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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.

Background In 2020, the number of new cancer cases was estimated at 20 490 862 worldwide up from 18.1 million in 2018 and 14.1 million in 2012. Since the 2000s, cancer treatments have significantly improved, allowing either a cure or control of the disease. Patients share their experience of the disease and use supportive care solutions through involvement in patient associations and online forums. All the associations were built on the principle of “peer support,” which is based on mutual aid between people who suffer or have suffered from the same somatic or psychological illness or had the same life experience. This experiential knowledge can be explored to understand the role of peers and associations in the appropriation of their cancer. Methods A qualitative phenomenological study was undertaken through semi-structured interviews with 12 participants. Interviews were audio-recorded, transcribed verbatim, then analyzed by means of triangulation up to the point of theoretical saturation by a semio-pragmatic method. Results Four categories emerged: (1) “Transforms a painful experience into a positive one. It mobilizes the human values of sharing, love, and humility, which facilitates resilience”; (2) “The characteristics of the association, a non-medical place between people sharing a common destiny, resonates with patients’ needs and improves their well-being”; (3) “The association transforms the patients’ experiences by facilitating engagement that leads to a patient-expert (empowerment)”; and (4) “Understanding what is happening to them is soothing, reassuring, because patients’ concerns need to be heard and their care understood”. Conclusions This study highlights patient associations can serve as the mediator of NPI and facilate the empowerment of breast cancer patients. Practice implications Educating health professionals in initial and continuing education about non-pharmacological interventions will be a major issue. Teaching the patient-centred approach to health professionals is one of the priorities in initial and continuing medical education.

In France, breast cancer has been the most commonly diagnosed and the most lethal cancer in women. The risk-benefit ratio of organized breast cancer screening has been the focus of much scientific controversy, especially about overdiagnosis. A citizen conference and some scientific organizations have asked for a better education for women. The aim of this study was to analyze the numerous decision support tools and other information media, both in form and in substance.A review of the existing publications has been done by 4 researchers between 2006 and 2016. Original articles included, in French or in English, focused on information media or decision aid tools for organized screening without any restriction on the type of studies.The 69 articles included in this review have shown that a better education of the patients was not related to an increase in the will to take part or in the actual participation in screening. The information media (pamphlet, video…) does not appear to have any influence on those ratios. The participants like having a discussion with a trained interviewer. In a third of the studies, the population was included on ethnic and social criteria. 8 studies focused on overdiagnosis.This review underlines the importance of repeated interviews, as a support for shared decision making. Specific interactions (such as patient navigator) could help to reduce social health inequalities. The patients should be informed about the current uncertainty regarding the ratio of overdiagnosis.

Scientific controversies on breast cancer screening have induced the French authorities to launch online citizen consultation. The objective of this netnography was to identify the knowledge and values underlying contributors’ choices. The choice of supporters was often based on emotions: impression of disease severity and efficacy of screening, fearfulness stemming from personal experience and testimony from relatives. Opponents emphasized the risks of the screening and the doctors’ perceived lack of relational and technical skills. The ‘non-decision’ profile was explained by information deemed simplistic, guilt-inducing and partial. Future research should focus on how to appeal to emotions to support shared decision.

A 57-year-old female experienced two successive peripheral facial paralysis (PFP) episodes following influenza immunization in 2009 and 2016 with two different vaccines. The similarity of chronology and semiology between the two events and the absence of alternative etiology plead for intrinsic accountability. Extrinsic accountability relies on previous case reports of PFP related to flu vaccination (26 cases in the French pharmacovigilance database and 4 cases in the medical literature).

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Contexte : En 2012, en France, le cancer du sein etait le premier cancer diagnostique et la premiere cause de deces par cancer chez la femme. La balance benefice-risque du depistage organise du cancer du sein (DOCS) fait l’objet de controverses scientifiques, en particulier au sujet des surdiagnostics. Dans ce contexte, une conference citoyenne a ete organisee en 2015 par l’Institut national du cancer (INCa) et certaines societes savantes pour reclamer une meilleure information des femmes. L’objectif de cette etude etait d’analyser les differents outils d’aide a la decision et documents d’information tant sur le fond que sur la forme.Methode : Une revue de la litterature a ete realisee par quatre chercheurs sur la periode 2006-2016. Les articles originaux inclus, en langue francaise ou anglaise, traitent des documents d’information ou d’outils d’aide a la decision dans le DOCS sans restriction sur le type d’etude.Resultats : Les 69 articles inclus montrent qu’une progression des connaissances chez les participantes n’est pas correlee a une augmentation de l’intention de participer ni a une augmentation de la participation. La forme de l’information (brochures, videos…) ne semble pas influencer ces taux. Les participantes apprecient les entretiens avec un interlocuteur forme. Dans un tiers des etudes, la population est incluse sur des criteres ethniques et sociaux. Huit etudes abordent la problematique du surdiagnostic.Conclusion : Cette revue rappelle l’importance des entretiens repetes, support d’une decision medicale partagee. Des interventions specifiques comme le concept de « patient navigator » pourraient lutter contre les inegalites sociales de sante. L’incertitude actuelle concernant le taux de surdiagnostics peut etre communiquee aux patientes.

Objective In France, chronic pain prevalence, causing professional or domestic activity restriction, increases with age, and reaches more than 60% people over 85 years old. In 2006, 40% of patients suffering from chronic pain are still not satisfied with practioners’ monitoring and therefore multiply consultations. The aim of this study was to analyse the phenomenon of chronic pain, thanks to patients’ experience and consciousness of their own situations. Material/Patients and methods This qualitative phenomenological study had the objective to enter in patients’ “singular universe” by using two-fold hermeneutics, both empathic and critical. The interview guidelines tackled patients’ experience of the disease and their expectations about the multiple doctors they had met. The analysis followed an iterative and inductive process (uncontextualisation-recontextualisation). The internal validity has been guaranteed by an independent double analysis. Results Fifteen different interviews, lasting from 36 to 64 minutes, were done in the period between September 2012 and December 2014. Patients told “a before and an after” chronic pain. They did not want “to be a charge to their relatives” but also wanted “to be recognized”. The loss of his prior condition falls within the context of a therapeutic path, geared towards the search for confidence, empathy but also of a precise diagnosis and an efficient treatment. Disappointments can get patients close to look for alternative therapies. Discussion/Conclusion The ambivalence of the patient, the impotence felt by the physician shakes the relationship. The narration contextualizes the painful complaint. It may be therapeutic. Unrolling his life story the patient can understand the intervention of other determinants in his suffering.

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 ».