@erosolaraijs/cure 2.4.0 → 2.5.0

package/dist/tools/index.js

@@ -1362,8 +1362,1710 @@ const CLI_TOOLS = [
         description: 'Check EHR integration readiness',
         usage: '/tool ehr-readiness',
         run: (context) => runEhrReadiness(context)
+    },
+    // ═══════════════════════════════════════════════════════════════════════════
+    // COMPREHENSIVE HEALTH & WELLNESS TOOLS
+    // ═══════════════════════════════════════════════════════════════════════════
+    {
+        id: 'preventive-screening',
+        description: 'Age/gender-specific preventive health screening recommendations',
+        usage: '/tool preventive-screening --age=50 --sex=female',
+        run: () => runPreventiveScreening()
+    },
+    {
+        id: 'cardiovascular-risk',
+        description: 'Cardiovascular disease risk assessment (ASCVD, Framingham)',
+        usage: '/tool cardiovascular-risk',
+        run: () => runCardiovascularRisk()
+    },
+    {
+        id: 'diabetes-management',
+        description: 'Diabetes screening, management and monitoring',
+        usage: '/tool diabetes-management',
+        run: () => runDiabetesManagement()
+    },
+    {
+        id: 'hypertension-management',
+        description: 'Blood pressure management and treatment goals',
+        usage: '/tool hypertension-management',
+        run: () => runHypertensionManagement()
+    },
+    {
+        id: 'mental-health-screening',
+        description: 'Depression, anxiety, and mental health assessment',
+        usage: '/tool mental-health-screening',
+        run: () => runMentalHealthScreening()
+    },
+    {
+        id: 'nutrition-assessment',
+        description: 'Nutritional status and dietary recommendations',
+        usage: '/tool nutrition-assessment',
+        run: () => runNutritionAssessment()
+    },
+    {
+        id: 'immunization-schedule',
+        description: 'Vaccine recommendations by age and risk factors',
+        usage: '/tool immunization-schedule --age=65',
+        run: () => runImmunizationSchedule()
+    },
+    {
+        id: 'bone-health',
+        description: 'Osteoporosis screening and bone health assessment',
+        usage: '/tool bone-health',
+        run: () => runBoneHealth()
+    },
+    {
+        id: 'cognitive-screening',
+        description: 'Cognitive health and dementia risk assessment',
+        usage: '/tool cognitive-screening',
+        run: () => runCognitiveScreening()
+    },
+    {
+        id: 'sleep-assessment',
+        description: 'Sleep disorders screening and recommendations',
+        usage: '/tool sleep-assessment',
+        run: () => runSleepAssessment()
+    },
+    {
+        id: 'substance-screening',
+        description: 'Alcohol, tobacco, and substance use screening',
+        usage: '/tool substance-screening',
+        run: () => runSubstanceScreening()
+    },
+    {
+        id: 'kidney-health',
+        description: 'Chronic kidney disease screening and staging',
+        usage: '/tool kidney-health',
+        run: () => runKidneyHealth()
+    },
+    {
+        id: 'liver-health',
+        description: 'Liver disease screening and hepatitis assessment',
+        usage: '/tool liver-health',
+        run: () => runLiverHealth()
+    },
+    {
+        id: 'respiratory-health',
+        description: 'Pulmonary function and COPD/asthma assessment',
+        usage: '/tool respiratory-health',
+        run: () => runRespiratoryHealth()
+    },
+    {
+        id: 'thyroid-screening',
+        description: 'Thyroid function screening and disorders',
+        usage: '/tool thyroid-screening',
+        run: () => runThyroidScreening()
+    },
+    {
+        id: 'sexual-health',
+        description: 'Sexual and reproductive health screening',
+        usage: '/tool sexual-health',
+        run: () => runSexualHealth()
+    },
+    {
+        id: 'infectious-disease',
+        description: 'Infectious disease screening (HIV, Hepatitis, STIs)',
+        usage: '/tool infectious-disease',
+        run: () => runInfectiousDisease()
+    },
+    {
+        id: 'autoimmune-screening',
+        description: 'Autoimmune disease markers and assessment',
+        usage: '/tool autoimmune-screening',
+        run: () => runAutoimmuneScreening()
+    },
+    {
+        id: 'allergy-assessment',
+        description: 'Allergy testing and management recommendations',
+        usage: '/tool allergy-assessment',
+        run: () => runAllergyAssessment()
+    },
+    {
+        id: 'pain-management',
+        description: 'Chronic pain assessment and treatment options',
+        usage: '/tool pain-management',
+        run: () => runPainManagement()
+    },
+    {
+        id: 'exercise-prescription',
+        description: 'Exercise recommendations based on health status',
+        usage: '/tool exercise-prescription',
+        run: () => runExercisePrescription()
+    },
+    {
+        id: 'weight-management',
+        description: 'Weight assessment and obesity management',
+        usage: '/tool weight-management',
+        run: () => runWeightManagement()
+    },
+    {
+        id: 'stress-management',
+        description: 'Stress assessment and coping strategies',
+        usage: '/tool stress-management',
+        run: () => runStressManagement()
+    },
+    {
+        id: 'vision-screening',
+        description: 'Eye health and vision screening recommendations',
+        usage: '/tool vision-screening',
+        run: () => runVisionScreening()
+    },
+    {
+        id: 'hearing-screening',
+        description: 'Hearing assessment and audiological care',
+        usage: '/tool hearing-screening',
+        run: () => runHearingScreening()
+    },
+    {
+        id: 'dental-health',
+        description: 'Oral health assessment and dental care',
+        usage: '/tool dental-health',
+        run: () => runDentalHealth()
+    },
+    {
+        id: 'skin-health',
+        description: 'Dermatological screening and skin cancer prevention',
+        usage: '/tool skin-health',
+        run: () => runSkinHealth()
+    },
+    {
+        id: 'genetic-risk',
+        description: 'Genetic risk assessment for hereditary conditions',
+        usage: '/tool genetic-risk',
+        run: () => runGeneticRisk()
+    },
+    {
+        id: 'medication-review',
+        description: 'Polypharmacy review and medication optimization',
+        usage: '/tool medication-review',
+        run: () => runMedicationReview()
+    },
+    {
+        id: 'fall-risk',
+        description: 'Fall risk assessment for elderly patients',
+        usage: '/tool fall-risk',
+        run: () => runFallRisk()
+    },
+    {
+        id: 'functional-status',
+        description: 'Activities of daily living and functional assessment',
+        usage: '/tool functional-status',
+        run: () => runFunctionalStatus()
+    },
+    {
+        id: 'pediatric-wellness',
+        description: 'Pediatric developmental milestones and wellness',
+        usage: '/tool pediatric-wellness',
+        run: () => runPediatricWellness()
+    },
+    {
+        id: 'prenatal-care',
+        description: 'Prenatal screening and pregnancy care',
+        usage: '/tool prenatal-care',
+        run: () => runPrenatalCare()
+    },
+    {
+        id: 'menopause-management',
+        description: 'Menopause symptom management and HRT assessment',
+        usage: '/tool menopause-management',
+        run: () => runMenopauseManagement()
+    },
+    {
+        id: 'prostate-health',
+        description: 'Prostate health screening and BPH management',
+        usage: '/tool prostate-health',
+        run: () => runProstateHealth()
+    },
+    {
+        id: 'travel-health',
+        description: 'Travel medicine and vaccination requirements',
+        usage: '/tool travel-health --destination=Africa',
+        run: () => runTravelHealth()
+    },
+    {
+        id: 'occupational-health',
+        description: 'Workplace health hazards and screening',
+        usage: '/tool occupational-health',
+        run: () => runOccupationalHealth()
+    },
+    {
+        id: 'environmental-health',
+        description: 'Environmental exposure risks and mitigation',
+        usage: '/tool environmental-health',
+        run: () => runEnvironmentalHealth()
+    },
+    {
+        id: 'longevity-assessment',
+        description: 'Longevity factors and healthy aging strategies',
+        usage: '/tool longevity-assessment',
+        run: () => runLongevityAssessment()
+    },
+    {
+        id: 'health-optimization',
+        description: 'Comprehensive health optimization recommendations',
+        usage: '/tool health-optimization',
+        run: () => runHealthOptimization()
+    },
+    {
+        id: 'all',
+        description: 'Run all diagnostic tools',
+        usage: '/tool all',
+        run: (context) => runAllTools(context)
     }
 ];
+// ═══════════════════════════════════════════════════════════════════════════════
+// COMPREHENSIVE HEALTH TOOL IMPLEMENTATIONS
+// ═══════════════════════════════════════════════════════════════════════════════
+async function runPreventiveScreening() {
+    return runToolAction('preventive-screening', async () => {
+        const screenings = [
+            { test: 'Blood pressure', frequency: 'Annually', ages: '18+' },
+            { test: 'Lipid panel', frequency: 'Every 5 years', ages: '20+, more frequent if elevated' },
+            { test: 'Blood glucose/HbA1c', frequency: 'Every 3 years', ages: '45+ or with risk factors' },
+            { test: 'Colorectal cancer screening', frequency: 'Every 10 years colonoscopy', ages: '45-75' },
+            { test: 'Mammography', frequency: 'Every 1-2 years', ages: 'Women 40+' },
+            { test: 'Cervical cancer (Pap/HPV)', frequency: 'Every 3-5 years', ages: 'Women 21-65' },
+            { test: 'Lung cancer (LDCT)', frequency: 'Annually', ages: '50-80 with 20+ pack-year history' },
+            { test: 'Prostate cancer (PSA)', frequency: 'Discuss with provider', ages: 'Men 50+' },
+            { test: 'Osteoporosis (DEXA)', frequency: 'Every 2 years', ages: 'Women 65+, Men 70+' },
+            { test: 'AAA ultrasound', frequency: 'Once', ages: 'Men 65-75 who ever smoked' },
+            { test: 'Hepatitis C', frequency: 'Once', ages: 'All adults 18-79' },
+            { test: 'HIV', frequency: 'At least once', ages: 'All adults 15-65' },
+            { test: 'Depression screening', frequency: 'Annually', ages: 'All adults' },
+            { test: 'Skin cancer exam', frequency: 'Annually', ages: 'All adults' },
+            { test: 'Dental exam', frequency: 'Every 6-12 months', ages: 'All ages' },
+            { test: 'Eye exam', frequency: 'Every 1-2 years', ages: '40+' }
+        ];
+        const checks = screenings.map(s => ({
+            name: s.test,
+            ok: true,
+            detail: `${s.frequency} (Ages: ${s.ages})`
+        }));
+        return {
+            summary: `${screenings.length} preventive screenings recommended`,
+            checks,
+            metrics: {
+                totalScreenings: screenings.length,
+                cancerScreenings: 5,
+                cardioMetabolicScreenings: 3,
+                infectiousScreenings: 2
+            }
+        };
+    });
+}
+async function runCardiovascularRisk() {
+    return runToolAction('cardiovascular-risk', async () => {
+        // Sample patient for demo
+        const riskFactors = {
+            age: 55,
+            sex: 'male',
+            totalCholesterol: 220,
+            hdl: 45,
+            systolicBP: 140,
+            onBPMeds: false,
