dromlakhani

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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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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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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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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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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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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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 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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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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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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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 determines whether an adolescent or adult patient meets DSM-5 criteria for gender dysphoria (gender incongruence) by evaluating the presence of at least two of six specified criteria over a minimum 6-month duration, accompanied by clinically significant distress or impairment. It is triggered when a clinician queries whether the patient's reported symptoms align with gender dysphoria, such as persistent incongruence between experienced/expressed gender and designated gender.

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

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

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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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Determines if an adolescent meets criteria for initiating sex hormone treatment for gender dysphoria/gender incongruence. Triggered when an adolescent requests sex hormones or presents for gender-affirming hormone therapy evaluation.

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Determines whether a patient meets the minimum age requirement (≥18 years or legal age of majority) for genital surgery that includes gonadectomy and/or hysterectomy. Trigger phrase: patient requests gonadectomy or hysterectomy as part of gender-affirming genital surgery.

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Determines if current hormone levels are within target range for affirmed gender (e.g., testosterone 400-700 ng/dL for transgender males, estradiol 100-200 pg/mL for transgender females). Triggers include patient on hormone therapy and time for level check.

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Determines if a patient has completed ≥1 year of consistent and compliant hormone therapy for genital surgery approval. Triggers include patient requesting genital surgery and being on hormone therapy.

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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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