Week 4: Skin Comprehensive SOAP Note

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Week 4: Skin Comprehensive SOAP Note

Week 4

Skin Comprehensive SOAP Note

Patient Initials: D.W.              Age: 32                                   Gender: Female

SUBJECTIVE DATA:

Chief Complaint (CC) (Graphic 2): “I feel less confident around people, including my husband, and I cannot go out to swim or wear bikini or crop tops.”

History of Present Illness (HPI): D.W. is a 32-year-old single African American woman who is 29 weeks pregnant and presenting at the clinic with complaints of increasing stretch marks in the past one and a half months. D.W. claims that due to the stretch marks, she has lost confidence and self-esteem. She denies feeling any pain in places of the abdomen but explains that the area might be “itchy” and that the lines are continuing to darken. She claims that since she cannot wear a bikini, crop top, or swimsuit, she would like anything to reduce the stretch marks. She indicates 0/10 for reported pain on the pain scale and denies fever. Over-the-counter cocoa butter was ineffective in eliminating or reducing stretch marks. She also thinks her stretch marks are related to weight gain.

Medications:

  1. Prenatal Rx: 1 tablet daily
  2. Amlodipine for HTN: 10 mg daily
  3. Albuterol 90mcg for Asthma
  4. Cortisone OTC for itching skin: Applies at least 6 times daily

 

Allergies: Patient reports she is allergic to dust, mold, pollen, and metronidazole

Past Medical History (PMH): The patient developed HTN when she was 24, asthma at 4 years, although controlled, and allergic rhinitis at age 7. She also has past medical history of bacterial vaginosis, controlled with medication, and anxiety, which was managed without medication.

Past Surgical History (PSH): The patient underwent a surgical report of the umbilical hernia in 2006.

Sexual/Reproductive History: D.W. reports that she is married with one child, which she conceived at 26 years. This is her second pregnancy. She is sexually active and not on using condoms. She has one sexual partner, and together they go for regular testing for STIs, every four months.

Personal/Social History: She is married and currently lives with her husband. She has an extended family comprising of her mother and father and two brothers.

Health Maintenance:

  • She does not smoke
  • She maintains one sexual partner
  • Maintains a healthy diet, although she has experienced weight gain during pregnancy.
  • She maintains a healthy, supportive relationships with members of the extended family and friends.

Immunization History:

  1. Covid vaccination
  2. Influenza vaccine: 09/10/2019
  3. Tdap: 07/4/2020
  4. Measles and Rubella

Significant Family History: She has an extended family comprising of the mother, father and two brothers. Her grandparents are dead. The mother, 60, has a history of asthma and depression. The father, 63, has a history of diabetes. The brothers are 35 and 27 years and have no medical history.

Review of Systems:

General: The patient reports fatigue over the last two months. She denies fever, syncope, lightheadedness with standing or ambulation, or chills. She reports sleeping 7-10 hours a day. She reports pervasive weight gain over the course of her pregnancy, gaining about 10 pounds.

            HEENT

Respiratory: Patient reports a history of asthma. Denies history of pneumonia, dyspnea or hemoptysis. Reports dyspnea during vigorous physical activities like running or walking fast.

Cardiovascular/Peripheral Vascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Gastrointestinal: The patient reports diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Patient reports experiencing constipation.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color.

Musculoskeletal: The patient reports occasional muscle pain and weakness. Denies back pain and muscle or joint stiffness.

Neurological: Denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

Psychiatric: Patient reports a history of anxiety, controlled nonmedically through meditation and physical exercise.

Skin/hair/nails: Patient indicates intermittent abdominal pruritus, scalp dandruff. Patient denies dermatitis on other body areas, spontaneous bruising, brittle hair, yellowing nails, or fungal infections. She reports itching, controlled using Cortisone OTC.  

OBJECTIVE DATA:

Physical Exam:

Vital signs: temp: 98.6F, B.P.: 100/65, P: 85, R.R.: 18, pain: 0/10 Ht: 5’5 feet, Wt.: 167 lbs., BMI: 27.8

General: Well-nourished and groomed AXOx4 32-year-old Black female, with appropriate mood, bright affect, and polite.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Chest/Lungs: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is within normal range, and capillaries refill within two seconds.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Abdomen: Normal active bowel sounds x4. No rebound tenderness X 4. Soft abdomen. No organomegaly. Fundal distance 30cm

Genital/Rectal: D.W. decline, reporting seeing a gynecologist routinely.

Musculoskeletal: Normal range of motion. Low muscle mass for age. No signs of swelling or joint deformities. Muscle and back pain rated 0/10.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear.

Skin: Multiple stretch marks visible on the abdomen; color nigrae and albae. Noted skin xerosis to the abdomen, linea nigra vertically from pubic bone to intermediary breast. No lymph nodes on palpation. Severe striae as indicated by TSS:> 18

Diagnostic results:

  1. HCT – 36
  2. WBC 5.89
  3. Albumin – 3.7
  4. Sodium – 135
  5. Potassium – 3.7
  6. AIC – 4.6
  7. Fibrinogen – 215
  8. Rh negative

ASSESSMENT:

Primary diagnosis:

  1. Striae gravidarum and Linea Nigra:

Stretch marks, or striae gravidarum, develop in roughly 50 to 90% of pregnant women as the uterus grows inside the abdominal cavity and separates the connective tissue beneath (Oakley & Patel, 2022). Early stretch marks are reddish-purple and develop as skin collagen is damaged and blood vessels enlarge. White or brown mature stretch marks result from melanocytes or pigment-producing cells dying due to collagen remodeling. Stretch marks most frequently appear on the breasts, thighs, and abdomen (Dai et al., 2021). A woman’s skin type and family history affect the thickness of the striae. The weight gain D.W. experienced could explain the striae gravidarum, the first confirmed diagnosis, vividly noticeable to her abdomen.

Linea is a brown line visible on the abdomen, running from the umbilical to the symphysis pubis. Usually, around the second or third trimester of pregnancy, linea nigra symptoms manifest. Linea nigra hyperpigmentation is brought on by hormonal fluctuations in progesterone and estrogen during pregnancy, which lead the cells to stimulate melanocytes in the skin more (Barnawi et al., 2021). The skin’s increased melanocyte count is what makes the abdomen darker. Linea nigra is also vividly noticeable on D.W. abdomen, confirming it as the second diagnosis.

Differential Diagnosis

  1. Linear Focal Elastosis: Uncertain etiology characterizes linear focal elastosis (LFE), an unusual benign acquired elastotic disease. Clinically, it is distinguished by several asymptomatic, raised, yellowish striae-like lines or bands dispersed horizontally throughout the lower and middle portion of the posterior trunk (Florell et al., 2017). The dermis’s focused increase in elastic fibers is the histological sign of LFE. The most common differential for LFE is Striae distensae.
  2. Steroid Induced Skin Atrophy: Topical steroids applied excessively on the skin might lead to steroid-induced skin atrophy. D.W.  exceeded the recommended dosage by using cortisone at least six times daily. Two to three times a day is recommended for using cortisone cream. When applied excessively, topical cortisone creams can lead to lipocortin production that blocks enzyme phospholipase A2, resulting in erythema and striae distensae (Niculet et al., 2020). Protein catabolism and increased mitotic activity caused the enzyme phospholipase to develop, which helps to reduce inflammation. As seen in striae distensae, the atrophy brought on by excessive topical steroid use can elevate the skin, create vasoconstriction, and cause itching.
  3. Cushing’s Syndrome: Cushing’s syndrome frequently presents as different skin disorders because of endogenous glucocorticoids and hypercortisolism. Although miscarriages are uncommon during pregnancy, they are highly likely when high blood pressure is present (Chaudhry & Singh, 2022). Striae distensae, a Cushing’s syndrome-related condition, results in dark, medium-sized to wide marks on the back, hips, thighs, and belly. Stretch marks are caused in patients with this illness by significant weight gain, high cortisol levels, and thin skin.
  4. Pruritic Urticarial and Plagues of Pregnancy (PUPPP): PUPPP can develop at the end of the second trimester and continue into the third trimester in places including the belly, legs, and forearms (Ishikawa-Nishimura et al., 2021). D.W.’s belly shows extensive striae, which she describes as itchy. Target lesions on the abdomen might appear in PUPPP patients as itchy, edematous eczema lesions resembling stretch marks or a combination of stretch marks and eczema. Owing to PUPPP’s pathophysiology, it frequently goes undetected and eludes treatment during pregnancy. In PUPPP, Th2 cytokines such as IL-9 and IL-33 are upregulated. These cytokines target body parts where there is an excess of cortisol and cause hyperpigmentation, skin eruptions, and patchy white lesions with stretch marks.

Week 4: Skin Comprehensive SOAP Note

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

 

References

Barnawi, A. M., Barnawi, G. M., & Alamri, A. M. (2021). Women’s Health: Most Common Physiologic and Pathologic Cutaneous Manifestations During Pregnancy. Cureus, 13(7), e16539. https://doi.org/10.7759/cureus.16539

Chaudhry, H. S., & Singh, G. (2022). Cushing syndrome. In StatPearls [Internet]. StatPearls Publishing.