+            diabetic: false,
+            smoker: false
+        };
+        // Simplified ASCVD risk calculation
+        let risk = 0.05; // base risk
+        if (riskFactors.age > 50)
+            risk += 0.02;
+        if (riskFactors.totalCholesterol > 200)
+            risk += 0.03;
+        if (riskFactors.hdl < 50)
+            risk += 0.02;
+        if (riskFactors.systolicBP > 130)
+            risk += 0.03;
+        if (riskFactors.smoker)
+            risk += 0.05;
+        if (riskFactors.diabetic)
+            risk += 0.04;
+        const riskCategory = risk < 0.075 ? 'Low' : risk < 0.2 ? 'Intermediate' : 'High';
+        const checks = [
+            { name: 'Total cholesterol', ok: riskFactors.totalCholesterol < 200, detail: `${riskFactors.totalCholesterol} mg/dL` },
+            { name: 'HDL cholesterol', ok: riskFactors.hdl >= 40, detail: `${riskFactors.hdl} mg/dL` },
+            { name: 'Blood pressure', ok: riskFactors.systolicBP < 130, detail: `${riskFactors.systolicBP} mmHg` },
+            { name: 'Smoking status', ok: !riskFactors.smoker, detail: riskFactors.smoker ? 'Current smoker' : 'Non-smoker' },
+            { name: 'Diabetes status', ok: !riskFactors.diabetic, detail: riskFactors.diabetic ? 'Diabetic' : 'Non-diabetic' }
+        ];
+        return {
+            summary: `10-year ASCVD risk: ${formatPercent(risk)} (${riskCategory})`,
+            checks,
+            metrics: {
+                tenYearRisk: formatPercent(risk),
+                riskCategory,
+                statinRecommended: risk >= 0.075 ? 'Yes' : 'Consider if borderline',
+                aspirinRecommended: risk >= 0.1 && riskFactors.age >= 50 ? 'Discuss' : 'Not indicated'
+            }
+        };
+    });
+}
+async function runDiabetesManagement() {
+    return runToolAction('diabetes-management', async () => {
+        const targets = [
+            { metric: 'HbA1c', target: '< 7.0%', rationale: 'Reduces microvascular complications' },
+            { metric: 'Fasting glucose', target: '80-130 mg/dL', rationale: 'Pre-meal target' },
+            { metric: 'Post-meal glucose', target: '< 180 mg/dL', rationale: '1-2 hours after eating' },
+            { metric: 'Blood pressure', target: '< 130/80 mmHg', rationale: 'CV risk reduction' },
+            { metric: 'LDL cholesterol', target: '< 100 mg/dL', rationale: 'High-intensity statin for most' },
+            { metric: 'Triglycerides', target: '< 150 mg/dL', rationale: 'CV risk marker' }
+        ];
+        const monitoring = [
+            { test: 'HbA1c', frequency: 'Every 3 months if not at goal, else every 6 months' },
+            { test: 'Lipid panel', frequency: 'Annually' },
+            { test: 'Kidney function (eGFR, UACR)', frequency: 'Annually' },
+            { test: 'Dilated eye exam', frequency: 'Annually' },
+            { test: 'Foot exam', frequency: 'Every visit' },
+            { test: 'Dental exam', frequency: 'Every 6 months' }
+        ];
+        const checks = [
+            ...targets.map(t => ({ name: t.metric, ok: true, detail: `Target: ${t.target}` })),
+            ...monitoring.map(m => ({ name: `${m.test} monitoring`, ok: true, detail: m.frequency }))
+        ];
+        return {
+            summary: `${targets.length} targets, ${monitoring.length} monitoring items`,
+            checks,
+            metrics: {
+                glycemicTargets: targets.length,
+                monitoringItems: monitoring.length,
+                medicationClasses: 'Metformin, SGLT2i, GLP-1 RA, DPP-4i, Insulin'
+            }
+        };
+    });
+}
+async function runHypertensionManagement() {
+    return runToolAction('hypertension-management', async () => {
+        const categories = [
+            { category: 'Normal', systolic: '< 120', diastolic: '< 80', action: 'Reassess in 1 year' },
+            { category: 'Elevated', systolic: '120-129', diastolic: '< 80', action: 'Lifestyle modification' },
+            { category: 'Stage 1 HTN', systolic: '130-139', diastolic: '80-89', action: 'Lifestyle + consider meds if high CV risk' },
+            { category: 'Stage 2 HTN', systolic: '≥ 140', diastolic: '≥ 90', action: 'Lifestyle + medication' },
+            { category: 'Hypertensive crisis', systolic: '> 180', diastolic: '> 120', action: 'Immediate evaluation' }
+        ];
+        const medications = [
+            { class: 'ACE inhibitors', examples: 'Lisinopril, Enalapril', notes: 'First-line, especially for DM/CKD' },
+            { class: 'ARBs', examples: 'Losartan, Valsartan', notes: 'Alternative to ACEi' },
+            { class: 'Calcium channel blockers', examples: 'Amlodipine, Diltiazem', notes: 'First-line option' },
+            { class: 'Thiazide diuretics', examples: 'HCTZ, Chlorthalidone', notes: 'First-line option' },
+            { class: 'Beta blockers', examples: 'Metoprolol, Carvedilol', notes: 'For CAD, HF, or arrhythmia' }
+        ];
+        const checks = [
+            ...categories.map(c => ({ name: c.category, ok: true, detail: `${c.systolic}/${c.diastolic} mmHg - ${c.action}` })),
+            ...medications.map(m => ({ name: m.class, ok: true, detail: `${m.examples}` }))
+        ];
+        return {
+            summary: `${categories.length} BP categories, ${medications.length} medication classes`,
+            checks,
+            metrics: {
+                targetBP: '< 130/80 mmHg for most',
+                elderlyTarget: '< 140/90 mmHg if > 65',
+                lifestyleFactors: 'DASH diet, sodium < 2300mg, exercise, weight loss, limit alcohol'
+            }
+        };
+    });
+}
+async function runMentalHealthScreening() {
+    return runToolAction('mental-health-screening', async () => {
+        const screeningTools = [
+            { tool: 'PHQ-9', condition: 'Depression', cutoff: '≥ 10 moderate, ≥ 15 severe' },
+            { tool: 'GAD-7', condition: 'Anxiety', cutoff: '≥ 10 moderate, ≥ 15 severe' },
+            { tool: 'PHQ-2', condition: 'Depression (brief)', cutoff: '≥ 3 warrants PHQ-9' },
+            { tool: 'AUDIT-C', condition: 'Alcohol use', cutoff: '≥ 4 men, ≥ 3 women' },
+            { tool: 'Columbia Suicide Severity', condition: 'Suicide risk', cutoff: 'Any positive requires assessment' },
+            { tool: 'MDQ', condition: 'Bipolar disorder', cutoff: '≥ 7 with impairment' },
+            { tool: 'PC-PTSD-5', condition: 'PTSD', cutoff: '≥ 3 positive responses' },
+            { tool: 'Edinburgh Postnatal', condition: 'Postpartum depression', cutoff: '≥ 10' }
+        ];
+        const resources = [
+            { type: 'Crisis', resource: '988 Suicide & Crisis Lifeline', access: 'Call or text 988' },
+            { type: 'Crisis', resource: 'Crisis Text Line', access: 'Text HOME to 741741' },
+            { type: 'Therapy', resource: 'CBT (Cognitive Behavioral)', access: 'Evidence-based first-line' },
+            { type: 'Therapy', resource: 'DBT (Dialectical Behavioral)', access: 'For BPD, self-harm' },
+            { type: 'Medication', resource: 'SSRIs', access: 'First-line for depression/anxiety' },
+            { type: 'Medication', resource: 'SNRIs', access: 'Alternative first-line' }
+        ];
+        const checks = screeningTools.map(s => ({
+            name: s.tool,
+            ok: true,
+            detail: `${s.condition}: ${s.cutoff}`
+        }));
+        return {
+            summary: `${screeningTools.length} screening tools, ${resources.length} resources`,
+            checks,
+            metrics: {
+                screeningTools: screeningTools.length,
+                crisisResources: 2,
+                therapyTypes: 2,
+                medicationClasses: 2
+            }
+        };
+    });
+}
+async function runNutritionAssessment() {
+    return runToolAction('nutrition-assessment', async () => {
+        const macronutrients = [
+            { nutrient: 'Protein', recommendation: '0.8-1.2 g/kg body weight', notes: 'Higher for elderly, athletes' },
+            { nutrient: 'Carbohydrates', recommendation: '45-65% of calories', notes: 'Focus on complex carbs, fiber' },
+            { nutrient: 'Fat', recommendation: '20-35% of calories', notes: 'Limit saturated < 10%' },
+            { nutrient: 'Fiber', recommendation: '25-38 g/day', notes: 'Most adults fall short' },
+            { nutrient: 'Water', recommendation: '8-10 cups/day', notes: 'More with activity, heat' }
+        ];
+        const micronutrients = [
+            { nutrient: 'Vitamin D', recommendation: '600-800 IU/day', risk: 'Deficiency common, especially in northern latitudes' },
+            { nutrient: 'Vitamin B12', recommendation: '2.4 mcg/day', risk: 'Screen elderly, vegans, on metformin' },
+            { nutrient: 'Iron', recommendation: '8-18 mg/day', risk: 'Menstruating women at higher risk' },
+            { nutrient: 'Calcium', recommendation: '1000-1200 mg/day', risk: 'Bone health, especially postmenopausal women' },
+            { nutrient: 'Omega-3', recommendation: '250-500 mg EPA+DHA', risk: 'CV benefit' },
+            { nutrient: 'Folate', recommendation: '400 mcg/day', risk: '600 mcg if pregnant' }
+        ];
+        const checks = [
+            ...macronutrients.map(m => ({ name: m.nutrient, ok: true, detail: m.recommendation })),
+            ...micronutrients.map(m => ({ name: m.nutrient, ok: true, detail: m.recommendation }))
+        ];
+        return {
+            summary: `${macronutrients.length + micronutrients.length} nutritional targets`,
+            checks,
+            metrics: {
+                macronutrients: macronutrients.length,
+                micronutrients: micronutrients.length,
+                dietPatterns: 'Mediterranean, DASH, MIND recommended'
+            }
+        };
+    });
+}
+async function runImmunizationSchedule() {
+    return runToolAction('immunization-schedule', async () => {
+        const adultVaccines = [
+            { vaccine: 'Influenza', schedule: 'Annually', ages: 'All adults' },
+            { vaccine: 'COVID-19', schedule: 'Per current guidance', ages: 'All adults' },
+            { vaccine: 'Tdap/Td', schedule: 'Tdap once, Td every 10 years', ages: 'All adults' },
+            { vaccine: 'Shingles (Shingrix)', schedule: '2 doses', ages: '50+' },
+            { vaccine: 'Pneumococcal (PCV20 or PCV15+PPSV23)', schedule: '1-2 doses', ages: '65+ or high-risk' },
+            { vaccine: 'RSV', schedule: '1 dose', ages: '60+' },
+            { vaccine: 'HPV', schedule: '2-3 doses', ages: 'Through age 26 (catch-up to 45)' },
+            { vaccine: 'Hepatitis B', schedule: '2-3 doses', ages: 'All adults < 60, high-risk 60+' },
+            { vaccine: 'Hepatitis A', schedule: '2 doses', ages: 'High-risk groups' },
+            { vaccine: 'MMR', schedule: '1-2 doses if no immunity', ages: 'Adults born after 1957' },
+            { vaccine: 'Varicella', schedule: '2 doses if no immunity', ages: 'Adults without immunity' },
+            { vaccine: 'Meningococcal', schedule: 'High-risk groups', ages: 'College freshmen, asplenia, complement deficiency' }
+        ];
+        const travelVaccines = [
+            { vaccine: 'Yellow Fever', regions: 'Africa, South America' },
+            { vaccine: 'Typhoid', regions: 'South Asia, developing countries' },
+            { vaccine: 'Japanese Encephalitis', regions: 'Asia' },
+            { vaccine: 'Rabies', regions: 'Pre-exposure for high-risk travel' },
+            { vaccine: 'Cholera', regions: 'Endemic areas' }
+        ];
+        const checks = adultVaccines.map(v => ({
+            name: v.vaccine,
+            ok: true,
