A s is so often the case, research projects are born out of nurses asking "why" questions about their practice. This project was no different and is best illustrated with this patient story.Max, in his early 60s, was an un-kept, homeless man admitted to the hospital with a large myocardial infarction for a nearly five-week stay. His size (six foot, 4 inches, 420-pound frame) and illness had a strong effect on the staff's ability to provide care. He did not fit in the bed, and the pressure on his legs and heels, as well as the presence of 3+ pitting edema, led to sloughing of his skin. The insertion site from the coronary angiogram and intraaortic balloon pump procedures done on admission had not healed due to the presence of a body rash from the use of multi-. Prevention of incontinence-related skin breakdown for acute and critical care patients: Comparison of two products. Urologic Nursing, 32(3).Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.Key Words: Urinary/fecal incontinence, dermatitis, skin care/nursing, cost-benefit analysis, dermatologic agents/therapeutic use.

Pituitary pars intermedia dysfunction (PPID), also known as Equine Cushing's disease, is most often diagnosed in older horses and ponies. To the authors' knowledge, there have been no reports of its diagnosis in captive nondomestic equids. A 13-yr old onager (Equus hemionus onager) at the Zoological Society of London (ZSL) Whipsnade Zoo showed clinical signs suggestive of PPID, including hirsutism, fat redistribution, weight loss, laminitis, and chronic infections. A dexamethasone suppression test was performed to confirm PPID. Subsequently, adenomatous hyperplasia and microadenoma of the pars intermedia were identified postmortem. Four months later, this onager's dam died suddenly, and adenomatous hyperplasia of the pars intermedia was diagnosed following necropsy. The dam had shown no clinical signs of PPID. Examination of archives identified eight other adult onagers that died or were euthanized between 1993 and 2007. The brain was not examined in four of these, but pituitary glands were described as enlarged during necropsy in three animals based on the subjective assessment of an experienced zoo and wildlife pathologist, making an overall prevalence of enlargement of 83.3%. Hyperplastic pituitary changes are positively correlated with age in domestic equids, and this may also be the case in onagers. Alternative etiologies are also discussed.

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