const { useMemo, useState } = React;

const toolMeta = [
  { id: 'af', title: 'AF Anticoagulation Decision Aid', label: 'Stroke and bleeding decision aid', subtitle: 'CHA₂DS₂-VASc, HAS-BLED-style bleeding review, estimated 1/5/10-year stroke risk, anticoagulation effect framing, and warfarin/DOAC danger zones.' },
  { id: 'antithrombotic', title: 'Antithrombotic Safety Assistant', label: 'Vascular medicine safety tool', subtitle: 'Thrombosis on anticoagulation, LMWH/fondaparinux exposure, anti-Xa interpretation, antithrombin deficiency, PF4/HIT/VITT spectrum, APS, DOAC danger zones, and vascular red flags.' },
  { id: 'hyponatremia', title: 'Hyponatremia Diagnostic Engine', label: 'GIM diagnostic engine', subtitle: 'Symptoms first, then tonicity, urine osmolality, urine sodium, volume context, low-solute/polydipsia, SIADH mimics, uric acid/FEUA, and correction-safety guardrails.' },
  { id: 'vte', title: 'Medical Inpatient VTE Prophylaxis Tool', label: 'QI / hospital medicine', subtitle: 'Structured prophylaxis status: pharmacologic, mechanical, already anticoagulated, contraindicated, or reassess in 24 hours.' },
  { id: 'surgical-vte', title: 'Post-op DVT/VTE Prophylaxis Assistant', label: 'Surgical prophylaxis: orthopedic + non-orthopedic', subtitle: 'Thrombosis Canada-style bedside tool for orthopedic and non-orthopedic surgical prophylaxis: procedure type, bleeding risk, VTE risk, renal function, neuraxial timing, mechanical vs pharmacologic prophylaxis, and duration prompts.' },
  { id: 'hypokalemia', title: 'Hypokalemia + Acid–Base Engine', label: 'GIM electrolyte reasoning', subtitle: 'K replacement safety, magnesium, acid–base pattern, urine potassium/chloride, blood pressure, renal vs GI loss, RTA, diuretics, and mineralocorticoid states.' },
  { id: 'proteinuria', title: 'Proteinuria Interpreter', label: 'Renal/GIM reasoning', subtitle: 'Proteinuria phenotype, nephrotic/nephritic flags, albumin context, systemic clues, and next bedside checks.' },
  { id: 'cirrhosis', title: 'Coagulation in Cirrhosis', label: 'Coagulation reasoning', subtitle: 'INR interpretation, fibrinogen/platelet thresholds, procedure/bleeding context, thrombosis paradox, TEG/ROTEM, vitamin K, lupus anticoagulant, factor VIII/vWF logic.' },
  { id: 'periop-doac', title: 'Perioperative DOAC Interruption Planner', label: 'PAUSE-style perioperative anticoagulation', subtitle: 'Procedure bleeding risk, neuraxial flag, DOAC type, renal function, pre-op hold timing, post-op restart timing, and bridging cautions.' },
  { id: 'unusual-thrombosis', title: 'Unusual-Site Thrombosis Workup Tool', label: 'Niche vascular medicine workup', subtitle: 'Splanchnic, hepatic/portal, cerebral venous, renal vein, upper-extremity, young arterial thrombosis, OCP/estrogen, Lp(a), APS, JAK2/MPN, PNH, malignancy, vasculitis, and anatomic triggers.' },
  { id: 'mins', title: 'MINS Probability & Tracker Tool', label: 'Perioperative GIM', subtitle: 'Postoperative troponin probability framing, serial tracking, ischemic vs non-ischemic triggers, ECG/symptoms, anemia, sepsis, PE, hypotension, and follow-up actions.' },
  { id: 'vascular-clinic-pathways', title: 'PAD / Vascular Clinic Pathway', label: 'PAD clinic visit standardization', subtitle: 'Junior-friendly pathway for suspected PAD, confirmed PAD, CLTI red flags, ABI/TBI logic, antithrombotic choices, risk-factor care, referral triggers, counseling, and follow-up.' },
  { id: 'thrombosis-clinic-pathway', title: 'Thrombosis Clinic Pathway', label: 'VTE / arterial thrombosis clinic standardization', subtitle: 'Clinic pathway for new or chronic VTE/arterial thrombosis: provoked vs unprovoked, duration, recurrence, APS/MPN/PNH/Lp(a), CTEPH/PTS, antithrombotic choice, and follow-up.' }
];

// Soft access gate for GitHub Pages.
// This is not true security because static-site code is public.
// For true registered-user access, put the tools behind Cloudflare Access or another server-side auth layer.
const ACCESS_USERNAME = 'fahad';
const ACCESS_PASSWORD = 'ChangeThisPassword2026!';

const toolCategories = [
  {
    title: 'Vascular Medicine Clinic Tools',
    description: 'PAD, CLTI, vascular risk reduction, limb-threat triage, referral triggers, and clinic standardization.',
    ids: ['vascular-clinic-pathways']
  },
  {
    title: 'Thrombosis / Antithrombotic Tools',
    description: 'Anticoagulant safety, AF, DOAC interruption, unusual-site thrombosis, VTE prophylaxis, and thrombosis clinic follow-up.',
    ids: ['antithrombotic', 'af', 'periop-doac', 'unusual-thrombosis', 'vte', 'surgical-vte', 'thrombosis-clinic-pathway']
  },
  {
    title: 'General Internal Medicine Tools',
    description: 'Electrolytes, renal interpretation, perioperative troponin reasoning, and complex inpatient diagnostic reasoning.',
    ids: ['hyponatremia', 'hypokalemia', 'proteinuria', 'cirrhosis', 'mins']
  }
];

function navigate(route) {
  window.location.hash = route;
  window.scrollTo({ top: 0, behavior: 'smooth' });
}
function currentRoute() {
  const raw = window.location.hash.replace('#', '').replace(/^\//, '');
  return raw || 'home';
}
function App() {
  const [route, setRoute] = useState(currentRoute());
  React.useEffect(() => {
    const onHash = () => setRoute(currentRoute());
    window.addEventListener('hashchange', onHash);
    return () => window.removeEventListener('hashchange', onHash);
  }, []);
  const toolId = route.startsWith('tool/') ? route.split('/')[1] : null;
  return <><Header />{toolId ? <ToolPage id={toolId} /> : <Home route={route} />}<Footer /></>;
}
function Header() {
  const links = [['home','Home'],['clinical-tools','Tools'],['crft','CRFT'],['qi-projects','QI Projects'],['vascular-medicine','Vascular Medicine'],['publications','Publications'],['contact','Contact']];
  return <header className="site-header"><button className="brand" onClick={() => navigate('home')}><span className="brand-mark">FA</span><span>Fahad Almalki, MD</span></button><nav>{links.map(([id,label]) => <button key={id} onClick={() => navigate(id)}>{label}</button>)}</nav></header>;
}
function Home({ route }) {
  React.useEffect(() => { if (route && route !== 'home') { const el = document.getElementById(route); if (el) setTimeout(() => el.scrollIntoView({ behavior:'smooth', block:'start' }), 50); } }, [route]);
  return <main>
    <section id="home" className="hero compact-hero journey-hero"><div className="hero-inner"><p className="hero-subtitle hero-subtitle-only">General Internal Medicine · Vascular Medicine · Clinical Reasoning · Quality Improvement</p></div></section>
    <section id="clinical-tools" className="section tinted tools-section"><p className="eyebrow">Tools</p><h2>Bedside decision-support tools</h2><ToolGroups /></section>
    <section id="crft" className="section crft-clean"><p className="eyebrow">CRFT</p><h2>Clinical Reasoning Framework for Teaching</h2></section>
    <section id="qi-projects" className="section tinted"><p className="eyebrow">QI Projects</p><h2>Systems that make good care easier</h2><div className="cards"><SimpleCard title="VTE Prophylaxis Standardization" text="Clarify prophylaxis status, contraindications, reassessment, and dashboard reliability for medical inpatients." /><SimpleCard title="CTU Readmission Review" text="Classify early readmissions by diagnostic uncertainty, medication issues, follow-up gaps, social barriers, and discharge readiness." /><SimpleCard title="Perioperative MINS Screening" text="Structured postoperative myocardial injury screening, interpretation, and follow-up pathways." /></div></section>
    <section id="vascular-medicine" className="section"><p className="eyebrow">Vascular Medicine</p><h2>Thrombosis, PAD, antithrombotic therapy, and vascular risk.</h2><p>Resources here emphasize practical bedside reasoning: when thrombosis is real anticoagulant failure, when it is pseudo-failure, when the drug is wrong for the biology, and when vascular red flags suggest a deeper diagnosis.</p></section>
    <section id="publications" className="section tinted"><p className="eyebrow">Publications</p><h2>Publications, abstracts, QI reports, and digital tools</h2><p>Selected work will be added as projects are completed, presented, or published.</p></section>
    <section id="contact" className="section contact"><p className="eyebrow">Contact</p><h2>Professional contact</h2><p><a href="mailto:contact@fahadalmalkimd.com">contact@fahadalmalkimd.com</a></p><p><a href="mailto:fahad@fahadalmalkimd.com">fahad@fahadalmalkimd.com</a></p></section>
  </main>;
}
function ToolCard({ tool }) { return <article className="card tool-card"><p className="tag">{tool.label}</p><h3>{tool.title}</h3><p>{tool.subtitle}</p><button className="primary" onClick={() => navigate('tool/' + tool.id)}>Open tool</button></article>; }
function ToolGroups() {
  return <div className="tool-groups">{toolCategories.map(group => <section className="tool-group" key={group.title}><div className="tool-group-heading"><p className="eyebrow">{group.title}</p><p>{group.description}</p></div><div className="cards">{group.ids.map(id => toolMeta.find(t => t.id === id)).filter(Boolean).map(tool => <ToolCard key={tool.id} tool={tool} />)}</div></section>)}</div>;
}
function SimpleCard({ title, text }) { return <article className="card"><h3>{title}</h3><p>{text}</p></article>; }
function InfoBlock({ title, items }) { return <div className="info-block"><h3>{title}</h3><ul>{items.map(i => <li key={i}>{i}</li>)}</ul></div>; }
function ToolPage({ id }) {
  const meta = toolMeta.find(t => t.id === id);
  const [authed, setAuthed] = useState(() => localStorage.getItem('fahadToolsAccess') === 'true');
  if (!authed) {
    return <main className="tool-page"><section className="tool-hero"><button className="ghost" onClick={() => navigate('home')}>← Back to Home</button><h1>{meta?.title || 'Protected tool'}</h1><p>{meta?.subtitle}</p></section><AccessGate onSuccess={() => setAuthed(true)} /></main>;
  }
  return <main className="tool-page"><section className="tool-hero"><button className="ghost" onClick={() => navigate('home')}>← Back to Home</button><button className="ghost" onClick={() => navigate('clinical-tools')}>Tools</button><button className="ghost" onClick={() => { localStorage.removeItem('fahadToolsAccess'); setAuthed(false); }}>Log out tools</button><h1>{meta?.title || 'Tool'}</h1><p>{meta?.subtitle}</p></section>{id === 'af' && <AFTool />}{id === 'antithrombotic' && <AntithromboticTool />}{id === 'hyponatremia' && <HyponatremiaTool />}{id === 'vte' && <VTETool />}{id === 'surgical-vte' && <SurgicalVTETool />}{id === 'hypokalemia' && <HypokalemiaTool />}{id === 'proteinuria' && <ProteinuriaTool />}{id === 'cirrhosis' && <CirrhosisTool />}{id === 'periop-doac' && <PeriopDOACTool />}{id === 'unusual-thrombosis' && <UnusualThrombosisTool />}{id === 'mins' && <MINSTool />}{id === 'vascular-clinic-pathways' && <VascularClinicPathwaysTool mode="vascular" />}{id === 'thrombosis-clinic-pathway' && <VascularClinicPathwaysTool mode="thrombosis" />}</main>;
}
function AccessGate({ onSuccess }) {
  const [u, setU] = useState('');
  const [p, setP] = useState('');
  const [err, setErr] = useState('');
  function submit(e) {
    e.preventDefault();
    if (u === ACCESS_USERNAME && p === ACCESS_PASSWORD) {
      localStorage.setItem('fahadToolsAccess', 'true');
      setErr('');
      onSuccess();
    } else {
      setErr('Incorrect username or password.');
    }
  }
  return <section className="section access-section"><div className="access-card"><p className="eyebrow">Protected clinical tools</p><h2>Sign in to open this tool</h2><p className="muted">The home page remains public. Tool pages are gated for invited users.</p><form onSubmit={submit} className="access-form"><label>Username<input value={u} onChange={e=>setU(e.target.value)} autoComplete="username" /></label><label>Password<input type="password" value={p} onChange={e=>setP(e.target.value)} autoComplete="current-password" /></label>{err && <p className="error-text">{err}</p>}<button className="primary" type="submit">Open tool</button></form><p className="small-note">Technical note: this is a static-site gate for convenience. Do not place confidential patient data or restricted content here.</p></div></section>;
}

