Use the seven audit scenarios and their Protocol v1.0 criteria alongside the updated handover record. The on-screen checklist supports your review; the formal audit is recorded separately.

Not part of audit: Clinical + labs and Working impression are labelled Not part of audit. They remain available as optional clinical support outside the audit workflow; their findings and generated results are not the formal audit record.

Search by scenario name, number or abbreviation, such as AKI, chest pain or NEWS2, then select the matching scenario. Search is limited to the seven audit scenarios and Trust is fixed to NHS GGC. The normal Filter control is hidden.

The selected scenario's Audit working checklist opens automatically. Review each Protocol v1.0 criterion against the updated handover record and use the ticks to track what you have reviewed. Tap the checklist heading to collapse or reopen it. A tick does not confirm that care was performed.

Checklist ticks are memory only. They stay with each scenario during the current Audit Mode session, but turning Audit Mode off, resetting the session or reloading the page clears them.

Use the updated handover record for auditing and enter the formal audit data in the study's Microsoft Forms form on an NHS machine. Amara's checklist does not save or submit the audit record.

After recording the audit, use Reset to clear the current clinical selections and checklist progress and smoothly return to Search. It does not focus the search field or open the keyboard. Choosing a different scenario alone does not clear the current clinical findings or the session's checklist ticks.

The finding and lab shortcuts below the checklist, and Clinical + labs, feed the live Working impression. Select only findings actually reported, observed or measured. Choosing a scenario or ticking its audit criteria does not add patient evidence. Pattern Alerts and Next Actions are clinical support, not proof of a diagnosis or completed care.

Selected Findings & Context, including Ward content and Patient factors, is hidden while Audit Mode is on.

Use the switch beside Trust to enable or disable Audit Mode for this page session. The full Amara guide returns when Audit Mode is off.

Amara Acute is a clinical decision-support surface for UK acute medicine. It helps structure reasoning through an acute presentation; it does not replace clinical judgement, local protocols, or formal escalation pathways.

Amara Acute combines LabSense, ClinSense, Clinical detail, Pattern Alerts and Next Actions. Amara Flow supports temporal clinical reasoning. Amara Palliate contains adult palliative symptom references, an opioid conversion reference, Last Days and Ceiling sections. Open each module from its navigation link; a reference search does not establish a diagnosis.

The home screen starts with the red Clinical safety note above a single search field. This is not a substitute for clinical assessment; verify live local protocol and escalate if uncertain.

The search shell is search-only. Suggestions open directly under Search symptoms, labs, diagnoses.... Choose a suggestion or press Enter for an unambiguous match.

The search shell toolbar contains the active Trust dropdown and the Filter button. Filter slides open a side panel where one or more categories can be selected for suggestions and typed Enter resolution; All resets back to the full search surface without refreshing the full Acute screen.

On phones, the Trust and Filter controls stack into full-width tap targets, the Filter side panel uses the full safe viewport, and long Next Actions labels wrap inside the card rather than forcing horizontal scrolling.

With Audit Mode off, the Selected Findings & Context card below search holds selected findings and the Ward content and Patient factors controls.

Ward content and Patient factors open as scrollable menus and stay open while you select multiple options. Close a menu by tapping its pill again, tapping outside it, or pressing Escape. Selected patient factors have individual remove controls.

Clinical + labs is the single collapsible manual input area. It contains the Clinical and Labs lanes together, and both lanes stay complete and editable. Every clinical and lab subcategory starts collapsed; expand only the category needed.

Within Obstetrics & Gynaecology, granular examination and context findings remain visible first. The 33 broader O&G presentation findings sit behind Expand additional O&G presentations. If one is selected or found through search, that active presentation remains visible even while the additional group is collapsed.

Working impression is the single live results panel below the inputs. It remains available when Clinical + labs is collapsed.

The Working impression is always the full current result stream. Search keeps combined results visible instead of narrowing the result panel.

Inside Working impression, tap Clinical detail to collapse or reopen the whole group, then tap an individual sign, chronic-context, or DDx-reference heading to control that card. A search opens its matched detail once; after you collapse it, ordinary result refreshes keep it closed until you reopen it or run a new explicit search.

A searched DDx keeps its highlight when collapsed; tap the same DDx heading to close or reopen its workup.

Select Working impressions to move to your results. The compact shortcut has its own row above Clinical + labs, so it never covers findings or the help and version controls.

