Search and retrieve clinical practice guidelines from 12+ authoritative sources — NICE, WHO, NCCN, AHA, ADA, SIGN, USPSTF, IDSA, NIH consensus, ESMO/ESC/EASL European societies, and US specialty associations. Use for evidence-graded treatment recommendations, dosing protocols, screening guidance, an

Clinical Guidelines Search & Retrieval Guideline Hierarchy Not all guidelines carry equal weight. Evaluate sources in this order: 1. NICE and WHO — Evidence graded, regularly updated, rigorous systematic review process. NICE guidelines include explicit recommendation strength (e.g., "offer" vs "consider"). 2. Society guidelines (AHA, ADA, NCCN, SIGN) — Expert consensus panels within a specialty. May lag behind the latest evidence by 1 3 years. Strong within their domain but narrower scope. 3. Aggregator databases (GIN, TRIP, OpenAlex) — Index guidelines from multiple societies. Good for breadth and discovery, but you must verify the original source. 4. Literature databases (PubMed, EuropePMC) — Return guideline related publications, not curated guideline text. Useful as a fallback, not a primary source. Always check publication date. A 2015 guideline may be superseded by a 2024 update. When presenting results, include the year prominently and note if newer guidance may exist. COMPUTE, DON'T DESCRIBE When analysis requires computation (statistics, data processing, scoring, enrichment), write and run Python code via Bash. Don't describe what you would do — execute it and report actual results. Use ToolUniverse tools to retrieve data, then Python (pandas, scipy, statsmodels, matplotlib) to analyze it. Search Strategy Step 1: Start Narrow, Then Broaden 1. Search the condition name + "guideline" in NICE, TRIP, and GIN simultaneously (parallel calls). 2. If the question targets a specialty, add the society tool: AHA for cardiology, ADA for diabetes, NCCN for oncology, CPIC for pharmacogenomics. 3. If initial searches return nothing, broaden to the disease category (e.g., "heart failure" instead of "HFpEF with SGLT2 inhibitors"). 4. If society specific tools fail, fall back to PubMed/EuropePMC with [condition] guideline [year] . Step 2: Search at Least 3 Sources Always query a minimum of 3 databases to catch guidelines that one source may miss. Prioritize: NICE GIN TRIP Society specific Literature databases . Step 3: Retrieve Full Text When Available After identifying relevant guidelines from search results, use full text tools to get recommendation details before synthesizing. Diagnostic Test Selection Reasoning When a clinical question asks "which test should be ordered?" or "what is the most appropriate next diagnostic step?", apply this reasoning framework BEFORE searching guidelines. Step 1: What Is the Clinical Question Actually Asking? Diagnostic tests serve different purposes. Identify which one the question demands: Screening : Detect disease in an asymptomatic population. Prioritize SENSITIVITY (minimize false negatives). Example: ANA for SLE screening. Confirmation : Confirm a suspected diagnosis. Prioritize SPECIFICITY (minimize false positives). Example: anti dsDNA or anti Smith for SLE confirmation. Differentiation : Distinguish between two diagnoses that look similar. Choose the test that is POSITIVE in one and NEGATIVE in the other. Example: ASO titers to distinguish PSGN from SLE nephritis (both have low complement and hematuria, but only PSGN has elevated ASO). Staging/Prognosis : Determine disease severity after diagnosis is established. Example: renal biopsy ISN/RPS class for lupus nephritis. Monitoring : Track response to treatment. Example: anti dsDNA titers and complement levels in SLE. Step 2: Match the Test to the Diagnostic Gap Ask: "What piece of information am I MISSING that would change management?" Step 3: Sensitivity vs Specificity Decision Matrix Scenario Prioritize Reasoning Ruling OUT a dangerous condition High sensitivity A negative result reliably excludes the disease Confirming before invasive treatment High specificity A positive result reliably confirms the disease Differentiating two similar conditions Test unique to one Choose marker present in condition A but absent in condition B Emergency with life threatening DDx Fastest available test Speed trumps perfect accuracy in acute settings Step 4: Common Test Selection Pitfalls 1. Ordering a test that is positive in BOTH conditions on the differential — C3/C4 is low in both SLE and PSGN; it does not differentiate. Always ask: "Would this test result change my differential?" 2. Ordering a screening test when a confirmatory test is needed — ANA is sensitive but not specific for SLE. If you already suspect SLE, order anti dsDNA or anti Smith (specific). 3. Skipping the simple test for the exotic one — ASO titers are cheap and fast. Do not jump to renal biopsy before checking whether streptococcal infection explains the presentation. 4. Forgetting temporal context — PSGN complement normalizes in 6 8 weeks; SLE complement stays persistently low. A single complement level is less useful than a trend. 