Tom Heston

1. CASE REPORTS

2. ECOLOGIC

3. CROSS-SECTIONAL: assesses a group of people via personal interview, survey,
or examination to determine if they have the disease and to determine if they
have had the exposure

a. PRO: exposure and disease measured in the same person

b. PRO: good at measuring prevalence

c. CON: can only measure prevalent cases, which may exclude those who die soon
after the disease

d. CON: temporal relationships cannot be established.

4. CASE-CONTROL: an observational study comparing the history of exposure in the
cases compared with the history of exposure in the controls.

a. retrospective

b. subjects selected based upon DISEASE status

c. then history of exposure is obtained.

d. cases should be representative of people with the disease

e. controls should be representative of the healthy population

f. CON: can examine multiple exposures but only 1 outcome

g. CON: appropriate controls are hard to find

h. CON: unable to determine incidence

5. COHORT

a. can examine multiple outcomes of a single exposure

b. can determine temporal relationship between exposure and disease

c. subjects selected based upon EXPOSURE status. They do not have the disease
at baseline.

d. able to determine incidence of disease in exposed and unexposed groups

e. over time, see who gets the disease.

f. can be assembled in the present and followed into the future: a concurrent
cohort

g. can be identified from past records and followed forward: a historical
cohort

6. RANDOMIZED CLINICAL TRIAL

7. MODIFIERS

a. prospective vs retrospective.

b. (single / double) blinded vs open

NuclearWiki.com

6/17/2009 – 09:12 AM – I will be giving an oral presentation of the research abstract “Exercise capacity and body mass index are more important than diabetes in the prediction of high risk markers on myocardial perfusion imaging” by Thomas F. Heston, MD and Richard L. Wahl, MD. This will be held at the Metro Toronto Centre.

Cancer is an insideous disease. But it can be prevented in many cases, and also cured. Here are some “secret” cancer treatments that your doctor probably doesn’t tell you about.

1. The best cure? prevention. Exercise is probably the #1 prevention measure, yet unbelievably, this is not widely discussed in the doctor’s office or in medical policymakers.

2. Radioactivity. Not external beam radioactivity or internal seeds, but rather radioimmunotherapy. For cancer patients, an antibody targeted to the tumor is used to deliver a lethal dose of radiation directly to the tumor cells.

In emergency medicine, I was taught that “a person isn’t dead unless they are warm and dead.” This saying basically means that hypothermic patients can appear lifeless, but when warmed up you can revive them. You should never pronounce a person as dead unless they are warmed up first.

For cancer patients, perhaps there is a similar sentiment. We shouldn’t give up on certain lymphoma patients unless we have tried radioimmunotherapy. We shouldn’t declare patients with advanced lymphoma as “dead” unless we have tried radioimmunotherapy.

This thought was expressed recently at Hopkins during a noon conference. One of the world’s leading experts in radioimmunotherapy said to all of us, in effect, that although radioimmunotherapy has not been perfected yet, it can be life-saving. In particular, certain subtypes of lymphoma respond to radioimmunotherapy. We should not tell patients that “we have tried everything” until we have tried radioimmunotherapy.

It doesn’t work for everyone, but many of us who practice nuclear medicine believe that radioimmunotherapy is really underutilized. Ask your doctor about it.