Audit Mode is a temporary study view inside the full Amara Acute interface. Use the switch beside Trust to enable or disable it for the current page session. When active, the main search is limited to the seven audit scenarios, the normal Filter control is hidden, and Trust is locked to NHS GGC. Clinical + labs, Working impression, Pattern Alerts and Next Actions remain active.

While Audit Mode is on, Selected Findings & Context, including Ward content and Patient factors, is hidden. Switch Audit Mode off to show the card again. Existing selections are retained when switching modes. Review or change findings using Clinical + labs or the scenario shortcuts.

Selecting a scenario keeps the current reading position and reveals its exact identity and Protocol v1.0 working checklist. Optional reported-finding and lab shortcuts appear below the checklist. The scenario itself is not patient evidence; only selecting a reported, observed or measured shortcut adds it to the live Acute engine.

The Audit working checklist opens automatically after scenario selection so the exact Protocol v1.0 criteria are ready to test. It can still be collapsed from its heading. Checklist completion is memory only, is not written to the audit record and clears when the Audit Mode session or page is reset. Use the updated handover record for auditing. Collect the formal audit data separately using the study's Microsoft Forms form on an NHS machine.

In Audit Mode, Clinical + labs and Working impression are labelled Not part of audit. They remain available as optional clinical support outside the audit workflow. How to use switches to the audit guide while Audit Mode is on.

1. Type into the Search symptoms, labs, diagnoses... field. Suggestions can include presenting complaints, symptoms, labs, Infection Presentations, high-risk diagnoses, syndromes, calculators, protocols, chronic-symptom DDx cards, and pattern alerts.

Exact and near-complete selectable findings stay visible ahead of incidental mentions inside pathology, alert or action text. Submitting an exact symptom selects that symptom only; it does not silently substitute a broader presenting complaint or Pattern Alert.

Selecting a LabSense search result keeps the current reading position while the Working impression updates.

2. Tap a suggestion to open it in the same Working impression. Disease, Infection Presentation, DDx and Pattern Alert versions of the same concept converge on one canonical Pattern Alert card; they do not create patient findings. Collapsed live alert cards use two lines: clinical signal, condition and matched fraction first, then brief evidence and context. Expanded live alert cards show one linked Next action, a compact Review against control, and Details. Investigations, treatment, monitoring and referral are rendered once through governed Next Actions. Related signs, symptoms, DDx references and supporting Flow maps appear afterwards as collapsed supporting references.

Searching a Pattern Alert or Infection Presentation opens Clinical detail with its linked CliniSense and LabSense cards. Authored alert criteria and related differential references are labelled separately. All linked cards are available; expand a card to read its assessment and differential detail. Each differential retains its own management and sources. Searching adds no patient findings or results. Select actual findings separately in Clinical + labs.

3. Only an explicit symptom or lab suggestion adds that finding. A disease, pathway, DDx, Pattern Alert, Flow map or Next Action reference opens information and routing only; use + or Clinical + labs to record findings actually present.

4. Use Filter to open the side panel and choose one or more of All, DDx, Chronic Pathology, CliniSense, LabSense, or Pattern Alerts. Press Enter to apply a uniquely resolved exact finding or an explicitly named route from the selected filters; ambiguous text remains available as choices. Use Clinical + labs to add or adjust Clinical findings and Labs manually.

Type a syndrome name (e.g. pneumonia, neutropenic sepsis, MSCC, thyroid storm, DKA, sepsis, HHS, spinal epidural abscess) and choose its Pattern Alert to open a search reference. Search does not select the alert's CliniSense, LabSense, context or patient-factor criteria and does not create a live match, diagnosis or treatment route. The reference card shows its authored criteria, sources, connected presentations and reference actions so the clinician can decide which findings are actually present and record them through Clinical + labs. The same reference-only rule applies to linked Infection Presentation search rows. Once independently selected patient evidence satisfies the authored gate, the canonical card changes to the live patient-evidence state and its governed actions become eligible. There is one Pattern Alerts section and one card per canonical condition. Selected rows remain removable through the normal shared controls. Internal fluid-management phenotype gates are expanded into their real selectable findings and labs; internal gate names are not presented as patient findings.

