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APPENDIX E Workshop Agendas WORKSHOP I APRIL 16, 1998 Mirage Room I, Holiday Inn Georgetown AGENDA 8:15 Introduction of the Study and the Purpose of the Workshop Philip Russell, MD. Samuel Gaze, MD. Johns Hopkins School of Public Washington University Health 8:30 Force Medical Protection LTC Tom Clines, USA Medical Readiness Division The Joint Stay J-4 8:45 Health Enrollment Assessment Review (HEAR) Maj Vincent Fonseca, USAF, MC Office for Prevention and Health Service Assessment 9:05 Pre- and Postdeployment Questionnaires Maj Sheila Kin ty, USAF, BSC Director, Deployment Surveillance Team 9:20 Proposed Recruit Assessment Program CAPT Craig Hyams, MC, USN Frances Murphy, ~D., ~P.H. Naval Medical Research Institute Department of Veterans Affairs 9:40 Break 9:50 Global Epidemiologic Tracking System Maj Kevin Hall, USAF, MC Office of the Command Surgeon, Langley AFB 222

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APPENDIX E 223 10:05 Current Deployment Surveillance Practices in Bosnia and SW Asia LTC(P) Robert F. DeFraites, MC, USA Office of the Army Surgeon General 10:35 DMSS/DMED and Progress Toward Integrated Medical Surveillance John F. Brundage, ~D., ~P.H., (COL, Ret. J Henry ~ Jackson Foundation 1 1:00 Break 1 1:10 Panel Discussion on Medical Surveillance Issues LTC Catherine Bonnefil, AN, Capt Samuel Hall, USAF, BSC USA USA CHPPM John F. Brundage, MD., MP.H., (COL, Ret) Henry Jackson Foundation LTC Tom Clines, USA J-4, Medical Readiness Division LTC(P) Robert F. DeFraites, MC, USA Office of the Army Surgeon General Maj Vincent Fonseca, USAF, MC Ofc. for Prevention and Health Svc. Assessment Maj Kevin Hall, USAF, MC Ofc. of the Command Surgeon, Langley AFB Ofc. for Prevention and Health Svc. Assessment CDR Kevin R. Hanson, MC, USN USUHS-PMB CAPT Craig Hyams, MC, USN NMR7 COL Bruce H. Jones, MC, USA USA CHPPM LTC(P) Patrick W. Kelley, MC, USA WRAIR Maj Sheila Kin ty, USAF, BSC Clinical Business Area/CHCSII Frances Murphy, ~D., ~P.H. Department of Veterans Affairs 12:30 Working Lunch continuing discussion 1:20 Medical Recordkeeping-CHCS and CHCSII Col Lynn Ray, USAF, BSC C7-7(~.S 77 Program Manager

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224 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES Medical Recordkeeping CPR and GCPR Col Lynn Ray, USAF, BSC Robert Kolodner, ~D. CHCS II Program Manager Department of Veterans Affairs Force Health Protection and the Portable Information Carrier Col Lynn Ray, USAF, BSC CHCS II Program Manager LTC Mark Lyford, USA Theater Information Management Program 2:20 Panel Discussion on Medical Recordkeeping Issues MAJ Catherine Beck, MS, USA Robert Kolodner, ~D. TATRC Department of Veterans Affairs Maj Kevin Hall, USAF, MC Ofc. of the Command Surgeon, Langley AFB Col Lynn Ray, USAF, BSC CHCS II Program Manager 3:15 Open Portion of Meeting Adjourned LTC Mark Lyford, USA Theatre Information Management Program WORKSHOP II JULY 14-15, 1998 Mirage Room I, Holiday Inn Georgetown AGENDA 8:15 Introduction of the Study and the Purpose of the Workshop Samuel Gaze, MD. Washington University Philip Russell, MD. Johns Hopkins School of Public Health I. What do we know about unexplained physical symptoms and how they might be prevented? Unexplained Physical Symptoms in Primary Care and the Community: What Might We Learn for Prevention in the Military? (presented July 15 for schedule conflict reasons) 8:30 Medically Unexplained Symptoms in Survivors of Community Disasters Carol North, ~D. Washington University

