Impact of the emotional development approach on psychotropic medication in adults with intellectual and developmental disabilities: a retrospective clinical analysis.

BACKGROUND: Compared with the general population, adults with an intellectual developmental disorder (IDD) are more likely to develop mental health problems and to receive high levels of psychotropic medication, particularly antipsychotics. The emotional development (ED) approach may help to better understand the nature of challenging behaviour (CB) and tailor treatment and support accordingly. The aim of this retrospective study was to investigate the impact of the ED approach on the prescription of psychotropic medication during inpatient psychiatric treatment. METHODS: The clinical data of 1758 patients were analysed within a retrospective study design over a period of 12 years. ED level was assessed (1) for the first time (INITIAL-SEO), (2) during a previous hospital stay (PAST-SEO) or (3) not at all (NO-SEO). The effects of the ED assessment and the respective intervention during the current admission on the number of psychotropics and the number and dosage of antipsychotics were analysed for the total sample, including those with CB, autism spectrum disorders and psychosis. Group differences were analysed by a chi-square test and a one-factorial analysis of variance. For analysing the impact of the application of the ED approach on psychotropic medication, a covariance model was applied. Changes between the subsamples were analysed by t-tests for dependent samples. RESULTS: The ED approach had a significant impact on reducing the overall amount of psychotropic medication and the dosage of antipsychotics in all patients with IDD. These effects were mainly attributable to those showing CB. In patients with autism spectrum disorders, the developmental approach reduced the number of antipsychotics. No effects could be observed in patients with psychosis; in this subsample, both the number and dosage of antipsychotics increased. CONCLUSIONS: The application of the ED approach in the current hospital stay reduced the number of psychotropic drugs and the number and dosage of antipsychotics, especially in those patients with IDD and CB, but also in those with autism spectrum disorders.

A brief version of the Scale of Emotional Development - Short.

BACKGROUND: The Scale of Emotional Development - Short (SED-S) captures the level of emotional development in persons with a disorder of intellectual development (DID) with 200 items on five developmental levels. The study aims to develop a brief version of the SED-S. METHODS: Based on item analysis (proportions, χ2 -test, Spearman's ρ and corrected item-total correlation), a brief version of the SED-S was developed in a sample of 224 adults with a DID (n1 ) and validated in a second independent matched sample (n2  = 223). RESULTS: Item reliability ranged per item set from Cronbach's α = 0.835 to 0.924. Weighted kappa resulted in κω  = 0.743 (P < 0.001, 95% confidence interval = 0.690-0.802). Overall agreement of the brief version with the original SED-S was PO  = 0.7. The brief version of the SED-S showed weaknesses in distinguishing level 2 from the adjacent levels. CONCLUSIONS: The brief version of the SED-S showed good reliability and moderate to good validity results. Items of phase 2 and, to some degree, of phase 5 should be revised to further improve the psychometric properties of the scale.

Determination of a Safe Zone for Ischial Screw Placement in Total Hip Arthroplasty.

BACKGROUND: Implantation of acetabular components with supplemental screw fixation is commonly performed to improve osteointegration and long-term stability in total hip arthroplasty (THA). Placement of ischial screws improves stability in biomechanical studies, but can be technically challenging. The study aimed to provide a safe zone for ischial screw placement with reference to easily identifiable intra-operative landmarks. METHODS: A retrospective review of patients was performed and 27 preoperative pelvis computed tomography scans were collected. After converting these images to 3-dimensional reconstructions of the pelvis, a safe zone for ischial screw placement was established with reference to the anterior superior iliac spine (ASIS) and the acetabular center and rim. RESULTS: The safe zone of an ischial screw in the en face sagittal plane was a median of 17 degrees (interquartile range [IQR]: 11,23) anterior to 13 degrees (IQR: 10,18) posterior to the reference line from the ASIS through the center of the acetabulum. The safe zone in the coronal plane was 34 degrees (IQR: 18,68) medial to 13 degrees (IQR: 8,19) lateral from a start point 1 centimeter medial to the inferior acetabular rim with a screw length of 25 millimeters. An ischial screw optimized for length directed down the center of the ischium was qualitatively demonstrated to have a start point unobtainable intraoperatively, originating within the cotyloid fossa. CONCLUSION: The ASIS, center of the acetabulum, and acetabular rim provide identifiable intraoperative landmarks for guiding ischial screw placement in hip arthroplasty.

Brief report comparing the Scale of Emotional Development - Short (SED-S) with other scales for emotional development.

