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Background: Self-application of topicals on the back can be challenging., Objective: The aim was to assess topical back coverage using commercially available back applicators., Materials and Methods: Ten subjects applied sunscreen to their back using their hands and then with 3 back applicators (large foam tip, small foam tip, roller tip). The amount of lotion used and the time it took to perform the application were recorded. The resulting distribution of sunscreen was assessed with a Wood's lamp; the area covered fluoresced less than the uncovered skin. Images were captured and then analyzed using an automated thresholding technique., Results: Subjects applied more lotion when using the large foam tip (7.58 g, 95% CI 6.47-8.70 g; P < .004) and small foam tip (7.46 g, 95% CI 6.35-8.57 g; P < .006) applicators compared to hands alone (6.22 g, 95% CI 5.10-7.33 g). Application time was longer with the small foam tip applicator (113.4 s, 95% CI 96.7-130.1 s) relative to hand application (78.7 s, 95% CI 62-95.4 s) ( P < .03). Coverage of the back was higher for the large foam tip (84.8%, 95% CI 78.4%-91.3%; P < .03), small foam tip (88.0%, 95% CI 81.6%-91.5%; P < .006), and roller tip (84.3%, 95% CI 77.9%-90.8%; P < .04) applicators compared to hand application (71.5%, 95% CI 65%-78%). The middle back tended to have less coverage when applying with the hands., Conclusions: Topical coverage of the back is improved with the use of applicator devices during self-application.

A recent study by Frantz et al. investigated the relationship between length of stay (LOS) and several factors in a small, rural hospice and found significant differences in LOS by primary physician specialty, referral source, and diagnosis (American Journal of Hospice & Palliative Care, March/April 1999). The purpose of the present study was to replicate and extend the Frantz et al. study in a midsized, urban hospice setting and to examine the relationship of LOS with additional variables, such as living status, discharge status, race, and religion. Significant differences in LOS by gender, diagnosis, physician specialty, referral source, type of insurance, living status, and discharge status were found. No significant differences in LOS were found by race, religion, and place of death. Results are interpreted in the light of previous research findings regarding LOS and in the context of the sample size. Strategies are suggested for increasing patients' LOS.

Many hospice patients are referred comparatively late in the course of their disease progression, therefore minimizing the time of services to the patient, caregivers, and families. Untimely referrals can create organizational, clinical, and emotional problems for all involved; a better understanding of the factors related to length of stay (LOS) in hospice is necessary. This study investigated the relationship between LOS and selected variables. There were significant differences in LOS by diagnosis, physician type, and referral source. No significant differences were found in LOS by gender or insurance type. Factors related to LOS can assist hospices in identifying those particular patients more likely to have longer stays. Additionally, administrators may tailor their programs to meet the needs of the individual hospice.