@peopl-health/nexus 5.71.6 → 5.71.8

package/lib/clinical/helpers/gradeEstimateHelper.js

@@ -77,7 +77,7 @@ function gradeEstimateSchema(description) {
       source: {
         type: 'string',
         enum: GRADE_SOURCES,
-        description: 'Where this grade came from. Required whenever you set best_estimate. `proctcae_composite`: you are carrying over the number the PRO-CTCAE triage already computed — say this even when you agree with it. When what the patient tells you this turn contradicts that number (they can do today what the questionnaire said they could not), what they tell you now wins: grade it yourself as `agent_adjudicated`. `agent_adjudicated`: you read the grade_scale clauses yourself against what the patient said. `carried_forward`: the case\'s previous grade, unchanged, with no new evidence this turn.',
+        description: 'Where this grade came from. Required whenever you set best_estimate. `proctcae_composite`: you are carrying over the number the PRO-CTCAE triage already computed — say this even when you agree with it. When what the patient tells you this turn contradicts that number (they can do today what the questionnaire said they could not), what they tell you now wins: when the term has a grade_scale, grade it yourself as `agent_adjudicated`. `agent_adjudicated`: you read the grade_scale clauses yourself against what the patient said. `carried_forward`: the case\'s previous grade, unchanged, with no new evidence this turn.',
       },
       matched_grade: {
         type: ['integer', 'null'],

package/lib/clinical/providers/BaseLLMProvider.js

@@ -377,6 +377,7 @@ class BaseLLMProvider {
       'Si una contingencia activa ya cubre la preocupación, no la cruces con otro seguimiento. Si programas, primero usa schedulePatientReminder con reminder_type seguimiento y la misma utility_basis concreta; luego registra hold con el mismo next_check_at.',
       '',
       'Si escribes, que sea para ELLA: lo que te contó, lo que quedó abierto, lo que quieres saber ahora.',
+      'Tu texto llega dentro de una plantilla que ya empieza con «Hola {su nombre},»: no saludes ni escribas su nombre, entra directo a lo que quieres decirle, breve (menos de 500 caracteres) y con un emoji como máximo. Es un contacto sobre su cuidado: no le sumes invitaciones a charlas, sesiones ni actividades.',
       'LÍMITE UTILITY: escribe sólo cuando puedas anclar el contacto en algo concreto que la paciente contó, preguntó o acordó, o en una interacción de cuidado todavía vigente. La inactividad por sí sola no basta. Si escribes, registra esa ancla en utility_basis; si sólo queda un saludo general para generar engagement, registra hold con hold_reason no_utility_anchor y utility_basis null.',
       'No repitas un mensaje que ya le enviaste, y no menciones automatizaciones, listas ni seguimientos programados.',
     );

package/lib/clinical/services/gradeAnchorService.js

@@ -70,7 +70,7 @@ function gradeAnchorNotice({ ctcaeTerm, grade, anchor }) {
   const named = leaned === 'self_care' ? 'self-care' : 'instrumental';
   if (rulesOutFunctionalPart(leaned, anchor)) {
     return `Grade ${grade} of ${ctcaeTerm} can only stand on the non-functional part of its clause: the patient is not limited in ${named} ADL. `
-      + '`reasoning` must name that criterion; if it is not met, record the grade below.';
+      + '`reasoning` must name that criterion; if it is not met, record the grade below and name in `improvement_basis` what rules this grade out.';
   }
   return `Grade ${grade} of ${ctcaeTerm} was recorded without the ${named} ADL limitation its clause mentions. `
     + 'That is fine when another part of the clause is met or the whole picture makes it the most likely grade — `reasoning` must name which. '

package/lib/clinical/services/gradeClaimService.js

@@ -52,9 +52,9 @@ const GUARDS = [
   }),
 ];
 
-function gradeClaimError({ ctcaeTerm, grade, stated = null, previous = null, restatesPriorEvidence = true, continuesEpisode = false, recordsOngoingRead = false, trace = null }) {
+function gradeClaimError({ ctcaeTerm, grade, stated = null, previous = null, restatesPriorEvidence = true, recordsOngoingRead = false, trace = null }) {
   const resolved = grade || {};
-  const claim = { ctcaeTerm, grade: resolved, stated: stated || resolved, previous, restatesPriorEvidence, continuesEpisode, recordsOngoingRead, trace };
+  const claim = { ctcaeTerm, grade: resolved, stated: stated || resolved, previous, restatesPriorEvidence, recordsOngoingRead, trace };
   for (const guard of GUARDS) {
     const error = guard(claim);
     if (error) return error;

package/lib/clinical/tools/recordClinicalImpressionTool.js

@@ -121,7 +121,6 @@ function buildAssessment(condition, previous, args, runtime, restatesPriorEviden
       stated: parseGradeEstimate(args.grade_estimate),
       previous: previous.grade,
       restatesPriorEvidence,
-      continuesEpisode,
       recordsOngoingRead: ONGOING_READ_EVENTS.includes(normalisedEvent(args)),
       trace: runtime?.trace || null,
     });
@@ -175,6 +174,10 @@ function requireCeilingGap(args, event) {
   return error ? fail(error) : null;
 }
 
