其他技能

Applies standard breast-screening guidelines for transgender females who have been assessed as having no known increased risk of breast cancer. Trigger phrases include transgender female and assessed as no increased breast cancer risk.

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Recommends RT-CGM devices for adult patients with well-controlled type 1 diabetes who are willing and able to use the devices on a nearly daily basis. Trigger phrases include 'Controlled T1DM patient interested in CGM' and 'Consider RT-CGM for glycemic stability in well-controlled T1DM'.

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Apply the four published expert-consensus clinical scenarios to manage GI adverse events in complex GLP-1 receptor agonist patients — persistent nausea mid-titration, GERD/heartburn after up-titration, elderly with sarcopenia risk, and insulin-treated elderly with CKD plus diarrhoea. Use when a clinician describes a patient resembling one of these archetypes, or asks "how to manage GLP-1 in an elderly patient with CKD", "patient on liraglutide developed reflux", "sarcopenia worry on semaglutide in 80-year-old", or "persistent nausea on semaglutide despite escalation". Grounded in Gorgojo-Martínez 2023 Table 4.

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Calculates initial and escalating dose for pubertal induction hormone therapy based on patient weight or body surface area. Triggers include patient eligible for sex hormone treatment, ready to start hormones.

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Determines if adolescent meets criteria for GnRH agonist treatment to suppress pubertal development. Triggers include adolescent requesting to suppress puberty, adolescent with gender dysphoria seeking pubertal blockade, or clinician noting Tanner G2/B2 with request for hormone suppression.

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This skill determines whether testicular volume should be used as the primary or sole indicator of sexual development in male childhood cancer survivors who have received gonadotoxic treatments such as alkylating agents or testicular radiotherapy. Triggers include clinician questions like “Can I use testicular volume to assess puberty in this male survivor after chemotherapy?” or “Is testis size reliable for sexual maturity evaluation post‑radiation?”

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Considers adapting the basal insulin rate at hospital admission for patients using insulin pump therapy. Triggered by clinician questions such as "Should we adjust the basal rate upon admission for pump therapy?" or when evaluating pump continuation versus transition to scheduled subcutaneous insulin.

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Determines if patient meets criteria for genital gender-affirming surgery affecting fertility. Triggers include patient on hormones, considering surgery.

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This skill guides individualized prostate cancer screening for transgender females receiving estrogen therapy based on personal risk. Trigger phrase: transgender female receiving estrogens.

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This skill guides clinicians to inform and counsel individuals seeking gender-affirming medical treatment about fertility preservation options before initiating puberty suppression in adolescents or before starting hormonal therapy in adolescents and adults. It is triggered when a patient is eligible for pubertal suppression or sex hormone treatment and is about to begin such therapy.

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Decide whether commonly-excluded patients (eating disorders, elderly ≥75, upper GI disease) can actually receive a GLP-1 receptor agonist. Use when a clinician asks "can I give semaglutide to a patient with binge eating disorder / anorexia / bulimia", "is liraglutide safe in an 80-year-old", "GLP-1 with GERD or chronic gastritis", "GLP-1 in sarcopenic elderly", or anytime a patient is being ruled out for GLP-1 therapy based on a perceived contraindication. Grounded in Gorgojo-Martínez 2023 §6 (Myths or Reality).

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Determines whether bone mineral density (BMD) measurement is indicated when patients have osteoporosis risk factors or have discontinued sex hormone therapy following gonadectomy. Clinical triggers include documented osteoporosis risk factors (e.g., low body weight, glucocorticoid use, prior fracture) or cessation of sex hormone therapy after surgical gonadectomy.

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Assists clinicians in determining whether to proceed with social transition for prepubertal youth experiencing gender dysphoria or gender incongruence. Triggers include prepubertal youth with GD/gender incongruence and discussions about initiating social transition.

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Determines if patient meets ICD-10 criteria for transsexualism. Triggered when a clinician uses ICD-10 for diagnostic purposes in gender identity assessment.

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Evaluates cardiovascular risk factors in persons receiving hormone therapy by obtaining fasting lipid profiles and diabetes screening. Triggered when a patient is on gender-affirming hormone therapy and due for routine cardiovascular risk assessment.

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Determines whether an adult patient meets eligibility criteria for initiating gender-affirming hormone therapy. Triggered when an adult patient requests gender-affirming hormones or presents for evaluation of hormone therapy eligibility.

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Transition insulin pump to scheduled subcutaneous basal bolus insulin when anticipated hospital length of stay exceeds 1 to 2 days and pump expertise is unavailable. Triggers include: "Patient expected to stay >2 days, should we switch pump to scheduled insulin?

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Assesses Tanner stage to determine if physical changes of puberty have begun (stage G2/B2 or higher) for considering pubertal suppression. Triggered when a clinician evaluates pubertal development in an adolescent patient.

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Verify that insulin pump supplies (provided by patient or family) will be available throughout the hospitalization to support continued pump use. Triggered by questions such as "Do we have sufficient pump supplies for the hospital stay?"

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If CGM fails or is removed, revert the insulin pump to manual mode provided basic criteria for pump use in hospital are still met. Trigger phrase: "CGM failed, should we switch pump to manual mode?

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This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?"

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Suggests short-term, intermittent real-time CGM use in adult patients with type 2 diabetes not on prandial insulin who have A1C ≥7% and are willing and able to use the device. Triggered by phrases such as “T2DM basal-only, A1C ≥7%, consider intermittent CGM” or “Short-term CGM for non-prandial T2DM with elevated A1C”.

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This skill confirms whether a hospital has the necessary policies and expertise to support inpatient insulin pump therapy, including informed consent, standardized order sets, and device management guidance for imaging and surgical procedures. Triggered by questions such as "Are hospital policies and expertise in place for insulin pump use?" to ensure safe continuation of pump therapy in noncritical illness.

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Assesses whether hysterectomy and oophorectomy are medically necessary as part of gender-affirming surgery for transgender patients. Triggered when a patient is planning gender-affirming surgery and clinicians need to determine if total hysterectomy and oophorectomy should be included.

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