+            detail: `${v.schedule} - ${v.ages}`
+        }));
+        return {
+            summary: `${adultVaccines.length} routine vaccines, ${travelVaccines.length} travel vaccines`,
+            checks,
+            metrics: {
+                routineVaccines: adultVaccines.length,
+                travelVaccines: travelVaccines.length,
+                annualVaccines: 'Influenza, COVID-19 (as recommended)'
+            }
+        };
+    });
+}
+async function runBoneHealth() {
+    return runToolAction('bone-health', async () => {
+        const riskFactors = [
+            { factor: 'Age > 65 (women) or > 70 (men)', weight: 'Major' },
+            { factor: 'Prior fragility fracture', weight: 'Major' },
+            { factor: 'Parental hip fracture', weight: 'Moderate' },
+            { factor: 'Low body weight (< 127 lbs)', weight: 'Moderate' },
+            { factor: 'Smoking', weight: 'Moderate' },
+            { factor: 'Excess alcohol (> 3 drinks/day)', weight: 'Moderate' },
+            { factor: 'Glucocorticoid use', weight: 'Major' },
+            { factor: 'Rheumatoid arthritis', weight: 'Moderate' },
+            { factor: 'Secondary osteoporosis causes', weight: 'Variable' }
+        ];
+        const tscore = [
+            { category: 'Normal', range: 'T-score ≥ -1.0', action: 'Reassess per guidelines' },
+            { category: 'Osteopenia', range: 'T-score -1.0 to -2.5', action: 'Lifestyle, consider FRAX' },
+            { category: 'Osteoporosis', range: 'T-score ≤ -2.5', action: 'Treatment indicated' },
+            { category: 'Severe osteoporosis', range: 'T-score ≤ -2.5 + fracture', action: 'Aggressive treatment' }
+        ];
+        const treatments = [
+            { class: 'Bisphosphonates', drugs: 'Alendronate, Risedronate, Zoledronic acid', notes: 'First-line' },
+            { class: 'RANK-L inhibitor', drugs: 'Denosumab', notes: 'Alternative first-line' },
+            { class: 'Anabolic', drugs: 'Teriparatide, Abaloparatide, Romosozumab', notes: 'For severe or refractory' },
+            { class: 'SERM', drugs: 'Raloxifene', notes: 'Postmenopausal, also reduces breast cancer risk' }
+        ];
+        const checks = [
+            ...tscore.map(t => ({ name: t.category, ok: true, detail: `${t.range}: ${t.action}` })),
+            ...treatments.map(t => ({ name: t.class, ok: true, detail: t.drugs }))
+        ];
+        return {
+            summary: `${riskFactors.length} risk factors, ${treatments.length} treatment classes`,
+            checks,
+            metrics: {
+                screeningAge: 'Women 65+, Men 70+, earlier if risk factors',
+                calciumTarget: '1000-1200 mg/day',
+                vitaminDTarget: '800-1000 IU/day',
+                exerciseRecommendation: 'Weight-bearing + resistance training'
+            }
+        };
+    });
+}
+async function runCognitiveScreening() {
+    return runToolAction('cognitive-screening', async () => {
+        const screeningTools = [
+            { tool: 'Mini-Cog', time: '3 min', components: '3-word recall + clock draw' },
+            { tool: 'MMSE', time: '10 min', components: '30-point scale, < 24 abnormal' },
+            { tool: 'MoCA', time: '10 min', components: '30-point scale, < 26 abnormal' },
+            { tool: 'SLUMS', time: '7 min', components: '30-point scale' },
+            { tool: 'AD8', time: '3 min', components: 'Informant questionnaire' }
+        ];
+        const dementiaTypes = [
+            { type: 'Alzheimer disease', percentage: '60-80%', features: 'Memory loss, gradual onset' },
+            { type: 'Vascular dementia', percentage: '10-20%', features: 'Step-wise decline, CV risk factors' },
+            { type: 'Lewy body dementia', percentage: '5-10%', features: 'Visual hallucinations, parkinsonism' },
+            { type: 'Frontotemporal', percentage: '5-10%', features: 'Behavior/language changes, younger onset' },
+            { type: 'Mixed dementia', percentage: 'Common', features: 'AD + vascular most common' }
+        ];
+        const modifiableRisk = [
+            'Hypertension', 'Diabetes', 'Obesity', 'Smoking', 'Depression',
+            'Physical inactivity', 'Social isolation', 'Hearing loss', 'Excessive alcohol'
+        ];
+        const checks = [
+            ...screeningTools.map(s => ({ name: s.tool, ok: true, detail: `${s.time}: ${s.components}` })),
+            ...dementiaTypes.map(d => ({ name: d.type, ok: true, detail: `${d.percentage}: ${d.features}` }))
+        ];
+        return {
+            summary: `${screeningTools.length} screening tools, ${dementiaTypes.length} dementia types`,
+            checks,
+            metrics: {
+                modifiableRiskFactors: modifiableRisk.length,
+                riskReduction: 'Up to 40% of dementia potentially preventable',
+                medications: 'Cholinesterase inhibitors, Memantine, Lecanemab (amyloid-targeting)'
+            }
+        };
+    });
+}
+async function runSleepAssessment() {
+    return runToolAction('sleep-assessment', async () => {
+        const disorders = [
+            { disorder: 'Obstructive Sleep Apnea', prevalence: '10-30%', screening: 'STOP-BANG questionnaire' },
+            { disorder: 'Insomnia', prevalence: '10-15%', screening: 'Insomnia Severity Index' },
+            { disorder: 'Restless Legs Syndrome', prevalence: '5-15%', screening: 'Clinical criteria' },
+            { disorder: 'Circadian Rhythm Disorders', prevalence: 'Variable', screening: 'Sleep diary, actigraphy' },
+            { disorder: 'Narcolepsy', prevalence: '0.02-0.05%', screening: 'Epworth Sleepiness Scale' }
+        ];
+        const hygiene = [
+            'Consistent sleep/wake times (even weekends)',
+            'Bedroom: dark, quiet, cool (65-68°F)',
+            'Avoid screens 1 hour before bed',
+            'Limit caffeine after noon',
+            'Avoid alcohol close to bedtime',
+            'Regular exercise (but not close to bedtime)',
+            'Avoid large meals before bed'
+        ];
+        const checks = [
+            ...disorders.map(d => ({ name: d.disorder, ok: true, detail: `${d.prevalence}: ${d.screening}` })),
+            { name: 'Sleep hygiene', ok: true, detail: `${hygiene.length} recommendations` }
+        ];
+        return {
+            summary: `${disorders.length} sleep disorders, ${hygiene.length} hygiene tips`,
+            checks,
+            metrics: {
+                recommendedSleep: '7-9 hours for adults',
+                osaTreatment: 'CPAP, oral appliances, weight loss, surgery',
+                insomniaTreatment: 'CBT-I first-line, short-term medications if needed'
+            }
+        };
+    });
+}
+async function runSubstanceScreening() {
+    return runToolAction('substance-screening', async () => {
+        const screeningTools = [
+            { tool: 'AUDIT', substance: 'Alcohol', description: '10 questions, ≥ 8 hazardous use' },
+            { tool: 'AUDIT-C', substance: 'Alcohol (brief)', description: '3 questions, ≥ 4 men / ≥ 3 women' },
+            { tool: 'CAGE', substance: 'Alcohol', description: '4 questions, ≥ 2 suggests problem' },
+            { tool: 'DAST-10', substance: 'Drugs', description: '10 questions, ≥ 3 moderate problem' },
+            { tool: 'NIDA Quick Screen', substance: 'All substances', description: 'Single question each' },
+            { tool: 'Fagerström', substance: 'Nicotine', description: 'Nicotine dependence severity' }
+        ];
+        const interventions = [
+            { level: 'Brief intervention', description: 'FRAMES: Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy' },
+            { level: 'Motivational interviewing', description: 'Patient-centered, explore ambivalence' },
+            { level: 'Behavioral therapy', description: 'CBT, contingency management' },
+            { level: 'Medication-assisted treatment', description: 'Naltrexone, buprenorphine, methadone for OUD' },
+            { level: 'Smoking cessation', description: 'NRT, varenicline, bupropion + counseling' }
+        ];
+        const checks = [
+            ...screeningTools.map(s => ({ name: s.tool, ok: true, detail: `${s.substance}: ${s.description}` })),
+            ...interventions.map(i => ({ name: i.level, ok: true, detail: i.description }))
+        ];
+        return {
+            summary: `${screeningTools.length} screening tools, ${interventions.length} intervention levels`,
+            checks,
+            metrics: {
+                safeAlcoholLimits: 'Men ≤ 2 drinks/day, Women ≤ 1 drink/day',
+                smokingQuitlineNumber: '1-800-QUIT-NOW',
+                overdoseReversal: 'Naloxone (Narcan) - prescribe to at-risk patients'
+            }
+        };
+    });
+}
+async function runKidneyHealth() {
+    return runToolAction('kidney-health', async () => {
+        const ckdStages = [
+            { stage: 'G1', gfr: '≥ 90', description: 'Normal or high', action: 'Monitor if albuminuria' },
+            { stage: 'G2', gfr: '60-89', description: 'Mildly decreased', action: 'Monitor, control risk factors' },
+            { stage: 'G3a', gfr: '45-59', description: 'Mild-moderate decrease', action: 'Nephrology referral, adjust meds' },
+            { stage: 'G3b', gfr: '30-44', description: 'Moderate-severe decrease', action: 'Nephrology, prepare for RRT' },
+            { stage: 'G4', gfr: '15-29', description: 'Severely decreased', action: 'RRT planning' },
+            { stage: 'G5', gfr: '< 15', description: 'Kidney failure', action: 'Dialysis or transplant' }
+        ];
+        const albuminuria = [
+            { category: 'A1', level: '< 30 mg/g', description: 'Normal to mildly increased' },
+            { category: 'A2', level: '30-300 mg/g', description: 'Moderately increased' },
+            { category: 'A3', level: '> 300 mg/g', description: 'Severely increased' }
+        ];
+        const checks = [
+            ...ckdStages.map(s => ({ name: `Stage ${s.stage}`, ok: true, detail: `GFR ${s.gfr}: ${s.description}` })),
+            ...albuminuria.map(a => ({ name: `Albuminuria ${a.category}`, ok: true, detail: `${a.level}: ${a.description}` }))
+        ];
+        return {
+            summary: `${ckdStages.length} CKD stages, ${albuminuria.length} albuminuria categories`,
+            checks,
+            metrics: {
+                screeningIndications: 'Diabetes, HTN, CVD, family history, AKI',
+                nephroprotection: 'ACEi/ARB, SGLT2i for proteinuria',
+                avoidNSAIDs: 'Yes, especially in advanced CKD',
+                contrastPrecautions: 'Hydration, minimize contrast in GFR < 30'
+            }
+        };
+    });
+}
+async function runLiverHealth() {
+    return runToolAction('liver-health', async () => {
+        const conditions = [
+            { condition: 'NAFLD/MASLD', prevalence: '25-30%', screening: 'FIB-4, transient elastography' },
+            { condition: 'Hepatitis B', prevalence: '0.3-0.5% (US)', screening: 'HBsAg, anti-HBc, anti-HBs' },
+            { condition: 'Hepatitis C', prevalence: '1%', screening: 'Anti-HCV, confirm with HCV RNA' },
+            { condition: 'Alcoholic liver disease', prevalence: 'Variable', screening: 'AUDIT, AST:ALT > 2' },
+            { condition: 'Autoimmune hepatitis', prevalence: 'Rare', screening: 'ANA, SMA, IgG levels' },
+            { condition: 'Hemochromatosis', prevalence: '1/200-300', screening: 'Iron studies, HFE gene' }
+        ];
+        const fibrosisStaging = [
+            { stage: 'F0', description: 'No fibrosis', action: 'Lifestyle modification' },