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APPENDIX E 8:55 9:20 10:10 Break Somatic and Psychosomatic Consequences of Technological Disasters Evelyn Bromet Ph.D. SUNY Stony Brook War Syndromes and Their Evaluation CAPT Craig Hyams, MC, USN Naval Medical Research Institute War Syndromes Since 1900: An Ongoing Study Dr. Edgar Jones University of London Relationship of Psychological Symptoms and Self-Reported Exposure to Gulf War Health Problems: Preliminary Findings Jessica Wolfe, Ph.D. VA Medical Center, Boston 10:45 The Prewar Health Care Seeking Patterns of Soldiers Who Develop Unexplained Illnesses Dick Miller, MD. Medical Follow-up Agency 11:00 Current Early Testing Practices in the Military LTC Margot Krauss, MC, USA Walter Reed Army Institute of Research Dr. Imelda Idar Office of Naval Training CDR Glenna Tinney Navy Bureau of Medicine and Surgery 225 12:00 Stressful Events and Factors That Modify or Amplify Their Impact Bruce Dohrenwend Ph.D. New York State Psychiatric Institute and Columbia University Working Lunch provided 1:15 Can We Predict the Development of Medically Unexplained Illnesses? Psychological, Medical, and Public Policy Challenges Terry Keane, Ph.D. VA Medical Center, Boston

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226 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES 1:40 Summary from USUHS conference, "Pathways, Dynamics, arid Relationships Involved ire the Somatic Cor~sequer~ces arid Symptomatic Responses to Stress The Directions of Future Research. " Ann Norwood, ~D. Uniformed Services University of the Health Sciences II. Examining Opportunities for Prevention/Intervention in the Military Setting A. Induction/Start of Basic Training Panel Discussion What appears to be the epidemiology of unexplained symptoms? . To what extent is it possible to identify people at high risk of developing unexplained illnesses? . What screening tests might be appropriate for the military? . How many people might be identified as at higher risk? . What prevention efforts might be directed at those at higher risk? . What additional data are needed? 3:00 Break E. Tertiary Prevention-What is known about treatment? 3:15 Multidisciplinary Treatment of Persistent Symptoms After Gulf War Service Charles Engel, Jr., ~D., OPT. Walter Reed Army Medical Center Uniformed Services University of the Health Sciences Treating Medically Unexplained Symptoms: The Real and Potential Contributions of Cognitive-Behavioral Therapy Arthur New, Ph.D. Allegheny University of the Health Sciences Treating Medically Unexplained Symptoms: Linking Physiologic Mechanisms to More Effective Treatments Daniel Claw, ~D. Georgetown University Medical Center 4:15 Panel Discussion What has been learned about tertiary prevention of unexplained symptoms? . What additional research is needed? Are any additional methods of treatment being explored?

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APPENDIX E 5:15 Adjourn AGENDA CONTINUED July 15, 1998 8:10 Reintroduction to the Workshop, quick recap of July 14 Dr. Samuel Gaze 8:20 Unexplained Physical Symptoms in Primary Care and the Community: What Might We Learn for Prevention in the Military? Wayne Katon, MD. University of Washington Host Neuroendocrine Factors in Susceptibility and Resistance to Inflammatory and Infectious Diseases: Implications for Unexplained Symptoms Esther Sternberg, ~D. National Institute of Mental Health 9:10 Neuroendocrinology of Stress and Related Pathophysiology George Chrousos, MD. National Institute of Child Health and Human Development 9:35 Panel Discussion-Physiologic Measures . What implications do these presentations on the physiologic factors and unexplained illnesses provide for prevention in the military setting? . What additional data are needed? 10:30 Break II. Examining Opportunities for Prevention/Intervention in the Military Setting (continued) B. Predeployment (Routinely or Immediate-Predeployment) 10:40 Risk Communication 227 What Are Current Risk Communication Practices in the Military, and What Is Known of Their Efficacy? Kevin Delaney U.S. Army Center for Health Promotion and Preventive Medicine

