CJEM Articles: Dennis Scolnik

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  • Integrating CanMEDS competencies into global health electives: an innovative elective program
    January 2011 13 1
    Abi Sriharan, Dennis Scolnik, MSc, Rahim Valani

    Globalization has opened the doors for medical students to undertake international health electives, providing an opportunity for them to gain valuable competencies and skills outside their formal curriculum. As the number of medical students embarking on these electives increases, there is a need to structure the electives with specific learning objectives and to ensure adequate educational outcomes.
    We describe the International Pediatric Emergency Medicine Elective (IPEME), which is a novel global health elective that brings together students from Canada and the Middle East who are selected on the basis of a competitive application process and brought to Toronto for a 4-week living and studying experience. The program was introduced in 2004 and uses four specific areas to provide its structure: pediatric emergency medicine, global health, leadership, and peace building. The elective uses core CanMEDS competencies to foster cross-cultural dialogue, networking, and cooperation and fulfills the program's aim of using health as a bridge to peace.
    The lessons learned from the curriculum planning and implementation process are highlighted and the impact of the program explored to help provide a framework for developing similar international electives.

  • What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria?
    November 2003 5 6
    Anne Matlow, Dennis Scolnik, Lauren Linett, Ran D. Goldman

    Objective: To determine the rate of bacterial meningitis among febrile infants in the emergency department (ED) who have pyuria detected in an initial catheterized urine specimen.

    Methods: This retrospective chart review, conducted at the Hospital for Sick Children, Toronto, Ont., involved all children aged 0 to 3 months who presented to the ED with fever and pyuria (

    >=10 white blood cells/mm3) over a 3-year period. Cerebrospinal fluid (CSF) was evaluated using standard methods, and the rate of meningitis in children with pyuria was determined.

    Results: The study sample included 211 infants with fever and pyuria -- 79 of these under 1 month of age. Eighty-one percent (171/211) had positive urine cultures, and 143 underwent lumbar puncture to rule out meningitis. Of these, 140 CSF samples were culture negative and 3 grew coagulase negative Staphylococcus -- 2 because of contamination and 1 because of a ventriculo-peritoneal shunt infection. Both children with CSF contamination grew Escherichia coli in the urine. The rate of bacterial meningitis in the study sample was 0% (95% confidence interval, 0%-2.6%).

    Conclusions: In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%. This suggests that recommendations for mandatory lumbar puncture in such children should be reconsidered. However, until larger prospective studies define a patient subset that does not require CSF analysis, it is prudent to rule out meningitis, administer parenteral antibiotics for urinary tract infection, and admit for close observation.

  • Lack of efficacy of humidification in the treatment of croup: Why do physicians persist in using an unproven modality?
    July 2001 3 3
    Dennis Scolnik, Elana Lavine

    Background: Humidification is a time-honoured therapy for childhood croup (acute laryngotracheobronchitis). Despite a paucity of evidence supporting its use, many physicians, nurses and parents still apply this treatment. Our objective was to summarize available evidence and assess the rationale for the ongoing use of humidity to treat childhood croup.

    Methods: Searches of both MEDLINE and the Cochrane Database were conducted for English-
    language original or review literature on the treatment of croup with humidity, for the years 1966-1999.

    Results: Only 2 published studies have attempted to evaluate humidification therapy for croup, and none has been published since 1984. There is no published evidence to support the commonly held empirical view that humidity helps alleviate the symptoms of childhood croup, and no understanding of which factors of moisture or temperature affect patient outcomes. Risks may include scalding and unnecessary discomfort.

    Interpretation: There is no strong evidence supporting the use of humidity in the treatment of croup. Although such treatment is still widely used, it is not without risk, and further trials are required to address its efficacy.

  • A clinical perspective on diagnosis of urinary tract
    July 2001 2 3
    Anna Jarvis, Dennis Scolnik