicine as a creative act of healing, the author has woven together these disparate strands into a remarkable tapestry merging arts, physics, and caregiving.

Citation: Heston, Thomas F. (2023). The Beholder - A Symphony of Life in Medicine. International Journal of Scientific Research. 2023;12(12):1-2.

November 30, 2023

Elevated coronary calcium scores in patients with normal myocardial perfusion

 A study evaluated coronary artery calcium scoring in 2351 patients undergoing myocardial perfusion imaging who had normal perfusion results. 55% had a calcium score of 0, 36% had scores from 1-400, and 9% had scores above 400. Higher calcium scores were significantly associated with older age, hypertension, hyperlipidemia, smoking, diabetes, male sex, and family history. After adjustment, age, hypertension, and hyperlipidemia remained associated. Despite having normal myocardial perfusion, nearly 10% of patients had concerningly elevated calcium scores above 400, suggesting the potential utility of assessing coronary calcium even in some patients with normal perfusion.

Citation: Heston T, Merrill J, Bengel F, Wahl R. Coronary calcium scores in patients with normal myocardial perfusion. Journal of Nuclear Medicine. 2009;50(Suppl 2):1160. 

DOI: 10.5281/zenodo.10230802 


November 28, 2023

Safeguarding Medical Research Integrity Through Statistical Ethics

 A new narrative review underscores how the ethical application of statistics is fundamental for rigorous, reproducible medical research. It highlights common statistical pitfalls like p-hacking and over-reliance on p-values that can undermine findings. Historical examples demonstrate how such errors have led to public harm, including with past hormone therapy and vaccine trials. Recommendations to raise standards encompass more statistical oversight during proposal reviews, requiring open access data and mandating an ethical discussion. As the article emphasizes, upholding core ethical principles in clinical trials necessitates meticulous statistical planning and analysis.

Citation: Heston TF. Statistical Ethics in Medical Research: A Narrative Review. Jour Clin Med Res. 2023;4(3):1-10.

November 27, 2023

One-Third of Normal Patients Misclassified by Typical Statistically Significant Cutoffs

 A study in a nuclear medicine journal investigated how often a statistically significant cutoff between normal and abnormal values would misclassify healthy patients. Analyzing 32 test results, the typical cutoff fell just 0.66 SDs from the mean. At that point, one SD encompasses 34% of normally distributed data on both sides of the mean. Consequently, 34% of healthy patients fall beyond 0.66 SDs and would be erroneously deemed abnormal. The authors conclude statistical significance frequently fails to ensure clinical usefulness on an individual level.

Citation: Heston TF, Wahl RL. How often are statistically significant results clinically relevant? Not often. J Nucl Med. 2009;50(Suppl 2):1370. DOI: 10.5281/zenodo.10198933

November 13, 2023

Comparing Approaches to Smoking Cessation: What Works Best?

In 1993, a meta-analysis examined the efficacy of various smoking cessation strategies. The review found clinical interventions to be more successful than community-based programs. Brief counseling from healthcare providers, nicotine replacement therapy, workplace smoking bans, and increased tobacco taxes were among the most effective clinical approaches. While this meta-analysis illuminated the short-term effectiveness of different cessation tactics, further research is required to understand long-term outcomes. These findings highlight the value of integrating smoking cessation initiatives into comprehensive tobacco control efforts.

Citation: Heston TF. Smoking cessation strategies: a meta-analysis. Southern Medical Journal. 1993;86(Suppl):S36. doi:

November 10, 2023

Gender Disparities in Emergency Cardiac Care Persist

 A study from 1997 confirms previous findings that women face gender disparities in emergency care for suspected heart attacks. Compared to men, women experienced delays in obtaining ECGs and being evaluated by physicians. Women were also less likely to be admitted to intensive care units. Despite increased awareness, these gaps in care for women persist nationwide. More training and protocols are needed to eliminate gender bias and improve outcomes for female cardiac patients.

Citation: Heston, T. F., & Lewis, L. M. (1997). Gender bias in acute myocardial infarction. The American Journal of Cardiology, 79(6), 844.

