Janet Martin

Janet Martin
The University of Western Ontario | UWO · Department of Anesthesia and Perioperative Medicine

BScPhm, PharmD, MSc(HTA&M), PhDeq

About

261
Publications
72,536
Reads
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7,614
Citations
Introduction
Dr. Janet Martin is Associate Professor in the Departments of Anesthesia and Perioperative Medicine and Epidemiology & Biostatistics. She is also Director, MEDICI Centre, Schulich School of Medicine & Dentistry, University of Western Ontario. Dr. Martin's research and knowledge translation work focuses on Surgery, Anesthesia, Perioperative Medicine, Clinical Trials, Epidemiology, Decision-Making, and Evidence Reversals in low-, middle- and high-income settings (LMICs and HICs). Current projects include "Global Surgery, Anesthesia & Perioperative Care", "Evidence Reversals", "Health Technology Assessment", and "Decision-Relevant Guidelines". Dr. Martin received the Distinguished Leader Award of Excellence for Graduate/Postgraduate Education at the Schulich School of Medicine & Dentistry.
Additional affiliations
June 2017 - present
The University of Western Ontario
Position
  • Managing Director
Description
  • Informed decision-making through synthesis of evidence, economics, ethics, and 'everything else' that should be considered when making difficult decisions in healthcare, with emphasis surgery, anesthesia, and perioperative medicine using Know4Go.
January 2012 - June 2017
The University of Western Ontario
Position
  • Managing Director
Description
  • Informed decision-making through synthesis of evidence, economics, ethics, and "everything else" that should weigh on decisions when making difficult trade-offs in healthcare, with emphasis on assessing health technologies & programs of care via Know4Go.
January 2012 - present
The University of Western Ontario
Position
  • Assistant Professor & Director, MEDICI