BACKGROUND: Different instruments were devised for assessing emotional development (ED) level in persons with an intellectual disability (ID), that is, the Scale of Emotional Development - Short (SED-S), the Scheme for Appraisal of Emotional Development (SAED), the Scale for Emotional Development - Second Revision (SED-R2 ) and the Schaal voor Emotionele Ontwikkeling - Lukas (SEO-Lukas). The aim of this study was to compare the level of emotional functioning as assessed with the SED-S with the SAED, SED-R2 and SEO-Lukas. METHODS: Emotional development was measured in adults with ID with the SED-S (N = 186) and the SAED (n = 85), the SED-R2 (n = 50) and the SEO-Lukas (n = 51). Correlation analysis and Cohen's kappas were calculated between the SED-S and the three respective scales. Internal consistencies (Cronbach's alpha) of the four scales were determined. RESULTS: The SED-S results correlated most with the SEO-Lukas (γ = 1; кω = 0.936) followed by the SAED (γ = 0.809; кω = 0.343) and least by the SED-R2 (γ = 0.665; кω = 0.182). The stage of ED assessed with the SED-S was lower than the ED results measured with the SAED, but higher than with the SED-R2 and most similar to the SEO-Lukas. Cronbach's alphas were high, ranging from 0.853 to 0.975. CONCLUSIONS: Given the respective differences between the scales, the SED-S may equalise the results as compared with previous versions.

Scale of Emotional Development - Short: reliability and validity in adults with intellectual disability.

BACKGROUND: Intellectual disability (ID) is often associated with delays in emotional development (ED). The Scale of Emotional Development - Short (SED-S) was developed to assess the level of ED and to adapt treatment and care accordingly. METHODS: In a sample of 724 adults from five study sites in three countries, a confirmatory factor analysis with a one-factor model was conducted on the entire dataset as well as in different subgroups. Furthermore, internal consistency was investigated using Cronbach's alpha. RESULTS: The confirmatory factor analysis indicated that a single-factor model fits the SED-S data well. The subgroup analyses revealed good model fit, regardless of the severity of ID and irrespective of sex or the presence of autism spectrum disorder or psychiatric disorders. Internal consistency was excellent for the entire sample (Cronbach's alpha = 0.93) and various subgroups (0.869-0.938). CONCLUSION: The results of this study suggest that the SED-S is psychometrically sound and can be used to assess the level of ED in adults with ID.

Early Tibial Baseplate Fracture After Medial Unicondylar Knee Arthroplasty: A Report of 2 Cases.

CASE: Implant failure after unicondylar knee arthroplasty (UKA) is a rare but well-described complication in the arthroplasty literature. However, there is a paucity of literature regarding rapid catastrophic failure of modern implant designs. This is a case report of 2 patients with early catastrophic failure of the tibial baseplate after UKA with a Stryker Restoris MultiCompartmental Knee System implant using Mako robotic assistance, both requiring revision to total knee arthroplasty. CONCLUSION: Improved awareness and understanding of early UKA tibial baseplate failure may help identify both patient and surgical risk factors that could help prevent further instances in the future.

Bilateral Flexor Digitorum Accessorius Longus Precipitating Bilateral Tarsal Tunnel Syndrome: A Case Report.

CASE: A 29-year-old woman presented with bilateral tarsal tunnel syndrome caused by bilateral flexor digitorum accessorius longus, experiencing immediate relief of symptoms after surgical intervention through 1 year. CONCLUSION: Accessory muscles can cause compressive neuropathies in multiple areas of the body. In patients who have FDAL as the cause of their tarsal tunnel syndrome, surgeons should have a high index of suspicion of bilateral FDAL if the same patient develops similar contralateral symptoms.

Suture Tape Augmentation for the Repair of Index Finger Radial Collateral Ligament Injury: A Biomechanical Study.

PURPOSE: Despite their clinical importance in maintaining the stability of the pinch mechanism, injuries of the radial collateral ligament (RCL) of the index finger may be underrecognized and underreported. The purpose of this biomechanical study was to compare the repair of index finger RCL tears with either a standard suture anchor or suture tape augmentation. METHODS: The index fingers from 24 fresh-frozen human cadavers underwent repair of torn RCLs using either a standard suture anchor or suture tape augmentation. Following the repairs, the initial displacement of the repair with a 3-N ulnar deviating load was evaluated. Next, the change in displacement (cyclic deformation) of the repair after 1,000 cycles of 3 N of ulnar deviating force was calculated (displacement of the 1000th cycle - displacement of the first cycle). Finally, the amount of force required to cause clinical failure (30° ulnar deviation) of the repair was determined. RESULTS: Suture tape augmentation repairs displayed significantly less cyclic deformation (0.8 ± 0.5 mm) after cyclic loading than suture anchor repairs (1.8 ± 0.7 mm). There was no significant difference in the force required to cause the clinical failure of the repairs between the suture tape (35.1 ± 18.1 N) and suture anchor (24.5 ± 9.2 N) repairs. CONCLUSIONS: Index finger RCL repair with suture tape augmentation results in decreased deformation with repetitive motion compared with RCL repair alone. CLINICAL RELEVANCE: Suture tape augmentation may allow for early mobilization following index finger RCL repair by acting as a brace that protects the repaired ligament from deforming forces.