function Field({ label, children, hint }) { return <label className="field"><span>{label}</span>{children}{hint && <small>{hint}</small>}</label>; }
function Check({ label, checked, onChange, help }) { return <label className="check"><input type="checkbox" checked={checked} onChange={e => onChange(e.target.checked)} /> <span>{label}{help && <small className="check-help">{help}</small>}</span></label>; }
function HelpText({ children }) { return <small className="help-text">{children}</small>; }
function Num({ value, onChange, min, max, step='1' }) { return <input type="number" value={value} min={min} max={max} step={step} onChange={e => onChange(e.target.value)} />; }
function Select({ value, onChange, children }) { return <select value={value} onChange={e => onChange(e.target.value)}>{children}</select>; }
function Output({ title, children, tone='' }) { return <div className={'output ' + tone}><h3>{title}</h3>{children}</div>; }
function Pill({ children, tone='' }) { return <span className={'pill ' + tone}>{children}</span>; }
function pct(x) { if (x === null || isNaN(x)) return '—'; return (x < 1 ? x.toFixed(1) : x.toFixed(1)) + '%'; }
function cumRisk(annual, years) { const p = annual/100; return (1 - Math.pow(1-p, years))*100; }
function list(items) { const filtered = items.filter(Boolean); return filtered.length ? <ul>{filtered.map((i,idx) => <li key={idx}>{i}</li>)}</ul> : <p>No major flags selected.</p>; }
function copyText(text) { navigator.clipboard && navigator.clipboard.writeText(text); }

const strokeRisk = {0:0.2,1:0.6,2:2.2,3:3.2,4:4.8,5:7.2,6:9.7,7:11.2,8:10.8,9:12.2};
const bleedRisk = {0:1.1,1:1.0,2:1.9,3:3.7,4:8.7,5:12.5,6:12.5,7:12.5,8:12.5,9:12.5};

function AFTool() {
  const [s,setS] = useState({sex:'male', age:'0', chf:false, htn:false, dm:false, stroke:false, vascular:false, renal:false, liver:false, bleed:false, labile:false, drugs:false, alcohol:false, mechanical:false, ms:false, rheumatic:false, pregnant:false, severeRenal:false, severeLiver:false, aps:false, adherence:false, falls:false, anemia:false});
  const chads = (s.chf?1:0)+(s.htn?1:0)+(s.dm?1:0)+(s.stroke?2:0)+(s.vascular?1:0)+(s.sex==='female'?1:0)+(s.age==='65'?1:0)+(s.age==='75'?2:0);
  const hasbled = (s.htn?1:0)+(s.renal?1:0)+(s.liver?1:0)+(s.stroke?1:0)+(s.bleed?1:0)+(s.labile?1:0)+((s.age==='65'||s.age==='75')?1:0)+(s.drugs?1:0)+(s.alcohol?1:0);
  const annualStroke = strokeRisk[Math.min(chads,9)] || 0;
  const annualBleed = bleedRisk[Math.min(hasbled,9)] || 1.1;
  const treatedStroke = annualStroke * 0.35;
  const decision = (s.mechanical||s.ms||s.rheumatic) ? 'Warfarin-preferred zone' : chads >= (s.sex==='female'?3:2) ? 'Anticoagulation usually recommended' : chads === (s.sex==='female'?2:1) ? 'Intermediate zone: shared decision' : 'Low annual stroke risk: usually no anticoagulation';
  const danger = [s.mechanical && 'Mechanical valve: DOACs should not be used; warfarin pathway.', s.ms && 'Moderate-to-severe mitral stenosis: warfarin preferred.', s.rheumatic && 'Rheumatic AF: warfarin favored based on rheumatic-valvular AF data.', s.pregnant && 'Pregnancy/breastfeeding context: anticoagulant choice requires specialist pathway.', s.severeRenal && 'Severe renal dysfunction: DOAC dose/choice may be unsafe or off-label.', s.severeLiver && 'Significant liver disease/coagulopathy: DOAC bleeding and metabolism concerns.', s.aps && 'Known/suspected high-risk APS: avoid reflex DOAC use.', s.adherence && 'Adherence concern: DOAC short half-life makes missed doses matter.', s.falls && 'Falls/frailty: do not automatically withhold AC; quantify falls/trauma risk and modifiable factors.', s.anemia && 'Unexplained anemia/occult bleed: investigate and mitigate bleeding source.'];
  const note = `AF anticoagulation discussion: CHA2DS2-VASc ${chads}, estimated untreated stroke/systemic embolism risk ~${pct(annualStroke)} at 1 year, ${pct(cumRisk(annualStroke,5))} at 5 years, ${pct(cumRisk(annualStroke,10))} at 10 years. Estimated on-anticoagulation residual stroke risk ~${pct(treatedStroke)} at 1 year. HAS-BLED-style score ${hasbled}, estimated major bleeding risk ~${pct(annualBleed)} / year. Decision frame: ${decision}. Key cautions: ${danger.filter(Boolean).join(' ') || 'no major danger-zone selected.'}`;
  return <ToolShell disclaimer="Risk estimates are approximations to support shared decision-making, not individualized prediction. Use local policy and clinical judgment.">
    <div className="tool-grid"><div className="panel"><h2>Stroke risk: CHA₂DS₂-VASc</h2><Field label="Age"><Select value={s.age} onChange={v=>setS({...s,age:v})}><option value="0">&lt;65</option><option value="65">65–74</option><option value="75">≥75</option></Select></Field><Field label="Sex"><Select value={s.sex} onChange={v=>setS({...s,sex:v})}><option value="male">Male</option><option value="female">Female</option></Select></Field><Check label="Heart failure / LV dysfunction" checked={s.chf} onChange={v=>setS({...s,chf:v})}/><Check label="Hypertension" checked={s.htn} onChange={v=>setS({...s,htn:v})}/><Check label="Diabetes" checked={s.dm} onChange={v=>setS({...s,dm:v})}/><Check label="Prior stroke/TIA/systemic embolism" checked={s.stroke} onChange={v=>setS({...s,stroke:v})}/><Check label="Vascular disease: MI/PAD/aortic plaque" checked={s.vascular} onChange={v=>setS({...s,vascular:v})}/></div>
    <div className="panel"><h2>Bleeding and danger-zone review</h2><Check label="Abnormal renal function" checked={s.renal} onChange={v=>setS({...s,renal:v})}/><Check label="Abnormal liver function" checked={s.liver} onChange={v=>setS({...s,liver:v})}/><Check label="Prior major bleeding / predisposition" checked={s.bleed} onChange={v=>setS({...s,bleed:v})}/><Check label="Labile INR if on warfarin" checked={s.labile} onChange={v=>setS({...s,labile:v})}/><Check label="Antiplatelet/NSAID or interacting drugs" checked={s.drugs} onChange={v=>setS({...s,drugs:v})}/><Check label="Alcohol excess" checked={s.alcohol} onChange={v=>setS({...s,alcohol:v})}/><hr/><Check label="Mechanical valve" checked={s.mechanical} onChange={v=>setS({...s,mechanical:v})}/><Check label="Moderate-to-severe mitral stenosis" checked={s.ms} onChange={v=>setS({...s,ms:v})}/><Check label="Rheumatic valvular disease" checked={s.rheumatic} onChange={v=>setS({...s,rheumatic:v})}/><Check label="Pregnancy/breastfeeding context" checked={s.pregnant} onChange={v=>setS({...s,pregnant:v})}/><Check label="Severe renal disease / dialysis / unstable AKI" checked={s.severeRenal} onChange={v=>setS({...s,severeRenal:v})}/><Check label="Significant liver disease/coagulopathy" checked={s.severeLiver} onChange={v=>setS({...s,severeLiver:v})}/><Check label="Known/suspected APS" checked={s.aps} onChange={v=>setS({...s,aps:v})}/><Check label="Adherence or absorption concern" checked={s.adherence} onChange={v=>setS({...s,adherence:v})}/><Check label="Falls/frailty/trauma risk" checked={s.falls} onChange={v=>setS({...s,falls:v})}/><Check label="Unexplained anemia/occult bleeding concern" checked={s.anemia} onChange={v=>setS({...s,anemia:v})}/></div></div>
    <div className="result-grid"><Output title="Decision frame" tone="highlight"><p><Pill tone="blue">CHA₂DS₂-VASc {chads}</Pill> <Pill tone="amber">HAS-BLED style {hasbled}</Pill></p><h4>{decision}</h4><p>Teaching point: separate the <b>need for stroke prevention</b> from the <b>choice of anticoagulant</b>. A high bleeding score usually means “fix bleeding risks and monitor,” not automatically “withhold anticoagulation.”</p></Output><Output title="Estimated risk frame"><table><tbody><tr><th></th><th>1 year</th><th>5 years</th><th>10 years</th></tr><tr><td>Untreated stroke/systemic embolism</td><td>{pct(annualStroke)}</td><td>{pct(cumRisk(annualStroke,5))}</td><td>{pct(cumRisk(annualStroke,10))}</td></tr><tr><td>Estimated on anticoagulation</td><td>{pct(treatedStroke)}</td><td>{pct(cumRisk(treatedStroke,5))}</td><td>{pct(cumRisk(treatedStroke,10))}</td></tr><tr><td>Absolute risk reduction</td><td>{pct(annualStroke-treatedStroke)}</td><td>{pct(cumRisk(annualStroke,5)-cumRisk(treatedStroke,5))}</td><td>{pct(cumRisk(annualStroke,10)-cumRisk(treatedStroke,10))}</td></tr><tr><td>Major bleeding estimate</td><td>{pct(annualBleed)}</td><td>{pct(cumRisk(annualBleed,5))}</td><td>{pct(cumRisk(annualBleed,10))}</td></tr></tbody></table></Output><Output title="Do-not-miss cautions" tone="warning">{list(danger)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div>
  </ToolShell>;
}

