Claude Skills by dromlakhani

Recommends against routine 25(OH)D testing during pregnancy. Use when a clinician considers ordering 25(OH)D tests for pregnant patients lacking established indications such as hypocalcemia or malabsorption.

The skill advises against routine 25(OH)D testing in asymptomatic adults younger than 50 years who lack established indications for vitamin D assessment. It is triggered when a clinician considers ordering a 25(OH)D test for preventive screening in this age group.

Recommends against routine vitamin D supplementation beyond the Dietary Reference Intake in adults aged 50 to 74 years. Use when a clinician considers vitamin D supplementation for adults aged 50-74 without established indications such as osteoporosis, malabsorption, or chronic kidney disease.

Recommends against empiric vitamin D supplementation beyond the Dietary Reference Intake (DRI) in adults younger than 50 years. Use when a clinician considers vitamin D supplementation for non‑pregnant adults under 50 without established indications for treatment.

Recommends daily, lower-dose vitamin D instead of nondaily, higher-dose vitamin D for adults aged 50 years and older who have an indication for vitamin D supplementation. Trigger phrases include 'vitamin D dosing strategy for patients over 50', 'daily versus intermittent vitamin D in older adults', and 'vitamin D supplementation plan for adults 50+ requiring treatment'.

Suggests empiric vitamin D supplementation to prevent nutritional rickets and potentially lower respiratory tract infection risk in children and adolescents aged 1 to 18 years. Use when a clinician asks about vitamin D supplementation for patients aged 1 to 18 years to prevent rickets or respiratory infections.

Suggests empiric vitamin D supplementation plus lifestyle modification to reduce diabetes progression risk in adults with high-risk prediabetes. Use when a clinician considers vitamin D for patients with prediabetes meeting 2 or more ADA glycemic criteria (fasting glucose, HbA1c, 2‑hour OGTT) to prevent diabetes.

The skill suggests empiric vitamin D supplementation to lower mortality risk in adults aged 75 years and older. Use when a clinician inquires about vitamin D supplementation for patients aged 75 years or older to reduce mortality risk.

The guideline suggests empiric vitamin D supplementation during pregnancy to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality. Consider this when a clinician inquires about vitamin D supplementation for pregnant patients to reduce pregnancy complications.

Recommends daily lower-dose vitamin D over intermittent high-dose dosing for adults aged 50 years and older who have indications for vitamin D supplementation. Trigger phrases include: "Should I prescribe daily or intermittent vitamin D for this patient?" and "What dosing frequency is best for vitamin D in adults over 50?"

The guideline recommends against routine 25(OH)D screening and subsequent vitamin D treatment in adults with dark complexion who lack established indications for testing. Consider this recommendation when clinicians ask, "Should I screen for vitamin D deficiency in this patient with dark skin?" or "Is vitamin D testing indicated based on skin complexion?"

Recommends against routine 25(OH)D screening and subsequent vitamin D treatment in healthy adults without established indications. Triggered by clinician questions such as "Should I screen for vitamin D deficiency in this healthy adult?" or "Is vitamin D testing indicated for asymptomatic patients?"

This skill recommends against routine 25-hydroxyvitamin D [25(OH)D] screening and subsequent vitamin D supplementation in adults with obesity when no established indication exists. It is triggered by clinician questions such as “Should I screen for vitamin D deficiency in this obese patient?” or “Is vitamin D testing indicated based on BMI?”

Recommends against routine vitamin D supplementation beyond the Dietary Reference Intake in adults aged 50-74 years without established indications for vitamin D treatment. Triggers include clinician questions such as "Should I prescribe vitamin D to this middle-aged adult?" or "Is vitamin D supplementation needed for patients aged 50-74?"

Recommends against empiric vitamin D supplementation beyond the Dietary Reference Intake in adults younger than 50 years. Triggered by questions such as "Should I prescribe vitamin D to this young adult?" or "Is vitamin D supplementation needed for patients under 50?"

