@erosolaraijs/cure 1.0.0 → 1.0.2

package/dist/bin/cure.js.map

@@ -1 +1 @@
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package/dist/clinician/decisionSupport.d.ts

@@ -0,0 +1,325 @@
+/**
+ * Clinician Decision Support System
+ *
+ * Provides clinical decision support features:
+ * - Treatment recommendations with explanations
+ * - Override management and documentation
+ * - Tumor board integration
+ * - Evidence summaries
+ * - Risk-benefit visualization
+ * - Alert acknowledgment workflows
+ *
+ * Designed to augment (not replace) clinical judgment.
+ */
+import { EventEmitter } from 'events';
+export interface ClinicalRecommendation {
+    id: string;
+    patientId: string;
+    generatedAt: Date;
+    validUntil: Date;
+    primaryRecommendation: {
+        regimen: string;
+        drugs: {
+            name: string;
+            dose: string;
+            schedule: string;
+            route: string;
+        }[];
+        setting: 'neoadjuvant' | 'adjuvant' | 'first-line' | 'second-line' | 'third-line-plus' | 'maintenance';
+        confidenceScore: number;
+    };
+    alternativeOptions: {
+        regimen: string;
+        drugs: string[];
+        confidenceScore: number;
+        comparisonToPrimary: string;
+    }[];
+    supportingEvidence: {
+        type: 'clinical-trial' | 'guideline' | 'real-world' | 'expert-consensus';
+        source: string;
+        description: string;
+        strength: 'strong' | 'moderate' | 'limited';
+        url?: string;
+    }[];
+    biomarkerRationale: {
+        biomarker: string;
+        status: string;
+        impact: string;
+        evidenceLevel: string;
+    }[];
+    predictions: {
+        responseRate: {
+            value: number;
+            ci95: [number, number];
+        };
+        medianPFS: {
+            value: number;
+            ci95: [number, number];
+            unit: 'months';
+        };
+        medianOS: {
+            value: number;
+            ci95: [number, number];
+            unit: 'months';
+        };
+        grade3PlusToxicity: {
+            value: number;
+            topRisks: string[];
+        };
+        qualityOfLife: {
+            score: number;
+            considerations: string[];
+        };
+    };
+    clinicalConsiderations: {
+        category: 'efficacy' | 'safety' | 'practical' | 'cost';
+        consideration: string;
+        importance: 'critical' | 'important' | 'notable';
+    }[];
+    monitoringPlan: {
+        item: string;
+        frequency: string;
+        rationale: string;
+    }[];
+    clinicalTrialOptions?: {
+        nctId: string;
+        title: string;
+        phase: string;
+        matchingBiomarkers: string[];
+        distance?: number;
+    }[];
+    status: 'active' | 'accepted' | 'modified' | 'rejected' | 'expired';
+    reviewedBy?: string;
+    reviewedAt?: Date;
+}
+export interface ClinicianOverride {
+    id: string;
+    recommendationId: string;
+    patientId: string;
+    clinicianId: string;
+    clinicianName: string;
+    clinicianRole: string;
+    timestamp: Date;
+    overrideType: 'full' | 'partial' | 'modification';
+    originalRecommendation: {
+        regimen: string;
+        drugs: string[];
+    };
+    selectedTreatment: {
+        regimen: string;
+        drugs: string[];
+        doses?: string[];
+    };
+    reason: {
+        category: OverrideCategory;
+        freeText: string;
+        clinicalJustification: string;
+    };
+    riskAcknowledgment?: {
+        acknowledgedRisks: string[];
+        mitigationPlan?: string;
+        signature: string;
+        timestamp: Date;
+    };
+    supervisorApproval?: {
+        required: boolean;
+        supervisorId?: string;
+        supervisorName?: string;
+        approved?: boolean;
+        approvalTimestamp?: Date;
+        comments?: string;
+    };
+    auditStatus: 'pending-review' | 'reviewed' | 'flagged';
+}
+export type OverrideCategory = 'patient-preference' | 'comorbidity' | 'prior-treatment' | 'access-availability' | 'clinical-trial' | 'contraindication' | 'organ-function' | 'performance-status' | 'cost-coverage' | 'clinical-judgment' | 'other';
+export interface TumorBoardCase {
+    id: string;
+    patientId: string;
+    scheduledDate: Date;
+    status: 'scheduled' | 'presented' | 'completed' | 'deferred';
+    presenter: {
+        id: string;
+        name: string;
+        role: string;
+        department: string;
+    };
+    attendees: {
+        id: string;
+        name: string;
+        specialty: string;
+        present: boolean;
+    }[];
+    caseSummary: {
+        diagnosis: string;
+        stage: string;
+        relevantHistory: string;
+        currentStatus: string;
+        questionForBoard: string;
+    };
+    systemRecommendation?: ClinicalRecommendation;
+    boardDecision?: {
+        recommendation: string;
+        rationale: string;
+        votingResult?: {
+            agree: number;
+            disagree: number;
+            abstain: number;
+        };
+        dissenting_opinions?: string[];
+        followUpPlan: string;
+        recordedBy: string;
