Background: In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers. Methods: A PRISMA systematic review was utilized from PubMed from the years 1952-2022. A broad keyword search of "Cardiology Anesthesiology Echocardiogram" and "Echocardiography Anesthesiology" to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists. Results: Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study. Conclusion: Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.

There have been multiple studies that evaluated the websites of various fellowships and many of them were lacking specific details.1-3 These types of studies are crucial since applicants rely heavily on fellowship program websites for information. Addressing the shortcomings of the website material presented will assist applicants in making informed decisions about where to apply and selecting the program that best suits their needs. Fellowship programs can also benefit from this study by identifying areas for improvement in their website content to effectively showcase their program's strengths and attract potential applicants. This study aims to evaluate and compare the information available between different pediatric anesthesiology fellowship websites to identify areas that need to be improved. There were 61 ACGME pediatric anesthesiology fellowships in the United States at the time of this inquiry. Researchers then used the search engine, Google, to gather websites of the 61 available pediatric anesthesiology fellowship programs. Two researchers were only able to find 60 of the websites through Google. 24 different criteria were used to evaluate each pediatric anesthesiology fellowship website that similar studies used to critique other fellowship webpages.1, 4, 5 Two researchers independently evaluated whether or not the criteria were fulfilled by the websites as shown in Table 1. In the event of a disagreement between these evaluators, a third impartial researcher settled the discrepancy. The results with each criterion are shown in Table 1. The websites, on average, covered 13.19 out of 24 criteria (54.9%), with individual counts ranging from 8 to 20. 40 out of the 60 websites (66.7%) had more than 50% of the information available. Although most of the 60 websites met more than 50 percent of the criteria, there were a few categories that many websites lacked such as case log numbers, call responsibilities, clinic/office responsibilities, alumni, and summary. The decision was made to not assess the quality of the information to ensure objectivity in the evaluation process. While our researchers did not pinpoint the specific information sought by pediatric fellows when they were applying, addressing specific details that are underreported provides opportunities for enhancing the site because they can potentially yield valuable insights. For example, case logs allow applicants to be informed about the procedures they will be performing Providing applicants with information about their responsibilities in clinics, including pain or perioperative settings, and during on-call periods provides perspective into a fellow's daily routine and anticipated work–life balance. Alumni information allows applicants to contact previous graduates for details of the fellowship experience, ascertain their personal impressions of the training program, examine the career trajectory of previous trainees, and potential for their own career development based on graduate performance. Program summaries on websites would provide an excellent way for applicants to quickly identify points that make the fellowships unique, without having to browse throughout the whole website. By enhancing the content and presentation of websites, program directors can empower applicants to become more knowledgeable about what each program offers, ultimately fostering a more effective and mutually beneficial selection process. The data that support the findings of this study are available in Accreditation Council for Graduate Medical Education (ACGME) at https://apps.acgme.org/ads/Public/Reports/ReportRun. These data were derived from the following resources available in the public domain: Accreditation Council for Graduate Medical Education (ACGME), https://apps.acgme.org/ads/Public/Reports/Report/1.

