Skin Comprehensive SOAP Note 

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Skin Comprehensive SOAP Note 

(Skin Comprehensive SOAP Note)

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. (Week 4 – Skin Comprehensive SOAP Note)

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. (Week 4 – Skin Comprehensive SOAP Note)

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. (Week 4 – Skin Comprehensive SOAP Note)

            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 (Week 4: Skin Comprehensive SOAP Note )

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. (Week 4 – Skin Comprehensive SOAP Note)

Week 4: Skin Comprehensive SOAP Note

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.

Week 4: Skin Comprehensive SOAP Note

  1. 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.
  2. Week 4: Skin Comprehensive SOAP Note
  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.

Week 4: Skin Comprehensive SOAP Note 

  1. 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)

Polymorphic Eruption of Pregnancy: Background, Epidemiology, Etiology

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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Discussion 3 (1)

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Discussion 3 (1)

(Discussion 3 (1))

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 under coverage 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). (Discussion 3 (1))

Discussion 3 

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. (Discussion 3 (1))

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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Topic 6 DQ 1

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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. (Topic 6 DQ 1)

Topic 6 DQ 1

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. (Topic 6 DQ 1)

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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 Medication Guide

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 Medication Guide

(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. (Medication Guide)

 Medication Guide

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. (Medication Guide)

 

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. (Medication Guide)

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 Guide)

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. (Medication Guide)

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.  (Medication Guide)

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. (Medication Guide)

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.  (Medication Guide)

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.  (Medication Guide)

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.   (Medication Guide)

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. (Medication Guide)

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. (Medication Guide)

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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Topic 5 DQ 1 Replies

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Topic 5 DQ 1 Replies

Reply to Maratas

Hello, Maratas. (Topic 5 DQ 1 Replies)

Thank you for an informative and elaborative discussion. Research is done for various purposes, but the aim is always to develop usable and beneficial outcomes that can be used to enhance and inform practice. Indeed statistically significant results are not always clinically significant, but they are useful in informing researchers whether the outcomes of their research are due to chance or due to some factor of interest. A statistically significant result means that it is real and not due to luck in the sample selection. Clinically significant results help improve practice, treatment, or patient care. For instance, a drug with positive effects can be said to have clinical significance. (Topic 5 DQ 1 Replies)

References

Sharma H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi journal of anaesthesia, 15(4), 431–434. https://doi.org/10.4103/sja.sja_158_21

 

Reply to Schott

Hello, Schott.

Thank you for the great post. Statistically significance results can be clinically significance, but not always. Statistical significance means that the results from data generated through an experiment or testing is likely to be linked to a particular cause rather than occurring by chance. It helps researchers determine the relationship between variables. Some variables have weak effects, but their results are statistically significant. However, the effect has to be considerable for a result to be considered clinically significant. For instance, a treatment intervention or research experiment that helps a patient to a point they recover from their illness would be categorized as clinically significant. (Topic 5 DQ 1 Replies)

References

Ranganathan, P., Pramesh, C. S., & Buyse, M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspectives in clinical research, 6(3), 169–170. https://doi.org/10.4103/2229-3485.159943

 

Reply to Blake

Hello, Blake.

I enjoyed reading you discussion for its clarity and comprehensiveness. Indeed clinicians should adopt current best evidence to inform medical and clinical decisions. Statistical significance shows that the results of a research study can relied on, are real, and are not due to chance. Researchers can determine that a relationship between two variables exists and is authentic through statistical significance. I concur that the results or effects of a relationship must be large enough to be considered clinically significant. For instance, the Covid-19 vaccine was allowed for use in treating the virus after researchers determined the effect was large enough to help patients recover. Clinical significance also means that the effects outweighs the costs and any inconveniences that are linked to the intervention or information obtained from research. (Topic 5 DQ 1 Replies)

Topic 5 DQ 1 Replies

References

Sharma H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi journal of anaesthesia, 15(4), 431–434. https://doi.org/10.4103/sja.sja_158_21

 
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Future of Work Paper

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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. (Future of Work Paper)

Future of Work Paper

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. (Future of Work Paper)

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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Community Assessment and Representative Interview Analysis

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Community Assessment and Representative Interview Analysis

(Community Assessment and Representative Interview Analysis)

Community Assessment and Representative Interview Analysis

 

