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Adequacy of the Comprehensive Clinical Evaluation Program

Adequacy of the Comprehensive Clinical Evaluation Program

A Focused Assessment

  • Publisher: National Academies Press
  • ISBN: 9780309059497
  • eISBN Pdf: 9780309591423
  • Place of publication:  United States
  • Year of digital publication: 1997
  • Month: December
  • Pages: 142
  • Language: English
  • Adequacy of the Comprehensive Clinical Evaluation Program
  • Copyright
  • Contents
  • Executive Summary
    • CONCLUSIONS AND RECOMMENDATIONS
      • Medically Unexplained Symptom Syndromes
      • Stress
      • Screening
      • Program Evaluation
      • Coordination with the VA
  • 1 Introduction
  • 2 Overview of the Institute of Medicine's Persian Gulf Activities
  • 3 The Comprehensive Clinical Evaluation Program
    • OVERVIEW
    • SIGNS, SYMPTOMS, AND ILL-DEFINED CONDITIONS (SSID)
    • CHRONIC FATIGUE SYNDROME (CFS) AND FIBROMYALGIA IN THE CCEP POPULATION
    • STRESS AND PSYCHIATRIC DISORDERS
  • 4 IOM Review: Difficult-to-Diagnose and Ill-Defined Conditions
    • CHRONIC FATIGUE SYNDROME
    • FIBROMYALGIA
    • MULTIPLE CHEMICAL SENSITIVITY
    • CONTROVERSIES AND OVERLAP
  • 5 IOM Review: Stress, Psychiatric Disorders, and Their Relationship to Physical Signs and Symptoms
    • STRESSORS AND STRESS
    • CONSEQUENCES OF STRESS
      • Depression
      • Posttraumatic Stress Disorder
      • Substance Abuse
      • Other Consequences
  • 6 Conclusions and Recommendations
    • MEDICALLY UNEXPLAINED SYMPTOM SYNDROMES
    • STRESS
    • SCREENING
    • PROGRAM EVALUATION
    • COORDINATION WITH THE VA
  • References and Selected Bibliography
  • Appendix A Presidential Advisory Committee on Gulf War Veterans' Illnesses: Final Report Recommendations
    • RECOMMENDATIONS
      • Outreach
      • Medical and Clinical Issues
      • Research
      • Chemical and Biological Weapons
      • Coordination
  • Appendix B Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate…
    • FINDINGS AND RECOMMENDATIONS
    • DATA AND DATABASES
      • Finding I
      • Recommendations
      • Finding 2
      • Recommendation
      • Finding 3
      • Recommendations
    • COORDINATION/PROCESS
      • Finding 4
      • Recommendation
      • Finding 5
      • Recommendations
    • CONSIDERATIONS OF STUDY DESIGN NEEDS
      • Finding 6
      • Recommendations
      • Finding 7
      • Recommendations
      • Finding 8
      • Recommendation
      • Finding 9
      • Recommendations
      • Finding 10
      • Recommendation
      • Finding 11
      • Recommendation
      • Finding 12
      • Recommendation
      • Finding 13
      • Recommendations
      • Finding 14
      • Recommendations
  • Appendix C Health Consequences of Service During the Persian Gulf War: Recommendations for Research...
    • CHARGE TO THE COMMITTEE: ITS FINDINGS AND RECOMMENDATIONS
      • Overview
    • THE COMMITTEE'S CHARGE
      • Charge 1
      • Charge 2
      • Charge 3
    • FINDINGS AND RECOMMENDATIONS
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
      • Finding
  • Appendix D Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluat...
    • 1.) OVERALL ASSESSMENT OF THE CCEP GOALS PROCEDURES
    • 2.) GENERAL RECOMMENDATIONS FOR THE IMPLEMENTATION OF THE CCEP
      • 2.1.) Referrals of Patients from Phase I to Phase II of the CCEP
        • 2.1.1.) Structure and revise the CCEP protocol and logistics to allow the majority of patients to re...
