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Suggests that pregnant patients with primary adrenal insufficiency be monitored for clinical signs of glucocorticoid over- or under-replacement such as normal weight or gain, fatigue, postural hypotension or hypertension, and hyperglycemia, with at least one review each trimester. Use when managing a pregnant patient with PAI to assess glucocorticoid dosing adequacy.

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This skill outlines monitoring of mineralocorticoid replacement in primary adrenal insufficiency, focusing on clinical assessment of salt craving, postural hypotension, or edema alongside serum electrolyte measurements. It is initiated when evaluating patients on fludrocortisone therapy to ensure adequate dosing and avoid over- or under-replacement.

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。

This skill outlines monitoring glucocorticoid replacement in children with primary adrenal insufficiency (PAI) using clinical assessment of growth velocity, weight, blood pressure, and energy levels. Trigger when evaluating a child with PAI for adequacy of glucocorticoid therapy during routine follow-up.

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This skill recommends simultaneous measurement of plasma renin and aldosterone in patients with primary adrenal insufficiency (PAI) to determine the presence of mineralocorticoid deficiency. It is triggered when assessing for mineralocorticoid deficiency in PAI, such as in patients with unexplained hyponatremia, hyperkalemia, or salt craving despite glucocorticoid replacement.

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Evaluates likelihood of primary aldosteronism by measuring plasma aldosterone suppression after oral captopril; normal suppression ≥30% makes PA unlikely, while lack of suppression with persistently suppressed plasma renin activity suggests PA. Use when assessing captopril challenge test (CCT) results for PA diagnosis in patients with positive aldosterone-to-renin ratio.

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Interprets the saline infusion test (SIT) to assess the probability of primary aldosteronism when a patient has a positive aldosterone-to-renin ratio (ARR) and requires confirmatory testing. Triggers include evaluating post‑infusion plasma aldosterone concentration (PAC) after a positive ARR, hypertension work‑up, or when deciding whether to proceed to adrenal venous sampling (AVS).

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This skill guides annual evaluation of patients with primary adrenal insufficiency (PAI) for symptoms and signs of glucocorticoid and mineralocorticoid over- or under-replacement. Use during annual follow-up when assessing for weight changes, blood pressure abnormalities, edema, or symptoms such as fatigue, insomnia, or salt craving.

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Recommends performing biochemical testing for HPA axis at least 18-24 hours after last hydrocortisone dose or longer for synthetic glucocorticoids. Use when scheduling HPA axis testing in glucocorticoid-treated patient needing assessment of adrenal reserve.

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Calculate and interpret the PREVENT-ASCVD risk score (10-year and 30-year) for primary prevention of atherosclerotic cardiovascular disease per the 2026 ACC/AHA multisociety dyslipidaemia guideline. Covers inputs required, risk-category thresholds (low <3%, borderline 3–<5%, intermediate 5–<10%, high ≥10%), when to use the 30-year calculation (adults 30–59), and how PREVENT differs from the older Pooled Cohort Equations (lower risk estimates by 40–50%, race-agnostic). Use when a clinician asks what the 10-year ASCVD risk is, how to calculate PREVENT, PCE vs PREVENT, risk category for this patient, does my patient need a statin, 30-year risk calculation, primary prevention risk assessment. Grounded in the 2026 ACC/AHA multisociety dyslipidaemia guideline.

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Work a primary-prevention patient through the 2026 ACC/AHA multisociety dyslipidaemia guideline CPR framework — Calculate (10-year and 30-year PREVENT-ASCVD), Classify (low / borderline / intermediate / high), Personalize (demographic, clinical, biomarker, and reproductive risk enhancers), and Reclassify (coronary artery calcium scoring where appropriate). Use when a clinician asks how to assess ASCVD risk for primary prevention, who needs a statin, borderline risk patient what to do, intermediate risk should I start a statin, risk enhancers to look for, premature family history of ASCVD how does it change risk, pregnancy-related risk factors, PCOS and cardiovascular risk. Grounded in the 2026 ACC/AHA multisociety dyslipidaemia guideline.

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Accounts for estrogen-induced elevation of total serum cortisol via increased corticosteroid-binding globulin (CBG) when evaluating adrenal reserve or hydrocortisone replacement adequacy. Triggered when assessing glucocorticoid adequacy in patients receiving estrogen therapy (e.g., oral estrogen replacement) or interpreting cortisol levels in estrogen-exposed individuals.

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Use when assessing AI/ML systems for prompt injection, jailbreak vulnerabilities, model inversion risk, data poisoning exposure, or agent tool abuse. Covers MITRE ATLAS technique mapping, injection signature detection, and adversarial robustness scoring.

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Testing and benchmarking LLM agents including behavioral testing, capability assessment, reliability metrics, and production monitoring—where even top agents achieve less than 50% on real-world benchmarks

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This skill should be used when the user asks to "implement LLM-as-judge", "compare model outputs", "create evaluation rubrics", "mitigate evaluation bias", or mentions direct scoring, pairwise comparison, position bias, evaluation pipelines, or automated quality assessment.

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Use for SWOT analysis, or when the user wants to assess where a team, product or company stands: "strengths and weaknesses", "should we enter this market?", "review our position", "competitor comparison". Turns findings into actions. Skip for detailed planning or pure market sizing.

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Evaluate and install ecosystem tools (Hermes plugins, skills, integrations) — assess complexity vs. benefit before installation, show examples for visual tools, and avoid "cloned but not configured" states.

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Analyze NFT projects for investment decisions — evaluate fundamentals, identify red flags, assess risk, and provide buy/hold/avoid recommendations

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Conducts multi-axis code review. Use before merging any change. Use when reviewing code written by yourself, another agent, or a human. Use when you need to assess code quality across multiple dimensions before it enters the main branch.

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Analyze the current uncommitted diff and give a detailed summary with risk assessment. Use when asking what changed, reviewing changes before a commit, or requesting a change summary.

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Find overly complex code: files over 300 lines, functions over 50 lines, deeply nested conditions (4+ levels), and magic numbers. Use for code quality reviews, pre-release checks, or when asked to assess code maintainability.

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Expert-level clinical engineering covering medical equipment management, hospital technology systems, healthcare IT integration, safety standards, and health technology assessment.

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Evaluate design from a UX perspective, assessing visual hierarchy, information architecture, emotional resonance, cognitive load, and overall quality with quantitative scoring, persona-based testing, automated anti-pattern detection, and actionable feedback. Use when the user asks to review, critique, evaluate, or give feedback on a design or component.

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Post-epic review to extract lessons and assess success. Use when the user says "run a retrospective" or "lets retro the epic [epic]"

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Code comment accuracy verification, documentation completeness assessment, comment rot detection.

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。