Written as an editorial commentary regarding Farr BM. Preventing Recurrent Pressure-Related Furuncles (boils) with an Alternating Air Cushion on pages 21 – 24 of the Journal.
The author found himself in the difficult situation of having recurrent Staphylococcus aureus furuncles (boils) develop over pressure points on his buttocks as his multiple sclerosis progressed. Initially, the furuncles developed only after each course of steroids for a multiple sclerosis exacerbation. Then, after he lost the ability to walk without a walker, the furuncles began appearing after prolonged periods of sitting on a hard surface without steroid use. Over the 9 years before the trial began, the furuncles required increasingly long periods of warm compress applications with resultant deterioration in his quality of life. Furthermore, given the potential likelihood that the furuncles might ultimately require incision and drainage or be accompanied by bloodstream infection and/or metastatic infection and require hospitalization, the author felt that a preventative solution was necessary.
As addressed in his report, all conventional antistaphylococcal approaches such as antibacterial soaps (including 4% chlorhexidine gluconate), staphylococcal decolonization by topical or systemic antibiotics, sitting on foam cushions, and gel-filled cushions either failed or were not feasible. After extensive research, the author felt that the most promising solution to his problem was the use of an alternating pressure seat cushion. These devices were developed to mimic hospital beds that attempt to prevent pressure sores. In patients with spinal cord injuries and elderly patients requiring wheel chairs, such devices have been shown to reduce the risk of pressure sores on the buttocks2,3; however, no data exist related to the prevention of staphylococcal furuncles in the same location. When the pace of technological advance is moving so rapidly that randomized clinical trials cannot keep up with determining what is optimal therapy or when randomized clinical trial are too expensive to perform, one approach that has been shown to be quite valuable is an n-of-1 trial.
From the Wake Forest University School of Medicine, Winston-Salem, NC.
Correspondence to: Robert J. Sherertz, MD, Wake Forest University School of Medicine, Winston-Salem, NC 27157. E-mail: sherertz@wakehealth.edu.
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
better than the other cushion. Thus, to reach the desired statistical end point, the investigator/patient had to knowingly continue to experience all of the pain and suffering that occurred with each new furuncle. This puts Dr Farr in the same company with a long list of other physicians who have experimented on themselves to improve the greater good. In acknowledgment of your sacrifice in such a way that it will improve the lives of others, Dr Farr, I solute you.
1. Farr B. Preventing recurrent, pressure-related furuncles with an alternating air cushion. Infect Dis Clin Pract. 2013; 21:21Y24.
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