5. Ignoring pre test probability — A test with 95% specificity still has a 50% false positive rate if the pre test probability is only 5%. Consider the clinical picture first. Lab Test Interpretation Strategy Always consider pre test probability before interpreting any result. A positive test in a low prevalence population has a high false positive rate regardless of test accuracy. SnNOut : A highly Se nsitive test, when N egative, rules Out the disease. Use sensitive tests for screening. SpPIn : A highly Sp ecific test, when P ositive, rules In the disease. Use specific tests for confirmation. For conflicting results (e.g., one test positive, another negative): repeat the discordant test, order a different confirmatory test, or re evaluate the clinical picture and pre test probability. Likelihood ratios trump sensitivity/specificity alone. LR+ 10 or LR <0.1 meaningfully shift post test probability. Surgical Decision Making Indications : Determine whether surgery is necessary. Absolute indications (e.g., perforated viscus, acute limb ischemia) require immediate action; relative indications (e.g., symptomatic gallstones) allow shared decision making. Timing : Emergent (within minutes hours, life/limb threat), urgent (within 24 72 hours, deterioration risk), elective (scheduled, optimized pre operatively). Approach : Choose the least invasive option that achieves the therapeutic goal. Laparoscopic before open, endovascular before surgical, unless contraindicated by anatomy or urgency. Applying Guidelines to Patients Guidelines give population level recommendations . When presenting findings: 1. Cite the source explicitly — "Per the 2024 ADA Standards of Care, Section 9..." not "guidelines recommend..." 2. Note patient specific modifiers — Comorbidities, drug interactions, renal/hepatic function, age, pregnancy, and patient preferences may all change the recommendation. 3. Flag when evidence is weak — Grade D / expert consensus recommendations should be presented differently from Grade A / high confidence ones. 4. Identify conflicts between guidelines — When NICE and ADA disagree, present both positions and note the discrepancy. 5. State limitations — If the patient's scenario falls outside the guideline's studied population, say so explicitly. Tool Workflow General Guideline Search (Parallel Calls) Tool Key Parameters Notes NICE Clinical Guidelines Search query , limit (both required) Best general source; returns list directly GIN Guidelines Search query , limit (both required) Best multi society aggregator TRIP Database Guidelines Search query , limit , search type='guidelines' (all required) Must include search type WHO Guidelines Search query , limit Limited topic filtering; may return unrelated WHO docs CMA Guidelines Search query , limit Canadian guidelines SIGN search guidelines query (NOT q ), limit Scottish/UK CTFPHC search guidelines query (NOT q ), limit Canadian prevention OpenAlex Guidelines Search query , limit , optional year from / year to Academic publications EuropePMC Guidelines Search query , limit Loosely relevant; use for discovery PubMed Guidelines Search query , limit , optional api key Literature fallback All general search tools return lists directly — access as result[0]['title'] . Society Specific Tools ADA (Diabetes) ADA list standards sections() — No params. Lists all sections of ADA Standards of Care. ADA search standards(query, limit) — Use broad medical terms, not specific drug names. ADA get standards section(section number) — Returns section abstract only. AHA/ACC (Cardiology) AHA ACC search guidelines(query, limit) — Search AHA/ACC guidelines. AHA list guidelines(limit) / ACC list guidelines(limit) — List recent. AHA ACC get guideline(pmid) — Full text via PMC. NCCN (Oncology) NCCN list patient guidelines(limit) — Field is cancer type , NOT title . NCCN search guidelines(query, limit) — Returns JNCCN abstracts, not proprietary text. NCCN get patient guideline(url) — Pass full URL string, NOT an integer ID. MAGICapp (Living Guidelines) MAGICapp list guidelines(limit) — Returns dict : use r.get('data', []) . Field is name , NOT title . MAGICapp get guideline(guideline id) / MAGICapp get recommendations(guideline id) / MAGICapp get sections(guideline id) NCI — Catalogs research tools/datasets, NOT clinical guidelines. Use q (not query ), size (not limit ). Access: r.get('data',{}).get('results',[]) . Pharmacogenomics (CPIC) All CPIC tools return dict wrapped : use r.get('data', []) . Workflow: 1. CPIC get gene info(genesymbol='CYP2D6') — Gene overview 2. CPIC get gene drug pairs(genesymbol='CYP2D6') — All drugs with CPIC levels (A=strongest) 3. CPIC list guidelines(limit=50) — Find guidelineId for target gene+drug pair 4. CPIC get recommendations(guideline id=N) — Dosing recommendations (deduplicate by phenotype) 5. CPIC get alleles(genesymbol='CYP2D6') — Use clinicalfunctionalstatus (NOT functionalstatus ) Gotchas: CPIC get recommendations takes guideline id (integer), NOT genesymbol CPIC search gene drug pairs requires PostgREST syntax: genesymbol='eq.CYP2D6' Deduplicate recommendations by phenotype before presenting (many duplicate records per allele combo) Full Text Retrieval Source Tool Input NICE NICE Guideline Full Text(url) URL from search results; try .../chapter/Recommendations WHO WHO Guideline Full Text(url) May return PDF link, not full text AHA/ACC AHA ACC get guideline(pmid) PMID from search results NCCN NCCN get patient guideline(url) Full URL from list results Evidence Grading Quick Reference System Strong Moderate Weak/Expert Opinion ADA Grade A Grade B/C Grade E (consensus) AHA/ACC Class I Class IIa/IIb Class III SIGN Strong Conditional Good practice point CPIC Level A Level B Level C/D NICE "Offer" (strong) "Consider" (weaker) Research recommendation Fallback Strategy NICE returns empty try TRIP or GIN ADA returns 0 results broaden terms ( 'pharmacologic approaches' not 'metformin first line' ) WHO returns irrelevant results skip WHO, use GIN or EuropePMC CPIC returns no recommendations present gene drug pairs with CPIC levels as proxy TRIP returns 403/gated PDFs note limited access, try alternative sources Synthesis Template Known Limitations WHO Guidelines Search : Unreliable topic filtering; supplement with GIN for international guidelines. NCI search cancer resources : Research tool catalog, NOT clinical guidelines. NICE Guideline Full Text : Overview page only; sub pages may need direct URL. SIGN : No full text tool; PDFs only. ADA get standards section : Abstract only, not fu

tooluniverse-clinical-guidelines