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临床诊断思维 (临床诊断思维 / 临床推理 (Clinical Diagnostic Reasoning) — 医生『怎么想病』的元学科:从症状/体征/检查到诊断结论的认知操作系统,从业者(临床医生/住院医/规培生,尤其全科/急诊/大内科等以未分化主诉为生的科室)、医学生与医学教育者、诊断安全与质量改进研究者、以及做医疗 AI 辅助诊断产品的人的视角。覆盖: (a) 第一性张力 — **直觉模式识别 (System 1: illness scripts 疾病脚本 / pattern recognition / gestalt, 『资深人一眼认出 aunt Minnie』) ⇄ 分析性推理 (System 2: hypothetico-deductive 假设演绎 / Bayesian 概率更新)** 的 dual-process 双过程理论 (Kahneman→Croskerry/Norman 谱系), 资深≠更会分析而是『脚本库更大+校准更好』; 更深层论战 — **『认知去偏可教 (Croskerry: bias awareness / cognitive forcing strategies / diagnostic timeout) ⇄ 偏倚标签是马后炮、知识结构才是主因 (Norman/Sherbino/Monteiro: debiasing 干预 transfer 证据弱, bias 是 hindsight 标签)』** — 本行最核心学术对垒; 『概率思维 (验前概率 × 似然比 → 验后概率, Pauker-Kassirer test/treatment threshold 阈值模型) ⇄ 穷尽式排查 (rule-out everything / 防御性医疗 / VOMIT)』; 『临床 gestalt ⇄ 结构化临床决策规则 (Wells/PERC/HEART)』; 『诊断简约 Occam's razor ⇄ Hickam's dictum (病人可以同时得 N 个病)』; 『床旁体格检查复兴 (Verghese Stanford 25 / McGee 循证体检) ⇄ 影像检验替代床旁』; (b) 方法论正典 — illness script theory (Schmidt/Boshuizen: enabling conditions/fault/consequences 三段结构), problem representation + semantic qualifiers 问题表征与语义限定词 (Bowen NEJM 2006, 把病人翻成 one-liner), hypothetico-deductive model (Elstein 1978《Medical Problem Solving》: 早期假设生成+定向检验), Bayesian 工具箱 (sensitivity/specificity/LR/Fagan nomogram/SnNout-SpPin), threshold model (Pauker-Kassirer NEJM 1975/1980), 认知偏倚分类学 (anchoring/premature closure/availability/confirmation/base-rate neglect/search satisficing/diagnostic momentum — Croskerry 偏倚清单), 去偏与元认知策略 (diagnostic timeout/cognitive forcing/Ely checklist/calibration), schema-based reasoning (Clinical Problem Solvers schemas: 按 pivot 症状走分支), reflective practice 结构化反思 (Mamede/Schmidt), 诊断错误科学 (NAM 2015 报告定义 / Newman-Toker Big Three / Hardeep Singh e-triggers / SAFER Dx 框架); (c) 行业结构与角色 — 医学生→实习/住院医 (晨会 morning report/查房被 pimping/汇报训练)→主治 attending→master clinician (NEJM CPC discussant/晨会大师如 Dhaliwal); 配套生态: 医学教育者 (clinical reasoning curriculum + 评估: script concordance test/key features exam/OSCE), 诊断安全研究者 (SIDM/AHRQ), 诊断辅助与 CDS 工具开发者 (DDx generator/AI); (d) 核心工作流 — 数据采集 (病史为王 + 循证体检 + 针对性检验影像) → 问题表征 (one-liner + semantic qualifiers) → 鉴别诊断生成 (schema / 解剖定位法 / VINDICATE-M 病因筛, 按『常见可能 × 致命不能漏 can't-miss』双轴排序) → 假设定向检验 (按 LR 选检查 / 阈值决策) → working diagnosis + 安全网 (red flags 交代 / test of time / test of treatment) → 反馈校准 (follow-up / M&M / diagnostic timeout); 教学工作流: 晨会渐进披露汇报 / CPC / SNAPPS / one-minute preceptor / virtual morning report; AI 增强工作流 (2023-2026: LLM 鉴别诊断头脑风暴 / OpenEvidence 检索 / ambient scribe 释放认知带宽 + 自动化偏倚 guardrails); (e) 产出物 — one-liner, problem list, prioritized DDx, assessment & plan (按问题分层), 晨会/CPC 汇报, M&M 复盘, 诊断不确定性沟通 (『最可能是 X, 但出现 Y 红旗立刻回来』); (f) 教育与评估 — script concordance test / key feature exam / EPA / 里程碑; 中国语境: 人卫《诊断学》教材 / 执业医师考试 / 规培结业临床思维考核; (g) 争议/批判 — debiasing 之争 (Croskerry vs Norman-Sherbino『knowledge is the cure』, 去偏 RCT 效果弱 / bias 标签不可证伪), 诊断错误率数字之争 (『10-15%』经典估计 / Newman-Toker 79.5 万美国年严重伤害外推方法被质疑 / 尸检符合率), dual-process 二分被批过度简化 (连续谱 / 难以实证分离), 决策规则 vs gestalt (资深 gestalt 常不输 Wells 类规则 / 算法厌恶), vignette 研究外推性 + context/case specificity (推理高度内容绑定不可通用迁移 [Norman/Eva] — 对『教推理通用课』产业的根本批判), AI 辅助诊断 2023-2026 (GPT-4 在 NEJM CPC/vignette 追平或超医生 [Kanjee 2023 JAMA / Goh 2024 JAMA Netw Open『AI alone > physician+AI』悖论] / Google AMIE / OpenEvidence 爆发 vs 自动化偏倚 / 去技能化 / 真实环境验证缺失), 防御性医疗与过度检查 (incidentaloma 瀑布 / VOMIT), 体检衰亡之争, pimping 教学法争议; (h) 流派/思想谱系 — 决策科学/Bayesian 派 (Ledley-Lusted 1959 → Elstein/Kassirer/Sox/Pauker/Eddy → Brush) vs 认知心理/双过程派 (Kahneman-Tversky → Croskerry/Graber) vs 教育认知派 (Schmidt/Boshuizen illness scripts → Norman/Eva/Mamede/Durning 情境认知) vs 诊断安全/系统派 (NAM 2015 / Newman-Toker / Hardeep Singh / Graber-SIDM: 错误=系统×认知共因) vs 床旁临床派 (Osler 传统 → Tierney aphorisms / Verghese / McGee / Dhaliwal / Saint: 病史体检为王 + 刻意练习) vs AI/计算派 (INTERNIST-1/DXplain 专家系统 → Isabel → LLM 世代 Rodman/Topol)。不含: 具体专科治疗方案与手术决策深度 (足踝外科/种植牙等另有 skill), 中医辨证 (另有 skill), EBM 文献批判性评价方法学 (相关但本 skill 聚焦诊断推理本身), 护理诊断体系 (NANDA), 影像/病理知觉型读片训练 (相邻但独立), 精神科 DSM 结构化访谈细节, 医患沟通技巧全集 (只覆盖诊断不确定性沟通), 患者自查/自我诊断指

