Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.

LETTERS ''Dropped head syndrome'' in syringomyelia: report of two cases ''Dropped head syndrome'' is characterised by weakness of the extensor muscles of the neck, with or without involvement of the neck flexors, and is commonly caused by a variety of neuromuscular disorders, including myasthenia gravis, polymyositis, amyotrophic lateral sclerosis, facio-scapulo-humeral dystrophy, nemaline myopathy, carnitine deficiency, spinal muscular atrophy, and isolated neck extensor myopathy. 1 2 There are isolated reports of dropped head syndrome occurring in cervical spondylitis and ankylosing spondylitis. 3 In this report, we describe the clinical and imaging findings of two patients who had dropped head syndrome as a rare neurological sign secondary to syringomyelia.

Brain injury rehabilitation is a complex and challenging task for all members of the multidisciplinary team. Medical advances have allowed more severely impaired patients to survive and consequently the number of patients in the vegetative and minimally conscious states have proportionately increased. Thus, the need for evidence-based practice and further research demonstrating the effects of specific rehabilitation interventions is required. This article reviews the current research and consensus on rehabilitation for patients in the vegetative and minimally conscious states.

This paper reports on the findings of a pilot school-based professional development programme for Tanzanian primary school teachers launched in February 2011 and evaluated in December 2012 by the Ministry of Education and Vocational Training with the support of UNICEF. The study set out to investigate the effectiveness and efficiency of the pilot programme in changing pedagogical practices before it was scaled up nationally. It was found that teachers who had participated in the school-based training showed significant differences in their pedagogical practices and demonstrated a positive attitude towards their training and their pupils, and saw teaching and learning as an interactive, communicative process. Drawing on the findings, the paper explores the challenges and the lessons learned for scaling up school-based teacher development at the national level in Tanzania and other countries in the east and southern African region.

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