Results for “adr”

Designs system architecture, selects technology stack, creates ERDs and sequence diagrams, and records ADRs from BA artifacts, declaring a design freeze gate.

Determines when adrenal venous sampling may be skipped in primary aldosteronism. Applies to patients <35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions suggestive of cortical adenoma on CT.

Recommends using the lowest tolerable hydrocortisone dose to potentially decrease risks of metabolic and cardiovascular disease in central adrenal insufficiency. Triggers include managing a patient with central adrenal insufficiency requiring glucocorticoid replacement.

Recommends administering stress-dose glucocorticoids before surgery and tapering after surgery in patients with adrenal insufficiency before repeat testing. Triggers include preoperative planning for surgery in a patient with known or suspected adrenal insufficiency.

Detects drift between declared reality (docs, manifests, inventories, ADRs) and actual reality (filesystem, git state, dependencies, hooks) on session start, reporting findings with severity and evidence.

Recommend continuing glucocorticoid replacement until hypothalamic-pituitary-adrenal (HPA) axis recovery after surgical resection of ACTH-secreting pituitary tumors. Use when managing postoperative patients following ACTH-secreting tumor surgery to prevent adrenal insufficiency during HPA axis recovery.

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

Helps distinguish unilateral from bilateral adrenal disease based on 18-oxocortisol levels, which are typically higher in aldosterone-producing adenoma than idiopathic adrenal hyperplasia. Use when evaluating 18-oxocortisol results during PA workup to guide subtype classification after a positive ARR.

Teaches AI patients about stress-dosing and emergency glucocorticoid administration; instructs to obtain emergency card/bracelet/necklace and kit with injectable high-dose GC. Triggers when counseling any patient with adrenal insufficiency (e.g., "Use when counseling patient with adrenal insufficiency...").

Suggests testing HPA axis functionality before and after starting GH replacement in patients not receiving glucocorticoid replacement with apparently normal pituitary-adrenal function. Triggers include initiating GH replacement in a GHD patient who is not on glucocorticoids and has normal adrenal function.

Builds and validates Russian Obsidian repository wikis, architecture docs, and code/docs/ADR drift reports.

Determines whether to recommend unilateral laparoscopic adrenalectomy or medical therapy with a mineralocorticoid receptor antagonist for patients with confirmed unilateral PA (aldosterone-producing adenoma or unilateral adrenal hyperplasia). Triggered when discussing treatment options after confirming unilateral PA in a hypertensive patient with hypokalemia or resistant hypertension.

Identifies patients with normokalemia and no adrenal tumors on CT who likely have bilateral PA and may proceed directly to medical therapy without AVS. Triggers include when a clinician notes normokalemia and clean adrenal CT and asks 'Is AVS necessary if I suspect bilateral disease?'

Identifies patients with adrenal tumors on CT who should undergo dexamethasone suppression test to evaluate for autonomous cortisol co-secretion. Triggers include when a clinician finds an adrenal tumor on CT and asks 'Should I test for cortisol co-secretion?' or is planning AVS for a tumor >3.0 cm.

Write, review, and maintain architecture decision records with clear context, alternatives, consequences, and lifecycle governance. Use when a consequential technical decision must remain understandable.

Convierte especificaciones aprobadas en un plan técnico detallado, documentando decisiones de arquitectura, flujo de datos y cambios de archivos.

Opens a browser for login and captures an authentication token for AEM Edge Delivery Services admin APIs.

Determines whether to perform adrenal venous sampling (AVS) to lateralize aldosterone excess in patients with confirmed primary aldosteronism (PA) who are being evaluated for surgical treatment. Indicated when surgery is feasible and desired by the patient, or when subtype workup is planned for a surgical candidate, especially in those younger than 35 years with spontaneous hypokalemia, marked aldosterone excess, and unilateral adrenal lesions on CT.

Manage your Radarr (movies) and Sonarr (TV series) media library from the terminal. Search and browse movies/series, add new content, check calendars, view queue and download history, inspect quality profiles, and trigger searches. Use when the user mentions Radarr, Sonarr, the *arr stack, adding a movie or series, checking the library, finding something to watch, what's in the queue, download history, upcoming releases, media server setup, or movie/TV automation.

Finds the open GitHub PR for the current branch and helps address review comments using the gh CLI.

Creates an Architecture Decision Record following the Nygard format to document significant technical decisions, their context, and consequences. Use when making technical choices that affect system architecture, technology selection, or development patterns.

Implements real-time pub/sub messaging with Ably's edge infrastructure, covering presence, message history, and token authentication.

Record a decision: finalized → ADR (optionally rule + guide or spec + plan); open proposal → RFC. Use for 'we decided', 'record this decision', 'make it a standard', 'draft an RFC', 'should we switch to Y'. Not for feature planning or documenting existing code.

Provides technical leadership frameworks for architecture decisions, engineering team scaling, technology strategy, and technical debt assessment.

Recommends hydrocortisone replacement dosing of 15–20 mg total daily, administered as a single dose or divided doses with the highest dose given in the morning upon awakening and the second dose in the afternoon (two-dose regimen) or second and third doses at lunch and late afternoon (three-dose regimen). Use when initiating glucocorticoid replacement for adrenal insufficiency; triggers include diagnosing adrenal insufficiency requiring glucocorticoid replacement.

Police the project's vocabulary — bust vague terms, keep the CONTEXT.md glossary sharp, and lock in decisions worth remembering as ADRs. Use when the user debates naming, says "what should we call this", asks to pin down terminology, wants a decision recorded, or when another skill (hot-seat, whiteboard) surfaces a decision that clears the ADR bar. Just reading the glossary for vocabulary is NOT this skill — trigger only when the words or decisions are being changed.

Evaluates central hypothyroidism (CH) patients for adrenal insufficiency (AI) prior to initiating levothyroxine (L‑T4) replacement. Triggers include consideration of L‑T4 start in central hypothyroidism needing thyroid replacement.

Record decisions with rationale, alternatives, and consequences — the ADR pattern as a primitive. Use when a consequential choice is made — architecture, tooling, process, scope, trade-off. Capture WHY, not just WHAT.

Extrai conhecimento de negócio implícito do projeto legado — regras de negócio, ADRs retroativos via Git, máquinas de estado e matriz de permissões. Use na fase de interpretação de uma análise de engenharia reversa.

Finds architectural friction in a codebase and proposes deep-module refactors to improve testability and AI-navigability, informed by the domain glossary and ADRs.