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Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1–5) and continue treatment at home under remote supervision (sessions 6–30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.

Increased attention towards infection control measures during the COVID-19 pandemic have brought to light the dermatological consequences of intensified hand hygiene measures. Healthcare workers are inherently at an increased risk of developing both allergic and irritant contact dermatitis. Individuals with a history of atopy are especially vulnerable given their impaired native skin barriers and increased sensitivities at baseline. Examination gloves not only induce contact allergies from manufacturing chemicals, but also serve as an occlusive catalyst for facilitating contact sensitization and irritant dermatitis. Similarly, handwashing practices with soap and alcohol-based hand rubs (ABHRs) undermine the natural skin barriers with increasing frequency of use. We highlight clinical pearls for the frontline healthcare worker experiencing COVID-19 surges and offer practical measures to minimize the development of hand-based dermatitis.