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ChristianaCare Becomes First in Delaware to Offer CAR-T Therapy for Advanced Multiple Myeloma
ChristianaCare’s Helen F. Graham Cancer Center & Research Institute is the first in Delaware to offer a powerful new tool in the fight against multiple myeloma—a type of blood cancer that affects plasma cells in the bone marrow. That tool is a new chimeric antigen receptor (CAR) T-cell therapy, called CARVYKTI, which can improve treatment for adults with multiple myeloma that has returned or stopped responding to other treatments. “CAR-T cell therapy represents a paradigm shift in the treatment of multiple myeloma,” said Thomas Schwaab, M.D., Ph.D., Bank of America Endowed Medical Director of the Helen F. Graham Cancer Center & Research Institute." We are expanding access to this life-extending therapy right here in Delaware — close to home, close to hope. This is part of our ongoing commitment at the Graham Cancer Center to ensure our community has access to the most advanced cancer therapies.” Multiple myeloma is a relatively rare cancer, but it still affects a significant number of people each year. In the United States, it is estimated that around 36,110 new cases will be diagnosed in 2025, according to the American Cancer Society What is CAR-T Therapy? CAR-T cell therapy uses a patient’s own immune cells to fight cancer. Doctors first collect the patient’s T cells, which are a type of white blood cell that helps the body fight infections. In the lab, these T cells are reprogrammed by adding a special receptor called a chimeric antigen receptor (CAR). This receptor allows the T cells to recognize specific proteins on cancer cells, acting like a navigation system to help the T cells find and attack the cancer. After this genetic modification, the reprogrammed T cells are expanded in the lab to create a larger army of cancer-fighting cells. Then, they are infused back into the patient’s body, where they go on to find and destroy the cancer cells. This therapy is approved for adults who have already tried several standard treatments, like proteasome inhibitors, immunomodulators and anti-CD38 antibodies, without success. When those treatments stop working, CARVYKTI can offer a powerful new option. CAR T-cell therapy has given new hope to patients with multiple myeloma whose cancer has returned or stopped responding to other treatments. Many people see their cancer shrink or even disappear for a period of time, which can help them live longer and feel better. While the treatment can have short-term side effects, many patients report feeling stronger and having fewer symptoms once they recover. It’s not a cure, but for some, it can mean more time with loved ones and a better quality of life. “This therapy gives our patients a chance when other treatments have failed,” said Zhifu Xiang, M.D., medical oncologist at ChristianaCare Oncology Hematology. “It’s a deeply personalized approach that uses the patient’s own immune system to fight the cancer in a powerful new way. Being able to offer this locally means our patients don’t have to travel far for world-class care.” A Leader in Cell Therapy The Graham Cancer Center’s dedicated team of specialists have been offering CAR-T cell therapy for other cancer types, such as lymphoma and leukemia, since 2018. The center is also recognized by the Foundation for the Accreditation of Cellular Therapy (FACT) for meeting the highest standards in safety, quality and patient care. To learn more about CAR-T cell therapy or other cancer treatments at ChristianaCare, visit christianacare.org/cancer or call the Helen F. Graham Cancer Center & Research Institute at 302-733-HOPE (4673).
Georgia Southern University’s Office of Student Wellness and Health Promotion, Jiann-Ping Hsu College of Public Health (JPHCOPH) Center for Addiction Recovery and Health Services have partnered to provide overdose prevention education to the campus community. The University will distribute naloxone, which is used to rapidly and temporarily reverse the effects of an opioid overdose, allowing time for first responders to arrive and initiate further intervention, to the campus community at no cost. Savannah nonprofit No More O.D.s donated a large quantity of naloxone to Georgia Southern for this purpose. “The health and safety of our campus and the many visitors it welcomes are of high priority,” said Shay Little, Ph.D., vice president for Student Affairs. “By increasing access to naloxone we are equipping our community with another life-saving tool.” Georgia Southern Public Health Administrator Sean Bear, DPH, agrees. “Naloxone is a life-saving medication,” he noted. “It is safe, fast-acting and easy to use.” Although many in the Georgia Southern community do not consume alcohol or other recreational substances, opioid overdoses can occur under a number of circumstances. Misuse of prescription opioids provided by a health care provider or the use of illegal opioids can result in negative health consequences, including overdoses. Some common prescription opioids include codeine, morphine, hydrocodone and oxycodone, among others. Counterfeit pills designed to look like prescription opioids often contain a synthetic opioid known as fentanyl, with many