Prioritising nurses and doctors health at work: a scoping review of monitoring instruments

Objective
Nurses’ and doctors’ health at work is crucial for their overall performance and the quality of care they provide. The Jobs Demands Resources (JD-R) model offers a framework for health at work, encompassing ‘job demands’, ‘job resources’, ‘personal resources’, ‘leadership’, ‘well-being’ and ‘outcomes’. While various instruments exist to measure health, an overview of instruments specifically designed for assessing nurses and doctors health is currently missing. This study provides a comprehensive overview of available health instruments specifically developed and validated for healthcare professionals in hospital care.

Design
Scoping review.

Data sources
MEDLINE, Embase and CINAHL.

Eligibility criteria
Studies assessing the health of nurses and/or doctors in hospitals using or evaluating instruments based on the JD-R model, published between January 2011 and January 2024, excluding student-exclusive samples.

Data extraction and synthesis
We extracted data on study and sample characteristics, as well as details of the measurement instruments, including main and subconstructs. Instruments were categorised based on the JD-R model domains. Descriptive analysis and data visualisation were performed using Excel and Python.

Results
We included 1204 studies, reporting 986 unique instruments. We identified 32 comprehensive instruments suitable for broad health screening, measuring four or more of the JD-R model domains. Additionally, we identified instruments focusing on specific domains for targeted screening needs. Furthermore, we present frequently reported instruments assumed to be extensively evaluated, user-friendly, accessible and available in multiple languages.

Conclusions
Health at work cannot be determined by a single instrument alone, underscoring the multidimensional nature of workplace health. Alternatively, organisations should select instruments based on domains most relevant and applicable to their context. This approach ensures a more comprehensive assessment of health at work.

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Barriers to and enablers of the transition from child and adolescent to adult mental health services for autistic young people and/or those with attention deficit hyperactivity disorder: protocol for a scoping review

Introduction
Autistic young people and/or those with attention deficit hyperactivity disorder (ADHD) who have co-occurring mental health conditions experience significant challenges when transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). However, barriers and facilitators to this service transition are poorly understood for this population. This scoping review aims to synthesise the available evidence on barriers and enablers to the transition from CAMHS to AMHS for autistic young people and/or those with ADHD.

Methods and analysis
Arksey and O’Malley’s six-step framework for scoping reviews will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will guide the reporting of this review. Electronic databases of Medline, PsycINFO, CINAHL, Scopus, ProQuest Central and Google Scholar will be searched for relevant articles published in English with no date limitations. Title, abstract and full-text screening will be completed by two independent reviewers. Studies will be eligible for inclusion if the article focuses on (1) adolescents and/or young people (aged 18–24) with a primary diagnosis of autism spectrum disorder and/or ADHD (population) and (2) describes factors associated with service or care transitions (concept) (3) from CAMHS to AMHS (context). Study quality will be evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Data describing the factors that enable or inhibit the transition from CAMHS to AMHS will be extracted and synthesised using the Bronfenbrenner’s social ecological model as a framework for organising and reporting results.

Ethics and dissemination
Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences.

Trial registration number
https://doi.org/10.17605/OSF.IO/BZPQF.

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Barriers and facilitators of cardiovascular disease prevention services for women with prior gestational diabetes or hypertensive disorders of pregnancy in low-income, middle-income and high-income settings: a scoping review protocol

Introduction
Women with previous pregnancy-related cardiovascular risk indicators, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), have an increased risk of future cardiovascular disease (CVD). Although CVD screening and preventive care beginning in the early postpartum period are recommended, certain barriers limit access to such services. We plan to conduct a scoping review of the literature to explore and summarise evidence on the barriers and facilitators of postpartum CVD preventive services in women with a history of GDM and HDP.

Methods and analysis
This scoping review will be conducted in line with the Arksey and O’Malley’s (2005) methodological framework and the Joanna Briggs Institute guidance for conducting a systematic scoping review and will follow the Evidence for Policy and Practice Information and the Coordinating Centre at the Institute of Education guidelines. The review results will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We will search the following databases: Medline, Embase and CINAHL. We will conduct grey literature searches for registered dissertations and theses. Inclusion and exclusion criteria will be kept broad. Qualitative and quantitative studies published in English or French that investigated and reported percieved barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM and HDP will be included. Individual, interpersonal, organizational, and system level factors will be reported. Qualitative findings will be summarised narratively, and quantitative findings will be absorbed within the themes using the multisource synthesis method.

