It is argued in this article that although the original purpose of the Individualized Education Program (IEP) was for it to serve as an accountability device, it has become an instructional as well as evaluative mechanism. A review of the forces that led to the inclusion of the IEP in P.L. 94-142—prior legislation, professional articles, testimony at hearings—indicates that proponents hoped that individualized programming would diminish categorical placements in favor of least restrictive environments, encourage parental participation in establishing and overseeing educational goals, and provide a method to evaluate children's progress on mutually agreed-upon objectives. The IEP was never intended to specify what or how teachers should teach. Given the luxury of hindsight, however, our analysis suggests that the provisions for establishing “short-term objectives” to be evaluated through “objective criteria” made it more likely than not that programs would choose specific skills and attainments as objectives, and rely on teacher directed instructional methods. The IEP regulations make it difficult to pursue a child-directed, highly interactive teaching approach with ends left fluid. Suggestions are made for enlarging the construction of the curriculum and evaluation procedures by establishing multiple alternative objectives, using portfolios or videotapes for assessment, including narrative reviews for evaluation, and substituting as objectives, in some instances, methods rather than outcomes. More important, debate on the IEP is encouraged.

A randomized, double-blind, placebo-controlled trial was conducted in eight hematologic units to determine the efficacy and safety of oral enoxacin for infection prevention in adult patients with acute nonlymphocytic leukemia. One hundred nineteen patients undergoing remission induction or consolidation chemotherapy were enrolled; 62 of them received enoxacin (400 mg orally every 12 h). Patients received antifungal prophylaxis with oral mycostatin (1,000,000 U four times daily) or clotrimazole (1 troche five times daily). Analysis was performed on an intent-to-treat basis. There was no significant difference between groups in race, age, or type and stage of leukemia, but there were more males in the placebo group (P = 0.073 [Fisher's exact test]). Fewer enoxacin patients had gram-negative bacteremia (1 versus 14 [P < 0.001]), gram-negative infection at any site (2 versus 19 [P < 0.001]), or bacterial and/or fungal infection (17 versus 26 [P = 0.056]). There was no significant difference in the number of patients with gram-positive infection at any site (12 versus 16), gram-positive bacteremia (9 versus 10), deep fungal infection (6 versus 2), death (2 versus 3), other antimicrobial therapy required (48 versus 48), therapy with amphotericin B (15 versus 7 [P = 0.105]), any adverse event (45 versus 36), or any study drug-associated adverse events (13 versus 6). Logistic regression confirmed (odds ratios and 95% confidence intervals are given in parentheses) that enoxacin reduced the risk of gram-negative infection (0.07; 0.01 to 0.30), especially gram-negative bacillary bacteremia (0.05; 0.01 to 0.37), without altering the risk of gram-positive bacterial (0.63; 0.26 to 1.5), deep fungal (2.57; 0.47 to 13.9), or Clostridium difficile (1.16; 0.3 to 4.56) infection. The median time to the onset of fever of more than or equal 102.8 F (39.3 degree C) was 32 days for the enoxacin group versus 15 days for patients receiving placebo (P=0.0007 [Wilcoxon test]). In patients with acute nonlymphocytic leukemia, oral enoxacin prevents gram-negative infections, delays the onset of fever, does not alter the incidence of gram-positive or proven deep fungal infections, and is well tolerated.

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