of these pills containing enough fentanyl in just one dose to cause an opioid overdose. “The primary aim of distributing naloxone and providing education on overdose prevention, recognition and response is to save lives,” said Robert Bohler, Ph.D., JPHCOPH assistant professor. Just as AED/CPR first aid boxes are placed strategically across campus, naloxone kits and utilization instructions will be placed in high-traffic, high-risk areas. Distribution locations include the Campus Food Pantries (all campuses), Center for Addiction and Recovery (Statesboro Campus), Health Centers (Statesboro and Armstrong campuses), Counseling Centers (Statesboro and Armstrong campuses), and Student Wellness and Health Promotion (Statesboro and Armstrong campuses). “All naloxone packages come with instructions, however, additional educational information, such as a video link on how to administer naloxone, where to find additional information and more will be available at each of these distribution locations,” said Gemma Skuraton, DPH, director of Student Wellness and Health Promotion. Universities play a vital role in promoting harm-reduction strategies. As such, Georgia Southern is committed to ensuring the availability, accessibility and education surrounding naloxone on each of its campuses. Educational initiatives will focus on overdose prevention, recognizing signs and symptoms of overdose, overdose response planning, naloxone administration, legal protections (Georgia’s 911 Medical Amnesty Law and Georgia Southern’s Amnesty Protocol), bystander intervention, and treatment and recovery service availability on campus and in the community. You can sign-up for an open workshop to learn more on the Student Wellness and Health Promotion webpage: Interested in learning more? If you want to connect with any of the experts from this story and want to book time to talk or interview, then let us help - simply contact Georgia Southern's Director of Communications Jennifer Wise at jwise@georgiasouthern.edu to arrange an interview today.
ChristianaCare has once again been recognized by the American Association of Critical-Care Nurses (AACN) for its exceptional complex care. The AACN has awarded the Beacon Award for Excellence to three intensive care units at Christiana Hospital in Newark, Delaware: the Medical Intensive Care Unit (MICU), the Surgical Critical Care Complex (SCCC), and the Transitional Surgical Unit (TSU) Beacon Awards honor critical-care nursing units that demonstrate exceptional patient care, improved patient health outcomes, a supportive work environment and opportunities for collaboration. The Beacon Award is widely considered to be the most prestigious award in critical-care nursing. “The Beacon Award shines a light on individual nursing units for their commitment to providing critically ill patients with exceptional care and evidence-based practices,” said Danielle Weber, DNP, MSM, RN-BC, NEA-BC, chief nurse executive at ChristianaCare. “These awards reflect nursing excellence and commitment to exceptional health outcomes, an outstanding work environment and superior patient experience.” AACN President Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM, applauds the commitment of the caregivers at ChristianaCare for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. These dedicated healthcare professionals join other members of our exceptional community of nurses, who set the standard for optimal patient care. “The Beacon Award for Excellence recognizes caregivers in outstanding units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care,” Adamski said. Consecutive successes Each of these units has received multiple Beacon Awards. • The MICU has been continuously recognized as a Beacon unit since 2009. It is the sixth time that the MICU—Delaware’s first Beacon Award-winning unit—has received the national award, with four silver and two gold recognitions. The unit holds the most Beacon Awards in Delaware. • The SCCC received a silver-level award for the fourth time. • The TSU received a gold-level award for the first time, after receiving two silver-level awards. “For us to be designated for such a consecutive amount of time is a testament to the ongoing, intensive work that we do and the focus on excellence that we have,” said Carol Ritter, MSN, RN, CCRN, CNML, nurse manager for the MICU. “It’s an affirmation of the care that the nurses provide and the excellence that they bring every day, using advanced protocols and the latest technology and research.” Beacon-designated units are renowned for their healthy work environments and high morale, which results in strong relationships among the nurses and outstanding patient care. “Our nurses are committed to providing exceptional care and patient outcomes,” said Amanda Latina, MSN, MBA, RN, TCRN, nurse manager of the TSU and SCCC. “They embody what it means to be a critical-care nurse.” Of the seven Beacon Award-winning patient care units currently in Delaware, all are at Christiana Hospital in Newark. These include the Neuro Critical Care Unit (silver), the Cardiovascular Stepdown Unit 4E (silver), the Cardiovascular Critical Care Complex (three-time gold winner), the Transitional Medical Unit and the 3C Intermediate Medical Unit (both silver).
