Design and Application of Electronic Rehabilitation Medical Record (ERMR) Sharing Scheme Based on Blockchain Technology

As the value of blockchain has been widely recognized, more and more industries are proposing their blockchain solutions, including the rehabilitation medical industry. Blockchain can play a powerful role in the field of rehabilitation medicine, bringing a new research idea to the management of rehabilitation medical data. The electronic rehabilitation medical record (ERMR) contains rich data dimensions, which can provide comprehensive and accurate information for assessing the health of patients, thereby enhancing the effect of rehabilitation treatment. This paper analyzed the data characteristics of ERMR and the application requirements of blockchain in rehabilitation medicine. Based on the basic principles of blockchain, the technical advantages of blockchain used in ERMR sharing have been studied. In addition, this paper designed a blockchain-based ERMR sharing scheme in detail, using the specific technologies of blockchain such as hybrid P2P network, block-chain data structure, asymmetric encryption algorithm, digital signature, and Raft consensus algorithm to achieve distributed storage, data security, privacy protection, data consistency, data traceability, and data ownership in the process of ERMR sharing. The research results of this paper have important practical significance for realizing the safe and efficient sharing of ERMR, and can provide important technical references for the management of rehabilitation medical data with broad application prospects

Construção e validação de indicadores interdisciplinares em um centro de reabilitação

O uso de indicadores caracteriza-se como uma estratégia que possibilita a busca da eficácia e eficiência das estruturas organizacionais, dos processos de trabalho e dos resultados da assistência, permitindo que os profissionais monitorem e avaliem todo o processo. Portanto, para estruturar um indicador é necessário que haja participação de vários profissionais, tendo em vista a interdisciplinaridade. Desse modo, este trabalho tem por objetivo propor uma matriz de indicadores de processo e resultado na assistência em saúde com enfoque interdisciplinar no âmbito do atendimento ambulatorial em reabilitação. Estudo quanti-qualitativo realizado no Centro de Reabilitação Lucy Montoro da Unidade de Marília - SP, com amostra intencional, dividida em 2 grupos: construção dos indicadores e validação dos indicadores. Para a construção dos indicadores, participaram 33 profissionais de saúde, entre eles enfermeiros, nutricionistas, psicólogos, terapeutas ocupacionais, fonoaudiólogos, assistentes sociais, educadores físicos e fisioterapeutas. Foram constituídas 3 etapas, sendo a primeira uma oficina de planejamento, na qual foi apresentado o conceito de indicador e os critérios para a construção. A segunda etapa foram as oficinas de trabalho com os terapeutas de cada setor utilizando a técnica de brainstorm, definindo as principais práticas assistenciais empregadas no centro de reabilitação que se correlacionassem entre os setores para a elaboração dos indicadores, segundo o modelo proposto por Donabedian. Na terceira etapa os indicadores foram submetidos à juízes especialistas para validação de conteúdo através da técnica de conferência de consenso. A validação foi realizada por 5 juízes, e todos os 10 indicadores elaborados foram validados. Acredita-se que o emprego desse instrumento colabore com a avaliação e gestão da qualidade nos serviços de reabilitação.Palavras-chave: Avaliação da qualidade dos cuidados de saúde. Assistência à saúde. Centros de reabilitação. Equipe de assistência ao paciente. ABSTRACTThe use of indicators is characterized as a strategy that enables the search for the effectiveness and efficiency of organizational structures, work processes and care results, allowing professionals to monitor and evaluate the entire process. Therefore, to structure an indicator it is necessary to participate several professionals, in view of interdisciplinarity. Thus, this work aims to propose a matrix of process and result indicators in health care with an interdisciplinary focus in the scope of outpatient care in rehabilitation. Quantitative-qualitative study conducted at the Lucy Montoro Rehabilitation Center of the Marília Unit - SP, with an intentional sample, divided into 2 groups: construction of indicators and validation of indicators. To construct the indicators, 33 health professionals participated, including nurses, nutritionists, psychologists, occupational therapists, speech therapists, social workers, physical educators and physiotherapists. Three stages were constituted, the first being a planning workshop, in which the concept of indicator and the criteria for construction were presented. The second stage were the workshops with the therapists of each sector using the brainstorm technique, defining the main care practices employed in the rehabilitation center that correlated between the sectors for the elaboration of indicators, according to the model proposed by Donabedian. In the third stage, the indicators were submitted to expert judges for content validation through the Consensus Conference technique. The validation was performed by 5 jurors, and all 10 indicators elaborated were validated. It is believed that the use of this instrument collaborates with the evaluation and quality management of rehabilitation services.Keywords: Evaluation of the quality of health care. Health care. Rehabilitation centers. Patient care team

