Claude Skills by dromlakhani

Perform digital rectal examination (DRE) in all men before initiating testosterone therapy to exclude prostate abnormalities or support suspicion of hypogonadism when prostate volume is reduced. Triggered when a clinician considers starting testosterone and questions whether a prostate exam is needed first or whether to check the prostate before prescribing TTh.

Estimates that bariatric surgery can raise serum testosterone by approximately 10 nmol/L in obese hypogonadal patients. Triggered when a clinician considers surgical weight loss for a hypogonadal obese patient and wonders how much testosterone might rise after surgery or what T change to anticipate from bariatric procedures.

Estimates the expected rise in serum testosterone following a 10% weight loss in obese hypogonadal men, using the approximation of a 2-4 nmol/L increase. Triggered when a clinician discusses lifestyle modification with an obese hypogonadal patient and questions the anticipated testosterone change from diet and exercise.

This skill guides clinicians to maintain hematocrit below 54% before and during testosterone therapy, with particular attention to high-altitude populations to mitigate polycythemia risk. It is triggered when reviewing labs and asking, "Is the hematocrit safe or do I need to adjust or hold testosterone due to high Hct?"

This skill confirms the diagnosis of male hypogonadism by requiring both characteristic clinical symptoms and consistently low total testosterone levels on two separate morning measurements. It is triggered when a clinician evaluates a patient with suspected hypogonadism and wonders whether low testosterone and symptoms are present or if the diagnosis should be confirmed.

Recommends evaluating testosterone in men presenting with sexual symptoms (low libido, erectile dysfunction, decreased morning erections), metabolic conditions (obesity, type 2 diabetes, metabolic syndrome), HIV infection, opioid or glucocorticoid use, bone density loss, or male infertility. Triggers when a clinician encounters a patient with any of these indications and considers whether to check testosterone levels.

Recommends measuring total testosterone in the morning fasting state (07:00–11:00) using a reliable assay for patients suspected of hypogonadism. Triggered when a clinician orders a testosterone test and questions whether the sample should be drawn fasting and in the morning.

This skill guides offering testosterone therapy after radiation or brachytherapy when a patient's PSA has fallen to a low level, typically at 3-6 months post-treatment. It is triggered when clinicians consider initiating testosterone and seek confirmation that the PSA is sufficiently low, accompanied by a consent form discussing uncertainties.

This skill guides clinicians to consider testosterone therapy in postoperative radical prostatectomy patients who have undetectable PSA and favorable pathology (negative margins, seminal vesicles, and lymph nodes). Trigger when a postoperative patient reports recovered undetectable PSA and pathology is clear, raising the question of initiating testosterone replacement.

Advises checking for smaller testes, decreased body hair, and gynecomastia as physical clues to hypogonadism. Triggered when evaluating a man with suspected testosterone deficiency who asks what physical exam findings support the diagnosis or whether any exam signs suggest hypogonadism.

Recommends prostate-specific antigen (PSA) testing and digital rectal examination (DRE) to monitor prostate health during testosterone therapy, following evidence-based guidelines for prostate cancer surveillance. Use when managing a patient on testosterone and questioning whether prostate checks are needed or when PSA/DRE are due.

This skill advises caution when using ADAM, AMS, or MMAS questionnaires for hypogonadism screening due to good sensitivity but low specificity limiting diagnostic utility. Triggered when a clinician wonders whether a questionnaire can reliably detect hypogonadism or if these surveys are accurate enough for daily practice.

Conducts regular monitoring for testosterone therapy response and adverse events. Triggered when testosterone therapy is initiated and the clinician plans follow‑up, asking when to check symptom improvement or what to monitor for side effects.

Recommends repeating total testosterone measurement on at least two separate occasions when the initial result is below 12 nmol/L before starting testosterone therapy. Triggered when a clinician finds a low total testosterone (<12 nmol/L) and questions whether confirmation is needed prior to treatment.

