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Additional info for Adequacy of the Comprehensive Clinical Evaluation Program: a focused assessment
All CCEP participants are evaluated by a primary care physician at their local medical treatment facility and receive specialty consultations if these are deemed appropriate by their primary care physician. Evaluation at this phase includes a survey for nonspecific patient symptoms, including fatigue, joint pain, diarrhea, difficulty concentrating, memory and sleep disturbances, and rashes. *The material in this section is based, in part, on presentations and discussion by Lt. Col. D. Page 18 The primary care physician may refer patients to Phase II for further specialty consultations if he or she determines that it is clinically indicated.
Late in 1995, DoD asked the IOM to continue its evaluation of the CCEP with special attention to three issues: (1) difficult-to-diagnose individuals and those with ill-defined conditions; (2) the diagnosis and treatment of patients with stress and psychiatric conditions; and (3) assessment of the health problems of those who may have been exposed to low levels of nerve agents. The committee was also to consider whether there are medical tests or consultations that should be added systematically to the CCEP to increase its diagnostic yield.
When Tilt Table testing was applied in a study by BouHolaigah et al. , development of syncope or severe presyncope with at least a 25 mm Hg decrease in systolic blood pressure and no associated increase in heart rate) was observed in 22 of 23 patients with CFS versus 4 of 14 controls. The authors of the study concluded that CFS is associated with neurally mediated hypotension and that its symptoms may be improved in a subset of patients by therapy directed at this abnormal cardiovascular reflex.