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name: evidence-insight description: "Routes medical-research requests involving literature discovery, PubMed/PMC and database signals, PICO search design, evidence mapping, gap auditing, evidence ranking, and citation integrity while separating retrieval, synthesis, and provenance." disable-model-invocation: true metadata: disco-role: operating license: MIT

Evidence Insight

Use this route when the user needs an evidence-grounded view of medical or biomedical literature: find records, design a reproducible search, inspect PubMed/PMC or registry signals, screen and map evidence, identify defensible gaps, rank evidence, or verify that a claim is supported by its cited source.

This is a router and evidence-control skill, not a replacement for a protocol writer, statistical analyst, or manuscript writer. Keep all claims bounded by the records and source passages actually available. Never invent a citation, identifier, result, trial status, or database response.

Route by the requested deliverable

User need	Route here	Next route when the deliverable changes
Clarify a clinical/research question; build PICO/PICOS or PECO concepts	Define scope and search blocks	protocol-design for a study protocol or endpoints
Find biomedical literature or build a PubMed/PMC strategy	Search and retrieval workflow	academic-writing only for prose built from verified results
Find trials, studies, or database records	Registry/database signal workflow	protocol-design for trial design or eligibility planning
Screen records or organize evidence	Screening and evidence-map workflow	data-analysis for quantitative synthesis or modeling
Compare evidence strength or resolve contradictory findings	Evidence ranking and conflict workflow	protocol-design for a study that resolves the gap
Test whether a paper supports a claim or citation	Claim-source verification workflow	academic-writing for citation-safe manuscript wording
Identify a real, topic-specific research gap	Retrieval-first gap audit	protocol-design for a study-ready design
Fit models, calculate power, analyze clinical/omics data	Do not execute here	data-analysis
Draft a review, paper section, abstract, or submission package	Do not execute here	academic-writing

When a request spans routes, finish the evidence-insight handoff first and state which evidence is verified, provisional, or missing. Do not silently perform the sibling deliverable.

Operating sequence

1. Normalize the question. Record the population/problem, exposure or intervention, comparator, outcome, study design, setting, date/language, evidence layer, and intended use. Mark unknowns instead of filling them in.
2. Choose sources deliberately. Use PubMed/MEDLINE as the biomedical anchor when applicable; use PMC for accessible full text; use a trial or study registry for registry signals; add other databases only with their exact coverage and access recorded.
3. Build a reproducible search. Make concept blocks from PICO/PICOS or PECO. Combine synonyms with OR, concepts with AND, and use MeSH plus title/abstract terms. Keep a sensitive search and a precision refinement separate. Record the exact query, database, vocabulary version or search date, filters, and result handling.
4. Retrieve and screen. Normalize PMID/PMCID/DOI and registry identifiers, deduplicate conservatively, and separate title/abstract screening from full-text verification. Automated scores are triage signals; a human must resolve ambiguous inclusion or exclusion decisions.
5. Map evidence before synthesizing. For each included item capture design family, population, exposure/intervention, comparator, endpoint, direction and magnitude only when verified, limitations, validation, and evidence role. Distinguish direct-topic evidence from adjacent evidence.
6. Audit claims and gaps. Decompose claims, trace each citation to the source actually checked, and keep association, prediction, mechanism, causation, and clinical utility distinct. A gap is formal only after the retrieval and evidence audit; reject generic requests for “more studies” or “more validation” without a topic-specific unresolved question.
7. Handoff or stop. Return a compact result with scope, search record, evidence map, provenance, uncertainty, and recommended sibling route. Stop when a required source, credential, full text, or verification gate is unavailable rather than fabricating a conclusion.

Use the bundled references progressively:

• workflows.md for PICO/search, retrieval, screening, mapping, gap, citation, and routing procedures.
• data-and-provenance.md for PubMed/PMC, registry/database signals, API and credential boundaries, citation ledgers, and evidence-status rules.
• troubleshooting.md for bounded recovery, partial results, contradictions, and route failures.

Required output shape

Unless the user requests a compatible structured format, return:

1. Question and scope — normalized PICO/PICOS or PECO, evidence layer, filters, and assumptions.
2. Sources and search record — databases/endpoints, exact queries or search logic, dates, access limitations, and counts only if observed.
3. Evidence result — records or an evidence map with study design, directness, limitations, and evidence role.
4. Integrity and provenance — identifiers, source locations, retrieval dates, verified versus inferred fields, exclusions, and unresolved items.
5. Routing — why the next action belongs here, protocol-design, data-analysis, or academic-writing; include a handoff payload.

A claim without a source location is not a verified finding. A missing count is preferable to an invented count. If only metadata or an abstract was checked, say so explicitly.

Hard boundaries

• Do not give patient-specific diagnosis, treatment, dosing, enrollment, or urgent-care advice. Redirect clinical decisions to qualified clinicians and appropriate guidance.
• Do not treat PubMed indexing, PMC availability, citation count, journal prestige, trial registration, or trial status as proof of efficacy or quality.
• Do not turn an abstract, title, review paraphrase, or registry record into a stronger claim than it supports. Separate primary from secondary evidence.
• Do not use an API key, institutional credential, or private full text unless the user has explicitly supplied an authorized runtime and the secret remains outside prompts, files, logs, and output. Prefer public access and ask for missing authorization.
• Do not execute statistical fitting, power calculations, protocol drafting, or manuscript composition in this route. Provide an evidence handoff and route to the sibling skill.
• Do not claim a research gap without a recorded retrieval and evidence audit.
• Do not expose PHI or place sensitive patient data in external queries.

Minimal handoff

When routing onward, pass only what the next skill needs:

question: <normalized question>
scope: <PICO/PICOS or PECO plus filters>
evidence_goal: <design, mechanism, prognosis, diagnosis, treatment, etc.>
sources_checked: <database, endpoint, date, query id>
verified_records: <PMID/PMCID/DOI/registry IDs with source status>
key_findings: <source-bounded findings and locations>
uncertainties: <missing full text, unresolved conflicts, inaccessible data>
requested_next_route: protocol-design | data-analysis | academic-writing

The handoff is not permission to infer beyond the evidence ledger.