States that testosterone therapy should be restricted to investigational protocols in patients with biochemical recurrence or metastatic prostate cancer due to unknown long-term risks. Triggers when a clinician encounters a patient with rising PSA after definitive treatment or metastatic disease and low testosterone, questioning whether testosterone can be used outside a trial.

This skill recommends screening men with obesity, type 2 diabetes mellitus, or metabolic syndrome for hypogonadism given the high comorbidity between these insulin‑resistant conditions and low testosterone. It is triggered when a clinician encounters a patient with obesity, diabetes, or metabolic syndrome and questions whether to check testosterone or suspects hypogonadism in this metabolic context.

Guides selection among hCG, recombinant FSH, aromatase inhibitors, SERMs, combined testosterone/hCG, or intranasal testosterone for men on or after testosterone therapy who wish to preserve fertility. Triggers when a clinician manages a man requesting sperm maintenance or spermatogenesis recovery while on or after testosterone and asks how to maintain sperm production or which agent to use.

Guides shared decision-making for testosterone therapy selection by discussing formulation, route, safety, efficacy, tolerability, availability, preference, and cost with the patient. Triggers when a clinician has decided to treat hypogonadism and asks, 'Which testosterone preparation should we use?' or 'How do we involve the patient in selecting therapy?'

Aims to correct serum total testosterone to the mid-normal reference range for young men during testosterone therapy. Triggers when a clinician monitors treatment and wonders what testosterone level should I aim for or is the patient's T in the target zone.

This skill outlines the monitoring schedule for testosterone therapy, detailing baseline, 3‑month, 6‑month, and yearly assessments of symptoms, adverse events, total testosterone, hematocrit, PSA, and DRE. Use it when a patient is receiving testosterone and the clinician asks what labs and checks are needed today or when the next monitoring visit should occur.

This skill applies a total testosterone threshold of less than 12 nmol/L (3.5 ng/mL) to diagnose late-onset hypogonadism. It is triggered when a clinician evaluates a testosterone result and questions whether the level is low enough to diagnose hypogonadism or what cutoff defines low T.

Testosterone therapy is more effective than placebo at correcting anemia in middle-aged and older men with confirmed hypogonadism. Consider this approach when evaluating a hypogonadal man with anemia and questioning whether testosterone will improve hemoglobin or if testosterone therapy should be used for anemia.

Recommends initiating testosterone therapy in symptomatic men with total testosterone less than 12 nmol/L (350 ng/dL). Triggers when patients present with low libido, erectile dysfunction, fatigue, or decreased vigor and have confirmed low T levels.

Reserve testosterone monotherapy for men with mild erectile dysfunction and an absolute demonstration of hypogonadism; otherwise combine testosterone therapy with a PDE5 inhibitor. Triggered when a clinician managing erectile dysfunction asks whether testosterone alone is sufficient or a PDE5 inhibitor should be added.

Recommends adding testosterone therapy to phosphodiesterase‑type‑5 inhibitor (PDE5i) for men with erectile dysfunction who do not respond to PDE5i monotherapy. Triggered when a patient reports inadequate response to sildenafil, tadalafil, or vardenafil and the clinician considers whether to add testosterone or pursue combination therapy.

Adjust basal insulin dose (Lantus, Basaglar, Ryzodeg/IDegAsp) based on fasting blood glucose trend. Use when a clinician asks how to titrate basal insulin, whether to increase or decrease Lantus/glargine/degludec/Ryzodeg dose, or how to adjust basal insulin based on fasting glucose readings. Triggers include: "adjust basal insulin", "titrate Lantus", "basal dose change", "FBG is high/low", "should I increase/decrease insulin".

Recommends basal insulin as the first‑line insulin regimen for obese patients with type 2 diabetes who require insulin, preferring it over insulin alone or insulin combined with a sulfonylurea to limit weight gain. Clinical triggers include questions such as “Which insulin regimen should I start for this obese patient with T2DM requiring insulin?” or “Is basal insulin preferred over premixed insulin in this patient?”.

