<< Background >>TO BE PART OF THE CREATION OF A COMMUNITY OF CITIZENS CONTRIBUTING TO A DIGITAL SOCIETY THAT IS SUSTAINABLE, INCLUSIVE, SUPPORTIVE AND RESPECTFUL OF THE ENVIRONMENT.With the check-ups that needed to be organised remotely, the pandemic has shown how important is that each patient takes charge of its own care, as this medical follow-up requires digital tools, leaving a large number of citizens in a difficult situation. In this context, our project, named Pragma-TIC, aims at bridging the digital divide for chronic patients suffering from digital illiteracy by giving the possibility to the frontline caregivers to become their e-health educators. To do this, Pragma-TIC will train the care staff and their patients in an innovative (blended learning) and inclusive way. The aim is to propose a solution, in order to reunite the strengths and resources that will allow each stakeholder to benefit from the work done by the group.This project will be carried out in collaboration with several European countries (Belgium, Latvia, Slovenia and Denmark). Hospitals in European countries need to implement digital support for their patients and frontline caregivers. Pragma-TIC proposes to implement a transnational educational project to address this need which will ultimately improve the health and quality of life of patients and relieve the workload of frontline carers in the long run. Through the support of Europe, Pragma-TIC will open doors that individual members of the Consortium would not have had access to on a national, regional or simply local level. It thus extends the scope and increases the visibility of the project.By responding to the KA220-ADU call, we wish to validate the competences acquired in digital literacy through non-formal certificates delivered by health institutions. Two levels of certifications will be targeted. At the level of the caregiver, the first level concerns the e-educator (involved caregivers) who will find themselves validated as educators and will use those new skills to train other patients. The second level concerns the e-educator + who will be able to train his peers. At the patient level, the first level concerns the e-patients who will find themselves assessed as capable of having a follow-up at home. The second level concerns the e-patients + who will use their new skills to train their fellow patients. The e-educator certificates will be integrated into the professional portfolio of the caregiver and those of the e-patient in patient's medical record.This project aims to meet the needs of the 3 actors of the health sector, which are the Hospital Institutions, the frontline caregivers (field staff) and the patient.HOSPITAL INSTITUTIONSare considerably short of beds, means and resources, while the number of patients is increasing exponentially. Therefore, the continuation of care in the patient's home is absolutely necessary and must be of high quality. FRONTLINE CAREGIVERS Lack the time and the means to educate their patients. Pragma-TIC will allow the patients to be trained in new learning modes, in order to evolve professionally and to be better prepared for any unforeseen circumstance, to feel involved and more valued as caregivers through a non-formal certificate.While they are looking for solutions with their project colleagues, they will be able to share through forums or exchange networks their difficulties and more. They will also create a community of carers on an international scale.The project will support the field staff in their role of therapeutic educators by implementing digital and pedagogical tools shared among peer carers. PATIENTS The chronic patients is isolated at home in the face of new technologies that they do not master.They lack the resources, the contacts, the self-confidence and the support.manage to teach the patients to be resilient by getting control back over their life project and their care (autonomy);- involve them in a learning process<< Objectives >>This project aims to meet the needs of the 3 main actors, i.e. the Hospital Institutions, the frontline caregivers and patients.The implementation of the project aims to overcome the digital divide in an inclusive way in order to access all the resources and benefits that telemonitoring offers in the health care environment. HOSPITAL INSTITUTIONSThis project will contribute to the digital and sustainable transformation of healthcare institutions while promoting savings in terms of human, material and financial resources. It should reduce the overcrowding of hospitals, which has a negative impact on the quality of care.At the same time, we want to collaborate and cooperate across the board and on all levels of competence and decision-making power, in order to facilitate the digital transition in the health sector.FRONTLINE CAREGIVERS In order to provide e-Health training in compliance with the RGPD, our values, and ethics, we want to help field staff to integrate e-Health into their daily work as educators. Therefore, it is imperative to provide them with the opportunity to develop skills through appropriate didactic and pedagogical materials. This will enable them to transfer to the patients in a sustainable way the knowledge and skill necessary to master telemonitoring so that, autonomously, the patients continue to follow their treatment in all circumstances in a secure manner and stay in contact with their care partner. PATIENTS To improve their quality of life through TELEMONITORING. It is imperative to strengthen the ability to LEARN TO TRANSMIT via the BLENDED LEARNING. Other objectives are to enable the patient to:- learn the basic techniques and knowledge (touch screen, keyboard, voice recognition, etc.) needed to use computer systems- search for and collect relevant and secure information- communicate with messaging software, chat, and on a forum with peers and carers- develop critical thinking skills in relation to digital technology (understanding the benefits of the Internet and its risks).OBJECTIVES1.Developing flexible and innovative education that promotes patients’ INCLUSION in digital literacy, so that they can acquire a minimal digital skill basis while evaluating them on a regular basis allowing them to use the Internet safely, health apps and medical devices. Developing or improving adult, and particularly elderly, patients’ Digital Health Literacy to empower them to manage their health.2. Using technology to engage in A DIGITAL PEDAGOGY adapted to their PTS, CGS could contribute to the design and development of toolkits, participate in a clinical study that aims to assess the usefulness of the toolkits for PTS, and exchange good, digitalized practices with peers and PTS.3. Building a PATIENT-ORIENTED digital learning platform in health (Pragma-TIC) as an intervention method to gain autonomy and eventually