In this prospective, randomized study of 80 patients, Abdel-Salem and Eyres reported significantly lower pain scores in the non-tourniquet group than in the tourniquet group using a linear analogue scale (mean pain score at 4 hours = 4 and 8, respectively, p<0.05). In addition, the authors identified more cases of wound infection and deepvein thrombosis in the tourniquet group.In this randomized radiosteriometric analysis (RSA) study of 50 patients, Ledin et al. found pain measurements using a visual analogue scale were lower in the nontourniquet group ( p=0.01) and range of motion was 11 degrees greater in the non-tourniquet group (p=0.001 at 2 years). In addition, RSA showed no significant differences in loosening at 6 months, 1 year, and 2 years.Effects of tourniquet during total knee arthroplasty. A prospective randomised study. Abdel-Salam A, Eyres KS. J Bone Joint Surg Br. 1995;77(2):250-253.

Purpose: To examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States. Methods: A search for reviews was performed using the keywords "Orthopedic Sports Medicine" on Yelp.com for 8 major metropolitan areas. Single-star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical. Results: A total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1-star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians' bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant (P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities. Conclusion: Our study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1-star reviews were from surgical patients. Clinical Relevance: Patients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality-improvement measures and to assist surgeons in maintaining favorable online reputations.

Background Although physicians tend to prefer data-driven quality metrics, emerging evidence suggests that patients prefer crowd-sourced information containing patient narrative descriptions of the care experience. Currently, yelp.com is the most commonly accessed Web resource among patients who use online information to choose a surgeon. The purpose of this study is to characterize extremely negative reviews of total joint arthroplasty surgeons and practices on yelp.com. Methods We searched yelp.com for one-star (out of 5) reviews of total joint providers and practices in 8 major US metropolitan areas. These reviews were then classified into categories based on content: clinical, nonclinical, or both. Reviews were further subcategorized as “surgical” and “nonsurgical” representing reviews of a nonsurgical experience (eg, initial office visit). Results A higher proportion of reviews came from patients who did not report prior surgery by the surgeon or practice named in the review than form those who reported surgery (240 reviews, 75.0%, 95% confidence interval: 70.0%-79.4% vs 80 reviews, 25.0%, 95% confidence interval: 20.6%-30.0%, P < .0001). Compared with surgical reviews, nonsurgical reviews were more likely to contain nonclinical complaints (92.1% vs 53.8%, P < .0001) and less likely to contain clinical complaints (21.3% vs 78.7%, P < .0001). Conclusions The vast majority of extremely negative reviews of total joint arthroplasty surgeons and practices were related to nonclinical concerns posted by patients who did not report prior surgery by the surgeon or practice being reviewed. The results of this study may help explain the wide disparity commonly observed between conventional quality metrics and crowd-sourced online reviews.

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During a one-year period 44 patients were treated with reduced-compression bandaging in the vascular unit at a district general hospital. Twenty patients with venous ulcers were referred from community leg ulcer clinics because they could not tolerate standard compression bandaging (group 1). A further 24 patients had mixed aetiology leg ulcers (group 2), and high-compression bandaging was not attempted because of significant peripheral vascular disease (ankle brachial pressure index < 0.8). Forty-two patients tolerated reduced-compression bandaging without discomfort or skin pressure changes. Healing was achieved in 32 patients (13 in group 1 and 19 in group 2). All non-healed ulcers were considered smaller at the time of final follow-up, and had less exudate. Reduced-compression bandaging has been shown to be effective and well tolerated by patients with venous ulcers who cannot comply with high-compression bandaging. With close supervision, it is safe to use in patients with significant peripheral vascular disease.