Search

Most people become more reliant on care and support as they age. The constitution of ageing people in the context of nursing support thus represents a material aspect in the daily life of these people and must be taken into account in the science of gerontology. However, theories of (geriatric) care have previously been predominantly human-centric. In light of the material turn, the goal of this paper is to highlight the potential to be found in using agential realism to critically examine geriatric care. It will begin by detailing previous perspectives on geriatric care and any use of material aspects to be found in it. It will then present a conceptual-methodical approach that allows for an examination of the act of caring, taking material aspects into account. The application of this approach to empirical material drawn from an example of acute care in Germany will, in conclusion, illustrate significant elements that, in light of agential realism, must also be taken into account when investigating what it means to provide good geriatric care., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to analyze the feasibility and clinical results of linear accelerator (linac-)based stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SFRT) with flattening filter-free (FFF) volumetric modulated arc therapy (VMAT) in elderly patients affected by brain metastases (BMs)., Patients and Methods: Patients selected for the present analysis were ≥65 years old with a life expectancy of >3 months, a controlled or synchronous primary tumor, and <10 BMs with a diameter <3 cm. All patients were treated with FFF linac-based SRS/SFRT. The prescribed total dose (15-30 Gy/1-5 fractions) was based on BM size and proximity to organs at risk (OAR). Toxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. MedCalc v18.2 (MedCalc Software, Ostend, Belgium) was used for statistical analysis., Results: From April 2014 to December 2017, 40 elderly patients with 110 BMs were treated by FFF linac-based SRS/SFRT. With a median follow-up of 28 months (range 6-50 months), median and 1‑year overall survival were 9 months and 39%, respectively; median intracranial progression-free survival was 6 months. At the time of the analysis, local control was reported in 109/110 BMs (99.1%): 12 BMs had a complete response; 51 a partial response; 46 showed stable disease. One BM (0.9%) progressed after 2 months. BM volume (<1 cc) and higher SRS/SFRT dose correlated to treatment response (p = 0.01 and p = 0.0017, respectively). No adverse events higher than grade 2 were observed., Conclusion: The present findings highlight the feasibility, safety, and effectiveness of FFF linac-based SRS/SFRT in elderly patients with BMs.

The history of plastic surgery is identified throughout the centuries with the history of rhinoplasty. The Indian Koomas first and later the Italian surgeons found valid solutions to the problems caused by partial loss of the nasal pyramid. However, the idea of rebuilding, with a single forehead flap, the tip and columella and providing at the same time a lining of skin for the newly formed nose goes back to the middle of the nineteenth century. The Italian Natale Petrali (1842) and the Germans Johann Friedrich Dieffenbach (1845) and Ernst Blasius (1848) contend for precedence in carrying out this important procedure still used today, which, barring postoperative contracture, represented a great advance in successful total rhinoplasty.