+            { stage: 'F1', description: 'Portal fibrosis', action: 'Monitor, address etiology' },
+            { stage: 'F2', description: 'Periportal fibrosis', action: 'Consider treatment' },
+            { stage: 'F3', description: 'Bridging fibrosis', action: 'Treatment, surveillance' },
+            { stage: 'F4', description: 'Cirrhosis', action: 'HCC surveillance, varices screening' }
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: `${c.prevalence}: ${c.screening}` })),
+            ...fibrosisStaging.map(f => ({ name: `Fibrosis ${f.stage}`, ok: true, detail: f.description }))
+        ];
+        return {
+            summary: `${conditions.length} liver conditions, ${fibrosisStaging.length} fibrosis stages`,
+            checks,
+            metrics: {
+                hccSurveillance: 'Ultrasound ± AFP every 6 months in cirrhosis',
+                varicesSurveillance: 'EGD at cirrhosis diagnosis',
+                hepatitisVaccination: 'HBV vaccine for all non-immune adults'
+            }
+        };
+    });
+}
+async function runRespiratoryHealth() {
+    return runToolAction('respiratory-health', async () => {
+        const conditions = [
+            { condition: 'COPD', prevalence: '6%', diagnosis: 'Spirometry: FEV1/FVC < 0.70' },
+            { condition: 'Asthma', prevalence: '8%', diagnosis: 'Spirometry with reversibility' },
+            { condition: 'Interstitial lung disease', prevalence: '0.03%', diagnosis: 'HRCT, PFTs' },
+            { condition: 'Pulmonary hypertension', prevalence: 'Rare', diagnosis: 'Echo, RHC' },
+            { condition: 'Sleep apnea', prevalence: '10-30%', diagnosis: 'Polysomnography' }
+        ];
+        const copdGold = [
+            { stage: 'GOLD 1 (Mild)', fev1: '≥ 80%', symptoms: 'May have chronic cough' },
+            { stage: 'GOLD 2 (Moderate)', fev1: '50-79%', symptoms: 'Dyspnea on exertion' },
+            { stage: 'GOLD 3 (Severe)', fev1: '30-49%', symptoms: 'Increased dyspnea, exacerbations' },
+            { stage: 'GOLD 4 (Very severe)', fev1: '< 30%', symptoms: 'Severe limitation, respiratory failure' }
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: `${c.prevalence}: ${c.diagnosis}` })),
+            ...copdGold.map(g => ({ name: g.stage, ok: true, detail: `FEV1 ${g.fev1}` }))
+        ];
+        return {
+            summary: `${conditions.length} respiratory conditions, COPD GOLD staging`,
+            checks,
+            metrics: {
+                spirometryIndications: 'Smokers, dyspnea, chronic cough, wheezing',
+                copdTreatment: 'Bronchodilators (LAMA, LABA), ICS for exacerbations',
+                asthmaControl: 'ICS cornerstone, step-up/down approach',
+                smokingCessation: 'Most important intervention for COPD'
+            }
+        };
+    });
+}
+async function runThyroidScreening() {
+    return runToolAction('thyroid-screening', async () => {
+        const disorders = [
+            { disorder: 'Hypothyroidism', tsh: 'Elevated', t4: 'Low', symptoms: 'Fatigue, weight gain, cold intolerance' },
+            { disorder: 'Subclinical hypothyroidism', tsh: 'Mildly elevated', t4: 'Normal', symptoms: 'Often asymptomatic' },
+            { disorder: 'Hyperthyroidism', tsh: 'Low', t4: 'High', symptoms: 'Weight loss, palpitations, heat intolerance' },
+            { disorder: 'Thyroid nodules', tsh: 'Variable', t4: 'Variable', symptoms: 'Often incidental' },
+            { disorder: 'Thyroid cancer', tsh: 'Variable', t4: 'Variable', symptoms: 'Nodule, lymphadenopathy' }
+        ];
+        const management = [
+            { condition: 'Hypothyroidism', treatment: 'Levothyroxine', monitoring: 'TSH in 6-8 weeks, then annually' },
+            { condition: 'Hyperthyroidism', treatment: 'Methimazole, RAI, surgery', monitoring: 'TFTs every 4-6 weeks initially' },
+            { condition: 'Thyroid nodules', treatment: 'FNA if indicated by size/features', monitoring: 'Ultrasound surveillance' },
+            { condition: 'Thyroid cancer', treatment: 'Surgery ± RAI', monitoring: 'Thyroglobulin, neck ultrasound' }
+        ];
+        const checks = [
+            ...disorders.map(d => ({ name: d.disorder, ok: true, detail: `TSH ${d.tsh}, T4 ${d.t4}` })),
+            ...management.map(m => ({ name: m.condition, ok: true, detail: m.treatment }))
+        ];
+        return {
+            summary: `${disorders.length} thyroid disorders, ${management.length} management approaches`,
+            checks,
+            metrics: {
+                screeningIndications: 'Symptoms, family history, pregnancy, radiation exposure',
+                tshGoal: '0.5-4.0 mIU/L (varies by lab and age)',
+                noduleWorkup: 'TSH, ultrasound, FNA if > 1cm or suspicious features'
+            }
+        };
+    });
+}
+async function runSexualHealth() {
+    return runToolAction('sexual-health', async () => {
+        const screenings = [
+            { test: 'HIV', who: 'All adults 15-65, high-risk annually', method: 'HIV Ag/Ab' },
+            { test: 'Chlamydia', who: 'Sexually active women < 25, high-risk', method: 'NAAT' },
+            { test: 'Gonorrhea', who: 'Sexually active women < 25, high-risk', method: 'NAAT' },
+            { test: 'Syphilis', who: 'MSM, HIV+, high-risk pregnancy', method: 'Treponemal/non-treponemal' },
+            { test: 'Hepatitis B', who: 'Unvaccinated with risk factors', method: 'HBsAg, anti-HBs' },
+            { test: 'HPV/Cervical', who: 'Women 21-65', method: 'Pap ± HPV co-testing' }
+        ];
+        const contraception = [
+            { method: 'IUD (hormonal)', efficacy: '99.8%', duration: '3-7 years' },
+            { method: 'IUD (copper)', efficacy: '99.2%', duration: '10-12 years' },
+            { method: 'Implant', efficacy: '99.9%', duration: '3-5 years' },
+            { method: 'Injection', efficacy: '94%', duration: 'Every 3 months' },
+            { method: 'Pill/Patch/Ring', efficacy: '91%', duration: 'Daily/weekly/monthly' },
+            { method: 'Condoms', efficacy: '82%', duration: 'Per use' }
+        ];
+        const checks = [
+            ...screenings.map(s => ({ name: s.test, ok: true, detail: `${s.who}` })),
+            ...contraception.map(c => ({ name: c.method, ok: true, detail: `${c.efficacy} effective, ${c.duration}` }))
+        ];
+        return {
+            summary: `${screenings.length} STI screenings, ${contraception.length} contraception options`,
+            checks,
+            metrics: {
+                prep: 'PrEP (Truvada/Descovy) for HIV prevention in high-risk',
+                pep: 'PEP within 72 hours of exposure',
+                hpvVaccine: 'Recommended through age 26, available to 45'
+            }
+        };
+    });
+}
+async function runInfectiousDisease() {
+    return runToolAction('infectious-disease', async () => {
+        const screenings = [
+            { disease: 'HIV', recommendation: 'All adults 15-65 at least once, high-risk annually' },
+            { disease: 'Hepatitis C', recommendation: 'All adults 18-79 once' },
+            { disease: 'Hepatitis B', recommendation: 'High-risk populations' },
+            { disease: 'Tuberculosis (latent)', recommendation: 'High-risk: immigrants, healthcare workers, immunocompromised' },
+            { disease: 'Syphilis', recommendation: 'Pregnant women, MSM, HIV+' },
+            { disease: 'Chlamydia/Gonorrhea', recommendation: 'Sexually active women < 25' }
+        ];
+        const vaccines = [
+            { vaccine: 'Influenza', schedule: 'Annually' },
+            { vaccine: 'COVID-19', schedule: 'Per current CDC guidance' },
+            { vaccine: 'Pneumococcal', schedule: 'Age 65+ or high-risk' },
+            { vaccine: 'Shingles', schedule: 'Age 50+' },
+            { vaccine: 'Hepatitis B', schedule: 'All adults' }
+        ];
+        const checks = [
+            ...screenings.map(s => ({ name: s.disease, ok: true, detail: s.recommendation })),
+            ...vaccines.map(v => ({ name: `${v.vaccine} vaccine`, ok: true, detail: v.schedule }))
+        ];
+        return {
+            summary: `${screenings.length} ID screenings, ${vaccines.length} vaccines`,
+            checks,
+            metrics: {
+                hivTreatment: 'Start ART immediately upon diagnosis',
+                hcvCure: '> 95% cure rate with DAAs (8-12 weeks)',
+                ltbiTreatment: '3HP, 4R, or 9H regimens'
+            }
+        };
+    });
+}
+async function runAutoimmuneScreening() {
+    return runToolAction('autoimmune-screening', async () => {
+        const conditions = [
+            { condition: 'Rheumatoid arthritis', markers: 'RF, anti-CCP', prevalence: '0.5-1%' },
+            { condition: 'SLE (Lupus)', markers: 'ANA, anti-dsDNA, anti-Smith', prevalence: '0.02-0.05%' },
+            { condition: 'Sjögren syndrome', markers: 'ANA, anti-SSA/SSB', prevalence: '0.5-1%' },
+            { condition: 'Systemic sclerosis', markers: 'ANA, anti-Scl70, anti-centromere', prevalence: '0.02%' },
+            { condition: 'Autoimmune thyroiditis', markers: 'Anti-TPO, anti-thyroglobulin', prevalence: '5-15%' },
+            { condition: 'Type 1 diabetes', markers: 'Anti-GAD, anti-IA2, anti-insulin', prevalence: '0.4%' },
+            { condition: 'Celiac disease', markers: 'Anti-tTG IgA, EMA', prevalence: '1%' },
+            { condition: 'Inflammatory myopathy', markers: 'ANA, anti-Jo1, anti-Mi2', prevalence: 'Rare' }
+        ];
+        const checks = conditions.map(c => ({
+            name: c.condition,
+            ok: true,
+            detail: `${c.markers} (${c.prevalence})`
+        }));
+        return {
+            summary: `${conditions.length} autoimmune conditions with markers`,
+            checks,
+            metrics: {
+                anaInterpretation: 'Positive ANA common (15% healthy), pattern and titer matter',
+                rheumatologyReferral: 'Positive specific antibodies + symptoms',
+                treatmentApproach: 'DMARDs, biologics, immunosuppressants'
+            }
+        };
+    });
+}
+async function runAllergyAssessment() {
+    return runToolAction('allergy-assessment', async () => {
+        const allergyTypes = [
+            { type: 'Allergic rhinitis', prevalence: '10-30%', testing: 'Skin prick, serum IgE' },
+            { type: 'Asthma (allergic)', prevalence: '8%', testing: 'Spirometry, allergen testing' },
+            { type: 'Food allergy', prevalence: '2-5% adults', testing: 'Skin prick, serum IgE, oral challenge' },
+            { type: 'Drug allergy', prevalence: '10% report, <2% confirmed', testing: 'Skin testing, challenge' },
+            { type: 'Atopic dermatitis', prevalence: '2-5% adults', testing: 'Clinical, patch testing' },
+            { type: 'Anaphylaxis', prevalence: '0.05-2%', testing: 'Tryptase, specific IgE' }
+        ];
+        const treatments = [
+            { approach: 'Avoidance', description: 'Identify and avoid triggers' },
+            { approach: 'Antihistamines', description: 'H1 blockers (cetirizine, loratadine)' },
+            { approach: 'Intranasal corticosteroids', description: 'First-line for allergic rhinitis' },
+            { approach: 'Immunotherapy', description: 'Subcutaneous or sublingual for selected allergens' },
+            { approach: 'Epinephrine', description: 'Auto-injector for anaphylaxis risk' },
+            { approach: 'Biologics', description: 'Omalizumab for severe asthma/urticaria' }
+        ];
+        const checks = [
+            ...allergyTypes.map(a => ({ name: a.type, ok: true, detail: `${a.prevalence}: ${a.testing}` })),
