At Lifebox, an evidence-based approach is how we build our programmes, monitor their impact, and assess future opportunities.
We’re committed to proven pathways that make surgery and anaesthesia safer. But we’re equally determined to play a part in building the body of academic research that will put safer global surgery on the map – for every patient, every time.
Here’s where you’ll find some of the most important research in the field, from our trustees, friends and colleagues around the world.
Anesthesiology – Measuring Perioperative Mortality
“[In a middle-income country] a simple focus on quality and data collection was in itself a driver to improvement.” Lifebox trustees, Drs Walker and Wilson ask some critical questions with regards to measuring perioperative mortality.
Anesthesiology – Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool
Perioperative mortality rate is regarded as a credible quality and safety indicator of perioperative care, but its documentation in low- and middle-income countries is poor. Critical provider-driven report from Kenya.
Royal College of Physicians and Surgeons of Glasgow – Global Citizenship in the Scottish Health Service
A policy report by the RCPSG on the mutual benefits of international volunteering by Scotland’s health service workers.
Indian Journal of Anaesthesia – Safe anaesthesia for all: a distant dream?
As our work continues in partnerships across India, our colleagues ask some critical questions. Divatia JV. 2017;61:531-3
Globalization and Health – Interval follow up of a 4-day pilot program to implement the WHO surgical safety checklist at a Congolese hospital
Lifebox and Mercy Ships collaborative study looking at implementation of the WHO Surgical Safety Checklist at a hospital in the Republic of Congo. Overall positive results showing over 50% of participants using the SSC at 15 months.
Anaesthesia – Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia
Study showing how Lifebox oximeters and training in Malawi lead to an increase in knowledge – and that knowledge put to life-saving use!
Journal of Anesthesia History – Continuous Monitoring in Global Health, Taking Principles of Anesthesia Care Abroad: The Lifebox Model
Luca Koritsanszky writes about our work in Guatemala, and a model of global change at the local level for the Journal of Anesthesia History.
Anesthesia-Analgesia – Pulse Oximeter: Disruptive Technology or Standard of Care?
“Lifebox, an organization that has seized a responsibility to be an advocate for the provision of safe anaesthesia and surgery for all patients.” Elizabeth T. Drum, International Anesthesia Research Society, June 15, 2016, Volume 6, Number 12
Anesthesia-Analgesia – Lifebox: A Global Patient Safety Initiative
The safety of anesthesia was dramatically improved by the introduction of pulse oximetry. However, clinicians in low- and middle-income countries lack access to basic anaesthesia equipment. The Lifebox Foundation was formed to determine how a suitable oximeter could be made available to anesthesia providers in these countries. Angela Enright et al. International Anesthesia Research Society, June 15, 2016, Volume 6, Number 12
Anesthesia-Analgesia – The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications
Low-cost pulse oximeters have become increasingly available with limited regulatory agency oversight. The Lifebox pulse oximeter is cited as a model proven to meet US FDA accuracy standards. Michael S. Lipnick et al, Anesthesia & Analgesia, 13th April 2016
World Journal of Surgery – Surgical Non-governmental Organizations: Global Surgery’s Unknown Nonprofit Sector
Lifebox is one of around 400 NGOs providing surgery in 139 low/middle income countries. Joshua S. Ng-Kamstra et al, 23rd March 2016
Anaesthesia – The World Health Organization safe surgery checklist as a catalyst for system improvement
Lifebox trustee Dr Alexander Hannenberg with an eloquent recognition of the context, challenges and value of celebrating incremental improvements that lead to long-term change. 2015, 70, 1335-1344
Anaesthesia – Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda – a quality improvement project
In spite of the barriers – particularly understaffing, malfunctioning equipment or total lack of it – the improvmenet is evident. Through evaluation and structured feedback, the team was able to raise compliance rates from 29.5% to 85% (using the Checklist) and from 25.5% – 83% (counting surgical swabs). Lilaonitkul M. et al, Anaesthesia. 2015 Dec;70(12):1345-55
Journal of Anesthesia – Incidence of hypoxia and related events detected by pulse oximeters provided by the Lifebox Foundation in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo
The Lifebox oximeter enables early detection of hypoxia for patients undergoing surgery before irreversible damage occurs. Pulse oximetry is cost-effective intervention and should be more accessible in all operating rooms of this type. Sama H.D. et al, Journal of Anesthesia. 2015 Dec;29(6):971-3
The Lancet – Global Surgery
Atul Gawande writes about Dr Shrikant Jaiswal, the first and only anaesthetist in Umarkhed, the central Indian town in the state of Maharashtra closest to the rural village where his father grew up. Atul Gawande. 2015. doi:10.1016/S0140-6736(15)60764-4
World Journal of Surgery – The Amsterdam Declaration on Essential Surgical Care
Lifebox® and WFSA co-signatories. Matthijs Botman et al World Journal of Surgery (2015) 39:1335-1340
The Lancet – Commission on Global Surgery
All the data from this landmark undertaking to understand and take action on global surgery.
The Lancet – Essential surgery: key messages from Disease Control Priorities, 3rd edition
Lifebox Chair Atul Gawande contributes to this insightful review into the landmark study. Mock CN et all, Lancet. 2015 May 30;385(9983):2209-19
Spotlight on surgery. Evidence on intervention efficacy and programme effectiveness for the leading causes of global disease burden.