This skill recommends against routine 25(OH)D testing in asymptomatic adults aged 50–74 years. It is triggered by questions such as "Should I order a vitamin D level for this patient aged 50-74?" or "Is vitamin D testing indicated for asymptomatic middle-aged adults?"

Recommends against routine 25(OH)D testing in adults aged 75 years and older. Triggered by questions such as "Should I order a vitamin D level for this patient over 75?" or "Is vitamin D testing indicated for asymptomatic elderly adults?"

Recommends against routine 25(OH)D testing during pregnancy. Triggers include: "Should I order a vitamin D level for this pregnant patient?" and "Is vitamin D testing indicated for asymptomatic pregnant patients?"

Recommends against routine 25(OH)D testing in adults younger than 50 years. Triggers include clinician questions such as "Should I order a vitamin D level for this patient under 50?" or "Is vitamin D testing indicated for asymptomatic young adults?"

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Suggests empiric vitamin D supplementation to lower mortality risk in adults aged 75 years and older. Triggered by clinician questions such as “Should I prescribe vitamin D to this elderly patient?” or “Is vitamin D supplementation indicated for patients over 75?”

Suggests empiric vitamin D supplementation plus lifestyle modification to reduce diabetes progression in adults with high-risk prediabetes. Triggered by clinician questions such as "Should I prescribe vitamin D to this patient with prediabetes?" or "Is vitamin D supplementation indicated for prediabetes management?"

Suggests empiric vitamin D supplementation during pregnancy to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality. Triggered by clinician questions such as "Should I prescribe vitamin D to this pregnant patient?" or "Is vitamin D supplementation indicated for pregnant patients?"

Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, G...

For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the ...

Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, o...

Decide whether a person with confirmed early-stage type 1 diabetes qualifies for teplizumab (Tzield) — the anti-CD3 disease-modifying antibody that delays progression from Stage 2 to Stage 3 T1D — and outline the 14-day intravenous course, expected benefit, regulatory status, and pre-treatment work-up. Use when a clinician asks whether a patient with early T1D qualifies for teplizumab, indication for Tzield, Stage 2 T1D what treatment is available, how to delay onset of T1D, is teplizumab ava...

Guides comorbidity-stratified selection of initial and further glucose-lowering medicines for adults with type 2 diabetes using the NICE NG28 (2026) framework, covering six clinical profiles: no relevant comorbidity, heart failure, atherosclerotic cardiovascular disease, early onset, obesity, chronic kidney disease, and frailty.

Guides individualised HbA1c target-setting and identifies the correct intensification trigger for adults with type 2 diabetes using the NICE NG28 (2026) framework, covering standard targets, hypoglycaemia-risk adjustment, indications for target relaxation, and appropriate monitoring frequency.

Select oral and injectable glucose-lowering agents for a newly diagnosed patient with type 2 diabetes using a compelling-indication hierarchy (heart failure → ASCVD → DKD → obesity) followed by glucose-pattern matching. Incorporates modern GLP-1 receptor agonists — Ozempic (semaglutide SC, T2D), Mounjaro (tirzepatide), and Wegovy/Noveltreat (semaglutide 2.4 mg, obesity). Use when a clinician asks "what drug to start for newly diagnosed T2D", "which OAD to use", "first-line diabetes medication...

Guides next-step management after a thyroid FNA result using the Bethesda System for Reporting Thyroid Cytopathology (categories I–VI), integrating clinical risk, sonographic pattern, and molecular testing options. Use when a clinician asks "what do I do with a Bethesda III result", "Bethesda IV FNA what next", "should I repeat FNA or do molecular testing", "FLUS result management", "Bethesda II follow-up interval", or any question about acting on a thyroid FNA cytology report. Source: 2015 A...

