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Biomedical subjects

D Messer

Publications and source records attributed to D Messer.

8 recordsLinked to original sources
PubMed2004

Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric senior house officers.

OBJECTIVES: To assess the implications and cost-effectiveness of extending the role of midwives to include the routine (24-hour) examination of the healthy newborn usually carried out by junior doctors. DESIGN: The study included a prospective randomised controlled trial (RCT) with mother and baby dyads randomised to either senior house officer (SHO) or midwife for the routine examination of the newborn. Midwives and SHOs were also videoed while performing the examinations and the videos were rated by an independent consultant and senior midwife. In addition extensive interviews, surveys, consultations and assessments were carried out. SETTING: A District General Hospital (for the RCT), a London Teaching Hospital, general practices and mothers' homes (for interviews); questionnaires were sent to all maternity units in England (for the National Survey). PARTICIPANTS: A total of 826 mother and baby dyads in a District General Hospital in south-east England. Midwives and SHOs, as well as midwifery managers, paediatric consultants; general practitioners (GPs) and representatives of key organisations. INTERVENTIONS: A routine examination of a newborn baby was carried out at about 24 hours from birth and a further examination for half the babies in each group, at 10-days at home by the community midwife. MAIN OUTCOME MEASURES: Referrals assessed as appropriate and as major or minor by three independent consultants. Problems identified during the first year of life assessed as identifiable at 24 hours. Quality assessment by video against an agreed written proforma. Maternal satisfaction. Opinion of professionals and mothers about aspects of the examination. RESULTS: There was no statistical difference between SHO and midwife examinations in appropriate referral rates to hospital or community or in inappropriate referral rates to hospital. Videoed assessments were assessed as carried out more appropriately by the midwives than by the SHOs. Overall maternal satisfaction was high and higher when a midwife rather than an SHO examined. Few new health problems were identified at the 10-day examination. From the National Survey, it was estimated that about 2% of babies in England are examined by a midwife. If midwives were to examine all babies where there were no complications of birth or antenatal history, there would be savings of about 2 pounds per baby born, equivalent to savings of 1.2 pounds million nationally. Were midwives to examine all babies on normal wards savings would increase to about 4.30 pounds per baby born or 2.5 million pounds nationally. Representatives of the professional bodies were of the opinion that having trained midwives carrying out the examination would be valuable. CONCLUSIONS: All component aspects of the study were consistent in showing benefits or at least no significant barriers to suitably qualified, trained midwives carrying out the examinations. Developing the role of the midwife to include examination of the newborn is likely to result in improved quality of examinations and higher satisfaction from mothers. It would slightly reduce overall health service costs, with some increased resources needed by midwifery departments, and some decrease in resource needs of paediatric departments. There is a need for further research into the value of the examination being carried out at home rather than in hospital; the overall unsatisfactory quality of the examination of the hips; and appropriate inclusion criteria for which babies' midwives should examine.

Adult↗
PubMed2000

Recall for self and other in autism: children's memory for events experienced by themselves and their peers.

Research on memory processing suggests that memory for events that an individual experiences should be superior to that for similar events that someone else experiences (e.g., Baker-Ward et al., 1990). However, such predictions may not be applicable to individuals with autism. There are already suggestions that individuals with autism have specific difficulties in remembering (Boucher & Lewis, 1989). In addition, they are known to have more general difficulties involving processes related to the "self." If children with autism have difficulties in encoding information about themselves this could result in a deficit in personal episodic memory. The studies reported here compare memory for personally experienced events with that of memory for events experienced by a peer. An adaptation of a method devised by Boucher and Lewis has been employed to assess recall. Two separate studies were conducted to investigate whether children with autism are impaired at recalling personal events. Two groups of children took part in Study 1, a group of children with autism and a control group of typical children matched for verbal mental age. A group of children with moderate learning difficulties were employed in the second study to investigate whether the findings also occur in other groups of individuals who have learning disabilities. Findings indicate that, in the group with autism, events performed by the individual were recalled significantly less well than the observed events performed by a peer. However, the results for the nonautistic children in both studies showed that the opposite was true. Theoretical claims are discussed in the light of these findings.