The Lancet – Avoidable maternal and neonatal deaths associated with improving access to caesarean delivery in countries with low caesarean delivery rates: an ecological modelling analysis
Increased caesarean delivery in countries with low CDRs could avert as many as 163,513 maternal deaths and 803,129 neonatal deaths annually. G Molina et al. 2015 April 27; 385 Suppl 2:S33. do: 10.1016/S0140-6736(15)60828-5
Bulletin of the World Health Organization – Peri-operative pulse oximetry in low-income countries: a cost-effectiveness analysis
Pulse oximetry is a cost-effective intervention for low-income settings. Samantha L Burn, Peter J Chilton, Atul A Gawande and Richard J Lilford. 2014;92:858-867
British Journal of Obstetrics and Gynecology – The global met need for emergency obstetric care: a systematic review
Considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. H. Holmer et al. 2015 Jan;122(2):183-9. doi: 10.1111/1471-0528.13230.
Patient Safety in Surgery – Implementation of the WHO Surgical Safety Checklist in an Ethiopian Referral Hospital
Tom Bashford, Sophie Reshamwalla, Jacqueline McAuley, Nikole H Allen, Zahira McNatt, Yohannes D Gebremedhen. 2014, 8:16. doi:10.1186/1754-9493-8-16
Current Anesthesiology Reports – Improving Anesthesia Safety in Low-Income Regions of the World
Isabeau A. Walker, Tom Bashford, J. E. Fitzgerald, Iain H. Wilson. Curr Anesthesiol Rep (2014) 4:90–99
Anaesthesia – Evaluation of a large-scale donation of Lifebox pulse oximeters to non-physician anaesthetists in Uganda
Finch, L. C., Kim, R. Y., Ttendo, S., Kiwanuka, J. K., Walker, I. A., Wilson, I. H., Weiser, T. G., Berry, W. R. and Gawande, A. A. (2014). 69: 445–451. doi: 10.1111/anae.12632
Anaesthesia – Accuracy of the Lifebox pulse oximeter during hypoxia in healthy volunteers
G.Dubowitz, K.Breyer, M.Lipnick, J.W. Sall, J.Feiner, K.Ikeda, D.G.MacLeod, P.E.Bickler. 2013 (doi:10.1111/anae.12382)
British Journal of Hospital Medicine – Quality improvement in low resource settings: an Ethiopian experience
T.Bashford, May 2013, Vol 74, No 5
Canadian Journal of Anesthesia – Special Issue: Innovation in Perioperative Patient Safety
An overview of quality and safety in heathcare Alan F. Merry, (2013) 60:101-110
Perioperative checklist methodologies Thomas G. Weiser, William R. Berry (2013) 60:136-142
Safety aspects of anesthesia in under-resourced locations Angela Enright (2013)60:152-158
Tropical Medicine and International Health – Innovative newborn health technology for resource-limited environments
January 2013, volume 18 no 1 pp 117-128. L. Thairu, M. Wirth, K.Lunze
Health in the Post-2015 Development Agenda – Health priorities post-2015: surgery must feature on the priority health agenda for the 15 years after 2015
December 20, 2012. Reshamwalla, S. Kessler, I. Wilson
British Journal of Obstetrics and Gynecology – Surgically avertable burden of obstetric conditions in low- and middle-income regions: a modelled analysis
Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs. H. Higashi et al.. DOI: 10.1111/1471-0528.13198
Annals of Surgery – Implementation of the World Health Organization Surgical Safety Checklist, Including Introduction of Pulse Oximetry, in a Resource-Limited Setting
Kwok AC, Funk LM, Baltaga R, Lipsitz SR, Merry AF, Dziekan G, Ciobanu G, Berry WR, Gawande AA. 2012 Nov 30
Paediatric Anaesthesia – Safe perioperative pediatric care around the world
2012 Oct;22(10)947-51. Ivani G, Walker I, Enright A, Davidson A.
British Journal of Anaesthesia – Surgical safety checklists: do they improve outcomes?
I. A. Walker, S. Reshamwalla and I. H. Wilson. doi:10.1093/bja/aes175
BMJ Quality and Safety – Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Dziekan G, Herbosa T, Kibatala PL, Lapitan MC, Merry AF, Reznick RK, Taylor B, Vats A, Gawande AA;Safe Surgery Saves Lives Study Group. 2011 Jan;20(1):102-7.
Canadian Journal of Anaesthesia – International Standards for a Safe Practice of Anesthesia 2010
Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. 2010 Nov; 57 (11):1027-34. Epub 2010 Sep 21
Canadian Journal of Anaesthesia – An iterative process of global quality improvement: the International Standards for a Safe Practice of Anesthesia 2010
Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. Can J Anaesth. 2010 Nov; 57 (11):1021-6. Epub 2010 Sep 21.
The Lancet – Global operating theatre distribution and pulse oximetry supply: an estimation from reported data
Funk LM, Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC, Wilson IH, Dziekan G, Gawande AA. 2010 Sep 25;376(9746):1055-61. Epub 2010 Jul 2.
Anaesthesia – Global oximetry: an international anaesthesia quality improvement project
Walker IA, Merry AF, Wilson IH, McHugh GA, O’Sullivan E, Thoms GM, Nuevo F, Whitaker DK; GO Project teams. 2009 Oct; 64 (10):1051-60.
The Lancet – Anaesthesia in developing countries–a risk for patients
Walker IA, Wilson IH. 2008 Mar 22; 371 (9617):968-9
Anaesthesia – Anaesthesia in developing countries
Walker I, Wilson I, Bogod D. 2007 Dec; 62 Suppl 1:2-3.
F1000 Medicine Reports – Has anesthesia care become safer and is anesthesia-related mortality decreasing?
Merry AF, Webster CS. 2009 Sep 14;1. pii: 69.