{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:32:17Z","timestamp":1792665137725,"version":"4.5.0"},"reference-count":51,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T00:00:00Z","timestamp":1494201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Major vessel hemorrhage in endoscopic, endonasal skull\u2010base surgery is a rare but potentially fatal event. Surgical simulation models have been developed to train surgeons in the techniques required to manage this complication. This mixed\u2010methods study aims to quantify the stress responses the model induces, determine how realistic the experience is, and how it changes the confidence levels of surgeons in their ability to deal with major vascular injury in an endoscopic setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty consultant surgeons and surgeons in training underwent training on an endoscopic sheep model of jugular vein and carotid artery injury. Pre\u2010course and post\u2010course questionnaires providing demographics, experience level, confidence, and realism scores were taken, based on a 5\u2010point Likert scale. Objective markers of stress response including blood pressure, heart rate, and salivary alpha\u2010amylase levels were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean \u201crealism\u201d score assessed posttraining showed the model to be perceived as highly realistic by the participants (score 4.02). Difference in participant self\u2010rated pre\u2010course and post\u2010course confidence levels was significant (<jats:italic>p<\/jats:italic> &lt; 0.0001): mean pre\u2010course confidence level 1.66 (95% confidence interval [CI], 1.43 to 1.90); mean post\u2010course confidence level 3.42 (95% CI, 3.19 to 3.65). Differences in subjects\u2019 heart rates (HRs) and mean arterial blood pressures (MAPs) were significant between injury models (<jats:italic>p<\/jats:italic> = 0.0008, <jats:italic>p<\/jats:italic> = 0.0387, respectively). No statistically significant difference in salivary alpha\u2010amylase levels pretraining and posttraining was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Results from this study indicate that this highly realistic simulation model provides surgeons with an increased level of confidence in their ability to deal with the rare but potentially catastrophic event of major vessel injury in endoscopic skull\u2010base surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21941","type":"journal-article","created":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T11:02:45Z","timestamp":1494241365000},"page":"576-583","source":"Crossref","is-referenced-by-count":16,"title":["Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study"],"prefix":"10.1002","volume":"7","author":[{"given":"Alistair K.","family":"Jukes","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"},{"name":"Department of Neurosurgery Royal Adelaide Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Mascarenhas","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lia","family":"Stepan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara N.","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Pontificia Universidad Cat\u00f3lica de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio A.","family":"Callejas","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Pontificia Universidad Cat\u00f3lica de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Valentine","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"},{"name":"Department of Otolaryngology Royal Adelaide Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.J.","family":"Wormald","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"},{"name":"Department of Medicine University of Adelaide Queen Elizabeth Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alkis J.","family":"Psaltis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Queen Elizabeth Hospital  Adelaide Australia"},{"name":"Department of Medicine University of Adelaide Queen Elizabeth Hospital  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,8]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"107","volume-title":"Stress, Workload, and Fatigue","author":"Stokes AF","year":"2001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21453"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21326"},{"key":"e_1_2_7_5_1","first-page":"ons261","article-title":"Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes","volume":"73","author":"Gardner 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