Dai, H., Liu, Y., Zhu, Y., Yu, Y., & Meng, L. (2021). Study on the methodology of striae gravidarum severity evaluation. Biomedical engineering online, 20(1), 109. https://doi.org/10.1186/s12938-021-00945-w

Florell, A. J., Wada, D. A., & Hawkes, J. E. (2017). Linear focal elastosis associated with exercise. JAAD case reports, 3(1), 39–41. https://doi.org/10.1016/j.jdcr.2016.10.012

Ishikawa-Nishimura, M., Kondo, M., Matsushima, Y., Habe, K., & Yamanaka, K. (2021). A Case of Pruritic Urticarial Papules and Plaques of Pregnancy: Pathophysiology and Serum Cytokine Profile. Case reports in dermatology, 13(1), 18-22. https://doi.org/10.1159/000511494

Niculet, E., Bobeica, C., & Tatu, A. L. (2020). Glucocorticoid-Induced Skin Atrophy: The Old and the New. Clinical, cosmetic and investigational dermatology, 13, 1041–1050. https://doi.org/10.2147/CCID.S224211

Oakley, A.M., & Patel, B.C. (2022). Stretch Marks. In: StatPearls [Internet]. StatPearls Publishing.

 
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Bipolar Illness (BD)

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Bipolar Illness (BD)

Bipolar Illness (BD)

By (Student Name)

Bipolar Disorder Depressed

Depression in people with bipolar illness (BD) poses significant clinical difficulties. Depression, the most common psychopathology even in BD that has been treated, is linked to excess morbidity, mortality from co-occurring general medical illnesses, and a high risk of suicide. Risks for cardiovascular disease, metabolic syndrome, diabetes, and other medical conditions, as well as the accompanying mortality rates, are many times higher in BD than in the general population or those with other psychiatric conditions (Baldessarini et al., 2020). The likelihood of suicide among people with BD is 20 times higher than the rate for the general population and is higher than the rate for those with other severe psychiatric conditions. In BD, hospitalization, time spent depressed, and mixed and depressive phases are all highly linked to suicide.

Signs And Symptoms

Patients with BD frequently fear, try to avoid, report, and seek therapeutic assistance for depression. On the other hand, they might not regard little improvements in mood, vigor, activity, or libido as clinically significant hypomanic symptoms and might even enjoy such states (Barney, 2022). Diagnostic ambiguity is pervasive early in the illness and the absence of corroborating information from a family member or close friend. Initially undiagnosed, bipolar disorder (BD) is characterized by recurrent bouts of mania or hypomania that alternate with depressive episodes (Barney, 2022). Bipolar disorder’s depression phase can cause people to feel down, anxious, or empty, have little to no energy, feel like they cannot enjoy anything, sleep too little or too much, struggle to get out of bed, eat too little or too much, struggle to concentrate or remember things, struggle to make decisions, and even consider suicide or death. People may experience some or all of these symptoms. Bipolar disorder patients can experience extreme sadness and high energy levels (Barney, 2022). Those who experience depression for an extended period, often at least two weeks, are more likely to be in the depressive phase of BD. Patients may experience these episodes infrequently or frequently each year.

Pharmacological Treatments

Pharmacological treatment for bipolar disorder depressed includes FDA-approved drugs such as olanzapine and fluoxetine (OFC), quetiapine, lurasidone, cariprazine, and lumateperone. Other common BD-D treatments include classic mood stabilizers and antipsychotics (Yalin & Young, 2020). The first medication that the US FDA expressly approved to treat BD-D was OFC. While treating BD-D, lurasidone is taken alone or in conjunction with lithium or valproate. Cariprazine lessens the symptoms of depression. Recently, lumateperone was licensed for treating depression in either BD-I or BD-II disorder as a monotherapy or as an additional therapy with lithium or valproate. Lithium is beneficial in the short-term management of mood and prevention of mania, and it may be especially effective in a subset of patients (Yalin & Young, 2020). Asenapine, risperidone, clozapine, aripiprazole, and ziprasidone have not received FDA approval.

Nonpharmacological Treatments

Common nonpharmacological treatments for BD-D are electroconvulsive therapy and cognitive-behavioral therapy. Electroconvulsive therapy (ECT) delivers a rapid clinical reaction and can be utilized in urgent clinical conditions, including suicidal behaviors, severe psychosis or catatonia (Levenberg & Cordner, 2022). Patients with BD-D typically notice improvement after seven ECT sessions, while the number of sessions required varies considerably. There is a relatively minimal probability of negative side effects with psychotherapy. Pharmaceutical therapy is supplemented by cognitive behavioral therapy (CBT). CBT has been linked to decreased BD-D relapse rates and improved depressive symptoms.

Appropriate Community Resources and Referrals

NAMI and NAMI Affiliates provide people with information about various community resources and support on an individual and family level. For questions concerning bipolar disorder and available resources, contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org. The Depression and Bipolar Support Alliance (DBSA) is a national nonprofit that assists people with depression and bipolar mood disorders. The group also provides a support system for parents of kids who have pediatric mood disorders. Assistance is provided through local chapter meetings and online tools like educational videos, discussion forums, and support groups. The American Academy of Child and Adolescent Psychiatry (AACAP) is a prestigious nonprofit group of doctors and other mental health specialists committed to assisting kids, teenagers, and families experiencing mental, behavioral, or developmental issues. The AACAP offers information for parents on its website, including a link to a local pediatric and adolescent psychiatrist.

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

Barney, A. (2022). Depression in Bipolar Disorder: What You Can Do. https://www.webmd.com/bipolar-disorder/guide/depression-symptoms

Levenberg, K., & Cordner, Z. A. (2022). Bipolar depression: a review of treatment options. General Psychiatry, 35(4).

Yalin, N., & Young, A. H. (2020). Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options?. Neuropsychiatric disease and treatment, 16, 1459–1472. https://doi.org/10.2147/NDT.S245166

 
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Letter of Analysis – Becoming a Better Academic Writer

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Letter of Analysis – Becoming a Better Academic Writer

Letter of Analysis - Becoming a Better Academic Writer

Dear Royce,

I went through your classical argument and identified the following:

Praise

Your thesis or focus of the paper is clear and well developed, and sustained throughout the paper. The essay focuses on the importance of communication in the clinical environment and the consequence of communication failure. The thesis highlights the problem statement indicating that not all members are involved in communication currently, the interventions to enhance communication, including using a standardized checklist, participating in simulation-based training, and providing education on the communication process to every member, and the outcome, which is improved communication among interdisciplinary team members. These thesis elements are sustained throughout the paper, with supported information from current, peer-reviewed studies. You did well in this section, and you achieved your stated purpose. I was also impressed with your idea development corresponding to the thesis. Your reasoning is clear and logical, and every statement and point developed or argument brought forward is well-thought and convincing. Regarding idea development, I am convinced you did a proper job, which helped sustain the thesis elements throughout the paper and deliver a compelling argument.

(Letter of Analysis – Becoming a Better Academic Writer)

Recommendations

However, I have concerns about some elements of writing that you need to improve to become a better academic writer. Your thesis and idea development is proper, but your organization or rhetorical arrangement, paragraph organization, and transitions within the paragraphs need improvement. Although the ideas are well developed, the organization is flawed and sometimes fails to support the focus and unify the ideas in your essay. The organization contains gaps that, if addressed, would make the essay more aesthetic and free-flowing. Notably, the organization does not attend to the APA style regarding heading levels. The level one headings in a classical argument are the introduction, background, body (argument), opposition, refutation, and conclusion. I am more interested in the body section of the paper. Based on your thesis and main ideas, the interventions shared are subtopics within the body section and should be developed as level two headings rather than level one. Also, it is vital to use heading levels provided in word to specify level one and level two headers.

Your paragraph organization and transition within the paragraphs are a major concern. Often, a paragraph has a topic sentence, evidence, critical thinking, and a transition, meaning that a paragraph requires at least four sentences. Some paragraphs have less than four sentences and do not follow the basic paragraph model. For instance, paragraphs one and two have three sentences. Paragraph four has two sentences. Paragraph nine has three sentences. Your paragraphs should follow the basic model to be more convincing and make your essay more robust. Also, you mention research studies in some paragraphs without in-text citations, for instance, in paragraphs one, three, and five. Your refutation paragraph is not evidence supported. Notably, most of your citations are indicated at the end of the paragraph instead of within the paragraph and at the end of the evidence sentence (s). Proper citations would make your work more credible and reliable.

