Publications by authors named "Gavin Clark"

Aims: Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) have both been shown to be effective treatments for osteoarthritis (OA) of the knee. Many studies have compared the outcomes of the two treatments, but less so with the use of robotics, or individualized TKA alignment techniques. Functional alignment (FA) is a novel technique for performing a TKA and shares many principles with UKA.

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Aims: Functional alignment (FA) in total knee arthroplasty (TKA) aims to achieve balanced gaps by adjusting implant positioning while minimizing changes to constitutional joint line obliquity (JLO). Although FA uses kinematic alignment (KA) as a starting point, the final implant positions can vary significantly between these two approaches. This study used the Coronal Plane Alignment of the Knee (CPAK) classification to compare differences between KA and final FA positions.

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Introduction: The COVID-19 pandemic disrupted normal pathways to cancer diagnosis, particularly for screening and non-acute symptomatic patients. While reductions in overall cancer diagnoses have been reported elsewhere, any differential effects on emergency presentations, which are associated with poorer outcomes, have not been described.

Material And Methods: Cross-sectional descriptive study from 2015 to 2021, based on International Cancer Benchmarking Partnership methods, where emergency route to diagnosis is defined as presenting as an emergency admission in the 30 days prior to cancer incidence date.

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Purpose: Mid-flexion instability has been identified as a cause for dissatisfaction following total knee arthroplasty (TKA). Robotic-assisted surgery using the Mako robot only allows for assessment of stability at 10° and 90°. This study aimed to investigate any evidence of mid-flexion instability in Mako-assisted TKA.

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Article Synopsis
  • The study examines the impact of 3D CT-based surgical robotics on knee alignment during total knee arthroplasty (TKA) by a traditionally-trained surgeon over five years.
  • An analysis of 1,394 robotically-assisted TKAs showed a trend towards varus positioning and a broader range of joint line obliquity in component alignment over time.
  • The findings suggest that the integration of 3D CT planning allowed for more tailored surgical approaches, moving away from conventional biomechanical alignment strategies, although further outcome data is needed to assess the benefits of these changes.
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Purpose: Loose flexion gaps are associated with poor functional outcomes and instability in total knee arthroplasty (TKA). The effect of a trapezoidal flexion gap in a functionally aligned TKA remains unknown. The aim of this study was to investigate the effect of a larger lateral flexion gap in a robotic-assisted (RA), functionally aligned (FA) and cruciate-retaining (CR) TKA on clinical outcomes.

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  • The study aimed to improve colorectal cancer (CRC) detection by using risk scoring models (RSMs) alongside faecal immunochemical testing (FIT) in symptomatic patients, potentially reducing the need for endoscopies.
  • By analyzing data from nearly 19,000 patients, key factors such as faecal haemoglobin levels, age, sex, and iron deficiency were identified to create a risk score that improved sensitivity for detecting CRC compared to standard f-Hb thresholds.
  • The findings suggest that while RSMs may enhance detection in some cases, they did not significantly help patients with very low f-Hb levels, indicating a need for alternative strategies that incorporate additional risk factors beyond just FIT.
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Background: Early maladaptive schemas (EMSs) have been theorised to contribute to reoccurring interpersonal problems. This study developed a novel experimental paradigm that aimed to assess if EMSs moderate the impact of interpersonal situations on interpersonal responses by manipulating the degree of rejection in a series of interpersonal vignettes depicting acceptance, ambiguous rejection and rejection.

Method: In a sample of 158 first-year psychology students (27.

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Objective: To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage.

Methods: The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design.

Results: With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively.

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Article Synopsis
  • A study aimed to create a risk-scoring model for colorectal cancer by analyzing faecal haemoglobin levels and other factors in participants of the Scottish Bowel Screening Programme.
  • Data from over 232,000 participants revealed that only faecal haemoglobin concentration and age were significantly linked to colorectal cancer, with a notable interval cancer rate, particularly higher in women (38.1%) than men (27.5%).
  • The findings suggest that developing a risk scoring model was not achievable, but adjusting faecal haemoglobin thresholds by age may help address the gender disparity in cancer detection rates.
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Background: Functional alignment (FA) strives to balance the knee soft-tissue envelope during total knee arthroplasty (TKA) using implant alignment adjustments rather than soft-tissue releases. There is a debate on how best to achieve FA. We compared minimum two-year outcomes between FA with a mechanical alignment plan [FA(m)] and FA with a kinematic alignment plan [FA(k)].

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Background: Ideal goals for alignment and balance in total knee arthroplasty (TKA) remain controversial. We aimed to compare initial alignment and balance using mechanical alignment (MA) and kinematic alignment (KA) techniques and to analyze the percentage of knees that could achieve balance using limited adjustments to component position.

