Adequacy of the Comprehensive Clinical Evaluation Program A Focused Assessment (1997) / Chapter Skim
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Appendix D
Appendix D
Pages 91-108
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From page 91... ...
This appendix is excerpted from the Institute of Medicine report, Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluation, Washington, D.C.: National Academy Press, 1996.
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From page 92... ...
It would require regional medical center physicians to provide adequate quality assurance of MTF work-ups and timely feedback to MTF providers. On January 17, 1995, the DoD adopted these suggestions by setting goals that about 80% of patients would receive a definitive diagnosis at an MTF level.
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From page 93... ...
The decision to refer to Phase II should be based on the clinical judgment of the primary care physician, which, in turn, would be dependent on the clarity of the patient's diagnoses and the feasibility of the proposed treatment program at the MTF level. The DoD should continue its goal of enhanced accessibility of RMC physicians to allow regular consultations with MTF primary care physicians on patients with more complex diagnoses.
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From page 94... ...
The committee concludes that this is a more likely interpretation than the interpretation that a high proportion of the CCEP patients are suffering from a unique, previously unknown "mystery disease." 3.1.1.3.) Provide more detailed information on specific diagnoses in future reports: By providing more detailed information on specific diagnoses in its future reports, the DoD might help correct the impressions among the general public that exist about the high degree of prevalence of a "mystery disease" or a new, unique "Persian Gulf Syndrome." 3.1.1.4.)
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From page 95... ...
There is a lack of clinical evidence of a unique Persian Gulf Syndrome: The committee agrees with DoD that there is currently no clinical evidence in the CCEP of a previously unknown, serious illness among Persian Gulf veterans. If there were a new or unique illness or syndrome among Persian Gulf veterans that could cause serious impairment in a high proportion of veterans at risk, it would probably be detectable in the population of 10,020 CCEP patients.
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From page 96... ...
Review of military or civilian medical records that predate enrollment in the CCEP may provide contemporaneous documentation of the onset of symptoms in some patients, especially if the symptoms are serious. In addition, it is important to determine whether service in the Persian Gulf has contributed to the exacerbation of preexisting diseases in some CCEP patients.
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From page 97... ...
The CCEP patients, as well as their primary care physicians, also need to understand the prevalence of and the concomitant morbidity that result from psychiatric disorders in the general population (major depression, for example)
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From page 98... ...
The DoD should consider establishing detailed guidelines for the psychiatric evaluations and should attempt to obtain greater standardization of these evaluations among the various hospitals across the country. These guidelines could provide suggested procedures for the use of selected self-report instruments for the assessment of the most commonly diagnosed disorders, as well as procedures for more in-depth structured clinical interviews when indicated.
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From page 99... ...
3.2.1.11.) Utilize results of on-going studies to revise CCEP: It is possible that the DoD will be able to use the results of ongoing epidemiologic studies on psychiatric conditions to revise Me CCEP, that is, to revise the standardized questionnaires or to add or delete targeted lab tests or specialty consultations.
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From page 100... ...
3.2.4.2.) Veterans are not likely afflicted with some previously unknown pathogen: On the basis of We current evidence, it is unlikely that a significant proportion of Persian Gulf veterans are afflicted with some previously unknown pathogen that is evading the current diagnostic efforts.
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From page 101... ...
Estimating prevalence of chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity is difficult: The IOM committee's review of the CCEP protocol suggests that data on chronic fatigue syndrome (CFS) , fibromyalgia (FM)
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From page 102... ...
3.3.1.2.) Distribute CCEP findings to all primely care physicians at MlFs and RMCs: The medical findings of the CCEP should be distributed promptly to all primary care physicians at the MTFs and RMCs.
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From page 103... ...
Use CCEP examination results to improve standardization practices: The DoD now has results on the examinations of more than 10,000 CCEP patients, which could be used to improve the standardized questionnaires, lab tests, and specialty consultations.
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From page 104... ...
In addition, the final disposition of these cases could be evaluated, including the potential relationship between particular diseases and Persian Gulf service. The DoD could use the results of these disability determinations to predict which diseases are likely to be associated with the most impairment among CCEP patients in Me future.
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From page 105... ...
Medical staff at Me SCC will need to know whether a particular therapeutic plan is feasible at the patient's nearest MTF and whether long-term follow-up care can be performed. The primary care physician at the MTF needs to encourage continuous patient compliance with the carefully designed, individualized therapeutic regimens.
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From page 106... ...
3.4.1.1.) Utilize on-going epidemiological studies for revising or improving the CCEP: The results of on-going epidemiological studies may be useful for making revisions or improvements in the CCEP medical protocol itself, for example, to revise Me standardized questionnaires or to add or delete targeted lab tests.
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From page 107... ...
3.4.2.2.) Investigate exposures restricted to particular locations or special occupational groups: The committee encourages the DoD to investigate exposures Cat were restricted to particular locations or special occupational groups, such as troops who had direct combat exposure.
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From page 108... ...
Rosemary Sokas, Associate Professor of Medicine, Division of Occupational and Environmental Medicine, George Washington University School of Medicine, Washington, D.C. Guthrie Turner, Chief Medical Consultant, Division of Disability Determination Services, State of Washington, Tummwater, Washington Michael Weisman, Professor, Division of Rheumatology, University of California at San Diego Medical Center, San Diego, California Sip Michael A
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