(Letter of Analysis – Becoming a Better Academic Writer)

Strategies for Improvement

Based on these concerns, I would advise that your review essay structuring or rhetoric organization and paragraph structuring and transition notes provided by the instructors. To improve essay structure:

  1. The Paragraph Shuffle: Create a set of index cards, with one card for each paragraph in your essay. Write one idea per index card.  If you have more than one idea in each paragraph, write the second (and third, etc.) idea on a separate card.  Now, shuffle the cards.  Inspect the order.  Try rearranging the cards to deliver your focus, ideas and overall message more effectively.
  2. Color The Categories: Use a highlighter to separate your ideas into categories. Use one color highlighter to mark all of your sentences dealing with one category in your essay. Use a different color to code the second category, etc. Now organize your essay into matching colors/categories

To improve paragraph structuring and transition within paragraphs, I recommend:

  1. Basic Paragraph Model: Use this paragraph model to make sure your body paragraphs are developed and organized so that readers can clearly understand the relationship between your ideas and the progression of your thoughts.
    1. Topic Sentence: states the main idea of this paragraph and shows how it supports the thesis
    2. Evidence: expert opinion, example, fact, statistical, or logical argument
    3. Critical Thinking: analyzes, synthesizes and/or evaluates the evidence
    4. Transition: makes a connection between the main idea of this paragraph, the thesis statement of the paper, and the main point of the next paragraph.
  2. Transition Test: or Q & A
    1. Look at the last sentence of your body paragraph.
    2. Write three questions about your main idea. Begin each question with how, why, or what.
    3. Now look at the first sentence of the following paragraph–does it answer or respond to any one of those implied questions? If not…
    4. Write the answer to the question…
    5. That answer may fit as the first sentence of your paragraph that already exists.
    6. OR! You may need to create another new paragraph.
 
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Consumer Health Information Website Analysis Paper

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Consumer Health Information Website Analysis Paper

Consumer Health Information Website Analysis Paper

Consumer Health Information Website Analysis Paper

The world is in an information age as consumers seek more information to understand products, including health products. Concurrently, more information is available about health on multiple online sources, readily available to everyone with internet access. However, the credibility of the information varies because most people present as health experts on their websites, providing health information and advice without supporting evidence or authority (NIH, 2023). Most websites are for sale, and only a few provide authentic and evidence-based information for educational purposes. This paper addresses diabetes mellitus and analyzes a website offering information on diabetes mellitus, including its authority, credibility, and adequacy.

Diabetes Mellitus

Diabetes mellitus is a metabolic illness that involves abnormally high glucose levels. It is a chronic disease occurring due to impaired insulin secretion, resistance to insulin peripheral actions, or both (Xu et al., 2018). Diabetes mellitus significantly impacts the quality of life and can damage other body organs and systems, making individuals disabled and living with multiple health complications like retinopathy, nephropathy, and neuropathy (Liu et al., 2020). Diabetes increases the risk of macrovascular complications two to four times, making an individual more susceptible to cardiovascular diseases.

Diabetes mellitus is classified into type 1 diabetes, type 2 diabetes mellitus, and gestational diabetes. Type 1 diabetes is marked by autoimmune damage of insulin-producing beta cells in the pancreas, resulting in insulin deficiency (Sapra & Bhandari, 2022). It can develop at any stage of life but is more common among children and adolescents. Type 2 diabetes mellitus accounts for 90% of all diabetes mellitus cases, and its etiology is linked to insulin resistance (Sapra & Bhandari, 2022). Type 2 diabetes mellitus is more common among adults, particularly those above 45 years old, although cases are increasing among children and young adults due to sedentary lifestyles and calorie-dense foods. Gestational diabetes occurs during pregnancy due to hyperglycemia (Sapra & Bhandari, 2022). Risk factors include age, ethnicity, family history of diabetes, physical inactivity, obesity, and smoking.

Website Description and Analysis

The American Diabetes Association (ADA) website provides information, services, and support to ensure a life free of diabetes and associated burdens or consequences. The organization’s mission is to prevent and cure diabetes and enhance people’s lives (ADA, n.d.). The organization owning the website fund research towards diabetes prevention, cure, and management, delivers associated services to American communities, offers objective and credible information, and gives voice to those facing denied rights due to diabetes.

Overall, the web pages are well arranged with working buttons to navigate the website from one page to another. The pages are visible at the top of the websites, and the reader can easily go to the webpage they are interested in. It is easy to find information. The website provides previews for the various elements and a “Learn More” or “Get Started” button that directs the reader to more information about a particular topic. The website is not text-dense and easy to read. If the reader requires more information, they can click the “Learn More” or “Get Started” button. The colors contrast perfectly, and the fonts are large enough, making reading easy. The website looks professional. The only issue is the pop-ups about donating that come up every time the website is refreshed or opened again.

The American Diabetes Association sponsors the websites. It has memberships who donate to the websites, but anyone is open to donating. The website is updated annually, but it can be more frequent when new information, evidence, or regulatory changes are made, and it has to incorporate them (ADA, n.d.). The website was created in 1995. It was last updated as recently as December last year. The website does not state whether the content is medical advice or not. All Americans comprise the intended audience because it provides information to prevent, treat, cure, and manage diabetes. It also specifically targets medical professionals, community groups, and students with the latest diabetes research and treatment and general information to enhance awareness, knowledge, and attitudes regarding diabetes prevention, cure, and management (ADA, n.d.). The information presented is appropriate for the general public and people of all ages and ethnicities.

Information Credibility

Authority

Behind the American Diabetes Association, which sponsors the website, is a network of over 565,000 volunteers, including their families and caregivers and a professional society of over 12,000 healthcare professionals and 250 staff members (ADA, n.d.). Professionals working with ADA have the expertise and authority to publish information on the websites in various forms, including panel discussions and research. ADA network of professionals offers exclusive education, career development, engagement resources, and other information and education materials for the diverse audience of the general public and healthcare professionals (ADA, n.d.). The website publishes journals providing necessary research information related to diabetes. Readers can access multiple abstracts, which also include the authors’ information and the various institutions they are affiliated with. Many are affiliated with universities and medical institutions, and some are members of the ADA research community, giving them credibility to conduct research and publish information on the website. The website does not offer a place to contact the authors, but it has a center for information where readers can leave or post their inquiries.

Bias

The website’s authors are multiple, and most publications are new updates on diabetes and research journals. There are publications on general health information, including food and nutrition, weight loss criteria, health and wellness, and diabetes care products, without mentioned authors, only the date when they were last updated (ADA, n.d.). The website is professional and does not indicate any form of bias in the information published. The publications are not promoting any products but offer information to help people prevent, cure, and manage diabetes, including information on lifestyle choices that enhance the quality of life.

Supporting Evidence

ADA website is a professional one with various types of publications. Some publications provide general information on various topics without reference lists indicating supporting evidence. On the other hand, there are journals or research publications available as abstracts for the general public, but full articles can be accessed only by members (ADA, n.d.). The journals have a complete list of works cited, referencing credible and authoritative sources. The information presented as research publications is valid and supported by evidence. The website is committed to providing objective information, and its purpose is clear. The information posted on the website includes peer-reviewed and scholarly articles which are credible, reliable, and valid sources of information in terms of accuracy. The publications providing general information are consistent with the wide knowledge of diabetes. Readers can click on multiple links directing them to additional, valuable resources with minimum effort, although it is easier for members who can access full publications.

Adequacy

The website is educative, providing informative publications in different forms, including statistics, research publications, education guides on healthy living, and additional tools, products, and resources the audience can access to learn more about diabetes prevention, treatment, and management (ADA, n.d.). The educational information is adequate, and the audience does not have to go elsewhere to get answers about topics presented on the websites. The consumer can access general information on the various web pages and gain more information by accessing multiple research journals published on the website. The information targets every individual, and the level of information sophistication, especially on publications providing general information on diabetes, is elementary to ease understanding and provide uncomplicated data. More technical and advanced information is provided in the research journals. The website communicates its clear purpose through its mission and vision statements, and the information published on it corresponds with its purpose. The website is intended to educate the general public on diabetes.

References

American Diabetes Association (ADA). (n.d.). Diabetes. https://diabetes.org/

Liu, J., Ren, Z. H., Qiang, H., Wu, J., Shen, M., Zhang, L., & Lyu, J. (2020). Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention. BMC public health, 20(1), 1415. https://doi.org/10.1186/s12889-020-09502-x

National Institute on Aging (NIH). (2023, January 12). How To Find Reliable Health Information Online. https://www.nia.nih.gov/health/how-find-reliable-health-information-online

Sapra, A., & Bhandari, P. (2022). Diabetes mellitus. In: StatPearls [Internet]. StatPearls Publishing.

Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L. G., Hu, F. B., & Bao, W. (2018). Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ (Clinical research ed.), 362, k1497. https://doi.org/10.1136/bmj.k1497

 
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Medication Guide – MDD

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Medication Guide – MDD

Medication Guide - MDD

Medication Guide

Introduction

WHO ranked major depressive disorder (MDD) as the third leading cause of disease burden, projected to be the leading cause of disease burden by 2030. Depression, in general, is the first-ranking cause of disability worldwide. It affects individuals across all populations, ages, and ethnicities. Still, it is significant among vulnerable populations like the elderly, youth, and individuals with physical illnesses like obesity, diabetes, and other chronic conditions. Older adults are at an increased risk of developing MDD, a typical cause of geriatric psychiatric disorders and a significant risk factor for disability and mortality among older patients (Zenebe et al., 2021). Depression is the most common mental health issue among older adults despite being undiagnosed in half of the cases. The paper address major depressive disorder among older adults, including causes, symptoms, diagnosis, and medications.

