The effect of cryotherapy on fibromyalgia: a randomised clinical trial carried out in a cryosauna cabin.

Evidence of symptomatic treatment for fibromyalgia (FM) is very low. Whole body cryotherapy (WBC) modulates different neurotransmitters, which might have a role in pain alleviation and could exert an effect on FM. Our aim was to evaluate the efficacy of WBC for the control of pain and impact of disease in FM. For this we run an open, randomized, crossover trial of Cryosense TCT™ cabin vs rest. Patients with FM according to ACR criteria were recruited consecutively from general practices. Trial endpoints were change (∆) in pain after 2 and 4 weeks, measured by a visual analogue scale (VAS), ∆ burden of disease, evaluated by the Fibromyalgia Impact Questionnaire (FIQ), and severity of FM, measured by the Combined Index of Severity of Fibromyalgia (ICAF). Within group differences, sequence and period effects were tested with Student's t or Mann-Whitney U tests. Multiple linear regression models were used to adjust effect by baseline differences between groups. Sixty patients were included in the trial. A period effect was noted, with residual effect of WBC; therefore, only results from the first sequence were analysed. ∆VAS pain, ∆FIQ and ∆ICAF scores were significantly larger in the WBC group after the first period (3.0 vs 0.3 in ∆VAS pain; 32.1 vs 0.4 in ∆FIQ; 13.7 vs 0.07 in ∆ICAF; all p < 0.001), and were confirmed after adjustment. In conclusion, WBC with a Cryosense TCT cabin may be a useful adjuvant therapy for FM; further studies on long-term effect and compared to other physical therapies are warranted.Trial registration NCT03425903.

Mixed integer programming model for optimizing the layout of an ICU vehicle.

BACKGROUND: This paper presents a Mixed Integer Programming (MIP) model for designing the layout of the Intensive Care Units' (ICUs) patient care space. In particular, this MIP model was developed for optimizing the layout for materials to be used in interventions. This work was developed within the framework of a joint project between the Madrid Technical Unverstity and the Medical Emergency Services of the Madrid Regional Government (SUMMA 112). METHODS: The first task was to identify the relevant information to define the characteristics of the new vehicles and, in particular, to obtain a satisfactory interior layout to locate all the necessary materials. This information was gathered from health workers related to ICUs. With that information an optimization model was developed in order to obtain a solution. From the MIP model, a first solution was obtained, consisting of a grid to locate the different materials needed for the ICUs. The outcome from the MIP model was discussed with health workers to tune the solution, and after slightly altering that solution to meet some requirements that had not been included in the mathematical model, the eventual solution was approved by the persons responsible for specifying the characteristics of the new vehicles. According to the opinion stated by the SUMMA 112's medical group responsible for improving the ambulances (the so-called "coaching group"), the outcome was highly satisfactory. Indeed, the final design served as a basis to draw up the requirements of a public tender. RESULTS: As a result from solving the Optimization model, a grid was obtained to locate the different necessary materials for the ICUs. This grid had to be slightly altered to meet some requirements that had not been included in the mathematical model. The results were discussed with the persons responsible for specifying the characteristics of the new vehicles. CONCLUSION: The outcome was highly satisfactory. Indeed, the final design served as a basis to draw up the requirements of a public tender. The authors advocate this approach to address similar problems within the field of Health Services to improve the efficiency and the effectiveness of the processes involved. Problems such as those in operation rooms or emergency rooms, where the availability of a large amount of material is critical are eligible to be dealt with in a simmilar manner.