Water for wound cleansing.

BACKGROUND: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and is not thought to interfere with the normal healing process. Tap water is commonly used in community settings for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. OBJECTIVES: To assess the effects of water for wound cleansing. SEARCH METHODS: For this fifth update, in May 2021 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that assessed wound cleansing using different types of water (e.g. tap water, distilled, boiled) compared with no cleansing or with other solutions (e.g. normal saline). For this update, we excluded quasi-RCTs, thereby removing some studies which had been included in the previous version of the review. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out trial selection, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS: We included 13 trials in this update including a total of 2504 participants ranging in age from two to 95 years. Participants in the trials experienced open fractures, surgical wounds, traumatic wounds, anal fissures and chronic wounds. The trials were conducted in six different countries with the majority conducted in India and the USA. Three trials involving 148 participants compared cleansing with tap water with no cleansing. Eight trials involving 2204 participants assessed cleansing with tap water compared with cleansing with normal saline. Two trials involving 152 participants assessed cleansing with distilled water compared with cleansing with normal saline.  One trial involving 51 participants also assessed cleansing with cooled boiled water compared with cleansing with normal saline, and cleansing with distilled water compared with cleansing with cooled boiled water. Wound infection: no trials reported on wound infection for the comparison cleansing with tap water versus no cleansing. For all wounds, eight trials found the effect of cleansing with tap water compared with normal saline is uncertain (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.59 to 1.19); very low-certainty evidence. Two trials comparing the use of distilled water with normal saline for cleansing open fractures found that the effect on the number of fractures that were infected is uncertain (RR 0.70, 95% CI 0.45 to 1.09); very low-certainty evidence. One trial compared the use of cooled boiled water with normal saline for cleansing open fractures and found that the effect on the number of fractures infected is uncertain (RR 0.83, 95% CI 0.37 to 1.87); very low-certainty evidence. This trial also compared the use of distilled water with cooled boiled water and found that the effect on the number of fractures infected is uncertain (RR 0.59, 95% CI 0.24 to 1.47); very low-certainty evidence. Wound healing: results from three trials comparing the use of tap water with no wound cleansing demonstrated there may be little or no difference in the number of wounds that did not heal between the groups (RR 1.04, 95% CI 0.95 to 1.14); low-certainty evidence. The effect of tap water compared with normal saline is uncertain; two trials were pooled (RR 0.57, 95% CI 0.30 to 1.07) but the certainty of the evidence is very low. Results from one study comparing the use of distilled water with normal saline for cleansing open fractures found that there may be little or no difference in the number of fractures that healed (RR could not be estimated, all wounds healed); the certainty of the evidence is low. Reduction in wound size: the effect of cleansing with tap water compared with normal saline on wound size reduction is uncertain (RR 0.97, 95% CI 0.56 to 1.68); the certainty of the evidence is very low. Rate of wound healing: the effect of cleansing with tap water compared with normal saline on wound healing rate is uncertain (mean difference (MD) -3.06, 95% CI -6.70 to 0.58); the certainty of the evidence is very low. COSTS: two trials reported cost analyses but the cost-effectiveness of tap water compared with the use of normal saline is uncertain; the certainty of the evidence is very low. Pain: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in pain scores. The certainty of the evidence is low. Patient satisfaction: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in patient satisfaction. The certainty of evidence is low. The effect of cleansing with tap water compared with normal saline is uncertain as the certainty of the evidence is very low. AUTHORS' CONCLUSIONS: All the evidence identified in the review was low or very low certainty. Cleansing with tap water may make little or no difference to wound healing compared with no cleansing; there are no data relating to the impact on wound infection. The effects of cleansing with tap water, cooled boiled water or distilled water compared with cleansing with saline are uncertain, as is the effect of distilled water compared with cooled boiled water. Data for other outcomes are limited across all the comparisons considered and are either uncertain or suggest that there may be little or no difference in the outcome.

Preprocedural Anxiety in the Transradial Cardiac Catheterization Era.

BACKGROUND: Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce. OBJECTIVE: The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures. METHODS: Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety. RESULTS: A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety. CONCLUSION: Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.

Reliability, validity, and responsiveness of multidimensional pain assessment tools used in postoperative adult patients: a systematic review of measurement properties.

OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence relating to the measurement properties of the multidimensional pain assessment tools used to assess postoperative pain in adults. INTRODUCTION: Pain is a common and poorly managed occurrence in patients during the postoperative period. Currently, postoperative pain is usually evaluated with assessment tools that measure one dimension of pain, namely pain intensity, resulting in inadequate management of postoperative pain. It is important to understand the complex nature of pain by considering all dimensions for optimal postoperative pain management. Systematic, robust evidence is lacking regarding the most psychometrically reliable and valid multidimensional pain assessment tool for adult postoperative patients. INCLUSION CRITERIA: This systematic review considered all study types for inclusion. Studies were considered if they assessed the measurement properties of a multidimensional pain assessment tool in adult postoperative patients within two weeks post-surgery. The outcomes included measurement of at least one of the psychometric properties, including reliability, validity, and responsiveness. METHODS: A three-step search strategy was undertaken, including a search of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases performed in October 2019. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar, and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies was assessed independently by three reviewers using the COSMIN checklist. RESULTS: Seventeen studies involving five multidimensional postoperative pain assessment tools were included in the review: American Pain Society Pain Outcomes Questionnaire-Revised; Brief Pain Inventory; Houston Pain Outcome Instrument; McGill Pain Questionnaire; and the Quality Improvement in Postoperative Pain Management Postoperative Pain Questionnaire. The two most commonly used tools were the Brief Pain Inventory and the American Pain Society Pain Outcomes Questionnaire-Revised, which were assessed in six studies each. The included studies mainly reported internal consistency reliability, with four of the five identified tools demonstrating high Cronbach's alpha values ranging from 0.72 to 0.92. However, the Houston Pain Outcome Instrument demonstrated mixed findings, with eight of the nine subscales having moderate to high reliability while the expectations about pain subscale had poor reliability (α=0.003). CONCLUSIONS: This review provides much needed information about the current tools used in many clinical, educational, and research settings. Of the five tools included in this review, the Brief Pain Inventory demonstrated strong evidence of psychometric validity and is recommended for use in assessing postoperative pain. Further psychometric validation of multidimensional postoperative pain assessment tools with emphasis on responsiveness and measurement error is required in order to accurately assess the minimal clinically important difference in postoperative pain outcomes.

Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review.

OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. INTRODUCTION: Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. INCLUSION CRITERIA: Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. METHODS: A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. RESULTS: Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1). CONCLUSIONS: This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit.

BACKGROUND: Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. OBJECTIVES: The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). METHODS: Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. RESULTS: A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. CONCLUSIONS: Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.

Effect of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus: a systematic review.

OBJECTIVE: The objective of this review was to synthesize the best available research evidence regarding the effectiveness of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus. INTRODUCTION: There has been an increase in the use of complementary therapy, particularly botanical products, for management of type 2 diabetes mellitus. It has been reported that increasing mono- and polyunsaturated fatty acids in diet effectively lowers the risk of development of type 2 diabetes mellitus. Hence, it was hypothesized that consumption of nuts, which are high in polyunsaturated fatty acids and mono-unsaturated fatty acids, may aid in preventing diabetes and reducing levels of blood glucose by reducing glycemic load by displacing dietary carbohydrates present in diet. INCLUSION CRITERIA: This systematic review included randomized controlled trials that compared the consumption of any type and form of tree nut with a placebo or any other intervention in adults with type 2 diabetes mellitus. Trials were included if they measured fasting blood glucose, postprandial blood glucose, and/or glycated hemoglobin. Trials that assessed triglyceride levels and weight postintervention were also considered for inclusion. Trials were restricted to the English language. METHODS: A three step search of PubMed, CINAHL, Embase, Trip database, and Cochrane Central Register of Controlled Trials (CENTRAL) was done in July 2019. To find unpublished studies, ClinicalTrials.gov and Google Scholar were searched. Studies from the search were reviewed against the inclusion criteria by two reviewers. The JBI critical appraisal checklist for randomized controlled trials was used to assess the potential studies for methodological quality. A meta-analysis and subgroup analysis was conducted among trials with the same type of intervention and outcome measures. Results are presented in a narrative format where statistical pooling was not possible. RESULTS: Fifteen trials were included with a total sample size of 667. Consumption of pistachios demonstrated a significant reduction in triglyceride levels (mmol/L) at three month or earlier follow-up (mean difference [MD] -0.28; confidence interval -0.33, -0.23; P <0.00001). The meta-analysis including all tree nuts combined showed reduction in both fasting blood glucose and glycated hemoglobin (MD -0.26 mmol/L and -0.11% respectively) at three month or earlier follow-up. The subgroup analysis demonstrated MD of -0.45, -0.16, and -0.90 mmol/L in fasting blood glucose following ingestion of walnuts, almonds, and hazelnuts, respectively, and -0.17% in glycated hemoglobin following ingestion of walnuts at three month or earlier follow-up. Although not clinically significant, these figures give an indication that further research with larger sample sizes and longer follow-up may show encouraging results. CONCLUSIONS: The authors found that pistachio consumption for three months or less significantly reduced triglyceride levels. Other tree nuts (walnuts, almonds, and hazelnuts) reduced fasting blood glucose and glycated hemoglobin levels by varying degrees. Further robust randomized controlled trials with power calculation-based sample size, comparing same type, dose, and method of nut intervention, will provide more evidence. For now, clinical decisions should be based on standard practice local guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019133558.

Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic.

