[Care for family carers of people with dementia in municipal communities during the pandemic: A Qualitative Study]. / Versorgung pflegender Angehöriger von Menschen mit Demenz in der Kommune während der Pandemie.

Care for family carers of people with dementia in municipal communities during the pandemic: A Qualitative Study Abstract: Background: The availability of support services for family carers of persons with dementia in the municipal community shows deficits due to the Corona pandemic and thus entails a change in the support of carers. Research question: The questions arise, what changes in the care of family carers of people with dementia do those affected perceive, how do actors from the municipal community experience the care situation during the pandemic and to what extent do the perceptions of the groups coincide or differ. Method: The database consists of town hall talks and focus groups from 13 municipal communities in Germany. Participants were family carers and actors from the municipal community. For data analysis, a qualitative content analysis was carried out. Result: Negative changes in the care of caregivers can be seen, for example, in the omission of care services or groups of relatives. Above all, actors perceived positive changes, such as advancing digitalization or increased neighborly help. The perception of changes in the care situation differs in several subcategories between carers and actors. Conclusion: Although large gaps in care have been created by the pandemic, emerging challenges also create new ways for support such as digital groups for family carers. In the future, opportunities need to be created to implement already developed interventions in such a way that the target group can make use of them.

[Advance care planning (ACP) in the context of dementia : Development of an instrument for exploration of perspectives of affected persons]. / Advance Care Planning im Kontext von Demenz : Entwicklung eines Instruments zur Exploration von Perspektiven der Betroffenen.

BACKGROUND: Since 2015, the Hospice and Palliative Care Act has defined the entitlement of nursing home residents to preventive planning in the final phase of their lives. Nevertheless, the advance care planning (ACP) concept has not yet been sufficiently researched in Germany. The deficient evidence on this topic appears to be even more considerable in connection with dementia. The necessity of such a discussion increases exponentially when dementia is diagnosed, not only for the person affected but also for their relatives and other caregivers and companions. OBJECTIVE: With respect to people with dementia, documents by a prominent German ACP provider were assessed as being insufficient by the authors. The aim of the pilot study presented here was to modify a questionnaire (value anamnesis) frequently used in the national context in order to apply it to this vulnerable group. MATERIAL AND METHODS: The value anamnesis was modified in 11 steps and pre-tested on people with dementia in an early stage. The focus of the document is on attitudes towards life, death and life-prolonging measures. The modification process was carried out in an iterative process based on the grounded theory according to Strauss and Corbin. RESULTS AND CONCLUSION: The stepwise adaptation of the document has created a practicable and low-threshold approach that also enables the vulnerable group of people with dementia to comprehensively deal with existential issues and to exchange views on them. This catalogue of questions is used as a basis document for the subsequent main study: here the life attachment of people with dementia is explored and thus a new perspective is placed on ACP.

Heart immunoengineering by lentiviral vector-mediated genetic modification during normothermic ex vivo perfusion.

Heart transplantation is associated with major hurdles, including the limited number of available organs for transplantation, the risk of rejection due to genetic discrepancies, and the burden of immunosuppression. In this study, we demonstrated the feasibility of permanent genetic engineering of the heart during ex vivo perfusion. Lentiviral vectors encoding for short hairpin RNAs targeting beta2-microglobulin (shß2m) and class II transactivator (shCIITA) were delivered to the graft during two hours of normothermic EVHP. Highly efficient genetic engineering was indicated by stable reporter gene expression in endothelial cells and cardiomyocytes. Remarkably, swine leucocyte antigen (SLA) class I and SLA class II expression levels were decreased by 66% and 76%, respectively, in the vascular endothelium. Evaluation of lactate, troponin T, and LDH levels in the perfusate and histological analysis showed no additional cell injury or tissue damage caused by lentiviral vectors. Moreover, cytokine secretion profiles (IL-6, IL-8, and TNF-α) of non-transduced and lentiviral vector-transduced hearts were comparable. This study demonstrated the ex vivo generation of genetically engineered hearts without compromising tissue integrity. Downregulation of SLA expression may contribute to reduce the immunogenicity of the heart and support graft survival after allogeneic or xenogeneic transplantation.

Community support for caring relatives of people with dementia: qualitative analysis using the Theoretical Domains Framework.

Aim: Although caring relatives of people with dementia are a mainstay of many care systems, the availability of support services for them within the municipal community shows deficiencies. Adopting the Theoretical Domains Framework (TDF) this study aims to investigate 1) which of the TDF domains adapted to gerontology show up in public dialogue, and 2) the results that public dialogues produce in terms of support services for caring relatives. Subject and methods: The data consists of town hall meetings and focus groups from 14 municipal communities in Germany. Participants were caring relatives and stakeholders of the communities. A qualitative content analysis was conducted, focusing on the assessment of three TDF domains, namely knowledge, goals, and sociopolitical context as well as outcomes of care optimisation. Results: With regard to domain knowledge, it was evident that in every community there were actors aware of the situation and relevance of carers and their relatives. Only some actors mentioned goals for optimising the care of the target group. The sociopolitical context is often addressed through statements about incomplete requirements. Conclusion: Overall, a relation between the discussion about the domains in public dialogues and changes in supporting carers of people with dementia can be assumed. The results indicate that an increased discussion about the domains within town hall meetings influences the actors and their statements with regard to the improvement of support services for caring relatives of people with dementia. Since the domains were not developed exclusively for the outlined context, this approach can also be applied to other areas of care. Supplementary information: The online version contains supplementary material available at 10.1007/s10389-022-01744-w.