        • 2.1.2.) Curtail diagnostic work-ups in patients not seriously disabled with minor complaints
        • 2.1.3.) Require additional efforts to provide more care at the primary care level
        • 2.1.4.) Continue referral of subgroups of patients whose illnesses are difficult to diagnose
      • 2.2.) Systematic Guidelines for Psychiatric Referrals and Adequacy of Psychiatric Resources
        • 2.2.1.) Develop explicit guidelines for the identification of Phase I patients who would benefit fro...
        • 2.2.2.) Alert primary care physicians about the high prevalence of psychiatric disorders
    • 3.) SPECIFIC OBSERVATIONS OF AND RECOMMENDATIONS FOR THE IMPLEMENTATION OF THE CCEP
      • 3.1.) Analysis and Interpretation of the CCEP Results
        • 3.1.1.) Symptoms and diagnoses in the CCEP population
          • 3.1.1.1.) No evidence has been found that the DoD has been trying to avoid reaching a single unifyin...
          • 3.1.1.2.) Signs and symptoms in many patients can be explained by well-recognized conditions
          • 3.1.1.3.) Provide more detailed information on specific diagnoses in future reports
          • 3.1.1.4.) Investigate the diagnosis in patients with disability processing actions
          • 3.1.1.5.) Don't view CCEP results as estimates of the prevalence of disability related to Persian Gu...
        • 3.1.2.) Evidence of a New, Unique Persian Gulf Syndrome
          • 3.1.2.1.) There is a lack of clinical evidence of a unique Persian Gulf Syndrome
          • 3.1.2.2.) Share the entire CCEP data set with qualified researchers outside of the DoD
        • 3.1.3.) Potential Relationship of Illnesses in CCEP Patients to Service in the Persian Gulf
          • 3.1.3.1.) Discuss the issue of causality explicitly and unambiguously in its future reports
          • 3.1.3.2.) Determine the timing of the onset of disease
        • 3.1.4.) Comparison of the CCEP Population with Other Populations
          • 3.1.4.1.) Be cautious about comparison with other populations
          • 3.1.4.2.) It's difficult to establish causal relationships by relying on CCEP data alone
          • 3.1.4.3.) Consider the CCEP data to have high clinical utility
      • 3.2.) Specific Medical Diagnosis
        • 3.2.1.) Psychiatric Conditions
          • 3.2.1.1.) Make patients aware of psychiatric conditions and their prevalence and morbidity
          • 3.2.1.2.) Emphasize effects and diagnosis of psychosocial stressors
          • 3.2.1.3.) Identify people with risk of developing depression or PostTraumatic Stress Disorder (PTSD)
          • 3.2.1.4.) Improve standardization of psychiatric evaluations
          • 3.2.1.5.) Document and investigate the onset and course of symptoms and psychosocial stressors
          • 3.2.1.6.) Standardize neuropsychological evaluations
          • 3.2.1.7.) Standardize classification and coding of diseases
          • 3.2.1.8.) Document headache categories differently
          • 3.2.1.9.) Add explicit written instruction on medical recordkeeping and coding
          • 3.2.1.10.) Expand discussion of psychological stressors
          • 3.2.1.11.) Utilize results of on-going studies to revise CCEP
        • 3.2.2.) Musculoskeletal Conditions
          • 3.2.2.1.) Provide more details of diagnostic categorization of musculoskeletal conditions
          • 3.2.2.2.) Place more emphasis on musculoskeletal conditions
        • 3.2.3.) Signs, Symptoms, and Ill-Defined Conditions
          • 3.2.3.1.) Clarify types of disorders included in the ICD-9 category
        • 3.2.4.) Infectious Diseases
          • 3.2.4.1.) Infectious disease is not a frequent cause of serious illness
          • 3.2.4.2.) Veterans are not likely afflicted with some previously unknown pathogen
        • 3.2.5.) Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivity
          • 3.2.5.1.) Estimating prevalence of chronic fatigue syndrome, fibromyalgia, and multiple chemical sen...
          • 3.2.5.2.) Collect data using established diagnostic criteria for CFS and FM
          • 3.2.5.3.) Established diagnostic criteria do not exist for MCS
          • 3.2.5.4.) Include CFS, FM, and MCS in on-going and future epidemiological research studies
          • 3.2.5.5.) Continue thorough workup to diagnose sleep disturbances and fatigue
      • 3.3.) Use of the CCEP Results for Education Improvements in the Medical Protocol and Outcome Evaluat...
