The impact of self-efficacy on nonoperative treatment of atraumatic shoulder pain.

CONTEXT: Atraumatic shoulder pain is frequently encountered in primary care and surgical clinics. With increased recognition of the biopsychosocial model, there has been an increased emphasis on identifying patient factors associated with less effective coping strategies such as pain catastrophizing. It remains uncertain what impact self-efficacy has on the response to nonoperative treatment of shoulder pain. OBJECTIVES: Our purpose is to determine the influence of patient coping strategies (self-efficacy) on the outcome of nonoperative treatment of atraumatic shoulder pain. We hypothesize that higher levels of self-efficacy are associated with increased self-reported function after nonoperative treatment. METHODS: We conducted a retrospective case-control study for a consecutive series of patients seen in our clinic with nonoperatively managed atraumatic shoulder pain. Baseline demographics and range of motion were recorded. Patients completed the Simple Shoulder Test (SST), PROMIS Pain Interference (PI), and PROMIS Self-Efficacy for Managing Symptoms (SE). After 3 months of nonoperative treatment, patients were placed into two groups: patients who clinically improved (Group 1) and those that did not (Group 2), with clinical improvement defined as an increase of 2 or greater on the SST. RESULTS: Seventy-eight patients returned for follow-up and completed all questionnaires. There were no statistically significant differences for age, sex, or tobacco use between the two groups. Half of the patients in our series had symptoms for >12 months, with rotator cuff syndrome being the most frequent diagnosis (40.0%). Patients in Group 1 had significantly higher PROMIS SE scores (42 vs. 39, p=0.0094) at initial evaluation. At 3-month follow-up, patients in Group 1 also had significantly lower Numeric Pain Rating Scale (NPRS) scores (4.5 vs. 6.5, p=0.0067), compared to Group 2. CONCLUSIONS: Patients who experience clinical improvement with nonoperative treatment of atraumatic shoulder conditions demonstrate higher self-efficacy than patients who fail to improve. Guiding patients with atraumatic shoulder pain and low self-efficacy toward interventions aimed at improving coping strategies, rather than addressing musculoskeletal factors alone, may contribute to the goal of improving outcomes.

Spermatogonial Stem Cell Numbers Are Reduced by Transient Inhibition of GDNF Signaling but Restored by Self-Renewing Replication when Signaling Resumes.

One cause of human male infertility is a scarcity of spermatogonial stem cells (SSCs) in testes with Sertoli cells that neither produce adequate amounts of GDNF nor form the Sertoli-Sertoli junctions that form the blood-testis barrier (BTB). These patients raise the issue of whether a pool of SSCs, depleted due to inadequate GDNF stimulation, will expand if normal signaling is restored. Here, we reduce adult mouse SSC numbers by 90% using a chemical-genetic approach that reversibly inhibits GDNF signaling. Signal resumption causes all remaining SSCs to replicate immediately, but they primarily form differentiating progenitor spermatogonia. Subsequently, self-renewing replication restores SSC numbers. Testicular GDNF levels are not increased during restoration. However, SSC replication decreases as numbers of SSCs and progenitors increase, suggesting important regulatory interactions among these cells. Finally, sequential loss of SSCs and then pachytene spermatocytes causes dissolution of the BTB, thereby recapitulating another important characteristic of some infertile men.

Comparison of Editor, Reviewer, and Author Demographics in The Journal of Hand Surgery.

Purpose: To determine whether demographic differences exist among editors, reviewers, and authors in The Journal of Hand Surgery (JHS). We aimed to test the null hypothesis that there would be no difference among these 3 groups with respect to gender, geographic location, academic productivity, and financial relationships with industry. Methods: Editors, reviewers, and physician authors were identified for 2018 JHS. Gender and geographic location were recorded for each person. We used the Scopus database to determine the Hirsch index (h-index) as well as the number of publications and citations for members of each group. Industry payment information was obtained using the Open Payments Web site. Results: The editor group contained 20% women compared with the author group (17% women). Authors (59%) were less likely to be from the United States compared with editors (91%) and reviewers (88%). Editors were found to have a higher h-index (16) compared with reviewers (14) and authors (12). Authors demonstrated significantly higher mean total payments from industry ($41,738) compared with editors ($13,712) and reviewers ($20,457). Conclusions: In 2018, there appeared to be an even distribution with respect to gender among editors, authors and reviewers in the JHS. International editors and reviewers are relatively under-represented compared to authors. Whereas editors and reviewers demonstrated higher h-indices compared with authors, JHS authors had significantly higher mean total payments in the Open Payments database. Clinical relevance: Defining demographics, academic productivity, and conflicts of interest for journal editors, reviewers, and authors may aid in identifying potential sources of both author and peer review bias.