The default workflow is Acute. Pattern matching is tuned to time-critical presentations such as sepsis, ACS, DKA, AECOPD, anaphylaxis, PE, meningitis, and other high-risk syndromes. Live Pattern Alerts require independently selected patient evidence; searched transport rows and derived protocol signals cannot create a live card by themselves. Alerts are rule matches, not diagnoses or probability estimates. Next Actions use four timing buckets: Now, Urgent, Today, and Monitor.

Every visible Pattern Alert includes a linked Next Action control. Stable alert identity keeps the link intact through canonical deduplication, Infection Presentations, DDx references, direct Pattern Alert search, and actions contributed by more than one source group. Related DDx cards do not create a second management surface. Where a management or action record declares a structured medicine reference, the medicine name links directly to that official source; unbound doses remain withheld or explicitly marked for source review. A review / governance action is a reassessment row shown when condition-specific actions are gated or suppressed; it is not treatment advice.

Open Review against inside a Pattern Alert to see its compact Clinical checks. Checks start collapsed and only one opens at a time; full clinical detail, the next step, assessment control and sources appear on demand. Record a check as Findings support alert, Not reviewed, Reassuring for this check, or Alternative cause found. Unreviewed information stays unknown—Amara never treats a missing selection as an absent finding. For every Pattern Alert, these states annotate the review. They never diagnose, demote, hide or exclude the alert, and they do not remove its governed safety actions. Engine-backed reviews may change which criterion-specific reassessment appears first in Next Actions. Review completion records that a clinician assessed the check even when stronger selected patient evidence determines the displayed state; auto-matched evidence alone never counts as a completed review.

When Trust: NHS GGC is selected, verified relevant local links activate in the Pattern Alert, its Clinical checks and linked Next Actions. NICE, RCPsych, BAP, SPS and handbook references remain visible as national or supporting evidence. A criterion-specific local link activates only for its named discriminator; where no public alert-specific NHS GGC page was verified, Amara says so and offers the policy directory without presenting it as a clinical source.

Switching back to Generic (UK) removes NHS GGC activation metadata and local-workup fallbacks without changing which findings match the alert. The NHS GGC active badge means at least one final action carries an exact source binding for the selected trust; it does not imply claim-level review of every sentence or dose.

Infection Presentations keep distinct diagnoses and acquisition classes separate. Under NHS GGC, 22 exact presentations and their DDx references show source-transcribed treatment branches from the governed registry. The complete ladder remains visible, but exactly one source-defined branch must be selected manually before it can appear in Next Actions; Amara never exports every mutually exclusive band or infers an unrecorded clinical sub-branch. Verify the linked live source, indication, allergy, renal/hepatic function, pregnancy and interactions before prescribing. Generic UK receives none of this NHS GGC regimen content or branch state.

For AECOPD, the older NHS GGC respiratory assessment page remains review required for copied assessment, NIV and related respiratory claims because its public page was reviewed in August 2022 and last updated in September 2022. Separately, under the NHS GGC toggle, the current Guideline 165 purulent-sputum antimicrobial branch is source-transcribed, linked to its official source and manually selectable for Next Actions. It is never shown as a local regimen in Generic UK.

Chronic Pathology is a first-class search filter for chronic conditions, comorbidities, and risk modifiers. Search a chronic tag or chronic-symptom card (e.g. chronic cough, exertional dyspnoea) to open its typed card inside Clinical detail, with expandable differential rows, workup, red flags, management pointers, sources, and chronic-context Next Actions when authored.

Chronic differentials use the same compact, priority-ranked expandable rows as Acute differentials. A selected chronic context can contribute its authored assessment and follow-up to Next Actions. An exact searched chronic DDx remains reference only: it contributes conditional investigation and escalation prompts, never diagnosis-specific treatment, and adds no patient finding or live Pattern Alert.

The shared chronic runtime is not a Psychiatry-only layer. It merges 12 authored general-medicine specialty files—respiratory, cardiovascular, gastroenterology/hepatology, haematology/oncology, endocrine, renal, rheumatology/autoimmune, neurology, infectious disease, dermatology, multisystem and Head & Neck—then adds the Psychiatry extension and narrowly scoped runtime safety patches. Stable IDs are deduplicated once for search, matching, detail routing and Next Actions; the same renderer and action exporter are used across specialties.

