Kaweah Health Medical Center was founded in 1963 as a district hospital. Offering comprehensive health services including cardiac surgery, general surgery, cancer treatment,mental health services, orthopedic surgery, a renowned NICU and pediatric center, and more. Now the largest hospital in Tulare County and a certified level III Trauma Center. Kaweah Health is located in Visalia, California, United States. It is operated by the Kaweah Delta Care District Board , a political subdivision of the State of California which is governed by an elected board of directors.
INTRODUCTION:Chronic back pain is a significant global healthcare challenge, with a lifetime incidence affecting approximately 80% of people worldwide. Most patients respond positively to nonsurgical management, while a substantial proportion of the remainder obtain relief from surgical therapy. For the minority of patients with chronic back pain who do not respond to conventional medical management (CMM) and are not candidates for spine surgery, spinal cord stimulation (SCS) may be a viable treatment option. This Delphi consensus focused on identifying the thoughts and opinions of pain management and referral specialties on the use of SCS in patients with chronic back pain who are not suitable for spine surgery. METHODS:A steering group of US healthcare professionals specialized in spine surgery and chronic back pain management generated 35 statements across six main domains. Using a four-point Likert scale, the survey was created and shared with a wider panel of specialists. Results were analyzed to produce an aggregated agreement level for each statement. The consensus threshold was set at 75% agreement, which is defined as strong consensus, and ≥ 90% agreement was considered powerful consensus. RESULTS:A total of 211 responses were received from the following specialties: pain physician (18%; n = 38), physical therapist (18%; n = 38), orthopedic surgeon (18%; n = 37), neurosurgeon (17%; n = 36), primary care physician (15%; n = 32), and musculoskeletal radiologist (14%; n = 30). Of the 35 consensus statements developed for broader testing, 30/35 (86%) achieved consensus; 18 (51%) of which achieved ≥ 90% agreement. The remaining five (15%) statements failed to achieve consensus among the wider panel. CONCLUSION:Based on the agreement scores, the steering group agreed on seven key findings to consider for pain management in patients with chronic back pain who are not candidates for spine surgery. These findings are opinion-based and are meant to be a starting point to help identify appropriate patients who may benefit from SCS therapy and when an evaluation for SCS candidacy should be considered.
PURPOSE:The purpose of this cross-sectional study was to determine the prevalence of long COVID and identify its clinical manifestations among farmworkers in California.METHODS:We collected data on sociodemographic characteristics, anthropometrics, clinical chemistries and anti-SARS-CoV-2 immunoglobulin G antibodies, self-reported SARS-CoV-2 infection history, and standardized health tests and scales from 297 farmworkers in California between February and July 2022.RESULTS:Most participants were born in Mexico or Central America, had less than a high school diploma, and were overweight or obese. The prevalence of long COVID (defined as self-reported SARS-CoV-2 infection with symptoms >28 days) among farmworkers with a suspected or test-confirmed infection was 61.8%. Participants with long COVID had higher mean [95% CI] body mass index (32.9 [31.6-34.1]) and high-sensitivity C-reactive protein levels (4.8 [3.7, 6.0]) than those with no COVID-19 history (30.5 [29.3-31.7], and 3.3 [2.2, 4.3], respectively). Farmworkers with long COVID also reported greater fatigue, dyspnea, taste and smell problems, and overall poorer mental and physical health, than those with no COVID-19 history. Farmworkers with long COVID had increased odds of functional limitations compared to those with a self-reported SARS-CoV-2 infection with symptoms ≤28 days (OR [95% CI]: 7.46 [3.26, 17.09]).CONCLUSIONS:A significant proportion of farmworkers experience long COVID with persistent symptoms that limit their ability to perform their work. A comprehensive approach that addresses the unique needs and challenges of farmworkers is warranted given this population's high prevalence of long COVID and the essential nature of their work.