Major Depressive Disorder Causes and Symptoms

MDD etiology is multifactorial, including environmental, biological, genetic, and psychosocial factors. MDD is mainly attributed to neurotransmitter abnormalities, particularly dopamine, norepinephrine, and serotonin. It is indicated by the use of various antidepressants like selective serotonin receptor inhibitors, serotonin-norepinephrine receptor inhibitors, and dopamine-norepinephrine receptor inhibitors in treating depression (Bains et al., 2022). MDD is highly prevalent among mental health conditions, with a lifetime prevalence of around 5 to 17% and an average of 125. The disease is more common among women than men, almost double, and among individuals without close interpersonal relationships, such as those who are divorced, separated, or widowed, which is the case among many older adults (Bains et al., 2022). Most people with MDD present with symptoms including pervasive low and depressed mood, decreased interest and enthusiasm in previously pleasured activities, guilt and worthlessness feelings, low energy, poor or impaired concentration, and changes in appetite (Bains et al., 2022). These individuals also experience psychomotor retardation, agitation, sleep disturbances, and suicidal thoughts.

 

Figure 1: MDD causes and symptoms

MDD Diagnosis for the Elderly

Older people are a valuable resource in society, but many age-related actors influence their health and well-being by exposing them to multiple physical and mental illnesses. The elderly population is growing, and it will be the case going into the future, which has extensive economic, social, and health consequences in the world and the United States. The increasing aging population is attributed to reduced mortality and fertility rates and improved quality of life over the past two decades, leading to increased life expectancy. In 2019, older people aged 60 years and over were 1 billion, and the number will rise to 1.4 million by 2030 and to over 2.1 billion by 2050, and by then, 80% will live in low- and middle-income countries (Zenebe et al., 2021). With the increasing aging population, the incidence of mental health problems is also expected to increase, with depression being the most prevalent disorder. This population is categorized as vulnerable because of the high disease encounter associated with aging and the likelihood of experiencing multiple conditions that impede their functioning, including mobility, which is a barrier to healthcare access.

Figure 2: Depression prevalence by age

MDD among older adults is diagnosed through comprehensive psychiatric evaluation of the individual and mental health examination. The practitioners conduct a history and physical assessment, including medical history, family history, social history, alcohol and substance use history, and psychiatric history (Bains et al., 2022). Among older adults, collateral information from family members or friends is immensely important in psychiatric evaluation because, in some cases, older adults experience cognitive decline and judgement impairment. A comprehensive physical examination, including a neurological examination, is conducted to help diagnose and rule out any root cause, organic or medical, of depressive symptoms. The diagnosis follows the ICD-10 or the DMS-5 criteria. According to the DMS-5 criteria, five of the following symptoms must be present for a diagnosis to be made: difficulty sleeping, loss of interest or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, difficulties concentrating or listening intently, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood.

Medication Treatment Options

Various modalities, including pharmacological, psychotherapeutic, interventional, and lifestyle changes, are used to treat major depressive disorder. Medication treatment includes FDA-approved medications, including all antidepressants, which are equally effective but with varying side effects profiles. Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment and include fluoxetine, sertraline, citalopram, paroxetine, and fluvoxamine (Bains et al., 2022). However, SSRIs can increase agitation and anxiety and cause indigestion, diarrhea or constipation, appetite and weight loss, dizziness, dry mouth, or blurred vision. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used among patients with comorbid pain disorders (Bains et al., 2022). SNRIs include venlafaxine, milnacipran, duloxetine, and levomilnacipran. However, these drugs can cause nausea, dry mouth, dizziness, headache, and excessive sweating.

Patients can also be prescribed serotonin modulators like vilazodone, trazodone, and vortioxetine (Bains et al., 2022). Despite their high effectiveness, serotonin modulators can lead to gastrointestinal adverse reactions, central nervous system adverse reactions, bleeding, sexual dysfunction, and hyponatremia. Possible treatment also includes atypical antidepressants like bupropion and mirtazapine, often prescribed as augmenting agents when an individual develops sexual side effects after using SSRIs or SNRIs (Bains et al., 2022). Common side effects of atypical antidepressants include lightheadedness, dizziness, and dry mouth. Additionally, mood stabilizers and antipsychotics help improve antidepressant effects (Bains et al., 2022). However, the patient can experience blurred vision, dry mouth, drowsiness, muscle tremors, and weight gain after taking mood stabilizers and antipsychotic medications.

Figure 3: Antidepressants commonly used to treat MDD

Medication Considerations of Medication Examples Prescribed

Older adults are vulnerable individuals, and most are experiencing multiple comorbidities and taking multiple drugs simultaneously. Therefore, optimizing drug therapy for older adults is crucial to ensure their safety and reduce the risk of medication-related complications. Prescribing medication among older adults is a complex process, and the practitioner has to consider the patient’s physiological status, drug effectiveness and toxicity, and potential side effects (Rochon & Schmader, 2019). Avoidable adverse drug events should always be evaluated when prescribing for older adults. The practitioner has to consider and review current drug therapy, discontinue ineffective therapy, review avoidable drug-drug interaction, and appropriate use of prescribed drugs or medication adherence.

SSRIs are commonly prescribed to treat MDD and used as first-line treatment. However, safety considerations for prescribing SSRIs are paramount to avoid complications like adverse drug events, drug-drug interactions, disabling side effects, and fatality. When prescribing SSRIs or selecting a specific SSRI, it is imperative to consider common possible complications like vascular events, which are life-threatening, patients at a higher risk of cardiovascular risk, and relevant comorbidity and co-medication (Mortensen & Andersen, 2022). Additional considerations include potential interaction with particular foods and drinks and the presence of diseases like diabetes, epilepsy, and kidney disease. The practitioner should evaluate current drug therapy because SSRIs can interact with some over-the-counter painkillers and herbal remedies.

Monitoring Labs and Comorbid Medical Issues

To date, there are no diagnostic laboratory tests available to diagnose MDD. However, labs can be used to exclude other medical illnesses that present symptoms as MDD, including complete blood cell (CBC) count, thyroid tests, fasting blood glucose tests, and folate and vitamin B12 tests. These lab tests are a vital consideration, especially for individuals experiencing multiple comorbidities, to determine the presence of depressive symptoms by excluding potential links to other illnesses presenting as MDD (Wainberg et al., 2021). The comorbidity of MDD with chronic illnesses like diabetes, obesity, and eating disorders should be monitored to determine how the pathologic processes associated with the diseases interact (Almeida et al., 2020). Other comorbid medical issues with MDD include psychotic disorders, OCP, anxiety disorders, and substance use. Their association with MDD must be evaluated to develop a comprehensive patient treatment plan and education plan. Identifying comorbidities is vital for accurate diagnosis and developing treatment and management strategies.

Special Considerations

When working with MDD patients, it is vital to consider laws like the Mental Healthcare Act of 2017 that explicitly describes the rights of individuals with mental illnesses, specifying ethical and legal responsibilities practitioners and the government have (Bipeta, 2019). The law corresponds with the fundamental rights of human beings and ethical principles, including autonomy, non-maleficence, beneficence, justice, confidentiality, informed consent, and boundary violations. Ethical issues and dilemmas associated with autonomy, respect of persons, informed consent, and beneficence can arise when working with MDD patients, hence the need for ethical imperatives like ensuring confidentiality and privacy, respecting autonomy and the law, demonstrating compassion, beneficence, and promoting justice, honesty, and fidelity (Bipeta, 2019). For instance, older people with cognitive decline need surrogates or caregivers to offer informed consent and address autonomy and confidentiality issues.

Cultural considerations are imperative in treating depression, especially for ethical or racial minorities. The epidemiology of depression varies across various racial and ethnic groups. This variability is due to contextual factors in the different groups, including cultural beliefs and practices, cultural adaptations, and intersectionality (Cardemil et al., 2020). Moreover, every culture looks at mental health differently, and practitioners should consider these differences in treating depression. Social determinants of health, including socio-economic status, family relationships, educational attainment, social isolation, and supportive relationships, should be considered when treating MDD because of their influence on development and progression of depression and healthcare access and service utilization for depression.

Figure 4: Ethical issues in psychopharmacology

Resources to Follow Up for more information

Multiple resources available in the community can offer more information regarding depression, including the National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), National Suicide Prevention Lifeline, American Psychological Association (APA), National Institute of Mental Health (NIMH), and Centers for Disease Control and Prevention (CDC) Division of Mental Health. These resources or institutions publish information on their websites accessible to the general public in search of further information on depression. The institutions are on a mission to reduce mental health concerns’ impact on American communities, hence providing a wealth of information and services accessible to all.

Prescription Examples

The patient will initially be prescribed FDA approved SSRIs, including citalopram, escitalopram, and fluoxetine.

Prescription 1

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Citalopram

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay, increasing to 40 mg/day after 1 week

Clinician Name: J.M.

Prescription 2

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Escitalopram

Dosage Form: Tablet

Quantity Prescribed: 10 mg PO qDay; may increase to 20 mg/day after 1 week

Clinician Name: J.M.

Prescription 3

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Fluoxetine

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay initial, and consider gradual increase after several weeks by 20mg/day, not exceeding 80 mg qDay

Clinician Name: J.M.