Structured evidence depth is not yet equal across that corpus. The shared general-medicine detail store currently contains 22 symptom-led records and 52 complete expandable DDx rows; the Psychiatry extension adds 57 richer typed records. Missing named sources or pathophysiology maps remain labelled as gaps and are not upgraded merely because a JSON source file exists. Automated checks prove loading, selection, search and action linkage—not clinical validity.

🔬 Chronic Conditions may appear on searched pattern-alert groups when chronic-related searched alerts are present; it shows or hides those chronic-related searched cards without changing Acute mode.

Duration-, investigation-, and fever-pattern criteria for rare/chronic alerts must be selected explicitly. For example, ordinary acute fever does not satisfy the PUO duration or unrevealing-work-up criteria.

The manual Clinical lane now includes Mental State & Behaviour and Psychiatry Context & Medicines. Select only findings that were reported or observed. Safety dimensions such as suicidal ideation, intent, plan, access to means and preparatory acts are separate parameters; Amara does not infer one from another.

Psychiatry Pattern Alerts are assessment and action prompts, not diagnoses, probabilities, or suicide/violence prediction scores. Acute or atypical mood, psychosis, agitation, panic, catatonia and behavioural change must retain delirium, substance/withdrawal, medicine, neurological and other physical causes in the differential.

Each psychiatry parameter now follows the normal CliniSense card order first: Management, Escalate, Workup, Likely Causes, Focused Hx and Focused Ix. Psychiatry-specific interview depth, full safety detail, expandable differential rows, avoidance points, Mechanism / maintenance map, linked patterns and source evidence remain available under Additional psychiatry assessment, safety and evidence. Tap a differential to open its fit, against, investigations, management, escalation and source fields. Sign / symptom, Chronic context and DDx reference badges show what the card means. Chronic history and medicine tags from Psychiatry Context & Medicines appear in Clinical detail with their source-backed Next Actions; they never manufacture an unselected current symptom.

A searched psychiatry differential opens the relevant detail as DDx reference · not asserted and highlights the named row; it does not select that diagnosis or a patient finding. Only complete authored differential rows are displayed. If a row lacks its explanation, investigation, management, escalation, or named source, Amara withholds it instead of showing placeholder text.

The supplied Oxford Handbook of Psychiatry (4th ed., 2019) and Oxford Handbook of Clinical Psychology, Updated Edition (2011/2014) are secondary sources for phenotype, interviewing and maintenance models. Current NICE, RCPsych, BAP and NHS guidance governs urgent actions. Older MARSIPAN thresholds, handbook medicine doses, detention wording and rapid-tranquillisation regimens are not imported.

For NHS GGC serotonin syndrome and neuroleptic malignant syndrome, Amara links the live emergency pages and keeps recognition, investigation and escalation prompts in view. It deliberately withholds copied medicine doses and treatment-specific regimens until claim-level review is complete.

Management - authored action suggestions, ordered by urgency. They are not automatically patient-specific or claim-level verified; check the displayed source state and the current live local pathway before acting.

Escalation - when to call seniors, ICU, specialty teams, or formal pathways.

Workup - investigations to send. This is separate from immediate management.

Differential - alternative diagnoses to consider after immediate action content.

DDx detail and Management - every direct DDx keeps its authored one-line rationale and now resolves a non-empty Management plan. 📖 marks authored diagnosis-specific assessment/workup; 💊 management only means no expanded assessment was authored, but an exact source-linked management, routing and safety-net contract is available. The template has five possible sections; only authored sections are shown, and omitted sections are identified instead of being padded with generic advice. Amara never fills a gap from the parent symptom, lab, panel, specialty, category or a fuzzy name match. Each plan stays on its exact DDx: it is not combined into the parent CliniSense Management summary or exported as a Pattern Alert action. Composite and finding labels receive interpretation and routing—not invented treatment for an unconfirmed diagnosis.

Clinical detail — distinguishes an observed or reported finding from longitudinal context and a searched reference. The type badge on each card keeps that meaning explicit.

DDx antimicrobial guidance - follows the selected Trust and every selected Patient factor. Fixed antibiotic text in pathology Management is withheld and routed through one governed panel. The legacy resolver remains fail-closed. With NHS GGC selected, 22 exact Infection Presentations now read their actual source-transcribed regimen branches from the central governed registry used by DDx detail, Infection Presentations and Next Actions. Drug names link to the exact official source. When one source variant covers the complete recorded factor combination, that matched antimicrobial branch becomes the primary displayed branch and the other source branches move into a comparison disclosure; the Infection Presentation and its Next Action both state the factor effect. When no complete variant exists, the regimen is explicitly withheld instead of appearing unchanged. Missing mappings and rare, specialist-only, expired or scope-limited sources stay pending/link-only, and another trust is never substituted.

