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openclaw skills install medsyniq-liteFree medical intelligence for AI assistants. 5 agents, 20 skills. Lite version of MedSynIQ Pro.
openclaw skills install medsyniq-liteFree medical intelligence for AI assistants. 5 agents, 20 skills covering clinical reasoning, pharmacology, evidence-based medicine, biostatistics, and medical education.
DISCLAIMER: All output is AI-generated educational content. It does not constitute medical advice, diagnosis, or treatment. Clinical decisions must be made by qualified healthcare professionals with direct access to the patient.
MedSynIQ Lite includes 5 specialist agents. Each agent activates automatically based on context.
| # | Agent | Domain | Trigger |
|---|---|---|---|
| 1 | clinical-reasoner | Differential diagnosis, Bayesian reasoning, decision rules | Symptoms, cases, diagnostic workup |
| 2 | pharmacologist | Drug interactions, dosing, pharmacokinetics | Medications, prescriptions, drug safety |
| 3 | evidence-appraiser | Critical appraisal, GRADE, evidence synthesis | Study evaluation, guidelines, research quality |
| 4 | biostatistician | Sample size, hypothesis testing, survival analysis | Statistics, study design, power calculations |
| 5 | medical-educator | Teaching cases, learning objectives, curriculum design | Teaching, assessment, clinical training |
Skill 1.1 -- Differential Diagnosis
Generate structured differentials using systematic frameworks.
Frameworks available:
Process:
Cognitive debiasing: Flag anchoring bias, premature closure, availability bias, search satisfying, base rate neglect, and representativeness error. Apply the "rule of three" -- maintain at least three active diagnoses until one is confirmed.
Example -- /differential 65yo male, acute chest pain, diaphoresis, HTN, DM, smoker:
Problem representation: "65-year-old male with multiple cardiovascular risk factors presenting with acute substernal pressure-like chest pain with diaphoresis."
Cannot-miss: ACS (high), aortic dissection (low but must exclude), PE (low) Moderate: Hypertensive emergency, unstable angina Lower: Pericarditis, GERD, musculoskeletal
Next steps: STAT ECG, serial hs-troponin, CXR, HEART score calculation
See: references/clinical-reasoner.md for full frameworks, illness script template, and worked examples.
Skill 1.2 -- Bayesian Reasoning
Apply Bayesian probability updating to diagnostic decisions.
Core calculation:
Likelihood ratio interpretation:
Threshold approach: Test only when the result can shift probability across a decision threshold (test threshold or treatment threshold). If pre-test probability is very low or very high, testing may not change management.
Sequential testing: Post-test probability from test 1 becomes pre-test for test 2. Tests must be conditionally independent (D-dimer then CTPA: valid; CRP then ESR: correlated, invalid).
Skill 1.3 -- Clinical Decision Rules
Apply validated scoring systems to standardize risk stratification.
| Rule | Application | Components |
|---|---|---|
| Wells (PE) | PE pre-test probability | Clinical signs DVT, PE most likely dx, HR>100, immobilization/surgery, prior VTE, hemoptysis, cancer |
| HEART | Chest pain risk stratification | History, ECG, Age, Risk factors, Troponin |
| CURB-65 | Pneumonia severity | Confusion, Urea >7, RR >=30, BP low, Age >=65 |
| CHA2DS2-VASc | Stroke risk in AF | CHF, HTN, Age, DM, Stroke/TIA, Vascular disease, Sex |
| HAS-BLED | Bleeding risk on anticoagulation | HTN, Abnormal renal/liver, Stroke, Bleeding, Labile INR, Elderly, Drugs/alcohol |
| PERC | PE rule-out without testing | Age <50, HR <100, SpO2 >94%, no hemoptysis, no estrogen, no surgery/trauma, no prior VTE, no unilateral leg swelling |
| Ottawa ankle/knee | Need for radiography | Bone tenderness, inability to weight-bear |
| Centor/McIsaac | Strep pharyngitis probability | Tonsillar exudate, tender anterior cervical nodes, fever, absence of cough, age |
Always report: the score, interpretation, and limitations of the rule for the specific patient.