Part I: Assessment

The selected community site is a community health center in Winston-Salem. The physical assessment focuses on secondary prevention/screening for vulnerable populations, in this case, older adults 65 years and above. The primary purpose of the assessment was to identify key health needs and problems through systematic and comprehensive data collection and analysis to give the organization robust information regarding the current health status, needs, and issues affecting the target population and the community at large. The assessment also assessed the community’s partnerships, funding sources, and health priorities. (Community Assessment and Representative Interview Analysis)

The assessment findings indicate that the community health center has a steering community comprised of public health officers, hospital and healthcare professionals, EMS providers, law enforcers, public school system representatives, and community organizations as partners. The steering community addresses common health issues in the community. The assessment also found that the community has health priorities that include preventing chronic disease and related health conditions, promoting behavioral health, including reducing drug overdose and fostering mental health, improving life expectancy, preventing infectious diseases, and addressing social health determinants, particularly poverty and poverty education. The results also indicate funding sources for the community health center vary. Primary funding sources include reimbursements from Medicaid, Medicare, and private insurance. The center also receives federal and state grants; some are funded by the HRSA’s Community Health Center Fund (CHCF). Federal grant funding is through the Health Center Program. The community health center also has partnerships with the public school system, community organizations, epidemiology and surveillance program, and the local church association, especially the Union Baptist Church. (Community Assessment and Representative Interview Analysis)

Part II: Interview

The interview was conducted in a community health center in Winston-Salem. The interview topic was secondary prevention/screenings for a vulnerable population. The target population was individuals 65 years and above. The interview focused on the health needs of this population. The nursing manager at the community health center was involved in the interview. The interview was in-person at the community health center. The purpose of the interview was to understand the role of the nurse manager in the community, common health issues the community health center faces, and the role of public health in addressing environmental issues the community faces, notably pollution from various industries like tobacco and cigarette, brewers, and textile, the barriers and challenges in the community that hamper the community health center from delivering quality, safe, equitable, and affordable care, and the community’s health priorities based on the identified health needs and issues. The determination of these interview aspects would help understand the current state of health in the community and the various health needs that must promptly address to promote a healthy community. (Community Assessment and Representative Interview Analysis)

Interview Questions

  1. What is the role of the nursing manager at this community health center?
  2. What are the common health issues faced at the community health center?
  3. What is the role of public health in addressing environmental issues facing the community?
  4. What are the barriers and challenges of delivering equitable, quality, and safe care in the community?
  5. What are the community’s health priorities?

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10353612/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847055/

 
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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. (Scenario and Alternative Futures)

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.

Scenario and Alternative Futures

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).  (Scenario and Alternative Futures)

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. (Scenario and Alternative Futures)

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. (Scenario and Alternative Futures)

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? (Scenario and Alternative Futures)

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. (Scenario and Alternative Futures)

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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Section 5: Digital Evidence Controls – Computer Forensic Analysis – and Recovering Files

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Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

(Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

Preserving Information for Forensic Analysis

Digital evidence can be stored and maintained in physical or digital devices. After information collection, it will be moved to physical media for storage and where it can be accessed. The data acquired and the device used for storage are secured until the information is required for forensic analysis. The physical and digital storage systems or a smart management system are integrated to form the evidence management system to be used at the organization. Preservation is required to ensure the legal admissibility of the information stored. The evidence management system will include drive imaging, hash values, and a clear chain of custody (Simon, 2023). Rather than the original information, the company will create images of the evidence that will be used for analysis. The analysist will develop a duplicate of the drive used to store the information to help retain the original evidence for investigation. Investigators can exclusively use the duplicate image rather than the original media. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Hash values will also aid in preserving the evidence or information generated when duplicates or images of the original media are produced. The hash values will help determine the authenticity and integrity of the duplicates as an exact image of the original information. Hash values will help ascertain if the information was altered at any point, which is a vital part of forensic analysis and admitting the evidence in court if necessary (Simon, 2023). Creating new or editing existing files generates new hash values that can only be accessed using special software. The hash values must match the expected values, and if not, they will help confirm that the evidence was altered. A clear chain of custody is vital in digital evidence preservation. The company forensic analyst or investigator will document all media and evidence transfers on the Chain of Custody (CoC) forms and capture signatures and dates after handing off media. The chain-of-custody paperwork will help determine that the image of the digital evidence is or was under known possession from the time the duplicate or image was created (Simon, 2023). A lapse in the chain of custody would allow the company to nullify the legal value or dependability of the image. Generally, the primary purpose of preserving the evidence is to ensure legal admissibility. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Digital Evidence Controls