function AntithromboticTool() {
  const [s,setS]=useState({newClot:false, arterial:false, unusual:false, massive:false, anticoag:'lmwh', doses:false, wrongDose:false, renal:false, obesity:false, absorption:false, malignancy:false, pregnancy:false, pltFall:false, heparin5:false, vaccine:false, necrosis:false, thrombosisOnHeparin:false, pf4Prev:false, atLow:false, nephrotic:false, liver:false, dic:false, antiXa:false, antiXaTiming:'unknown', aps:false, tripleAPS:false, valve:false, ms:false, cancer:false, mpn:false, pnh:false, vasculitis:false, anatomic:false, postop:false, infection:false, tPlatelet:'1', tTiming:'1', tThrombosis:'0', tOther:'1'});
  const fourT = Number(s.tPlatelet)+Number(s.tTiming)+Number(s.tThrombosis)+Number(s.tOther);
  const hitProb = fourT <= 3 ? 'Low HIT probability' : fourT <=5 ? 'Intermediate HIT probability' : 'High HIT probability';
  const red=[s.massive&&'Massive/submassive PE, limb-threatening thrombosis, stroke, mesenteric ischemia, or organ-threatening event: urgent escalation.',s.arterial&&'Arterial thrombosis: think APS, HIT/PF4, MPN, PNH, embolic source, vasculitis, anatomic lesion.',s.unusual&&'Unusual-site thrombosis: splanchnic/cerebral/adrenal/skin necrosis pattern needs non-routine thrombosis workup.',s.pltFall&&'Thrombocytopenia with thrombosis: PF4/HIT/VITT spectrum until proven otherwise.',s.necrosis&&'Skin necrosis or adrenal hemorrhage pattern: HIT/PF4, warfarin necrosis, DIC, APS/catastrophic APS.',s.tripleAPS&&'Triple-positive/high-risk APS: avoid DOAC as default; warfarin or specialist pathway.',s.valve&&'Mechanical valve: DOAC danger zone.',s.ms&&'Moderate-to-severe mitral stenosis/rheumatic AF: warfarin pathway.'];
  const pseudo=[s.doses&&'Missed doses/holding for procedures: pseudo-failure before declaring drug failure.',s.wrongDose&&'Wrong dose or wrong renal adjustment: verify indication dose, weight, renal function, and start date.',s.renal&&'Renal dysfunction: DOAC/LMWH accumulation or under/over-dosing depending on agent and timing.',s.obesity&&'Extreme weight: consider drug exposure, dosing caps, and whether monitoring is interpretable.',s.absorption&&'Poor absorption: vomiting, bowel resection, feeding tube, interacting food/meds may make oral agents unreliable.',s.malignancy&&'Cancer-associated thrombosis: recurrent VTE may need class switch/intensification after adherence confirmed.',s.pregnancy&&'Pregnancy/postpartum: physiology and drug choice change; avoid casual DOAC selection.'];
  const heparin=[s.atLow&&'Low antithrombin can reduce UFH/LMWH/fondaparinux effect because these amplify AT activity.',s.nephrotic&&'Nephrotic protein loss can lower AT and increase thrombosis risk.',s.liver&&'Liver disease can lower AT and also distort INR-based thinking.',s.dic&&'DIC/sepsis can consume AT and create heparin resistance patterns.',s.antiXa&&`Anti-Xa selected: timing = ${s.antiXaTiming}. Interpret only if assay is drug-calibrated and sampled at the right time.`];
  const pf4=[s.heparin5&&'Heparin exposure 5–10 days before platelet fall fits typical HIT timing.',s.pf4Prev&&'Recent heparin exposure can cause rapid-onset HIT after re-exposure.',s.vaccine&&'Recent adenoviral-vector vaccine + thrombosis/thrombocytopenia suggests VITT/PF4-spectrum review.',s.thrombosisOnHeparin&&'Thrombosis progressing on heparin/LMWH plus platelet fall is a HIT emergency pattern.'];
  const workup=[s.mpn&&'MPN screen: CBC trend, JAK2/CALR/MPL when splanchnic/unusual thrombosis or erythro/thrombocytosis.',s.pnh&&'PNH screen: flow cytometry if hemolysis/cytopenias/unusual thrombosis.',s.vasculitis&&'Vasculitis/inflammation: ESR/CRP, complements, ANCA/ANA/APS context when arterial/multisystem.',s.anatomic&&'Anatomic lesion: May-Thurner, thoracic outlet, catheter/device, tumor compression, aneurysm/mural thrombus.',s.cancer&&'Malignancy: age-appropriate and phenotype-directed evaluation; avoid indiscriminate testing.',s.infection&&'Infection/inflammation can drive thrombosis and thrombocytopenia; search for source if clinical clues.',s.postop&&'Postoperative thrombosis: check prophylaxis interruptions, bleeding holds, immobility, catheter/device.'];
  const immediate=[fourT>=4&&'If HIT probability intermediate/high: stop all heparin/LMWH flushes, send PF4 immunoassay ± functional assay, start non-heparin anticoagulant if no prohibitive bleeding.',s.vaccine&&'If VITT suspected: avoid heparin until clarified, send PF4 ELISA, fibrinogen, D-dimer; urgent hematology; IVIG pathway if likely.',s.atLow&&'If thrombosis on UFH/LMWH with low AT/heparin resistance: do not just increase dose blindly; verify anti-Xa assay/timing and consider non-AT-dependent anticoagulant strategy with hematology.',s.tripleAPS&&'If high-risk APS: avoid DOAC continuation after recurrent thrombosis; consider warfarin/heparin specialist plan.',s.newClot&&'Confirm true new/progressive thrombosis with imaging comparison before labeling failure.'];
  const note=`Antithrombotic Safety Assistant: anticoagulant=${s.anticoag}; true/progressive thrombosis=${s.newClot?'yes':'no'}; 4Ts=${fourT} (${hitProb}). Key red flags: ${red.filter(Boolean).join(' ')||'none selected'}. Pseudo-failure checks: ${pseudo.filter(Boolean).join(' ')||'none selected'}. Heparin/anti-Xa/AT issues: ${heparin.filter(Boolean).join(' ')||'none selected'}. PF4 spectrum: ${pf4.filter(Boolean).join(' ')||'none selected'}. Immediate considerations: ${immediate.filter(Boolean).join(' ')||'confirm phenotype and medication history.'}`;
  return <ToolShell disclaimer="This tool is a safety checklist. It does not replace urgent hematology/vascular/cardiology input for organ- or limb-threatening thrombosis."><div className="tool-grid"><div className="panel"><h2>Event phenotype</h2><Check label="Confirmed new/progressive thrombosis while anticoagulated" checked={s.newClot} onChange={v=>setS({...s,newClot:v})}/><Check label="Arterial thrombosis" checked={s.arterial} onChange={v=>setS({...s,arterial:v})}/><Check label="Unusual-site thrombosis" checked={s.unusual} onChange={v=>setS({...s,unusual:v})}/><Check label="Massive/submassive or organ/limb-threatening" checked={s.massive} onChange={v=>setS({...s,massive:v})}/><Field label="Current anticoagulant"><Select value={s.anticoag} onChange={v=>setS({...s,anticoag:v})}><option value="ufh">UFH</option><option value="lmwh">LMWH</option><option value="fondaparinux">Fondaparinux</option><option value="doac">DOAC</option><option value="warfarin">Warfarin</option><option value="none">None/held</option></Select></Field></div><div className="panel"><h2>Pseudo-failure checklist</h2><Check label="Missed doses / held for procedure" checked={s.doses} onChange={v=>setS({...s,doses:v})}/><Check label="Wrong dose / wrong renal adjustment" checked={s.wrongDose} onChange={v=>setS({...s,wrongDose:v})}/><Check label="Renal dysfunction" checked={s.renal} onChange={v=>setS({...s,renal:v})}/><Check label="Extreme body weight" checked={s.obesity} onChange={v=>setS({...s,obesity:v})}/><Check label="Absorption concern" checked={s.absorption} onChange={v=>setS({...s,absorption:v})}/><Check label="Cancer-associated thrombosis" checked={s.malignancy} onChange={v=>setS({...s,malignancy:v})}/><Check label="Pregnancy/postpartum" checked={s.pregnancy} onChange={v=>setS({...s,pregnancy:v})}/></div><div className="panel"><h2>PF4/HIT/VITT screen</h2><Check label="Platelet fall / thrombocytopenia" checked={s.pltFall} onChange={v=>setS({...s,pltFall:v})}/><Check label="Heparin exposure 5–10 days" checked={s.heparin5} onChange={v=>setS({...s,heparin5:v})}/><Check label="Recent heparin exposure with rapid fall" checked={s.pf4Prev} onChange={v=>setS({...s,pf4Prev:v})}/><Check label="Thrombosis progressing on heparin/LMWH" checked={s.thrombosisOnHeparin} onChange={v=>setS({...s,thrombosisOnHeparin:v})}/><Check label="Recent adenoviral-vector vaccine context" checked={s.vaccine} onChange={v=>setS({...s,vaccine:v})}/><Check label="Skin necrosis/adrenal hemorrhage pattern" checked={s.necrosis} onChange={v=>setS({...s,necrosis:v})}/><div className="score-guide"><h3>4Ts score — quick bedside guide</h3><p>The 4Ts score estimates pre-test probability of HIT. Use it before ordering PF4 testing. 0–3 = low, 4–5 = intermediate, 6–8 = high.</p><p><b>Important:</b> for “Other causes,” the scoring is reversed: 2 means no clear alternative cause; 0 means another cause is very likely.</p></div><div className="mini-grid"><Field label="Platelet fall" hint="2: >50% fall and nadir ≥20. 1: 30–50% fall or nadir 10–19. 0: <30% fall or nadir <10."><Select value={s.tPlatelet} onChange={v=>setS({...s,tPlatelet:v})}><option value="0">0 — not typical</option><option value="1">1 — possible</option><option value="2">2 — typical</option></Select></Field><Field label="Timing" hint="2: day 5–10 after heparin, or ≤1 day if heparin exposure in last 30 days. 1: unclear day 5–10, after day 10, or rapid fall with exposure 30–100 days ago. 0: ≤4 days without recent heparin."><Select value={s.tTiming} onChange={v=>setS({...s,tTiming:v})}><option value="0">0 — wrong timing</option><option value="1">1 — possible timing</option><option value="2">2 — classic timing</option></Select></Field><Field label="Thrombosis" hint="2: new thrombosis, skin necrosis, or acute systemic reaction after IV heparin. 1: progressive/recurrent thrombosis or suspected thrombosis. 0: none."><Select value={s.tThrombosis} onChange={v=>setS({...s,tThrombosis:v})}><option value="0">0 — no thrombosis</option><option value="1">1 — possible/suspected</option><option value="2">2 — new/clear thrombosis</option></Select></Field><Field label="Other causes" hint="2: no other likely cause. 1: possible other cause. 0: definite alternative cause such as sepsis/DIC/chemo/drug/post-op dilution/bleeding."><Select value={s.tOther} onChange={v=>setS({...s,tOther:v})}><option value="0">0 — definite other cause</option><option value="1">1 — possible other cause</option><option value="2">2 — no clear other cause</option></Select></Field></div></div><div className="panel"><h2>AT / anti-Xa / DOAC danger zones</h2><Check label="Known/suspected low antithrombin" checked={s.atLow} onChange={v=>setS({...s,atLow:v})}/><Check label="Nephrotic syndrome/protein loss" checked={s.nephrotic} onChange={v=>setS({...s,nephrotic:v})}/><Check label="Liver disease" checked={s.liver} onChange={v=>setS({...s,liver:v})}/><Check label="DIC/sepsis/consumption" checked={s.dic} onChange={v=>setS({...s,dic:v})}/><Check label="Anti-Xa being interpreted" checked={s.antiXa} onChange={v=>setS({...s,antiXa:v})}/><Field label="Anti-Xa timing"><Select value={s.antiXaTiming} onChange={v=>setS({...s,antiXaTiming:v})}><option value="unknown">unknown</option><option value="peak">peak/right time</option><option value="trough">trough/wrong time</option><option value="after hold">after held doses</option></Select></Field><Check label="Known/suspected APS" checked={s.aps} onChange={v=>setS({...s,aps:v})}/><Check label="Triple-positive/high-risk APS" checked={s.tripleAPS} onChange={v=>setS({...s,tripleAPS:v})}/><Check label="Mechanical valve" checked={s.valve} onChange={v=>setS({...s,valve:v})}/><Check label="Moderate-to-severe MS/rheumatic AF" checked={s.ms} onChange={v=>setS({...s,ms:v})}/></div><div className="panel"><h2>Deep vascular red flags</h2><Check label="MPN clue" help="Think myeloproliferative neoplasm: unexplained erythrocytosis/thrombocytosis/leukocytosis, splenomegaly, splanchnic/portal/hepatic vein thrombosis, Budd–Chiari, microvascular symptoms, or thrombosis out of proportion." checked={s.mpn} onChange={v=>setS({...s,mpn:v})}/><Check label="PNH clue" help="Think PNH: thrombosis at unusual sites plus hemolysis/cytopenias — dark urine, high LDH, low haptoglobin, abdominal pain, pancytopenia, or aplastic anemia/MDS context." checked={s.pnh} onChange={v=>setS({...s,pnh:v})}/><Check label="Vasculitis/systemic inflammation" help="Arterial events, renal/skin/neurologic signs, constitutional symptoms, high inflammatory markers, low complements, ANCA/ANA clues." checked={s.vasculitis} onChange={v=>setS({...s,vasculitis:v})}/><Check label="Anatomic lesion/device/compression" help="May-Thurner, thoracic outlet, catheter/device, tumor compression, aneurysm/mural thrombus, local venous obstruction." checked={s.anatomic} onChange={v=>setS({...s,anatomic:v})}/><Check label="Malignancy concern" help="Unprovoked/recurrent VTE, unusual sites, weight loss, anemia, high platelets, smoking history, or age-appropriate screening gaps." checked={s.cancer} onChange={v=>setS({...s,cancer:v})}/><Check label="Post-op/immobility/catheter context" help="Clarify whether prophylaxis was held, bleeding risk changed, central line/device present, or mobility was reduced." checked={s.postop} onChange={v=>setS({...s,postop:v})}/><Check label="Infection/inflammation context" help="Sepsis, osteomyelitis, necrotizing infection, inflammatory flare, severe COVID/viral illness can drive thrombosis and thrombocytopenia." checked={s.infection} onChange={v=>setS({...s,infection:v})}/></div></div><div className="result-grid"><Output title="Immediate safety frame" tone="highlight"><p><Pill tone={fourT>=4?'red':'blue'}>4Ts {fourT}: {hitProb}</Pill></p>{list(immediate)}</Output><Output title="Red flags" tone="warning">{list(red)}</Output><Output title="Pseudo-failure before true failure">{list(pseudo)}</Output><Output title="Heparin / fondaparinux / anti-Xa / AT reasoning">{list(heparin)}</Output><Output title="PF4 spectrum">{list(pf4)}</Output><Output title="Niche vascular workup prompts">{list(workup)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>;
}

