Should whole brain radiation therapy (WBRT) be used as the sole therapy in patients with newly-diagnosed, surgically accessible, single brain metastases, compared with WBRT plus surgical resection, and in what clinical settings?Target populationThis recommendation applies to adults with newly diagnosed single brain metastases amenable to surgical resection; however, the recommendation does not apply to relatively radiosensitive tumors histologies (i.e., small cell lung cancer, leukemia, lymphoma, germ cell tumors and multiple myeloma).RecommendationSurgical resection plus WBRT versus WBRT aloneLevel 1 Class I evidence supports the use of surgical resection plus post-operative WBRT, as compared to WBRT alone, in patients with good performance status (functionally independent and spending less than 50% of time in bed) and limited extra-cranial disease. There is insufficient evidence to make a recommendation for patients with poor performance scores, advanced systemic disease, or multiple brain metastases.If WBRT is used, is there an optimal dosing/fractionation schedule?Target populationThis recommendation applies to adults with newly diagnosed brain metastases.RecommendationLevel 1 Class I evidence suggests that altered dose/fractionation schedules of WBRT do not result in significant differences in median survival, local control or neurocognitive outcomes when compared with “standard” WBRT dose/fractionation. (i.e., 30 Gy in 10 fractions or a biologically effective dose (BED) of 39 Gy10).If WBRT is used, what impact does tumor histopathology have on treatment outcomes?Target populationThis recommendation applies to adults with newly diagnosed brain metastases.RecommendationGiven the extremely limited data available, there is insufficient evidence to support the choice of any particular dose/fractionation regimen based on histopathology.The following question is fully addressed in the surgery guideline paper within this series by Kalkanis et al. Given that the recommendation resulting from the systematic review of the literature on this topic is also highly relevant to the discussion of the role of WBRT in the management of brain metastases, this recommendation has been included below.Does the addition of WBRT after surgical resection improve outcomes when compared with surgical resection alone?Target populationThis recommendation applies to adults with newly diagnosed single brain metastases amenable to surgical resection.RecommendationSurgical resection plus WBRT versus surgical resection aloneLevel 1 Surgical resection followed by WBRT represents a superior treatment modality, in terms of improving tumor control at the original site of the metastasis and in the brain overall, when compared to surgical resection alone.

This paper examines the trends and emerging issues in trade in educational services. It provides rough estimates of the size of the international market in educational services drawing on the limited data available in services trade statistics and data on foreign students in tertiary education in OECD countries. It outlines the current commitments for trade in educational services under the General Agreement on Trade in Services (GATS). It also reviews the implications of the on-going GATS negotiations for further multilateral trade liberalisation in this sector. It points out that OECD countries have been noticeably reluctant to make proposals for further liberalisation of trade in educational services. One reason for this is the concern in many countries about the potential threats posed to cultural values and national traditions by growing trade liberalisation in educational services. Finally, the paper reviews some of the main policy issues arising from trade in educational services. Copyright Blackwell Publishers Ltd 2002.

BackgroundOver recent years there has been an increase in teaching of both palliative care and reflective practice in UK medical schools. The palliative care teaching at the University of Cambridge School of Clinical Medicine is multi-faceted and involves students writing reflective essays after individually meeting patients approaching the end of life during their final year general practice and hospital medicine placements. This paper draws on two studies examining this teaching element to analyse what the students found valuable about it and to comment on the practice of meeting patients and subsequent reflective writing.MethodsTwo studies have explored students’ perceptions of these course components. The first was a thematic analysis of 234 reflective essays from 123 students written in 2007-2008, including examining what students wrote about the exercise itself. The second project involved a semi-structured questionnaire that students completed anonymously; this paper reports on the free text elements of that study [sample size =107]. Since similar themes were found in both studies, the coding structures from each project were compared and combined, enabling triangulation of the findings around what the students found valuable from the palliative care teaching involving meeting patients and reflective writing.ResultsOverall, students reported that these components of the palliative care teaching are valuable. Four main themes were identified as aspects that students valued: (1) dedicated time with patients, (2) learning about wider elements of treatment and holistic care, (3) practicing communication skills, and (4) learning about themselves through reflective writing. Some students expressed a dislike for having to formally write a reflective essay.ConclusionIt is possible to arrange for all of the medical students to individually meet at least two patients receiving palliative or end of life care. Students found these encounters valuable and many wrote about the benefit of formally writing about these experiences. Students reported finding this model useful in widening their skill-set and understanding of palliative care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0827-6) contains supplementary material, which is available to authorized users.

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Pharmacists' attitudes, pharmacy technician level of education, and number of technician hours worked per week were associated with MTM completion rates.