reintegrate in society after a pathology. It will help patients take responsibility (respecting their choices), understand their disease, change their behavior, apply their treatment (observance) and use tele-health tools. It will host a training catalog, digital support (in all partner languages + English) in digital health education co-created by the project partners and validated by the PT Committee of the partner hospitals.The other objectives we want to achieve are the following:- ensuring that the frontline caregivers are capable of accompanying the TELEMONITORING of chronic patients by facilitating their autonomy;- to make the patient feel secure by the support provided; - to acquire a sufficient base of techniques and knowledge to conduct educational activities and analyse the results;- to be part of an international community of caregivers; - to apply safety rules and good practice guidelines;- to provide clear, constructive and supportive feedback to patients and peers<< Implementation >>For 24 months, 20 frontline/field nurses from 4 hospitals will contribute to the development of digital health literacy skills for nearly 200 chronic patients (whose health condition requires daily care and are vulnerable) so that they can become more autonomous thanks to remote monitoring.IMPLEMENTATION: METHODOLOGY USED The implementation of the project consists in developing a simple, practical e-learning platform (in English and in the 4 languages of the Consortium), favouring through the blended-learning method the better understanding of the Web, medical devices tools, health Apps and other classic telecommunication tools.This platform will offer educational toolkits co-constructed and validated by the caregivers on the basis of their pedagogical tutorials. It will also provide access to places ideal for exchanges between patients, caregivers and their international peers, such as forums, messaging server, etc. The anonymization and RGPD will be guaranteed.PLANNING FOR THE CREATION OF THIS PLATFORMThe Co-CREATION of this platform will be organised over 2 years in 4 steps.Step 1Conceptualisation and requirements for the project, research, studies, analysis, reporting and co-creation of a learning tutorial repository validated by pedagogy specialists. Step 2Development and/or reinforcement of adult-friendly pedagogy and e-learning among frontline health workers who will participate in the study. They will get a better grasp of the e-Health tools with hybrid learning methods, either in self-taught or group settings. Their objective will be to build their own training plan for their patient. In order to experiment and readjust it, they will also train groups of digitally compromised patients by immersing them directly in digital learning via groups or individual sessions, via synchronous or asynchronous webinars. During this period, the carers will create their dashboard in which they will enter data that will be used to assess the benefits of this method.The caregivers will evaluate the results, readjust their training plan, model it and then MAKE IT SUBSTAINABLE AND SHARE IT WITH THEIR PAIRS. Patients from this first pool will also be very closely involved in the process and will complete satisfaction and self-assessment questionnaires. The caregivers will adjust their working methods based on the answers collected and update the contents of the platform.After step 2, all participants (caregivers and patients) will form a committee with the associated partners to establish the sustainability of the project.Step 3 A second pool of patients will be recruited. The group will be accompanied by the first pool of field staff in order to reinforce or readjust the process. Step 4 Preparation and presentation of the guidelines and recommendations on our platform which will be presented at the transnational closing meeting of the project and accessible to all interested parties.<< Results >>RESULTS and OTHER EXPECTED OUTCOMES 1.To relieve for overloaded hospital institutions and very expensive emergency departments.2.To lessen the risk of contracting nosocomial diseases. 3.To return or keep the patient at home with an economic and psychological impact on his health.4.To open new possibility of life goals with an impact on the patients’ acceptance of their treatment and on the positive evolution of their health condition. 5.To create a community of peer carers internally and internationally, as well as be part of it. 6. To harmonise the remote follow-up of the chronic patient and maintain the therapeutic link EVEN ABROAD or in remote rural areas.7.To strengthen the patient's ability to keep learning while developing a critical mind towards the digital world.8.To give access to the patient staff to training in an ATYPICAL environment reinforcing LIFELONG LEARNING.9.To reduce the carbon impact by cutting out any unnecessary travel to the hospital. 10.To reduce the carbon impact with fewer hospital visits. SUSTAINIBILITY through its TRANSFERABILITY to other institutions or sectors.

Chronic migraine is defined as a headache persistent for more than 3 months or a severe headache persistent for more than 15 days within a month. It affects approximately 2% of the world population. The World Health Organization classifies severe migraine attacks as among the most disabling illnesses, comparable to dementia and quadriplegia. Treatments start with pharmaceutical drugs, which have contra-indications and severe side effects and often remain ineffective in chronic migraine patients. Injectable treatments like Botox and nerve blocks can be effective but require multiple sessions per year and also have undesirable effects. Treatments using neurostimulation products that deliver electrical pulses to the occipital nerve have been up to 80% effective but they are designed for the back not the neck which results in high rates of surgical revisions. This leaves the chronic migraine population severely underserved and in need of an innovative solution. Our vision is fundamentally based on disrupting the continuum of care and referral pathway by creating a more effective non-surgical solution that reduces cost and risk and therefore increases accessibility to more physicians and patients. The consortium will develop a novel platform for the treatment of chronic migraine that will be particularly applicable to resource restricted environments and targeting underserved patients. We are working on 4 elements working together seamlessly. 1) LUNA-AIR: An implantable electronics device with neural write stimulation 2) LUNA-CONTROL: A wearable device that will communicate with and power the implantable device. 3) LUNA-APP; a mobile app to control the implant. 4) LUNA-INJECT; an ergonomic, minimally invasive, injection device that minimises tissue trauma and training required for physicians.