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228 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES 11:05 What Does the Research on Informational Interventions to Reduce the Stress of Medical Procedures Tell Us About Communicating to Troops the Risks of Deployment? Jean Johnson Ph.D., R.N., F.A.A.N. University of Rochester 11:30 Communicating with Veterans Exposed to Depleted Uranium Kathleen McPhaul, ~P.H., R.N. University of Maryland 11:55 Panel Discussion-Risk Communication . What type and how much information would be helpful in communicating to troops the risks of deployment? . What changes in risk communication methods are feasible within the deployment setting? . What are current risk communication training procedures for commanders? . What changes in communications Dom leaders are envisaged after hazardous exposures in future deployments? . What additional data are needed? 12:40 Working Lunch continued discussion C. During Deployment What Are Current Military Practices to Measure or Counteract Stress During Deployment? 1:15 Combat Stress Teams COL James Stokes Army Medical Department Center and School 1:40 Measuring Operational Physical Signs of Stress MAJSpencer Campbell WRAIR D. Redeployment (Return to U.S.) How Does the Military Currently Prepare Troops for Reintegration/Reunion ? Army Practices LTC James Jackson Army Community Service

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APPENDIX E 3:20 Navy Practices CDR Glenna Tinney Navy Bureau of Medicine and Surgery Panel Discussion-Prevention during and after deployment . Are current measures taken to prevent acute casualties also preventive for unexplained physical outcomes? Do any data exist to address this topic? What types of data are needed to better understand any relationship between stress during deployment and unexplained illnesses? What types of data are needed to better understand any relationship between reintegration difficulties and unexplained illnesses? . What additional preventive measures might be explored? Break 3:30 Concluding Discussions-What Additional Issues Should Be Considered for Action or Research for Preventing Unexplained Symptoms in Deployed Populations? 4:00 Public Portion of Meeting Adjourned Start of closed meeting Adjourn WORKSHOP III OCTOBER 1-2, 1998 Workshop on Medical Protection from Chemical and Biological Warfare Agents and Follow-Up Workshop on Medical Surveillance Green Building, Washington, D.C. AGENDA 8:00 Introduction of the Study and the Purpose of the Workshop Philip Russell, MD. Samuel Gaze, MD. Johns Hopkins School of Public Washington University Health 8:15 229 Medical Doctrine for NBC Threats Mr. Roy Flowers Technical Publications Writer AMEDD Center and School

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230 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES 8:45 Medical Protection from Chemical Warfare Agents COL James Little Commander, U.S. Army Medical Research Institute of Chemical Defense 9:15 Discussion of Medical Doctrine and Protection from CW 1 0:00 Break Medical Protection from Biological Warfare Agents 10:15 Threat, Training, and Treatment COL Gerald Parker Commander, U.S. Army Medical Research Institute of Infectious Disease Medical Product Development LTC Robert Borowski Deputy Program Manager for Medical Systems Joint Program Office for Biological Defense 1 1:15 Policy Development for Vaccine Use Major General John Parker Commander, U.S. Army Medical Research and Materiel Command Discussion of Medical Doctrine and Protection from BW 12:30 Working Lunch-continuing discussion After Lunch-Medical Surveillance Portion of Agenda 1:30 Presentation of Paper on Medical Surveillance in the Military (follow-up to IOM Workshop held April 16, 1998) Lee H. Harrison, ~D. Robert Pinner, ~D. University of Pittsburgh Centers for Disease Control and Prevention Panel Discussion of Medical Surveillance Issues 3:00 Break 3:15 Continued Discussion of Medical Surveillance Issues Surveillance Systems and Illness Registries After Future Deployments 5:00 Adjourn

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APPENDIX E AGENDA CONTINUED Friday, October 2 8:30 Improving the Denominators for Medical Surveillance Norma St. Claire Director, Joint Requirements and Integration Office of the Secretary of Defense for Personnel and Readiness Questions and Discussion 231 9:30 How Well Is Surveillance and Record Keeping Taking Place with the Administration of the Anthrax Vaccine? LTC Randy Randolph DOD Anthrax Program Office of the Army Surgeon General Questions and Discussion Open Meeting Adjourned WORKSHOP IV JANUARY 13-14, 1999 The Cecil and Ida Green Building, Washington, D.C. AGENDA 8:00 Introduction of the Study and the Purpose of the Workshop Samuel Gaze, MD. Philip Russell, MD. Washington University Johns Hopkins School of Public Health 8:05 Medical Record Keeping Update on Progress GCPR Robert Kolodner, ~D. Department of Veterans Affairs CHCSII and PIC Col Deborah Page Director, Force Health Protection CHCS II Program Office 9:00 Paper Presentation: Clement McDonald, MD. Regenstrief Institute for Health Care Maureen Coyle Department of Veterans Affairs Edward Hammond, Ph.D. Duke University Medical Center

