Gabriel Tse

All Publications

• Large Language Model Responses to Adolescent Patient and Proxy Messages. JAMA pediatrics Tse, G., Zahedivash, A., Anoshiravani, A., Carlson, J., Haberkorn, W., Morse, K. E. 2024

  View details for DOI 10.1001/jamapediatrics.2024.4438

  View details for PubMedID 39495530

• Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus. Movement disorders : official journal of the Movement Disorder Society Vogt, L. M., Yang, K., Tse, G., Quiroz, V., Zaman, Z., Wang, L., Srouji, R., Tam, A., Estrella, E., Manzi, S., Fasano, A., Northam, W. T., Stone, S., Moharir, M., Gonorazky, H., McAlvin, B., Kleinman, M., LaRovere, K. L., Gorodetsky, C., Ebrahimi-Fakhari, D. 2024

  Abstract

  Status dystonicus is the most severe form of dystonia with life-threatening complications if not treated promptly. We present consensus recommendations for the initial management of acutely worsening dystonia (including pre-status dystonicus and status dystonicus), as well as refractory status dystonicus in children. This guideline provides a stepwise approach to assessment, triage, interdisciplinary treatment, and monitoring of status dystonicus. The clinical pathways aim to: (1) facilitate timely recognition/triage of worsening dystonia, (2) standardize supportive and dystonia-directed therapies, (3) provide structure for interdisciplinary cooperation, (4) integrate advances in genomics and neuromodulation, (5) enable multicenter quality improvement and research, and (6) improve outcomes. © 2024 International Parkinson and Movement Disorder Society.

  View details for DOI 10.1002/mds.29794

  View details for PubMedID 38619077

• Perspective: Artificial intelligence and patient communication. Journal of hospital medicine Tse, G., Kuzma, N., Khan, A. 2024

  View details for DOI 10.1002/jhm.13301

  View details for PubMedID 38340353

• Using clinical decision support systems to decrease intravenous acetaminophen use: implementation and lessons learned. Applied clinical informatics Tse, G., Algaze, C., Pageler, N., Wood, M., Chadwick, W. 2023

  Abstract

  Clinical decision support systems (CDSS) can enhance medical decision-making by providing targeted information to providers. While they have the potential to improve quality of care and reduce costs, they are not universally effective and can lead to unintended harm.To describe the implementation of an unsuccessful interruptive CDSS that aimed to promote appropriate use of intravenous (IV) acetaminophen at an academic pediatric hospital, with an emphasis on lessons learned.Quality improvement methodology was used to study the effect of an interruptive CDSS, which set a mandatory expiry time of 24-hours for all IV acetaminophen orders. This CDSS was implemented on April 5, 2021. The primary outcome measure was number of IV acetaminophen administrations per 1,000 patient days, measured pre- and post-implementation. Process measures were the number of IV acetaminophen orders placed per 1,000 patient days. Balancing measures were collected via survey data and included provider and nursing acceptability and unintended consequences of the CDSS.There was no special cause variation in hospital wide IV acetaminophen administrations and orders after CDSS implementation, nor when the CDSS was removed. A total of 88 participants completed the survey. Nearly half (40/88) of respondents reported negative issues with the CDSS, with the majority stating that this affected patient care (39/40). Respondents cited delays in patient care and reduced efficiency as the most common negative effects.This study underscores the significance of monitoring CDSS implementations and including end-user acceptability as an outcome measure. Teams should be prepared to modify or remove CDSS that do not achieve their intended goal or are associated with low end-user acceptability. CDSS holds promise for improving clinical practice, but careful implementation and ongoing evaluation are crucial for maximizing their benefits and minimizing potential harm.

