Dataset Information

Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Interactive Self-Learning Module.

ABSTRACT:

Introduction

The use of transcranial magnetic stimulation (TMS) has become increasingly prevalent in psychiatry. A growing body of literature supports its use with treatment-resistant depression (TRD), and this indication has gained FDA approval. However, new psychiatry residents often have little exposure to or understanding of TMS.

Methods

This animated, fully narrated, self-learning module (SLM) introduces learners to TMS and its use in TRD and can be completed within 30 minutes. The goal is for viewers to be proficient with the basic science, indications, contraindications, side effects, and treatment process for TMS in TRD. Self-assessment questions throughout the module highlight and reinforce key learning points falling under the educational objectives.

Results

This SLM was deployed with PGY 1-4 training residents at the University of Minnesota during the 2016-2017 academic year as part of a study aimed at improving TMS education within our residency program. Fourteen residents participated in the study and offered feedback on the SLM's efficacy using 5-point Likert-scale surveys. Prior to the SLM's completion, the percentage of participants who disagreed or strongly disagreed with having met individual educational objectives ranged from 64% to 86%. Following completion, the percentage who agreed or strongly agreed with having met individual objectives ranged from 79% to 93%.

Discussion

This SLM provides an introductory curriculum on TMS for TRD to medical students and psychiatry residents who otherwise might not be adequately exposed to this treatment modality. As institutions adopt TMS, the module can serve as a primer for trainees prior to hands-on experience with the technology.

SUBMITTER: Wang J

PROVIDER: S-EPMC6342407 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Publications

Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Interactive Self-Learning Module.

Wang Junao J Nelson Brent B

MedEdPORTAL : the journal of teaching and learning resources 20180427

<h4>Introduction</h4>The use of transcranial magnetic stimulation (TMS) has become increasingly prevalent in psychiatry. A growing body of literature supports its use with treatment-resistant depression (TRD), and this indication has gained FDA approval. However, new psychiatry residents often have little exposure to or understanding of TMS.<h4>Methods</h4>This animated, fully narrated, self-learning module (SLM) introduces learners to TMS and its use in TRD and can be completed within 30 minute ...[more]

PMID: 30800913

Similar Datasets

Project description:ObjectivesTo evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT), and combining both treatments in a stepped care pathway for patients with treatment-resistant depression (TRD) in Ontario.MethodsA cost-utility analysis evaluated the lifetime costs and benefits to society of rTMS and ECT as first-line treatments for TRD using a Markov model, which simulates the costs and health benefits of patients over their lifetime. Health states included acute treatment, maintenance treatment, remission, and severe depression. Treatment efficacy and health utility data were extracted and synthesized from randomized controlled trials and meta-analyses evaluating these techniques. Direct costing data were obtained from national and provincial costing databases. Indirect costs were derived from government records. Scenario, threshold, and probabilistic sensitivity analyses were performed to test robustness of the results.ResultsrTMS dominated ECT, as it was less costly and produced better health outcomes, measured in quality-adjusted life years (QALYs), in the base case scenario. rTMS patients gained an average of 0.96 additional QALYs (equivalent to approximately 1 year in perfect health) over their lifetime with costs that were $46,094 less than ECT. rTMS remained dominant in the majority of scenario and threshold analyses. However, results from scenarios in which the model's maximum lifetime allowance of rTMS treatment courses was substantially limited, the dominance of rTMS over ECT was attenuated. The scenario that showed the highest QALY gain (1.19) and the greatest cost-savings ($46,614) was when rTMS nonresponders switched to ECT.ConclusionFrom a societal perspective utilizing a lifetime horizon, rTMS is a cost-effective first-line treatment option for TRD relative to ECT, as it is less expensive and produces better health outcomes. The reduced side effect profile and greater patient acceptability of rTMS that allow it to be administered more times than ECT in a patient's lifetime may contribute to its cost-effectiveness.

Project description:ImportanceTreatment-resistant major depression (TRMD) in veterans is a major clinical challenge given the high risk for suicidality in these patients. Repetitive transcranial magnetic stimulation (rTMS) offers the potential for a novel treatment modality for these veterans.ObjectiveTo determine the efficacy of rTMS in the treatment of TRMD in veterans.Design, setting, and participantsA double-blind, sham-controlled randomized clinical trial was conducted from September 1, 2012, to December 31, 2016, in 9 Veterans Affairs medical centers. A total of 164 veterans with TRD participated.InterventionsParticipants were randomized to either left prefrontal rTMS treatment (10 Hz, 120% motor threshold, 4000 pulses/session) or to sham (control) rTMS treatment for up to 30 treatment sessions.Main outcomes and measuresThe primary dependent measure of the intention-to-treat analysis was remission rate (Hamilton Rating Scale for Depression score ≤10, indicating that depression is in remission and not a clinically significant burden), and secondary analyses were conducted on other indices of posttraumatic stress disorder, depression, hopelessness, suicidality, and quality of life.ResultsThe 164 participants had a mean (SD) age of 55.2 (12.4) years, 132 (80.5%) were men, and 126 (76.8%) were of white race. Of these, 81 were randomized to receive active rTMS and 83 to receive sham. For the primary analysis of remission, there was no significant effect of treatment (odds ratio, 1.16; 95% CI, 0.59-2.26; P = .67). At the end of the acute treatment phase, 33 of 81 (40.7%) of those in the active treatment group achieved remission of depressive symptoms compared with 31 of 83 (37.4%) of those in the sham treatment group. Overall, 64 of 164 (39.0%) of the participants achieved remission.Conclusions and relevanceA total of 39.0% of the veterans who participated in this trial experienced clinically significant improvement resulting in remission of depressive symptoms; however, there was no evidence of difference in remission rates between the active and sham treatments. These findings may reflect the importance of close clinical surveillance, rigorous monitoring of concomitant medication, and regular interaction with clinic staff in bringing about significant improvement in this treatment-resistant population.Trial registrationClinicalTrials.gov Identifier: NCT01191333.

Dataset Information

Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Interactive Self-Learning Module.

Introduction

Methods

Results

Discussion

Publications

Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Interactive Self-Learning Module.

Similar Datasets

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