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[null,null,"Titolo",null,"Adequacy of the VA Persian Gulf registry and uniform case assessment protocol / / Committee on the Evaluation of the Department of Veterans Affairs Uniform Case Assessment Protocol, Division of Health Promotion and Disease Prevention, Institute of Medicine"]
[null,null,"Pubbl/distr/stampa",null,"Washington, D.C., : National Academy Press, 1998"]
[null,null,"ISBN",null,"9786610186860"]
[{"$nulls":4},"9780309174114"]
[{"$nulls":4},"0309174112"]
[{"$nulls":4},"9781280186868"]
[{"$nulls":4},"1280186860"]
[{"$nulls":4},"9780309591775"]
[{"$nulls":4},"0309591775"]
[{"$nulls":4},"9780585030685"]
[{"$nulls":4},"0585030685"]
[null,null,"Edizione",null,"[1st ed.]"]
[null,null,"Descrizione fisica",null,"1 online resource (204 pages) : forms"]
[null,null,"Disciplina",null,"616.9/8023"]
[null,null,"Soggetti",null,"Persian Gulf syndrome"]
[{"$nulls":4},"Medical protocols"]
[null,null,"Lingua di pubblicazione",null,"Inglese"]
[null,null,"Formato",null,"Materiale a stampa"]
[null,null,null,"Livello bibliografico","Monografia"]
[null,null,null,"Note generali","Bibliographic Level Mode of Issuance: Monograph"]
[null,null,null,"Nota di bibliografia","Includes bibliographical references."]
[null,null,"Nota di contenuto",null,"Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol -- Copyright -- Preface -- Acknowledgments -- Contents -- Executive Summary -- FINDINGS AND RECOMMENDATIONS -- Diagnostic Process -- Implementation and Administration -- Referrals -- Quality -- Patient Satisfaction -- Data Collection and Reporting -- Outreach -- Provider Education -- SUMMARY -- 1 Introduction -- 2 The Institute of Medicine's Persian Gulf Activities -- 3 The Department of Veterans Affairs Persian Gulf Registry and Uniform Case Assessment Protocol -- PERSIAN GULF REGISTRY -- PHASE II: UNIFORM CASE ASSESSMENT PROTOCOL -- REFERRAL -- DATA COLLECTION AND REPORTING -- PERSONNEL -- PERFORMANCE MONITORING -- DESCRIPTIVE STATISTICS -- OUTREACH -- PROVIDER EDUCATION -- 4 Committee on the Evaluation of the Department of Veterans Affairs Uniform Case Assessment Protocol -- SITE VISITS -- WRITTEN "]
[{"$nulls":4},"TESTIMONY -- VA Health Facilities -- Veterans' Service Organizations -- 5 Findings and Recommendations -- DISCUSSION -- DIAGNOSTIC PROCESS -- IMPLEMENTATION AND ADMINISTRATION -- Referrals -- Quality -- Patient Satisfaction -- Data Collection and Reporting -- OUTREACH -- PROVIDER EDUCATION -- 6 Conclusion -- References and Selected Bibliography -- Appendix A 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."]
[{"$nulls":4},"Recommendations -- Finding 14 -- Recommendations -- Appendix B Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems -- CHARGE TO THE COMMITTEE: ITS FINDINGS AND RECOMMENDATIONS -- Overview -- THE COMMITTEE'S CHARGE -- Charge 1 -- Charge 2 -- Charge 3 -- FINDINGS AND RECOMMENDATIONS -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Finding -- Appendix C Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluation Program: Overall… -- 1.) OVERALL ASSESSMENT OF THE CCEP GOALS PROCEDURES -- 2.) GENERAL RECOMMENDATIONS FOR THE IMPLEMENTATION OF THE CCEP -- 2.1.) Referrals of Patients from Phase I to Phase II of the CCEP -- 2.1.1.) Structure and revise the CCEP protocol and logistics to allow the majority of patients to receive a final diagnosis… -- 2.1.2.) Curtail diagnostic work-ups in patients not seriously disabled with minor complaints -- 2.1.3.) Require additional efforts to provide more care at the primary care level -- 2.1.4.) Continue referral of subgroups of patients whose illnesses are difficult to diagnose -- 2.2.) Systematic Guidelines for Psychiatric Referrals and Adequacy of Psychiatric Resources -- 2.2.1.) Develop explicit guidelines for the identification of Phase I patients who would benefit from a psychiatric… -- 2.2.2.) Alert primary care physicians about the high prevalence of psychiatric disorders -- 3.) SPECIFIC OBSERVATIONS OF AND RECOMMENDATIONS FOR THE IMPLEMENTATION OF THE CCEP -- 3.1.) Analysis and Interpretation of the CCEP Results -- 3.1.1.) Symptoms and diagnoses in the CCEP population -- 3.1.1.1.) No evidence has been found that the DoD has been trying to avoid reaching a single unifying diagnosis."]