Vishesh Agarwal, M.D., Appointed Chief of Addiction Medicine Services
Vishesh Agarwal, M.D., has been appointed chief of Addiction Medicine Services at ChristianaCare. In this role, Agarwal will lead and expand ChristianaCare’s comprehensive addiction treatment services, guiding care for people with substance use disorders across inpatient, outpatient, emergency and consultation settings. He will oversee addiction programs across all campuses, help create consistent care guidelines and support teams of experts working together to provide safe, effective and compassionate care for patients. A key priority for Agarwal will be to explore strategic growth opportunities to broaden ChristianaCare’s reach and strengthen its impact on individuals and families affected by substance use disorders. His leadership will be instrumental in ensuring that ChristianaCare continues to set the standard for innovation and excellence. Agarwal will continue in his role as vice chair of the Department of Psychiatry at ChristianaCare, maintaining his leadership of clinical and operational initiatives in the Behavioral Health Service Line. He will continue to lead efforts to improve provider well-being, develop care pathways and foster clinical growth. He also oversees the Behavioral Health Unit, Emergency Department crisis services and psychiatric consultations for hospitalized patients. Agarwal is board certified in general adult psychiatry, addiction psychiatry and obesity medicine. He has published research on substance use and behavioral addictions in peer-reviewed journals and has presented at national conferences. His 2021 study linking gambling disorder, major depression and suicide risk was published in Addictive Behaviors and gained national attention. Agarwal holds an Executive MBA from Quantic School of Business and Technology and completed an addiction psychiatry fellowship at the Zucker Hillside Hospital. He completed his psychiatry residency and served as administrative chief resident at Einstein Medical Center. He earned his medical degree from Gauhati Medical College. Agarwal teaches and mentors psychiatry residents and medical students as a clinical assistant professor at Sidney Kimmel Medical College at Thomas Jefferson University. He also co-chairs system committees and serves on the board of the Mental Health Association in Delaware. He reports to Mustafa Mufti, M.D., chair of the Department of Psychiatry.
Why Simultaneous Voting Makes for Good Decisions
How can organizations make robust decisions when time is short, and the stakes are high? It’s a conundrum not unfamiliar to the U.S. Food and Drug Administration. Back in 2021, the FDA found itself under tremendous pressure to decide on the approval of the experimental drug aducanumab, designed to slow the progress of Alzheimer’s disease—a debilitating and incurable condition that ranks among the top 10 causes of death in the United States. Welcomed by the market as a game-changer on its release, aducanumab quickly ran into serious problems. A lack of data on clinical efficacy along with a slew of dangerous side effects meant physicians in their droves were unwilling to prescribe it. Within months of its approval, three FDA advisors resigned in protest, one calling aducanumab, “the worst approval decision that the FDA has made that I can remember.” By the start of 2024, the drug had been pulled by its manufacturers. Of course, with the benefit of hindsight and data from the public’s use of aducanumab, it is easy for us to tell that FDA made the wrong decision then. But is there a better process that would have given FDA the foresight to make the right decision, under limited information? The FDA routinely has to evaluate novel drugs and treatments; medical and pharmaceutical products that can impact the wellbeing of millions of Americans. With stakes this high, the FDA is known to tread carefully: assembling different advisory, review, and funding committees providing diverse knowledge and expertise to assess the evidence and decide whether to approve a new drug, or not. As a federal agency, the FDA is also required to maintain scrupulous records that cover its decisions, and how those decisions are made. The Impact of Voting Mechanisms on Decision Quality Some of this data has been analyzed by Goizueta’s Tian Heong Chan, associate professor of information systems and operation management. Together with Panos Markou of the University of Virginia’s Darden School of Business, Chan scrutinized 17 years’ worth of information, including detailed transcripts from more than 500 FDA advisory committee meetings, to understand the mechanisms and protocols used in FDA decision-making: whether committee members vote to approve products sequentially, with everyone in the room having a say one after another; or if voting happens simultaneously via the push of a button, say, or a show of hands. Chan and Markou also looked at the impact of sequential versus simultaneous voting to see if there were differences in the quality of the decisions each mechanism produced. Their findings are singular. It turns out that when stakeholders vote simultaneously, they make better decisions. Drugs or products approved this way are far less likely to be issued post-market boxed warnings (warnings issued by FDA that call attention to potentially serious health risks associated with the product, that must be displayed on the prescription box itself), and more than two times less likely to be recalled. The FDA changed its voting protocols in 2007, when they switched from sequentially voting around the room, one