+            ...treatments.map(t => ({ name: t.approach, ok: true, detail: t.description }))
+        ];
+        return {
+            summary: `${allergyTypes.length} allergy types, ${treatments.length} treatments`,
+            checks,
+            metrics: {
+                epinephrineIndications: 'History of anaphylaxis, high-risk food allergy',
+                immunotherapyDuration: '3-5 years for disease modification',
+                referralIndications: 'Moderate-severe symptoms, anaphylaxis, immunotherapy candidate'
+            }
+        };
+    });
+}
+async function runPainManagement() {
+    return runToolAction('pain-management', async () => {
+        const painTypes = [
+            { type: 'Nociceptive (somatic)', example: 'Musculoskeletal', treatment: 'NSAIDs, acetaminophen, PT' },
+            { type: 'Nociceptive (visceral)', example: 'Abdominal', treatment: 'Antispasmodics, address cause' },
+            { type: 'Neuropathic', example: 'Diabetic neuropathy', treatment: 'Gabapentinoids, TCAs, SNRIs' },
+            { type: 'Inflammatory', example: 'Arthritis', treatment: 'NSAIDs, DMARDs, biologics' },
+            { type: 'Central sensitization', example: 'Fibromyalgia', treatment: 'Duloxetine, pregabalin, exercise' },
+            { type: 'Cancer pain', example: 'Tumor invasion', treatment: 'WHO ladder, adjuvants, interventions' }
+        ];
+        const nonPharmacologic = [
+            'Physical therapy', 'Occupational therapy', 'Cognitive behavioral therapy',
+            'Acupuncture', 'Massage', 'TENS', 'Heat/cold therapy', 'Exercise', 'Mindfulness'
+        ];
+        const opioidPrinciples = [
+            'Exhausted non-opioid options first',
+            'Start low, go slow',
+            'Use lowest effective dose',
+            'Regular reassessment',
+            'Naloxone co-prescription',
+            'Avoid concurrent benzodiazepines',
+            'Screen for OUD risk (ORT, SOAPP)'
+        ];
+        const checks = [
+            ...painTypes.map(p => ({ name: p.type, ok: true, detail: `${p.example}: ${p.treatment}` })),
+            { name: 'Non-pharmacologic options', ok: true, detail: `${nonPharmacologic.length} modalities` },
+            { name: 'Opioid stewardship', ok: true, detail: `${opioidPrinciples.length} principles` }
+        ];
+        return {
+            summary: `${painTypes.length} pain types, multimodal approach`,
+            checks,
+            metrics: {
+                whoLadder: 'Step 1 (non-opioids) → Step 2 (weak opioids) → Step 3 (strong opioids)',
+                mmeDailyLimit: '≤ 50 MME/day preferred, > 90 requires justification',
+                pdmp: 'Check prescription drug monitoring program'
+            }
+        };
+    });
+}
+async function runExercisePrescription() {
+    return runToolAction('exercise-prescription', async () => {
+        const guidelines = [
+            { type: 'Aerobic', recommendation: '150-300 min moderate OR 75-150 min vigorous/week' },
+            { type: 'Resistance', recommendation: '2+ days/week, all major muscle groups' },
+            { type: 'Flexibility', recommendation: '2-3 days/week' },
+            { type: 'Balance (older adults)', recommendation: '3+ days/week' },
+            { type: 'Bone-loading', recommendation: 'Weight-bearing activities' }
+        ];
+        const conditions = [
+            { condition: 'Cardiovascular disease', modification: 'Supervised initially, gradually increase' },
+            { condition: 'Diabetes', modification: 'Monitor glucose, timing with meals/insulin' },
+            { condition: 'Obesity', modification: 'Low-impact, gradual progression' },
+            { condition: 'Osteoporosis', modification: 'Weight-bearing, avoid high-impact or flexion' },
+            { condition: 'Arthritis', modification: 'Low-impact, aquatic exercise' },
+            { condition: 'COPD', modification: 'Pulmonary rehab, pacing' },
+            { condition: 'Pregnancy', modification: 'Moderate intensity, avoid supine after 1st trimester' }
+        ];
+        const checks = [
+            ...guidelines.map(g => ({ name: g.type, ok: true, detail: g.recommendation })),
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: c.modification }))
+        ];
+        return {
+            summary: `${guidelines.length} exercise types, ${conditions.length} condition modifications`,
+            checks,
+            metrics: {
+                fittPrinciple: 'Frequency, Intensity, Time, Type',
+                rpe: 'Rate of Perceived Exertion 12-14 for moderate',
+                contraindications: 'Unstable angina, severe AS, acute illness, uncontrolled arrhythmia'
+            }
+        };
+    });
+}
+async function runWeightManagement() {
+    return runToolAction('weight-management', async () => {
+        const bmiCategories = [
+            { category: 'Underweight', bmi: '< 18.5', action: 'Evaluate for underlying cause' },
+            { category: 'Normal', bmi: '18.5-24.9', action: 'Maintain healthy lifestyle' },
+            { category: 'Overweight', bmi: '25-29.9', action: 'Lifestyle modification' },
+            { category: 'Obesity Class I', bmi: '30-34.9', action: 'Intensive lifestyle ± medication' },
+            { category: 'Obesity Class II', bmi: '35-39.9', action: 'Consider bariatric surgery if comorbidities' },
+            { category: 'Obesity Class III', bmi: '≥ 40', action: 'Bariatric surgery consideration' }
+        ];
+        const medications = [
+            { drug: 'Semaglutide (Wegovy)', mechanism: 'GLP-1 agonist', weightLoss: '15-17%' },
+            { drug: 'Tirzepatide (Zepbound)', mechanism: 'GIP/GLP-1', weightLoss: '20-22%' },
+            { drug: 'Phentermine-topiramate', mechanism: 'Appetite suppressant + anticonvulsant', weightLoss: '10%' },
+            { drug: 'Naltrexone-bupropion', mechanism: 'Opioid antagonist + antidepressant', weightLoss: '5-6%' },
+            { drug: 'Orlistat', mechanism: 'Lipase inhibitor', weightLoss: '3%' }
+        ];
+        const surgeryOptions = [
+            { procedure: 'Sleeve gastrectomy', excess: '60-70%', mechanism: 'Restrictive' },
+            { procedure: 'Roux-en-Y gastric bypass', excess: '70-80%', mechanism: 'Restrictive + malabsorptive' },
+            { procedure: 'Duodenal switch', excess: '80%+', mechanism: 'Malabsorptive' }
+        ];
+        const checks = [
+            ...bmiCategories.map(b => ({ name: b.category, ok: true, detail: `BMI ${b.bmi}` })),
+            ...medications.map(m => ({ name: m.drug, ok: true, detail: `${m.weightLoss} weight loss` })),
+            ...surgeryOptions.map(s => ({ name: s.procedure, ok: true, detail: `${s.excess} excess weight loss` }))
+        ];
+        return {
+            summary: `BMI categories, ${medications.length} medications, ${surgeryOptions.length} surgical options`,
+            checks,
+            metrics: {
+                targetWeightLoss: '5-10% for metabolic benefit',
+                calorieDeficit: '500-1000 kcal/day for 1-2 lb/week',
+                proteinIntake: '1.2-1.5 g/kg ideal body weight'
+            }
+        };
+    });
+}
+async function runStressManagement() {
+    return runToolAction('stress-management', async () => {
+        const stressIndicators = [
+            { domain: 'Physical', signs: 'Headaches, muscle tension, fatigue, sleep issues' },
+            { domain: 'Emotional', signs: 'Anxiety, irritability, depression, feeling overwhelmed' },
+            { domain: 'Cognitive', signs: 'Difficulty concentrating, racing thoughts, forgetfulness' },
+            { domain: 'Behavioral', signs: 'Appetite changes, social withdrawal, substance use' }
+        ];
+        const strategies = [
+            { category: 'Relaxation', techniques: 'Deep breathing, progressive muscle relaxation, meditation' },
+            { category: 'Cognitive', techniques: 'Cognitive restructuring, mindfulness, journaling' },
+            { category: 'Behavioral', techniques: 'Time management, assertiveness, problem-solving' },
+            { category: 'Lifestyle', techniques: 'Exercise, sleep hygiene, nutrition, social support' },
+            { category: 'Professional', techniques: 'Therapy (CBT, MBSR), counseling, medication if needed' }
+        ];
+        const checks = [
+            ...stressIndicators.map(s => ({ name: s.domain, ok: true, detail: s.signs })),
+            ...strategies.map(s => ({ name: s.category, ok: true, detail: s.techniques }))
+        ];
+        return {
+            summary: `${stressIndicators.length} stress domains, ${strategies.length} strategy categories`,
+            checks,
+            metrics: {
+                screeningTool: 'Perceived Stress Scale (PSS)',
+                referralIndications: 'Persistent symptoms, functional impairment, suicidal ideation',
+                apps: 'Headspace, Calm, Insight Timer for guided practice'
+            }
+        };
+    });
+}
+async function runVisionScreening() {
+    return runToolAction('vision-screening', async () => {
+        const conditions = [
+            { condition: 'Refractive errors', prevalence: '50%+', screening: 'Visual acuity, refraction' },
+            { condition: 'Cataracts', prevalence: '50% by age 75', screening: 'Slit lamp exam' },
+            { condition: 'Glaucoma', prevalence: '2-3%', screening: 'IOP, optic nerve exam, visual fields' },
+            { condition: 'Age-related macular degeneration', prevalence: '10% > 65', screening: 'Dilated fundoscopy, OCT' },
+            { condition: 'Diabetic retinopathy', prevalence: '30% of diabetics', screening: 'Annual dilated exam' },
+            { condition: 'Dry eye', prevalence: '10-30%', screening: 'Symptom assessment, tear film eval' }
+        ];
+        const schedule = [
+            { age: '< 40', frequency: 'Every 2-4 years if asymptomatic' },
+            { age: '40-54', frequency: 'Every 2-4 years' },
+            { age: '55-64', frequency: 'Every 1-3 years' },
+            { age: '65+', frequency: 'Every 1-2 years' },
+            { age: 'Diabetics', frequency: 'Annually starting at diagnosis' }
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: `${c.prevalence}: ${c.screening}` })),
+            ...schedule.map(s => ({ name: `Age ${s.age}`, ok: true, detail: s.frequency }))
+        ];
+        return {
+            summary: `${conditions.length} eye conditions, ${schedule.length} screening intervals`,
+            checks,
+            metrics: {
+                glaucomaRisk: 'Age > 60, African descent, family history, high myopia',
+                amdRisk: 'Age, smoking, family history, obesity',
+                urgentReferral: 'Sudden vision loss, flashes/floaters, eye pain/redness'
+            }
+        };
+    });
+}
+async function runHearingScreening() {
+    return runToolAction('hearing-screening', async () => {
+        const hearingLoss = [
+            { degree: 'Normal', threshold: '< 20 dB' },
+            { degree: 'Mild', threshold: '20-40 dB' },
+            { degree: 'Moderate', threshold: '41-55 dB' },
+            { degree: 'Moderately severe', threshold: '56-70 dB' },
+            { degree: 'Severe', threshold: '71-90 dB' },
+            { degree: 'Profound', threshold: '> 90 dB' }
+        ];
+        const riskFactors = [
+            'Age > 50', 'Occupational noise exposure', 'Recreational noise (concerts, headphones)',
+            'Ototoxic medications (aminoglycosides, cisplatin)', 'Family history', 'Diabetes', 'Cardiovascular disease'
+        ];
+        const interventions = [
+            { intervention: 'Hearing aids', indication: 'Mild to profound hearing loss' },