Craniofacial surgery is an incredibly innovative field that can truly alter the course of an individual’s life. The conditions addressed by craniofacial surgery can arise from either trauma or congenital defects of the bone and soft tissues of the head and neck. Procedures to address these issues seek to both reconstruct and repair the targeted areas. Those who have completed a plastic surgery residency have the opportunity to subspecialize in craniofacial surgery after completion of a one-year fellowship. The internet is often the first point of contact for applicants to craniofacial fellowships. Our objectives in this article included analyzing the accessibility of the information available on these websites. This information has become particularly relevant during our current SARS-COV-2 pandemic because fellowship interviews have been conducted via virtual format. Applicants must make selections and judgments based on what they learn through various internet portals. However, the importance of accurate and updated websites has been documented in the literature even before the pandemic.1 Several studies have documented that there is limited content on these websites despite having an effect on an applicant’s rank order list.1–4 METHODS In December 2021, four investigators accessed the websites of 31 craniofacial fellowship websites as linked on the American Society of Craniofacial Surgeons’ Fellowship Directory. A set of 11 criteria from prior assessments was selected for evaluation, as listed in Table 1. Table 1. - Criteria Selected for Evaluation and Number of Websites That Contained the Information Pertaining to Each Criterion Criteria No. Programs (n = 31) Program description 29 (93.55%) Applicant process description 25 (80.65%) Program director contact 19 (61.29%) Coordinator contact 15 (48.29%) Current fellows 11 (35.48%) Research 21 (67.74%) Rotation schedule 4 (12.90%) Faculty 18 (58.06%) Alumni 11 (35.48%) Salary 12 (38.71%) Life in the area 6 (19.36%) RESULTS The American Society of Craniofacial Surgeons’ Fellowship Directory was used to access websites for the 31 programs in the United States and Canada. The results are listed in Table 1. The number of criteria contained on these websites ranged from 0 to 11, for a mean number of 5.51 criteria listed or 50.0%. Eighteen of the 31 programs (58.0%) contained 50% or more of the aforementioned criteria. DISCUSSION The pool of applicants and number of spots for craniofacial fellowships is significantly smaller than other surgical training programs. For example, in 2021, John Hopkins Hospital received three plastic surgery residents, whereas the John Hopkins Craniofacial Fellowship program during a typical fellowship cycle has 12–15 applicants compete for a single spot.5 In today’s applicant landscape prospective, craniofacial fellows can seek fellowships that provide the most academic value per congenital craniofacial case and have supplemental cases that allow the fellow to develop skills transferrable to treating craniofacial conditions in adults. Our assessment identified that the mean number of criteria is similar when compared with those in other similar studies reported in the literature.1–4 Our study showed that many craniofacial fellowship programs have not yet modified their online platforms to disclose commonly identified information that should be available on a program website (Table 1). For the programs that have met such milestones, we also suggest additional considerations by programs to include number and types of surgeries, types of evaluation and mentorship, and academic involvement and teaching (Table 2). Largely, these changes should be added for applicants to evaluate the type of cases and scholarly activity. Table 2. - Recommendations to Fellowship Programs about Additional Information to the Program Websites Number and type of surgeries Disclosure of the number and type of surgeries fellows within a program are a part of would assist a prospective fellow in determining their potential exposure to craniofacial surgery as well as surgeries that develop transferable skills. Disclosure of a previous fellow’s participation in addressing cleft lips and palates, neurofibromas, and hemangiomas would signal to a prospective fellow that they would be exposed to surgeries that provide these transferrable skills. Types of evaluation and mentorship Disclosure of how a fellow is assigned to cases would assist in a prospective fellow’s evaluation. Descriptions about if a program uses a purely rotational, or more single mentorship system would assist the fellow in determining if they are getting their desired balance of diversity of exposure and one-on-one time with mentors. Academic involvement and teaching Disclosure about a fellow’s academic involvement in the program would be helpful. Craniofacial surgeons trained within the last decade are primarily working within academic practices. Information about how a prospective fellow can develop both their own research and teaching experience would assist the prospective fellow in determining if the program prepares them for a future job in academics. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Introduction:Umbilical hernias are found in 2% of the American adult population with increasing prevalence in overweight and multiparous women. A mesh repair is considered to be a suitable option for those desiring non-cosmetic surgical repair. Despite the mesh plug's reported value in reduction of the recurrence of umbilical hernia from 11% to 1%, there is an increased risk in de-vascularizing the umbilicus with its use.Presentation of Case:We present a case which avoids fascial incisions near the umbilicus, thus preserving the blood supply employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication.Discussion of Case:Hernia repair can be associated with a host of issues, minor and major, including regional tissue ischemia and the distortion of natural anatomy, likely due to ischemia of the epigastric vessels. Abdominoplasty is a suitable option for patients with redundancy of the abdominal skin and laxity abdominal wall musculature. Abdominoplasty has excellent exposure and correction of abdominal wall hernias. This "anatomic repair" employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication can be used in place of a mesh overlay for the purposes of umbilical hernia repair especially when the hernia may be asymptomatic.Conclusion:Abdominoplasty uniquely allows for an open hernia repair when anticipated or discovered at the time of surgery and is considered a true anatomical repair of an umbilical hernia which does not necessitates the use of foreign materials.

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.