Efficacy and safety of knee flexion enhanced standardized home exercise program comparing supervised physiotherapy to improve mobility and quality of life after Total knee arthroplasty

Background: In the present study, we introduced a knee flexion enhanced standardized home exercise program assisted by a low stool and evaluate efficiency of this method in the management of rehabilitation after TKA.Methods: Patients were recruited from July 2014 and December 2015, and randomized into two groups, a knee flexion enhanced standardized home exercise program group (group KFEH) and commonly-used supervised physiotherapy group (group SPT). Outcomes were evaluated by observing the joint function with the Knee Society score (KSS), Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and ROM assessment at selected time points (pre-operation and 1 week, 1 month, 3 month, 6 month and 1 year following post-operation). Results: At last, we observed pain and functional improvements in both groups. Noninferiority was shown 12 months postoperatively for clinical outcomes except group KFEH had better ROM range at 1 month (P<0.01). The absolute value of WOMAC and KSS were slight better in group KFEH without significant difference, and there was no difference about VAS between two groups as well as complication incidence rate. Additionally, home program would save patients’ times and decrease economic burden. Patents would save 14 times postoperative rehabilitation in outhospital service, and cut down at least 782 RMB in total. Conclusion: Taking the rehabilitation and economical efficiency, we recommend knee flexion enhanced home exercise program for TKA rehabilitation management.

Identification and Recent Approaches for Evaluation and Management of Rehabilitation Concerns for Patients with Freeman–Burian Syndrome: Principles for Global Treatment

Freeman–Burian syndrome, formerly Freeman–Sheldon syndrome, is a rare congenital complex myopathic craniofacial syndrome that frequently involves extremity joint deformities, abnormal spinal curvatures, and chest wall mechanical problems that, together with spinal deformities, impair pulmonary function. As part of a clinical practice guideline development, we evaluated 19 rehabilitation-related articles from our formal systematic review, and from these and our experience, we describe rehabilitation considerations. Research in this area has widespread methodologic problems. While many challenges are present, much can be done to afford these patients a good quality of life through careful planning.

RELASI SOSIAL DALAM PENGELOLAAN LAHAN REHABILITASI TAMAN NASIONAL MERU BETIRI (Studi Kasus Desa Wonoasri Kecamatan Tempurejo Kabupaten Jember)

Forest rehabilitation in Meru Betiri National Park is the main point in environmental sustainability. Forest land rehabilitation activities include breeding ecosystems for security in the forest. The method of determining the research area is done intentionally (purposive method) and the research method uses a qualitative approach. Determination of informants is done by snowball sampling method. The data collection method was carried out by observation, interview and document study and analyzed using the Miles and Huberman analysis method. The results showed that social relations that occur in the management of rehabilitation have 2 forms of domains, namely 1) interpersonal domains that can be seen with communal relations, collegial relations and hirearkis relations. Judging from its power relations are divided into symmetrical and asymmetrical relationships. Symmetrical relationship occurs between rehab land farmers where rehab land farmers have an equal position can be seen from daily relationships and friendly relations in managing rehabilitation land. Asymmetrical relationship that occurs in the rehabilitation of land management occurs between the TNMB and farmers of the rehabilitation land where the TNMB party has the highest authority in the management of rehabilitation land. Keywords : Social Relation, Rehabilitation land, Meru Betiri National Park

THE THEORETICAL AND PRACTICAL ASPECTS OF APPLYING MEDICAL SOCIAL ON-LINE SERVICES IN MANAGEMENT OF REHABILITATION OF PATIENTS OF TRAUMATOLOGICAL ORTHOPEDICS PROFILE

The issue of digital technologies implementation in practice of health care becomes one of the priorities in the conditions of resources deficiency. The digitalization of health care system is economically expedient as it allows achieving particular medical and social results without significant infrastructural investments. The on-line communication possesses significant potential in this regard. The digital health care using on-line communication democratizes access to medical services and allows to qualitatively remodel the existing model of interaction between patient and health care system. In the sociology of medicine, the sociology of rehabilitation is selected to investigate such issues as social and organizational context of rehabilitation, social orientation of medical care, role of health care personnel and other interested specialists. The article substantiates the efficiency of on-line communication in management of rehabilitation of patients as exemplified by the Monitoring and Feedback System designed and introduced in the Research Institute of Traumatology, Orthopedics and Neurosurgery of V.I. Razumovsky Saratov State Medical University.