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Dive into the research topics where Gilles Hejblum is active.

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Featured researches published by Gilles Hejblum.


Arthritis & Rheumatism | 2014

Development and Validation of the HScore, a Score for the Diagnosis of Reactive Hemophagocytic Syndrome

Laurence Fardet; Lionel Galicier; Olivier Lambotte; Christophe Marzac; Cédric Aumont; Doumit Chahwan; Paul Coppo; Gilles Hejblum

Because it has no unique clinical, biologic, or histologic features, reactive hemophagocytic syndrome may be difficult to distinguish from other diseases such as severe sepsis or hematologic malignancies. This study was undertaken to develop and validate a diagnostic score for reactive hemophagocytic syndrome.


Emergency Medicine Journal | 2009

A systematic review of models for forecasting the number of emergency department visits

M Wargon; Bertrand Guidet; T D Hoang; Gilles Hejblum

The ability to predict patient visits to emergency departments (ED) is crucial for designing strategies aimed at avoiding overcrowding. A good working knowledge of the mathematical models used to predict patient volume and of their results is therefore essential. Articles retrieved by a Medline search were reviewed for studies designed to predict patient attendance at ED or walk-in clinics. Nine studies were identified. Most of the models used to predict patient volume were either linear regression models including calendar variables or time series models. These models explained 31–75% of patient-volume variability. Although the day of the week had the strongest effect, this variable explained only part of the variability. Other causes of this variability are to be defined. However, the performance of the models was good, with errors ranging from 4.2% to 14.4%. Adding meteorological data failed to improve model performance. The mathematical methods developed to predict ED visits have a low rate of error, but the prediction of daily patient visits should be used carefully and therefore does not allow day-to-day adjustments of staff. ED directors or managers should be aware of the model limitations. These models should certainly be used on a larger scale to assess future needs.


European Journal of Surgery | 2002

Selection of Patients with Solitary Thyroid Nodules for Operation

Laurence Leenhardt; Fabrice Menegaux; Brigitte Franc; Thierry Delbot; Georges Mansour; Catherine Hoang; Claudine Guillausseau; Helyett Aurengo; Danièle Le Guillouzic; Gérard Turpin; André Aurengo; Jean Paul Chigot; Gilles Hejblum

OBJECTIVE To improve the preoperative selection for operation of patients with solitary thyroid nodules. DESIGN Prospective cohort study. SETTING University hospital, France. PATIENTS 155 consecutive patients who presented with solitary thyroid nodules and were operated on. INTERVENTIONS Clinical examination, ultrasound examination, fine needle aspiration biopsy, followed by total thyroid lobectomy with frozen section and final histological examination. MAIN OUTCOME MEASURE Correct prediction of thyroid carcinoma or benign adenoma. RESULTS A logistic regression analysis indicated that absence of rim (p < 0.002), solid and hypoechoic feature (p < 0.003) and malignant or suspicious fine needle aspiration biopsy results (p < 0.0001) were significantly associated with malignancy. Selection for operation by the logistic model would save 40 of 73 patients from operation and 40 of 59 from unnecessarily radical operation. It would detect a similar number of cancers as a strategy based solely on fine needle aspiration cytology. CONCLUSIONS A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.


PharmacoEconomics | 2009

Economics of treatments for non-small cell lung cancer.

C. Chouaid; K. Atsou; Gilles Hejblum; Alain Vergnenegre

AbstractThe purpose of this article is to review the economics of treatments for non-small cell lung cancer (NSCLC). We systematically analysed the cost effectiveness of treatments for the different stages of NSCLC, with particular emphasis on more recently approved agents.Numerous economic analyses in NSCLC have been conducted, with a variety of methods and in a number of countries. In patients with localized disease, adjuvant chemotherapy appears to have greater cost effectiveness than observation; however, there are few published data. In locally advanced disease, combined modalities (chemotherapy, surgery and/or radiotherapy) are probably cost effective, but high-quality economic analyses are lacking. In advanced NSCLC, third-generation chemotherapies used in the first-line setting can be administered with acceptable incremental cost effectiveness. In the second-line setting, new agents (docetaxel, pemetrexed and erlotinib) have acceptable cost effectiveness. The lack of cost-utility analyses for elderly patients and patients with a poor prognosis rules out firm conclusions.This review suggests that most therapies for NSCLC are cost effective when the patient has a good performance status, with an incremental costeffectiveness ratio under


PLOS ONE | 2014

A Web-Based Delphi Study for Eliciting Helpful Criteria in the Positive Diagnosis of Hemophagocytic Syndrome in Adult Patients

Gilles Hejblum; Olivier Lambotte; Lionel Galicier; Paul Coppo; Christophe Marzac; Cédric Aumont; Laurence Fardet

US50 000 per life-year gained in the majority of cases.