Conclusion

Major depressive disorder is a disabling illness among older adults and a significant contributor to the disease burden. MDD co-occurs with other illnesses, mostly age-related, including diabetes, psychotic disorders, anxiety disorders, and eating disorders, that make MDD treatment and management challenging. Pharmacological treatments effectively address MDD; SSRIs are prescribed as the first-line treatment modality. Considering that older people experience multiple comorbidities and are taking multiple drugs, it is vital to consider potential side effects, drug interactions, adverse events like complications, medication adherence, and drug effectiveness and appropriateness when prescribing medication for MDD. Legal, ethical, cultural, and social actors influence MDD development, progression and treatment perception, and these must be considered when working with MDD patients. More information on MDD can be obtained from CDC, ADAA, APA, NIMH, and NAMI websites and online publications.

References

Almeida, S. S., Zizzi, F. B., Cattaneo, A., Comandini, A., Di Dato, G., Lubrano, E., Pellicano, C., Spallone, V., Tongiani, S., & Torta, R. (2020). Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach. Frontiers in psychology, 11, 542444. https://doi.org/10.3389/fpsyg.2020.542444

Bains, N., Abdijadid, S., & Miller, J. L. (2022). Major depressive disorder (nursing). In StatPearls [Internet]. StatPearls Publishing.

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Cardemil, E. V., Noyola, N., & He, E. (2020). Cultural Considerations in Treating Depression. Handbook of Cultural Factors in Behavioral Health: A Guide for the Helping Professional, 309-321.

Mortensen, J. K., & Andersen, G. (2022). Safety considerations for prescribing SSRI antidepressants to patients at increased cardiovascular risk. Expert opinion on drug safety, 21(4), 467–475. https://doi.org/10.1080/14740338.2022.1986001

Rochon, P. A., & Schmader, K. E. (2019). Drug prescribing for older adults. Dostpuno na https://www. uptodate. com/contents/drug-prescribing-for-older-adults. Pristupljeno.

Wainberg, M., Kloiber, S., Diniz, B., McIntyre, R. S., Felsky, D., & Tripathy, S. J. (2021). Clinical laboratory tests and five-year incidence of major depressive disorder: a prospective cohort study of 433,890 participants from the UK Biobank. Translational Psychiatry, 11(1), 380.

Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Annals of general psychiatry, 20(1), 55. https://doi.org/10.1186/s12991-021-00375-x

 
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Analyzing Liability –  CapraTek Employee Thomas Lee

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Analyzing Liability –  CapraTek Employee Thomas Lee

Analyzing Liability -  CapraTek Employee Thomas Lee

Analyzing Liability

The purpose of this analysis is to examine a complaint letter from CapraTek employee Thomas Lee. It will identify potential legal liabilities based on U.S. laws relevant to the complaint letter. It will discuss the potential harm to the company, employees, and workplace culture if the complaint goes unattended. Furthermore, this analysis will identify preventative measures to avoid legal liability for the company and suggest viable legal defenses if the company is required to defend this complaint, including the specifics of this complaint letter. Finally, this analysis will address the ethical principles and implications of the complaint letter.

Summary of the Complaint

The complaint letter is by Mr. Thomas Lee about his disappointment with the company for failing to ensure a secure workplace for individuals from all backgrounds and nationalities. Mr. Lee is an American of Chinese origin who complains of racial discrimination at the workplace following the accusation that he brought COVID-19 to the workplace because he is Chinese. The employee presented a verbal complaint to the supervisor, who failed to listen to him and questioned Mr. Lee’s customs and beliefs. Mr. Lee says the workplace is hostile and intimidating, and he has received threats from other employees who have singled him out for allegations of spreading the virus on the basis of his origin and ethnicity, sending him negative messages through texts, emails, social media and telephone. Mr. Lee continues to point out that several people have died after exposure to Covid-19, insisting the company’s judgment and preparedness was the primary reason.

Furthermore, another letter by Karen Small, a security guard, confirms the allegation. She points out that she probably acquired the virus from Mr. Lee, who the company allowed into the premise, hence the disease spread. Mr. Lee is an American Citizen who has lived in Alabama and cannot contemplate why he is being singled out for spreading the virus merely because he is Chinese. Mr. Lee says the company has done nothing to address the situation and lacks leadership, which encourages the behavior. He is considering a lawsuit if the issue is not dealt with.

Associated U.S. laws or regulations and how they are relevant to the identified liability

First Mr. Lee complains of racial discrimination at the workplace, which Title VII of the Civil Rights Act of 1964 addresses. This Act makes it illegal to discriminate against people on the mere basis of their color, race, religion, national origin, or sex. For example, Hahn et al. (2018) provide that this Act is fundamental in ensuring racial and ethnic equity and eliminating discriminatory behavior, implying the Act corresponds to the identified liability of preventing racial discrimination based on color, race, gender, or nationality. The law protects all employees from retaliation if they decide to forward a claim on discrimination at the workplace.

Mr. Lee also points out that most people acquired and were exposed to the virus because of the company’s lapse in judgment and preparedness, addressed by the Occupational Safety and Health Act of 1970. The Act requires employers to keep the workplace free from hazardous conditions, stressing employees’ rights to information regarding the dangers in their job. For example, in Michaels & Wagner (2020), employers are legally required to offer an environment that protects employees from COVID-19 per OSHA provisions. Michaels & Wagner (2020) argue that only employers can make the workplace safe by enforcing OSHA guidelines, and a failure to do so is considered a non-adherence and non-compliance. This scenario implies that the OSHA is relevant to the identified liability of keeping employees safe from Covid-19 at the workplace. The law also protects employees from being punished if they decide to exercise their rights per OSHA.

The potential harm to the company, its employees, and its workplace culture that could result from a lawsuit emanating from the selected complaint

Suppose the company is found liable for non-compliance with Title VII. In that case, it could face penalties for intentional discrimination, enforced as either compensatory or punitive damage up to a maximum provided by the Title VII of the Civil Rights Act of 1964 according to the number of employees in the company. The company would have to pay either back pay, compensatory damages, or punitive damages. For instance, in Lund (2020), the case, titled Bostock v. Claton County, involves the Supreme Court upholding non-discrimination based on race and sex, against which an employer is liable and faces paying compensatory damages. This case implies that if the company is found liable under the interpretation of Title VII of the Civil Rights Act, it would have to pay compensatory damages to Mr. Lee.

Confirming liability would affect other employees, especially those of other nationalities, who have experienced the same and may also choose to forward their case. This liability would label the workplace as toxic, discriminatory, and lacking diversity. Suppose the company is found liable under OSHA for failing to protect its employees from Covid-19 exposure. In that case, it could face penalties based on the type of violation, ranging between $15,625 and $156,259 per violation. In this case, dealing with litigations for OSHA non-compliance will be costly for the company. For instance, Sadeh et al. (2022) address the cost impact of Covid-19 OSHA citations and specify that fines for non-compliance and regulatory violations significantly impact a company. If the company is found liable, it means that the company would also be liable for all other Covid-19-related cases, amounting to millions of dollars in fines and compensatory damages that would be detrimental to the company’s finances. It would also mean the work environment is unsafe, and the company cannot protect its most valuable resource, leading to a demoralized workforce.

Realistic preventative measures that could have avoided legal liability

The company must promote workplace diversity by developing and enforcing anti-harassment and anti-discrimination policies that condemn discrimination based on race, color, gender, ability or disability, sexual orientation, and other identifiers to protect employees from bullying and harassment. Cross-cultural or cultural sensitivity training and education would be necessary to ensure a discrimination-free environment. For example, Shepherd (2019) offers evidence supporting cross-cultural training, including diversity training, anti-racism raining, and micro-aggression training, effectiveness in enhancing cultural competence, safety, humility, and intelligence, which are integral in ensuring a workplace free from discrimination, harassment, and intimidation.

The training would include all employees because there are allegations of lapse in conduct and professionalism among low-level employees and supervisors. It would ensure that all employees respect cultural and racial differences, act professionally in conduct and speech, refuse to instigate, participate, or condone discrimination and harassment, and avoid race-based or culturally offensive acts, including humor and pranks (Shepherd, 2019). Systematic factors contribute to discrimination, harassment, and retaliation in the workplace. Therefore, the company should develop an effective internal complaints procedure and address such issues internally to avoid legal liability. These procedures, coupled with dispute resolution systems, can help prevent discrimination and harassment, as provided by Dobbin and Kalev (2020), who offer guidelines for making discrimination and harassment systems better.

Individuals and departments that would need to be involved in the proposed measures

Mr. Lee complained of harassment daily, from a fellow security guard to the supervisor. This case implies a lack of cultural sensitivity and awareness across employees of all levels. Therefore, all employees, including supervisors and managers, will be involved in the proposed measures, particularly the cross-cultural or cultural sensitivity training, and education. The Human Resources Department will be involved because it is responsible for outlining disciplinary action policies and procedures to respond to actions or behavior that violate the company’s policies. It will help formulate and enforce anti-harassment and anti-discrimination policies and formalize the internal complaints procedure to orient all employees on the code of discipline.

