Contact

  • Academic
    gtse@stanford.edu
    University - Scholar Department: Pediatrics Position: Medical Fellow

All Publications

  • 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