person after another, to simultaneous voting procedures. And the results are stunning. Tian Heong Chan, Associate Professor of Information Systems & Operation Management “Decisions made by simultaneous voting are more than twice as effective,” says Chan. “After 2007, you see that just 3.4% of all drugs and products approved this way end up being discontinued or recalled. This compares with an 8.6% failure rate for drugs approved by the FDA using more sequential processes—the round robin where individuals had been voting one by one around the room.” Imagine you are told before hand that you are going to vote on something important by simply raising your hand or pressing a button. In this scenario, you are probably going to want to expend more time and effort in debating all the issues and informing yourself before you decide. Tian Heong Chan “On the other hand, if you know the vote will go around the room, and you will have a chance to hear how others’ speak and explain their decisions, you’re going to be less motivated to exchange and defend your point of view beforehand,” says Chan. In other words, simultaneous decision-making is two times less likely to generate a wrong decision as the sequential approach. Why is this? Chan and Markou believe that these voting mechanisms impact the quality of discussion and debate that undergird decision-making; that the quality of decisions is significantly impacted by how those decisions are made. Quality Discussion Leads to Quality Decisions Parsing the FDA transcripts for content, language, and tonality in both settings, Chan and Markou find evidence to support this. Simultaneous voting or decision-making drives discussions that are characterized by language that is more positive, more authentic, and more even in terms of expressions of authority and hierarchy, says Chan. What’s more, these deliberations and exchanges are deeper and more far-ranging in quality. We find marked differences in the tone of speech and the topics discussed when stakeholders know they will be voting simultaneously. There is less hierarchy in these exchanges, and individuals exhibit greater confidence in sharing their points of view more freely. Tian Heong Chan “We also see more questions being asked, and a broader range of topics and ideas discussed,” says Chan. In this context, decision-makers are also less likely to reach unanimous agreement. Instead, debate is more vigorous and differences of opinion remain more robust. Conversely, sequential voting around the room is typically preceded by shorter discussion in which stakeholders share fewer opinions and ask fewer questions. And this demonstrably impacts the quality of the decisions made, says Chan. Sharing a different perspective to a group requires effort and courage. With sequential voting or decision-making, there seems to be less interest in surfacing diverse perspectives or hidden aspects to complex problems. Tian Heong Chan “So it’s not that individuals are being influenced by what other people say when it comes to voting on the issue—which would be tempting to infer—rather, it’s that sequential voting mechanisms seem to take a bit more effort out of the process.” When decision-makers are told that they will have a chance to vote and to explain their vote, one after another, their incentives to make a prior effort to interrogate each other vigorously, and to work that little bit harder to surface any shortcomings in their own understanding or point of view, or in the data, are relatively weaker, say Chan and Markou. The Takeaway for Organizations Making High-Stakes Decisions Decision-making in different contexts has long been the subject of scholarly scrutiny. Chan and Markou’s research sheds new light on the important role that different mechanisms have in shaping the outcomes of decision-making—and the quality of the decisions that are jointly taken. And this should be on the radar of organizations and institutions charged with making choices that impact swathes of the community, they say. “The FDA has a solid tradition of inviting diversity into its decision-making. But the data shows that harnessing the benefits of diversity is contingent on using the right mechanisms to surface the different expertise you need to be able to see all the dimensions of the issue, and make better informed decisions about it,” says Chan. A good place to start? By a concurrent show of hands. Tian Heong Chan is an associate professor of information systems and operation management. he is available to speak about this topic - click on his con now to arrange an interview today.
Expert Perspective: Mitigating Bias in AI: Sharing the Burden of Bias When it Counts Most
Whether getting directions from Google Maps, personalized job recommendations from LinkedIn, or nudges from a bank for new products based on our data-rich profiles, we have grown accustomed to having artificial intelligence (AI) systems in our lives. But are AI systems fair? The answer to this question, in short—not completely. Further complicating the matter is the fact that today’s AI systems are far from transparent. Think about it: The uncomfortable truth is that generative AI tools like ChatGPT—based on sophisticated architectures such as deep learning or large language models—are fed vast amounts of training data which then interact in unpredictable ways. And while the principles of how these methods operate are well-understood (at least by those who created them), ChatGPT’s decisions are likened to an airplane’s black box: They are not easy to penetrate. So, how can we determine if “black box