Designing a curriculum in a clinical setting: an iterative process.

A curriculum for the training of medical students was designed and implemented in a functioning clinical setting. The multidisciplinary, multiprofessional staff of a primary care center participated with professional educators in an iterative process for curriculum development. A three-stage plan was conceived: behaviorally oriented educational objectives were constructed, instructional methodologies to satisfy these objectives were created, and evaluation instruments were designed. Throughout each stage the educators facilitated the process by teaching the staff the necessary techniques for the design and implementation of the curriculum. The curriculum that resulted from this process is focused on those issues that are important to team delivery of primary care. An important outcome of the project is the increased enthusiasm and competence of the professional staff in the teaching of students in the health professions.

Patient participation in the problem-oriented system: a health care plan.

The problem-oriented system can be used to encourage the involvement of the patient in his health care. A Health Care Plan is described, the purposes of which include facilitation of provider-patient communication, and emphasis on the shared responsibility of provider and patient in problem solving and health maintenance. The Health Care Plan is not designed to supplant other parts of the system such as the problem list or audit.

Serum and urinary concentrations of cyclacillin in humans.

Cyclacillin is a semisynthetic penicillin produced from the penicillin nucleus (6-aminopenicillanic acid) by acylation with 1-aminohexanecarboxylic acid. The absorption and excretion characteristics of cyclacillin were defined in one completely randomized and three three-way crossover experiments. Mean peak serum cyclacillin levels appeared earlier and were fivefold higher than those obtained with equal doses of ampicillin. High serum cyclacillin concentrations were reached at 0.5 h and by 2 h were lower than ampicillin. Serum ampicillin concentrations peaked at 1.5 h, remaining slightly higher than those for cyclacillin for the next 4.5 h. The mean area for the cyclacillin curve was significantly superior to either of the ampicillin formulations. Mean serum concentrations of cyclacillin exhibited a smooth dose-response, approximately doubling in each instance as the dose was doubled from 250 to 500 and from 500 to 1,000 mg. High concentrations of cyclacillin were also demonstrated in urine. Neither ratio of drug to metabolite in the urine nor the percent of excretion was significantly affected by the dose level. Sixty-seven percent of the drug was excreted unchanged, and 17% was excreted as penicilloic acid, with most of the excretion occurring within 6 h of administration. In subjects given 500 mg of cyclacillin (four times daily) for 6 days, 2% of the drug was excreted as 1-aminocyclohexanecarboxylic acid, and approximately 55% (24 to 91%) was unchanged. Neither formation nor excretion of the former was sex dependent.