Skill 1.4 -- Illness Scripts
Construct and compare illness scripts for pattern-based reasoning.
Template:
DIAGNOSIS: [Name]
EPIDEMIOLOGY: [Who gets this? Age, sex, risk factors, prevalence]
PATHOPHYSIOLOGY: [Mechanism in 1-2 sentences]
TIME COURSE: [Onset, duration, progression]
CARDINAL FEATURES: [3-5 most characteristic findings]
EXPECTED FINDINGS:
History: [Key symptoms]
Physical exam: [Key signs]
Labs/Imaging: [Expected abnormalities]
COMPLICATIONS: [Major if untreated]
KEY DISTINGUISHING FEATURE: [Single feature separating from mimics]
Use illness scripts to: rapidly match presentations against known disease patterns, identify features that discriminate between competing diagnoses, and teach diagnostic reasoning through compare-and-contrast.
Skill 2.1 -- Drug Interactions
Systematic interaction analysis by mechanism.
Pharmacokinetic interactions (CYP450 system):
Pharmacodynamic interactions:
Severity: Contraindicated > Major > Moderate > Minor.
Example -- /drug-check warfarin, amiodarone, simvastatin, CKD stage 3:
CRITICAL: simvastatin + amiodarone -- CYP3A4 inhibition, rhabdomyolysis risk. Max simvastatin 20mg/day with amiodarone, or switch to pravastatin/rosuvastatin. MAJOR: warfarin + amiodarone -- CYP2C9 inhibition, INR elevation. Reduce warfarin dose 30-50%, monitor INR closely for 6-8 weeks. MODERATE: CKD stage 3 -- verify renal dosing for all agents.
See: references/pharmacologist.md for full CYP tables, TDM targets, and worked polypharmacy example.
Skill 2.2 -- Dose Adjustment
Individualize drug doses for organ impairment, body composition, and age.
Renal: Cockcroft-Gault for drug dosing (most FDA labels reference CrCl). Formula: CrCl = [(140-age) x weight x (0.85 if female)] / (72 x SCr). High-risk drugs: metformin (stop <30 eGFR), DOACs (agent-specific), digoxin, lithium, gabapentin, enoxaparin.
Hepatic: Child-Pugh score (bilirubin, albumin, INR, ascites, encephalopathy). Class A: usually no change. Class B: reduce 25-50%. Class C: avoid hepatically metabolized drugs. High extraction drugs (morphine, propranolol) have dramatically increased oral bioavailability in cirrhosis.
Obesity: IBW (Devine), AdjBW (IBW + 0.4 x excess), TBW. Aminoglycosides: AdjBW. Vancomycin: TBW. LMWH: TBW (cap 150kg). Chemo: actual weight BSA.
Pediatric: Weight-based (mg/kg), never exceeding adult max. Neonates: immature CYP, extended intervals. Ages 2-6: supranormal metabolism, may need higher mg/kg. Geriatric: start low, go slow. Apply Beers criteria and STOPP/START.
Skill 2.3 -- Adverse Drug Reactions
Classify and manage ADRs using the Rawlins-Thompson system.
Always check: Is a new symptom actually an ADR before adding another drug (prescribing cascade)?
Skill 2.4 -- Antimicrobial Stewardship
Optimize antimicrobial use: right drug, right dose, right duration.
Principles:
Skill 3.1 -- Critical Appraisal
Appraise research using CASP checklists matched to study design.
Three fundamental questions:
RCT appraisal: randomization adequate? Allocation concealed? Blinded? Groups similar at baseline? ITT analysis? Follow-up >80%?
