Provide the author with examples of areas

Provide the author with examples of areas you like most in the systematic review. Explain why you like these areas? Identify the strongest point the author has made? Explain why this is a strong point for the systematic review. Offer suggestions for the author to continue doing well. ………………………………………………………………………………………….. PICOT Approach to Treatment of Venous Leg Ulceration Systematic Review PICOT Question In adult patients with venous leg ulcers between 6 weeks and 6 months, does early ablation of superficial venous reflux result in faster healing after 2 weeks and more improved quality of life, and reduced chances of recurrence after 24 months compared to deferred ablation of superficial venous reflux? Background information Ulcers occur in almost all major parts of the body but more frequently on the legs. Venous leg ulcers result from complications that affect circulation in the lower extremities and are the most common form of chronic lower extremity ulcers affecting up to 1-3% of the US population according to Milan and Townsend (2019). The primary underlying mechanism for the development of venous ulcers is venous hypertension which results from venous reflux. According to Milan and Townsend, a large portion of the US population faces an increased risk of developing venous leg ulcers since 10-35 % of them have chronic venous insufficiency, a major risk factor for venous leg ulceration. Furthermore, venous leg ulcers are the major contributory factor to chronic venous insufficiency among patients who develop it from exposition by other risk factors that include increasing age and female gender. Problem The poor healing rate of affected patients and the recurrence of the condition are major problems associated with venous ulceration and are the major cause of concern to clinicians and patients as explained by Gohel et al. (2019). Poor healing rates and recurrence of venous leg ulceration not only impose extra financial obligations on patients and their families but also impact their quality of life negatively. According to Gohel et al., most of the interventions utilized in the management of venous ulcers are effective in healing the condition but fail to address the underlying factors. Failure to effectively address the underlying cause of venous ulceration, which in most cases is venous reflux, leads to poor healing rates, increased chances of recurrence, and consequently poor quality of life among the affected patients. Apart from the high cost incurred by patients, venous leg ulceration causes pain, odor, and wound discharge. These factors force one to socially isolate due to increased discomfort leading to an extremely poor quality of life. Outcomes The major outcomes of interventions aimed at managing venous leg ulceration include the healing rate of the condition, the chances of recurrence, and the quality of life. These outcomes, according to Gohel et al. (2019), are determined by the strategy utilized by healthcare providers. Current Standard (Comparison) Diverse approaches are utilized in the management of venous leg ulceration with the current guidelines recommending delayed ablation of venous reflux. However, delayed ablation of venous reflux has been demonstrated to result in undesired outcomes for healing rate, chances of recurrence, and quality of life. Gohel et al. (2019) demonstrated in their research study that delayed ablation of venous reflux causes. Kiguchi et al. (2022) demonstrated in their study that delayed referral of venous ulcers also resulted in increased usage of resources which is indicative of poor healing rates. The study noted that delayed onset of treatment options is normally a result of inaccurate diagnosis by surgery specialists leading to delay in ablation which showed a close connection to poor healing rates and increased healthcare costs. In a separate study, Gohel et al. (2018) demonstrated that delayed ablation of venous reflux was associated with lesser ulcer-free time compared to early ablation, a factor that plays a significant role in the recurrence of the problem. Intervention strategy effects on the outcome The alternate approach to the management of venous ulceration is the early ablation of venous reflux, demonstrated by research to be resulting in desired outcomes for healing rate, chances of recurrence, and quality of life. Kiguchi et al. (2020) analyzed the outcomes for healing rates at 1 month, 3 months, 6 months, and 12 months in two cohorts of patients who received early ablation and late ablation of venous reflux as interventions for the management of venous ulcers. The outcomes of the study demonstrated that in all periods, patients who received early ablation registered better healing percentages compared to those whose ablation was deferred. Gohel et al. (2020) investigated the healing rates, cost-effectiveness, and overall incidences of recurrences of the early ablation approach as an intervention for venous leg ulceration. Their study demonstrated that early assessment and treatment of venous leg ulceration resulted in desired outcomes for all the measures. Over 3 years, early ablation accelerated the rate of healing and reduced the incidences of recurrence of the condition. These factors decreased the financial burden on patients and were associated with a higher quality of life. References Gohel, M. S., Mora MSc, J., Szigeti, M., Epstein, D. M., Heatley, F., Bradbury, A., Bulbulia, R., Cullum, N., Nyamekye, I., Poskitt, K. R., Renton, S., Warwick, J., Davies, A. H., & Early Venous Reflux Ablation Trial Group (2020). Long-term Clinical and Cost-effectiveness of Early Endovenous Ablation in Venous Ulceration: A Randomized Clinical Trial. JAMA surgery, 155(12), 1113-1121. https://doi.org/10.1001/jamasurg.2020.3845 Gohel, M. S., Heatley, F., Liu, X., Bradbury, A., Bulbulia, R., Cullum, N., … & Davies, A. H. (2019). Early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration: the EVRA RCT. Health Technology Assessment (Winchester, England), 23(24), 1. Gohel, M. S., Heatley, F., Liu, X., Bradbury, A., Bulbulia, R., Cullum, N., Epstein, D. M., Nyamekye, I., Poskitt, K. R., Renton, S., Warwick, J., Davies, A. H., & EVRA Trial Investigators (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. The New England journal of medicine, 378(22), 2105-2114. https://doi.org/10.1056/NEJMoa1801214 Kiguchi, M. M., Reynolds, K. B., Biagetti, G. M., Knoles-Barnett, K., Naz, I., Alfawaz, A., … & Woo, E. Y. (2022). Delayed referral of venous ulcers increases resource usage. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 10(1), 87-93. https://doi.org/10.1016/j.jvsv.2021.04.011 Millan, S. B., Gan, R., & Townsend, P. E. (2019). Venous ulcers: diagnosis and treatment. American family physician, 100(5), 298-305.

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