function HyponatremiaTool(){
 const [s,setS]=useState({na:'124',glucose:'5.5',sym:'mild',serumOsm:'',urineOsm:'',urineNa:'',volume:'unknown',diuretic:false,thiazide:false,lowSolute:false,polydipsia:false,edema:false,siadh:false,adrenal:false,thyroid:false,uric:false,ods:false,hypokalemia:false,malnutrition:false,liver:false,alcohol:false});
 const na=Number(s.na), glu=Number(s.glucose), serum=Number(s.serumOsm), uosm=Number(s.urineOsm), una=Number(s.urineNa); const corrected= na + Math.max(0,(glu-5.6))*0.4;
 let pathway='Enter serum osmolality and urine studies to classify.'; let reasoning=[]; let action=[];
 if(s.sym==='severe'){action.push('Severe symptoms: treat as emergency; hypertonic saline bolus pathway while monitoring Na frequently. Do not wait for full urine workup.');}
 if(serum){ if(serum>=275) {pathway='Non-hypotonic or translocational hyponatremia'; reasoning.push('Check glucose, mannitol, contrast, pseudohyponatremia from lipids/protein. Do not fluid restrict automatically.');} else {pathway='Hypotonic hyponatremia'; reasoning.push('Hypotonicity confirmed: now decide whether ADH is off or on using urine osmolality.'); if(uosm){ if(uosm<100){pathway+=' → ADH-off pattern'; reasoning.push('Urine Osm <100: kidney is appropriately dumping free water. Think primary polydipsia, low solute intake, reset after water load.'); if(s.lowSolute) reasoning.push('Low solute clue: tea/toast/beer potomania physiology; adding solute can rapidly autocorrect sodium.'); if(s.polydipsia) reasoning.push('Polydipsia clue: water intake exceeds excretory capacity.'); action.push('Watch for rapid autocorrection once solute/volume is given; consider desmopressin strategy if high ODS risk.'); } else {pathway+=' → ADH-on pattern'; reasoning.push('Urine Osm ≥100: ADH is active; now urine sodium and volume context matter.'); if(una || una===0){ if(una<30){reasoning.push('Urine Na <30 suggests low effective arterial volume: hypovolemia, heart failure, cirrhosis, nephrosis, or low intake.');} else {reasoning.push('Urine Na ≥30 suggests SIADH, adrenal insufficiency, renal salt loss, or diuretic-confounded hypovolemia.');} } } } } }
 if(s.volume==='hypovolemic') action.push('Hypovolemic phenotype: isotonic saline may correct both volume and ADH stimulus; monitor for brisk water diuresis and overcorrection.');
 if(s.edema||s.volume==='hypervolemic') action.push('Edematous/low effective arterial volume: treat underlying HF/cirrhosis/nephrosis; fluid restriction/diuretics strategy depends on hemodynamics.');
 if(s.siadh) reasoning.push('SIADH is a diagnosis of pattern plus exclusion: hypotonic, urine Osm >100, urine Na often >30, clinically euvolemic, no adrenal/thyroid failure, no effective volume depletion.');
 if(s.thiazide) reasoning.push('Thiazide-associated hyponatremia can mimic SIADH; stop thiazide and monitor for autocorrection.');
 if(!s.adrenal) action.push('Before final SIADH label, exclude adrenal insufficiency when clinical context supports it.');
 if(!s.thyroid) action.push('Check thyroid status when clinically indicated; severe hypothyroidism is an uncommon but important mimic.');
 const highRisk=s.ods||s.hypokalemia||s.malnutrition||s.liver||s.alcohol;
 if(highRisk) action.push('High ODS risk: use stricter correction targets, frequent Na checks, and consider desmopressin clamp if sodium starts rising quickly.');
 action.push('Typical safety ceiling: avoid correction >10 mmol/L in 24 h; use ≤8 mmol/L/24 h in high-risk patients.');
 const note=`Hyponatremia: measured Na ${na}, glucose ${glu}, corrected Na ~${corrected.toFixed(1)}. Symptoms: ${s.sym}. Serum Osm ${s.serumOsm||'not entered'}, urine Osm ${s.urineOsm||'not entered'}, urine Na ${s.urineNa||'not entered'}. Pathway: ${pathway}. Reasoning: ${reasoning.join(' ')} Actions/safety: ${action.join(' ')}`;
 return <ToolShell disclaimer="In severe symptomatic hyponatremia, symptoms drive emergency treatment before diagnostic perfection."><div className="tool-grid"><div className="panel"><h2>Core inputs</h2><Field label="Measured serum sodium"><Num value={s.na} onChange={v=>setS({...s,na:v})}/></Field><Field label="Glucose mmol/L"><Num value={s.glucose} onChange={v=>setS({...s,glucose:v})} step="0.1"/></Field><Field label="Symptoms"><Select value={s.sym} onChange={v=>setS({...s,sym:v})}><option value="none">None/minimal</option><option value="mild">Mild/moderate</option><option value="severe">Severe: seizure, coma, severe confusion, severe vomiting/resp distress</option></Select></Field><Field label="Serum osmolality"><Num value={s.serumOsm} onChange={v=>setS({...s,serumOsm:v})}/></Field><Field label="Urine osmolality"><Num value={s.urineOsm} onChange={v=>setS({...s,urineOsm:v})}/></Field><Field label="Urine sodium"><Num value={s.urineNa} onChange={v=>setS({...s,urineNa:v})}/></Field></div><div className="panel"><h2>Context</h2><Field label="Clinical volume phenotype"><Select value={s.volume} onChange={v=>setS({...s,volume:v})}><option value="unknown">unclear</option><option value="hypovolemic">hypovolemic</option><option value="euvolemic">euvolemic</option><option value="hypervolemic">edematous/hypervolemic</option></Select></Field><Check label="Thiazide/diuretic confounder" checked={s.thiazide} onChange={v=>setS({...s,thiazide:v})}/><Check label="Low solute intake" checked={s.lowSolute} onChange={v=>setS({...s,lowSolute:v})}/><Check label="Primary polydipsia clue" checked={s.polydipsia} onChange={v=>setS({...s,polydipsia:v})}/><Check label="Edema/low effective arterial volume" checked={s.edema} onChange={v=>setS({...s,edema:v})}/><Check label="SIADH clue: pain, nausea, CNS/lung disease, meds, malignancy" checked={s.siadh} onChange={v=>setS({...s,siadh:v})}/><Check label="Adrenal insufficiency excluded" checked={s.adrenal} onChange={v=>setS({...s,adrenal:v})}/><Check label="Severe hypothyroidism excluded" checked={s.thyroid} onChange={v=>setS({...s,thyroid:v})}/><Check label="Low uric acid / high FEUA supports SIADH pattern" checked={s.uric} onChange={v=>setS({...s,uric:v})}/></div><div className="panel"><h2>ODS risk</h2><Check label="Na ≤105 or very chronic/unknown duration" checked={s.ods} onChange={v=>setS({...s,ods:v})}/><Check label="Hypokalemia" checked={s.hypokalemia} onChange={v=>setS({...s,hypokalemia:v})}/><Check label="Malnutrition" checked={s.malnutrition} onChange={v=>setS({...s,malnutrition:v})}/><Check label="Advanced liver disease" checked={s.liver} onChange={v=>setS({...s,liver:v})}/><Check label="Alcohol use disorder" checked={s.alcohol} onChange={v=>setS({...s,alcohol:v})}/></div></div><div className="result-grid"><Output title="Pathway" tone="highlight"><h4>{pathway}</h4><p>Corrected Na for hyperglycemia: <b>{corrected.toFixed(1)}</b></p></Output><Output title="Reasoning that should stick">{list(reasoning)}</Output><Output title="Next actions / treatment guardrails" tone="warning">{list(action)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>;
}

function VTETool(){ const [s,setS]=useState({active:false, bleeding:false, plt:'180', renal:'normal', procedure:false, vte:false, cancer:false, immobile:false, infection:false, hf:false, prior:false, contraindication:false}); const plt=Number(s.plt); const risk=[s.vte,s.cancer,s.immobile,s.infection,s.hf,s.prior].filter(Boolean).length; let rec='No pharmacologic prophylaxis trigger selected; reassess daily.'; if(s.active) rec='Already therapeutically anticoagulated: do not add prophylaxis; document indication and reassess holds.'; else if(s.bleeding||s.contraindication||plt<50||s.procedure) rec='Hold pharmacologic prophylaxis; document reason and reassess within 24 hours. Use mechanical prophylaxis if appropriate.'; else if(risk>=1) rec='Order pharmacologic VTE prophylaxis unless local contraindication exists.'; const labs=[plt<50&&'Platelets <50: bleeding/hold threshold context; reassess trend and reason.',s.renal==='severe'&&'Severe renal dysfunction: choose UFH or renal-adjusted strategy per policy.',s.procedure&&'Procedure planned: specify timing of hold and restart.',s.bleeding&&'Active bleeding: document site, stability, and restart plan.']; const note=`VTE prophylaxis: active therapeutic anticoagulation ${s.active?'yes':'no'}, bleeding/hold ${s.bleeding||s.contraindication?'yes':'no'}, platelets ${plt}, renal ${s.renal}, risk factors ${risk}. Recommendation: ${rec}`; return <ToolShell><div className="tool-grid"><div className="panel"><h2>Status</h2><Check label="Already therapeutically anticoagulated" checked={s.active} onChange={v=>setS({...s,active:v})}/><Check label="Active bleeding" checked={s.bleeding} onChange={v=>setS({...s,bleeding:v})}/><Field label="Platelets"><Num value={s.plt} onChange={v=>setS({...s,plt:v})}/></Field><Field label="Renal function"><Select value={s.renal} onChange={v=>setS({...s,renal:v})}><option value="normal">normal/mild</option><option value="moderate">moderate CKD</option><option value="severe">severe CKD/AKI/dialysis</option></Select></Field><Check label="Procedure/neuraxial/operation planned" checked={s.procedure} onChange={v=>setS({...s,procedure:v})}/><Check label="Other contraindication documented" checked={s.contraindication} onChange={v=>setS({...s,contraindication:v})}/></div><div className="panel"><h2>VTE risk prompts</h2><Check label="Acute medical admission/reduced mobility" checked={s.immobile} onChange={v=>setS({...s,immobile:v})}/><Check label="Active cancer" checked={s.cancer} onChange={v=>setS({...s,cancer:v})}/><Check label="Infection/inflammation" checked={s.infection} onChange={v=>setS({...s,infection:v})}/><Check label="Heart/respiratory failure" checked={s.hf} onChange={v=>setS({...s,hf:v})}/><Check label="Prior VTE/thrombophilia" checked={s.prior} onChange={v=>setS({...s,prior:v})}/><Check label="Known acute VTE?" checked={s.vte} onChange={v=>setS({...s,vte:v})}/></div></div><div className="result-grid"><Output title="Prophylaxis status" tone="highlight"><h4>{rec}</h4></Output><Output title="Documentation prompts">{list(labs)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>}

