ABSTRACT
The chemistry foundation year at the University of East Anglia is a diverse cohort with a wide range of prior educational experience and confidence levels. A flexible learning program combining extensive online materials intended for asynchronous study and face to face peer instruction is provided. Study is divided into weekly topics. Students are directed to take a short introductory quiz at the beginning of the week, feedback on which allows them to tailor the extent of asynchronous learning to their own needs. All students attend a highly interactive synchronous teaching session which utilises active learning to develop their conceptual understanding. The week concludes with a reflective formative test. Measures of student activity on the online platform and audience response technology in the lecture theatre provide a quantitative picture of engagement with tailored blended learning, while semi-structured interviews provide qualitative insight into the student perception.
ABSTRACT
A 69-year-old female with a history of psoriatic arthritis was diagnosed with septic arthritis and started on broad-spectrum antibiotics. She underwent left hip excisional debridement of her prosthetic hip joint which grew group B Streptococcus (S. agalactiae). She was switched to IV ceftriaxone 2 g daily and her hemoglobin decreased to 5.4 g/dL on day 11. Peripheral blood smear showed normochromic normocytic anemia and thrombocytopenia without the presence of schistocytes. Increased lactate dehydrogenase (LDH), decreased haptoglobin and hemoglobin, and positive direct Coombs test (DCT) led to a presumptive diagnosis of drug-induced immune hemolytic anemia (DIIHA). As a result, she was switched from ceftriaxone to IV ertapenem 500 mg every 24 hours and oral prednisone 60 mg for four days during the initial phase. Her hemoglobin, LDH, and haptoglobin trended towards normal limits, further supporting the diagnosis of DIIHA secondary to ceftriaxone.
