Currently, the management of older cancer patients is directed by a personalized approach and, where possible, a tailor-made treatment. Based on our previous experiences and considering the opportunity of combining a geriatric department and a radiation-oncology department, we have developed a path that follows the patient from the beginning of the treatment, taking into account the complications/late toxicities and the survivors. This study aimed to evaluate the impact of remodeling and restructuring some oncology, radiotherapy, and geriatrics services based on the primary evidence for managing older cancer patients. In 2020, Gemelli ART underwent 60,319 radiation-oncology treatments, admitted 943 patients in the radiation-oncology and supportive care ward, and treated and followed 15,268 patients in clinics. The average length of stay of the admitted patients was reduced from 20.6 days to 13.2 days. In 2021, 1196 patients were assessed for frailty, 847 were admitted for toxicity, and 349 patients were evaluated within the geriatric oncology and supportive care outpatient clinic, and it was found that 59.2% were fit, 31.6% were vulnerable, and 9.2% were frail. This experience has shown a reduction in hospitalizations and the average hospital stay of patients in the case of side effects, a high toxicity to treatments, and the possibility of treating patients with a high level of complexity. This approach should represent the future target of geriatric oncology with the global management of older or complex patients with cancer.

New technologies, aging-related changes, and evolution in patients' needs have led to a new scenario in all oncological fields in front of which we have to move on. Technological progress has made it possible to increase the number of patients treated, including elderly patients and generally those at higher risk of toxicity. However, this scenario has led to new problems requiring new skills to be addressed. For this reason, Gemelli-ART (Advanced Radiation Therapy) of Fondazione Policlinico Universitario A. Gemelli IRCCS – Rome, Italy, started a collaboration with a team of geriatricians trained in geriatric oncology to manage the growing number of elderly patients and to deal with treatment-related toxicity and supportive care to complete planned treatment. This study evaluates the impact of geriatric oncology intervention performed by a geriatrician with particular expertise in managing complex cancer patients admitted to an Oncology Unit. The number of complex patients admitted to the Radiation Oncology Unit raised from 90 in 2016 to 226 in 2018 (+151.1%). 63.4% of complex patients underwent treatment, with a curative goal in 43.7% of cases. Among all admitted patients, the treatment discontinuation rate was 14%. The treatment discontinuation rate was 5.5% in patients over 80 years old with planned admission, versus 27.0% in patients admitted from the emergency room. Our data suggest that geriatric expertise in an Oncology Unit helps personalize patients' treatment and allows for treating an increasing number of complex patients. Identifying frail and complex patients is essential to manage these situations effectively and efficiently, optimize healthcare resources, avoid over and under-treatment, and provide the best care.

The Shaikh Khalifa Bin Salman Highway (SKBSH) and Shaikh Isa Bin Salman Highway (SIBSH) are two of the most important arterial roads of the Kingdom of Bahrain. A project to widen and improve the two highways included their junction, known as the SAAR Interchange, with an additional grade-separated left-turn ramp designed to link the southbound SKBSH to the eastbound SIBSH. The ramp comprised a 515m long flyover built using the incremental launch method. This paper gives an overview of the detailed design and discusses particular aspects of the construction method employed in greater depth.

<p>The Shaikh Khalifa Bin Salman Highway (SKBSH) and Shaikh Isa Bin Salman Highway (SIBSH) are two of the most important arterial roads of the Kingdom of Bahrain. The project for the widening and improvement of the two highways included their junction, known as the SAAR Interchange, with an additional grade separated left turn ramp designed to link the southbound SKBSH onto the eastbound SIBSH. The ramp comprised a 515m long flyover built using the incremental launch method (ILM). This paper gives an overview of the detailed design and discusses the specific aspects of the construction method employed.</p>