[Decisions of the German Federal Joint Committee in situations with insufficient data : Decision-making options for new diagnostic and treatment methods]. / Entscheidungen des Gemeinsamen Bundesausschusses bei unzureichender Datenlage : Entscheidungsoptionen bei neuen Untersuchungs- und Behandlungsmethoden.

BACKGROUND: In accordance with legal requirements, the Federal Joint Committee (German: Gemeinsamer Bundesausschuss, G­BA) decides based on the best available evidence which new diagnostic and treatment methods are reimbursed by statutory health insurance. If the benefit is proven with sufficient certainty, statutory health insurance providers pay for the new method, otherwise a trial study must be conducted. OBJECTIVES: To present the G­BA's decision-making options even in the case of insufficient evidence in the field of urology. MATERIALS AND METHODS: A document search was conducted on the homepage of the G­BA for the decisions about method evaluation and quality assurance in the field of urology of the last 10 years. The respective decisions are presented in the light of the decision options available in each case. RESULTS: Using the example of the debate on low-dose rate brachytherapy for localised prostate cancer, the years-long, ultimately futile, effort to increase the evidence base for an innovative method is presented. CONCLUSION: Compared to the development of guidelines, for example, the G­BA can only make dichotomous yes/no decisions and has to accept the often insufficient evidence situation, or (has to) try to increase the evidence base by initiating its own study. The latter is particularly difficult when specific methods are already established in routine care. A particular challenge is posed by new, especially invasive methods in the hospital sector, which has to be evaluated (benefit assessment) and, if necessary, tested by the G­BA with a trial study. To what extent this will succeed in the future is not yet foreseeable.

Playing Super Mario induces structural brain plasticity: gray matter changes resulting from training with a commercial video game.

Video gaming is a highly pervasive activity, providing a multitude of complex cognitive and motor demands. Gaming can be seen as an intense training of several skills. Associated cerebral structural plasticity induced has not been investigated so far. Comparing a control with a video gaming training group that was trained for 2 months for at least 30 min per day with a platformer game, we found significant gray matter (GM) increase in right hippocampal formation (HC), right dorsolateral prefrontal cortex (DLPFC) and bilateral cerebellum in the training group. The HC increase correlated with changes from egocentric to allocentric navigation strategy. GM increases in HC and DLPFC correlated with participants' desire for video gaming, evidence suggesting a predictive role of desire in volume change. Video game training augments GM in brain areas crucial for spatial navigation, strategic planning, working memory and motor performance going along with evidence for behavioral changes of navigation strategy. The presented video game training could therefore be used to counteract known risk factors for mental disease such as smaller hippocampus and prefrontal cortex volume in, for example, post-traumatic stress disorder, schizophrenia and neurodegenerative disease.

The effect of novelty on reinforcement learning.

Recent research suggests that novelty has an influence on reward-related learning. Here, we showed that novel stimuli presented from a pre-familiarized category can accelerate or decelerate learning of the most rewarding category, depending on the condition. The extent of this influence depended on the individual trait of novelty seeking. Different reinforcement learning models were developed to quantify subjects' choices. We introduced a bias parameter to model explorative behavior toward novel stimuli and characterize individual variation in novelty response. The theoretical framework allowed us to test different assumptions, concerning the motivational value of novelty. The best fitting-model combined all novelty components and had a significant positive correlation with both the experimentally measured novelty bias and the independent novelty-seeking trait. Altogether, we have not only shown that novelty by itself enhances behavioral responses underlying reward processing, but also that novelty has a direct influence on reward-dependent learning processes, consistently with computational predictions.