Cervical and Lumbar Disc Arthroplasty: A Review of Current Implant Design and Outcomes.

While spinal disc pathology has traditionally been treated using fusion-based procedures, recent interest in motion-preserving disc arthroplasties has grown. Traditional spinal fusion is associated with loss of motion, alteration of native spine kinematics, and increased risks of adjacent segment disease. The motion conferred by disc arthroplasty is believed to combat these complications. While the first implant designs resulted in poor patient outcomes, recent advances in implant design and technology have shown promising radiographic and clinical outcomes when compared with traditional fusion. These results have led to a rapid increase in the utilization of disc arthroplasty, with rates of cervical arthroplasty nearly tripling over the course of 7 years. The purpose of this review was to discuss the evolution of implant design, the current implant designs utilized, and their associated outcomes. Although disc arthroplasty shows significant promise in addressing some of the drawbacks associated with fusion, it is not without its own risks. Osteolysis, implant migration, and the development of heterotopic ossification have all been associated with disc arthroplasty. As interest in these procedures grows, so does the interest in developing improved implant designs aimed at decreasing these adverse outcomes. Though they are still relatively new, cervical and lumbar disc arthroplasty are likely to become foundational methodologies for the treatment of disc pathology.

Epidemiology of female youth ice hockey injuries presenting to United States emergency departments from 2002 to 2019.

BACKGROUND: This study documented injury types, rates and mechanisms for female youth ice hockey players reporting to US emergency departments to inform safety measures and sideline medical preparedness. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for ice hockey injuries (product code 1279) from 1 January 2002 to 31 December 2019. Incidence rate ratios (IRR) were calculated using OpenEpi and compared between age divisions. Spearman's rank correlation was utilized to evaluate the correlation between age and injury incidence. USA Hockey membership statistics were used to establish the population at risk and calculate incidence rates (IR). RESULTS: An estimated 20,384 ice hockey injuries presented to participating United States emergency departments. The number of female youth ice hockey players increased significantly from 36,258 in 2002 to 65,072 in 2019 (p < 0.01). The most commonly injured body parts were the head (n = 5,519, IR = 62.1 [95%CI 54.3-70.0 per 10,000 athletes), trunk (n = 2,364, IR = 26.6 [95%CI 21.2-32.0] per 10,000 athletes), and wrist (n = 1,824, IR = 20.5 [95%CI 15.7-25.4] per 10,000 athletes). The most commonly reported mechanisms of injury were player-to-player collision (n = 4,746, IR = 53.4 [95%CI 46.4-60.5] per 10,000 athletes) and falls (n = 4,585, IR = 51.6 [95%CI 44.1-59.1] per 10,000 athletes). The most common diagnoses were traumatic brain injury (n = 5,333, IR = 60.0 [95%CI 52.3-67.8] per 10,000 athletes), contusion (n = 4,204, IR = 47.3 [95%CI 40.3-54.4] per 10,000 athletes) and strain/sprain (n = 3,601, IR = 40.5 [95%CI 34.1-47.0] per 10,000 athletes). A positive correlation was found between age and injury incidence, as well as increasing age and injuries from player-to-player collision and TBI's. CONCLUSIONS: Though body checking is illegal at all levels of women's ice hockey, player-to-player collision prevailed as the leading mechanism on injury. Hopefully this study informs players, parents, coaches, trainers and clinicians about the impact of player-to-player collisions on overall injury burden in the older age divisions of youth female hockey.

Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload.

BACKGROUND: Induction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available. METHODS: Patients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type. RESULTS: A total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution's specialty personnel are most available. CONCLUSIONS: Time to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.

Epidemiology and trends of adult ice hockey injuries presenting to United States emergency departments: A ten-year analysis from 2007-2016.