BACKGROUND: Pandemics and epidemics are public health emergencies that can result in substantial deaths and socio-economic disruption. Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease. The experience of providing nursing care in this context has the potential to have significant short and long term consequences for individual nurses, society and the nursing profession. OBJECTIVES: To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic. DESIGN: This review was conducted using the Joanna Briggs Institute methodology for systematic reviews. DATA SOURCES: A structured search using CINAHL, MEDLINE, EMBASE, PubMed, Google Scholar, Cochrane Library, MedNar, ProQuest and Index to Theses was conducted. REVIEW METHODS: All studies describing nurses' experiences were included regardless of methodology. Themes and narrative statements were extracted from included papers using the SUMARI data extraction tool from Joanna Briggs Institute. RESULTS: Thirteen qualitative studies were included in the review. The experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on similarity of meaning. Three synthesized findings were generated from the categories: (i) Supportive nursing teams providing quality care; (ii) Acknowledging the physical and emotional impact; and (iii) Responsiveness of systematised organizational reaction. CONCLUSIONS: Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. This systematic review emphasises that nurses' require Governments, policy makers and nursing groups to actively engage in supporting nurses, both during and following a pandemic or epidemic. Without this, nurses are likely to experience substantial psychological issues that can lead to burnout and loss from the nursing workforce.

Pharmacological Treatment for Obesity in Adults: An Umbrella Review.

Objective: To synthesize the evidence from systematic reviews of clinical trials investigating the effectiveness of pharmacological therapies approved by the Australian Therapeutic Goods Administration and the US Food and Drug Administration for the management of obesity in adults. Data Sources: A 3-step literature search of the MEDLINE, EMBASE, CINAHL, and PubMed databases was conducted between March and May 2019. The key terms used were obesity, pharmacological therapy, antiobesity agent, antiobesity medication, weight loss, and systematic review. Study Selection and Data Extraction: Systematic reviews that evaluated the effectiveness of pharmacological therapies for the management of obesity in patients with a body mass index of or greater than 25 kg/m2. Data Synthesis: Nine systematic reviews involving three pharmacotherapies, liraglutide, orlistat, and naltrexone-bupropion were identified. The results indicate that the pharmacotherapies reduced weight when compared with placebo. Orlistat was effective in significantly reducing fasting blood glucose, HbA1c, total cholesterol, triglycerides, and systolic and diastolic blood pressure. All reviews discussed the presence or risk of gastrointestinal adverse effects including diarrhea, vomiting, and nausea related to orlistat and liraglutide. Relevance to Patient Care and Clinical Practice: This umbrella review compares the efficacy and safety of antiobesity medications for reducing weight and a discussion on their weight loss and metabolic control to guide clinicians when prescribing medications for obesity. Conclusions: All pharmacological therapies included in this review are superior to placebo in reducing weight. Clinicians should consider patient comorbidities and risk of adverse events when recommending medications for weight loss.

Effects of flavonoid-rich fruits on hypertension in adults: a systematic review.

OBJECTIVE: The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of hypertension. INTRODUCTION: Hypertension is a serious public health concern as it contributes to a significant burden of disease, leading to millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to their antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid-rich fruits on hypertension in adults. INCLUSION CRITERIA: This systematic review included randomized controlled trials (RCTs) that compared the administration of any type of flavonoid-rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded from the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels, were also assessed. METHODS: A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by JBI. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form. RESULTS: Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = -1.02, 95% confidence interval [CI] -3.12, 1.07; p = 0.34, I = 0%; diastolic mean difference = -0.90, 95% CI -2.10, 0.31; p = 0.15, I = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = -0.95, 95%CI -3.58, 1.68; p = 0.478, I = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI -1.11, 2.82; p = 0.393, I = 0%). CONCLUSIONS: The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. Further robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension.

Effectiveness of protection strategies for reducing radiation exposure in proceduralists during cardiac catheterization procedures: a systematic review protocol.

REVIEW QUESTION: What is the effectiveness of radiation protection strategies for reducing the radiation dose received by the proceduralist during cardiac catheterization procedures?

Reliability, validity and generalizability of multidimensional pain assessment tools used in postoperative adult patients: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the measurement properties of multidimensional pain assessment tools for postoperative pain in adults. INTRODUCTION: Effective postoperative pain management increases patient safety and satisfaction, and reduces healthcare costs. The most commonly used postoperative pain assessment tools only evaluate pain intensity, which is only one aspect of the sensory dimension of pain. Pain is a subjective phenomenon, and variability exists among patients. Efforts are underway to incorporate multidimensional assessment tools for postoperative pain assessment in clinical practice. INCLUSION CRITERIA: Eligible studies will include postoperative patients aged 18 years and older from all surgical disciplines. Studies evaluating multidimensional assessment instruments for the measurement of postoperative pain during the first two weeks following surgery will be considered. Studies will include the following measurement properties of assessment tools as outcomes: reliability, validity and generalizability. METHODS: MEDLINE, CINAHL, Embase, PsycINFO and Cochrane Trials (CENTRAL) will be searched, as well as ClinicalTrials.gov and multiple gray literature sources. There will be no limitations on publication date. Titles and abstracts will be screened by independent reviewers for inclusion. The full text of selected papers will be retrieved and assessed against the inclusion criteria. Two independent reviewers will assess papers for methodological quality using the COSMIN checklist, and papers with poor scores on relevant items will be excluded. Data will be extracted by two independent reviewers using a standardized data extraction tool. Statistical pooling will be performed, if possible.

Effectiveness of flavonoid rich fruits for hypertension in adults: a systematic review protocol.

REVIEW QUESTION: The question of this review is: what is the effectiveness of flavonoid rich fruits for blood pressure in adults with hypertension?