Differential details — expand a diagnosis row to review its assessment and management. Specific contradictory findings appear beneath the row when present. Pattern Alert explanations still show which findings and context contributed to the alert.

Next Actions are suggestions for clinician review. Read the complete action, its timing, conditions and source state before deciding whether it applies. A checkbox records your interaction with the checklist; it does not confirm that treatment was prescribed, administered or clinically appropriate. Testing of the suggestions and specialist clinical review remain necessary.

Management in a LabSense or Clinical detail card provides context for that exact finding or differential. Its shared Next Actions list starts collapsed; expand it to review the finding’s actions and criteria. The main Next Actions section brings together the applicable structured prompts. Shared reviewed records keep migrated content aligned, but reconciliation remains incomplete: a card and the checklist are not guaranteed to contain identical wording or every historical instruction.

Search-only references add no patient evidence. Conditional rows require their stated clinical conditions to be confirmed independently. Open the typed origin beneath a Next Action to review its exact LabSense, CliniSense or Pattern Alert context, and open the evidence control for its source and review status. If the two views conflict, use the current official guidance and obtain senior or specialist review.

Select an adult symptom, then expand a medicine reference to read its indication, route, dose, frequency, review and cautions together. The 27 symptom areas include explicit source gaps where a complete current regimen could not be verified. Mild, Moderate and Severe record symptom severity; they do not choose a medicine or dose.

Medicine options are alternatives to assess, not instructions to combine treatments. Check the patient's existing medicines, allergies, renal and hepatic function, formulation and local prescribing policy. Source retrieval dates describe the reference check; specialist clinical sign-off remains pending.

The Syringe Driver section gives only supported direct opioid conversion estimates before individual adjustment. It does not generate a prescription, automatic breakthrough dose or mixture-compatibility decision. Unsupported conversions direct you to the official table or specialist advice. Last Days and Ceiling support review and planning alongside the local pathway and documented patient preferences.

Tap the clipboard icon in the top bar (📋 Protocols / Calculators) to browse protocol navigators and built-in calculators labelled by their declared source or routing basis. An organisation or guideline name is provenance, not a claim that the navigator exactly transcribes the live source or has local clinical sign-off. Protocol and calculator chips in Next Actions open the same surface. Every protocol step keeps its guide-level source links visible; these are references bound to the guide as a whole, may include broad book or topic pages, and are not per-step claim verification or clinical sign-off. Fixed antimicrobial regimens are withheld unless the individual protocol node has an explicit verified binding to the active named local policy.

In the ABG / VBG Interpreter, Core blood gas remains open. Oxygenation, Anion gap and Additional measurements start collapsed at every screen size when empty; open them when those data are available. A populated optional section reopens automatically when saved values or its selected context are restored. On every screen size, all data-entry sections appear before the interpretation, and the result updates as values change.

When a protocol is opened from this catalogue, ← Back first moves through its steps and then restores the same catalogue search, filter, scroll position and activating card. ✕ Close exits the whole catalogue journey.

Before resuscitation, record fluid already given in the current episode, including pre-hospital treatment. Blank intake is unknown, not zero. In obesity, confirm the entered ideal body weight; changing the weight requires reconfirmation. Search references do not create patient exclusions.

Open Fluid Management and choose Adult IV Fluids — 5 Rs & Weight-based Maintenance or Hypovolaemia / Haemorrhage Screen. The embedded Adult IV-fluid prescription aid keeps Resuscitation, Routine maintenance and Replacement as separate modes. Routine maintenance and generic loss replacement are separate. The GGC high-output-stoma mode explicitly combines its agreed maintenance and losses, deducting IV medicines once. Redistribution and Reassessment remain clinical review steps: NICE's five Rs are Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.

For Routine maintenance, enter the clinician-confirmed prescribing weight and all oral, enteral, medicine, nutrition, blood-product and other IV intake expected over 24 hours. Standard output is 25–30mL/kg/day; the 20–25mL/kg/day control is only a considered reduced range for an individually assessed older/frail patient, renal impairment, cardiac failure, malnutrition or refeeding risk. In obesity, enter a documented ideal body weight, use the lower range, rarely exceed 3L/day and seek expert help if BMI is over 40.

