Sunday, October 23, 2022

Guidelines That Underplay Genomic Testing

Recent guidance documents for managing major depression, Barrett's esophagus, and CRC screening, give either no mention or neutral mention to the addition of molecular diagnostics.

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In the October 2022 Annals of Internal Medicine, discussion of a new DOD/VA guidance document for major depression  Evidence for pharmacogenetic testing in depression is rating as too equivocal to evaluate to a conclusion.

The VA/DOD guideline in full, is here:

https://www.healthquality.va.gov/guidelines/MH/mdd/index.asp

The summary by McQuaid et al. is here:

https://www.acpjournals.org/doi/10.7326/M22-1603

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A 2022 review of Barrett's esophagus, diagnosis and management, in JAMA does not mention molecular diagnostics.  Sharma 2022:

https://jamanetwork.com/journals/jama/fullarticle/2795263

Similarly, a 2022 guidance document in Amer J Gastroenterol by Shaheen et al. does not recommend molecular testing:

https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx


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A new 2022 review article on "How would you screen for CRC?" in Annals of Internal Medicine notes that one of the available methods is stool-based DNA-FIT, but does not provide any directional recommendation for using this much-more-expensive technology over other basic FIT technology.  Burns et al.:

https://www.acpjournals.org/doi/10.7326/M22-1961


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