Evidence-based. Always.

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.

The American Journal of Tropical Medicine and HygieneUsability Testing of a Reusable Pulse Oximeter Probe Developed for Health-Care Workers Caring for Children < 5 Years Old in Low-Resource Settings


British Medical JournalOpportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

Lifebox trustee Isabeau Walker and Lifebox champion Nick Boyd look into the challenges faced by pulse oximetry in paediatric pneumonia management across paediatric clinical settings in low-income countries.

Pediatric Pulmonology – Performance of a novel reusable pediatric pulse oximeter probe

Lifebox trustee Isabeau Walker, emeritus trustee Iain Wilson and Lifebox friend Nick Boyd look into the performance of pediatric probes, using a Lifebox pulse oximeter and probe.

Canadian Journal of Anesthesia – Evaluation de l’impact du projet Lifebox au Burkina Faso sur la pratique de l’oxymetrie pulse ́e et la check-list de l’organisation mondiale de la sante ́ pour la se ́curite ́ du patient au bloc operatoire

Cheik Tidiane Hafid Wind-Pouire ́ Bougouma et al, evaluates the impact of Lifebox projects in Burkina Faso, in implementing safe anesthesia and the surgical safety checklist.

Canadian Journal of Anesthesia – A friend in need: evaluating the impact of Lifebox in Burkina Faso

Lifebox trustee Angela Enright reflects on the impact of Lifebox’s lasting legacy in Burkina Faso, having delivered pulse oximeters and training in 2013.

Wiley Online Disseminating technology in Global Surgery

William Bolton et al, feature the Lifebox Pulse oximeter in their analysis of the use of technology in aiding global surgery.

JAMA Surgery – Minimum specifications for a Lifebox Surgical Headlight

Jared Forrester Tom Weiser and Kris Torgeson propose the minimum specifications for a Lifebox Surgical Headlight to help aid surgical teams who experience poor and inadequate lighting during operations.

RCS Bulletin – Tooling up: How the Lifebox Foundation are using safe surgical instruments as a lever to lift the operative ecosystem in global surgery

This piece from Edward Fitzgerald and Mahmood Bhutta chronicles the investigations taken place in the field to unravel the need for safer surgical instruments in operating rooms in LMICs.

BJMBritish Medical Journal – Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

Hamish R Graham et al delve into the adoption of peadiatric pulse oximetry in Nigerian hospitals, using Lifebox pulse oximeters.

BJS – British Journal of SurgeryTen Years of the Surgical Safety Checklist 

Dr Tom Weiser and Dr Alex Haynes explore how the WHO Surgical Safety Checklist has had a direct impact in reducing surgical-related complications and death ten years since it’s implementation, and the importance of the checklist for Lifebox’s work.

BMJ Postgraduate Medical Journal – Surgical safety checklist training: a national study of undergraduate medical and nursing student teaching, understanding and influencing factors

Dr Caroline Kilduff and Dr Ed Fitzgerald, Lifebox clinical advisor, show that UK undergraduate surgical safety checklist training does not meet the minimum standards set by the WHO.

Anesthesia-Analgesia – In Response 

Response letter lead by WFSA Director of Programmes, Dr Wayne Morriss, highlighting the educational components of the WFSA and Lifebox’s work.

Anesthesia-Analgesia – A World of Need 

Letter to the Editor with regards to the World Federation of Societies of Anaesthesiologists (WFSA)’s  World Anaesthesiology Workforce Map. This letter applauds the WFSA and Lifebox’s work and calls for more educational expertise to counter the global anaesthesia workforce disparity.

Anesthesia-Analgesia 70th World Health Assembly

Meeting report from the World Federation Societies of Anaesthesiologists (WFSA) about this year’s World Health Assembly held in Geneva, Switzerland. Lifebox Global CEO, Kris Torgeson and Director of Communications, Sarah Kessler were in attendance as part of the WFSA delegation.

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 GlasgowGlobal 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

Disease Control Priorities Network – DCP-3

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.