Ethics and dissemination
This review represents one objective of a larger project that was reviewed by the Ottawa Health Sciences Network Research Ethics Board (QI-184). We will disseminate knowledge emanating from this review through open-access publication, presentation/public forums on women’s cardiovascular health, women’s CVD prevention forums and social media. We will also present the findings of this review at the annual meeting of the Canadian Women’s Heart Health Alliance.

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How a population-based cohort of men estimate lifetime risk of prostate cancer in a survey before entering a prostate cancer screening trial in Sweden?

Objectives
Investigating men’s perceived lifetime risk of prostate cancer.

Design
Survey-based study to men invited for prostate-specific antigen (PSA) screening in the GÖTEBORG-2 trial between September 2015 and June 2020.

Setting
38 775 men in the Gothenburg area, Sweden, were invited for PSA-testing and participated in a survey.

Participants
17 980 men participated in PSA-testing, of whom 13 189 completed the survey. In addition, 1264 men answered the survey only.

Interventions
Before having the PSA-test, men answered an electronic survey and estimated their lifetime risk of receiving a prostate cancer diagnosis on a visual analogue scale from 0% to 100%.

Main outcome measures
The primary outcome was the median lifetime risk estimation, which was compared with Wilcoxon test to an anticipated lifetime risk of 20% (based on GÖTEBORG-1 trial). The secondary outcome was to determine factors associated with risk estimation in a multivariable linear regression model: previous prostate examination, family history, physical exercise, healthy diet, comorbidity, alcohol consumption, smoking, education level, marital status, urinary symptoms and erectile dysfunction.

Results
Among PSA-tested men, the median estimated lifetime risk of prostate cancer was 30% (IQR 19% to 50%), corresponding to a 10 percentage-points higher estimation compared with the anticipated risk (p5 percentage-points higher risk estimation. Similar results were obtained for non-PSA-tested men.

Conclusions
Most men overestimated their prostate cancer risk which underscores the importance of providing them accurate information about prostate cancer.

Trial registration number
ISRCTN94604465.

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Mapping the existing evidence of the effects of school food policies on health, acceptance and affordability of secondary school children in Europe: a scoping review protocol

Introduction
Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability.

Methods and analysis
The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary.

Ethics and dissemination
This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.

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Characteristics of effective parent-mediated interventions for parents of children with neurodevelopmental disorders in rural areas: a systematic review protocol

Introduction
Parent-mediated interventions are therapeutic approaches that use parent training to enable parents to provide primary support and intervention to their child through the development of necessary skills, knowledge, and resources.
Parent-mediated interventions can be broadly divided into two stages: (1) Clinicians educating, training and coaching parents in the implementation of an intervention and relevant information regarding their child’s condition and (2) Parent(s) mediating and implementing the intervention based on the coaching and education received. These interventions can act as the primary intervention for children or supplement clinical interventions. This review will include both stages of the implementation process as well as both primary and supplementary interventions. Outcomes of parent-mediated interventions include long-term symptom reduction, improved prognosis for a wide range of behavioural and brain functions and enhanced parent–child dyadic social communication.

Methods and analysis
This systematic review aims to synthesise existing evidence and identify the characteristics of effective parent-mediated intervention for parents of children with neurodevelopmental disorders residing in rural areas. Systematic searches of CINAHL, PsycINFO, ProQuest allied health and nursing database, Ebscohost Psych and Behavioural database and SocINDEX were conducted twice with the latest completed on 5 March 2024 using preidentified search terms. Citations will be imported into EndNote V.20.6 (Clarivate Analytics, Pennsylvania, USA) to organise and de-duplicate and then Covidence to complete screening and extraction. The articles will be screened and reviewed following the Joanna Briggs Institute (JBI) guidelines for systematic reviews of Mixed methods. The JBI appraisal tools for systematic reviews will be used to assess the trustworthiness, relevance and results of qualitative, quantitative and mixed-methods studies. The scope of the literature analysed will include articles published between 2013 and 2024 in English. Literature was limited to the last 10 years to ensure the relevance of results as the intention is to report on current evidence. The start date of the study was March 2023 and the planned completion date is October 2024.

Ethics and dissemination
This study will neither involve human nor animal subjects and does not require ethics approval. Results will be disseminated to relevant groups in peer-reviewed journal(s) and at relevant children and parent health conferences or rural conferences. The key outcomes will also be shared on social media to support access for non-research audiences.

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Prevalence and associated factors of suspected occupational skin diseases among restaurant workers in peninsular Malaysia: secondary data analysis of Registry for Occupational Disease Screening (RODS)

Objectives
Occupational skin diseases (OSDs) pose significant risks to the health and well-being of restaurant workers. However, there is presently limited evidence on the burden and determinants of OSDs among this occupational group. This research aims to estimate the prevalence and associated factors of suspected OSDs among restaurant workers in Peninsular Malaysia.