function SurgicalVTETool(){
  const [s,setS]=useState({
    surgery:'hip-knee', fracture:false, cancer:false, generalRisk:'moderate', bleedRisk:'moderate', neuraxial:false,
    activeBleed:false, plt:'180', renal:'normal', priorVte:false, thrombophilia:false, immobile:true, obesity:false, estrogen:false,
    age:false, infection:false, epidural:false, alreadyAC:false, plannedProcedure:false
  });
  const plt=Number(s.plt);
  const riskCount=[s.fracture,s.cancer,s.priorVte,s.thrombophilia,s.immobile,s.obesity,s.estrogen,s.age,s.infection].filter(Boolean).length;
  const majorOrtho=['hip-knee','hip-fracture'].includes(s.surgery);
  const lowerRiskOrtho=['arthroscopy','upper-limb'].includes(s.surgery);
  const nonOrtho=s.surgery==='nonortho';
  const contraindicated=s.activeBleed||plt<50||s.epidural||s.alreadyAC;
  let category=[]; let plan=[]; let agent=[]; let duration=[]; let timing=[]; let reasoning=[]; let dontmiss=[];
  if(s.alreadyAC){ category.push('Already therapeutically anticoagulated'); plan.push('Do not add routine prophylactic anticoagulation on top of therapeutic anticoagulation. Manage perioperative interruption/restart separately.'); }
  if(s.activeBleed) { category.push('Active bleeding/high immediate bleeding risk'); plan.push('Hold pharmacologic prophylaxis now; use mechanical prophylaxis if feasible and reassess daily.'); }
  if(plt<50) { category.push('Platelets <50 ×10⁹/L context'); plan.push('Usually hold pharmacologic prophylaxis or individualize with hematology/surgery if thrombosis risk is extreme.'); }
  if(s.epidural||s.neuraxial) { dontmiss.push('Neuraxial/epidural timing is a high-consequence safety issue. Follow local anesthesia/neuraxial timing rules for LMWH/UFH/DOAC start and catheter removal.'); }
  if(majorOrtho){
    category.push('Major orthopedic surgery: high baseline VTE risk');
    reasoning.push('Hip/knee arthroplasty and hip fracture have enough VTE risk that evidence-based prophylaxis is routine unless bleeding risk dominates.');
    plan.push('Use pharmacologic prophylaxis unless contraindicated; add mechanical prophylaxis early when bleeding risk is high or mobility is poor.');
    agent.push('Typical options depend on local policy and surgery: LMWH is a standard default; DOACs may be used after elective hip/knee arthroplasty when appropriate; aspirin-only pathways are protocol-dependent and usually for selected lower-risk arthroplasty patients.');
    duration.push(s.surgery==='hip-fracture'?'Consider extended prophylaxis, commonly about 4–6 weeks after hip fracture/major hip surgery when bleeding risk allows.':'Consider extended prophylaxis after hip/knee arthroplasty; many pathways use about 10–14 days for knee and up to 35 days/4–6 weeks for hip, depending on local protocol and patient risk.');
  } else if(lowerRiskOrtho){
    category.push('Lower-risk orthopedic procedure');
    reasoning.push('Routine anticoagulant prophylaxis is often not needed for minor/lower-limb arthroscopy or upper-limb surgery unless patient-specific VTE risk is high or immobilization is substantial.');
    plan.push(riskCount>=2?'Consider pharmacologic prophylaxis because patient-specific risk factors are accumulating.':'Early mobilization ± mechanical prophylaxis; pharmacologic prophylaxis only if patient-specific VTE risk is high.');
    duration.push('If prophylaxis is used, duration should match immobilization and local protocol rather than automatic extended major-ortho duration.');
  } else if(nonOrtho){
    category.push('Non-orthopedic surgery: risk-stratify rather than automatic prophylaxis');
    reasoning.push('For non-orthopedic surgery, prophylaxis depends on procedure magnitude, patient VTE risk, and bleeding risk. Major cancer surgery, prolonged immobility, prior VTE, thrombophilia, and infection raise risk.');
    if(s.bleedRisk==='high') plan.push('If bleeding risk is high: mechanical prophylaxis first, then start pharmacologic prophylaxis when hemostasis is secure.');
    else if(riskCount>=2||s.generalRisk==='high'||s.cancer) plan.push('Pharmacologic prophylaxis is favored if hemostasis is adequate, often with LMWH or UFH depending on renal function and local policy.');
    else if(riskCount===1||s.generalRisk==='moderate') plan.push('Moderate risk: pharmacologic or mechanical prophylaxis depending on bleeding risk and mobility; reassess daily.');
    else plan.push('Low risk and mobile: early ambulation may be enough; avoid automatic anticoagulant prophylaxis if bleeding risk exceeds benefit.');
    if(s.cancer) duration.push('Major abdominal/pelvic cancer surgery may need extended prophylaxis, commonly up to 4 weeks, if bleeding risk is acceptable.');
    else duration.push('Most non-orthopedic prophylaxis is continued while inpatient or until mobility recovers; extended prophylaxis is reserved for selected high-risk groups.');
  }
  if(!contraindicated && s.renal==='severe') agent.push('Severe renal dysfunction: avoid unadjusted LMWH accumulation; consider UFH or renal-adjusted/local protocol strategy.');
  if(!contraindicated && s.bleedRisk==='high') timing.push('Start pharmacologic prophylaxis only after surgical hemostasis is secure; mechanical prophylaxis can bridge the immediate high-bleeding-risk period.');
  if(!contraindicated && s.bleedRisk!=='high') timing.push('Common bedside frame: start post-op prophylaxis once hemostasis is secure and surgeon/anesthesia timing allows; do not start blindly before neuraxial/epidural safety is addressed.');
  dontmiss.push('Do not confuse DVT prophylaxis with therapeutic anticoagulation for known acute VTE. Known/suspected acute VTE needs a treatment pathway, not prophylaxis dosing.');
  dontmiss.push('Document one of four states: ordered, contraindicated/on hold with reason, mechanical only with reason, or already therapeutically anticoagulated.');
  dontmiss.push('Daily reassessment matters: bleeding risk usually changes faster than thrombosis risk after surgery.');
  const summary=[...category,...reasoning,...plan,...agent,...timing,...duration].filter(Boolean).join(' ');
  const note=`Post-op VTE prophylaxis assessment: surgery ${s.surgery}, bleeding risk ${s.bleedRisk}, renal ${s.renal}, platelets ${plt}, risk factors ${riskCount}, neuraxial/epidural concern ${s.neuraxial||s.epidural}, already anticoagulated ${s.alreadyAC}. Impression/action: ${summary}`;
  return <ToolShell disclaimer="Surgical VTE prophylaxis assistant based on a Thrombosis Canada-style approach. Always verify with local surgical/anesthesia policy, especially neuraxial/epidural timing.">
    <div className="tool-grid">
      <div className="panel"><h2>Procedure type</h2>
        <Field label="Surgery category"><Select value={s.surgery} onChange={v=>setS({...s,surgery:v})}>
          <option value="hip-knee">Elective hip/knee arthroplasty</option><option value="hip-fracture">Hip fracture / major hip surgery</option><option value="arthroscopy">Knee arthroscopy / minor lower-limb procedure</option><option value="upper-limb">Upper-limb orthopedic procedure</option><option value="nonortho">Non-orthopedic surgery</option>
        </Select><HelpText>Major hip/knee procedures are high VTE-risk by default. Non-orthopedic surgery needs patient + procedure risk stratification.</HelpText></Field>
        <Field label="Procedure bleeding risk"><Select value={s.bleedRisk} onChange={v=>setS({...s,bleedRisk:v})}><option value="low">Low</option><option value="moderate">Moderate</option><option value="high">High / critical-site / high-consequence</option></Select></Field>
        {s.surgery==='nonortho' && <Field label="Non-orthopedic procedure VTE risk"><Select value={s.generalRisk} onChange={v=>setS({...s,generalRisk:v})}><option value="low">Low: short/minor and mobile</option><option value="moderate">Moderate: abdominal/pelvic, longer surgery, reduced mobility</option><option value="high">High: major cancer, major abdominal/pelvic, trauma, ICU, prolonged immobility</option></Select></Field>}
        <Check label="Neuraxial anesthesia or spinal/epidural procedure" checked={s.neuraxial} onChange={v=>setS({...s,neuraxial:v})} help="High-consequence bleeding site: prophylaxis timing must follow anesthesia/neuraxial rules." />
        <Check label="Epidural catheter currently in place" checked={s.epidural} onChange={v=>setS({...s,epidural:v})} />
      </div>
      <div className="panel"><h2>Bleeding / medication safety</h2>
        <Check label="Already therapeutically anticoagulated" checked={s.alreadyAC} onChange={v=>setS({...s,alreadyAC:v})} help="Do not stack prophylaxis on top of therapeutic anticoagulation." />
        <Check label="Active bleeding or unsecured hemostasis" checked={s.activeBleed} onChange={v=>setS({...s,activeBleed:v})} />
        <Field label="Platelets"><Num value={s.plt} onChange={v=>setS({...s,plt:v})}/><HelpText>Very low platelets shift toward hold/mechanical/reassess rather than automatic pharmacologic prophylaxis.</HelpText></Field>
        <Field label="Renal function"><Select value={s.renal} onChange={v=>setS({...s,renal:v})}><option value="normal">Normal/mild CKD</option><option value="moderate">Moderate CKD</option><option value="severe">Severe CKD/AKI/dialysis</option></Select></Field>
      </div>
      <div className="panel"><h2>Patient VTE-risk modifiers</h2>
        <Check label="Hip fracture / major trauma" checked={s.fracture} onChange={v=>setS({...s,fracture:v})}/>
        <Check label="Active cancer or cancer surgery" checked={s.cancer} onChange={v=>setS({...s,cancer:v})}/>
        <Check label="Prior VTE" checked={s.priorVte} onChange={v=>setS({...s,priorVte:v})}/>
        <Check label="Known high-risk thrombophilia" checked={s.thrombophilia} onChange={v=>setS({...s,thrombophilia:v})}/>
        <Check label="Reduced mobility/expected immobility" checked={s.immobile} onChange={v=>setS({...s,immobile:v})}/>
        <Check label="Obesity" checked={s.obesity} onChange={v=>setS({...s,obesity:v})}/>
        <Check label="Estrogen/OCP or pregnancy/postpartum context" checked={s.estrogen} onChange={v=>setS({...s,estrogen:v})}/>
        <Check label="Older age/frailty" checked={s.age} onChange={v=>setS({...s,age:v})}/>
        <Check label="Acute infection/inflammation/ICU" checked={s.infection} onChange={v=>setS({...s,infection:v})}/>
      </div>
    </div>
    <div className="result-grid">
      <Output title="Suggested prophylaxis frame" tone="highlight"><h4>{category.join(' · ')||'Enter procedure context'}</h4>{list(plan)}</Output>
      <Output title="Agent / renal / mechanical reasoning">{list(agent.length?agent:['Select agent by local protocol. Core bedside choice is usually LMWH vs UFH vs mechanical based on renal function, bleeding risk, and procedure type.'])}</Output>
      <Output title="Start / restart timing" tone="warning">{list(timing)}</Output>
      <Output title="Duration prompt">{list(duration)}</Output>
      <Output title="Do not miss">{list(dontmiss)}</Output>
      <Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output>
    </div>
  </ToolShell>
}

function HypokalemiaTool(){ const [s,setS]=useState({k:'2.9',hco3:'18',bp:'normal',mg:false, urineK:'', urineCl:'', diarrhea:false, vomiting:false, diuretic:false, rta:false}); const k=Number(s.k), h=Number(s.hco3), uk=Number(s.urineK), ucl=Number(s.urineCl); let pattern=h<22?'Metabolic acidosis pattern':h>28?'Metabolic alkalosis pattern':'No clear bicarbonate pattern'; let reasons=[]; if(k<2.5) reasons.push('Severe hypokalemia: telemetry/urgent replacement if symptomatic, ECG changes, or high-risk comorbidity.'); if(s.mg) reasons.push('Hypomagnesemia makes K hard to correct; replace Mg.'); if(h<22){ if(s.diarrhea) reasons.push('Acidosis + diarrhea: GI bicarbonate and potassium loss likely.'); if(s.rta) reasons.push('Consider RTA if acidosis with renal K wasting and no diarrhea.'); if(uk>20) reasons.push('Urine K high despite hypokalemia: renal K wasting.'); }
 if(h>28){ if(s.vomiting && ucl<20) reasons.push('Vomiting/NG suction: low urine chloride chloride-responsive alkalosis.'); if(s.diuretic) reasons.push('Diuretic effect can raise urine chloride if active.'); if(s.bp==='high') reasons.push('Hypertension + alkalosis + renal K wasting: mineralocorticoid excess pattern.'); }
 const note=`Hypokalemia: K ${k}, HCO3 ${h}, BP ${s.bp}. Pattern: ${pattern}. Reasoning: ${reasons.join(' ')||'Need urine K/Cl and clinical context.'}`; return <ToolShell><div className="tool-grid"><div className="panel"><h2>Inputs</h2><Field label="Potassium"><Num value={s.k} onChange={v=>setS({...s,k:v})} step="0.1"/></Field><Field label="Bicarbonate"><Num value={s.hco3} onChange={v=>setS({...s,hco3:v})}/></Field><Field label="BP"><Select value={s.bp} onChange={v=>setS({...s,bp:v})}><option value="low">low</option><option value="normal">normal</option><option value="high">high</option></Select></Field><Field label="Urine potassium"><Num value={s.urineK} onChange={v=>setS({...s,urineK:v})}/></Field><Field label="Urine chloride"><Num value={s.urineCl} onChange={v=>setS({...s,urineCl:v})}/></Field><Check label="Hypomagnesemia" checked={s.mg} onChange={v=>setS({...s,mg:v})}/><Check label="Diarrhea" checked={s.diarrhea} onChange={v=>setS({...s,diarrhea:v})}/><Check label="Vomiting/NG suction" checked={s.vomiting} onChange={v=>setS({...s,vomiting:v})}/><Check label="Diuretic use" checked={s.diuretic} onChange={v=>setS({...s,diuretic:v})}/><Check label="RTA context" checked={s.rta} onChange={v=>setS({...s,rta:v})}/></div></div><div className="result-grid"><Output title="Pattern" tone="highlight"><h4>{pattern}</h4></Output><Output title="Reasoning">{list(reasons)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>}
function ProteinuriaTool(){ const [s,setS]=useState({acr:'',pcr:'150',albumin:'38',egfr:'90',hem:false,edema:false,dm:false,lupus:false}); const pcr=Number(s.pcr), alb=Number(s.albumin); let category=pcr>=3000?'Nephrotic-range proteinuria':pcr>=500?'Clinically significant non-nephrotic proteinuria':pcr>150?'Mild proteinuria':'Normal/near-normal PCR'; let reasons=[]; if(alb>=35&&pcr>500) reasons.push('Serum albumin can remain normal despite proteinuria when hepatic synthesis, nutrition, inflammation state, and duration compensate.'); if(pcr>=3000||s.edema) reasons.push('Nephrotic syndrome requires edema/hypoalbuminemia/lipid/thrombosis assessment, not PCR alone.'); if(s.hem) reasons.push('Hematuria plus proteinuria suggests glomerular/nephritic phenotype; check sediment, complements/serologies based on context.'); if(s.lupus) reasons.push('Lupus context: quantify proteinuria, urine sediment, complements, anti-dsDNA; consider nephrology threshold.'); const note=`Proteinuria: PCR ${pcr} mg/g or equivalent entry, serum albumin ${alb}. Category: ${category}. Reasoning: ${reasons.join(' ')}`; return <ToolShell><div className="tool-grid"><div className="panel"><h2>Inputs</h2><Field label="Urine PCR or equivalent"><Num value={s.pcr} onChange={v=>setS({...s,pcr:v})}/></Field><Field label="Serum albumin g/L"><Num value={s.albumin} onChange={v=>setS({...s,albumin:v})}/></Field><Field label="eGFR"><Num value={s.egfr} onChange={v=>setS({...s,egfr:v})}/></Field><Check label="Hematuria / active sediment" checked={s.hem} onChange={v=>setS({...s,hem:v})}/><Check label="Edema" checked={s.edema} onChange={v=>setS({...s,edema:v})}/><Check label="Diabetes" checked={s.dm} onChange={v=>setS({...s,dm:v})}/><Check label="Lupus/systemic disease" checked={s.lupus} onChange={v=>setS({...s,lupus:v})}/></div></div><div className="result-grid"><Output title="Proteinuria phenotype" tone="highlight"><h4>{category}</h4></Output><Output title="Reasoning">{list(reasons)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>}
function CirrhosisTool(){ const [s,setS]=useState({inr:'2.0',plt:'55',fib:'1.2',bleed:false,procedure:false,thrombosis:false,vitk:false,teg:false,la:false}); const inr=Number(s.inr), plt=Number(s.plt), fib=Number(s.fib); const ideas=['INR in cirrhosis reflects reduced procoagulant factors but misses reduced anticoagulants, high factor VIII, and vWF/endothelial activation. It is not a simple bleeding-risk meter.']; if(fib<1.5) ideas.push('Low fibrinogen is more actionable than INR in bleeding/procedure contexts.'); if(plt<50) ideas.push('Platelets near/below 50 matter for procedures/active bleeding, but threshold depends on procedure risk and local policy.'); if(s.thrombosis) ideas.push('Cirrhosis can be prothrombotic despite high INR: portal vein thrombosis/VTE risk remains real.'); if(s.vitk) ideas.push('Vitamin K helps only if deficiency/cholestasis/poor intake/warfarin effect; it does not fix rebalanced hemostasis.'); if(s.teg) ideas.push('TEG/ROTEM may guide product use better than INR in bleeding/procedure settings when available.'); if(s.la) ideas.push('Lupus anticoagulant can prolong clotting assays and coexist with thrombosis risk; interpret with clinical context.'); const note=`Cirrhosis hemostasis: INR ${inr}, platelets ${plt}, fibrinogen ${fib}. Context bleed=${s.bleed}, procedure=${s.procedure}, thrombosis=${s.thrombosis}. Reasoning: ${ideas.join(' ')}`; return <ToolShell><div className="tool-grid"><div className="panel"><h2>Inputs</h2><Field label="INR"><Num value={s.inr} onChange={v=>setS({...s,inr:v})} step="0.1"/></Field><Field label="Platelets"><Num value={s.plt} onChange={v=>setS({...s,plt:v})}/></Field><Field label="Fibrinogen g/L"><Num value={s.fib} onChange={v=>setS({...s,fib:v})} step="0.1"/></Field><Check label="Active bleeding" checked={s.bleed} onChange={v=>setS({...s,bleed:v})}/><Check label="Procedure planned" checked={s.procedure} onChange={v=>setS({...s,procedure:v})}/><Check label="Thrombosis present/concern" checked={s.thrombosis} onChange={v=>setS({...s,thrombosis:v})}/><Check label="Vitamin K given/considered" checked={s.vitk} onChange={v=>setS({...s,vitk:v})}/><Check label="TEG/ROTEM available" checked={s.teg} onChange={v=>setS({...s,teg:v})}/><Check label="Lupus anticoagulant positive" checked={s.la} onChange={v=>setS({...s,la:v})}/></div></div><div className="result-grid"><Output title="Rebalanced hemostasis frame" tone="highlight">{list(ideas)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>}