The result shows the daily water range, remaining IV volume after counted intake, mL/hour over 24 hours, approximately 1mmol/kg/day each Na/K/Cl, 50–100g/day glucose, and 1 L bag volume equivalents—not a bag order. It never rounds upward to finish a bag. Select a locally stocked product comparator to see its IV contribution of Na/K/Cl/glucose; this does not account for the composition of other intake and does not prescribe that product. NICE's 0.18% sodium chloride/4% glucose with about 27mmol/L potassium is shown as one day-1 example, not a universal default; more than 2.5L/day of that example increases hyponatraemia risk. Use a ready-mixed potassium product only; never add potassium manually.

For Resuscitation, the eligible general adult path shows 500mL crystalloid containing sodium 130–154mmol/L in less than 15 minutes with reassessment before any further 250–500mL. Suspected sepsis switches to the NICE NG253 250mL over 10–15 minutes pathway. Active major haemorrhage withholds a generic crystalloid plan and routes to the local major-haemorrhage pathway. For Replacement, enter a measured loss and a non-emergency period of 1–24 hours; the volume remains separate from maintenance and the bag-composition prompt follows the loss and current labs. A result above 5,000mL or 500mL/hour is withheld for urgent senior/specialist review rather than displayed as a routine plan.

The generic calculator is suppressed for under-16s, pregnancy/recent pregnancy (including postpartum presentations), diabetes mellitus or a diabetes-specific fluid pathway, severe renal or liver disease, burns, traumatic brain injury/neurosurgery, major haemorrhage, inotropes/critical care, surgical anaesthesia and major electrolyte derangement. Use the condition-specific and local specialist pathway instead.

With Trust: NHS GGC, the general calculation remains NICE CG174-based and a current board-wide NHSGGC policy has not been verified in Amara. Confirm the current NHSGGC/HEPMA stock, product composition and local policy with ward pharmacy. The NHS Scotland calculator is a supplemental cross-check requiring Board adoption and its linked manual page is past its stated review date. Exact current NHS GGC condition-specific guidance activates only where verified. High-output stoma guideline 1029 remains withheld until its adult acute-inpatient, clinical-dehydration, at-least-3-day output, threshold, stability and exclusion criteria are confirmed; enter the clinician-agreed maintenance volume before deducting IV medicines; the combined result subtracts medicine volume once. Do not add it to another maintenance calculation. A locally verified sodium-rich replacement comparator is required.

Search shell - one search field plus toolbar for Trust and Filter. Search can look through complaints, symptoms, labs, pathways, diagnoses, syndromes, protocols, calculators, chronic DDx cards, and pattern alerts.

Filter - slides open a side panel that can combine DDx, Chronic Pathology, CliniSense, LabSense, and Pattern Alerts, or reset to All. It does not hide safety-critical result panels after a result is selected.

Selected Findings & Context - selected context card containing Ward content, Patient factors, selected findings, lab results, and context chips.

Trust - active guideline dropdown in the search toolbar. NHS GGC activates only exact mapped local guidance; Generic UK never inherits an NHS GGC workup. Ward content scrolls internally in the selected-context card; Patient factors remains open for multi-select.

Clinical + labs - one collapsible manual-entry area with Clinical and Labs lanes feeding the same Working impression.

Working impression - live result stream for current search selections, clinical findings, labs, context, protocols, Pattern Alerts, and Next Actions.

● Red dot - immediately life-threatening.

● Orange dot - high urgency.

● Yellow dot - moderate urgency.

Pattern Alerts - one canonical section for searched references and live rule matches. A canonical condition is rendered once; its visible state says whether it is reference-only or supported by independently selected patient evidence.

Details - the shared Pattern Alert dialog containing exact authored criteria, selected-evidence arithmetic, source and governance state, differential, and reasoning. Confirmed findings can be added or removed from the shared patient evidence there; audit content is kept off the glanceable card.

Selected-evidence coverage - proportion of the authored rule evidence represented by independently selected findings. Generated pathway/protocol signals are excluded and disclosed separately. This is not diagnostic confidence, probability, sensitivity, or specificity.

🔎 Search reference · not patient-triggered - a non-patient-triggered Pattern Alert library result. It adds no findings or labs, labels severity as conditional, and keeps reference actions plus collapsed supporting DDx/Flow navigation available.