+        timestamp: Date;
+    };
+    actions?: {
+        action: string;
+        assignedTo: string;
+        dueDate?: Date;
+        completed: boolean;
+    }[];
+}
+export interface AlertAcknowledgment {
+    alertId: string;
+    alertType: string;
+    severity: 'critical' | 'high' | 'moderate' | 'low';
+    acknowledgedBy: string;
+    acknowledgedAt: Date;
+    action: 'proceed' | 'modify' | 'cancel' | 'defer';
+    reason?: string;
+    signature: string;
+}
+export declare class ClinicalDecisionSupportService extends EventEmitter {
+    private recommendations;
+    private overrides;
+    private tumorBoardCases;
+    private alertAcknowledgments;
+    constructor();
+    /**
+     * Generate a clinical recommendation
+     */
+    generateRecommendation(params: {
+        patientId: string;
+        cancerType: string;
+        stage: string;
+        biomarkers: {
+            name: string;
+            value: string | number;
+            status?: string;
+        }[];
+        genomicAlterations: {
+            gene: string;
+            alteration: string;
+        }[];
+        priorTherapies?: string[];
+        performanceStatus?: number;
+        comorbidities?: string[];
+        patientPreferences?: string[];
+    }): Promise<ClinicalRecommendation>;
+    /**
+     * Get recommendation by ID
+     */
+    getRecommendation(recommendationId: string): ClinicalRecommendation | undefined;
+    /**
+     * Get recommendations for a patient
+     */
+    getPatientRecommendations(patientId: string): ClinicalRecommendation[];
+    /**
+     * Accept a recommendation
+     */
+    acceptRecommendation(recommendationId: string, clinicianId: string, clinicianName: string): Promise<void>;
+    /**
+     * Record an override
+     */
+    recordOverride(override: Omit<ClinicianOverride, 'id' | 'timestamp' | 'auditStatus'>): Promise<string>;
+    /**
+     * Check if supervisor approval is required
+     */
+    private requiresSupervisorApproval;
+    /**
+     * Approve an override
+     */
+    approveOverride(overrideId: string, supervisorId: string, supervisorName: string, approved: boolean, comments?: string): Promise<void>;
+    /**
+     * Get overrides for a patient
+     */
+    getPatientOverrides(patientId: string): ClinicianOverride[];
+    /**
+     * Get pending approvals for a supervisor
+     */
+    getPendingApprovals(): ClinicianOverride[];
+    /**
+     * Create a tumor board case
+     */
+    createTumorBoardCase(caseData: Omit<TumorBoardCase, 'id' | 'status' | 'boardDecision' | 'actions'>): Promise<string>;
+    /**
+     * Record tumor board decision
+     */
+    recordTumorBoardDecision(caseId: string, decision: TumorBoardCase['boardDecision']): Promise<void>;
+    /**
+     * Acknowledge an alert
+     */
+    acknowledgeAlert(acknowledgment: Omit<AlertAcknowledgment, 'acknowledgedAt'>): Promise<void>;
+    /**
+     * Generate explanation for a recommendation
+     */
+    generateExplanation(recommendation: ClinicalRecommendation): {
+        summary: string;
+        detailedRationale: string[];
+        keyFactors: {
+            factor: string;
+            impact: 'positive' | 'negative' | 'neutral';
+            weight: number;
+        }[];
+        uncertainties: string[];
+        alternativeConsiderations: string[];
+    };
+    /**
+     * Generate risk-benefit analysis
+     */
+    generateRiskBenefitAnalysis(recommendation: ClinicalRecommendation): {
+        benefits: {
+            benefit: string;
+            magnitude: 'high' | 'moderate' | 'low';
+            confidence: number;
+        }[];
+        risks: {
+            risk: string;
+            probability: number;
+            severity: 'severe' | 'moderate' | 'mild';
+            manageable: boolean;
+        }[];
+        overallAssessment: string;
+        numberNeededToTreat?: number;
+        numberNeededToHarm?: number;
+    };
+    private determinePrimaryRecommendation;
+    private determineAlternatives;
+    private gatherEvidence;
+    private generateBiomarkerRationale;
+    private getBiomarkerImpact;
+    private getBiomarkerEvidenceLevel;
+    private generatePredictions;
+    private identifyConsiderations;
+    private generateMonitoringPlan;
+    private determineImpact;
+    private determineWeight;
+    private generateOverallAssessment;
+    /**
+     * Export decision data for quality review
+     */
+    exportDecisionData(startDate: Date, endDate: Date): {
+        recommendations: ClinicalRecommendation[];
+        overrides: ClinicianOverride[];
+        tumorBoardCases: TumorBoardCase[];
+        summary: {
+            totalRecommendations: number;
+            acceptanceRate: number;
+            overrideRate: number;
+            commonOverrideReasons: {
+                reason: OverrideCategory;
+                count: number;
+            }[];
+        };
+    };
+}
+export default ClinicalDecisionSupportService;
+//# sourceMappingURL=decisionSupport.d.ts.map

package/dist/clinician/decisionSupport.d.ts.map

@@ -0,0 +1 @@
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