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When the user wants to optimize post-signup onboarding, user activation, first-run experience, or time-to-value. Also use when the user mentions "onboarding flow," "activation rate," "user activation," "first-run experience," "empty states," "onboarding checklist," "aha moment," "new user experience," "users aren't activating," "nobody completes setup," "low activation rate," "users sign up but don't use the product," "time to value," or "first session experience." Use this whenever users are signing up but not sticking around. For ongoing email sequences, see emails.

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When the user wants to create, plan, or optimize a lead magnet for email capture or lead generation. Also use when the user mentions "lead magnet," "gated content," "content upgrade," "downloadable," "ebook," "cheat sheet," "checklist," "template download," "opt-in," "freebie," "PDF download," "resource library," "content offer," "email capture content," "Notion template," "spreadsheet template," or "what should I give away for emails." Use this for planning what to create and how to distribute it. For interactive tools as lead magnets, see free-tools. For writing the actual content, see copywriting. For the email sequence after capture, see emails.

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When the user wants to reduce churn, build cancellation flows, set up save offers, recover failed payments, or implement retention strategies. Also use when the user mentions 'churn,' 'cancel flow,' 'offboarding,' 'save offer,' 'dunning,' 'failed payment recovery,' 'win-back,' 'retention,' 'exit survey,' 'pause subscription,' 'involuntary churn,' 'people keep canceling,' 'churn rate is too high,' 'how do I keep users,' or 'customers are leaving.' Use this whenever someone is losing subscribers or wants to build systems to prevent it. For post-cancel win-back email sequences, see emails.

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Generate a diagram and route to the right engine — draw.io XML (precise, editable, C4, swimlanes) or Excalidraw JSON (hand-drawn, sketch, wireframes). One entry for flowcharts, architecture, ER, sequence, mind maps. Don't use for Mermaid or slides.

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Generate professional diagrams as valid draw.io XML — flowcharts, architecture, C4 models, ER diagrams, sequence diagrams, mind maps, and swimlanes. Don't use for Excalidraw or Mermaid output, hand-drawn sketch styles, or slide decks/presentations.

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Generate diagrams as valid Excalidraw JSON — flowcharts, architecture, ER diagrams, mind maps, sequence diagrams, wireframes, C4 models, and more. Don't use for draw.io/Mermaid output, slide decks, or pixel-perfect brand graphics.

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Applies the reasoning, principles, and frameworks of Jürgen Schmidhuber (LSTM co-inventor and deep learning pioneer). Reach for this skill whenever tackling problems involving sequence learning, artificial curiosity, intrinsic motivation, reinforcement learning architectures, or predicting long-term technological and cosmic evolution. Use this when discussing AGI timelines, the history and attribution of AI breakthroughs, data compression as learning, or when designing autonomous agents that must set their own goals. Trigger this skill for topics like recurrent neural networks, algorithmic information theory, open-source AI democratization, and evaluating true existential risks versus media hype.

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Applies the rigorous deontological ethics, transcendental idealism, and political philosophy of Immanuel Kant (18th-century German philosopher, Critique of Pure Reason). Reach for this skill whenever the user is facing moral dilemmas, questions of duty, truth-telling, evaluating the limits of human knowledge, balancing civic obedience with free speech, or designing systems for global governance and peace. Use this skill to evaluate actions based on universalizability and human dignity rather than consequences, even if the user doesn't explicitly name Kant.

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Plan pages, navigation and content sequence.

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Suede-owned SMS and MMS marketing discipline. Use when evaluating SMS as a channel, designing consent-aware sequences, drafting messages, setting cadence, comparing number types or platforms, or defining measurement (TCPA consent, A2P 10DLC, quiet hours, cart-recovery and win-back texts. NOT FOR: email campaigns (use suede-emails), phone capture UX (use suede-site-alchemy), or legal certification) this skill does not give legal advice and never sends, schedules, imports, or registers.

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Suede-affiliated lead-magnet strategy for choosing a downloadable format, defining useful depth, setting honest gating, planning delivery, and measuring qualified capture. Use when the user needs an ebook, checklist, template, content upgrade, or resource exchanged for contact details. NOT FOR: interactive free tools (use suede-free-tools), lifecycle sequences after capture (use suede-emails), or production copy (use suede-copy).

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Suede-affiliated onboarding and activation strategy for first-run sequencing, empty states, setup checklists, activation milestones, time to value, and retention-linked measurement. Use when users sign up but fail to reach first value or the product needs a new first-session flow. NOT FOR: registration optimization (use suede-signup), lifecycle email sequences (use suede-emails), or monetization prompts (use suede-paywalls).