AI” is fair? Some dedicated data scientists are working around the clock to tackle this big issue. One of those data scientists is Gareth James, who also serves as the Dean of Goizueta Business School as his day job. In a recent paper titled “A Burden Shared is a Burden Halved: A Fairness-Adjusted Approach to Classification” Dean James—along with coauthors Bradley Rava, Wenguang Sun, and Xin Tong—have proposed a new framework to help ensure AI decision-making is as fair as possible in high-stakes decisions where certain individuals—for example, racial minority groups and other protected groups—may be more prone to AI bias, even without our realizing it. In other words, their new approach to fairness makes adjustments that work out better when some are getting the short shrift of AI. Gareth James became the John H. Harland Dean of Goizueta Business School in July 2022. Renowned for his visionary leadership, statistical mastery, and commitment to the future of business education, James brings vast and versatile experience to the role. His collaborative nature and data-driven scholarship offer fresh energy and focus aimed at furthering Goizueta’s mission: to prepare principled leaders to have a positive influence on business and society. Unpacking Bias in High-Stakes Scenarios Dean James and his coauthors set their sights on high-stakes decisions in their work. What counts as high stakes? Examples include hospitals’ medical diagnoses, banks’ credit-worthiness assessments, and state justice systems’ bail and sentencing decisions. On the one hand, these areas are ripe for AI-interventions, with ample data available. On the other hand, biased decision-making here has the potential to negatively impact a person’s life in a significant way. In the case of justice systems, in the United States, there’s a data-driven, decision-support tool known as COMPAS (which stands for Correctional Offender Management Profiling for Alternative Sanctions) in active use. The idea behind COMPAS is to crunch available data (including age, sex, and criminal history) to help determine a criminal-court defendant’s likelihood of committing a crime as they await trial. Supporters of COMPAS note that statistical predictions are helping courts make better decisions about bail than humans did on their own. At the same time, detractors have argued that COMPAS is better at predicting recidivism for some racial groups than for others. And since we can’t control which group we belong to, that bias needs to be corrected. It’s high time for guardrails. A Step Toward Fairer AI Decisions Enter Dean James and colleagues’ algorithm. Designed to make the outputs of AI decisions fairer, even without having to know the AI model’s inner workings, they call it “fairness-adjusted selective inference” (FASI). It works to flag specific decisions that would be better handled by a human being in order to avoid systemic bias. That is to say, if the AI cannot yield an acceptably clear (1/0 or binary) answer, a human review is recommended. To test the results for their “fairness-adjusted selective inference,” the researchers turn to both simulated and real data. For the real data, the COMPAS dataset enabled a look at predicted and actual recidivism rates for two minority groups, as seen in the chart below. In the figures above, the researchers set an “acceptable level of mistakes” – seen as the dotted line – at 0.25 (25%). They then compared “minority group 1” and “minority group 2” results before and after applying their FASI framework. Especially if you were born into “minority group 2,” which graph seems fairer to you? Professional ethicists will note there is a slight dip to overall accuracy, as seen in the green “all groups” category. And yet the treatment between the two groups is fairer. That is why the researchers titled their paper “a burden shared is a burdened halved.” Practical Applications for the Greater Social Good “To be honest, I was surprised by how well our framework worked without sacrificing much overall accuracy,” Dean James notes. By selecting cases where human beings should review a criminal history – or credit history or medical charts – AI discrimination that would have significant quality-of-life consequences can be reduced. Reducing protected groups’ burden of bias is also a matter of following the laws. For example, in the financial industry, the United States’ Equal Credit Opportunity Act (ECOA) makes it “illegal for a company to use a biased algorithm that results in credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance,” as the Federal Trade Commission explains on its website. If AI-powered programs fail to correct for AI bias, the company utilizing it can run into trouble with the law. In these cases, human reviews are well worth the extra effort for all stakeholders. The paper grew from Dean James’ ongoing work as a data scientist when time allows. “Many of us data scientists are worried about bias in AI and we’re trying to improve the output,” he notes. And as new versions of ChatGPT continue to roll out, “new guardrails are being added – some better than others.” “I’m optimistic about AI,” Dean James says. “And one thing that makes me optimistic is the fact that AI will learn and learn – there’s no going back. In education, we think a lot about formal training and lifelong learning. But then that learning journey has to end,” Dean James notes. “With AI, it never ends.” Gareth James is the John H. Harland Dean of Goizueta Business School. If you're looking to connect with him - simply click on his icon now to arrange an interview today.