Design
A secondary data analysis of the 2023 Registry of Occupational Disease Screening (RODS) was performed. The RODS survey tool, which included the Nordic Occupational Skin Questionnaire, a symptoms checklist and items on work-relatedness, was used to screen for OSDs. Logistic regression analyses were performed to identify associated factors.

Setting and participants
Restaurant workers (n=300) registered in RODS from February 2023 to April 2023, aged 18 years and above and working in restaurants across Selangor, Melaka and Pahang for more than 1 year, were included in the study, whereas workers who had pre-existing skin diseases were excluded.

Results
The prevalence of suspected OSDs among study participants was 12.3%. Higher odds of suspected OSDs among study participants were observed among those exposed to wet work (adjusted OR (AOR) 22.74, 95% CI 9.63 to 53.68) and moderate to high job stress levels (AOR 4.33, 95% CI 1.80 to 10.43).

Conclusions
These findings suggest that OSDs are a significant occupational health problem among restaurant workers. Interventions targeting job content and wet work may be vital in reducing OSDs among this group of workers.

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Endometriosis Subtypes and Ovarian Cancer Risk

In 2024, an estimated 19 680 new ovarian cancers and 12 740 ovarian cancer–related deaths will occur in the US. Early detection continues to be elusive and screening strategies inadequate, even in women at high risk. Women continue to be diagnosed with advanced-stage disease, which portends a poor prognosis despite improved outcomes in women treated with a poly(adenosine diphosphate-ribose) polymerase inhibitor for maintenance therapy, particularly those with germline or somatic BRCA1 or BRCA2 sequence variations.

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Equity-informed social media COVID-19 risk communication strategies: a scoping review

Objectives
The COVID-19 pandemic has had devastating worldwide impact but most prominent was its effect on marginalised, underserved and equity-deserving populations. Social media arose as an important platform from which health organisations could rapidly disseminate information to equity-deserving populations about COVID-19 risks and events, provide instructions on how to mitigate those risks, motivate compliance with health directives, address false information, provide the opportunity for engagement and immediate feedback. The objective of this scoping review was to synthesise the academic and grey literature on equity-informed social media risk communication strategies developed during the pandemic.

Design
The review followed the Arksey and O’Malley framework and focused on the research question: What are the promising principles, processes, and practices for producing equity-informed social media risk communications?

Data sources
CINAHL Complete, MEDLINE (OVID), Business Source Complete, EMBASE database OVID, Scopus and PubMed’s curated COVID-19 literature hub: LitCovid, PsycINFO OVID were searched using terms related to access to health services, social media, risk communication, misinformation, community engagement, infectious disease, pandemics and marginalisation, supplemented by grey literature from relevant health organisations.

Eligibility criteria for selecting studies
Studies were eligible if the population of interest was an equity-deserving population, the concept discussed was COVID-19 risk communication and the article was published in English between January 2019 and December 2022.

Data extraction and synthesis
COVIDENCE facilitated screening and extraction. Charted data were thematically analysed following Braun and Clarke’s phased process. Preliminary findings were collaboratively discussed with representatives from health agencies and community organisations focused on serving equity-deserving groups.

Results
12 studies were included. In terms of principles and process, studies emphasised the need to collaboratively create plans for message construction and targeted dissemination using a risk communication framework, capitalise on access to community resources and pre-established communication mediums and be considerate of population-specific needs and concerns. Practice entails careful consideration of communication mediums, language usage, communication frequency and evaluation.

Conclusion
This scoping review provides valuable insights for health agencies and community organisations in developing principles, processes and practices to equitably communicate risk information through social media. Engagement with stakeholders further refined and confirmed the findings, offering insights for future crisis communication strategies.

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Testing a persuasive health communication intervention (PHCI) for emergency department patients who declined rapid HIV/HCV screening: a randomised controlled trial study protocol

Introduction
Previous studies have shown that substantial percentages of emergency department (ED) patients in the USA recommended for HIV or hepatitis C (HCV) decline testing. Evidence-based and cost-effective interventions to improve HIV/HCV testing uptake are needed, particularly for people who inject drugs (PWIDs) (currently or formerly), who comprise a group at higher risk for these infections. We developed a brief persuasive health communication intervention (PHCI) designed to convince ED patients who had declined HIV/HCV testing to agree to be tested. In this investigation, we will determine if the PHCI is more efficacious in convincing ED patients to be tested for HIV/HCV when delivered by a video or in person, and whether efficacy is similar among individuals who currently, previously or never injected drugs.

