Dr Om Lakhani

Walks a cardiologist through whether, where and how to order a germline genetic test for a suspected inherited cardiovascular disease: indication, written consent (with assent for minors), pre-test counseling, choice of test and laboratory, handling of VUS and secondary findings, and privacy. Use when a clinician asks 'should I order a genetic test', 'how do I consent for a cardiomyopathy or long QT gene panel', 'can I test this child or relative (cascade screening)', 'what do I tell the patient about VUS or a negative result', or 'where can this test be sent'. Based on the JCS/JCC/JSPCCS 2024 guideline; Japan-specific insurance and legal details are flagged.

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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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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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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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Suggests initiating inpatient CGM for select diabetic patients at high risk for hypoglycemia based on Table 3 criteria. Triggers include "Should I initiate CGM for this hospitalized diabetic patient at high risk for hypoglycemia?" or "Is inpatient CGM warranted for this patient?"

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Assess whether a hospitalized adult with diabetes on insulin pump therapy remains a candidate for continued inpatient pump use. Consider triggers such as the clinician asking "Is this patient appropriate to continue insulin pump in hospital?" and evaluate for impaired consciousness, inability to adjust pump settings, critical illness, DKA, or hyperosmolar hyperglycemic state.

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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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This skill recommends against initiating puberty blocking or gender-affirming hormone treatment in prepubertal children diagnosed with gender dysphoria or gender incongruence. Clinical triggers include a young child presenting with GD/gender incongruence and caregivers or clinicians considering hormone intervention.

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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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Suggests real-time CGM over no CGM for outpatients with type 2 diabetes who use insulin and/or sulfonylureas and are at high risk for hypoglycemia to detect and prevent low glucose events. Consider when initiating CGM in T2D patients on insulin/SU with a history of severe hypoglycemia or impaired awareness of hypoglycemia (IAH).

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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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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 continuing personal CGM with or without ADIP rather than discontinuation for inpatients already using it who are at high risk for hypoglycemia. Trigger phrases include "Should I continue or discontinue personal CGM for this inpatient who is already using it?" and "Is it appropriate to maintain personal CGM during hospitalization?"

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This skill determines whether inpatient diabetic patients meet high-risk criteria for CGM initiation using Table 3 factors such as age ≥65 years, BMI ≤27 kg/m², type 1 diabetes, insulin regimen, and specific clinical conditions. It is triggered by clinician questions like "Should I assess this inpatient for CGM initiation based on hypoglycemia risk?" or "Is this patient a candidate for inpatient CGM?"

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Recommends real-time CGM with confirmatory POC-BG for insulin dosing adjustments in insulin-treated hospitalized adults at high risk of hypoglycemia when resources and training are available. Triggers include: "Should we use CGM for insulin adjustments?" or "Is CGM appropriate for this patient?

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

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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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If CGM is not available, continue monitoring blood glucose with point-of-care testing as an alternative option. Trigger phrases include: "CGM is not available, what should we use for glucose monitoring?

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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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