PURPOSE: The adult population is under-represented in existing ice hockey injury studies, despite the number of United States (US) adult ice hockey players increasing from 103,533 in 2007 to 180,400 in 2016 (74%). This study establishes trends in demographics, injury location, and injury type for adult ice hockey players (≥19 years old) in the United States. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ice hockey injuries from January 1, 2007 to December 31, 2016. Cases under age 19 were excluded. Each injury's narrative text field was reviewed to determine mechanism of injury. RESULTS: A total of 1,653 patients, representing an estimated 68,786 ice-hockey related injuries, presented to NEISS-participating US EDs. The most commonly injured body parts were the face (n = 12,432, 18.1%), head (n = 10,201, 14.8%), shoulder (n = 9,654, 14.0%) and ankle (n = 5,389, 7.8%). The most common diagnoses made were laceration (n = 18,153, 26.4%), strain/sprain (n = 12,202, 17.7%), fracture (n = 10,079, 14.7%), contusion (n = 9,283, 13.5%) and concussion (n = 4,794, 7.0%). The most common mechanisms of injury were falling (n = 11,786, 18.7%), puck contact (n = 10,544, 15.3%) and player contact (n = 9,449, 13.7%). Concussions increased from 46 in 2007 to 928 in 2016 (R2 = 0.8, ß = 0.9, p < 0.001). Females (n = 1,852, 32%) had a higher proportion of head injuries than males (n = 8,349, 13.3%) (IPR = 2.4, p < 0.0001). The 50+ year old cohort showed a significant increase in injuries during the study period (n = 146 vs. 982, R2 = 0.75, ß = 0.87, p = 0.001). CONCLUSIONS: Despite changing trends in age and sex-related demographics, the majority of injuries in this population may be preventable with adequate enforcement of protective gear use. Increased education amongst players, coaches, trainers, orthopaedic surgeons and primary care physicians should be encouraged to minimize injuries.

Circulating Interleukin-6 Is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults.

BACKGROUND: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals. OBJECTIVES: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults. DESIGN: Randomized controlled trial. SETTING: Exercise laboratory on the Health Sciences campus of an urban university. PARTICIPANTS: 99 mobility-limited (Short Physical Performance Battery (SPPB) ≤9) older adults. INTERVENTION: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement. MEASUREMENTS: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention. RESULTS: At baseline, Spearman's correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in "higher" IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively). CONCLUSIONS: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.

Using Clinical Narratives in Program and Curriculum Evaluation.

Background: Using personal experience stories as teaching tools, clinical narratives are an effective means for sharing the art of nursing practice and provide insight into nurses' critical thinking and clinical proficiency. Using clinical narratives to assess curriculum effectiveness provides important insights into changed practice and learning beyond the classroom. Aim: This article provides an example of using clinical narratives in the evaluation of the Department of Veterans Health Affairs Office of Nursing Services (ONS) Evidence Based Practice Curriculum (EBPC). Methods: As part of a larger mixed-method evaluation of the EBPC, clinical narrative methods were employed to describe one incident where participants (n=3) applied at least two of three evidence based practice components (best available evidence; clinical expertise; patient preference). Results: Examination of clinical narratives demonstrated successful application of key components of evidence based practice and an integration into individual nursing practice beyond data obtained from other evaluation methods. Conclusions: Incorporating rich clinical narratives into a rigorous mixed-method program evaluation protocol provides insights beyond information uptake, satisfaction, efficacy, or competency assessment scores.

Evaluating an Evidence-Based Practice Curriculum for Nurses Entering Clinical Practice in the Veterans Health Administration.

Introduction: The Veterans Health Administration (VHA) registered nurse (RN) Transition to Practice (TTP) program is a 1-year comprehensive, standardized curriculum taught for entry-level nurses to assist them in transitioning to VA-trained, competent, professional RNs. The TTP program includes revised modules on Evidence-Based Practice (EBP) clinical decision making. The revised curriculum emphasizes EBP as a problem-solving approach to clinical decision making rather than a project-based approach to implement practice changes. The goal of this quality improvement project was to evaluate the content, delivery, and outcomes of a revised Evidence-Based Practice Curriculum (EBPC) for use in the VHA RN TTP program. Methods: Focus groups were conducted with TTP coordinators, who teach the program and facility EBP content experts from 32 VHA Medical Centers. All attended a three-day face-to-face training at a central location. Qualitative data were managed and analyzed with a rapid assessment process. Discussion: Leaders within and outside of organizations are commonly believed to affect the success of implementing and sustaining any program or initiative through their influence on organizational climate, leadership processes, and leadership alignment across multiple levels of leadership. Our findings were in line with other research showing that leaders should prioritize EBP and fuel it with resources to create sustainable change. Conclusions: In conclusion, the EBPC was reviewed very favorably by all who planned to use it in their facilities in teaching the content to practicing registered nurses. Future evaluation will focus on the degree to which faculty use the program, how they use the modules, and what feedback nurses provide after exposure to EBPC.