Epidemiology and Infection | 2008

The rising impact of mathematical modelling in epidemiology : antibiotic resistance research as a case study

Laura Temime; Gilles Hejblum; Michel Setbon; Alain-Jacques Valleron

The diagnosis of the reactive form of hemophagocytic syndrome in adults remains particularly difficult since none of the clinical or laboratory manifestations are specific. We undertook a study in order to elicit which features constitute helpful criteria for a positive diagnosis. In this Delphi study, the features investigated in the questionnaire and the experts invited to participate in the survey were issued from a bibliographic search. The questionnaire was iteratively proposed to experts via a web-based application with a feedback of the results observed at the preceding Delphi round. Experts were asked to label each investigated criterion in one of the following categories: absolutely required, important, of minor interest, or not assessable in the routine practice environment. A positive consensus was a priori defined as at least 75% answers observed in the categories absolutely required and important. The questionnaire investigated 26 criteria and 24 experts originating from 13 countries participated in the second and final Delphi round. A positive consensus was reached for the nine following criteria: unilineage cytopenia, bicytopenia, pancytopenia, presence of hemophagocytosis pictures on a bone marrow aspirate or on a tissue biopsy, high ferritin level, fever, organomegaly, presence of a predisposing underlying disease, and high level of lactate dehydrogenase. A negative consensus was reached for 13 criteria, and an absence of consensus was observed for 4 criteria. The study constitutes the first initiative to date for defining international guidelines devoted to the positive diagnosis of the reactive form of hemophagocytic syndrome.


PLOS ONE | 2011

Simulation-Based Estimates of Effectiveness and Cost-Effectiveness of Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease

Kokuvi Atsou; Christos Chouaid; Gilles Hejblum

Mathematical modelling of infectious diseases has gradually become part of public health decision-making in recent years. However, the developing status of modelling in epidemiology and its relationship with other relevant scientific approaches have never been assessed quantitatively. Herein, using antibiotic resistance as a case study, 60 published models were analysed. Their interactions with other scientific fields are reported and their citation impact evaluated, as well as temporal trends. The yearly number of antibiotic resistance modelling publications increased significantly between 1990 and 2006. This rise cannot be explained by the surge of interest in resistance phenomena alone. Moreover, modelling articles are, on average, among the most frequently cited third of articles from the journal in which they were published. The results of this analysis, which might be applicable to other emerging public health problems, demonstrate the growing interest in mathematical modelling approaches to evaluate antibiotic resistance.


Annals of Intensive Care | 2011

An integrated approach for prescribing fewer chest x-rays in the ICU

Vincent Ioos; Arnaud Galbois; Ludivine Chalumeau-Lemoine; Bertrand Guidet; Eric Maury; Gilles Hejblum

Background The medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. Objective Here, considering a COPD smoking patient, the specific burden of continuous smoking was estimated, as well as the effectiveness and the cost-effectiveness of smoking cessation. Methods A multi-state Markov model adopting societys perspective was developed. Simulated cohorts of English COPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were compared to identical cohorts of patients who quit smoking at cohort initialization. Life expectancy, quality adjusted life-years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: £/QALY) were estimated, considering smoking cessation programs with various possible scenarios of success rates and costs. Sensitivity analyses included the variation of model key parameters. Principal Findings At the horizon of a smoking COPD patients remaining lifetime, smoking cessation at cohort intitialization, relapses being allowed as observed in practice, would result in gains (mean) of 1.27 life-years and 0.68 QALY, and induce savings of −1824 £/patient in the disease-related costs. The corresponding ICER was −2686 £/QALY. Smoking cessation resulted in 0.72, 0.69, 0.64 and 0.42 QALY respectively gained per mild, moderate, severe, and very severe COPD patient, but was nevertheless cost-effective for mild to severe COPD patients in most scenarios, even when hypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon, the burden of continuous smoking in English COPD patients was estimated to cost a total of 1657 M£ while 452516 QALY would be simultaneously lost. Conclusions The study results are a useful support for the setting of smoking cessation programmes specifically targeted to COPD patients.


Chest | 2009

Cost-Benefit Analysis of a Simulated Institution-Based Preoperative Smoking Cessation Intervention in Patients Undergoing Total Hip and Knee Arthroplasties in France

Gilles Hejblum; Kokuvi Atsou; Bertrand Dautzenberg; Christos Chouaid

Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU.


Acta Anaesthesiologica Scandinavica | 2008

Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non-septic patients

P. Meyer; P. Pernet; Gilles Hejblum; J. L. Baudel; Eric Maury; Georges Offenstadt; Bertrand Guidet

BACKGROUND The literature on preoperative smoking cessation indicates that smoking patients are more likely to have postoperative complications. However, the economic implications of such complications are unclear. In particular, the balance between the cost of a preoperative intervention for smoking cessation (PISC) and the benefit resulting from the potential decrease in hospitalization costs is not known. METHODS Only one previous study, a randomized trial involving smokers scheduled for hip or knee replacement surgery, provides sufficient data to simulate the hospital course of patients subjected or not subjected to a PISC. We used a multistate Markov-type model and official French hospital costs for 2008 to simulate this situation. The cost-benefit analysis adopted the payers perspective. RESULTS The mean benefit, corresponding to the decrease in the cost of the hospital stay for a reference case patient having followed a PISC, was estimated at 313 euros, with a corresponding mean cost of the PISC estimated at 196 euros. Therefore, the PISC was associated with a cost saving of 117 euros per patient. The results were most sensitive to the cost of ICU care as a proxy for cost of smoking-related complications, and to the relative risk of complication between patients with and without a PISC. CONCLUSION Under the conditions simulated by this cost-benefit model, potential modest cost savings may accrue with implementation of an institution-based smoking cessation program through reduced total hospitalization costs that exceed the cost of the intervention.

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Judith Leblanc

Université Paris-Saclay

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