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232 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES 9:45 Discussion 11:15 Break 11:30 Medical Recordkeeping as Described in, "A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families After Future Deployments" LTC Mary Ann Morreale Military Health System Technology Interagency Sharing Office of the Assistant Secretary of Defense for Health Affairs 12: 15 Lunch 1:00 Reserve Issues Background, Medical Surveillance, and Health Care Mr. Dan Kohner CAPT Sheila Brackett Col Kathleen Woody Office of the Assistant Secretary of Defense for Reserve Affairs Reintegration of Reserve Component Members into the Home Environment upon Redeployment LTC Jane Meyer Office of the Assistant Secretary of Defense for Reserve Affairs Discussion 3:00 Break 3:15 Preventing Medically Unexplained Physical Symptoms Paper Presentation: Unexplained Physical Symptoms in Primary Care and the Community: What Might We Learn for Prevention in the Military? LTC Charles C. Engel, Jr., ~D., ~P.H. Walter Reed Army Medical Center Uniformed Services University Paper Presentation: Can We Predict the Development of Medically Unexplained Illnesses? Psychological, Medical, and Public Policy Challenges Terry Keane, Ph.D. VA Medical Center, Boston Discussion of Possibilities for Prevention 5:30 Adjourn for the day

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APPENDIX E 233 AGENDA CONTINUED Thursday, January 14, 1999 8:30 Discussion of "A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families After Future Deployments" Research Dr. Tim Gerrity Special Assistant to Chief Research and Development Officer Department of Veterans Affairs Discussion 9:00 Deployment Health CAPTDavid Trump Program Director, Preventive Medicine and Surveillance Office of the Assistant Secretary of Defense for Health Affairs Discussion 9:30 Risk Communication Dr. Max Lum Director, Office of Health Communications National Institute of Occupational Safety and Health Implementation of Risk Communication Changes Within the Military Input from: Kevin Delaney Risk Communication Team Center for Health Promotion and Preventive Medicine (unable to attend due to inclement weather) Lt Col Steve Williams Office of the Special Assistant for Gulf War mnesses Discussion 10:45 Break 11:00 Accession Standards Col Michael Ostroski Directorate for Accession Policy Retention Standards Ms. Tin a Wortzel Office of the Army Surgeon General

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234 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES Lunch 12:45 Role of Laboratories in Military Public Health Surveillance COL Patrick Kelley Walter Reed Army Institute of Research COL James Bolton U.S. Army Medical Command End of open portion of meeting "REALITY CHECK" MEETING MARCH 23-24, 1999 The Cecil and Ida Green Building, Washington, D.C. AGENDA 8:00 Introduction of the Study and the Purpose of the Meeting Philip Russell, MD. Samuel Gaze, MD. Johns Hopkins School of Public Washington University Health Introductions of Meeting Participants 8:30 Brief Review of Bosnia and SWA Morbidity Data COL Jose Sanchez-Bosnia Lt Col Don Thompson-SWA 9:15 CENTCOM Perspective on Deployment Surveillance Col Bruce Green, CENTCOM/SG 9:30 Discussion of Pre-Deployment Preventive Medicine and Protective Measures What has been the experience in Bosnia, SW Asia, or other recent deployments for: pre-deployment questionnaires . risk communication issues . degree ofautomation . psychological factors 10:30 Break Preventive Medicine and Protective Measures During Deployment . medical surveillance through weekly DNBI and other means . medical record keeping degree of automation and other issues risk communication

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APPENDIX E psychological factors . vaccination/prophylactic drugs Working Lunch Continued Discussion 1:00 Preventive Medicine and Protective Measures Following Return from Deployment . post-deployment questionnaires and follow-up . post-deployment serum draws . health surveillance following deployment risk communication . reintegration issues 2:30 Break General Issues in Preventive Medicine and Risk Reduction for Deployed Forces buy-in of line commanders . medical record keeping logistics of data collection . medically unexplained physical symptoms interaction of PM and mental health docs/caregivers . risk communication 4:15 Summary Comments and Suggestions from Military Participants Adjourn AGENDA CONTINUED March 24, 1999 At Skyline Buildings ir' North err' Virginia 8:00 Demonstration of Public Health Care Application (PHCA) 9:30 Briefing by Office of Information Management for the Military Health System Mr. James Reardon Director, Information Management, Technology, and Reengineering Adjourn Open Session 235