Reducing perioperative blood loss with antifibrinolytics and antifibrinolytic-like agents for patients undergoing total hip and total knee arthroplasty.

Total hip and knee arthroplasties may be associated with a significant amount of perioperative blood loss. The severity of blood loss may be great enough to require the use of blood transfusions to treat perioperative anemia. Various methods of blood preservation have been studied. The use of antifibrinolytics and antifibrinolytic-like agents to reduce perioperative bleeding has been researched in orthopaedics and other surgical subspecialties. This review aims to evaluate the current evidence supporting the use of tranexamic acid, aminocaproic acid, fibrin tissue adhesive, and aprotinin in the reduction of perioperative blood loss in total hip and knee arthroplasties.

Multidimensional Atom Optics and Interferometry.

We propose new multidimensional atom optics that can create coherent superpositions of atomic wave packets along three spatial directions. These tools can be used to generate light-pulse atom interferometers that are simultaneously sensitive to the three components of acceleration and rotation, and we discuss how to isolate these inertial components in a single experimental shot. We also present a new type of atomic gyroscope that is insensitive to parasitic accelerations and initial velocities. The ability to measure the full acceleration and rotation vectors with a compact, high-precision, low-bias inertial sensor could strongly impact the fields of inertial navigation, gravity gradiometry, and gyroscopy.

All-Optical Bose-Einstein Condensates in Microgravity.

We report on the all-optical production of Bose-Einstein condensates in microgravity using a combination of grey molasses cooling, light-shift engineering and optical trapping in a painted potential. Forced evaporative cooling in a 3-m high Einstein elevator results in 4×10^{4} condensed atoms every 13.5 s, with a temperature as low as 35 nK. In this system, the atomic cloud can expand in weightlessness for up to 400 ms, paving the way for atom interferometry experiments with extended interrogation times and studies of ultracold matter physics at low energies on ground or in Space.

Separated response function ratios in exclusive, forward π(±) electroproduction.

The study of exclusive π(±) electroproduction on the nucleon, including separation of the various structure functions, is of interest for a number of reasons. The ratio RL=σL(π-)/σL(π+) is sensitive to isoscalar contamination to the dominant isovector pion exchange amplitude, which is the basis for the determination of the charged pion form factor from electroproduction data. A change in the value of RT=σT(π-)/σT(π+) from unity at small -t, to 1/4 at large -t, would suggest a transition from coupling to a (virtual) pion to coupling to individual quarks. Furthermore, the mentioned ratios may show an earlier approach to perturbative QCD than the individual cross sections. We have performed the first complete separation of the four unpolarized electromagnetic structure functions above the dominant resonances in forward, exclusive π(±) electroproduction on the deuteron at central Q(2) values of 0.6, 1.0, 1.6 GeV(2) at W=1.95 GeV, and Q(2)=2.45 GeV(2) at W=2.22 GeV. Here, we present the L and T cross sections, with emphasis on RL and RT, and compare them with theoretical calculations. Results for the separated ratio RL indicate dominance of the pion-pole diagram at low -t, while results for RT are consistent with a transition between pion knockout and quark knockout mechanisms.

Can patients or clinicians predict the severity or duration of an acute upper respiratory infection?

PURPOSE: Acute upper respiratory infections (URI) are the second most common diagnosis in primary care offices. As treatments have limited effectiveness, patient counseling regarding expectations for the course of the URI is an important aspect of care. It is unknown how accurate patients, clinicians or questionnaires such as the Wisconsin Upper Respiratory Symptom Survey (WURSS) instrument are at predicting URI severity and duration, and whether these predictions should be used to counsel patients. METHODS: Seven hundred and nineteen individuals with recent onset cold in community clinic settings participated. Participants and clinicians predicted the severity and duration of the URI and participants completed the WURSS instrument at initial visit. Subsequent URI global severity was calculated as area under the curve using an average of twice-daily WURSS-21 self-reports as the y-axis and illness duration as the x-axis. URI duration was determined by self-report of beginning and end of illness. Linear regression analysis was used to correlate baseline predictions with subsequent outcomes. Analyses by gender, age and income were also performed. RESULTS: There was no significant association between participant and clinician predictions of severity or duration. Initial WURSS values explained 0.119 (95% CI: 0.074-0.163) of the variance in subsequent severity outcomes. There were no significant differences in associations by age, gender or income. CONCLUSIONS: Clinicians should not use their predictive assessments or their patients' predictions when advising patients on the expected course of a URI. This study also suggests that the WURSS instrument could give some predictive information, but whether this is clinically useful is uncertain.