(Analyzing Liability –  CapraTek Employee Thomas Lee)

Viable legal defenses the company could assert in a litigation context to defeat the complainant’s claims

The complainant must prove that he experienced racial discrimination at the workplace. It appears to be a serious case because the allegations are confirmed by other complaints, implying that employees think Mr. Lee spread the virus under the company’s watch. The company would also have to prove beyond doubt that Mr. Lee did not experience racial discrimination or that if he did, it was unintentional because only intentional racial discrimination is ruled as non-compliance. The company can also counter the claim by stating a lack of substantial evidence indicating that Mr. Lee experienced racial discrimination. The company has to show current policies that protect employees from racial discrimination and how it enforces these policies to respond to complaints. If the company proves that Mr. Lee indeed brought the virus to the workplace, it can avoid legal liability. In the interview transcript, interviewees provide that the company developed safety rules and measures per CDC to protect employees from Covid-19 exposure. It has to prove this claim with substantial evidence to avoid legal liability, given that other complaint letters point to the lapse of judgment and preparedness as the primary cause of over 70% of infections and several wrongful deaths. Lastly, the company has to convince the jury that employees acquired the virus outside the workplace, which is beyond the employer’s control, to avoid legal liability.

Ethical implications of the scenario and measures that address ethical issues

Harassment and discrimination are among the most significant ethical issues companies like Capra Tek face today, especially due to the increased workforce diversities and individual differences. Harassment and discrimination occurring at the workplace can be catastrophic to companies like Capra Tek financially and reputationally. Racial discrimination and harassment in the workplace are perceived as ethical failures due to cultures or practices of disrespect, unfairness, and harm (Elias & Paradies, 2021). It violates human rights due to an unjustified distinction created by the nature of the work environment or policy failures. Racial discrimination negatively impacts the work environment and the company at large. Employees harassed and singled out by other employees, including managers and supervisors, feel unheard and unprotected by the company. As a result, it creates a toxic environment, forming divides between employees that are detrimental to the company. Employees of other racial and ethnic minorities or nationalities fear engaging or collaborating meaningfully when the company does not protect them from harassment and discrimination. It would mean increased absenteeism, turnover, poor performance, loss of income and litigation, and damaged relationships with other companies that employ an anti-racist or anti-discrimination approach. If the case is forwarded to the US Equal Employment Opportunity Commission (EEOC), it would have legal ramifications for the company, which is undesirable and harmful to the company’s reputation.

(Analyzing Liability –  CapraTek Employee Thomas Lee)

It is paramount companies like Capra Tek consider robust measures to curb ethical issues like racial discrimination and harassment. The company should be aware of the primary ethical principles that guide professional conduct, including justice and fairness, respect of persons, responsibility, and protection from harm. The company should also be aware of the anti-discrimination laws and regulations like Title VII of the Civil Rights Act of 1964 that protect employee from unjust treatment in the workplace. Additionally, companies like Capra Tek can adopt the ILPA Industry Code of Conduct Guidelines that provides all individuals to be treated equally in an organization, and a company should not tolerate discrimination based on age, gender, race, religion, sexual orientation, family status, disability, marital status, or political beliefs (Institutional Limited Partners Association, 2018).

The company is faced with enforcing these ethical principles, anti-harassment and discrimination laws, and the code of conduct guidelines as measures to ensure ethical practice in the workplace. To curb discrimination and racism, protect employees from bullying and harassment, and promote a diverse and inclusive environment where employees respect each other’s differences, the company should apply ethical decision-making or preventive measure framework. The Ethical Work Climate 2.0 theory by Weber and Opoku-Dakwa (2022) presents an ethical framework for Capra Tek. Adopting this model would help establish an ethical workplace, setting up the company to successfully address employee complaints, assess legal liability, and promote ethical decision-making (Weber & Opoku-Dakwa, 2022). The model sets the antecedents that shape the expectations for ethical behavior within the company and fosters employees’ ability to implement benevolent and principled climates, which help foster organizational commitment, job satisfaction, performance, well-being, and ethical behavior.

References

Dobbin, F., & Kalev, A. (2020). Making discrimination and harassment complaint systems better. WHAT WORKS? 24.

Elias, A., & Paradies, Y. (2021). The Costs of Institutional Racism and its Ethical Implications for Healthcare. Journal of bioethical inquiry, 18(1), 45–58. https://doi.org/10.1007/s11673-020-10073-0

Hahn, R. A., Truman, B. I., & Williams, D. R. (2018). Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-population health, 4, 17-24.

Institutional Limited Partners Association. (2018). Code of conduct: harassment, discrimination and workplace violence: Guidelines for the private equity ecosystem.

Lund, N. (2020). Unleashed and Unbound: Living Textualism in Bostock v. Clayton County. Clayton County (July 14, 2020). Federalist Society Review, 21, 20-15.

Michaels, D., & Wagner, G. R. (2020). Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic. Jama, 324(14), 1389-1390.

Sadeh, H., Mirarchi, C., Shahbodaghlou, F., & Pavan, A. (2022). Predicting the trends and cost impact of COVID-19 OSHA citations on US construction contractors using machine learning and simulation. Engineering, Construction, and Architectural Management (ahead-of-print).

Shepherd, S. M. (2019). Cultural awareness workshops: limitations and practical consequences. BMC Medical Education, 19(1), 1-10.

Weber, J., & Opoku-Dakwa, A. (2022). Ethical Work Climate 2.0: A Normative Reformulation of Victor and Cullen’s 1988 Framework. Journal of Business Ethics, 1-18.

 
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Topic 6 DQ 1 – Critical Synthesis of Research Evidence

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Topic 6 DQ 1 – Critical Synthesis of Research Evidence

 

Topic 6 DQ 1 - Critical Synthesis of Research Evidence

Topic 6 DQ 1

The literature evaluation table helps with the critical synthesis of empirical and theoretical research evidence for research support. The table includes various sections that help with adopting a proper reference for the article and evaluating the research questions, purpose, aim, hypothesis, research design, methodology, data analysis and interpretation, research findings, and limitations to the research. Other sections include future research recommendations and evaluating how the research study reviewed supports the research topic or question. For the DPI project, using the literature evaluation table is paramount to extract data effectively and conduct a rigorous synthesis and review. It helps develop a synopsis of each article, succinctly presenting all relevant information pertinent to the review and research support (Younas & Ali, 2021). Conducting a literature evaluation using the table helps me see the information at a glance, including frameworks and methods, strengths and limitations, the conceptual contribution of each article reviewed, and themes.

The most crucial criterion is key research findings. The primary aim of every research is to generate outcomes that are useful scientifically, clinically, or in other ways desired by the researchers. The other sections or criteria help evaluate the reviewed article’s reliability, validity, authority, and robustness. However, the research findings are the primary target and help determine the study’s relevance and whether it supports the research topic and questions. Although the level of evidence does not always signify the quality of the research or evidence, it is vital in establishing the best available evidence for the research purpose. The “Levels of Evidence in Research” helps categorize the reviewed studies by evidence level, and level 1 evidence is often perceived as the best or appropriate evidence for the research question (Simmons University, 2022). It also helps determine the internal validity of the various studies. The “Criteria for Acceptance Research” helps understand the requirements for appropriate practice questions, literature searches, or primary research studies for inclusion in the DPI project. It guides what to consider and include during the literature search and review.

References

Simmons University. (2022, March 3). Nursing – Systematic Reviews: Levels of Evidence. https://simmons.libguides.com/c.php?g=1023284&p=7412063

Younas, A., & Ali, P. (2021). Five tips for developing useful literature summary tables for writing review articles. Evidence-Based Nursing, 24(2), 32-34.

 
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Discussion 3 – Complementary and Alternative Medicine Research

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Discussion 3 – Complementary and Alternative Medicine Research

Discussion 3 - Complementary and Alternative Medicine Research

Discussion 3

Veziari et al. (2022) explore the barriers ad enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand, adopting a qualitative descriptive research design. To ensure ethical conduct, the researchers obtained consent before conducting the interviews. The researchers did not use participant identifiers but assigned each participant a unique alpha-numerical identification pseudonym that ensured data could be used to identify the participants. Participants were selected from a contact list of a survey completed previously examining the barriers to the research conduct and application. A non-probability self-selection was used in choosing participants to ensure an individual had adequate experience in the study phenomena and could offer information-rich data. The researchers did not emphasize or focus on rigid distribution because they needed robust information to study the phenomenon in detail, so they used the contact list of a previous study with participants with already diverse experiences in the phenomena. However, this approach creates a selection bias that can impact the research findings’ generalizability and reliability. For instance, using a non-probability selection gives other willing participants no chance of being in the sample, increasing the risk of undercoverage bias, which conflicts with the principle of justice and fairness (Barrow et al., 2022). Also, the selection is based on ease of access, which creates a sampling bias, according to Andrade (2021).

The participants selected for the study do not fit the criteria of a vulnerable population because the study included only researchers and practitioners from a previous contact list. Researchers and practitioners have professional knowledge and understanding of the research phenomena and do not fall within groups considered vulnerable, including ethnic and racial minorities, children, the elderly, the disabled, the socioeconomically disadvantaged, and those with disabling medical conditions. The participants only shared their opinions and perspectives on the study phenomena and were not subjected to any physical harm or discomfort, not that is documented. The participants were interviewed via video-conferencing at a convenient date and time. The steps taken to ensure the privacy and confidentiality of participants include obtaining consent and avoiding the collection of personal identifiers, instead using a unique alpha-numerical identification pseudonym that ensured data could be used to identify the participants.