  View details for DOI 10.1055/a-2216-5775

  View details for PubMedID 37995743

• An unexpected cause of weight loss in a teenaged girl. Journal of paediatrics and child health Dong, E. E., Joshi, N., Tse, G. 2023

  View details for DOI 10.1111/jpc.16424

  View details for PubMedID 37171150

• Seasonal Trends in Pediatric Respiratory Illnesses: Using Google Trends to Inform Precision Outreach. Pediatric emergency care Tse, G., McLean, L. 2022; 38 (2): e752-e755

  Abstract

  Google Trends is an emerging tool that allows users to analyze search queries, showing when certain topics are searched most often. Multiple studies have compared Google Trends to epidemiological data of health conditions, but pediatric specific illnesses have not yet been investigated. An association between disease incidence and Google Trends data may help facilitate precision outreach in the form of digital resources and promotion. We sought to examine the relationship between Google Trends data and measured incidence of bronchiolitis and croup.We carried out a Google Trends search using the terms "bronchiolitis" and "croup" on July 24, 2019. The number of positive respiratory syncytial virus and parainfluenza tests published by the Public Health Agency of Canada was used to estimate incidence of bronchiolitis and croup, respectively. Emergency department discharge data were used to measure the number of patients with bronchiolitis and croup presenting to a Canadian pediatric hospital. Data from January 1, 2015, to December 31, 2018, were used for analysis.Google Trends revealed clear seasonal variation in search volume for both bronchiolitis and croup in keeping with known epidemiological data for these conditions. For data on bronchiolitis, Google Trends correlated strongly with Canadian Public Health and our hospital data. A positive correlation was also found with croup.Google Trends correlates with both laboratory-based and hospital incidence of respiratory viral diagnoses. This novel data source has implications for tracking disease epidemiology, tailoring health information, and providing precision outreach tools to patients and their families.

  View details for DOI 10.1097/PEC.0000000000002442

  View details for PubMedID 35100773

• A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis. The Journal of infectious diseases Kirolos, A., Manti, S., Blacow, R., Tse, G., Wilson, T., Lister, M., Cunningham, S., Campbell, A., Nair, H., Reeves, R. M., Fernandes, R. M., Campbell, H. 2020; 222 (Suppl 7): S672-S679

  Abstract

  Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients by reducing the performance of unnecessary tests, hospital admissions, and treatment with lack of a supportive evidence base. This review aimed to identify current clinical practice guidelines worldwide, appraise their methodological quality, and discuss variability across guidelines for the diagnosis and management of bronchiolitis.A systematic literature review of electronic databases EMBASE, Global Health, and Medline was performed. Manual searches of the gray literature, national pediatric society websites, and guideline-focused databases were performed, and select international experts were contacted to identify additional guidelines. The Appraisal of Guidelines for Research and Evaluation assessment tool was used by 2 independent reviewers to appraise each guideline.Thirty-two clinical practice guidelines met the selection criteria. Quality assessment revealed significant shortcomings in a number of guidelines, including lack of systematic processes in formulating guidelines, failure to state conflicts of interest, and lack of consultation with families of affected children. There was widespread agreement about a number of aspects, such as avoidance of the use of unnecessary diagnostic tests, risk factors for severe disease, indicators for hospital admission, discharge criteria, and nosocomial infection control. However, there was variability, even within areas of consensus, over specific recommendations, such as variable thresholds for oxygen therapy. Guidelines showed significant variability in recommendations for the pharmacological management of bronchiolitis, with conflicting recommendations over whether use of nebulized epinephrine, hypertonic saline, or bronchodilators should be routinely trialled.Future guidelines should aim to be compliant with international standards for clinical guidelines to improve their quality and clarity and to promote their adoption into practice. Variable recommendations between guidelines may reflect the evolving evidence base for bronchiolitis management, and platforms should be created to understand this variability and promote evidence-based recommendations.

  View details for DOI 10.1093/infdis/jiz240

  View details for PubMedID 31541233

• Corrigendum to: A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis. The Journal of infectious diseases Kirolos, A., Manti, S., Blacow, R., Tse, G., Wilson, T., Lister, M., Cunningham, S., Campbell, A., Nair, H., Reeves, R. M., Fernandes, R. M., Campbell, H. 2020; 221 (7): 1204

  View details for DOI 10.1093/infdis/jiz600

  View details for PubMedID 31917442