Background: Poorly managed diabetes mellitus increases health care expenditures and negatively impact health outcomes. There are 34 million people living with diabetes in the United States with a direct annual medical cost of $237 billion. The patient-centered medical home (PCMH) was introduced to transform primary care by offering teambased care that is accessible, coordinated, and comprehensive. Although the PCMH is believed to address multiple gaps in delivering care to people living with chronic diseases, the research has not yet reported clear benefits for managing diabetes. Objective: To review the scientific literature about diabetes mellitus outcomes reported by PCMHs, and understand the impact of team-based care, interdisciplinary communication, and care coordination strategies on the clinical, financial, and health related outcomes. Method: The systematic review was performed according to the Cochrane method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight databases were systematically searched for articles. The Oxford Centre for Evidence-based Medicine levels of evidence and the Critical Appraisal Skills Programme systematic review checklist were used to evaluate the studies. Results: The search resulted in 596 articles, of which 24 met all the inclusion criteria. Care management resulted in more screenings and better preventive care. Pharmacy-led interventions and technology were associated with positive clinical outcomes, decreased utilization, and cost savings. Most studies reported decreased emergency room visits and less inpatient admissions. Conclusion : The quality and strength of the outcomes were largely inconclusive about the overall effectiveness of the PCMH. Defining and comparing concepts across studies was difficult as universal definitions specific to the PCMH were not often applied. More research is needed to unpack the care model of the PCMH to further understand how the individual key components, such as care bundles, contribute to improved outcomes. Further evaluations are needed for team-based care, communication, and care coordination with comparisons to patient, clinical, health, and financial outcomes.

Resilience describes the ability of someone to adapt to adverse life experiences by adjusting to demands with behavioral flexibility. When encountering crisis situations, resilient people typically spring back emotionally with increased strength and internal composure. Measuring resilience is important for assessing the ability of adolescents to respond to adverse situations. The objective of this study was to evaluate the psychometric performance of the Spanish version of the Connor-Davidson Resilience Scale (CD-RISC) © for South America (CD-RISC-25SA) in a population of vulnerable Peruvian adolescents. This study used a cross-sectional design to measure sociodemographic variables and resilience. Participants were 451 adolescents living in a shelter in Lima, Perú. Face and content validity were established by expert panel, construct validity was evaluated with exploratory and confirmatory factor analysis, and internal consistency was assessed with Cronbach’s alpha. The analysis resulted in a four-dimensional model with 22 items explaining almost 27% of the variance with a Cronbach’s alpha of 0.90. The dimensions included self-confidence and self-trust from previous experiences, internal resources to cope with difficult situations, personal competence and tenacity, and self-regulation with external resources. Two of the 3 items eliminated from the instrument were related to the original dimension “spirituality influences” which may have been incorrectly translated and adapted without equivalence of meaning for cross-cultural research. The CD-RISC-25SA is not a stable multidimensional instrument for measuring resilience across the cultures and contexts of countries. However, the instrument appears to be stable for measuring resilience as a single dimension. For measuring resilience in the context of Peru, a four-dimensional model with 22 items was validated. Variations in the psychometric properties of translated instruments may result from not establishing the equivalence of meaning for each item before performing cross-cultural research. Researchers need to search for a more precise understanding of resilience as a universal concept transferable across borders and through translations.

Introducción: Los errores de medicación son uno de los eventos de mayor relevancia en la actualidad, derivándose de la interacción entre el medio y los profesionales. La educación debe entrenar a los estudiantes para la seguridad. Objetivo: identificar transgresiones y errores potenciales de medicación en estudiantes de enfermería en los subprocesos de preparación y administración de medicamentos por vía parenteral en ambiente simulado. Método: Estudio cuantitativo, descriptivo realizado en estudiantes de segundo, tercer y cuarto año de la carrera de enfermería de una Universidad chilena. Se evaluaron los subprocesos de preparación y administración a través de la aplicación de una pauta estandarizada de administración segura de medicamentos en ambiente de simulación. Se reconocieron ítems críticos (ítems de transgresiones o errores potenciales) utilizando un punto de corte del 70 %. Resultados: Los estudiantes presentaban edades promedio entre 22 y 24 años, predominando el sexo femenino. Los ítems identificados como críticos en el subproceso de preparación fueron: verificación de la fecha de caducidad del medicamento, transgresión de principios de infecciones asociadas a la atención de salud y preparación de la dosis correcta. En el subproceso de administración se identificó: verificación de alergias, manejo de accesos vasculares, entrega de información e identificación de paciente. Conclusiones: A través de este estudio se identificaron transgresiones y errores potenciales que deben ser trabajados con los estudiantes. La simulación clínica como metodología permite el entrenamiento de competencias orientadas a la provisión de cuidados seguros y de calidad en un ambiente real y protegido.