+function sameGradeAndAnchor(a, b) {
+  return !!a && !!b && a.bestEstimate === b.bestEstimate && a.functionalAnchor === b.functionalAnchor;
+}
+
 function sameGrade(a, b) {
   return JSON.stringify(projectGradeRead(a)) === JSON.stringify(projectGradeRead(b));
 }
@@ -351,7 +354,9 @@ async function handler(args = {}, context = {}) {
 
     const { condition, latestAssessment } = result;
     const consistency = inputConsistency(args);
-    const freshRead = ONGOING_READ_EVENTS.includes(event) && hasGradeSignal(args?.grade_estimate) && !isCarriedForward(args.grade_estimate);
+    // A hold of the same grade on the same anchor was already advised; repeating it re-asks the patient every turn.
+    const heldAsAdvised = event === 'add_evidence' && sameGradeAndAnchor(existing.latestAssessment?.grade, latestAssessment.grade);
+    const freshRead = ONGOING_READ_EVENTS.includes(event) && hasGradeSignal(args?.grade_estimate) && !isCarriedForward(args.grade_estimate) && !heldAsAdvised;
     const gradeNotice = freshRead ? gradeClaimNotice({ ctcaeTerm: condition.ctcaeTerm, grade: latestAssessment.grade }) : null;
     return JSON.stringify({
       success: true,

package/lib/core/NexusMessaging.js

@@ -38,7 +38,7 @@ const { ProcessingPipeline } = require('../core/ProcessingPipeline');
 const { preProcessMessages, configureOpenAIProvider, AssistantProcessor, TURN_KIND } = require('../clinical');
 const { deliveryOutcome } = require('../clinical/AssistantProcessor');
 const { UNASSIGNED, alertOpsForClaimedMessage, coverIfUnassigned, coverUnansweredPatient } = require('../clinical/services/pausedSafetyNetService');
-const { buildOutreachCarrier } = require('../clinical/services/outreachCarrierService');
+const { buildOutreachCarrier, validateAgentText } = require('../clinical/services/outreachCarrierService');
 const { routineOutreachCollisionReason, isWithinTriageProtectionWindow } = require('../clinical/services/outreachSweepService');
 const {
   readPendingReminderForPatient,
@@ -1037,6 +1037,14 @@ class NexusMessaging {
     }
     const accepted = Boolean(runResult.output) && delivery?.success === true && delivery?.deferred !== true;
     const delivered = ['delivered', 'read'].includes(String(delivery?.status || '').toLowerCase());
+    let carrierRejection = null;
+    if (dryRun && decision.decision === 'write') {
+      try {
+        validateAgentText(runResult.output, firstName);
+      } catch (error) {
+        carrierRejection = error.message;
+      }
+    }
     if (!dryRun && (decision.decision === 'write') !== accepted) {
       logger.warn('[processOutreach] decision and delivery disagree', {
         code, decision: decision.decision, accepted, status: delivery?.status || null,
@@ -1049,6 +1057,7 @@ class NexusMessaging {
       holdReason: decision.holdReason || null,
       nextCheckAt: decision.nextCheckAt || null,
       draft: dryRun ? (runResult.output || '') : null,
+      carrierRejection,
       accepted,
       delivered,
       deferred: Boolean(delivery?.deferred),

package/lib/index.d.ts

@@ -475,6 +475,8 @@ declare module '@peopl-health/nexus' {
     nextCheckAt: string | null;
     /** Drafted patient-facing text. Present only on a dry run. */
     draft?: string | null;
+    /** Why the out-of-window template would refuse the draft. Present only on a dry run. */
+    carrierRejection?: string | null;
     /** Whether the provider accepted the fixed-template send. This is not proof of delivery. */
     accepted?: boolean;
     /** Whether the provider status is already terminal delivered/read. */

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@peopl-health/nexus",
-  "version": "5.71.6",
+  "version": "5.71.8",
   "description": "Core messaging and assistant library for WhatsApp communication platforms",
   "keywords": [
     "whatsapp",