Publications

Publications (261)
Article
Full-text available
Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and proces...
Article
Background WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updat...
Article
Full-text available
There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality.
Article
Background: Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the le...
Article
Full-text available
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates an...
Article
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This paper quantifies the net impact (direct and indirect effects) of the pandemic on the United States population in 2020 using three metrics: excess deaths, life expectancy, and total years of life lost. The findings indicate there were 375,235 excess deaths, with 83% attributable to direct, and 17% attributable to indirect effects of COVID-19. T...
Article
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SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism....
Article
Full-text available
Summary SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboe...
Article
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Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequen...
Article
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We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which pati...
Preprint
Full-text available
Globally, there continues to be a surge in infectious disease outbreaks. While old diseases are re-emerging, new ones are also emerging. This speed of emergence and re-emergence is accelerated by human development, changes in demographics, population, and the environment. We continue to see new patterns of disease infections from their natural host...
Article
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Background: Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remo...
Article
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Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...
Article
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Objective: To extend the IDEAL Framework for device innovation, IDEAL-D, to include the preclinical stage of development (Stage 0). Background: In previous work, the IDEAL collaboration has proposed frameworks for new surgical techniques and complex therapeutic technologies, the central tenet being that development and evaluation can and should...
Preprint
Full-text available
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened...
Article
Full-text available
Differences in patient classification of myocardial injury between high-sensitivity cardiac troponin (hs-cTn) assays have largely been attributed to assay design and analytical sensitivity aspects. Our objective was to compare Ortho Clinical Diagnostics’ (OCD) hs-cTnI assay to OCD’s contemporary/conventional assay (cTnI ES) and another hs-cTnI assa...
Article
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High-sensitivity cardiac troponin (hs-cTn) testing has enabled physicians to make earlier diagnostic and prognostic decisions in the hospital setting than previous cardiac troponin assays. Analytical improvements have permitted one to measure cardiac troponin precisely in the nanogram per litre (ng/L) range with hs-cTn assays which has resulted in...
Article
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Objectives Our objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI. Methods We systematically reviewed the literature published in 2006...
Article
Purpose Intrathecal morphine-induced pruritus can cause significant discomfort in parturients and is refractory to conventional antipruritic treatment. This systematic review and network meta-analysis evaluates the effectiveness of the medications used for prevention of intrathecal (IT) morphine-induced pruritus after cesarean delivery under spinal...
Chapter
‘Fast-track’ cardiac anaesthesia and recovery is the term given to a multicomponent intervention during cardiac surgery and postoperatively, with the ultimate goal of early extubation (within 1–6 hours) in order to reduce duration of mechanical ventilation, length of stay in the intensive care unit, and overall resource utilization. Key components...
Article
Full-text available
Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on...
Article
Full-text available
p>Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications...
Article
Background Dexmedetomidine is used as a local-anesthetics adjuvant in caudal block to prolong analgesia in pediatric infra-umbilical surgery. Objective We evaluated the analgesic efficacy and safety of the addition of caudal dexmedetomidine to local anesthetics (vs local anesthetics alone) in pediatric infra-umbilical surgery. Evidence review We...
Chapter
Provision of anesthesia services outside the setting of the operating room, also known as non-operating room anesthesia (NORA), is growing due to increased demand for less invasive cardiac interventions. Recent advances in technology allows for increasingly complex cases, which may not otherwise be eligible for conventional surgery. Together with c...
Chapter
Fast-track cardiac care requires an interdisciplinary approach to anesthesia during surgery, as well as a coordinated approach after surgery, in order to achieve early extubation and an overall streamlined approach to recovery and hospital discharge. The use of protocols to define specific goals and criteria for extubation and an interdisciplinary...
Chapter
Neurologic complications including delirium, acute confusion, and stroke remain one of the most feared complications after cardiac surgery, and are associated with longer hospital stays, a higher risk of discharge to long-term care facilities, and higher risk of multiple morbidities and death during the index hospital stay and after discharge. This...
Chapter
‘Fast-track’ cardiac anesthesia (FTCA) is a multi-component intervention during and after cardiac surgery with the goal of early extubation. Early extubation aims to reduce the duration of mechanical ventilation, ICU length of stay, postoperative recovery, and overall resource utilization. To realize these benefits without increasing the risk of ad...
Book
This comprehensive yet concise book addresses current best practice in the combined areas of cardiac surgery and anesthesia, interventional minimally invasive cardiac procedures, perioperative management and monitoring, and critical care recovery. This book not only provides the latest best practices in the perioperative management of cardiac surgi...
Article
Full-text available
Background During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future...
Article
Objective: We aimed to define a globally applicable list of surgical procedures, or ‘‘basket,’’ which could represent a health system’s capacity to provide surgical care and standardize global surgical measurement. Summary of Background Data: Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care...
Article
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Background: There is considerable actual and potential waste in research. The aim of this paper is to describe how using an Evidence-Based Research approach before conducting a study helps to ensure that the new study truly adds value. Study design and setting: Evidence-Based Research is the use of prior research in a systematic and transparent...
Article
Background: There is considerable actual and potential waste in research. Using evidence-based research can ensure the value of a new study. The aim of this paper, the third in a series, is to describe an evidence-based research (EBR) approach to putting research results into context. Study design and setting: Evidence-Based Research is the use...
Preprint
Purpose: To examine the risk factors for Intensive Care Unit (ICU) admission, mechanical ventilation and mortality in hospitalized patients with COVID-19. Methods: This was a retrospective cohort study including 432 patients with laboratory-confirmed COVID-19 who were admitted to three medical centers in Hubei province from January 1st to April 10t...
Article
Full-text available
This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. Data sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. Study selection: Two independent reviewers screened citations. Eligible studies included randomized controlled tri...
Article
Full-text available
Background: Capacity to deliver outpatient care for patients with cardiac implantable electronic devices (CIEDs) may soon be outweighed by need. This systematic review aims to investigate the comparative effectiveness, safety, and cost for virtual or remote clinic interventions for patients with CIEDs and explores how outcomes may be influenced by...
Article
Randomized trials remain the foundation for evidence-based medicine by minimizing bias and confounding. Conduct of randomized trials in the perioperative period, including the conduct of trials related to cardiac anesthesia, is challenging. These challenges stem from not only the perception that randomized trials are easy to design, but that they a...
Article
Background Blood transfusion is a well-established independent risk factor for mortality in patients undergoing cardiac surgery but the impact of platelet transfusion is less clear. We performed a systematic review and meta-analysis of observational studies comparing outcomes of patients who received platelet transfusion following cardiac surgery....
Article
Aim: The First Episode Mood and Anxiety Program (FEMAP) is a community-based early intervention program that has been shown to improve health outcomes for emerging adults (EAs) with mood and anxiety disorders. However, not all EAs who are admitted to the program initiate treatment. Our aim was to identify factors that distinguish those who initiat...
Article
Article 25 of the United Nations’ Universal Declaration of Human Rights enshrines the right to health and well‐being for every individual. However, universal access to high‐quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri‐operative care, where an estimated five billion individuals lack ac...
Article
Full-text available
Objective To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery. Design Systematic review and network meta-analysis. Data sources Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019. Eligibi...
Article
Background Caudal epidural block, commonly performed for perioperative analgesia in pediatric patients undergoing infraumbilical surgeries, is limited by the duration of analgesia. Several adjuvant medications including clonidine, dexmedetomidine, dexamethasone, ketamine, magnesium, fentanyl, morphine, tramadol and neostigmine have been studied to...
Article
Introduction: A recent pan-Canadian survey of 48 health organizations concluded that structures, processes, factors and information used to support funding decisions on new non-drug health technologies (NDTs) vary within and across jurisdictions in Canada. Methods: A self-administered survey was used to determine demographic and financial charac...
Article
Introduction: Unlike those for publicly funded drugs in Canada, coverage decision-making processes for non-drug health technologies (NDTs) are not well understood. Objectives: This paper aims to describe existing NDT decision-making processes in different healthcare organizations across Canada. Methods: A self-administered survey was used to d...
Article
Study objective To assess the efficacy and safety of dexmedetomidine as an adjunct to general anesthesia for craniotomy. Design A meta-analysis after systematically searching PubMed, Medline, EMBASE, and Cochrane library for randomized trials (RCTs). Relative risk (RR) and weighted mean difference (WMD) were calculated using random-effects meta-an...
Article
Background: Two previous meta-analyses comparing staples versus sutures have led to conflicting relative risks for surgical site infection between skin closure methods after orthopaedic surgery. Consequently, the choice of sutures or staples for skin closure continues to be a subject of conversation. Recently, additional randomized trials have bee...
Article
Full-text available
Introduction Aortic stenosis is a significant cause of morbidity and mortality in older patients. The advent of transcatheter aortic valve implantation (TAVI) offers an alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis who are at high or intermediate risk of adverse events. Existing evidence highl...
Article
Full-text available
Objectives We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms. Design Systematic review. Data sources Major electronic databases including MEDLINE, EMBASE, LILACS. Eligibility criteria We included studies that reported the DTA of...
Article
Full-text available
Introduction Empirical, observational data relating to the diagnosis, management and outcome of three common worldwide cancers requiring surgery is lacking. However, it has been demonstrated that patients in low/middle-income countries undergoing surgery for cancer are at increased risk of death and major complications postoperatively. This study a...
Article
Purpose: To examine the effect of discontinuing hydroxyethyl starch (HES) solutions on length of hospital stay, transfusion, risk of death, acute kidney injury (AKI), and dialysis. Methods: We conducted a historical cohort study of linked administrative and clinical databases in patients undergoing coronary artery bypass surgery (CABG) on cardio...