Reclassifies differentiated thyroid cancer (DTC) patients at 6–24 months after initial therapy using ATA response-to-therapy categories (Excellent / Biochemical Incomplete / Structural Incomplete / Indeterminate) to guide ongoing surveillance intensity, TSH suppression targets, and further treatment. Use when a clinician asks "how is my thyroid cancer patient doing at follow-up", "what does a detectable Tg mean after thyroidectomy", "how do I interpret a low Tg with negative imaging", "is thi...

Assigns ATA initial risk of recurrence (Low / Intermediate / High) to a patient with differentiated thyroid cancer (DTC) after surgery, using the ATA 2009 Modified Risk Stratification System. Use when a clinician asks "what is the ATA risk for this DTC patient", "is this low or high risk thyroid cancer", "how do I risk-stratify this thyroid cancer after surgery", "ATA risk tier for DTC", "does this patient need RAI", "what follow-up does this thyroid cancer patient need", or any post-surgical...

Decides whether radioactive iodine (RAI) remnant ablation or adjuvant therapy is indicated after thyroidectomy for differentiated thyroid cancer, using ATA risk tier and specific pathologic features. Use when a clinician asks "does this DTC patient need RAI", "should I give radioiodine after thyroidectomy", "is RAI indicated for low risk thyroid cancer", "RAI for intermediate risk DTC", "radioactive iodine dosing for thyroid cancer", "RAI for lymph node metastases", or any question about post...

Decides whether a thyroid nodule needs FNA biopsy using the ATA 2015 sonographic pattern classification (high/intermediate/low/very low/benign) and nodule size thresholds. Use when a clinician asks "does this thyroid nodule need a biopsy", "should I FNA this nodule", "what size threshold for thyroid FNA", "is this nodule suspicious enough for biopsy", or describes a thyroid ultrasound finding and wants a biopsy recommendation. Distinct from EU-TIRADS — uses the ATA 5-pattern system.

Suggests thyroid ultrasound when a palpable thyroid nodule is detected on physical examination in patients with acromegaly. Trigger phrases include "palpable thyroid nodule," "thyroid nodularity on palpation," or "feeling a thyroid lump."

Classify a thyroid nodule using the EU-TIRADS system from an ultrasound image or US report, and give a risk-stratified FNA recommendation. Use when a clinician shares a thyroid ultrasound image or describes US features of a nodule and asks "what is the EU-TIRADS category", "is this nodule suspicious", "does this need a biopsy", "what is the risk of malignancy", "should I do FNA on this nodule", "interpret this thyroid ultrasound", or "rate this thyroid nodule". Also triggers on: "thyroid US r...

Step-wise management of constipation caused by defecatory disorder (pelvic floor dysfunction, dyssynergia, outlet obstruction) using the WGO cascade framework. Trigger when a patient strains excessively even with soft stools, uses manual manoeuvres to defecate, has difficult defecation with a feeling of blockage, is suspected of having pelvic floor dyssynergia, anorectal dyssynergia, obstructed defecation, or rectocele causing constipation.

Selects the right pharmacologic treatment for chronic constipation using a resource-stratified cascade approach (Level 1/2/3), with doses and NNTs for each agent. Trigger when a clinician asks which laxative to use, what to prescribe for constipation, how to escalate treatment for chronic constipation, which osmotic or stimulant laxative to choose, or when first-line treatment has failed and the next step is needed.

Complete bedside prescribing reference for Movicol (macrogol 3350 + electrolytes) covering dosing for chronic constipation and faecal impaction, special population adjustments, contraindications, warnings, and drug interactions. Trigger when a clinician asks how to dose Movicol, how many sachets to prescribe, how to use Movicol for faecal impaction, whether Movicol is safe in pregnancy or renal failure, or what the contraindications to Movicol are.

Guide pre-endoscopy management decisions for patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide etc.), deciding whether to proceed, delay, or modify the approach based on GI symptoms, fasting status, and indication. Trigger when a clinician asks about GLP-1 RA and endoscopy, semaglutide before colonoscopy, Ozempic before procedure, or whether to hold a GLP-1 agonist before endoscopy.

