Background: Patients with rotator cuff disease commonly complain of difficulty sleeping. Arthroscopic repair has been associated with improved sleep quality in many patients with rotator cuff tears; however, some individuals continue to suffer from sleep disturbance postoperatively. Purpose: To determine whether changes in sleep quality following rotator cuff repair are predicted by a patient’s narcotic use or ability to cope with stress (resilience). Study Design: Case series; Level of evidence, 4. Methods: A total of 48 patients undergoing arthroscopic rotator cuff repair were prospectively enrolled and completed the Connor-Davidson Resilience Scale (CD-RISC) preoperatively. The Pittsburgh Sleep Quality Index (PSQI) was administered preoperatively and at multiple intervals postoperatively for 6 months. Narcotic utilization was determined via a legal prescriber database. Pre- and postoperative sleep scores were compared using paired t tests and the McNemar test. Linear regression was used to determine whether narcotic use or CD-RISC score predicted changes in sleep quality. Results: An increased number of patients experienced good sleep at 6 months postoperatively ( P < .01). Mean ± SD nocturnal pain frequency improved from 2.5 ± 1.0 at baseline to 0.9 ± 1.1 at 6 months. CD-RISC score had a positive predictive value on changes in PSQI score ( R 2 = 0.09, P = .028) and nocturnal pain frequency ( R 2 = 0.08, P = .041) at 2 weeks. Narcotic use did not significantly predict changes in PSQI score or nocturnal pain frequency ( P > .05). Conclusion: Most patients with rotator cuff disease will experience improvement in sleep quality following arthroscopic repair. Patients demonstrated notable improvements in nocturnal pain frequency as soon as 6 weeks following surgery. CD-RISC resiliency scores had a significant positive predictive value on changes in sleep quality and nocturnal pain frequency at 2 weeks. Narcotic use was not associated with change in sleep quality.

Introduction: The purpose of this study was to determine how wait time duration is associated with patient satisfaction and how appointment characteristics relate to wait time duration and patient satisfaction in the orthopedic surgery clinic. Methods: Two hundred sixty-four patients visiting one of 3 ambulatory orthopedic surgery clinics were asked to estimate their wait time and to rate their satisfaction with the visit. The associations between appointment characteristics, wait time, and satisfaction were analyzed using t tests, 1-way analysis of variance, and Pearson correlation coefficients. Results: Wait times were significantly different based on visit type, appointment time, whether an X-ray was required, and whether a trainee was involved ( P < .001). Patients with wait times less than 30 minutes had higher satisfaction scores ( P < .001). Satisfaction ratings were significantly different based on the surgeon’s management recommendation ( P = .0211), but were not significantly different based on sex, age, office location, visit type, appointment time subsection, or time spent with the physician ( P > .05). Conclusion: Wait times negatively correlated with satisfaction. New patient visits, appointment times in the later third of the day, appointments requiring an X-ray, and appointments involving a trainee had significantly longer wait times. Care should be taken to inform patients with visits involving these characteristics that they may experience longer than average wait times.

The purpose of this study is to identify patterns of postoperative narcotic use and determine the impact of psychosocial and perioperative factors on postoperative opioid consumption following arthroscopic knee surgery. Fifty consecutive patients undergoing arthroscopic knee surgery were prospectively enrolled. Patients were contacted via telephone at 1 week postoperatively to report their pain level and opioid consumption. The patient was contacted again at 2 weeks, 4 weeks, and 90 days as necessary until opioid cessation, at which time the patient's plan for unused pills was inquired. Opioid consumption was compared using t-tests and one-way analysis of variance for demographic and surgical factors. Linear regression was used to determine whether the Pain Catastrophizing Scale (PCS), Resilience Scale (RS-11), International Knee Documentation Committee questionnaire, or patient-reported pain at 1 week predicted higher opioid consumption. The average morphine equivalent dose of opioid consumption was 142 mg. Sixty-four percent consumed less than 100 mg, and 68% discontinued opioid use by 1 week postoperatively. Seventy-four percent reported surplus pills, and 49% of those patients plans for pill disposal. Factors associated with higher consumption included undergoing a major procedure, having a regional anesthesia block, and higher area deprivation index score (p < 0.05). Higher PCS scores and reported average pain level at 1 week were predictive of higher opioid consumption (p < 0.05). In conclusion, a majority of patients undergoing outpatient knee surgery did not require the entirety of their narcotic prescription. The majority of patients consumed less than 100 mg of morphine equivalents and discontinued opioid use by 1 week postoperatively. Ligament reconstruction, living in an area with a higher index of deprivation, and higher score on the PCS were associated with greater opioid consumption. Overall, patient knowledge regarding opioid disposal was poor, and patients would likely benefit from additional education prior to surgery.

A dozen years ago Conrad Russell initiated a major historiographical debate when he rejected the traditional interpretation of seventeenth-century parliamentary history expounded in the classic studies of S. R. Gardiner and Wallace Notestein, whose work on early Stuart parliaments dominated the field for three quarters of a century. According to Russell, Gardiner's and Notestein's conviction that Jacobean and Caroline parliaments were the scene of escalating constitutional conflicts between the Crown and the House of Commons was the result of the two historians' failure to understand either the nature of early Stuart politics or seventeenth-century notions of Parliament's proper functions. Politics in general and parliamentary politics in particular were devoid of ideological content, and the provincial gentry who filled the benches of the House of Commons were as certain as the rest of their countrymen that the “proper business” of Parliament was the passing of bills, not the debating of issues of national or constitutional significance. Russell, of course, did not suggest that the conflicts so crucial to the traditional interpretation were made out of whole cloth, but he did deny that disagreements between Crown and Parliament were due to the emergence of a constitutional opposition. Instead, such disagreements were the inevitable product of the pervasive tension that marked the relationship between the royal government in London and the local communities in the provinces. During the reigns of James I and Charles I, the Crown's incompetent parliamentary management made it more difficult than usual for local gentlemen to reconcile their obligations to their king with their loyalties to their communities. The result was some remarkably unhappy parliaments, but since no important issue of principle divided parliamentary leaders from privy councilors or officers of state, there could be no organized, ideologically based opposition, no constitutional crisis leading inexorably to civil war.

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