To date, the possibility of doing research on quality-of-care assessment in emergency medicine has clashed against sustainability problems. The vast number of patients visiting an ED and the staff shortage that often afflicts these departments make ad hoc data collections unattainable. The only way to fill the gap between the need for clinical research and the availability of robust data is to directly extract such data from the EDs electronic health records (EHRs), avoiding dedicated data collection. Achieving this goal would enable distributed clinical research, which is now too much restricted to academic centres, and allow to leverage of clinical information to address a multitude of research questions. Nonetheless, obtaining consistent data from EHRs is a complex task. While a small part of the data registered in EHRs is structured (such as lab test results and vital parameters), most of the useful information on patients' conditions is variably contained in free text (e.g. presence of signs and symptoms, suspected and confirmed diagnosis, anamnesis, etc.). Moreover, as a proactive follow-up of ED patients is unfeasible, relying on the existing data sources is also necessary to measure the outcome of the patients at the most appropriate time interval for the research question of interest. This proposal has three main aims: 1) to develop new technical solutions to extract reliable clinical information from structured and unstructured data contained in different electronic patient files; 2) to FAIRify (i.e. making data Findable, Accessible, Interoperable, and Re-usable) the established databases for clinicians, researchers, health policymakers and citizens while respecting the European and national legislations; 3) to pilot the exploitation of the established databases in two relevant use cases: i) assessment of ED propensity to hospitalise a patient, and ii) development of a dashboard to be used by citizens and policymakers to improve the quality of care in ED.

PERSIST aims at developing an open and interoperable ecosystem to improve the care of cancer survivors. The key results to be achieved by partners are: increased self-efficacy and satisfaction with care as well as reduced psychological stress for a better management of the consequences of the cancer treatment and the disease, resulting in an improvement in health and wellbeing and a faster integration into the labour market, where applicable, compared to usual care (KR1); increased effectiveness in cancer treatment and follow-up by providing prediction models from Big Data that will support decision-making and contribute to optimal treatment decisions with positive consequences in the QoL and the health status of survivors (KR2); and improved information and evidence to advance the efficacy of management, intervention and prevention policies/strategies in order to timely treat side effects and, if possible, avoid secondary diseases and fatal events. The long-term result will be to reduce the socio-economic burden related to cancer survivors’ care (KR3). The ecosystem proposed consists of a Big Data platform to be built on top of an open infrastructure from one of the partners and a mHealth application for patients. The main building blocks to be developed are a multimodal sensing network running on a smart phone that will collect relevant data regarding the wellbeing of the patient; predictive models from anonymised health data from thousands of breast and colorectal patients; and modules essential for the development of a decision support system, which will employ the predictive models mentioned. Furthermore, PERSIST will contribute to establish evidence on the use of liquid biopsy techniques to the follow-up of cancer patients treated with curative purposes. A pilot study involving 160 patients and 32 health care professionals will be decisive to establish a co-creation methodology ranging from the earlies phases of the project throughout its conclusion.

Dementia is caused by a range of illnesses and disorders that damage the brain either directly or indirectly. With the rise of the ageing population in the EU, dementia is becoming a serious problem. Digital health interventions have the potential to improve the accessibility and effectiveness of palliative care. Palliative care is an area where these technologies are increasingly being evaluated for education (e.g. online learning, mobile applications or Virtual Reality tools), symptom management, care planning, decision-making, and interaction (e.g. professionals and caregivers using phones, internet and computer systems). However, most studies focus on a specific intervention with heterogeneous outcomes and are exposed to professional gatekeeping and biased samples consisting of patients who are mostly well and without considering cultural impacts. Due to improved understanding and treatment, more effective and innovative health technologies, improved patient safety and better ability and preparedness to manage epidemic outbreaks, along with priorities related to quality of life of dementia patients and survivors, treatment and dementia data monitoring should be crucial. This project will focus on: i) better understanding of dementia, focusing on their consequences, including pain, distress and causative links between health determinants, disease and interventions in order to provide evidence-base for policy-making, ii) identification of holistic intervention (treatment and care) and assessment of health outcomes, iii) innovative digital tools to optimize clinical workflows and iv) scientific evidence for improved/tailored policies and legal frameworks and to inform major policy initiatives at EU and global level. We target exactly those aspects of value by integrating digital interventions as palliative care of patients with poor prognosis of dementia and evaluating the impact of digital health interventions using Artificial Intelligence.