+            { intervention: 'Cochlear implants', indication: 'Severe-profound when aids insufficient' },
+            { intervention: 'Assistive devices', indication: 'TV amplifiers, alerting systems' },
+            { intervention: 'Aural rehabilitation', indication: 'Communication strategies, lip reading' }
+        ];
+        const checks = [
+            ...hearingLoss.map(h => ({ name: h.degree, ok: true, detail: h.threshold })),
+            ...interventions.map(i => ({ name: i.intervention, ok: true, detail: i.indication }))
+        ];
+        return {
+            summary: `${hearingLoss.length} hearing levels, ${interventions.length} interventions`,
+            checks,
+            metrics: {
+                screeningAge: 'Adults 50+ every 3 years, earlier if risk factors',
+                otcHearingAids: 'Available for mild-moderate loss without prescription',
+                cognitiveLink: 'Untreated hearing loss associated with cognitive decline'
+            }
+        };
+    });
+}
+async function runDentalHealth() {
+    return runToolAction('dental-health', async () => {
+        const conditions = [
+            { condition: 'Dental caries', prevalence: '90%+ lifetime', prevention: 'Fluoride, brushing, flossing' },
+            { condition: 'Periodontal disease', prevalence: '47% adults', prevention: 'Oral hygiene, regular cleanings' },
+            { condition: 'Oral cancer', prevalence: '3% of cancers', screening: 'Visual exam, high-risk screening' },
+            { condition: 'Tooth loss', prevalence: '26% of 65+', prevention: 'Preventive care, caries/perio treatment' }
+        ];
+        const oralSystemic = [
+            { condition: 'Diabetes', connection: 'Bidirectional relationship with periodontal disease' },
+            { condition: 'Cardiovascular disease', connection: 'Inflammation, endocarditis risk' },
+            { condition: 'Pregnancy', connection: 'Periodontal disease linked to preterm birth' },
+            { condition: 'Osteoporosis', connection: 'Bone loss affects jaw, tooth loss' }
+        ];
+        const schedule = [
+            { visit: 'Exam and cleaning', frequency: 'Every 6 months (or per risk)' },
+            { visit: 'Bitewing X-rays', frequency: 'Every 6-12 months' },
+            { visit: 'Full mouth X-rays', frequency: 'Every 3-5 years' }
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: `${c.prevalence}: ${c.prevention}` })),
+            ...oralSystemic.map(o => ({ name: o.condition, ok: true, detail: o.connection }))
+        ];
+        return {
+            summary: `${conditions.length} oral conditions, ${oralSystemic.length} systemic connections`,
+            checks,
+            metrics: {
+                brushing: '2 minutes twice daily with fluoride toothpaste',
+                flossing: 'Daily',
+                oralCancerRisk: 'Tobacco, alcohol, HPV (oropharyngeal)'
+            }
+        };
+    });
+}
+async function runSkinHealth() {
+    return runToolAction('skin-health', async () => {
+        const conditions = [
+            { condition: 'Actinic keratosis', risk: 'Precancerous', action: 'Cryotherapy, topical treatment, surveillance' },
+            { condition: 'Basal cell carcinoma', risk: 'Most common skin cancer', action: 'Surgical excision, Mohs' },
+            { condition: 'Squamous cell carcinoma', risk: 'Can metastasize', action: 'Surgical excision' },
+            { condition: 'Melanoma', risk: 'Highest mortality', action: 'Wide excision, staging, systemic therapy if advanced' },
+            { condition: 'Psoriasis', risk: 'Chronic, CV association', action: 'Topicals, phototherapy, biologics' },
+            { condition: 'Eczema', risk: 'Chronic, infection risk', action: 'Moisturizers, topical steroids, immunomodulators' }
+        ];
+        const abcde = [
+            { letter: 'A', criterion: 'Asymmetry' },
+            { letter: 'B', criterion: 'Border irregularity' },
+            { letter: 'C', criterion: 'Color variation' },
+            { letter: 'D', criterion: 'Diameter > 6mm' },
+            { letter: 'E', criterion: 'Evolution/change' }
+        ];
+        const sunProtection = [
+            'Broad-spectrum SPF 30+ sunscreen',
+            'Reapply every 2 hours',
+            'Seek shade 10am-4pm',
+            'Protective clothing, hats',
+            'Avoid tanning beds'
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: `${c.risk}` })),
+            ...abcde.map(a => ({ name: `ABCDE: ${a.letter}`, ok: true, detail: a.criterion }))
+        ];
+        return {
+            summary: `${conditions.length} skin conditions, ABCDE criteria for melanoma`,
+            checks,
+            metrics: {
+                selfExam: 'Monthly full-body skin self-exam',
+                dermatologyVisit: 'Annual for high-risk, as needed otherwise',
+                melanomaSurvival: '> 99% if localized, 35% if distant'
+            }
+        };
+    });
+}
+async function runGeneticRisk() {
+    return runToolAction('genetic-risk', async () => {
+        const hereditaryCancers = [
+            { syndrome: 'BRCA1/2', cancers: 'Breast, ovarian, prostate, pancreatic', prevalence: '1/400' },
+            { syndrome: 'Lynch syndrome', cancers: 'Colorectal, endometrial, ovarian', prevalence: '1/300' },
+            { syndrome: 'Li-Fraumeni', cancers: 'Sarcoma, breast, brain, leukemia', prevalence: 'Rare' },
+            { syndrome: 'Cowden syndrome', cancers: 'Breast, thyroid, endometrial', prevalence: '1/200,000' },
+            { syndrome: 'MEN syndromes', cancers: 'Thyroid, parathyroid, pheochromocytoma', prevalence: '1/30,000' }
+        ];
+        const cardiacGenetics = [
+            { condition: 'Familial hypercholesterolemia', prevalence: '1/250', testing: 'Lipid panel, cascade testing' },
+            { condition: 'Hypertrophic cardiomyopathy', prevalence: '1/500', testing: 'Echo, genetic panel' },
+            { condition: 'Long QT syndrome', prevalence: '1/2,500', testing: 'ECG, genetic panel' },
+            { condition: 'ARVC', prevalence: '1/5,000', testing: 'Echo, MRI, genetic panel' }
+        ];
+        const referralCriteria = [
+            'Personal history of cancer < 50',
+            'Multiple primary cancers',
+            'Multiple family members with cancer',
+            'Rare cancers (male breast, ovarian)',
+            'Ethnic backgrounds with founder mutations (Ashkenazi Jewish)'
+        ];
+        const checks = [
+            ...hereditaryCancers.map(h => ({ name: h.syndrome, ok: true, detail: h.cancers })),
+            ...cardiacGenetics.map(c => ({ name: c.condition, ok: true, detail: c.prevalence }))
+        ];
+        return {
+            summary: `${hereditaryCancers.length} hereditary cancer syndromes, ${cardiacGenetics.length} cardiac conditions`,
+            checks,
+            metrics: {
+                geneticCounseling: 'Pre- and post-test counseling essential',
+                cascadeTesting: 'Test at-risk family members if positive',
+                directToConsumer: 'Not sufficient for clinical decision-making'
+            }
+        };
+    });
+}
+async function runMedicationReview() {
+    return runToolAction('medication-review', async () => {
+        const polypharmacyConcerns = [
+            { concern: 'Drug-drug interactions', assessment: 'Review all medications including OTC' },
+            { concern: 'Anticholinergic burden', assessment: 'ACB scale, cognitive effects' },
+            { concern: 'Falls risk medications', assessment: 'Sedatives, antihypertensives, psychotropics' },
+            { concern: 'Renal dosing', assessment: 'Adjust for CrCl/eGFR' },
+            { concern: 'Hepatic dosing', assessment: 'Adjust for hepatic impairment' },
+            { concern: 'Inappropriate prescribing (elderly)', assessment: 'Beers criteria, STOPP/START' }
+        ];
+        const deprescribingPriorities = [
+            { class: 'PPIs', reason: 'Often used longer than needed, infection/fracture risk' },
+            { class: 'Benzodiazepines', reason: 'Falls, cognitive impairment, dependence' },
+            { class: 'Anticholinergics', reason: 'Cognitive impairment, constipation, urinary retention' },
+            { class: 'Antipsychotics (dementia)', reason: 'Increased mortality, limited benefit' },
+            { class: 'Sulfonylureas (elderly)', reason: 'Hypoglycemia risk' }
+        ];
+        const checks = [
+            ...polypharmacyConcerns.map(p => ({ name: p.concern, ok: true, detail: p.assessment })),
+            ...deprescribingPriorities.map(d => ({ name: d.class, ok: true, detail: d.reason }))
+        ];
+        return {
+            summary: `${polypharmacyConcerns.length} concerns, ${deprescribingPriorities.length} deprescribing priorities`,
+            checks,
+            metrics: {
+                polypharmacyThreshold: '≥ 5 medications (some use ≥ 10)',
+                medicationReconciliation: 'At every transition of care',
+                brownBagReview: 'Patient brings all medications to visit'
+            }
+        };
+    });
+}
+async function runFallRisk() {
+    return runToolAction('fall-risk', async () => {
+        const riskFactors = [
+            { factor: 'Age > 65', category: 'Non-modifiable' },
+            { factor: 'History of falls', category: 'Major predictor' },
+            { factor: 'Gait/balance impairment', category: 'Modifiable' },
+            { factor: 'Polypharmacy (≥ 4 meds)', category: 'Modifiable' },
+            { factor: 'Psychotropic medications', category: 'Modifiable' },
+            { factor: 'Visual impairment', category: 'Modifiable' },
+            { factor: 'Cognitive impairment', category: 'Partially modifiable' },
+            { factor: 'Environmental hazards', category: 'Modifiable' },
+            { factor: 'Orthostatic hypotension', category: 'Modifiable' },
+            { factor: 'Foot/footwear problems', category: 'Modifiable' }
+        ];
+        const assessments = [
+            { test: 'Timed Up and Go (TUG)', cutoff: '> 12 seconds = increased risk' },
+            { test: '4-Stage Balance Test', cutoff: 'Unable to hold tandem 10 sec = increased risk' },
+            { test: 'Orthostatic vitals', cutoff: 'SBP drop ≥ 20 or DBP ≥ 10' },
+            { test: 'Vision screening', cutoff: 'Worse than 20/40' },
+            { test: 'Medication review', cutoff: 'Any fall-risk-increasing drugs' }
+        ];
+        const interventions = [
+            'Exercise (balance, strength, gait training)',
+            'Medication review/reduction',
+            'Vision correction',
+            'Home safety assessment',
+            'Vitamin D supplementation',
+            'Assistive devices as needed',
+            'Hip protectors for high-risk'
+        ];
+        const checks = [
+            ...riskFactors.map(r => ({ name: r.factor, ok: true, detail: r.category })),
+            ...assessments.map(a => ({ name: a.test, ok: true, detail: a.cutoff }))
+        ];
+        return {
+            summary: `${riskFactors.length} risk factors, ${interventions.length} interventions`,
+            checks,
+            metrics: {
+                screeningQuestion: 'Have you fallen in the past year?',
+                fracturePrevention: 'Treat osteoporosis, vitamin D, calcium',
+                emergencyResponse: 'Medical alert system for high-risk'
+            }
+        };
+    });
+}
+async function runFunctionalStatus() {
+    return runToolAction('functional-status', async () => {
+        const adls = [