Methods and analysis
We will conduct a multisite, randomised controlled trial comparing PHCIs delivered by video versus in person by a health educator to determine which delivery method convinces more ED patients who had declined HIV/HCV testing instead to be tested. We will stratify randomisation by PWID status (current, former or never/non-PWID) to permit analyses comparing the PHCI delivery method by injection-drug use history. We will also perform a cost-effectiveness analysis of the interventions compared with current practice, examining the incremental cost-effectiveness ratio between the two interventions for the ED population overall and within individual strata of PWID. As an exploratory analysis, we will assess if a PHCI video with captions confers increased or decreased acceptance of HIV/HCV testing, as compared with a PHCI video without captions.

Ethics and dissemination
The study protocol has been approved by the institutional review board of the Icahn School of Medicine. The results will be disseminated at international conferences and in peer-reviewed publications.

Trial registration number
NCT05968573.

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High-Throughput Deep Learning Detection of Mitral Regurgitation

Circulation, Ahead of Print. BACKGROUND:Diagnosis of mitral regurgitation (MR) requires careful evaluation by echocardiography with Doppler imaging. This study presents the development and validation of a fully automated deep learning pipeline for identifying apical 4-chamber view videos with color Doppler echocardiography and detecting clinically significant (moderate or severe) MR from transthoracic echocardiograms.METHODS:A total of 58 614 transthoracic echocardiograms (2 587 538 videos) from Cedars-Sinai Medical Center were used to develop and test an automated pipeline to identify apical 4-chamber view videos with color Doppler across the mitral valve and then assess MR severity. The model was tested internally on a test set of 1800 studies (80 833 videos) from Cedars-Sinai Medical Center and externally evaluated in a geographically distinct cohort of 915 studies (46 890 videos) from Stanford Healthcare.RESULTS:In the held-out Cedars-Sinai Medical Center test set, the view classifier demonstrated an area under the curve (AUC) of 0.998 (0.998–0.999) and correctly identified 3452 of 3539 echocardiography videos as having color Doppler information across the mitral valve (sensitivity of 0.975 [0.968–0.982] and specificity of 0.999 [0.999–0.999] compared with manually curated videos). In the external test cohort from Stanford Healthcare, the view classifier correctly identified 1051 of 1055 manually curated videos with color Doppler information across the mitral valve (sensitivity of 0.996 [0.990–1.000] and specificity of 0.999 [0.999–0.999]). In the Cedars-Sinai Medical Center test cohort, MR moderate or greater in severity was detected with an AUC of 0.916 (0.899–0.932) and severe MR was detected with an AUC of 0.934 (0.913–0.953). In the Stanford Healthcare test cohort, the model detected MR moderate or greater in severity with an AUC of 0.951 (0.924–0.973) and severe MR with an AUC of 0.969 (0.946–0.987).CONCLUSIONS:In this study, a novel automated pipeline for identifying clinically significant MR from full transthoracic echocardiography studies demonstrated excellent performance across large numbers of studies and across multiple institutions. Such an approach has the potential for automated screening and surveillance of MR.

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Protocol for a randomised trial of a self-directed digital pain management intervention (Empowered Relief) tailored to adults with chronic pain and prescription opioid misuse/disorder: the MOBILE Relief study

Introduction
Chronic pain increases the risk of prescription opioid misuse or opioid use disorder (OUD). Non-pharmacological treatments are needed to dually address pain and opioid risks. The purpose of the Mobile and Online-Based Interventions to Lessen Pain (MOBILE Relief) study is to compare a one-session, video-based, on-demand digital pain relief skills intervention for chronic pain (‘Empowered Relief’ (ER); tailored to people at risk for opioid misuse or with opioid misuse/OUD) to a one-session digital health education intervention (‘Living Better’; no pain management skills).

Methods and analysis
MOBILE Relief is an international online randomised controlled clinical trial. Study participants are adults with chronic, non-cancer pain (≥6 months) with daily pain intensity ≥3/10, taking ≥10 morphine equivalent daily dose and score ≥6 on the Current Opioid Misuse Measure. Participants are recruited through clinician referrals and clinic advertisements. Study procedures include electronic eligibility screening, informed consent, automated 1:1 randomisation to the treatment group, baseline measures, receipt of assigned digital treatment and six post-treatment surveys spanning 3 months. Study staff will call participants at baseline and 1-month and 3 months post-treatment to verify the opioid prescription. The main statistical analyses will include analysis of covariance and mixed effects model for repeated measurements regression.

