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BACKGROUND: Approximately 10% of patients experience prolonged symptoms after Lyme disease. PTLDS (post treatment Lyme disease syndrome) is a controversial topic. It has been described as a source of overdiagnostic and off-label treatment. The objective of this work was to describe, in the context of the PTLDS, the diagnostic errors and adverse effects of drugs used outside the recommendations. METHODS: systematic review of the literature according to PRISMA criteria, including randomized clinical trials (RCT), observational studies, and case reports addressing diagnostic errors and adverse events published between January 2010 and November 2020 in English or French. RESULTS: 16 studies were included: 1 RCT, 7 observational studies and 8 case reports. In the 5 observational studies, overdiagnosis rates were very high, ranging from 80% to 100%. The new diagnoses were often psychiatric, rheumatological and neurological. Disorders with somatic symptoms were often cited. Diagnostic delays were identified for cancers and frontoparietal dementia. In the RCT and observational studies, prolonged anti-infective treatments were also responsible for adverse events, with emergency room visits and/or hospitalization. The most common adverse events were diarrhea, sometimes with Clostridium difficile colitis, electrolyte abnormalities, sepsis, bacterial and fungal infections, and anaphylactic reactions. CONCLUSION: This review informs patients and physicians of the risks of prolonged anti-infective treatment that has not been proven to be beneficial. It does not seem ethical to offer such treatments to patients given the imperative of the "primum non nocere" principle of non-maleficence.

Oral anticoagulants generate a burden of care that can affect the patient’s quality of life. The concept of treatment’s burden measures the impact of medical care for the patient’s quality of life. Various factors can exacerbate the burden. Several studies have assessed the satisfaction of patients treated with oral anticoagulants.This study has assessed the burden of patients treated with oral anticoagulants.An analytical cross-sectional study of patients recruited from pharmacies in the Loire. A questionnaire was carried out using the anti-clot treatment scale, assessing satisfaction, and the Zarit scale, assessing the burden on carers of demented patients.Anticoagulants were a burden for 41% (n = 158) of the 389 responding patients. Anticoagulants’ burden was higher when oral anticoagulant was responsible for side effects, anxiety or lifestyle changes.The patients could be satisfied with the benefit of the treatment, satisfied with its practical modalities, and describe modifications of lifestyle habits contributing to the burden of the treatment.Les anticoagulants oraux génèrent une charge de soins pouvant impacter la qualité de vie des patients. Le fardeau du traitement mesure l’impact de la prise en charge médicale sur la qualité de vie. Des facteurs divers peuvent aggraver le fardeau. Plusieurs études ont évalué la satisfaction des patients traités par anticoagulants oraux.Cette étude a évalué le fardeau des patients traités par anticoagulants oraux.Étude transversale analytique menée auprès de patients recrutés dans des pharmacies ligériennes. Un questionnaire a été réalisé à partir de l’échelle échelle anti-clot treatment scale évaluant la satisfaction et de l’échelle Zarit évaluant le fardeau des aidants de patients déments.Les anticoagulants étaient un fardeau pour 41 % (n = 158) des 389 répondants. Le fardeau des anticoagulants était plus important lorsque l’AO était responsable d’effets secondaires, d’angoisse ou modifiait leurs habitudes de vie.Les patients interrogés pouvaient être convaincus du bénéfice du traitement, satisfaits de ses modalités pratiques, et décrire un fardeau du traitement.

ObjectiveBreast cancer screening decision aids (DAs) are designed to help women decide whether or not to participate in mammography-based programmes. We aimed to explore women’s and healthcare professionals’ expectations of a breast cancer screening DA, as part of the French DEDICACES study.MethodsThis French qualitative study was based on semistructured, individual interviews with women from the general population, general practitioners (GPs), midwives, gynaecologists, radiologists and screening centre managers. Sampling was purposive and used diversification criteria. The inductive analysis was based on grounded theory.ResultsBetween April 2018 and May 2019, we interviewed 40 people: 13 women, 14 GPs, 4 gynaecologists, 3 midwives, 3 radiologists and 3 screening centre managers. The women and the healthcare professionals considered that a DA could help to improve levels of knowledge, harmonise medical practice and provide reliable, comprehensive information. Overall, the interviewees wanted an easy-to-use, intuitive, graphic-rich, interactive, computer-based, patient-centred DA. Use of the DA might be limited by a lack of familiarity with shared decision-making (SDM), the risk of misuse and a preference for asymmetric positive information.ConclusionThe present results are likely to facilitate the development of the first validated tool for SDM support in French breast cancer screening programmes.

Since the revision of the french law in 2016, artificial hydration is considered as a treatment and its withdrawal is part of the fight against extraordinary treatment at the end of life. Given its symbolism, the decision of withdrawal can be difficult for the patient, his or her entourage, and caregivers. The objective of this study was to assess the benefits and risks associated with artificial hydration (AH) at the end of life and the existing means of communication around this decision.Systematic review of the literature from the Pubmed® search engine, between 2011 and 2021, in French or English by four researchers.Among the 102 articles identified, the eleven studies included were in favor of no effect of AH on the quality and duration of survival. A reduction in AH appeared to reduce symptoms related to fluid overload and may be related to better quality of end of life or dying. Dry mouth was the most recurrent discomfort associated with AH reduction or discontinuation. Regular mouth care could prevent this discomfort. A clinical trial with patient education seemed to increase indecision about stopping AH.Despite the lack of good quality studies, the benefit-risk balance of AH does not seem to favour its continuation. Communication tools such as videos or multidisciplinary programs could reduce the decisional conflict of patients, their families and caregivers.

CONTEXTE : Le PTLDS (Post treatment Lyme disease syndrome) est un sujet de controverse. Il a été décrit comme source d’erreurs diagnostiques et de traitements hors recommandations.OBJECTIF : L’objectif de ce travail était de décrire les événements indésirables associés au diagnostic de PTLDS, à la fois pour les erreurs diagnostiques et pour les effets indésirables des traitements utilisés.MÉTHODES : Revue systématique de la littérature incluant les essais cliniques randomisés (ECR), études observationnelles et cases report abordant les erreurs diagnostiques et effets indésirables publiés entre janvier 2010 et novembre 2020 en langue française ou anglaise.RÉSULTATS : Trois chercheurs ont inclus 16 études : 1 ECR, 7 études observationnelles et 8 cases report. Dans les 5 études observationnelles, les taux de surdiagnostics étaient très importants de 80 à 100 %. Les nouveaux diagnostics étaient souvent psychiatriques, rhumatologiques et neurologiques. Les cases report ont identifié des conséquences graves avec des hospitalisations et un décès. Les retards diagnostiques identifiés concernaient des cancers et une démence frontotemporale. Dans l’ECR et les études observationnelles, les traitements anti-infectieux prolongés ont aussi été responsables d’effets indésirables parfois graves avec hospitalisation. Les principaux effets indésirables étaient des infections (Clostridium difficile), des anaphylaxies et un DRESS syndrome.CONCLUSION : Cette revue informe les patients et les médecins des risques d’un traitement prolongé anti-infectieux qui n’a pas fait la preuve de ses bénéfices. Il ne semble pas éthique de proposer de tels traitements aux patients compte tenu del’impératif du principe de non-malfaisance « primum non nocere ».