Look up NHS England genomic tests for rare and inherited diseases. Use this skill whenever a clinician asks what genetic test to order for a condition, which genes are covered for a specific diagnosis, what commissioning category a genomic test falls under (Core, Specialised, or Highly Specialised), or which tests belong to a specialty group (Neurology, Cardiology, Endocrinology, etc.). Also trigger for questions like what panel is used for a condition, whether there is an NHS test for someth...

Decide whether a newly-diagnosed multiple myeloma (NDMM) patient is eligible for high-dose melphalan + autologous stem cell transplantation (ASCT) as part of front-line therapy, using the EHA-ESMO 2021 criteria. Trigger when a clinician asks "is this myeloma patient fit for transplant", "ASCT eligibility for myeloma", "transplant-eligible NDMM", "should I refer for stem cell transplant", "high-dose melphalan candidate", or any decision about whether a newly-diagnosed myeloma patient should go...

Order the correct work-up for a patient with multiple myeloma (MM) at four clinical timepoints — diagnosis, response assessment, follow-up, and relapse — using the EHA-ESMO 2021 framework. Trigger when a clinician asks "what tests to order for myeloma", "MM diagnosis workup", "myeloma follow-up tests", "tests at relapse for myeloma", "what to do for newly diagnosed multiple myeloma", or "investigations for plasma cell dyscrasia". Covers blood, urine, bone marrow, and imaging.

Decide when and how to assess minimal residual disease (MRD) in multiple myeloma — bone marrow MRD by next-generation flow (NGF) or sequencing (NGS), plus imaging MRD by PET-CT — and how to act on the result. Trigger when a clinician asks "how to assess MRD in myeloma", "MRD-negative complete response", "PET-CT for MRD", "is bone marrow MRD enough", "when to test for MRD", "next-generation flow for myeloma", or "myeloma sustained MRD negativity". Based on EHA-ESMO 2021.

Select the correct empiric antibiotic regimen for a diabetic foot infection based on infection grade and MRSA risk, using the IWGDF/IDSA 2023 framework. Trigger when a clinician asks which antibiotic to use for a diabetic foot infection, DFI, or DFU, or asks about empiric treatment, antibiotic choice, or antibiotic duration for a foot wound in a diabetic patient.

Classify the severity of a Diabetes-related Foot Infection (DFI) using the IWGDF/IDSA 2023 step-by-step framework. Use this skill whenever a clinician presents a diabetic foot case and wants to know if it's infected, how severe it is, whether osteomyelitis is present, and what to do next. Trigger on mentions of diabetic foot ulcer, DFI, DFU with signs of infection, foot wound in diabetes, or requests to "classify" or "grade" a foot infection.

Distinguishes BPPV from its key mimics at the bedside — postural hypotension, vestibular paroxysmia, vestibular migraine, central positional vertigo, and chronic unilateral vestibular hypofunction — using history, trigger patterns, nystagmus characteristics, and response to treatment. Use when a patient has positional vertigo and you're unsure if it's BPPV, when Dix-Hallpike is atypical, or when the patient has not responded to repositioning maneuvers. Trigger phrases: "is this BPPV or someth...

Screens any dizzy patient for features that mandate urgent neuroimaging or neurology referral — distinguishing benign peripheral dizziness from a central or life-threatening cause. Use when a patient presents with dizziness and you want to quickly rule out stroke, cerebellar lesion, or other dangerous aetiology before attributing symptoms to a benign cause. Trigger phrases: "could this dizziness be serious", "rule out stroke in dizzy patient", "when to image a dizzy patient", "red flags in di...

Classifies a patient's dizziness into one of four categories — vestibular/vertigo, presyncope, disequilibrium, or nonspecific — using history, timing, triggers, and associated symptoms. Use when a patient presents with dizziness, giddiness, lightheadedness, feeling off-balance, spinning, or nearly blacking out and you need to determine the type before further workup.