[{"$nulls":4},"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 Gulf service -- 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 "]
[{"$nulls":4},"with Other Populations -- 3.1.4.1.) Be cautious about comparison with other populations -- 3.1.4.2.) It's difficult to establish causal relationships by relying on CCEP data alone -- 3.1.4.3.) Consider the CCEP data to have high clinical utility -- 3.2.) Specific Medical Diagnosis -- 3.2.1.) Psychiatric Conditions -- 3.2.1.1.) Make patients aware of psychiatric conditions and their prevalence and morbidity -- 3.2.1.2.) Emphasize effects and diagnosis of psychosocial stressors -- 3.2.1.3.) Identify people with risk of developing depression or Post-Traumatic Stress Disorder (PTSD) -- 3.2.1.4.) Improve standardization of psychiatric evaluations -- 3.2.1.5.) Document and investigate the onset and course of symptoms and psychosocial stressors -- 3.2.1.6.) Standardize neuropsychological evaluations -- 3.2.1.7.) Standardize classification and coding of diseases -- 3.2.1.8.) Document headache categories differently."]
[{"$nulls":4},"3.2.1.9.) Add explicit written instruction on medical record-keeping 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 sensitivity is difficult -- 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 Evaluations -- 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 veterans -- 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."]
[{"$nulls":4},"3.3.2.1.) Use CCEP examination results to improve standardization practices -- 3.3.2.2.) Refine questions related to potential psychological stressors -- 3.3.2.3.) Determine if lab tests or specialty consultations should be added to Phase I -- 3.3.2.4.) Compare and coordinate methods and clinical results of the CCEP and UCAP -- 3.3.3.) Use of the CCEP Results for Patient Outcome -- 3.3.3.1.) Perform targeted patient evaluations -- 3.3.3.2.) Communicate successful treatment methods between RMCs -- 3.3.3.3.) Review disorders among CCEP patients who have applied for disability payments or for medical discharge from the… -- 3.3.4.) Specialized Care Center (SCC) -- 3.3.4.1.) The DoD has made serious efforts to develop an SCC program that has ambitious goals -- 3.3.4.2.) Provide multidisciplinary treatment modalities -- 3.3.4.3.) Need for individualized follow-up and therapeutic regimens -- 3.3.4.4.) Develop objective measure of functional status for follow-up evaluation -- 3.3.4.5.) Evaluate the SCC program itself -- 3.3.4.6.) DoD has taken a serious approach to the treatment and rehabilitation of these patients "]
[{"$nulls":4},"in the SCC -- 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."]
[{"$nulls":4},"COMMITTEE ON THE DOD PERSIAN GULF SYNDROME COMPREHENSIVE CLINICAL EVALUATION PROGRAM."]
[null,null,null,"Sommario/riassunto","As mandated in Public Law 103-446, the Department of Veterns Affairs (VA) asked the Institute of Medicine (IOM) to review its Uniform Case Assessment Protocol (UCAP) for Persian Gulf veterans. The purpose of the program is to provide a systematic, comprehensive medical protocol for the diagnosis of health problems of Persian Gulf veterans. This report is the third in a series of studies by IOM reviewing the protocols used by the VA and the Department of Defense to diagnose the health complaints of Gulf veterans. The committee reviews and makes recommendations concerning the adequacy of the medical protocol and its implementation by the VA, as well as the VA's outreach and education efforts aimed at informing Persian Gulf veterans and their care providers of the purpose and availability of this program. In addition, the report contains as appendixes the findings and recommendations of the previous reports, as well as those of two related IOM reports on \"Health Consequences of Service During the Persian Gulf War.\""]