In obese patients with type 2 diabetes mellitus requiring insulin, a preferential trial of basal insulin is recommended before initiating premixed or combination insulin therapy. Consider this approach when clinicians ask, 'Should I try basal insulin alone before moving to premixed insulin in this patient?' or 'Is a basal‑only trial appropriate before initiating combination insulin therapy?'.

Recommends either carbohydrate counting or fixed prandial insulin dosing for adults with type 1 diabetes or insulin‑treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin. Triggered when a clinician asks about mealtime insulin dosing strategies for a patient on home insulin pump or multiple daily injections, such as prandial insulin need in a patient already using insulin at home.

The clinician continues the patient's pre‑admission scheduled insulin regimen, adjusting it for current nutritional status and illness severity to keep glucose between 100–180 mg/dL. Trigger phrases include a basal insulin dose ≥0.6 units/kg/day, altered nutritional intake, or worsening illness severity.

Recommends initiating correctional insulin alone for hospitalized adults without prior diabetes who develop hyperglycemia (blood glucose >140 mg/dL). If hyperglycemia persists (≥2 point‑of‑care glucose values ≥180 mg/dL within 24 hours while on correctional insulin), add scheduled basal‑bolus insulin.

Recommends either a dipeptidyl peptidase-4 inhibitor with correction insulin or scheduled insulin therapy for select adult patients with mild hyperglycemia and type 2 diabetes hospitalized for noncritical illness. Consider when HbA1c <7.5%, blood glucose <180 mg/dL, and total daily insulin dose <0.6 units/kg if previously on insulin.

Recommends using glucagon preparations that do not require reconstitution (e.g., nasal, autoinjector) over those needing reconstitution for treating outpatient severe hypoglycemia to ensure prompt, correct dosing. Triggered when prescribing glucagon for type 1 or type 2 diabetes patients on insulin or sulfonylureas, counseling caregivers on rescue therapy, or following a severe hypoglycemia episode.

Suggests initial therapy with correctional insulin or scheduled insulin to maintain glucose targets 100–180 mg/dL for adults treated with diet or noninsulin medications before admission; add scheduled insulin if hyperglycemia persists (≥2 POC‑BG ≥180 mg/dL in 24 h) or initiate scheduled insulin if admission glucose ≥180 mg/dL. Triggers include preoperative diet‑treated diabetes or persistent hyperglycemia despite correctional insulin.

Recommends continuing a patient’s personal continuous glucose monitor (CGM) in the hospital with or without algorithm-driven insulin pump (ADIP) therapy rather than discontinuing it for individuals already using CGM outpatient. Use when deciding whether to maintain personal CGM during admission or when a patient requests to keep their device, particularly in those at high risk for hypoglycemia.

Suggests initiating inpatient continuous glucose monitoring (CGM) for select hospitalized patients at high risk for hypoglycemia, combined with periodic point-of-care glucose checks for accuracy. Triggers include planning glucose monitoring for inpatients with prior severe hypoglycemia, renal or hepatic dysfunction, or age 65 years or older.

This skill recommends providing inpatient diabetes education as part of a comprehensive discharge-planning process for adults with diabetes hospitalized for noncritical illness, rather than omitting education. Use when planning discharge for a diabetic patient, particularly those at high readmission risk, newly diagnosed, or starting insulin.

Recommends implementing inpatient glycemic surveillance and management programs that leverage EHR data to identify and mitigate hypoglycemia risk versus standard care. Triggered by establishing hypoglycemia reduction programs, using EHR alerts for glucose trends, or responding to CMS hypoglycemia quality measures.

Recommends continuing insulin pump therapy in hospitals with pump expertise; otherwise transitioning to scheduled subcutaneous basal bolus insulin if anticipated length of stay exceeds 1–2 days before pump discontinuation. Consider this when anticipating a hospital stay >2 days, lacking pump expertise, or needing to conserve supplies.

