Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide.

OBJECTIVES: Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. METHODS: The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. RESULTS: Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. CONCLUSION: A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.

[Accuracy of ultrasound weight assessment--comparison of vertex vs. breech presentation]. / Genauigkeit der sonographischen Gewichtsschätzung--Vergleich Schädellage vs. Beckenendlage.

AIM: To determine the quality of prenatal sonographic weight estimation, comparing breech and vertex presentations. METHOD: In 147 breech presentations (BP) and 149 vertex presentations (VP), the biparietal head diameter (BPD), the fronto-occipital head diameter (FOD) and the transverse abdominal diameter (ATD) were measured. From these data, the weight was estimated, using Shepard's formula before 28 weeks and Hansmann's thereafter, and compared to the delivery weight. Both formula were modified to incorporate the virtual BPD (vBPD), derived from the BPD, FOD and the calculated head circumference. In the BP group, the role of examiner skills was evaluated, comparing the accuracy of experienced (DEGUM II qualifications) and average individuals. RESULTS: The accuracy for BP was nearly identical to that for VP (= 0.915 vs. = 0.929). The examiners' qualifications had a detectable but not significant influence on the results (= 0.942 vs. = 0.892). CONCLUSION: Ultrasound measurements yield comparable results in both BP and VP, if the vBPD is used. In our opinion, ultrasonic weight estimation is a useful adjunct when determining the manner of delivery in BP.

Maternal serum alpha-fetoprotein screening for neural tube defects. Report of a combined study in Germany and short overview on screening in populations with low birth prevalence of neural tube defects.

The basis of maternal serum alpha-fetoprotein (AFP)-screening for neural tube defects is discussed. A report is given of a large scale screening study in the Federal Republic of Germany combining the experiences in Giessen and Hannover on over 50,000 pregnant women, about evenly distributed among both centers. Published and known forthcoming data from other low incidence populations, particularly of European countries, are reviewed briefly. The conclusion is reached that general screening could effectively be instituted and in the final result should also be cost-beneficial.