基础设施与 DevOps技能

When picking a secrets store, designing rotation, or wiring scanning gates — multi-cloud (Vault, AWS, Azure, GCP), CI and Kubernetes — decision framework, provider deep-dives externalized.

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Use when establishing what observability a project actually has — the four Golden Signals, required signal to detected implementation to evidence, and SLI/SLO provenance.

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Use when working with Grafana — dashboards, Loki LogQL queries, alerting rules, monitoring panels — even when the user just says 'build me a dashboard' or 'query the logs' without naming Grafana.

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Use when setting up Laravel Pulse — real-time dashboard, built-in cards, custom recorders, performance insights — even when the user just says 'I need app monitoring' without naming Pulse.

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Use when configuring Laravel Reverb — the first-party WebSocket server with Pusher protocol compatibility, horizontal scaling, and Pulse monitoring.

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Use when working with Docker — Dockerfile edits, docker-compose services, containers, or the dual-container (fast + Xdebug) setup — even when the user just says 'my container won't start'.

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Use when working with AWS resources — ECS Fargate, ECR, EFS, Secrets Manager, gomplate templates, multi-env deployments — even when the user says 'deploy to staging' without naming AWS.

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Use when filling knowledge-layer context files — auth-model, tenant-boundaries, data-sensitivity, deployment-order, observability — interactive template walkthrough.

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This skill suggests using real-time continuous glucose monitoring (CGM) rather than no CGM for outpatients with type 2 diabetes (T2D) who take insulin and/or sulfonylureas and are at high risk for hypoglycemia. It is triggered by clinician questions such as "Should I use CGM for this T2D patient on insulin or sulfonylureas with high hypoglycemia risk?" or "Is CGM indicated for this patient?"

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Recommends CGM over SMBG for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Triggered by clinician questions such as "Should I use CGM or SMBG for this T1D patient on MDI?" or "Is CGM preferred for glucose monitoring in this patient?"

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This skill checks for contraindications or sources of inaccuracy that may affect continuous glucose monitoring (CGM) reliability in hospitalized adults. It is triggered when clinicians ask, “Are there factors that could make CGM unreliable?” or when assessing for skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, or medications such as acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea.

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This skill suggests using real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D). Trigger phrases include "Should I use RT-CGM+ADIP or MDI+SMBG for this T1D patient?" or "Is intensive pump therapy indicated for this patient?"

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Provides a monitoring schedule for patients receiving GnRH agonist therapy for pubertal suppression. Trigger phrases include 'patient undergoing GnRH agonist therapy' or 'initiating pubertal suppression'.

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Provides monitoring schedule for transgender females on estrogen therapy, including clinical evaluation, hormone levels, prolactin, electrolytes, BMD, and cancer screening. Triggered when a transgender female is receiving estrogen therapy for gender affirmation.

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Provides monitoring schedule for transgender males on testosterone therapy, detailing timing of clinical visits, laboratory tests, and assessment for virilization and adverse reactions. It is triggered when a clinician manages a transgender male patient on gender‑affirming hormone therapy and needs to schedule appropriate follow‑up.

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This skill indicates the need for periodic prolactin monitoring in transgender females undergoing estrogen therapy. Clinical triggers include a transgender female patient receiving estrogen treatment.

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Provides schedule for monitoring during sex hormone induction. Trigger: patient initiating gender-affirming hormone therapy (GAHT).

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Confirms patient understands that continuous glucose monitoring complements but does not replace self-monitoring of blood glucose. Triggers include: 'Clarify CGM role alongside fingersticks', 'Ensure patient knows CGM does not eliminate need for SMBG'.

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Recommends real-time continuous glucose monitoring (RT-CGM) for adult patients with type 1 diabetes mellitus (T1DM) whose hemoglobin A1C is above individualized target. Consider when clinician notes 'T1DM A1C above goal, consider RT-CGM' or 'Patient willing to wear CGM daily, A1C elevated'.

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Suggests that clinicians continue CSII in hospitalized patients with type 1 or type 2 diabetes when the institution has clear protocols for evaluating pump candidates and appropriate monitoring and safety procedures. Trigger phrases include: 'Admitted patient on pump, check hospital pump policy' and 'Inpatient with diabetes using pump, verify institutional guidelines'.

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Recommends using continuous glucose monitoring instead of fingerstick self-monitoring for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Use when a clinician evaluates glucose monitoring options for T1D on MDIs or manages hypoglycemia-prone T1D patients.

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This skill guides clinicians to reassess glucose monitoring frequency when discontinuing continuous subcutaneous insulin infusion (CSII) or transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Plan for glucose monitoring after pump stop' or 'Determine SMBG/CGM frequency post-pump' to ensure individualized glycemic goals are met.

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The skill suggests using real-time continuous glucose monitoring (CGM) combined with algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D) to lower hypoglycemia incidence. Clinical triggers include discussions about insulin pump therapy, CGM use, or reducing hypoglycemia in T1D patients on intensive insulin regimens.

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Reassesses annually the patient’s use of self-monitoring blood glucose to calibrate the CGM system. Triggered by ‘Yearly calibration practice review’ or ‘Annual check of SMBG calibration adherence’.

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