JP Morgan Chase works with a cybersecurity forensic investigator whose main role at the company is to watch over the data and find innovative ways to protect the data. Approaches used to control digital evidence include risk reviews and vulnerability analysis that help identify potential threats. The investigator conducts forensic preservation work and preliminary investigations, adopting established standards (JP Morgan Chase Company, n.d.). The investigator also helps identify violations of the JP Morga Chase Code of Conduct and identifies, collects, and preserves the associated digital evidence. The organization, through the investigator, conducts forensically sound collection and analysis of electronic evidence using different tools to enhance security, compliance, and legal processes. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

JP Morgan Chase preserves network and host-based digital forensics on Microsoft Windows-based systems and other necessary operating systems like LINUX and adopts standard digital forensic and network monitoring tools to plan and carry out forensic support independently. The organization adopts High-Security Access (HSA) systems for forensic investigations. It conducts an enhanced annual screening of users of the systems, including checking criminal and credit backgrounds (JP Morgan Chase Company, n.d.). Additionally, the organization ensures technology governance, risk, and compliance by regularly validating the effectiveness of the controls, assessing risk annually to ensure the implemented controls can protect the organization’s information, and adopting security policies and procedures to govern receipt, transmission, processing, storage, retrieval, access, and presentation of the information. The principle of least privilege is adopted to grant personnel access to the information. Physical facilities hosting the data are restricted and have detective monitoring controls and controls for hazards like fire and water. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Computer Forensic Tools for Forensic Analysis and File Recovery

The autopsy/the Sleuth Kit will be used for disk analysis. The tool is recommended for its ease of use, extensibility, speed, and cost-effectiveness. The Sleuth kit is a command-line tool that helps conduct forensic analysis of hard drives and smartphone images. The Autopsy is a GUI-based system using the Sleuth Kit in the background (Kaushik et al., 2020). Its modular and plug-in architecture ensures that the user can easily incorporate additional functionality. Law enforcement agencies and organizations can use this tool to investigate activities or events in a computer, analyze disk images, and recover associated files. The tool can analyze both Windows and LINUX disks. The Volatility tool will also help with memory forensics, incident response, and malware analysis. Often, investigations determine what activities occurred at the time of the incident. Volatility is used to link device, network, file system, and registry artifacts to confirm the list of all running processes, active and closed network connections, running Windows command prompts screenshots and clipboard contents that were in progress at the time of the incident (Mohanta et al., 2020). Investigators will use Volatility to assess processes, check command history, and retrieve files and passwords from the system. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

References

JP Morgan Chase Company. (n.d.). Cybersecurity Forensic Investigator. https://www.wayup.com/i-Financial-Services-j-JP-Morgan-Chase-Company-827769314821227/

JP Morgan Chase Company. (n.d.). JPMorgan Chase & Co. Minimum Control Requirements. https://www.jpmorganchase.com/content/dam/jpmc/jpmorgan-chase-and-co/documents/supplier-minimum-control-requirements.pdf

Kaushik, K., Tanwar, R., & Awasthi, A. K. (2020). Security tools. In Information Security and Optimization (pp. 181-188). Chapman and Hall/CRC.

Mohanta, A., Saldanha, A., Mohanta, A., & Saldanha, A. (2020). Memory Forensics with Volatility. Malware Analysis and Detection Engineering: A Comprehensive Approach to Detect and Analyze Modern Malware, 433-476.

Simon, M. (2023). Methods to preserve digital evidence for computer forensics. https://www.criticalinsight.com/resources/news/article/3-methods-to-preserve-digital-evidence-for-computer-forensics

 
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Alterations in Cardiovascular and Respiratory Systems

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Alterations in Cardiovascular and Respiratory Systems

(Alterations in Cardiovascular and Respiratory Systems)

 

Introduction

The cardiorespiratory system operates to serve body organs and tissues with enough oxygen supply in relation to oxygen intake. The physiological interactions between the cardiovascular and respiratory systems are complex and fundamental in optimal patient management. Alterations in these systems, for instance, altered intrathoracic pressure, can be transferred to the heart and lungs, dramatically altering cardiovascular performance (Cross et al., 2020). This paper addresses alterations in cardiovascular and respiratory systems, pathophysiological processes in these systems that contribute to disease systems, how the process affects each other, and ethnic/racial that affect physiological functioning. (Alterations in Cardiovascular and Respiratory Systems)