Main outcomes
Primary outcomes are self-reported pain catastrophising, pain intensity, pain interference, opioid craving and opioid misuse at 1-month and 3 months post-treatment. We will determine the feasibility of ER (≥50% participant engagement, ≥70% treatment appraisal ratings). We hypothesise the ER group will be superior to the Living Better group in the reduction of multiprimary pain outcomes at 1-month post-treatment and opioid outcomes at 1-month and 3 months post-treatment.

Ethics and dissemination
The study protocol was approved by the Stanford University School of Medicine Institutional Review Board (IRB 61643). We will publish results in peer-reviewed journals; National Institute of Drug Abuse (funder) and MOBILE Relief participants will receive result summaries.

Trial registration number
NCT05152134.

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Parental mental health during preconception years in association with offspring attention deficit hyperactivity disorder (ADHD): a systematic review protocol

Introduction
Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition prevalent in both children and adults. With growing awareness of the importance of the preconception period in health, it is essential to understand whether preconception parental mental health and related factors are related to onset of offspring ADHD. This protocol presents the methodology for undertaking a systematic review to investigate associations between parental mental health and/or psychotropic use during the preconception years and offspring ADHD.

Methods and analysis
Peer-reviewed literature will be identified by searching relevant electronic databases including Medline complete, Embase, PsycINFO and CINAHL; reference lists of eligible articles will be hand searched and grey literature considered. Eligible study designs include population-based and/or clinically based cohort or case–control studies. The primary exposure and outcome of interest is parental history of mental health conditions in the preconception period and offspring ADHD, respectively (ie, according to semistructured interviews/confirmed diagnosis by a relevant health professional or screening instruments). Critical appraisal will be undertaken. A descriptive synthesis will be presented including characteristics of the included studies, critical appraisal scores and a summary of main findings (eg, presented in tables, text and figures). A meta-analysis will be conducted, if possible, and statistical techniques will be employed if heterogeneity is detected.

Ethics and dissemination
Ethical permissions are not required for this systematic review since the study will only use published data. Findings from this systematic review will be published in a peer-reviewed scientific journal/presented at national and international conferences relevant to the field.

PROSPERO registration number
CRD42023460379.

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Quantitative analysis of nortriptylines analgesic properties: a comparative systematic review and meta-analysis

Objectives
This study aims to quantitatively analyse nortriptyline’s analgesic potency, safety and tolerability.

Design
Systematic review and meta-analysis.

Data sources
The systematic search was conducted in Scopus, Web of Science and PubMed in February 2023.

Eligibility criteria for selecting studies
Clinical trials evaluating the efficacy of nortriptyline in reducing pain scores (open-label studies and comparisons of nortriptyline with placebo or other analgesics) in different pain types were included.

Data extraction and synthesis
The data extraction procedure and the screening phases were carried out based on predetermined eligibility criteria. To pool the data, the standardised mean difference (SMD) and standardised mean change (SMC) methods, along with random-effect and fixed-effect meta-analysis, were used. The risk of bias was assessed using the Cochrane Collaboration method, and the Grading of Recommendations Assessment, Development and Evaluation criteria were used to measure the certainty of the results.

Results
14 of the initial 648 studies were eventually imported. Nortriptyline was reported to significantly reduce pain severity in chronic low back pain, painful symptoms in major depressive disorder, neuropathy, chronic pelvic pain and neuropathic corneal pain. However, it was not superior to placebo in fibromyalgia and knee osteoarthritis. In comparison to placebo and various alternative analgesics, the pooled SMD for lowering pain scores was 0.43 (0.23–0.64) and –0.18 (–0.39 to 0.03), respectively. In the pretreatment and post-treatment analyses, the pooled SMC was –1.20 (–1.48 to –0.93). Although constipation and xerostomia were the most commonly reported side effects, all references indicated that the adverse events were well tolerated at the administered dosages.

Conclusion
While nortriptyline is effective in some chronic pains, such as neuropathies, it lacks efficacy in some other chronic pains, such as fibromyalgia and osteoarthritis. Nortriptyline is well tolerated when administered in doses intended for its analgesic effects. Moreover, several studies suggested that the analgesic effects of nortriptyline are comparable to those of amitriptyline and gabapentin.

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Effect of home-based and remotely supervised combined exercise and cognitive intervention on older adults with mild cognitive impairment (COGITO): study protocol for a randomised controlled trial

Introduction
Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting.

Methods and analysis
This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants’ real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit.

Ethics and dissemination
The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.

Trial registration number
ChiCTR2300073900.

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