On July 1, 2009, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2009; 71: 505-510]. This is an in-depth publication on "quality-of-life assessment in health services research". Within the context of the health sciences, quality of life (QL) encompasses the subjective well-being and functioning in the physical, psychological and social domains. QL informs about the aspects of health care that "actually get to the patient". QL is what patients primarily experience, what they talk about and what to a large degree affects the acceptance of health-care services and processes in the society. Therefore, QL can be considered as a highly important endpoint within health services research. The importance of the construct quality of life is also emphasised in German treaties on social law and utility analyses. This paper is the first account on the relations between health services research and the concept and assessment of QL. Our working group has specified key criteria for QL assessment within studies on health services research. (1) Assessment instruments need to comply with standard quality criteria (reliability, validity, sensitivity, interpretability) and the decision for a particular instrument has to be reasonably justified. (2) Study design and study population have to match with the scientific research question and the sample size has to be biometrically sound. (3) QL assessment including time points over the course of the study has to follow a standardized protocol. (4) Criteria for analysis and interpretation have to be prospectively specified. (5) Studies focusing on diagnostic/therapeutic issues need to specify standards for diagnostic criteria and related therapeutic interventions.

Background: The Bariatric Quality of Life Index (BQL) was created and validated as a nine-factor model in 2005 for the measurement of quality of life (QoL)inpatients before and after bariatric surgery. Even though the results were acceptable, the statistical structure of the test was very unclear. Methods: A total·f466 patients were enrolled in an ongoing prospective longitudinal German study. The assessment took place preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. After that period, reevaluations were done on a yearly basis. In addition to demographic and clinical data, QoL data were collected using the BQL, the Short Form12 (SF-12v2), the Gastrointestinal Quality of Life Index (GIQLI),and the Bariatric Analysis and Reporting Outcome System (BAROS; old version since the study started in 2001). Statistical parameters for contingency (Cronbach’s Α),construct and criterion validity (Pearson’s r),and responsiveness (standardized effect sizes) were calculated. The data of the assessments conducted preoperatively and after 6 and 12 months were used for the validation. Results: The factor analysis and the screeplot showed that a one-factor solution explained 45.37%of variance. The selectivity of the items ranged between 0.61 and 0.85,and Cronbach’s Α was 0.898. The measurements showed similar excellent results with the analysis of all measurement points. Pearson’s test showed a good retest reliability (r = 0.9). The correlations with the SF-12 and the Moorehead-Ardelt I questionnaire (MA-I) were significant, while the correlation with the GIQLI was low. The results of the correlation with the excess weight loss (EWL)(0.45 and 0.49) and the BMI (–0.38 and –0.47) were good. Conclusion: The BQL is a valid instrument and should be preferred over generic questionnaires as it provides betterresponsiveness.

There is a need for surgeons to pay more attention to patient-related symptoms.

Since the ancient world relations exist between music and medicine. In the prehistoric music, dance, rhythm and religious practice were important parts of shamanism and early medical procedures. Important philosophers of the classic period already began with the scientific research of musical and medical questions. During the middle age convents conserved ancient knowledge. They offered medical care and taught the ancient knowledge of medicine, arts and music. The Gregorian choral was created. Traditions of popular believe expressed the relations between music and medicine. The Renaissance became the great époque of art, music and science. Leonardo da Vinci and Andreas Vesalius presented a new style of artistic working and scientific knowledge. Also the basics of western music, like tonality was developed. With the separation of scientific subjects in natural sciences and humanities, the relationships between music and medicine fall into oblivion. During the classic and romantic era music and art were important parts of cultural live of the well educated society. With the development of neurology, psychiatry and psychoanalysis more physicians and scientists were interested in musical questions. Questions about the role of music in human behavior and the ancient method to use music in medical treatment became popular. In the early 20th century the music therapy was developed. Today the effects of music to the human brain are investigated with radionuclear methods. A lot of investigations showed the effect of music and music performance to humans. Music plays an important part in psychotherapy, therapeutic pedagogy and medical care, the importance of music and music therapy increases. In the 80ies of the 20th century the performing arts medicine was developed, which asks for the medical problems of performing musicians.

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