Systematic review: PICO defined? Comprehensive search (PubMed + Embase + CENTRAL minimum)? Dual screening? Quality assessed? Heterogeneity evaluated? Publication bias assessed?
Cohort: Exposure measured accurately? Confounders identified? Follow-up complete? Watch for immortal time bias.
Case-control: Cases/controls clearly defined? Recall bias addressed? Confounders controlled?
Diagnostic: Valid reference standard? Applied to all? Spectrum representative? Blinded interpretation?
See: references/evidence-appraiser.md for full CASP checklists and worked DAPA-HF example.
Skill 3.2 -- Evidence Levels
Classify evidence using Oxford CEBM levels and GRADE certainty.
CEBM hierarchy (therapy): 1a (SR of RCTs) > 1b (individual RCT) > 2a-2b (cohort) > 3a-3b (case-control) > 4 (case series) > 5 (expert opinion). Note: optimal design depends on question type (therapy vs diagnosis vs prognosis).
GRADE certainty: High / Moderate / Low / Very Low. RCTs start High, observational starts Low. Downgrade for: risk of bias, inconsistency, indirectness, imprecision, publication bias. Upgrade observational for: large effect (RR >2), dose-response, residual confounding favoring null.
GRADE recommendation: Strong (benefits clearly outweigh risks) vs Conditional (balanced, uncertain, values-dependent). Strong recommendation CAN be based on low-certainty evidence (e.g., parachutes, insulin for T1DM).
Skill 3.3 -- GRADE Assessment
Apply the full GRADE framework to a body of evidence.
Steps:
Output as evidence profile table with each domain rated.
Skill 3.4 -- Quantitative Evidence Synthesis
Calculate and interpret key clinical metrics.
Red flag: A 50% RRR from 0.2% to 0.1% = NNT of 1000. Always demand absolute numbers alongside relative measures.
Skill 4.1 -- Hypothesis Testing
Select and interpret the correct statistical test.
Framework:
| Scenario | Parametric | Non-parametric |
|---|---|---|
| 2 independent groups, continuous | Welch's t-test | Mann-Whitney U |
| 2 paired groups | Paired t-test | Wilcoxon signed-rank |
| 3+ independent groups | One-way ANOVA | Kruskal-Wallis |
| 3+ related groups | Repeated measures ANOVA | Friedman |
| 2 categorical variables | -- | Chi-square / Fisher's exact |
| Correlation | Pearson r | Spearman rho |
| Time-to-event | -- | Log-rank, Cox PH |
P-value: probability of data this extreme given H0 is true. It is NOT the probability that H0 is true. A p=0.04 is not fundamentally different from p=0.06. Always report exact values with CIs and effect sizes.
Skill 4.2 -- Sample Size Calculation
Calculate required sample size for study planning.
Core inputs: alpha (0.05), power (80-90%), effect size (MCID), variability (SD or event rate), dropout rate.
Formulas:
Example -- /sample-size RCT, continuous, delta=5, SD=15, power=90%:
n/group = 2 * (1.96 + 1.28)^2 * 225 / 25 = 189. With 15% dropout: 189 / 0.85 = 223 per group. Total: 446 participants.
Adjustments: unequal allocation, covariate adjustment (multiply by 1-R^2), interim analyses (alpha spending).
Skill 4.3 -- Regression Modeling
Select and validate the right regression model.
Model building: pre-specified clinical models preferred over stepwise selection (inflates Type I error, produces unstable models).
Skill 4.4 -- Survival Analysis
Analyze time-to-event data.
Kaplan-Meier: non-parametric survival curve. Handles right-censoring. Report median survival with 95% CI. Compare groups: log-rank test (optimal when PH holds), Wilcoxon/Breslow (weights early events).
Cox PH: Adjusted hazard ratios. Check PH assumption. When violated: RMST (restricted mean survival time), milestone analysis, weighted log-rank (Fleming-Harrington), landmark analysis.
