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PAPERBACK list:$30.00 Web:$27.00 add to cart PDF BOOK your price: $23.00 add to cart Rights & Permissions Free Resources PDF EXECUTIVE SUMMARY Display this book on your site! Related Titles Gulf War and Health: Volume 4. Health Effects of Serving in the Gulf War Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol Other Related Titles Adequacy of the Comprehensive Clinical Evaluation Program: A Focused Assessment (1997) Institute of Medicine (IOM) Web Search Builder Use this book's key terms to search within this book, across our collection, or across the Web. Skim This Chapter Skim this chapter and use this chapter's key terms to search within this book. Reference Finder Paste in your own text to find books that relate to your topic. Page 127   E-mail  Facebook  Digg  Stumble  Twitter More The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. Appendix H Outline of the CCEP Medical Protocol FORM REQUIREMENTS At the MTF level, the CCEP record should include all CCEP forms and relevant medical data to the program. Blank forms included with this guide supersede previous editions of these forms and are intended to be used with the new CCEP. All individual forms will be complete and legible. Forms forwarded to NMIMC and maintained in the participant record shall be in the following order: Phase I completed: MTF Phase I Diagnosis Form Patient Questionnaire Provider-Administered Symptom Questionnaire Information Release Form Declination/Completion Form Page 127 Front Matter (R1-R8) Executive Summary (1-10) 1 Introduction (11-14) 2 Overview of the Institute of Medicine's Persian Gulf Activities (15-16) 3 The Comprehensive Clinical Evaluation Program (17-24) 4 IOM Review: Difficult-to-Diagnose and Ill-Defined Conditions (25-36) 5 IOM Review: Stress, Psychiatric Disorders, and Their Relationship to Physical Signs and Symptoms (37-44) 6 Conclusions and Recommendations (45-52) References and Selected Bibliography (53-60) Appendix A (61-66) Appendix B (67-78) Appendix C (79-90) Appendix D (91-108) Appendix E (109-112) Appendix F (113-120) Appendix G (121-126) Appendix H (127-130) Appendix I (131-133)

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OCR for page 127
--> Appendix H Outline of the CCEP Medical Protocol FORM REQUIREMENTS At the MTF level, the CCEP record should include all CCEP forms and relevant medical data to the program. Blank forms included with this guide supersede previous editions of these forms and are intended to be used with the new CCEP. All individual forms will be complete and legible. Forms forwarded to NMIMC and maintained in the participant record shall be in the following order: Phase I completed: MTF Phase I Diagnosis Form Patient Questionnaire Provider-Administered Symptom Questionnaire Information Release Form Declination/Completion Form

OCR for page 128
--> Phase II completed: RMC Phase II Diagnosis Form Declination/Completion Form MEDICAL PROTOCOLS The CCEP is based upon a thorough clinical evaluation which emphasizes comprehensive and continuous primary care. The local MTF primary care provider maintains responsibility for patient evaluation and care throughout the CCEP process. Medical Treatment Facility (Phase I) Phase I will consist of a comprehensive history and medical evaluation with completion of Phase I questionnaires and related forms. The examination, both in content and quality, should parallel an inpatient admission work-up. The Phase I examination will include a complete medical history including: family, occupation, social (including tobacco, alcohol, and drug use), exposure to possible toxic agents, psychosocial condition and review of symptoms. The provider will specifically inquire about the symptoms listed on the CCEP Provider-Administered Patient Questionnaire. A comprehensive medical evaluation, with focused attention to the patients' symptoms and health concerns, should be conducted. Individuals who, after completing MTF Phase I evaluations, do not have a clearly defined diagnosis which explains their symptoms should be reviewed by the CCEP-designated physician for further evaluation and consultations needed and/or for referral to the RMC. Phase II level evaluations are performed only after complete clinically indicated evaluations (including appropriate specialty consultations) are conducted at the MTF and the RMC. Phase I Laboratory Tests CBC U/A SMA-12

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--> Regional Medical Center (Phase II) Phase II evaluations consist of the following laboratory tests, consultations, and as necessary, symptom-specific examinations. Elements of the Phase II evaluation may be accomplished by the local MTF as needed in the comprehensive evaluation of the Phase I patient in order to obtain a definitive diagnosis. Phase II Laboratory Tests CBC  Sedimentation rate (ESR)  C-Reactive protein  Rheumatoid factor B12 and folate ANA Thyroid function tests Liver function CPK Urinalysis TB skin test (PPD) with controls Chest X-ray Hepatitis serology HIV testing VDRL B12 and folate Thyroid function tests Phase II Consults (if not accomplished at MTF level) Dental: Dental only if participant's annual screening not done Infectious disease Psychiatry: With physician-administered instruments: Structured Clinical Interview for DSMIII-R (SCID) (delete modules for mania and psychosis) Clinician-Administered PTSD Scale (CAPS) Neuropsychological Testing: Only as indicated by psychiatry consult SYMPTOM-SPECIFIC EXAMINATIONS The RMC CCEP physician ensures that Phase II patients with the following undiagnosed symptoms receive the tests and consultations listed below.

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--> Diarrhea Abdominal Headache GI consult Stool for O and P Stool leukocytes Stool culture Stool culture Stool volume Colonscopy with biopsies EGD with biopsies and aspiration Muscle Aches/ Numbness EMG/NCV Chronic Fatigue Polysomnography and MSLT Chronic Cough/SOB Pulmonary consult Pulmonary function Tests with exercise and ABG Methacholine challenge If PFTs are normal, consider broncho scopy with biopsy/ lavage GI consult EGD with biopsy/ aspiration Colonscopy with biopsy Abdominal ultrasound UGI series with small bowel FT Abdominal CT scan Memory Loss (Only if verified by psych evaluation) MRI-head Lumbar puncture Neuro consult Neuro psych testing Chest Pain/ Palpitations ECG Exercise stress test Holter monitor MRI-head LP (glucose protein, cell count, VDRL, oligoclonal myelin, basic protein, pressure) Neuro consult Vertigo/Tinnitus Audiogram ENG BAER Skin Rash Dermatology consult Consider biopsy Reproductive Concerns Urology consult GYN consult

Representative terms from entire chapter:

rmc phase