This systematic review evaluates the effectiveness of medication self-management education programs (MSEP) for older adults by analyzing the core characteristics and reported outcomes of successful interventions. Guided by King’s Goal Attainment Theory, this study identifies which program elements, such as scope, provider, and duration, are associated with positive clinical and psychosocial outcomes, aiming to provide evidence-based recommendations for practice and future research amid rising polypharmacy and inappropriate medication use. Methods: A systematic review searched seven databases (up to September 3, 2024) for randomized controlled trials and quasi-experimental studies of medication self-management education for adults 65+. Inclusion followed PICOTS-SD (Participants, Intervention, Comparison, Outcomes, Time, Setting, and Study Design). Quality was assessed (RoB 2.0, ROBINS-I). Data were narratively synthesized, mapping program characteristics to King’s theory (e.g., interaction, transaction) to analyze goal attainment pathways. Results: The 34 included studies demonstrated that MSEP are broadly effective in improving both clinical and psychosocial outcomes. Specifically, comprehensive, multi-session interventions were frequently associated with significant improvements in psychosocial outcomes such as quality of life and self-efficacy, particularly when delivered by multidisciplinary teams or nurses. In contrast, medication-specific programs (14 studies), often led by pharmacists, proved highly effective in enhancing key clinical outcomes, including medication adherence and the reduction of drug-related problems. Conclusion: MSEP effectively enhance adherence. In accord with King’s Goal Attainment Theory, effectiveness is achieved via a ‘transactional’ process. Programs strong in ‘interaction’ (multi-session, nurse-led) achieve psychosocial ‘goal attainment’, while ‘action’-focused programs (pharmacist-led, specific) achieve clinical ‘goals’. The theory may underscore the need for tailored interventions.

Since genetic models for retinal degeneration (RD) in animals larger than rodents have not been firmly established to date, we sought in the present study to develop a new rabbit model of drug-induced RD. First, intravitreal injection of N-methyl-N-nitrosourea (MNU) without vitrectomy in rabbits was performed with different doses. One month after injection, morphological changes in the retinas were identified with ultra-wide-field color fundus photography (FP) and fundus autofluorescence (AF) imaging as well as spectral-domain optical coherence tomography (OCT). Notably, the degree of RD was not consistently correlated with MNU dose. Then, to check the effects of vitrectomy on MNU-induced RD, the intravitreal injection of MNU after vitrectomy in rabbits was also performed with different doses. In OCT, while there were no significant changes in the retinas for injections up to 0.1 mg (i.e., sham, 0.05 mg, and 0.1 mg), outer retinal atrophy and retinal atrophy of the whole layer were observed with MNU injections of 0.3 mg and 0.5 mg, respectively. With this outcome, 0.2 mg MNU was chosen to be injected into rabbit eyes (n=10) at two weeks after vitrectomy for further study. Six weeks after injection, morphological identification with FP, AF, OCT, and histology clearly showed localized outer RD - clearly bordered non-degenerated and degenerated outer retinal area - in all rabbits. We suggest our post-vitrectomy MNU-induced RD rabbit model could be used as an interim animal model for visual prosthetics before the transition to larger animal models.
Animals ; Atrophy ; Intravitreal Injections ; Methylnitrosourea ; Models, Animal ; Models, Genetic ; Photography ; Rabbits ; Retina ; Retinal Degeneration ; Retinaldehyde ; Rodentia ; Tomography, Optical Coherence ; Vitrectomy