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Suede-owned B2B cold-email discipline for evidence-based personalization, subject lines, opening lines, concise bodies, one clear CTA, and bounded follow-up sequences. Use when writing or repairing outbound email to qualified prospects. NOT FOR: building or qualifying the prospect list (use suede-prospecting), lifecycle or nurture email (use suede-emails), or broader sales collateral (use suede-sales-enablement).

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Suede-owned lifecycle email design for welcome, onboarding, nurture, re-engagement, post-purchase, and trigger-based sequences. Use when the user needs a multi-email flow with entry criteria, cadence, message roles, and a measurement plan: drip campaigns, welcome series, win-back flows, or trigger-based automations. NOT FOR: cold prospecting (use suede-cold-email), SMS as part of the same lifecycle program (use suede-sms), in-product activation flows (use suede-onboarding), or lifecycle-stage operations beyond email (use suede-revops).

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Suede-owned operations-architecture discipline that fixes the shape of a system before anyone builds it: entity schema first, exactly one write path per entity, every unit of work routed to a deterministic automation, an AI agent, or a human decision, every existing tool marked absorb, keep, or kill, and the build sequenced into phases whose completion is proved by a command. Use when scoping an automation or agent build, deciding whether a workflow needs a model at all, consolidating a sprawling tool stack, designing the data model under a workflow, choosing a migration path off an old system, or ordering a build so nothing lands on a moving foundation. NOT FOR: executing a planned multi-file repo change (use suede-graph-flo-xr); coordinating parallel builders with file ownership (use suede-agent-teams); lead lifecycle, scoring, and CRM routing rules (use suede-revops); proving agent output quality against an eval set (use suede-ai-eval); reviewing the finished diff (use suede-code-review).

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Create and refine sales playbooks, deal strategies, MEDDPICC analyses, customer decks, and outreach sequences. Use for any sales methodology work, pipeline review, or go-to-market planning.

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Design audience-specific framing, drafts, and communication sequence for stakeholder updates.

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Uncover root causes through recursive Why questioning and consequence exploration. Use before acting on problems.

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Use when you need the end-to-end merge -> deploy -> watch -> verdict sequence for a delivery mode, or a tool result you did not expect (refusal, park, tag exists)

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Plan, write, art-direct, generate, and package a coherent 2-10 image minimal-zine social series from notes, articles, photographs, travel stories, products, reviews, cultural topics, data, PDFs, or mixed subjects. Use for Xiaohongshu/小红书图片, Instagram carousels, social visual essays, recommendation posts, photo diaries, evidence-backed explainers, or any multi-image editorial sequence. Produces analysis, card roles, subject-aware composition, saved prompts, real raster images, natural caption copy, evidence provenance when needed, and series-level QA.

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This skill covers two related use cases: (1) Creating high-converting webinar registration and event landing pages, and (2) Repurposing webinar recordings into multiple content assets including blog posts, social media, email sequences, and sales materials. Use when users need to build webinar pages or convert webinar content into multi-channel marketing materials.

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Use this skill when setting up marketing automation in HubSpot, Marketo, email sequences, lead scoring, and workflows.

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Email/SMS lifecycle and deliverability framework for SMB Product-Builder products that send transactional or lifecycle messages (booking reminders, CRM sequences, receipts, win-back). Codifies provider selection (Resend/Postmark/Twilio/SendGrid), domain auth (SPF/DKIM/DMARC), consent and compliance (TCPA, CAN-SPAM, CASL, quiet hours, double opt-in), suppression-list discipline, and the transactional-vs-marketing split. Applied by integrations-engineer and senior-dev whenever a feature sends messages — so deliverability and consent are designed in, not bolted on after the first spam complaint.

日本語の概要は準備中です。原文の説明を表示しています。