function PeriopDOACTool(){
  const [s,setS]=useState({drug:'apixaban',crcl:'>=50',bleed:'moderate',neuraxial:false,urgent:false,thrombotic:'standard',hemostasis:'secured'});
  const high=s.bleed==='high'||s.neuraxial;
  const low=s.bleed==='low';
  let pre='';
  let skip='';
  let restart='';
  let warnings=[];
  if(s.urgent){warnings.push('Urgent/emergency procedure: do not rely on elective PAUSE-style timing. Check last dose, renal function, bleeding urgency, drug-specific level if available, reversal pathway, and procedural necessity.');}
  if(s.drug==='dabigatran'){
    if(s.crcl==='<30'){pre='Avoid simple elective schedule; specialist/hematology/anesthesia plan needed.'; skip='Renal clearance is dominant; drug may persist.'; warnings.push('Dabigatran with CrCl <30: high accumulation risk; elective procedure should be individualized.');}
    else if(s.crcl==='30-49'){pre=high?'Last dose about 5 days before procedure':'Last dose about 3 days before procedure'; skip=high?'long hold because renal impairment prolongs dabigatran effect':'longer hold than Xa inhibitors because renal impairment prolongs effect';}
    else {pre=high?'Last dose about 3 days before procedure':'Last dose about 2 days before procedure'; skip=high?'skip about 4 doses':'skip about 2 doses';}
  } else if(s.drug==='apixaban'){
    pre=high?'Last dose about 3 days before procedure':'Last dose about 2 days before procedure';
    skip=high?'skip about 4 doses':'skip about 2 doses';
    if(s.crcl==='<30') warnings.push('Severe renal dysfunction: apixaban effect may persist; consider local guidance, anti-Xa calibrated for apixaban if available, and specialist input for high-risk surgery.');
  } else {
    pre=high?'Last dose about 3 days before procedure':'Last dose about 2 days before procedure';
    skip=high?'skip about 2 once-daily doses':'skip about 1 once-daily dose';
    if(s.crcl==='<30') warnings.push('Severe renal dysfunction can prolong DOAC effect; avoid automatic timing in major surgery or neuraxial procedures.');
  }
  if(low) { pre='For truly minimal-bleed procedures, many pathways allow no interruption or omit only the morning/day-before dose depending on drug, timing, and operator comfort.'; skip='confirm with proceduralist'; }
  restart=high?'Resume therapeutic dose usually 48–72 hours after surgery once hemostasis is secure; consider prophylactic-dose anticoagulation in the interim if thrombosis risk is high and bleeding is controlled.':'Resume usually about 24 hours after low/moderate-risk procedure if hemostasis is secure.';
  if(s.neuraxial) warnings.push('Neuraxial/spinal/epidural procedures are high-consequence bleeding scenarios: follow anesthesia/ASRA/local neuraxial timing, not generic tables.');
  if(s.thrombotic==='very-high') warnings.push('Very high thrombotic risk: discuss individualized plan; bridging is generally not used for DOAC interruption, but prophylactic anticoagulation after high-bleed-risk surgery may be considered when safe.');
  const procedureExamples = low ? ['Dental extraction 1–2 teeth, cataract surgery, dermatologic biopsy, endoscopy without biopsy: often minimal interruption.'] : high ? ['Neuraxial anesthesia, intracranial/spinal surgery, major cancer surgery, major vascular surgery, lung resection, TURP/bladder tumor resection, hip/knee replacement, kidney/prostate biopsy, high-risk endoscopic intervention.'] : ['Abdominal surgery such as cholecystectomy/hernia repair, many breast/orthopedic/vascular procedures, endoscopy with biopsy, lymph-node/bone-marrow biopsy, complex dental extraction.'];
  const note=`Perioperative DOAC plan: ${s.drug}, CrCl ${s.crcl}, procedure bleeding risk ${s.bleed}${s.neuraxial?' with neuraxial/high-consequence bleeding':''}. Pre-op: ${pre} (${skip}). Post-op: ${restart} Warnings: ${warnings.join(' ')||'none selected.'}`;
  return <ToolShell disclaimer="Elective DOAC interruption tool based on PAUSE-style/Thrombosis Canada-style principles. It does not replace urgent bleeding/reversal or local anesthesia guidance."><div className="tool-grid"><div className="panel"><h2>Drug + renal function</h2><Field label="DOAC"><Select value={s.drug} onChange={v=>setS({...s,drug:v})}><option value="apixaban">Apixaban</option><option value="rivaroxaban">Rivaroxaban</option><option value="edoxaban">Edoxaban</option><option value="dabigatran">Dabigatran</option></Select></Field><Field label="CrCl / renal function"><Select value={s.crcl} onChange={v=>setS({...s,crcl:v})}><option value=">=50">CrCl ≥50 mL/min</option><option value="30-49">CrCl 30–49 mL/min</option><option value="<30">CrCl &lt;30 mL/min / severe AKI</option></Select></Field><Check label="Urgent/emergency procedure" checked={s.urgent} onChange={v=>setS({...s,urgent:v})} help="Elective tables no longer apply; last dose, drug level/reversal, and urgency drive the plan."/></div><div className="panel"><h2>Procedure bleeding risk</h2><Field label="Procedure category"><Select value={s.bleed} onChange={v=>setS({...s,bleed:v})}><option value="low">Low / very low bleeding risk</option><option value="moderate">Moderate bleeding risk</option><option value="high">High bleeding risk</option></Select></Field><Check label="Neuraxial / spinal / epidural / high-consequence closed-space procedure" checked={s.neuraxial} onChange={v=>setS({...s,neuraxial:v})} help="Treat as high risk and verify anesthesia-specific rules."/><Field label="Thrombotic risk"><Select value={s.thrombotic} onChange={v=>setS({...s,thrombotic:v})}><option value="standard">Standard</option><option value="high">High: recent VTE/stroke, active cancer, severe thrombophilia</option><option value="very-high">Very high: very recent event or unstable thrombosis biology</option></Select></Field></div></div><div className="result-grid"><Output title="Pre-op hold" tone="highlight"><h4>{pre}</h4><p>{skip}</p></Output><Output title="Post-op restart"><h4>{restart}</h4></Output><Output title="Procedure examples / classification clue">{list(procedureExamples)}</Output><Output title="Warnings / bedside reasoning" tone="warning">{list(warnings)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>
}

function UnusualThrombosisTool(){
  const [s,setS]=useState({site:'splanchnic',age:'older',provoked:false,ocp:false,preg:false,cancer:false,infection:false,local:false,arterial:false,recurrent:false,platelets:false,ery:false,hemolysis:false,aps:false,lpa:false,nephrotic:false,bechet:false,catheter:false,anatomic:false});
  const core=['Confirm acute vs chronic clot and compare prior imaging; do not label anticoagulant failure until clot age is clear.','Medication/provocation history: OCP/estrogen, pregnancy/postpartum, recent surgery/immobility, central line, infection/inflammation, cancer therapy, hormones.','Basic labs: CBC with differential, smear if cytopenia/hemolysis, PT/aPTT/fibrinogen if DIC/liver context, renal/liver profile, urinalysis/proteinuria if nephrotic clue.'];
  let siteSpecific=[];
  if(s.site==='splanchnic') siteSpecific=['JAK2 V617F / MPN screen is high yield in portal, mesenteric, splenic, or hepatic vein thrombosis, especially if no local trigger.','Look for cirrhosis, intra-abdominal infection/inflammation, pancreatitis, malignancy, myeloproliferative neoplasm, PNH if cytopenia/hemolysis.'];
  if(s.site==='cvst') siteSpecific=['Ask specifically about OCP/estrogen, pregnancy/postpartum, dehydration/infection, malignancy, APS, Behçet/vasculitis, and thrombophilia context.','Check for headache/seizure/focal deficit; involve neurology early.'];
  if(s.site==='renal') siteSpecific=['Think nephrotic syndrome, renal malignancy, local compression, APS, dehydration, and extension from IVC. Quantify proteinuria and albumin.'];
  if(s.site==='upper') siteSpecific=['Central venous catheter, pacemaker/ICD lead, thoracic outlet/effort thrombosis, malignancy, and anatomic compression are common drivers.'];
  if(s.site==='young-arterial') siteSpecific=['Arterial thrombosis in a young patient: APS, smoking/stimulants, vasculitis/Behçet, embolic source, dissection/anatomic lesion, MPN, PNH, and Lp(a) if premature/recurrent arterial phenotype.'];
  if(s.site==='recurrent') siteSpecific=['Recurrent thrombosis: first separate pseudo-failure from biology failure, then evaluate APS, cancer, MPN/JAK2, PNH, nephrotic syndrome, occult inflammatory/anatomic drivers.'];
  let tests=[];
  if(s.platelets||s.ery||s.site==='splanchnic') tests.push('JAK2 V617F ± CALR/MPL/hematology referral if MPN clues: thrombocytosis, erythrocytosis, leukocytosis, splenomegaly, splanchnic thrombosis.');
  if(s.hemolysis) tests.push('PNH flow cytometry if unusual-site thrombosis plus hemolysis/cytopenias: high LDH, low haptoglobin, dark urine, abdominal pain, aplastic/MDS context.');
  if(s.aps||s.arterial||s.recurrent) tests.push('APS testing when arterial, recurrent, unprovoked unusual-site thrombosis, pregnancy morbidity, livedo, thrombocytopenia, prolonged aPTT. Avoid DOAC confidence in high-risk APS.');
  if(s.lpa||s.arterial||s.site==='young-arterial') tests.push('Lp(a) is most useful for premature/recurrent arterial disease or strong family history; it is not the main test for typical provoked VTE.');
  if(s.nephrotic||s.site==='renal') tests.push('Nephrotic workup: albumin, urine PCR/ACR, urinalysis, renal function; AT loss can affect heparin biology in severe nephrotic states.');
  if(s.bechet) tests.push('Behçet/vasculitis screen: oral/genital ulcers, uveitis, pathergy, arterial aneurysm, inflammatory markers, vascular imaging pattern.');
  if(s.cancer) tests.push('Cancer workup should be guided by symptoms, age-appropriate screening, clot site, CBC/chemistry, and imaging already indicated—not blind whole-body testing for every VTE.');
  if(s.local||s.anatomic||s.catheter) tests.push('Local/anatomic driver: catheter/lead, thoracic outlet, May-Thurner, tumor compression, infection/inflammation adjacent to clot; management may require source control or intervention, not just anticoagulation.');
  const pitfalls=['Do not order inherited thrombophilia panels reflexively during acute thrombosis or while anticoagulated if it will not change management.','Do not miss APS/MPN/PNH in unusual-site thrombosis: these are acquired, actionable, and more relevant than many inherited panels.','OCP/estrogen is a real provoking factor, but unusual site or recurrence still deserves deeper biology review.'];
  const note=`Unusual-site thrombosis: site ${s.site}. Key selected clues: OCP/estrogen ${s.ocp}, pregnancy/postpartum ${s.preg}, cancer ${s.cancer}, local/anatomic ${s.local||s.anatomic}, MPN clues ${s.platelets||s.ery}, PNH clue ${s.hemolysis}, APS clue ${s.aps}, Lp(a)/arterial ${s.lpa||s.arterial}. Workup: ${[...core,...siteSpecific,...tests].join(' ')}`;
  return <ToolShell disclaimer="Unusual-site thrombosis workup assistant. Use to decide which acquired, local, and systemic causes are worth checking before sending broad low-yield panels."><div className="tool-grid"><div className="panel"><h2>Thrombosis phenotype</h2><Field label="Site / phenotype"><Select value={s.site} onChange={v=>setS({...s,site:v})}><option value="splanchnic">Splanchnic / portal / mesenteric / hepatic / Budd–Chiari</option><option value="cvst">Cerebral venous sinus thrombosis</option><option value="renal">Renal vein thrombosis</option><option value="upper">Upper-extremity thrombosis</option><option value="young-arterial">Young or unexplained arterial thrombosis</option><option value="recurrent">Recurrent thrombosis / possible anticoagulant failure</option></Select></Field><Check label="Clearly provoked by surgery/immobility" checked={s.provoked} onChange={v=>setS({...s,provoked:v})}/><Check label="OCP / estrogen exposure" checked={s.ocp} onChange={v=>setS({...s,ocp:v})} help="Especially important for CVST, splanchnic thrombosis, and young VTE; still ask whether the site is unusual enough for deeper workup."/><Check label="Pregnancy/postpartum" checked={s.preg} onChange={v=>setS({...s,preg:v})}/><Check label="Catheter/lead/device" checked={s.catheter} onChange={v=>setS({...s,catheter:v})}/><Check label="Local infection/inflammation/tumor compression" checked={s.local} onChange={v=>setS({...s,local:v})}/></div><div className="panel"><h2>Acquired thrombophilia clues</h2><Check label="MPN clue" checked={s.platelets} onChange={v=>setS({...s,platelets:v})} help="Thrombocytosis, erythrocytosis, leukocytosis, splenomegaly, Budd–Chiari/splanchnic thrombosis."/><Check label="Erythrocytosis / high Hb-Hct" checked={s.ery} onChange={v=>setS({...s,ery:v})}/><Check label="PNH clue" checked={s.hemolysis} onChange={v=>setS({...s,hemolysis:v})} help="Hemolysis/cytopenias, dark urine, high LDH, low haptoglobin, abdominal pain, aplastic/MDS context."/><Check label="APS clue" checked={s.aps} onChange={v=>setS({...s,aps:v})} help="Arterial/recurrent thrombosis, pregnancy morbidity, livedo, thrombocytopenia, prolonged aPTT."/><Check label="Lp(a) clue / premature arterial phenotype" checked={s.lpa} onChange={v=>setS({...s,lpa:v})}/><Check label="Nephrotic syndrome clue" checked={s.nephrotic} onChange={v=>setS({...s,nephrotic:v})}/><Check label="Behçet / vasculitis clue" checked={s.bechet} onChange={v=>setS({...s,bechet:v})}/><Check label="Cancer concern" checked={s.cancer} onChange={v=>setS({...s,cancer:v})}/><Check label="Anatomic compression / vascular lesion" checked={s.anatomic} onChange={v=>setS({...s,anatomic:v})}/><Check label="Arterial event" checked={s.arterial} onChange={v=>setS({...s,arterial:v})}/><Check label="Recurrent event" checked={s.recurrent} onChange={v=>setS({...s,recurrent:v})}/></div></div><div className="result-grid"><Output title="Core workup frame" tone="highlight">{list(core)}</Output><Output title="Site-specific reasoning">{list(siteSpecific)}</Output><Output title="Targeted tests / referrals" tone="warning">{list(tests)}</Output><Output title="Pitfalls for residents">{list(pitfalls)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>
}

