Introduction:The selective neurokinin-1 receptor antagonist aprepitant is effective in the treatment of acute and delayed chemotherapy-induced nausea and vomiting (CINV) associated with both moderately and highly emetogenic chemotherapy. Fosaprepitant has been developed as an intravenous prodrug of aprepitant.Aims:To update the evidence underlying the use of fosaprepitant to prevent CINV.Evidence review:Aprepitant in combination with a serotonin antagonist and a corticosteroid controls acute and delayed symptoms of CINV in patients receiving moderately to highly emetogenic chemotherapy. Bioequivalence of fosaprepitant with aprepitant has recently been demonstrated, which has led to its inclusion in clinical guidelines for treatment of acute CINV with highly, and some regimens of moderately, emetogenic chemotherapy. Early studies of the clinical efficacy of fosaprepitant have shown improvement over treatment with ondansetron. Both aprepitant and fosaprepitant are well tolerated with most adverse events observed of mild or moderate intensity. Conflicting economic evidence has shown that whilst aprepitant provides an increased quality of life in patients treated for CINV, there are differing views over its absolute cost in relation to standard therapy. The incremental cost-effectiveness ratio of aprepitant, however, appears to lie within acceptable bounds.Place in therapy:Fosaprepitant and aprepitant are recommended in guidelines for preventing CINV due to moderately and highly emetogenic chemotherapy. Fosaprepitant is bioequivalent to aprepitant, and could offer potential benefits for patients who may be unable to tolerate oral administration of antiemetics during an episode of nausea or vomiting.

Objective This article describes lessons learned from the collaborative creation of logical models and standard Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) profiles for family planning and reproductive health. The National Health Service delivery program will use the FHIR profiles to improve federal reporting, program monitoring, and quality improvement efforts. Materials and Methods Organizational frameworks, work processes, and artifact testing to create FHIR profiles are described. Results Logical models and FHIR profiles for the Family Planning Annual Report 2.0 dataset have been created and validated. Discussion Using clinical element models and FHIR to meet the needs of a real-world use case has been accomplished but has also demonstrated the need for additional tooling, terminology services, and application sandbox development. Conclusion FHIR profiles may reduce the administrative burden for the reporting of federally mandated program data.

Consultation is an integral part of many Educational Psychologist’s (EPs) work. Yet there is a large heterogeneity in understanding and use of this tool. Such diversity makes evaluating its efficacy difficult. This research therefore sought to identify what the effective features of consultation are by linking observed features to changes in agreed outcomes for children and young people (CYP). Mixed methods were employed to explore what EPs believe are the key features of consultation, what the barriers to effective consultation are, what happens in a consultation for a child or young person, and what combination of features can be identified in consultations which lead to positive changes for CYP. To explore EP views towards the effective features of consultation, 30 EPs were interviewed. Observable features of consultation were tallied for six consultations. For those consultations, goals were identified by participants and a baseline rating was given for each goal using Target Monitoring Evaluation (TME) forms. There were 10 goals identified. Change for these goals was recorded through completing the same form 6-8 weeks later, to allow analysis of which combination of features were present for children with differing progress towards outcomes. This was assessed using Qualitative Comparative Analysis (QCA). The most effective features of consultation, as identified by EPs, included the expert knowledge EPs have, the collaborative nature of consultation, and creating a shared understanding of the CYP and context for all participants. Consultations which were most likely to see positive change for CYP were ones in which the consultation was not dominated by gaining an understanding of the presenting problem. These results give clarity as to what the features of an effective consultation are through a mixed methods analysis. The findings have implications for EPs who use consultation, as well as consultees and those whom consultations are for.

Consultation is an integral part of many Educational Psychologist’s (EPs) work. Yet there is a large heterogeneity in understanding and use of this tool. Such diversity makes evaluating its efficacy difficult. This research therefore sought to identify what the effective features of consultation are by linking observed features to changes in agreed outcomes for children and young people (CYP). Mixed methods were employed to explore what EPs believe are the key features of consultation, what the barriers to effective consultation are, what happens in a consultation for a child or young person, and what combination of features can be identified in consultations which lead to positive changes for CYP.To explore EP views towards the effective features of consultation, 30 EPs were interviewed. Observable features of consultation were tallied for six consultations. For those consultations, goals were identified by participants and a baseline rating was given for each goal using Target Monitoring Evaluation (TME) forms. There were 10 goals identified. Change for these goals was recorded through completing the same form 6-8 weeks later, to allow analysis of which combination of features were present for children with differing progress towards outcomes. This was assessed using Qualitative Comparative Analysis (QCA). The most effective features of consultation, as identified by EPs, included the expert knowledge EPs have, the collaborative nature of consultation, and creating a shared understanding of the CYP and context for all participants. Consultations which were most likely to see positive change for CYP were ones in which the consultation was not dominated by gaining an understanding of the presenting problem. These results give clarity as to what the features of an effective consultation are through a mixed methods analysis. The findings have implications for EPs who use consultation, as well as consultees and those whom consultations are for.