Seven normal male and seven normal female volunteers performed three types of biting exercises: an intermittent contraction at maximum voluntary bite force (MVBF) to pain intolerance; a ramp intermittent contraction starting at 10% MVBF and increasing 10% every 10 s; and a sustained biting at 100% MVBF to pain intolerance. The following measurements were made on the first and second days before exercise: a pre- and post-exertional overall jaw pain level; maximum pain-free jaw opening; bilateral masseter pressure pain threshold (PPT) and intolerance (PPI). The results showed that only females presented an increased overall pain level on the second day and a significant decrease in pain-free jaw opening, but no significant decrease of PPT and PPI. These results suggest that females respond differently than males to exertional jaw pain, by increasing their pain response 24 h later.
PURPOSE:The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population. PARTICIPANTS AND SETTING: Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States. APPROACH: Through our organization's "RUSH Way" QI model, we developed an evidence-based NAPI Bundle comprising a "T"-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated. RESULTS: In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal. CONCLUSION: The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.
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