Alterations in Cardiovascular and Respiratory Systems

Cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms

The patient has gained weight and is experiencing shortness of breath, peripheral edema, and abdominal swelling. A Framingham study shows that the prevalence of arterial pressure is high among overweight individuals. There is a direct correlation between hypertension and body weight in adults (Mendoza et al., 2020). The patient complains of weight gain, which is a likely cause of increased arterial pressure or hypertension, whose first symptom is shortness of breath (Oldroyd et al., 2022). The peripheral edema can be attributed to the high blood pressure due to constricted veins and arteries because any activity that increases capillary pressure, minimizes oncotic pressure, raises endothelial permeability, or impacts lymphatic drainage, can lead to edema. The abdominal swelling can be as a result of a large amount of fluid accumulating in the abdomen, which can be attributed to portal hypertension. (Alterations in Cardiovascular and Respiratory Systems)

How the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient

This case study depicts an alteration in cardiovascular and respiratory or cardiopulmonary systems as a result of weight gain. According to research, excess weight leads to fatty material build-up in the arteries, increasing arterial pressure because of the contractions in the arteries (Mendoza et al., 2020). The increased arterial pressure is a pathophysiological process of the cardiovascular system that leads to an alteration in the cardiopulmonary processes because the body is struggling to supply cells with adequate oxygen, requiring more blood to supply adequate oxygen (Cross et al., 2020). This alteration in the cardiopulmonary system as a result of the cardiovascular system is linked to the patient experiencing shortness of breath. (Alterations in Cardiovascular and Respiratory Systems)

Alterations in Cardiovascular and Respiratory Systems

Racial/ethnic variables that may impact physiological functioning

Most diseases, especially chronic diseases, vary by race and ethnicity. For instance, in the case of cardiovascular diseases, there is a high prevalence of hypertension among black adults, with 59% of black adults experiencing hypertension. Also, the likelihood of developing hypertension is twice among black women than among white women. Type 2 diabetes is more prevalent among American Indians, with 1 in 4 adults developing the disease compared to 1 in 12 whites (Cleveland Clinic, 2022). Regarding heart failure, the risk of a black man experiencing heart failure is 70% compared to a white man and 50% for black women compared with white women (Cleveland Clinic, 2022). Black adults are also more likely to experience coronary artery disease, heart attack, and stroke than other racial and ethnic groups. (Alterations in Cardiovascular and Respiratory Systems)

Modifiable and Non-modifiable Risks

Modifiable factors contributing to these numbers or racial disparities regarding physiological functioning include lifestyles and the living environment that encourages a sedentary lifestyle, minimal physical activity, and unhealthy eating patterns, money and resources to acquire basic needs, quality of education, quality of healthcare in the various communities, resources like nutritious foods, and societal factors like discrimination, violence, and capacity to build supporting relationships (Budreviciute et al., 2020). Some factors, like family history of illness and genetic factors, cannot be modified, but the risk can be reduced by optimizing the modifiable risk factors. (Alterations in Cardiovascular and Respiratory Systems)

Conclusion

Cardiovascular and cardiorespiratory systems interact at an optimal level to ensure optimal body functioning. However, alterations in one system can lead to an alteration in another, contributing to disease systems like shortness of breath, as indicated in the case study. In most cases, cardiovascular pathophysiological processes alter normal cardiorespiratory system functioning. Some races and ethnicities are more likely to develop particular diseases; for instance, black adults are more likely to develop cardiovascular diseases like heart failure, heart attack, stroke, and hypertension, than other races and ethnicities. The risk can be reduced by optimizing modifiable factors like lifestyles, living environment, education level or health literacy, financial ability, and quality of healthcare services. (Alterations in Cardiovascular and Respiratory Systems)

References

Budreviciute, A., Damiati, S., Sabir, D. K., Onder, K., Schuller-Goetzburg, P., Plakys, G., … & Kodzius, R. (2020). Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Frontiers in public health, 788.

Cleveland Clinic. (2022). How Race and Ethnicity Impact Heart Disease. https://my.clevelandclinic.org/health/articles/23051-ethnicity-and-heart-disease/

Cross, T. J., Kim, C. H., Johnson, B. D., & Lalande, S. (2020). The interactions between respiratory and cardiovascular systems in systolic heart failure. Journal of Applied Physiology, 128(1), 214-224.

Mendoza, M. F., Kachur, S. M., & Lavie, C. J. (2020). Hypertension in obesity. Current Opinion in Cardiology, 35(4), 389-396.

Oldroyd, S. H., Manek, G., Sankari, A., & Bhardwaj, A. (2022). Pulmonary Hypertension. In StatPearls. StatPearls Publishing.

 
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