+            { activity: 'Bathing', description: 'Ability to wash oneself' },
+            { activity: 'Dressing', description: 'Ability to dress/undress' },
+            { activity: 'Toileting', description: 'Using toilet, managing hygiene' },
+            { activity: 'Transferring', description: 'Moving in/out of bed or chair' },
+            { activity: 'Continence', description: 'Control of bladder and bowel' },
+            { activity: 'Feeding', description: 'Ability to feed oneself' }
+        ];
+        const iadls = [
+            { activity: 'Phone use', description: 'Using telephone' },
+            { activity: 'Shopping', description: 'Obtaining groceries/necessities' },
+            { activity: 'Food preparation', description: 'Planning and cooking meals' },
+            { activity: 'Housekeeping', description: 'Maintaining home' },
+            { activity: 'Laundry', description: 'Washing clothes' },
+            { activity: 'Transportation', description: 'Driving or using transport' },
+            { activity: 'Medications', description: 'Managing medications' },
+            { activity: 'Finances', description: 'Managing money' }
+        ];
+        const checks = [
+            ...adls.map(a => ({ name: `ADL: ${a.activity}`, ok: true, detail: a.description })),
+            ...iadls.map(i => ({ name: `IADL: ${i.activity}`, ok: true, detail: i.description }))
+        ];
+        return {
+            summary: `${adls.length} ADLs, ${iadls.length} IADLs assessed`,
+            checks,
+            metrics: {
+                katzIndex: 'ADL assessment tool',
+                lawtonScale: 'IADL assessment tool',
+                careNeeds: 'ADL dependence indicates need for personal care assistance'
+            }
+        };
+    });
+}
+async function runPediatricWellness() {
+    return runToolAction('pediatric-wellness', async () => {
+        const wellChildVisits = [
+            { age: 'Newborn', focus: 'Birth weight, feeding, jaundice, hearing screen' },
+            { age: '2-4 days', focus: 'Weight, feeding, jaundice follow-up' },
+            { age: '1 month', focus: 'Growth, feeding, development' },
+            { age: '2 months', focus: 'Vaccines, growth, development' },
+            { age: '4 months', focus: 'Vaccines, milestones, nutrition' },
+            { age: '6 months', focus: 'Vaccines, solid food introduction' },
+            { age: '9 months', focus: 'Development, dental, safety' },
+            { age: '12 months', focus: 'Vaccines, walking, language' },
+            { age: '15 months', focus: 'Vaccines, autism screening' },
+            { age: '18 months', focus: 'Autism screening, language' },
+            { age: '2 years', focus: 'Growth, behavior, dental' },
+            { age: '3-21 years', focus: 'Annual visits, vaccines per schedule' }
+        ];
+        const screenings = [
+            { screening: 'Newborn metabolic', timing: '24-48 hours' },
+            { screening: 'Hearing', timing: 'Before discharge, follow-up if abnormal' },
+            { screening: 'Vision', timing: '3-5 years formal screening' },
+            { screening: 'Lead', timing: '12 and 24 months (high-risk areas)' },
+            { screening: 'Autism (M-CHAT)', timing: '18 and 24 months' },
+            { screening: 'Depression (PHQ-A)', timing: '12+ years annually' },
+            { screening: 'Lipids', timing: '9-11 years, 17-21 years' }
+        ];
+        const checks = [
+            ...wellChildVisits.slice(0, 8).map(w => ({ name: w.age, ok: true, detail: w.focus })),
+            ...screenings.map(s => ({ name: s.screening, ok: true, detail: s.timing }))
+        ];
+        return {
+            summary: `${wellChildVisits.length} well-child visits, ${screenings.length} screenings`,
+            checks,
+            metrics: {
+                vaccineSchedule: 'Per CDC immunization schedule',
+                growthCharts: 'WHO (< 2 years) and CDC (≥ 2 years)',
+                developmentalMilestones: 'CDC milestone checklist'
+            }
+        };
+    });
+}
+async function runPrenatalCare() {
+    return runToolAction('prenatal-care', async () => {
+        const visits = [
+            { timing: 'First visit (< 12 weeks)', tests: 'Dating US, CBC, blood type, rubella, HIV, HBV, syphilis, urine culture' },
+            { timing: '10-13 weeks', tests: 'First trimester screen (NT, PAPP-A, hCG) or cfDNA' },
+            { timing: '15-20 weeks', tests: 'Quad screen if not done earlier, AFP' },
+            { timing: '18-22 weeks', tests: 'Anatomy ultrasound' },
+            { timing: '24-28 weeks', tests: 'Glucose tolerance test, repeat CBC, Rh antibody' },
+            { timing: '35-37 weeks', tests: 'Group B strep culture' },
+            { timing: '36+ weeks', tests: 'Weekly visits, fetal position, cervical exam if indicated' }
+        ];
+        const supplements = [
+            { supplement: 'Folic acid', dose: '400-800 mcg daily (start before conception)' },
+            { supplement: 'Prenatal vitamin', dose: 'Daily' },
+            { supplement: 'Iron', dose: '27 mg daily (in prenatal)' },
+            { supplement: 'DHA/Omega-3', dose: '200-300 mg daily' },
+            { supplement: 'Vitamin D', dose: '600 IU daily' }
+        ];
+        const warningsSigns = [
+            'Vaginal bleeding', 'Severe headache', 'Visual changes', 'Severe abdominal pain',
+            'Decreased fetal movement', 'Leaking fluid', 'Contractions < 37 weeks'
+        ];
+        const checks = [
+            ...visits.map(v => ({ name: v.timing, ok: true, detail: v.tests })),
+            ...supplements.map(s => ({ name: s.supplement, ok: true, detail: s.dose }))
+        ];
+        return {
+            summary: `${visits.length} prenatal visits, ${supplements.length} recommended supplements`,
+            checks,
+            metrics: {
+                visitFrequency: 'Monthly until 28 wks, q2wks 28-36, weekly 36+',
+                weightGain: 'Varies by pre-pregnancy BMI (25-35 lbs normal weight)',
+                urgentSymptoms: warningsSigns.length
+            }
+        };
+    });
+}
+async function runMenopauseManagement() {
+    return runToolAction('menopause-management', async () => {
+        const symptoms = [
+            { symptom: 'Vasomotor (hot flashes)', prevalence: '75%', duration: 'Average 7 years' },
+            { symptom: 'Genitourinary syndrome', prevalence: '50%', duration: 'Progressive without treatment' },
+            { symptom: 'Sleep disturbance', prevalence: '40-60%', duration: 'Variable' },
+            { symptom: 'Mood changes', prevalence: '20-40%', duration: 'Often perimenopausal' },
+            { symptom: 'Cognitive changes', prevalence: 'Common', duration: 'Often improves post-menopause' }
+        ];
+        const treatments = [
+            { treatment: 'Hormone therapy (systemic)', indication: 'Vasomotor symptoms, age < 60 or < 10 years post-meno' },
+            { treatment: 'Vaginal estrogen', indication: 'Genitourinary syndrome, minimal systemic absorption' },
+            { treatment: 'SSRIs/SNRIs', indication: 'Hot flashes, mood symptoms' },
+            { treatment: 'Gabapentin', indication: 'Hot flashes, especially if sleep issues' },
+            { treatment: 'Ospemifene', indication: 'Genitourinary syndrome (SERM)' },
+            { treatment: 'Fezolinetant', indication: 'Hot flashes (NK3 antagonist, non-hormonal)' }
+        ];
+        const contraindications = [
+            'Breast cancer history', 'Endometrial cancer', 'DVT/PE history', 'Stroke or MI', 'Active liver disease'
+        ];
+        const checks = [
+            ...symptoms.map(s => ({ name: s.symptom, ok: true, detail: `${s.prevalence}, ${s.duration}` })),
+            ...treatments.map(t => ({ name: t.treatment, ok: true, detail: t.indication }))
+        ];
+        return {
+            summary: `${symptoms.length} symptoms, ${treatments.length} treatment options`,
+            checks,
+            metrics: {
+                htTiming: 'Initiate < 60 years old or < 10 years post-menopause',
+                htDuration: 'Reassess annually, use lowest effective dose',
+                boneLoss: 'Accelerated in first 5 years post-menopause'
+            }
+        };
+    });
+}
+async function runProstateHealth() {
+    return runToolAction('prostate-health', async () => {
+        const conditions = [
+            { condition: 'BPH', prevalence: '50% by age 60, 90% by age 85', symptoms: 'LUTS, hesitancy, frequency' },
+            { condition: 'Prostatitis', prevalence: '5-10% lifetime', symptoms: 'Pelvic pain, dysuria, fever (acute)' },
+            { condition: 'Prostate cancer', prevalence: '1 in 8 men', screening: 'Shared decision-making for PSA' }
+        ];
+        const luts = [
+            { symptom: 'Weak stream', category: 'Voiding' },
+            { symptom: 'Hesitancy', category: 'Voiding' },
+            { symptom: 'Intermittency', category: 'Voiding' },
+            { symptom: 'Frequency', category: 'Storage' },
+            { symptom: 'Urgency', category: 'Storage' },
+            { symptom: 'Nocturia', category: 'Storage' }
+        ];
+        const bphTreatment = [
+            { class: 'Alpha blockers', examples: 'Tamsulosin, alfuzosin', mechanism: 'Relax smooth muscle' },
+            { class: '5-alpha reductase inhibitors', examples: 'Finasteride, dutasteride', mechanism: 'Reduce prostate size' },
+            { class: 'PDE5 inhibitors', examples: 'Tadalafil', mechanism: 'Also helps ED' },
+            { class: 'Surgical (TURP)', examples: 'Gold standard for large prostate', mechanism: 'Resection' },
+            { class: 'Minimally invasive', examples: 'UroLift, Rezum, aquablation', mechanism: 'Various' }
+        ];
+        const checks = [
+            ...conditions.map(c => ({ name: c.condition, ok: true, detail: c.prevalence })),
+            ...bphTreatment.map(b => ({ name: b.class, ok: true, detail: b.examples }))
+        ];
+        return {
+            summary: `${conditions.length} prostate conditions, ${bphTreatment.length} BPH treatments`,
+            checks,
+            metrics: {
+                psaSharedDecision: 'Age 55-69, discuss benefits/harms',
+                ipss: 'International Prostate Symptom Score for LUTS severity',
+                referralIndications: 'Elevated PSA, hematuria, urinary retention'
+            }
+        };
+    });
+}
+async function runTravelHealth() {
+    return runToolAction('travel-health', async () => {
+        const vaccines = [
+            { vaccine: 'Yellow fever', regions: 'Sub-Saharan Africa, South America', notes: 'Required for entry to some countries' },
+            { vaccine: 'Typhoid', regions: 'South Asia, developing countries', notes: 'Oral or injectable' },
+            { vaccine: 'Hepatitis A', regions: 'Developing countries', notes: 'If not immune' },
+            { vaccine: 'Hepatitis B', regions: 'All travelers if not vaccinated', notes: 'Also occupational/sexual exposure' },
+            { vaccine: 'Japanese encephalitis', regions: 'Rural Asia', notes: 'Extended travel' },
+            { vaccine: 'Rabies', regions: 'High-risk activities or limited access to care', notes: 'Pre-exposure prophylaxis' },
+            { vaccine: 'Meningococcal', regions: 'Meningitis belt (Africa), Hajj', notes: 'Quadrivalent' },
+            { vaccine: 'Cholera', regions: 'Endemic areas', notes: 'Oral vaccine' }
+        ];
+        const malariaRegimens = [
+            { drug: 'Atovaquone-proguanil (Malarone)', schedule: 'Start 1-2 days before, during, 7 days after' },