Recommends long-acting insulin analogs over human NPH insulin for basal therapy in adults and children at high hypoglycemia risk to reduce nocturnal hypoglycemia. Consider when selecting basal insulin for patients with type 1 or type 2 diabetes who have a history of severe hypoglycemia, impaired awareness of hypoglycemia, renal or hepatic impairment, or are aged over 65 years.

Recommends avoiding carbohydrate counting for prandial insulin dosing in adults with noninsulin‑treated type 2 diabetes who require mealtime insulin during noncritical illness hospitalization. Trigger phrases include “initiating prandial insulin in a diet‑ or oral‑agent‑managed type 2 diabetic” and “noninsulin‑treated T2D needing mealtime insulin in the ward.”

Recommends avoiding carbohydrate‑containing oral fluids preoperatively in adults with type 1, type 2, or other diabetes undergoing elective surgery. Consider when a clinician questions preoperative fluids for a diabetic patient, especially if orders include clear liquids or carbohydrate drinks.

Recommends neutral protamine Hagedorn–based or basal bolus insulin regimens for managing hyperglycemia in adults receiving enteral nutrition with diabetes-specific or nonspecific formulations during noncritical illness. Trigger phrases include hyperglycemia noted during enteral nutrition therapy, hyperglycemia on tube feeding, or enteral nutrition–associated hyperglycemia in a patient on PEG or NG tube.

Suggests glycemic management with either NPH-based insulin or basal bolus insulin regimens for adults experiencing hyperglycemia while receiving glucocorticoids in noncritical illness. Triggers include hyperglycemia during glucocorticoid therapy such as prednisone or methylprednisolone.

Suggests targeting preoperative blood glucose concentrations of 100–180 mg/dL when achieving HbA1c <8% is not feasible prior to elective surgery. Use when a clinician faces upcoming surgery with insufficient time to lower HbA1c below 8%.

Recommends targeting preoperative HbA1c <8% and blood glucose 100–180 mg/dL in adults with diabetes undergoing elective surgery. Use when scheduling elective surgery in a diabetic patient or reviewing HbA1c or point-of-care glucose.

The skill recommends using rapid-acting insulin analogs instead of regular human insulin for prandial coverage in basal-bolus regimens for adults and children at high hypoglycemia risk to reduce severe hypoglycemia episodes. Trigger phrases include prandial insulin selection for type 1 or type 2 diabetes patients on basal-bolus therapy with hypoglycemia concerns such as prior severe hypoglycemia, impaired awareness of hypoglycemia, or renal/hepatic dysfunction.

Recommends scheduled insulin therapy over noninsulin agents for glycemic management in most adult hospitalized patients with hyperglycemia (with or without known type 2 diabetes) during noncritical illness. Trigger phrases include new hyperglycemia without prior diabetes, known type 2 diabetes, or inpatient hyperglycemia prompting insulin vs noninsulin agent choice.

Recommends a structured patient education program with follow-up over unstructured advice for insulin-treated adults and children at high hypoglycemia risk (e.g., history of severe hypoglycemia, impaired awareness of hypoglycemia, or renal/hepatic dysfunction) to reduce severe hypoglycemia episodes. Use when planning diabetes education, addressing hypoglycemia fear, or after recurrent hypoglycemia events to guide choice of structured versus unstructured counseling.

In hospitalized adults initially managed with correctional insulin alone, persistent hyperglycemia is defined as two or more point-of-care blood glucose measurements ≥180 mg/dL within a 24‑hour period. When this pattern occurs, clinicians should consider adding scheduled (basal‑bolus or basal‑plus‑correction) insulin therapy to achieve glycemic targets of 100‑180 mg/dL, as triggered by the phrase “Started on correctional insulin alone, now BG ≥180 twice in 24h, add scheduled insulin?”.