On the Hunt for Missing Guidelines

Medical practice guidelines and recommendations are cornerstones for most major disease states. Payers and providers alike depend on timely, accurate medical guidelines for making appropriate healthcare decisions.

In an admission of our own self-interests, the Fitzpatrick Translational Science team depends on timely, current medical guidelines to defend the accuracy and up-to-date nature of our translational science programs. Sometimes this is difficult to do...

So, where are they?

For common disease states, such as cardiovascular diseases & vaccines, we can count on the dependable:
  • American Heart Association: Their annual HEART AND STROKE Statistics, fairly frequent guidelines for specific conditions like CHOLESTEROL and HYPERTENSION, and other CARDIOVASCULAR GUIDELINES

  • American College of Cardiology: They have a robust Guideline and Clinical Document Library for a variety of CARDIOVASCULAR CONDITIONS which is fairly current.

  • American College of Vascular Surgeons (ACS): They provide a range of both current and decade-old Clinical Practice Guidelines for VASCULAR CONDITIONS in a very simple to navigate page. 

  • American Diabetes Association (ADA):  Their annual Standards of Medical Care in Diabetes is the “Bible” for managing TYPE 1 & TYPE 2 DIABETES.

  • CDC: Their IMMUNIZATION Schedule for Children and Adolescents is updated annually.

  • Their Seasonal INFLUENZA Information for Health Professional (ACIP Guidelines) is published every year as well. There is no shortage of CDC or WHO guidelines for influenza. Their prediction accuracy is certainly lagging though.

  • The American College of Rheumatology (ACR): They provide excellent guidelines approximately every 4-6 years for major conditions such as RHEUMATOID ARTHRITIS.

  • The American Academy of Dermatology (AAD): This is the leading DERMATOLOGY professional association. Several guidelines are a bit out of date (2010 – 2011 publications). 

  • The American Academy of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE): They jointly publish OBESITY and other METABOLIC guidelines. While their guidelines are expertly written, they typically wait 3-4 years between publications.

For CANCER, there are two professional associations that publish most guidelines:
  • American Society of Clinical Oncology (ASCO): They publish an array of professional guidelines across 13 major categories. Not surprisingly, these guidelines get updated every few years – as our understanding of malignancies increases.

  • National Comprehensive Cancer Network (NCCN): They publish as an assortment of cancer-related guidelines. These encompass specific malignancy guidelines for treatment of cancer sites, as well as guidelines for supportive care, specific populations and patient resources.

There are some diseases whose major associations we would expect to provide timely disease management guidelines or even minor updates, but sometimes the updates are not as frequent as we would like...
  • ASTHMA. The last guideline was in 2007 - when the NHLBI’s massive EPR3 (Expert Panel Review) was published. There’s been nothing since. Note that in 2018, the NHLBI has begun drafting various EPR4 committees and reports, but I would not hold my breath to wait for any guidelines in the near future.

  • GROWTH CHARTS. The CDC growth charts were last updated in 2000.  Perhaps children’s growth patterns, particularly for different ethnicities have not changed much in the last 18 years, but that’s probably not the case.

  • COMMON COLD. There appears to be no specific professional association, nor government entity that wants to provide timely evidence-based guidelines around the common cold. In 2012, the American Academy of Family Practice (AAFP) took a stab and published a treatment recommendation.

  • CHRONIC RHINOSINUSITIS. Again, the AAFP took on Acute Bacterial Rhinosinusitis (ABRS) with their Clinical Practice Guideline in 2015, and the Canadian College of Family Physicians published 2013 guidelines for chronic rhinosinusitis.

  • SEXUALLY TRANSMITTED DISEASES. The CDC publishes treatment guidelines only about every 5 years. However, since the CDC is so good at tracking diseases, they do publish 1-off publications for specific disease updates, such as this 2017 update to gonorrhea treatment guidelines.

Why is the Fitzpatrick Translational Science team concerned about the relative frequency of medical management/treatment guidelines? Because we have addressed ALL of the above medical conditions, and referenced their respective medical association guidelines.  We wish to thank all of the above associations and organizations for providing these valuable source references.

Kevin Fitzpatrick
Fitzpatrick Translational Science
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