Competing risks: When another event prevents the outcome of interest (e.g., non-CV death prevents CV death). Use cumulative incidence function (Aalen-Johansen), NOT 1 minus KM. Gray's test for comparison. Fine-Gray model for covariate effects on CIF.
Immortal time bias: In observational studies, misclassifying pre-treatment time as exposed. Fix with landmark analysis or time-varying covariates.
Skill 5.1 -- Teaching Case Design
Build clinical teaching cases that develop reasoning skills.
Structure:
Case complexity levels:
Cognitive integration: Embed cognitive debiasing (anchoring, premature closure, availability) into case design by including misleading cues that test whether learners maintain broad differentials.
Skill 5.2 -- Learning Objectives
Write objectives using Bloom's taxonomy mapped to clinical competence.
| Level | Verb Examples | Clinical Application |
|---|---|---|
| Remember | List, define, name | Recall normal lab values, drug classes |
| Understand | Explain, describe, compare | Describe pathophysiology, compare drug mechanisms |
| Apply | Calculate, demonstrate, use | Calculate CrCl, apply Wells score, use GRADE |
| Analyze | Differentiate, distinguish, examine | Generate differential, identify drug interactions |
| Evaluate | Appraise, justify, critique | Critically appraise an RCT, justify treatment choice |
| Create | Design, construct, develop | Design a study protocol, construct a management plan |
Rules: Each objective should be specific, measurable, achievable, relevant, and time-bound (SMART). Use one active verb per objective. Align objectives with assessment methods.
Skill 5.3 -- Assessment Design
Create valid clinical assessments across formats.
Multiple choice questions (MCQs):
Clinical reasoning assessments:
Written assessments:
Skill 5.4 -- Curriculum Mapping
Design and organize medical curricula using competency frameworks.
Competency domains (derived from CanMEDS, ACGME, GMC):
Spiral curriculum: revisit topics at increasing complexity across training years. Map each session to competency domains and assessment methods. Identify gaps (topics not covered) and redundancies (excessive repetition without progression).
Integration strategies: horizontal (across disciplines within a year) and vertical (across training years). Use case-based learning to integrate basic science with clinical application.
| Command | What It Does | Agent |
|---|---|---|
| /differential [presentation] | Structured DDx with frameworks and probability tiers | clinical-reasoner |
| /drug-check [medications, context] | Drug interaction analysis with severity and management | pharmacologist |
| /evidence [PICO question] | Evidence search and appraisal framework | evidence-appraiser |
| /sample-size [design parameters] | Sample size calculation with formula and adjustments | biostatistician |
| /teach-case [topic, level] | Generate a clinical teaching case | medical-educator |
These findings demand immediate flagging regardless of context:
medsyniq-lite-clawhub/
SKILL.md -- This file (skill definition)
LICENSE -- MIT-0 (ClawHub required)
references/
clinical-reasoner.md -- Full agent: DDx frameworks, illness scripts, Bayesian analysis, worked examples
pharmacologist.md -- Full agent: CYP450 tables, TDM targets, polypharmacy worked example
evidence-appraiser.md -- Full agent: CASP checklists, GRADE methodology, DAPA-HF worked example
biostatistician.md -- Full agent: test selection, formulas, SAP structure, CVOT worked example
medical-educator.md -- Full agent: case design, Bloom's taxonomy, assessment, curriculum mapping
scripts/
disclaimer-check.js -- Ensures medical disclaimer on clinical outputs
interaction-warning.js -- Flags dangerous drug combinations
assets/
skill-map.txt -- Visual map of 5 agents and 20 skills
MedSynIQ Lite covers 5 of the 27 agents and 20 of the 142 skills available in MedSynIQ Pro. The Lite edition focuses on core clinical reasoning, pharmacology, evidence-based medicine, biostatistics, and medical education.
Not included in Lite:
MedSynIQ Lite -- 5 of 27 agents. Full version with 142 skills: medsyniq.com