function MINSTool(){
  const [s,setS]=useState({troponin:'',uln:'14',delta:'',symptoms:false,ecg:false,hypotension:false,anemia:false,sepsis:false,pe:false,aki:false,bleeding:false,cad:false,ckd:false,postday:'1'});
  const trop=Number(s.troponin), uln=Number(s.uln), delta=Number(s.delta); const abnormal=trop>uln; const dynamic=delta&&Math.abs(delta)>=5; let category='No troponin interpretation yet'; let reasoning=[]; let actions=[];
  if(abnormal){category='Postoperative myocardial injury pattern'; reasoning.push('Troponin above the assay upper reference limit after noncardiac surgery is myocardial injury; MINS requires ischemic attribution rather than a clearly non-ischemic cause.');}
  if(abnormal && !s.sepsis && !s.pe && !s.aki) {category='MINS possible if ischemic mechanism fits'; reasoning.push('MINS is often asymptomatic; absence of chest pain does not make it benign.');}
  if(s.symptoms||s.ecg){category='Type 1 MI / acute coronary syndrome concern until proven otherwise'; actions.push('Repeat ECG/troponin, assess symptoms/hemodynamics, call cardiology urgently, and balance antithrombotic treatment against surgical bleeding.');}
  if(s.hypotension||s.anemia||s.sepsis||s.bleeding) reasoning.push('Supply–demand mismatch triggers present: hypotension, anemia/bleeding, tachycardia, hypoxia, or sepsis can produce ischemic myocardial injury.');
  if(s.pe) reasoning.push('PE/right-heart strain can elevate troponin and is a must-not-miss non-coronary cause after surgery.');
  if(s.aki||s.ckd) reasoning.push('CKD/AKI can elevate baseline troponin; dynamic change and clinical context matter.');
  if(abnormal){actions.push('Repeat troponin to define rise/fall and obtain/review ECG.'); actions.push('Correct triggers: bleeding/anemia, hypoxia, hypotension, tachyarrhythmia, sepsis, pain.'); actions.push('Document as myocardial injury/MINS concern and arrange follow-up; do not ignore an asymptomatic postoperative troponin rise.');}
  else actions.push('If high-risk patient and within local screening pathway, continue scheduled postoperative troponin surveillance.');
  const note=`Post-op troponin assessment: day ${s.postday}, hs-troponin ${s.troponin||'not entered'} with ULN ${s.uln}, delta ${s.delta||'not entered'}. Category: ${category}. Reasoning: ${reasoning.join(' ')} Actions: ${actions.join(' ')}`;
  return <ToolShell disclaimer="MINS tool for postoperative myocardial injury triage. It does not replace ACS/PE/sepsis/bleeding evaluation."><div className="tool-grid"><div className="panel"><h2>Troponin + timing</h2><Field label="Post-op day"><Select value={s.postday} onChange={v=>setS({...s,postday:v})}><option value="0">Day 0</option><option value="1">Day 1</option><option value="2">Day 2</option><option value="3">Day 3</option><option value=">3">After day 3</option></Select></Field><Field label="hs-Troponin value"><Num value={s.troponin} onChange={v=>setS({...s,troponin:v})}/></Field><Field label="Assay ULN / 99th percentile"><Num value={s.uln} onChange={v=>setS({...s,uln:v})}/></Field><Field label="Delta/change if known"><Num value={s.delta} onChange={v=>setS({...s,delta:v})}/></Field><Check label="Chest pain, dyspnea, shock, arrhythmia, or ischemic symptoms" checked={s.symptoms} onChange={v=>setS({...s,symptoms:v})}/><Check label="New ischemic ECG change" checked={s.ecg} onChange={v=>setS({...s,ecg:v})}/></div><div className="panel"><h2>Competing causes / triggers</h2><Check label="Hypotension/tachycardia/hypoxia" checked={s.hypotension} onChange={v=>setS({...s,hypotension:v})}/><Check label="Anemia" checked={s.anemia} onChange={v=>setS({...s,anemia:v})}/><Check label="Bleeding" checked={s.bleeding} onChange={v=>setS({...s,bleeding:v})}/><Check label="Sepsis/infection" checked={s.sepsis} onChange={v=>setS({...s,sepsis:v})}/><Check label="PE concern" checked={s.pe} onChange={v=>setS({...s,pe:v})}/><Check label="AKI" checked={s.aki} onChange={v=>setS({...s,aki:v})}/><Check label="Known CAD / vascular disease" checked={s.cad} onChange={v=>setS({...s,cad:v})}/><Check label="CKD / chronically elevated troponin possible" checked={s.ckd} onChange={v=>setS({...s,ckd:v})}/></div></div><div className="result-grid"><Output title="Interpretation" tone="highlight"><h4>{category}</h4><p>Troponin above ULN: <b>{abnormal?'yes':'no/unknown'}</b>. Dynamic change entered: <b>{dynamic?'yes':'no/unknown'}</b>.</p></Output><Output title="Reasoning that should stick">{list(reasoning)}</Output><Output title="Next bedside actions" tone="warning">{list(actions)}</Output><Output title="Copy-ready note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output></div></ToolShell>
}


function VascularClinicPathwaysTool({mode='all'}={}){
  const defaultPathway = mode==='thrombosis' ? 'new-thrombosis' : 'suspected-pad';
  const [s,setS]=useState({pathway:defaultPathway,acuteLimb:false,restPain:false,wound:false,gangrene:false,infection:false,abi:'',tbi:'',exertional:true,atypical:false,pulses:false,diabetes:false,ckd:false,smoker:false,ldl:'',statin:false,antiplatelet:false,bleed:false,hf:false,revasc:false,af:false,fullAC:false,priorVte:false,newVte:false,unprovoked:false,cancer:false,ocp:false,preg:false,arterial:false,young:false,recurrent:false,aps:false,mpn:false,pnh:false,lpa:false,dyspnea:false,pts:false,renal:'normal'});
  const padRed=[]; const diagnostics=[]; const treatment=[]; const education=[]; const referrals=[]; const follow=[]; const dontmiss=[];
  const isPADPath=s.pathway==='suspected-pad'||s.pathway==='confirmed-pad'||s.pathway==='clti';
  const isThrombosisPath=s.pathway==='new-thrombosis'||s.pathway==='chronic-thrombosis';
  if(s.acuteLimb) padRed.push('Acute limb ischemia red flag: sudden pain/pallor/pulselessness/poikilothermia/paresthesia/paralysis → emergency vascular surgery/ED pathway, do not manage as routine clinic PAD.');
  if(s.restPain||s.wound||s.gangrene) padRed.push('CLTI red flag: ischemic rest pain, nonhealing ulcer, gangrene, or tissue loss → urgent vascular imaging/referral and foot/wound protection.');
  if(s.infection&&s.wound) padRed.push('Wound + infection in suspected ischemic limb: source control/antibiotics + urgent perfusion assessment; infection can convert a slow PAD visit into limb-threatening disease.');

  if(s.pathway==='suspected-pad'){
    diagnostics.push('Start with syndrome: exertional calf/thigh/buttock symptoms, walking distance, relief with rest, pulses, bruits, skin/foot exam, wounds, neurologic/spine mimics.');
    diagnostics.push('Order resting ABI with Doppler waveforms. If ABI is noncompressible/high or diabetes/CKD suggests calcified vessels, add TBI/toe pressure.');
    diagnostics.push('If symptoms are classic but resting ABI normal, request exercise ABI or treadmill testing if available.');
    diagnostics.push('Do not jump to CTA/MRA unless PAD is confirmed and revascularization is being considered, or CLTI/acute limb concern exists.');
    treatment.push('Begin risk reduction while confirming diagnosis: smoking cessation, BP/diabetes optimization, lipid intensification if vascular risk is high, walking program, foot care.');
    follow.push('Follow up with ABI/TBI results and decide: no PAD/mimic, confirmed PAD medical therapy, or urgent CLTI/revascularization pathway.');
  }
  if(s.pathway==='confirmed-pad'){
    diagnostics.push('Define PAD phenotype: asymptomatic ABI-only, claudication, lifestyle-limiting claudication, post-revascularization, or CLTI. Management intensity depends on phenotype.');
    treatment.push('Ensure high-intensity statin or maximally tolerated lipid therapy; document LDL and intensify if above local vascular target.');
    treatment.push('Use single antiplatelet therapy for symptomatic PAD unless contraindicated; do not use full-dose anticoagulation for PAD alone without another indication.');
    if(!s.bleed) treatment.push('Consider vascular-dose rivaroxaban 2.5 mg BID + aspirin in selected symptomatic PAD or post-revascularization patients with acceptable bleeding risk and no need for full-dose anticoagulation.');
    if(s.hf) treatment.push('Avoid cilostazol in heart failure.'); else treatment.push('For lifestyle-limiting claudication despite exercise/risk-factor therapy, cilostazol can be considered if no heart failure.');
    treatment.push('Structured/supervised exercise therapy is treatment, not just advice: prescribe walking to moderate claudication, rest, repeat, with progression.');
    referrals.push('Revascularization referral if CLTI, lifestyle-limiting claudication despite GDMT/exercise, or anatomy/imaging suggests treatable lesion.');
    follow.push('Track walking distance, wound status, pulses, medication adherence, LDL, smoking, BP/diabetes, and interval vascular events.');
  }
  if(s.pathway==='clti'){
    diagnostics.push('CLTI visit = limb-threat staging: wound location/depth, infection, ischemic rest pain, toe pressure/TBI, Doppler waveforms, neuropathy, diabetes/renal status.');
    diagnostics.push('Obtain anatomic imaging if revascularization is being planned: duplex/CTA/MRA/angiography based on renal function, local pathway, and urgency.');
    treatment.push('Protect the limb: offloading, wound care, infection treatment, pain control, avoid compression until arterial perfusion is understood, optimize antithrombotic/statin therapy.');
    referrals.push('Urgent vascular surgery/interventional referral; wound/diabetic foot team if ulcer/infection; consider admission if infection, uncontrolled pain, rapidly progressive tissue loss, or social inability to protect limb.');
    dontmiss.push('Do not debride aggressively or compress a severely ischemic limb without perfusion plan.');
  }
  if(s.pathway==='new-thrombosis'){
    diagnostics.push('First classify the event: venous vs arterial, site, severity, provoked vs unprovoked, recurrence, unusual site, cancer-associated, pregnancy/OCP context, and whether this is acute vs chronic imaging.');
    diagnostics.push('For VTE: assess PE severity, bleeding risk, renal/liver function, weight, drug interactions, cancer clues, APS clues, and need for admission vs outpatient treatment.');
    diagnostics.push('For arterial thrombosis: separate embolic, atherosclerotic plaque, vasculitis, dissection/anatomic lesion, APS/MPN/PNH, and cardioembolic sources.');
    treatment.push('Start appropriate anticoagulation promptly if VTE and no contraindication; choose DOAC vs LMWH vs warfarin based on renal/liver function, cancer, APS, pregnancy, drug interactions, adherence, and procedure needs.');
    if(s.arterial) treatment.push('Arterial event requires antiplatelet/statin/vascular imaging/cardiac source evaluation; anticoagulation only if embolic/AF/VTE/APS or another clear indication.');
    if(s.ocp||s.preg) treatment.push('Document estrogen/pregnancy/postpartum as provoking context; counsel to stop estrogen if appropriate and coordinate pregnancy-safe anticoagulation if relevant.');
    if(s.young||s.recurrent||s.arterial) diagnostics.push('Targeted acquired thrombophilia workup is higher-yield than broad inherited panels: APS, JAK2/MPN, PNH when clues, Lp(a) for premature arterial disease, nephrotic syndrome, malignancy/local anatomy.');
    follow.push('Before discharge/clinic close: define anticoagulant, dose, duration plan, follow-up date, bleeding precautions, return precautions, and pending tests owner.');
  }
  if(s.pathway==='chronic-thrombosis'){
    diagnostics.push('Reconstruct the timeline: index event, provoking factor, imaging proof, anticoagulant history, recurrence vs residual clot, bleeding history, and patient preference.');
    diagnostics.push('Classify duration decision: transient provoked, persistent risk factor, unprovoked, recurrent, cancer-associated, APS/high-risk thrombophilia, or anticoagulation failure.');
    treatment.push('For unprovoked/recurrent/persistent-risk VTE, reassess extended anticoagulation unless bleeding risk outweighs benefit. For transient provoked VTE, document why stopping is reasonable after treatment phase.');
    if(s.dyspnea) diagnostics.push('Dyspnea/exercise limitation after PE: screen for CTEPH/CTEPD with echo and V/Q-based pathway if persistent and unexplained.');
    if(s.pts) treatment.push('Post-thrombotic symptoms: confirm no acute recurrence, assess venous obstruction/reflux, compression if tolerated, exercise/weight/skin care, and consider venous referral when severe.');
    if(s.recurrent) diagnostics.push('Recurrent thrombosis on therapy: do not call it failure until adherence, dose, drug interactions, renal/liver function, absorption, weight, imaging chronicity, APS/cancer/MPN/PNH are checked.');
    follow.push('Annual/interval review: ongoing indication, bleeding risk, renal/liver function, CBC, drug interactions, procedures, patient values, and whether dose reduction is appropriate for secondary prevention.');
  }