Rural health documentary earns Peabody Award for Georgia Southern professor
Georgia Southern University Professor Matthew Hashiguchi has won a Peabody Award for his documentary, “The Only Doctor,” which focuses on rural health and the services provided by a single doctor in southwest Georgia. The Peabody Awards are prestigious accolades in storytelling across television, radio, streaming and other digital mediums. Categories for winning a Peabody include journalism, social video, interactive documentary, gaming and more. The nearly hour-long feature received the award in the Public Service category, which recognizes projects that address or respond to public health concerns, enhance public engagement or educate the public. For Hashiguchi, the award represents a personal and career accolade. “This award isn’t just a professional achievement, but also represents a moment in my life where I became a father,” said Hashiguchi. “I started filming right before my first daughter was born, and finished right after the second. While this award is an incredible acknowledgment of my work, it means even more to me as a priceless moment from their childhood.” The documentary focuses on Karen Kinsell, M.D., the sole physician serving 3,000 citizens in Clay County, Georgia, near the Georgia-Alabama border. The film spotlights the plight of a community in need of medical assistance and the dedicated doctor fighting to keep her clinic’s doors open. Hashiguchi delves into Kinsell’s sacrifices for her clinic’s operations, revealing her commitment to her patients. “Dr. Kinsell gets calls at home at all hours of the day and night,” Hashiguchi said. “She, at times, has had to pay the bills from her own bank account. But I’d say the biggest sacrifice is that she’s a doctor who does not have breaks.” The final cut of “The Only Doctor” is a bit different from the angle Hashiguchi took when he began work on it several years ago. He initially started the project to better understand the risks associated with maternal health care and childbirth when he and his wife were expecting their first child. Through his work, he learned of a more complex issue of health care access in rural communities. The documentary first premiered on the PBS program Reel South and is now available internationally on Al Jazeera’s documentary series “Witness.” Hashigchi’s work earned him a 2019 Gucci Tribeca Documentary Fund award and a 2021 American Stories Documentary Fund award from Points North Institute. The film’s world premiere took place at the 2023 Hot Docs International Documentary Film Festival in Toronto, Canada, and was awarded Best Documentary Feature at the 2024 South Georgia Film Festival, Best Feature at the 2023 Newburyport Documentary Film Festival and Award of Merit at the 2023 University Film and Video Association Conference. His rise to media prominence wasn’t on his radar early in his academic career. He described himself as a “C student,” and still sees himself as that young boy struggling with math and science courses. With one of the nation’s highest media honors, he can show his students new paths to success as well as the skills it takes to win a Peabody. “I want my students to know how I failed and know that I struggled,” he said. “I tell them that if they want to excel, they really have to put in hard work. That’s very much who I am now as I devote myself to these films.” If you're interested in learning more and want to book time to talk or interview with Matthew Hashiguchi then let us help - simply contact Georgia Southern's Director of Communications Jennifer Wise at jwise@georgiasouthern.edu to arrange an interview today.
Aston University researcher to help uncover hidden impact of painkiller overuse among older people
The HOPE-AO project led by the University of Plymouth will look at the potential harms of overprescribed pain medication in older people in the UK Aston University’s Professor Ian Maidment will bring his expertise in pharmacy and work with patient groups on medicine optimisation The project has been funded by the National Institute for Health and Care Research (NIHR) A new study led by the University of Plymouth will explore chronic pain prescribing in older adults across the UK, with the aim of understanding whether current treatments and processes meet their needs. The HOPE-AO: Helping to Optimise Pain control in the Elderly experiencing Analgesic Overprescribing project is being supported by the National Institute for Health and Care Research (NIHR) and includes Aston University’s Professor Ian Maidment. It will investigate whether certain groups of the older population are more likely to have analgesic (pain relief) medication overprescribed to them, and any side effects or other harms these medications can pose if taken for long periods. It aims to identify alternative treatment solutions to reduce the use of unnecessary pain medicines, working with patients to develop a list of acceptable strategies that could be tested and implemented across the UK. Around 4m older people across the UK live with varying degrees of chronic pain as a result of conditions including arthritis, diabetes or frailty. While some people benefit from pain relief medicines, many end up receiving long-term repeated prescriptions – for medications ranging from paracetamol and ibuprofen to opioids and antidepressants – for weeks, months or years at a time. The project is being led by researchers from the University of Plymouth, working with colleagues at the University of Exeter, Aston University, University of Aberdeen and the North East London Foundation NHS Trust. It is funded by through a Programme Development Grant from the National Institute for Health and Care Research (NIHR). The project team comprises experts in the care of older people – including healthcare researchers, nurses, consultants, GPs, pharmacists and psychiatrists working across the UK – as well as medical statisticians and health economists. It also involves an advisory group of patients with lived experience of receiving repeat prescriptions for pain medication. During the project, the team will speak to patients aged 65 and over with a history of chronic pain for which they are taking, or have taken, medication and families who cared for and supported relatives with chronic pain. They will also speak to healthcare professionals who are either prescribing or supporting older adults taking medication for chronic pain management. Alongside this work, the team will analyse anonymised healthcare data to understand more about older adults who are prescribed medication for chronic pain. This includes patterns in prescribing, health and demographic factors associated with pain medication use, and potential health outcomes, and will help identify those likely to benefit most from support. Professor Maidment, from Aston Pharmacy School, will bring his expertise in pharmacy, medication use in day-to-day clinical practice and working with diverse groups of patients to support medication optimisation. He said: “From my experience in community pharmacy, the use of pain medicines is very common in older people. We need to work with older people to understand how we can help older people to use other potentially safer approaches.” Patricia Schofield, professor of clinical nursing at the University of Plymouth and one of the study’s chief investigators, said: “Very often, older people are told by a doctor that the most effective means of treating a health condition is through some form of pain relief. But they often don’t get any form of follow-up appointment and, as a generation, are less likely to seek one as they either feel pain is part of the ageing process or they don’t wish to be seen as a burden. The result is that they end up getting repeat prescriptions, potentially for pain medications they no longer need and also at significant cost to the NHS. “This study will give us a clearer understanding of the scale of the issue which we can use to develop ways of benefitting patients and their families, and the healthcare professionals working to treat and support them.” Victoria Abbott-Fleming MBE, founder of the charity Burning Nights CRPS Support, is the chair of the Patient and Public Involvement and Engagement group for the HOPE-AO study. It will be made up of several adults over the age of 65 who live with chronic pain and have received repeat prescriptions for pain medication. Victoria has herself lived for more than 20 years with a chronic pain condition, Complex Regional Pain Syndrome (CRPS), and set up Burning Nights to support those affected by it on a day-to-day basis and their families. She is also chair of the Expert Patient and Carer Committee at the British Pain Society. She said: “I’m excited to support this study that places the voices of older adults and their carers at the heart of pain management. All too often, those living with chronic pain – especially older adults – are prescribed medication without regular review or consideration of alternative approaches. This study is a vital step towards more informed and balanced care, helping ensure that older people living with chronic pain are not just treated, but truly heard and supported.”