+            { drug: 'Doxycycline', schedule: 'Start 1-2 days before, during, 28 days after' },
+            { drug: 'Mefloquine', schedule: 'Start 2 weeks before, during, 4 weeks after' },
+            { drug: 'Chloroquine', schedule: 'Only for chloroquine-sensitive areas' }
+        ];
+        const generalAdvice = [
+            'Safe water and food practices',
+            'Insect precautions (repellent, bed nets, clothing)',
+            'Sun protection',
+            'Altitude sickness prevention if applicable',
+            'Travel insurance with medical evacuation'
+        ];
+        const checks = [
+            ...vaccines.map(v => ({ name: v.vaccine, ok: true, detail: v.regions })),
+            ...malariaRegimens.map(m => ({ name: m.drug, ok: true, detail: m.schedule }))
+        ];
+        return {
+            summary: `${vaccines.length} travel vaccines, ${malariaRegimens.length} malaria prophylaxis options`,
+            checks,
+            metrics: {
+                consultTiming: 'Ideally 4-6 weeks before travel',
+                cdcResource: 'wwwnc.cdc.gov/travel for country-specific recommendations',
+                travelerssDiarrhea: 'Azithromycin or fluoroquinolone for treatment'
+            }
+        };
+    });
+}
+async function runOccupationalHealth() {
+    return runToolAction('occupational-health', async () => {
+        const hazards = [
+            { hazard: 'Noise exposure', industries: 'Construction, manufacturing', surveillance: 'Audiometry annually' },
+            { hazard: 'Respiratory exposures', industries: 'Mining, construction, healthcare', surveillance: 'Spirometry, chest X-ray' },
+            { hazard: 'Lead exposure', industries: 'Battery manufacturing, painting', surveillance: 'Blood lead levels' },
+            { hazard: 'Ergonomic', industries: 'Office, manufacturing', surveillance: 'MSK assessment' },
+            { hazard: 'Bloodborne pathogens', industries: 'Healthcare', surveillance: 'HBV vaccine, post-exposure protocol' },
+            { hazard: 'Radiation', industries: 'Healthcare, nuclear', surveillance: 'Dosimetry, thyroid monitoring' },
+            { hazard: 'Chemical exposures', industries: 'Various', surveillance: 'Biomonitoring per agent' }
+        ];
+        const requirements = [
+            { requirement: 'Pre-placement exam', purpose: 'Baseline health, fitness for duty' },
+            { requirement: 'Periodic surveillance', purpose: 'Monitor for occupational illness' },
+            { requirement: 'Return to work', purpose: 'Assess fitness after illness/injury' },
+            { requirement: 'Respirator clearance', purpose: 'Medical evaluation for respirator use' },
+            { requirement: 'DOT physical', purpose: 'Commercial driver fitness' }
+        ];
+        const checks = [
+            ...hazards.map(h => ({ name: h.hazard, ok: true, detail: `${h.industries}` })),
+            ...requirements.map(r => ({ name: r.requirement, ok: true, detail: r.purpose }))
+        ];
+        return {
+            summary: `${hazards.length} occupational hazards, ${requirements.length} exam types`,
+            checks,
+            metrics: {
+                oshaRecordkeeping: 'Log 300 for work-related injuries/illnesses',
+                nioshtopic: 'Total Worker Health - integrates safety with wellness',
+                workersComp: 'Report work injuries within required timeframe'
+            }
+        };
+    });
+}
+async function runEnvironmentalHealth() {
+    return runToolAction('environmental-health', async () => {
+        const exposures = [
+            { exposure: 'Air pollution', health: 'Respiratory, cardiovascular', mitigation: 'Air purifiers, avoid outdoor activity on high days' },
+            { exposure: 'Lead (housing)', health: 'Neurodevelopmental (children)', mitigation: 'Paint abatement, testing' },
+            { exposure: 'Radon', health: 'Lung cancer (2nd leading cause)', mitigation: 'Home testing, mitigation systems' },
+            { exposure: 'Arsenic (water)', health: 'Cancer, cardiovascular', mitigation: 'Water testing, filtration' },
+            { exposure: 'Pesticides', health: 'Neurologic, cancer', mitigation: 'Wash produce, limit exposure' },
+            { exposure: 'PFAS', health: 'Cancer, thyroid, immune', mitigation: 'Water filtration, avoid certain products' },
+            { exposure: 'Mold', health: 'Respiratory, allergic', mitigation: 'Moisture control, remediation' }
+        ];
+        const climateHealth = [
+            { effect: 'Heat-related illness', populations: 'Elderly, outdoor workers, athletes' },
+            { effect: 'Air quality (wildfires)', populations: 'Respiratory disease, children, elderly' },
+            { effect: 'Vector-borne diseases', populations: 'Expanding geographic range' },
+            { effect: 'Extreme weather', populations: 'Mental health impacts, displacement' }
+        ];
+        const checks = [
+            ...exposures.map(e => ({ name: e.exposure, ok: true, detail: `Health: ${e.health}` })),
+            ...climateHealth.map(c => ({ name: c.effect, ok: true, detail: c.populations }))
+        ];
+        return {
+            summary: `${exposures.length} environmental exposures, ${climateHealth.length} climate effects`,
+            checks,
+            metrics: {
+                radonTesting: 'EPA recommends all homes be tested',
+                leadTesting: 'Required in homes built before 1978 with children',
+                airQualityIndex: 'Check AQI daily, especially for sensitive groups'
+            }
+        };
+    });
+}
+async function runLongevityAssessment() {
+    return runToolAction('longevity-assessment', async () => {
+        const pillars = [
+            { pillar: 'Nutrition', strategies: 'Mediterranean diet, intermittent fasting, caloric moderation' },
+            { pillar: 'Exercise', strategies: '150+ min aerobic, resistance training, HIIT' },
+            { pillar: 'Sleep', strategies: '7-9 hours, consistent schedule, sleep hygiene' },
+            { pillar: 'Stress management', strategies: 'Mindfulness, social connection, purpose' },
+            { pillar: 'Social connection', strategies: 'Strong relationships, community involvement' },
+            { pillar: 'Cognitive engagement', strategies: 'Lifelong learning, mental challenges' },
+            { pillar: 'Preventive care', strategies: 'Age-appropriate screenings, vaccinations' },
+            { pillar: 'Avoid toxins', strategies: 'No smoking, limit alcohol, clean environment' }
+        ];
+        const biomarkers = [
+            { marker: 'Blood pressure', target: '< 120/80 mmHg', relevance: 'CV mortality' },
+            { marker: 'Fasting glucose', target: '< 100 mg/dL', relevance: 'Diabetes, CV risk' },
+            { marker: 'LDL cholesterol', target: '< 100 mg/dL', relevance: 'CV disease' },
+            { marker: 'HbA1c', target: '< 5.7%', relevance: 'Glycemic control' },
+            { marker: 'hs-CRP', target: '< 1 mg/L', relevance: 'Inflammation' },
+            { marker: 'Vitamin D', target: '30-50 ng/mL', relevance: 'Bone, immune health' },
+            { marker: 'Body composition', target: 'BMI 18.5-24.9, low visceral fat', relevance: 'Metabolic health' },
+            { marker: 'VO2 max', target: 'Above average for age', relevance: 'Cardiorespiratory fitness' }
+        ];
+        const checks = [
+            ...pillars.map(p => ({ name: p.pillar, ok: true, detail: p.strategies })),
+            ...biomarkers.map(b => ({ name: b.marker, ok: true, detail: `Target: ${b.target}` }))
+        ];
+        return {
+            summary: `${pillars.length} longevity pillars, ${biomarkers.length} biomarkers`,
+            checks,
+            metrics: {
+                blueZones: 'Ikaria, Okinawa, Sardinia, Nicoya, Loma Linda',
+                lifeExpectancy: 'Modifiable factors account for ~25% of longevity',
+                healthspan: 'Quality of life years, not just quantity'
+            }
+        };
+    });
+}
+async function runHealthOptimization() {
+    return runToolAction('health-optimization', async () => {
+        const domains = [
+            { domain: 'Cardiovascular', optimizations: 'Exercise, nutrition, BP/lipid control, stress management' },
+            { domain: 'Metabolic', optimizations: 'Weight management, glucose control, reduce visceral fat' },
+            { domain: 'Musculoskeletal', optimizations: 'Resistance training, protein intake, vitamin D, flexibility' },
+            { domain: 'Neurological', optimizations: 'Sleep, cognitive stimulation, social engagement, exercise' },
+            { domain: 'Immune', optimizations: 'Vaccines, sleep, stress reduction, nutrition, exercise' },
+            { domain: 'Gastrointestinal', optimizations: 'Fiber, probiotics, hydration, regular meals' },
+            { domain: 'Hormonal', optimizations: 'Sleep, stress management, exercise, healthy weight' },
+            { domain: 'Psychological', optimizations: 'Therapy, mindfulness, social connection, purpose' }
+        ];
+        const actionItems = [
+            'Complete age-appropriate preventive screenings',
+            'Optimize sleep (7-9 hours, consistent schedule)',
+            '150+ min moderate aerobic + 2x strength training weekly',
+            'Mediterranean-style diet, limit processed foods',
+            'Maintain healthy weight (BMI 18.5-24.9)',
+            'No smoking, limit alcohol (≤ 1-2 drinks/day)',
+            'Stress management practice daily',
+            'Strong social connections',
+            'Stay current on vaccinations',
+            'Annual wellness visit with primary care'
+        ];
+        const checks = domains.map(d => ({
+            name: d.domain,
+            ok: true,
+            detail: d.optimizations
+        }));
+        return {
+            summary: `${domains.length} health domains, ${actionItems.length} action items`,
+            checks,
+            metrics: {
+                weeklyExercise: '150+ min moderate aerobic + 2x resistance',
+                sleepTarget: '7-9 hours per night',
+                dietPattern: 'Mediterranean, DASH, or plant-forward',
+                stressManagement: 'Daily practice (meditation, breathing, etc.)'
+            }
+        };
+    });
+}
+async function runAllTools(context) {
+    const start = Date.now();
+    const allReports = [];
+    const toolIds = CLI_TOOLS.filter(t => t.id !== 'all').map(t => t.id);
+    for (const id of toolIds) {
+        const tool = CLI_TOOLS.find(t => t.id === id);
+        if (tool) {
+            try {
+                const report = await tool.run(context, []);
+                allReports.push(report);
+            }
+            catch {
+                allReports.push({
+                    toolId: id,
+                    ok: false,
+                    summary: 'Tool execution failed',
+                    durationMs: 0
+                });
+            }
+        }
+    }
+    const passed = allReports.filter(r => r.ok).length;
+    const failed = allReports.filter(r => !r.ok).length;
+    const checks = allReports.map(r => ({
+        name: r.toolId,
+        ok: r.ok,
+        detail: r.summary
+    }));
+    return {
+        toolId: 'all',
+        ok: failed === 0,
+        summary: `${passed}/${allReports.length} tools passed`,
+        durationMs: Date.now() - start,
+        checks,
+        metrics: {
+            totalTools: allReports.length,
+            passed,
+            failed,
+            totalDurationMs: Date.now() - start
+        }
+    };
+}
 export function listCliTools() {
     return CLI_TOOLS;
 }