References

Andrade C. (2021). The Inconvenient Truth About Convenience and Purposive Samples. Indian journal of psychological medicine, 43(1), 86–88. https://doi.org/10.1177/0253717620977000

Barrow, J. M., Brannan, G. D., & Khandhar, P. B. (2022). Research ethics. In StatPearls [Internet]. StatPearls Publishing.

Veziari, Y., Kumar, S., & Leach, M. J. (2022). An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study. Plos one, 17(2), e0264221.

 
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Scenario and Alternative Futures

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Scenario and Alternative Futures

Scenario and Alternative Futures

Organizations define their vision through strategic planning that helps identify their goals and objectives and strategies to achieve them within the desired framework. Planning for the future is a business best practice to remain relevant and sustainable. However, future planning needs an understanding of the potential situation, which can be accomplished through scenario frameworks that help organizations prepare for various alternative futures. Scenario frameworks provide organizational leaders with plans, budgets, and predictions to prepare the business for growth and the potential effects of future events. This paper provides a synthesis of various scenario frameworks and the application of a scenario framework to a pharmaceutical industry case study.

Part 1: Scenario Synthesis

Framework
Main Idea		 Day & Schoemaker, (2020) Godet & Roubelat, (2003) Hussain et al., (2017) Ramirez et al. (2017) Your Synthesis
A.

Changes and the future of organizations.

 

 Unwarranted changes like new regulations, market entries, and environmental changes present new opportunities and challenges for companies Organizations face dramatic changes, and have to respond accordingly. Technological changes are rampant and business need technology foresight to keep a breast Organizations experience unprecedented changes like natural disasters, disruptive innovation, economic changes, and unexpected political events. May changes occurring in the business world are unwarranted and unpredictable, but have significant impact on organizations, their operations, and their future. Some of the unprecedented changes include new regulations, market entries, environmental changes, including natural disasters, technological changes, economic changes, and disruptive innovation
B.

Change anticipation.

 Companies should prepare for the future by anticipating changes. Companies should anticipate these changes and transform the anticipation into action. Company should adopt mapping the future of technology as an established practice. Organization should explore sources of the changes or uncertainty rather than focusing on preparing for the future. An organization’s strategic planning includes preparing for the future. Companies can prepare for the future by anticipating changes by mapping underlying causes and potential impacts. Notably, exploring the sources of these changes can help companies cope with the uncertainties.
C.

Importance of future surveillance and prediction.

 Periphery surveillance is a critical business success factor Good forecasts can help arrive at the desired objective. Technology foresight helps businesses plan for the future of technology.   Periphery surveillance or forecasting the future as accurately as possible is a critical business success factor. Business should have a foresight attitude as part of the strategic planning process.
D.

Predicting the future and its challenges.

 The future is hard to predict, but possible with a scenario planning It is impossible to foretell or forecast the future due to the many uncertainties, which can only be reduced as far as possible   Companies should learn to cope with uncertainties rather than focusing on planning for the future. It is impossible and difficult to predict the future or foretell what will happen due to the multiple uncertainties. Business can reduce the uncertainties as far as possible or learn to cope with them rather than investing everything planning for the future.
E.

Scenario frameworks.

 A question-based framework can help survey the periphery more effectively and efficiently Structural analysis, strategy analysis, and morphological methods or probability can help appropriate the anticipation into action. Companies can adopt scenario-driven road mapping to plan for the future of technology. Scenario planning can help companies reshape their long-term strategies. There are multiple ways a business can anticipate changes and change the anticipation into action, including the question-based framework, structural analysis, strategy analysis, and morphological methods or probability, scenario-driven road mapping, or scenario planning.

 

Part 2: Scenario Framework for Pharmaceutical Industry

Scenario Framework

Scenario planning or development is an integral part of an organization or industry’s future and begins with assessing the current situation, creating informed assumptions regarding the future, and comparing potential effects and the likely responses of various factors. For instance, over time, there have been predictions about when crude oil would no longer be available. Most predictions are based on scenarios, although they have been widely wrong. The pharmaceutical industry segment, Kenedy (2021, 32541a), involves Brand-name Pharmaceutical Manufacturing based in the US and faces a near future patent protection situation because most essential patents for blockbuster drugs will expire in the next five years (Khaustovich, 2023). Often, the patent’s lifespan is 20 years, and it cannot be renewed, remaining in the public domain after expiring. Therefore, organizations have to prepare for these situations. Scenario planning can provide the company with actionable insights o what to do or expect at the end of the five years. The company needs a 5-year scenario development, which can be achieved using the question-based framework (Day & Schoemaker, 2020).

The Question-based framework is desirable and suitable because it provides insights into how the company can capitalize on the situation or the changes in the industry, including increased competition and economic and global market changes. Looking at the current trend and scenarios, the company can anticipate what is to happen and develop a strategic plan to prepare for the future with clear goals and objectives (Day & Schoemaker, 2020). The question-based framework can help the company survey the periphery more efficiently and effectively. It has three parts: learning from the past, examining the present, and envisioning the future. The organization asks itself multiple questions: What were its past blind sports? What instructive analogues do other industries offer? Who in the industry can help pick up the weak signals and act on them? To learn from the past (Day & Schoemaker, 2020). The present is evaluated by asking about the vital signals the company is rationalizing, what the outliers, unconventional, defectors, and complainers are telling the company, and the peripherals consumers and competitors are thinking about (Day & Schoemaker, 2020). Envisioning the future involves asking about what could hurt or help the company, technologies that could change the game, and any unprecedented scenario that might hamper or disrupt the business. The answer to these questions will help the organization anticipate problems or opportunities appearing on the horizon.

Current State Pharma Industry Trends

Multiple pharma industry trends require pharma companies to develop strategic planning that prepares companies for the changes occurring in the future or any disruptions. For instance, artificial intelligence is accelerating drug discovery and development. Many new companies are adopting the technology to address the many pharma industry challenges, including automation to optimize business processes (Khaustovich, 2023). This technology forces current organizations to reshape their strategies to adapt to the changes. The changing market dynamics are forcing the pharma industry to consider flexible production. Minimizing downtime and enhancing productivity is necessary, and flexible production approaches like single-use bioreactors and continuous manufacturing can be valuable. Precision medicine, due to omic and data analysis advancement, is also a current trend that helps pharma researchers and experts understand more the drug interaction with the body (Hartl et al., 2021). Precision medicine means that personalized medicine is becoming more of a reality. The pharma industry will also have to develop scenarios for the future of additive manufacturing using technologies like 3D printers for tissues and cells (Mohammed et al., 2020). This technology means the development of precision pills, microfluidics, and tissue engineering. Lastly, real-world data (RWD) and real-world evidence (RWE) are revolutionizing innovations in the pharma industry by intensifying research and increasing the reliability of discoveries (Breckenridge et al., 2019). Data means the industry can produce new drugs more often while maintaining reliability and real value.

Trigger Questions

According to Leufkens et al. (2022), the future of the pharma industry, including drug discovery and development and direction and success, is influenced by current and anticipated scientific advances, socioeconomic, medical need, policy, and geopolitical actors. Also, growing concerns about a global divide could also impact drug accessibility and affordability (Leufkens et al., 2022). Also, it is unclear whether the pharma industry will be more regulated, monitored and guided in the future and whether international and interdisciplinary collaboration and connectivity will affect the operation of the pharma industry. Based on the supported understanding, the executive team should ask itself the following questions:

  1. What scientific advances will realign or impact unwarranted, challenging opportunities relating to drug discovery and development in the future?
  2. What socio-economic, medical need, policy, and geopolitical actors will impact our direction and success?
  3. What if the growing concern regarding the global divide impacts accessibility and affordability or medicines?
  4. What if the future will be more complex with more need for monitoring and guidance in the operations of the pharma industry?
  5. Will international and interdisciplinary collaboration and the increased connectivity advance pharmaceutical science?

Conclusion

Strategic planning is integral to a business’s future and sustainability. It can be accomplished through scenario planning, which involves scenario building using past and current events and trends leading to a likely future. Scenario frameworks provide organizations with insights into alternative futures for planning and try to reduce uncertainties as far as possible. An organization can adopt the question-based framework that focuses on learning from the past, evaluating the present, and envisioning the future.

References

Breckenridge, A. M., Breckenridge, R. A., & Peck, C. C. (2019). Report on the current status of the use of real‐world data (RWD) and real‐world evidence (RWE) in drug development and regulation. British Journal of Clinical Pharmacology, 85(9), 1874-1877.

Day, G. S., & Schoemaker, P. J. H. (2005). Scanning the periphery. Harvard Business Review, 83(18), 135–148.

Godet, M., & Roubelat, F. (1996). Creating the future: The use and misuse of scenarios. Long Range Planning, 29(2), 164–171.

Hartl, D., de Luca, V., Kostikova, A., Laramie, J., Kennedy, S., Ferrero, E., … & Roth, A. (2021). Translational precision medicine: an industry perspective. Journal of translational medicine, 19(1), 1-14.

Hussain, M., Tapinos, E., & Knight, L. (2017). Scenario-driven road mapping for technology foresight. Technological Forecasting and Social Change, 124, 160–177.

Khaustovich, V. (2023). Industry Report 32541A: Brand Name Pharmaceutical Manufacturing in the US. IBISWorld.