ChristianaCare Hospitals Earn Top Patient Safety Rating From Leapfrog Group
ChristianaCare’s Christiana Hospital, Union Hospital and Wilmington Hospital have each received an ‘A’ grade in the Spring 2025 Leapfrog Hospital Safety Grade, a national distinction that recognizes ChristianaCare’s achievements in protecting patients from harm and providing safe health care. “At ChristianaCare, patient safety is our highest priority and an essential part of our mission of service to the community,” said Kert Anzilotti, M.D., MBA, system chief medical officer and president of the Medical Group of ChristianaCare. “We are incredibly proud of this achievement. “This ‘A’ grade is not just a letter; it’s a testament to the hard work and passion of our caregivers, who strive every day to ensure our patients receive the highest quality care and feel safe throughout their journey with us.” The Leapfrog Group assigns an ‘A,’ ‘B,’ ‘C,’ ‘D’ or ‘F’ grade to hospitals across the country based on over 30 performance measures reflecting the prevention of errors, accidents, injuries and infections. This Leapfrog recognition comes on the heels of multiple other recent quality and safety awards that ChristianaCare has received, including: • ChristianaCare was recognized as one of the best hospitals in the nation by Money in its 2025 hospital rankings, making it the only hospital in Delaware to achieve this distinction. • ChristianaCare is ranked by Newsweek among the World’s Best Hospitals and rated by U.S. News & World Report as the No. 1 hospital in Delaware. • ChristianaCare earned the Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN) for three of its intensive care units: the Medical Intensive Care Unit (MICU), the Surgical Critical Care Complex (SCCC), and the Transitional Surgical Unit (TSU) at Christiana Hospital in Newark, Delaware. • ChristianaCare is the only four-time Magnet-designated health care organization in Delaware, recognized for continued dedication to excellence and innovation, high-quality patient care and experience, nurse engagement and work culture.
From Saver to Spender: Navigating the Retirement Mindset Shift
Let’s start with a familiar—and slightly ridiculous—scene: a retired couple with $750,000 safely tucked away in investments, quietly nibbling no-name tuna on toast while muttering, “We just can’t afford steak anymore.” Sound absurd? Sadly, it’s not fiction. Despite having ample savings, many retirees live with perpetual financial anxiety, clinging to their nest egg as if it were their last roll of toilet paper during a pandemic. Meanwhile, they try to survive solely on government pensions, making life unnecessarily stressful and, let’s face it, a bit joyless. I've wrestled with this as someone who entered retirement earlier than expected. Years in finance taught me how to budget, invest, and plan, but transitioning from saving to spending required a whole new mindset. I learned quickly that being financially “prepared” doesn’t mean you’re emotionally or psychologically ready to spend. So, what’s going on here? The Hypothesis: Individuals Prefer Spending Income Rather Than Saving Retirees prefer spending income (pensions or annuities) rather than withdrawing from savings or investment accounts. This isn’t just a quirky behavioural trend—it’s a deeply ingrained bias, and neuroscience supports it. Research by Michael S. Finke, a professor at The American College and noted researcher in retirement economics, revealed that retirees tend to spend most of their guaranteed income but only withdraw about half of their savings. In his words: “Retirees spend lifetime income, not savings.” The implication is clear: it’s not about how much money you have but how it feels to use it. This is partly due to what behavioral economists call “mental accounting.” We categorize our money into imaginary buckets: income is for spending, and savings are for safekeeping. Unfortunately, this can lead to financially irrational and highly risk-averse behaviors, such as eating cat food while having six figures in a TFSA. The Neuroscience of Spending Fear Add a little neuroscience, and the story deepens. As we age, changes in the brain, particularly in the prefrontal cortex, can affect how we assess risk and manage uncertainty. This can lead to: • Increased loss aversion: We more acutely feel the pain of spending or loss. • Decision paralysis: We delay or avoid withdrawals, even when reasonable. • Heightened anxiety about the future: We fear running out more than we enjoy spending in the present. This Fear of Running Out (FORO), which I’ve written about in a previous post, keeps many retirees in a defensive crouch, emotionally hoarding their savings rather than using them to enrich the years they