Next Actions pathology accordion and time windows - generated actions are organised by pathology first. Open one pathology to see its Now, Urgent, Today, and Monitor actions together; within each window, rows are grouped as Escalation, Initial care, Investigations, Management & treatment, Reassess / monitor, and Guidance & other actions. The other pathology headers stay minimised and scrollable. Urgent has no inferred one-hour deadline: follow the action or pathway deadline. Timing tags are removed from displayed instructions while their conditions and stated deadlines remain visible. A timing label is not a guarantee that an action is appropriate for the individual patient. Next Actions are not directly searchable.

LabSense Next Actions flow audit: all 93 LabSense tiles use one reviewed structured Next Actions owner. The older free-text Management, Escalate, Workup and Antimicrobial fields remain explanatory detail and are never parsed into a dose, fluid, blood-product, imaging or medicine order.

Each LabSense plan follows Danger → Act → Verify → Investigate → Manage → Route → Reassess. Interpretive classification stays on the explanatory card and is not exported as a checklist task. Every tile starts with a concise bedside Do now action and a concrete investigation. Where current governed guidance supports it, the plan states the first safe condition-gated management step; otherwise it gives an explicit safety or referral destination. Every plan ends with a reassessment target. Related selected analytes share one panel-level verification at the earliest required time window.

Conditional management and referral rows are conditional prompts, not treatment triggered by a laboratory result alone. Each shows Condition followed by its exact branch condition. The action states what to start, stop, support or arrange; the live pathway remains the source for exact dose, rate and eligibility detail. Until the condition is established, the row has no completion checkbox and is excluded from completion totals. The same applies to reference-only and non-activating source-review rows.

LabSense software checks cover isolated labs, both Trust modes and multi-lab combinations, including duplicate actions, timing and source routing. Results apply to the tested scope only. Overall prelaunch reconciliation and clinical review remain incomplete; see About / Version / Governance for the current release status.

Legacy LabSense management, workup and escalation prose is candidate material, not an automatic action source. Legacy content is reconciled into structured records with its source and review state retained; reconciliation is not clinical sign-off. AST:ALT ratio below 1 and above 2 retain Danger, Verify, Investigate, acute-liver-failure, toxicology and persistent-cause Route branches and gated Reassess. For AST-predominant results, muscle/CK context precedes liver-specific interpretation when relevant; severe alcohol-related hepatitis is a specialist phenotype-gated branch, never a treatment instruction from the ratio. The ratio remains a contextual clue: it does not diagnose alcohol-associated disease, prescribe corticosteroids or provide definitive fibrosis staging.

An isolated laboratory result now follows its analyte-specific ward-action route. Raised K⁺ (hyperkalaemia) is one combined live finding: the duplicate lab-only Hyperkalaemia Pattern Alert is absorbed into LabSense, while an explicit Pattern Alert search remains a non-patient-triggered reference. Its Do now action obtains an urgent ECG and stops potassium sources; its investigation confirms a fresh non-haemolysed potassium and reviews renal function, acid-base state, medicines and cause. The Only if management row then states the first safe hyperkalaemia actions while the current UKKA or local pathway supplies severity-specific doses and monitoring. A genuine AKI + Hyperkalaemia alert still requires separate renal evidence. Raised sodium or glucose alone cannot launch HHS or DKA treatment. Confirmed HHS retains one canonical four-row clinical bundle in both trusts; NHS GGC alone adds one review-only linked HHS tool (4+1). Confirmed hypoglycaemia retains one canonical emergency owner. Hyperglycaemic symptoms alone remain assessment-only and open no DKA or HHS tool.

Identical tasks emitted by aliases of the same pathology are shown once with merged provenance, while identical wording from different pathologies remains separate. Every final row has a stable action and completion ID that survives added clinical context. When several unsafe unverified rows would render the same withholding notice, the notice is shown once per pathology and reason with the hidden-row count retained.

Generic UK action wording and source IDs never inherit NHS GGC content. Current NHS GGC links are used only where a maintained, relevant public route exists. Raised-potassium routing opens the current external UKKA or NHS GGC pathway; the legacy internal dose/threshold tree is not activated. Review-required sodium guidance and all source gaps are deliberately non-activating; broad group guidance is not over-attributed to generic laboratory interpretation. Where no specific current guideline exists, LabSense stays at confirmation, assessment, cause-directed investigation and escalation rather than inventing a threshold or dose.