Methods: Prospective data on 331 primary robotic TKAs (115 MAs and 216 KAs) were analyzed.

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  • Colorectal cancer (CRC) screening through faecal tests has reduced mortality rates, prompting a study to examine sex and age-related differences in mortality trends in Scotland from 1990 to 2020.
  • The analysis showed that while CRC mortality generally declined over this period, the rate of decline varied significantly between men and women, with men experiencing a more substantial decrease following the start of screening.
  • The findings suggest that screening programs had a more pronounced beneficial impact on men's CRC mortality and indicate the need for sex-specific thresholds in screening to promote equality in health outcomes.
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This current concepts article reviews the literature pertaining to the use of robot-assisted systems in total hip arthroplasty (THA). The bulk of the literature is regarding the MAKO (currently the most used system worldwide) and the historic ROBODOC robotic systems. There is a paucity of literature available on other systems, with several still in pilot-phase development.

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Purpose: Total knee arthroplasty with functional alignment uses pre-resection balancing to determine component position within the soft tissue envelope to achieve balance and restoration of native joint obliquity. The purpose of this study was to assess the balance achievable with a mechanical axis alignment and kinematic axis alignment plan, and the subsequent balance achievable after adjustment of the component position to functional alignment.

Methods: A prospective cohort of 300 knees undergoing cruciate retaining total knee arthroplasty were included in this study.

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Objective: Guidelines on colorectal cancer (CRC) screening with guaiac faecal occult blood tests (gFOBTs) and faecal immunochemical tests (FITs) include the need for a pilot before a programme is introduced. Interval cancers (ICs), cancers arising after a negative screening test result but before the next scheduled invite, are important indicators of programme quality. Our aim was to compare IC in the gFOBT-based Scottish Bowel Screening Programme (SBoSP), a FIT-based pilot, and the FIT-based SBoSP, to assess if the pilot provided data that was reflected in the subsequent programme.

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Aims: The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI?

Methods: A prospective, multicentre, trial enrolled 100 patients undergoing KA TKA using IDI, with follow-up to five years. Alignment measures were conducted pre- and postoperatively to assess constitutional alignment and final implant position.

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Aims: The aim of this study was to report patient and clinical outcomes following robotic-assisted total knee arthroplasty (RA-TKA) at multiple institutions with a minimum two-year follow-up.

Methods: This was a multicentre registry study from October 2016 to June 2021 that included 861 primary RA-TKA patients who completed at least one pre- and postoperative patient-reported outcome measure (PROM) questionnaire, including Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR), and pain out of 100 points. The mean age was 67 years (35 to 86), 452 were male (53%), mean BMI was 31.

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Article Synopsis
  • * The use of a single f-Hb threshold in screening leads to lower detection rates and worse outcomes for women, including higher rates of interval cancer and CRC mortality.
  • * Implementing different f-Hb thresholds for men and women could improve screening equity, but this approach would require careful consideration of various factors and additional colonoscopy resources, highlighting the need for government support in resource allocation.
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  • The study aimed to investigate how faecal haemoglobin (f-Hb) levels change between rounds of colorectal cancer (CRC) screening and how they relate to colonoscopy results in Scotland's bowel screening program.
  • Researchers compared f-Hb concentrations and outcomes from the first and second rounds among participants with different initial test results, including negative and positive FIT results.
  • Findings indicated that f-Hb levels varied depending on the test results from the first round, and having a negative colonoscopy does not completely rule out the possibility of significant pathology being found in subsequent screenings.
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Our aim was to understand whether using different landmarks for tibial component rotation influenced articular contact pressures in a balanced total knee arthroplasty (TKA). Twelve patients underwent TKA (Triathlon CR, Stryker Inc., Mahwah, NJ) and contact pressures were assessed using a wireless sensor.

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Background: The purpose of this study was to compare early clinical and patient-reported outcomes between robotic assisted (RA) and computer navigation (CN) total knee arthroplasty (TKA).

Methods: One hundred and fifty patients were enrolled in this prospective, single-surgeon, cohort study, with 75 patients each receiving CN-TKA or RA-TKA in a consecutive series. There were no differences in patient age ( = .

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Background: Greater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions in six high-income countries.

Methods: Using a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017.

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Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter.

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Article Synopsis
  • * Results revealed that women had a lower median faecal haemoglobin concentration (720 µg Hb/g) compared to men (473 µg Hb/g), and this difference was most significant for left-sided cancers and earlier stages of the disease.
  • * The study suggests that to address these gender disparities, screening programs might consider using different faecal haemoglobin threshold levels for women and men.
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