worked so hard to reach. It’s no wonder money stress impacts us so deeply—our brains are wired that way. From an evolutionary perspective, our minds are designed to fear scarcity because running out of resources once posed a real danger. When we perceive that threat today, whether it’s a dip in our investments or rising grocery bills, our brain shifts into fight-or-flight mode and begins releasing cortisol—the stress hormone that heightens our anxiety. Then our amygdala, that little alarm system in our brain designed to protect us from danger, can’t differentiate between a financial crisis and a sabre-toothed tiger. So, it reacts similarly, nudging us toward quick, often irrational decisions. Sometimes that means freezing and doing nothing; other times, it leads to panicking and regretful choices. Understanding how our brains function under financial stress allows us to step back, breathe, and make better, calmer decisions—ones that serve us, not scare us. Retirement can be wonderfully freeing—no more commutes, no more meetings—but let’s be honest: it also comes with a significant shift in financial responsibility. Without that steady paycheck, it’s completely normal to feel uneasy about how you'll manage your money, especially when unexpected expenses arise. Sure, there are mindset tools and mental prep strategies that can help ease that existential “What now?” feeling before retirement. But let’s be specific—here are the real, concrete financial stressors that keep many retirees awake at night: • Not Enough Income: One of the biggest fears? Your savings won’t stretch far enough to support the life you want—or handle surprises. • Healthcare Costs: As we age, medical expenses climb. It’s not just the big stuff, either. Even prescriptions and dental bills can blow a hole in your budget. • Market Ups and Downs: A stock market dip can uniquely affect retirees. Observing your investments fluctuate can cause genuine anxiety regarding your income, especially in today’s “trade war” environment. • Inflation: We all feel it. The gradual rise of higher prices erodes your purchasing power, making that carefully saved nest egg feel less secure. • Living Longer Than Planned: It's both a blessing and a challenge. If you're healthy and living well into your 90s (and many do), the big question becomes: will your money last as long as you do? Here’s the good news: when you acknowledge these risks and build a plan around them, you exchange fear for control. And with power comes clarity, confidence, and significantly less stress. That’s when you can truly enjoy retirement—on your terms. How to Flip the Script: Make Savings Feel Like Income So, how can retirees overcome this psychological hurdle? Here are 3 powerful strategies: 1. Create Artificial Income Streams Turn a portion of your savings into predictable, automatic income. This could mean: • Setting up regular monthly withdrawals from an RRIF • Purchasing an annuity • Utilizing a bucket strategy, in which one portion of savings is maintained in a cash-like account to replicate a paycheck When money shows up like a salary, you’re more likely to feel permission to spend it. 2. Use Home Equity as a Back-Up Income Source A secured line of credit (HELOC) or a reverse mortgage can serve as a “Plan B” or income buffer. Knowing that the funds are available can alleviate anxiety, whether you use them or not. 3. Involve Family in Income Planning Sometimes, the best way to reframe a spending decision is through conversation. Adult children or trusted advisors can help develop a spending strategy that feels both secure and reasonable. Families can be invaluable in helping you design: • Emergency funding plans for unexpected expenses like healthcare • Gifting strategies (Want to help the kids or grandkids? Do it while you’re alive to see the joy!) • Income simulations replacing a regular paycheck Open conversations can also help uncover mismatched expectations. For instance, some older adults worry that spending their savings will leave less of an inheritance for their children, which might cause disappointment. But in many cases, their children would much rather see their parents use that money to care for themselves and enjoy their retirement years. The great irony of retirement? The hardest part isn’t building wealth; it’s allowing yourself to enjoy it. So, let’s retire the notion that frugality is forever. Replace the guilt of spending with the confidence of an income strategy. And if you're facing your savings with trepidation, remember: cat food may be a pantry staple for your pet, but it’s no reward for 40 years of hard work. Retirement isn't merely a financial phase—it’s a shift in mindset. That shift begins when we stop hoarding and start living.