Only renderer-authored structured Infection Presentation guidance controls can become interactive links. Authored and untrusted markup is escaped, and infection controls remain treatment-ineligible unless the governed source-defined branch and required patient factors are confirmed.

Tap a Pattern Alert's linked Next Action control to open and filter to its matching action rows. Changing a finding, lab, or context clears stale focus and reopens the current action set. While focused, the banner names the exact Pattern Alert whose actions are shown. Clinical action text stays visible. The complete instruction and its essential conditions remain visible, including on narrow screens. When an exact CliniSense, LabSense, or Pattern Alert origin is available, a small typed link directly beneath the action opens, scrolls to, and briefly highlights that card; if no stable origin is recorded, no origin link is shown. The separate compact evidence-state control on the right — Verified, Review, Related, or Source gap — opens source links, review state and provenance. Protocol and calculator rows use one explicit control containing the tool type, its name, and Open. Use Show all to return from a focused Pattern Alert without clearing the searched condition or pathway that generated it.

When Show all is active, pathology is the top-level accordion. Opening one pathology shows all of its non-empty Now, Urgent, Today and Monitor windows together and minimises the previously open pathology. Every other pathology header remains visible as a compact list you can scroll through and select quickly. Completion counts cover only unconditional, patient-triggered, activating actions; conditional, reference-only and review-only rows are counted separately. A focused Pattern Alert view names the alert in its banner and shows its matching rows directly; Show all returns to the pathology accordion without clearing the searched condition or pathway.

Pattern Alert details — show trigger evidence and clinical reasoning for the alert.

📖 - authored diagnosis-specific assessment/workup is available. 💊 management only marks an exact source-linked Management contract without an expanded assessment record. Every direct DDx has Management; neither marker asserts that the diagnosis is present.

🦠 - Infection Presentation grouping. It does not mean that Amara has selected an antimicrobial or a guideline severity band. Under NHS GGC, populated cards show all source-transcribed bands for manual confirmation; pending cards link to the live source.

📘 Chronic DDx - legacy search label for a chronic-symptom or differential reference; the selected result now opens inside the typed Individual Detail section.

🔬 Chronic Conditions - show/hide chronic-related searched pattern-alert cards when present.

📋 Protocols / Calculators - top-bar clipboard button opens the protocol and calculator browser.

Reset - clears the current Acute selections and smoothly returns to Search without focusing the search field or opening the keyboard. Its brief animation lasts 0.9 seconds; reduced-motion preferences are respected.

🌙 Dark / ☀ Light - theme toggle; preference persists.

Declared source + linked guidance means the authored item names a source and Amara can link to relevant authoritative guidance. It does not prove that every claim, threshold, or dose has been independently checked.

Related guidance is a topic-level official link only; it is not the source of every displayed sentence.

Secondary clinical reference identifies explanatory material such as MSD Manual Professional. It can support pathophysiology, phenotype, differential diagnosis and broad investigation context, but it is not UK guidance and cannot by itself validate a dose, antimicrobial regimen, timing or numeric threshold, referral/admission decision, legal requirement or NHS GGC pathway.

Source gap means no direct authoritative source link is bound to that displayed alert or action row. Treat the content as unverified and use the live local protocol.

Citation integrity failure means the named guideline is unrelated to the condition or has been replaced. The affected action is withheld until its wording and replacement source are reviewed.

On each Next Actions row, the Source control opens a popup containing its exact evidence state, governance note, declared or related links, version information and unresolved provenance. The compact control does not remove or upgrade the source warning.

NHS GGC current-link audit: on 26-08-2026, Acute checked 101 governed NHS GGC source records: all 100 records with a public URL reached or officially redirected to an approved official host, one eating-disorder policy record remained citation-only, and there were 0 broken/network-error, access-limited, critical or high findings. The audit also found 0 ungoverned direct-runtime URLs. This is dated link and governance evidence, not claim-level clinical validation. Review-overdue, review-required, scope-limited, navigation-only, supporting-only and uncontrolled-copy records remain labelled and non-activating.

Automated checks cover pattern retrieval, structural registries, and stable Pattern Alert-to-Next Action linkage. They verify software routing, not clinical accuracy or treatment suitability.