Adolescent↗
PubMed1998

Spontaneous play in children with autism: a reappraisal.

Much controversy remains regarding the ability of children with autism to engage in spontaneous play. In this study children with autism, Down syndrome and typical development with verbal mental ages of approximately 2 years were assessed for play abilities at three data points. Even in this group of children with autism, who had relatively low verbal mental ages, symbolic play skills were not totally absent. However, it was possible to distinguish their pattern of play behaviors from the other two groups. Consequentially, it is argued that there are unusual features in early spontaneous play in children with autism and these atypical patterns are not restricted to their difficulties in the production of symbolic play. Such differences in early spontaneous play raise interesting questions about the etiology of autism, the direction of future research, and the theoretical models that can account for the condition.

Autistic Disorder↗
PubMed1997

Imitation of pretend play acts by children with autism and Down syndrome.

Although there has recently been considerable research interest in the difficulties that children with autism have engaging in pretend play, little attention has been paid to the ability of these children to imitate pretend play acts. Furthermore, suggestions that children with Down syndrome have relatively advanced abilities in pretend play have not been accompanied by an examination of their capacity to imitate pretend play. Three groups of children: autistic, Down syndrome, and normally developing were studied for their capacity to imitate single pretend acts and a series of pretend acts that formed scripts. While the children with autism were surprisingly better than the other two groups on the single-scheme task, they demonstrated specific difficulties on the multischeme task. Results are discussed in relation to current theories of autism and the notion of imitation.

Adolescent↗
PubMedDate not supplied

Children with word-finding difficulties--prevalence, presentation and naming problems.

There is increasing interest from therapists and researchers in children's word-finding difficulties (WFDs). Word finding difficulties are usually considered to be present when children are able to identify a referent from a set of exemplars, but have difficulty producing the target word when shown a picture or in conversation. Word finding difficulties are associated with a number of conversational forms such as delays in the production of a word, the use of long pauses within phrases, frequent use of place holders ('uh', 'um', etc.) and the use of circumlocutions. Although interest is being shown in WFDs, most of the data come from relatively small samples with the result that one knows little about the prevalence of the condition, what circumstances exacerbate the condition, the occurrence of associated difficulties and the types of therapy that are employed. To obtain this information a survey was carried out in the South-East of England of practitioners working with children who have language difficulties. Twenty-three per cent of children in language support services were identified as having WFDs. Most respondents used a mixture of formal and informal assessments. It was reported that WFDs were associated with difficulties in grammatical production, word meaning and grammatical comprehension. WFDs in addition were more likely to occur in situations with high processing demands. A variety of intervention strategies were identified. These findings are discussed in relation to current practice and the authors understanding of the condition.

Adolescent↗
PubMedDate not supplied

Fat contents of cereal foods: comparison of classical with recently developed extraction techniques.

Eight cereal products ranging from a fat-free ready-to-eat (RTE) cereal (frosted flakes) to a full-fat high-ratio cake mix were subjected to analyte separation by anhydrous diethyl ether extraction (EE), acid hydrolysis/mixed ether extraction (AH), solid-phase extraction (SPE), and supercritical fluid extraction (SFE) with CO2 and with CO2 modified with 15% ethanol (SFEmod). Gravimetric analyses of extracts indicated higher (P < or = 0.05) crude fat values by AH than by EE, SFE, or SFEmod. Extractions followed by fatty acid methyl ester analysis also produced higher (P < or = 0.05) triglyceride means by AH than by other methods used for heat-treated RTE cereals and for ready-to-cook (RTC) cream of wheat. Therefore, for labeling purposes, AH seems most appropriate because in most cases it achieves higher triglyceride values than extraction with solvent(s) alone. SFE and SPE, on the other hand, yield fat values similar to those obtained by EE and offer the advantages of reduced solvent volume, short extraction times, and ease of laboratory automation.

Dietary Fats↗