Krishnaveni, C., Arvapalli, S., & Sharma, J. V. C. (2019). Artificial intelligence in pharma industry-a review. International Journal of Innovative Pharmaceutical Sciences and Research, 7(10), 37-50.

Leufkens, H. G., Kusynová, Z., Aitken, M., Hoekman, J., Stolk, P., Klein, K., & Mantel-Teeuwisse, A. K. (2022). Four scenarios for the future of medicines and social policy in 2030. Drug Discovery Today, 27(8), 2252-2260. https://doi.org/10.1016/j.drudis.2022.03.018

Mohammed, A., Elshaer, A., Sareh, P., Elsayed, M., & Hassanin, H. (2020). Additive manufacturing technologies for drug delivery applications. International Journal of Pharmaceutics, 580, 119245.

Ramirez, R., Churchhouse, S., Palermo, A., & Hoffmann, J. (2017). Using scenario planning to reshape strategy. MIT Sloan Management Review, 58(4), 31–37.

 
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Future of Work Paper

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Future of Work Paper

Future of Work Paper

Future of Work Paper

The social, technological, and ethical issues that will shape the future of the U.S. workplace

The world is technology-driven, where people, especially businesses and organizations, adopt technology to improve productivity, effectiveness, efficiency, and the general quality of life. Automation, in particular, is one for the future and part of the new workplace. Automation will impact the jobs lost and gained, workforce transition, and the type of jobs created to adapt to the changes (Wang & Siau, 2019). Moreover, automation will potentially impact workforce skills and wages. The transition can be challenging because of the potential occupational shifts and job loss due to displacement by automation adoption, although there might be enough jobs to ensure full employment. The current scenario has few fully automated jobs, but most of these jobs could be automated, which means changes and a significant transformation for all workers (Wang & Siau, 2019). It is not necessarily that the adoption of automation will cause employment decline because automation will also mean the creation of new roles and responsibilities. However, technology feasibility beyond human labor substitution will impact the speed of automation.

(Future of Work Paper)

Society is also changing significantly, profoundly impacting the working world, including the nature of work, the people needed to do the work, and work expectations, standards, and regulations. Society is transitioning to a knowledge economy where knowledge and information are perceived as the most valuable resource (Wang & Siau, 2019). Employees are more responsible for updating themselves based on the new knowledge. This trend will continue, affecting employees’ roles and responsibilities and the scope of work. The US is also experiencing increased diversity, a trend that will continue to grow into the future. For instance, women are a growing part of the workplace, and it is predicted that women will be the majority of the workforce in the future (Köllen, 2021). Also, the US is generally highly ethnically diverse, meaning that the workforce is becoming more ethnically diverse. Sexual orientation, especially the recognition of queer people in the workplace, is also a growing trend, significantly impacting workforce composition, ethical standards, and workplace rules and regulations. Increased diversity is positive in the workplace as it is associated with increased productivity, creativity, and job satisfaction.

The rise in automation, societal changes like increased diversity, remote working, and the use of online platforms to engage employees and customers raise ethical issues that can potentially impact the future of work. There is a change in the perception of work due these trends, but there are also ethical concerns like data privacy and confidentiality, justice and fairness, transparency, and bias that should be addressed (Bourhis et al., 2019). The government and businesses have to develop new measures to regulate these growing trends, including working-from-home policies, justifiable standards of using online platforms and automated tools for workplace engagement and business transactions, and justice and fairness associated with increased diversity at the workplace (Schwartz et al., 2020). There would be more privacy and access controls, accountability, fairness, and transparency rules to address ethical issues in the future.

(Future of Work Paper)

The impact of the COVID-19 pandemic on remote work, the use of artificial intelligence, and other workplace trends

Covid-19 disrupted society and accelerated some trends like remote work and artificial intelligence. The long-term influence of the pandemic on labor demands, workforce skills, and labor occupations is immense, especially with the growing trend of remote work. Remote work is the most apparent impact of the pandemic on labor, with a considerable increase in employees working from home (McKinsey & Company, 2021). Most companies realized and are realizing that about 20 to 25 percent of the workforce could work from home for most of the work days without a loss in productivity (McKinsey & Company, 2021). Many organizations consider creating flexible workspaces after positive experiences with remote work, especially a reduction in office costs, travel costs, and overall office space.

Also, Covid-19 accelerated the adoption of artificial intelligence. Covid-19 accelerated digital transformation, offering business leaders vital lessons and insights, especially what AI and data analytics can bring to the business. Examples of AI and data analytic tools adopted during and after the pandemic include direct-to-customer business. More companies accelerated their AI and analytics adoption, and there is a promising trend that AI will become mainstream technology (McKinsey & Company, 2021). Businesses are optimistic about AI’s role in the future in increasing the efficiency of business processes, the development of new business models, and the creation of new products and services.

The argument for increasing the use of robots and artificial intelligence (AI) in the workplace

Adopting robotics and artificial intelligence in the workplace is inevitable, and individuals should brace themselves for a future full of robots and AI technologies and tools working alongside them. Robotics and AI applications are growing, creating new opportunities and challenges for businesses and significant workplace changes (Howard, 2019). A combination of robotics and AI has already revolutionized everyday life. It is necessary to find a way to co-exist and adapt them to make life easier for everyone. Robotics have increased accuracy and efficiency in surgical processes, reduced the cost of production, and reduced human involvement in risky jobs like machine operations, industry-complex roles, dealing with hazardous materials, and disaster response (Madakam et al., 2019). Robots complement human skills and should not be viewed as threats but as solutions to critical human problems, especially with an aging workforce and declining expertise in fields like engineering and medicine.

(Future of Work Paper)

Pros and cons of a universal basic income, a guaranteed federal job, and a reduced workweek

The world is working towards more equality by addressing poverty and unemployment. The creation of the universal basic income (UBI) would help reduce poverty rates and income inequality, enhances physical and mental health, increases higher education accessibility, can potentially improve wages, eliminates the need for government programs, fosters entrepreneurship, and protects individuals from economic shocks (Estlund, 2019). However, UBI is costly, reduces work incentives, encourages laziness, gives additional income to individuals who do not need it, conflicts with self-worth by reducing a job to only a source of income, and does not address the underlying cause of poverty like poor health and lack of educational skills. Creating a guaranteed federal job is a move to make society more equitable, sustainable, and prosperous (Estlund, 2019). It is a form of remaking the economic order by making having a job a fundamental right (Estlund, 2019). Positives include increasing state and local tax revenues, enhancing the bargaining power of labor, and addressing society’s most critical needs like eldercare and nursing shortages. However, categorizing a job as a fundamental right would be burdensome to the government and potentially make people entitled because they understand the government is their last resort.

The reduced work week has long been considered an approach to address employees’ health and well-being. Working for fewer days has been associated with a reduced risk of burnout and improved productivity (Estlund, 2019). It would help achieve a better work-life balance, increase focus and productivity, and reduce travel costs. However, understaffing makes its adoption challenging, it might be incompatible with some people, and it may force people to forego after-work activities because they work more hours during the working days. Nonetheless, I would recommend reducing the work week because it looks beyond income and pay and seeks to address employees” health and well-being.

(Future of Work Paper)

Another change in the future workplace that could significantly benefit humankind

I recommend a shift in the physical space and remodeling it as companies shift to a flexible workforce, where some employees work remotely for most of the work days. In the future, companies should seek to alter their footprint and layout because the in-person work will substantially transform, and the workspace should be in tune with the people’s objective. For instance, eliminating pre-pandemic cubicles would create a more collaborative, community-focused, and innovative workspace that allows continuous engagement between in-person employees and remote workers (Ayoko & Ashkanasy, 2020). Also, creating video-conference rooms and online workspaces would twin into remote work and more flexible workspaces, allowing companies to tap talents around the country without the need to report physically.

References

Ayoko, O. B., & Ashkanasy, N. M. (2020). The physical environment of office work: Future open plan offices. Australian Journal of Management, 45(3), 488-506.

Bourhis, P., Demartini, G., Elbassuoni, S., Hoareau, E., & Rao, H. R. (2019). Ethical challenges in the future of work. Bulletin of the Technical Committee on Data Engineering.

Estlund, C. (2019). Three big ideas for future of less work and three-dimensional alternative. Law and Contemporary Problems, 82(3), 1–44.

Howard, J. (2019). Artificial intelligence: Implications for the future of work. American journal of industrial medicine, 62(11), 917-926.

Köllen, T. (2021). Diversity management: A critical review and agenda for the future. Journal of Management Inquiry, 30(3), 259-272.

Madakam, S., Holmukhe, R. M., & Jaiswal, D. K. (2019). The future digital work force: robotic process automation (RPA). JISTEM-Journal of Information Systems and Technology Management, 16.

McKinsey & Company. (2021). The future of work after COVID-19. https://www.mckinsey.com/featured-insights/future-of-work/the-future-of-work-after-covid-19

Schwartz, J., Denny, B., Mallo, D. (2020). Ethics and the future of work: From “could we” to “how should we.”

Wang, W., & Siau, K. (2019). Artificial intelligence, machine learning, automation, robotics, future of work and future of humanity: A review and research agenda. Journal of Database Management (JDM), 30(1), 61-79.

 
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