  if(isPADPath){
    if(s.diabetes||s.ckd) diagnostics.push('Diabetes/CKD can make ABI falsely high/noncompressible: TBI/toe pressure and waveforms matter.');
    if(s.smoker) treatment.push('Smoking cessation is limb therapy: document readiness, offer pharmacotherapy/referral, and revisit every visit.');
    education.push('Teach the PAD triad to patients: walking program, foot protection, and cardiovascular risk reduction. PAD is a heart/brain risk marker, not only a leg problem.');
    dontmiss.push('Always remove shoes/socks and inspect feet. A PAD visit without a foot exam can miss CLTI.');
  }
  if(isThrombosisPath){
    if(s.aps) dontmiss.push('APS clue: arterial/recurrent thrombosis, pregnancy morbidity, thrombocytopenia/livedo/prolonged aPTT. Avoid reflex DOAC in high-risk APS.');
    if(s.mpn) diagnostics.push('MPN/JAK2 clue: erythrocytosis, thrombocytosis, leukocytosis, splenomegaly, splanchnic/Budd–Chiari thrombosis.');
    if(s.pnh) diagnostics.push('PNH clue: unusual-site thrombosis + hemolysis/cytopenias/dark urine/high LDH/low haptoglobin.');
    if(s.lpa) diagnostics.push('Lp(a) is most relevant in premature/recurrent arterial disease or strong family/premature ASCVD phenotype.');
    education.push('Teach the patient the anticoagulation plan in one sentence: why they are taking it, how long, what bleeding signs matter, and who owns follow-up.');
  }
  const clinicClose=['Problem representation documented in one line.','Red flags addressed before routine management.','Medication reconciliation completed: antiplatelet/anticoagulant/statin/NSAIDs/interactions.','Labs/imaging ordered with a named reason, not a reflex panel.','Follow-up interval and escalation instructions documented.'];
  const selectedPath={
    'suspected-pad':'Suspected PAD visit', 'confirmed-pad':'Confirmed PAD visit', 'clti':'CLTI / limb-threat pathway', 'new-thrombosis':'New VTE or arterial thrombosis visit', 'chronic-thrombosis':'Chronic VTE / arterial thrombosis follow-up'
  }[s.pathway];
  const note=`Vascular clinic pathway: ${selectedPath}. Red flags: ${padRed.join(' ')||'none selected'}. Diagnostics: ${diagnostics.join(' ')} Treatment/plan: ${treatment.join(' ')} Referrals: ${referrals.join(' ')||'none selected'} Follow-up: ${follow.join(' ')}.`;
  return <ToolShell disclaimer="Clinic pathway support for clinician use. This is designed to standardize vascular clinic visits for juniors; adapt to local referral pathways, imaging availability, and specialist input.">
    <div className="tool-grid">
      <div className="panel"><h2>Choose visit pathway</h2>
        <Field label="Clinic pathway"><Select value={s.pathway} onChange={v=>setS({...s,pathway:v})}>
          {mode !== 'thrombosis' && <option value="suspected-pad">Suspected PAD</option>}{mode !== 'thrombosis' && <option value="confirmed-pad">Confirmed PAD</option>}{mode !== 'thrombosis' && <option value="clti">CLTI / limb-threat</option>}{mode !== 'vascular' && <option value="new-thrombosis">New VTE or arterial thrombosis</option>}{mode !== 'vascular' && <option value="chronic-thrombosis">Chronic VTE / arterial thrombosis follow-up</option>}
        </Select><HelpText>{mode==='vascular'?'Vascular clinic pathway: suspected PAD, confirmed PAD, or CLTI/limb-threat.':mode==='thrombosis'?'Thrombosis clinic pathway: new or chronic VTE/arterial thrombosis follow-up.':'The aim is to make the visit reproducible: identify danger, classify phenotype, order the right tests, start standard care, and close the loop.'}</HelpText></Field>
        <Check label="Acute limb ischemia concern" checked={s.acuteLimb} onChange={v=>setS({...s,acuteLimb:v})} help="Sudden pain, pallor, pulselessness, poikilothermia, paresthesia, paralysis = emergency, not routine clinic."/>
        <Check label="Rest pain" checked={s.restPain} onChange={v=>setS({...s,restPain:v})}/>
        <Check label="Nonhealing wound/ulcer" checked={s.wound} onChange={v=>setS({...s,wound:v})}/>
        <Check label="Gangrene/tissue loss" checked={s.gangrene} onChange={v=>setS({...s,gangrene:v})}/>
        <Check label="Wound infection/cellulitis" checked={s.infection} onChange={v=>setS({...s,infection:v})}/>
      </div>
      <div className="panel"><h2>PAD phenotype inputs</h2>
        <Field label="ABI if known"><Num value={s.abi} onChange={v=>setS({...s,abi:v})} step="0.01"/><HelpText>ABI ≤0.90 supports PAD; very high/noncompressible ABI needs toe pressure/TBI/waveforms.</HelpText></Field>
        <Field label="TBI/toe pressure if known"><Num value={s.tbi} onChange={v=>setS({...s,tbi:v})} step="0.01"/></Field>
        <Check label="Exertional leg symptoms relieved by rest" checked={s.exertional} onChange={v=>setS({...s,exertional:v})}/>
        <Check label="Atypical leg symptoms / mimic possible" checked={s.atypical} onChange={v=>setS({...s,atypical:v})}/>
        <Check label="Reduced/absent pulses or bruits" checked={s.pulses} onChange={v=>setS({...s,pulses:v})}/>
        <Check label="Diabetes" checked={s.diabetes} onChange={v=>setS({...s,diabetes:v})}/>
        <Check label="CKD" checked={s.ckd} onChange={v=>setS({...s,ckd:v})}/>
        <Check label="Current smoker" checked={s.smoker} onChange={v=>setS({...s,smoker:v})}/>
        <Field label="LDL if known"><Num value={s.ldl} onChange={v=>setS({...s,ldl:v})} step="0.1"/></Field>
      </div>
      <div className="panel"><h2>Thrombosis phenotype inputs</h2>
        <Check label="New VTE" checked={s.newVte} onChange={v=>setS({...s,newVte:v})}/>
        <Check label="Unprovoked or persistent-risk event" checked={s.unprovoked} onChange={v=>setS({...s,unprovoked:v})}/>
        <Check label="Prior VTE" checked={s.priorVte} onChange={v=>setS({...s,priorVte:v})}/>
        <Check label="Arterial thrombosis phenotype" checked={s.arterial} onChange={v=>setS({...s,arterial:v})}/>
        <Check label="Young patient / premature arterial disease" checked={s.young} onChange={v=>setS({...s,young:v})}/>
        <Check label="Recurrent thrombosis" checked={s.recurrent} onChange={v=>setS({...s,recurrent:v})}/>
        <Check label="Cancer concern" checked={s.cancer} onChange={v=>setS({...s,cancer:v})}/>
        <Check label="OCP/estrogen or pregnancy/postpartum context" checked={s.ocp||s.preg} onChange={v=>setS({...s,ocp:v,preg:v})}/>
        <Check label="Dyspnea after PE / CTEPH concern" checked={s.dyspnea} onChange={v=>setS({...s,dyspnea:v})}/>
        <Check label="Post-thrombotic syndrome symptoms" checked={s.pts} onChange={v=>setS({...s,pts:v})}/>
      </div>
      <div className="panel"><h2>Medication / biology checks</h2>
        <Check label="Already on statin" checked={s.statin} onChange={v=>setS({...s,statin:v})}/>
        <Check label="Already on antiplatelet" checked={s.antiplatelet} onChange={v=>setS({...s,antiplatelet:v})}/>
        <Check label="High bleeding risk" checked={s.bleed} onChange={v=>setS({...s,bleed:v})}/>
        <Check label="Heart failure" checked={s.hf} onChange={v=>setS({...s,hf:v})} help="Cilostazol is avoided in heart failure."/>
        <Check label="Prior revascularization" checked={s.revasc} onChange={v=>setS({...s,revasc:v})}/>
        <Check label="AF or other full-dose anticoagulation indication" checked={s.af||s.fullAC} onChange={v=>setS({...s,af:v,fullAC:v})}/>
        <Check label="APS clue" checked={s.aps} onChange={v=>setS({...s,aps:v})}/>
        <Check label="MPN/JAK2 clue" checked={s.mpn} onChange={v=>setS({...s,mpn:v})}/>
        <Check label="PNH clue" checked={s.pnh} onChange={v=>setS({...s,pnh:v})}/>
        <Check label="Lp(a) clue" checked={s.lpa} onChange={v=>setS({...s,lpa:v})}/>
      </div>
    </div>
    <div className="result-grid">
      <Output title="Danger first" tone={padRed.length?'warning':'highlight'}>{list(padRed.length?padRed:['No emergency limb-threat flag selected. Still document pulses, feet/wounds, and return precautions.'])}</Output>
      <Output title="Diagnostic pathway">{list(diagnostics)}</Output>
      <Output title="Treatment / standard care" tone="highlight">{list(treatment.length?treatment:['Select a pathway and phenotype inputs to generate standard care prompts.'])}</Output>
      <Output title="Referrals / escalation">{list(referrals.length?referrals:['No urgent referral generated by selected inputs; use local pathways if symptoms are severe, progressive, or diagnosis uncertain.'])}</Output>
      <Output title="Patient education">{list(education)}</Output>
      <Output title="Close-the-loop checklist">{list([...follow,...clinicClose])}</Output>
      <Output title="Do not miss / resident teaching points" tone="warning">{list(dontmiss.length?dontmiss:['Do not close a vascular visit without classifying phenotype, checking antithrombotics/statin, and assigning follow-up for pending tests.'])}</Output>
      <Output title="Copy-ready clinic note"><pre>{note}</pre><button className="ghost" onClick={()=>copyText(note)}>Copy note</button></Output>
    </div>
  </ToolShell>
}

function ToolShell({children, disclaimer}){return <section className="section tool-shell"><div className="disclaimer"><b>Clinician-use note:</b> {disclaimer || 'Decision support only. Verify with local policy, patient-specific details, and specialist input when needed.'}</div>{children}</section>}
function Footer(){return <footer><div><b>Fahad Almalki, MD</b><p>General Internal Medicine · Vascular Medicine · Clinical Reasoning · Quality Improvement</p></div><div><a href="mailto:contact@fahadalmalkimd.com">contact@fahadalmalkimd.com</a></div></footer>}

ReactDOM.createRoot(document.getElementById('root')).render(<App />);