        • 3.3.1.) Use of the CCEP Results for Education
          • 3.3.1.1.) Continue public release of analysis results of the CCEP on an on-going, periodic basis
          • 3.3.1.2.) Distribute CCEP findings to all primary care physicians at MTFs and RMCs
          • 3.3.1.3.) Develop a more concise version of the DoD report for active-duty service personnel and vet...
          • 3.3.1.4.) Develop a more comprehensive document describing potential exposures in more detail
        • 3.3.2.) Use of the CCEP Results to Improve the Medical Protocol
          • 3.3.2.1.) Use CCEP examination results to improve standardization practices
          • 3.3.2.2.) Refine questions related to potential psychological stressors
          • 3.3.2.3.) Determine if lab tests or specialty consultations should be added to Phase I
          • 3.3.2.4.) Compare and coordinate methods and clinical results of the CCEP and UCAP
        • 3.3.3.) Use of the CCEP Results for Patient Outcome
          • 3.3.3.1.) Perform targeted patient evaluations
          • 3.3.3.2.) Communicate successful treatment methods between RMCs
          • 3.3.3.3.) Review disorders among CCEP patients who have applied for disability payments or for medic...
        • 3.3.4.) Specialized Care Center (SCC)
          • 3.3.4.1.) The DoD has made serious efforts to develop an SCC program that has ambitious goals
          • 3.3.4.2.) Provide multidisciplinary treatment modalities
          • 3.3.4.3.) Need for individualized follow-up and therapeutic regimens
          • 3.3.4.4.) Develop objective measure of functional status for follow-up evaluation
          • 3.3.4.5.) Evaluate the SCC program itself
          • 3.3.4.6.) DoD has taken a serious approach to the treatment and rehabilitation of these patients in...
          • 3.3.4.7.) Investigate costs and benefits of the SCC program
          • 3.3.4.8.) Identify the most effective elements of the SCC program
      • 3.4.) Research Relevant to the CCEP
        • 3.4.1.) Epidemiological Research Relevant to the CCEP
          • 3.4.1.1.) Utilize on-going epidemiological studies for revising or improving the CCEP
          • 3.4.1.2.) Acknowledge the serious limitations of the CCEP data for epidemiological purposes
        • 3.4.2.) Exposure Assessment Research Relevant to the CCEP
          • 3.4.2.1.) Investigate experiences of individuals in UICs with higher rates of CCEP participation
          • 3.4.2.2.) Investigate exposures restricted to particular locations or special occupational groups
  • Appendix E Workshop on the Adequacy of the CCEP for Evaluating Individuals Potentially Exposed to N...
    • NATIONAL ACADEMY OF SCIENCES INSTITUTE OF MEDICINE
    • AGENDA
      • SPEAKERS
  • Appendix F Adequacy of the Comprehensive Clinical Evaluation Program: Nerve Agents
    • RECOMMENDATIONS
    • COMMITTEE ON THE EVALUATION OF THE DOD COMPREHENSIVE CLINICAL EVALUATION PROGRAM
      • Staff
  • Appendix G Workshop Agendas and Speakers Lists
    • WORKSHOP ON DIFFICULT-TO-DIAGNOSE AND ILL-DEFINED CONDITIONS
      • AGENDA
        • SPEAKERS
    • WORKSHOP ON STRESS AND PSYCHIATRIC DISORDERS
    • AGENDA
      • SPEAKERS
  • Appendix H Outline of the CCEP Medical Protocol
    • FORM REQUIREMENTS
      • Phase I completed
      • Phase II completed
    • MEDICAL PROTOCOLS
      • Medical Treatment Facility (Phase I)
        • Phase I Laboratory Tests
      • Regional Medical Center (Phase II)
        • Phase II Laboratory Tests
        • Phase II Consults
    • SYMPTOM-SPECIFIC EXAMINATIONS
  • Appendix I Screening Instruments for Substance Abuse
    • CAGE
    • BRIEF MAST
    • T-ACE
    • TWEAK
    • AUDIT

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