November 7, 2023

Efficacy of Behavioral Changes on Weight Loss in Hypertension Risk Groups

This study meticulously examines the correlation between behavioral modifications and weight loss among individuals at risk of hypertension. It scrutinizes the outcomes of a 14-week intervention targeting dietary habits and physical activity. The intervention's efficacy is measured by the change in participants' Body Mass Index (BMI), with a notable reduction from an initial mean BMI of 28.9 kg/m² to 27.5 kg/m². The research identifies the precision of food record-keeping and the initial BMI as significant predictors, explaining a 38% variance in weight loss. These findings advocate for the critical role of self-monitoring dietary intake and starting BMI in weight loss programs, particularly for those at elevated risk for hypertension.

Citation: Heston, T. F. (1992). Predictors of weight loss in a hypertension prevention program. Southern Medical Journal, 85(Supplement), 3S–31.

November 3, 2023

Assessing Research Findings: Beyond Statistical Significance

 Traditionally, p-values have been used to determine statistical significance of research findings. However, statistical significance does not guarantee clinical relevance. The fragility index provides additional insight into robustness but still depends on p-values. In contrast, the relative risk index focuses on divergence from therapeutic equivalence, independent of statistical significance. A recent simulation found the relative risk index weakly correlates with p-values, suggesting distinct information. The relative risk index may better capture clinical relevance. Rather than solely relying on p-values and fragility indices, the relative risk index warrants consideration as a complementary metric when evaluating research to guide evidence-based practice.

Citation: Heston TF. Statistical significance versus clinical relevance: a head-to-head comparison of the fragility index and relative risk index. Cureus. 2023;15(10):e47741. DOI:10.7759/cureus.47741.

November 1, 2023

The Cost of Living Index as a Primary Driver of Homelessness

A new study analyzed data across all 50 US states to identify factors driving differences in homelessness rates. It found the cost of living index, mainly housing costs, as the primary contributor to homelessness. Unemployment, poverty, and alcohol misuse also emerged as significant factors. Unexpectedly, reduced access to prescription opioids was linked with increased homelessness, suggesting restrictive opioid policies may have unintended consequences. The insights can inform resource allocation and policies to alleviate homelessness through comprehensive, collaborative approaches.

Citation: Heston TF. The Cost of Living Index as a Primary Driver of Homelessness in the United States: A Cross-State Analysis. Cureus. 2023;15(10):e46975. Published 2023 Oct 13. doi:10.7759/cureus.46975

August 25, 2016

Longitudinal Associations Between Cyberbullying Involvement and Adolescent Mental Health.

Adolescent cyber bully victims are more likely to experience depressive symptoms, social anxiety symptoms, and below average well-being. J Adolesc Health. 2016 Aug 12.

Comment: The most astonishing part of this study was the prevalence of cyber bullying: 8% of subjects reported being cyber bullies, and 20% of subjects reported being a cyber bully victim within the previous year!

August 20, 2016

A Cross Cultural Study of Mental Health among Internet Addicted and Non-Internet Addicted: Iranian and Indian Students.

Internet addicted college students have multiple mental health issues compared to non-addicted students, including depression, anxiety, paranoia, obsession, and life dissatisfaction. Glob J Health Sci. 2016;9(1):58269

Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study.

When pharmaceutical companies pay specialists to speak and consult, the result is increased prescribing of those drugs in the physicians geographical region. BMJ. 2016 Aug 18;354:i4189.

Comment: Payments for educational materials was not associated with increased prescribing of the pharmaceutical being marketed, perhaps because of stringent rules placed upon printed material. Speakers, however, has much more leeway and this study found that paying them to speak about the pharmaceutical being marketed paid off, in that the result was more prescribing of that drug.

April 23, 2015

Assessment of medical students' attitudes on social media use in medicine: a cross-sectional study.

Social media is being used extensively by medical students, however, they do not appear aware of possible ethical issues.  (BMC Med Educ. 2015 Feb 15;15(1):18)
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Social media: the key to health information access for 18- to 30-year-old college students.

The Internet and social media appear to be effective health communication channels for 18- to 30-year-old college students. Health educators should consider using social media to present important health information to 18- to 30-year-old college students.  (Comput Inform Nurs. 2015 Apr;33(4):132-41.)
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April 19, 2015

The use of social networking platforms for sexual health promotion: identifying key strategies for successful user engagement.

Among Twitter and Facebook profiles promoting sexual health, the strategies that created the greatest engagement were: a) making regular updates (median 46 posts or 124 tweets per month by the top-ranked profiles); b) individualised interaction with users; and c) encouraging interaction and conversation by posing questions. Uploading multimedia material and highlighting celebrity involvement were also key strategies.  (BMC Public Health. 2015 Feb 6;15(1):85.)
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