Audit: QRS - Ezetimibe to Lower LDL
Audit conducted on 10/31/2026 15:17 using AI4L / Opus 5.5
Summary
| Items | Count |
|---|---|
| Total | 97 |
| Passed | 88 |
| Failed | 0 |
| N/A | 9 |
| Pass Rate | 100.00% |
- Total = Passed + Failed + N/A
- Pass Rate = Passed / (Passed + Failed) × 100
- N/A items are excluded from the pass rate calculation
1. General Rules
| # | Description | Result | Comments |
|---|---|---|---|
| 1.1 | Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER. | 🟢 | Lede, Protocol, Time to effect, gates, tiers, markers and cadence all trace to ER text (Conclusion, Therapeutic Protocol, Practical Considerations, Key Interactions, Monitoring table) |
| 1.2 | Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing. | 🟢 | Lede keeps “not fewer deaths”, “small, possible bowel-cancer risk remains unresolved”, “Evidence in younger, healthy adults is thinner” in line with the ER Conclusion |
| 1.3 | The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”). | 🟢 | Contraindications mirror ER “Populations who should avoid”; gemfibrozil/bezafibrate item carries the ER’s own “Avoid.” |
| 1.4 | The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc. | 🟢 | Benefits/Risks in ER tiers; “Fibrates other than fenofibrate” is flagged “Avoid.” in the ER and counts as a contraindication per the section hint |
| 1.5 | PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact. | 🟢 | Only “RACING” and “ACC/AHA” appear, both in the ER for the same facts |
2. Focus, Tone & Audience
| # | Description | Result | Comments |
|---|---|---|---|
| 2.1 | The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing. | 🟢 | |
| 2.2 | The tone of the QRS is expert, accessible, objective, and data-driven | 🟢 | |
| 2.3 | The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor | 🟢 | |
| 2.4 | The QRS avoids language that implies medical or clinical advice | 🟢 | |
| 2.5 | The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising” | 🟢 | |
| 2.6 | The QRS never addresses the reader directly — it presents evidence, not guidance | 🟢 | |
| 2.7 | The QRS is written in plain language, avoiding unnecessary medical jargon | 🟢 | Technical terms (Child-Pugh, rhabdomyolysis, thrombocytopenia, paresthesia) are ER labels carried verbatim |
| 2.8 | Information is presented in a concise and very compact manner | 🟢 | |
| 2.9 | The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review. | 🟢 | |
| 2.10 | The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort. | 🟢 | |
| 2.11 | The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort. | 🟢 | |
| 2.12 | Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience. | 🟢 | Lede flags thinner evidence in younger, healthy adults versus heart patients |
| 2.13 | The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim. | 🟢 | |
| 2.14 | The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt. | 🟢 | Lede uses “once-daily oral prescription medication”; no lay route phrasing |
3. Template Integrity
| # | Description | Result | Comments |
|---|---|---|---|
| 3.1 | The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why” | 🟢 | Diff against template shows all fixed labels unchanged |
| 3.2 | Every element carrying a data-qrs-var attribute in [qrs_template] is present in the QRS with the same name | 🟢 | All template variables present; marker_# and qualitative_item_# expanded to 1..6 and 1..5 |
| 3.3 | Everything outside the data-qrs-var spans — markup, text, styles, comments — is as in the template; spans that no checklist item addresses are left unchanged as well | 🟢 | Diff against template shows changes only inside data-qrs-var spans, display:none attributes on empty spans and the metadata block |
4. Formatting
| # | Description | Result | Comments |
|---|---|---|---|
| 4.1 | An empty ER section never produces visible empty-state text in the QRS: the corresponding region is hidden or left empty. Phrases such as “None documented in human trials to date” or “Not formally studied” appear only where the ER uses them for a fact the QRS carries over. | 🟢 | Empty tiers (benefits_medium, risks_high/medium/speculative) and time_3 hidden; no empty-state text |
| 4.2 | Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label. | 🟢 | Protocol labels (“Standard dose”, “Guideline target approach (U.S.)”, “Up-front combination”) and gate items use ER bold labels verbatim |
| 4.3 | Labels are not paraphrased, abbreviated, or invented. | 🟢 | Gloss parentheses dropped (e.g., “(immunosuppressant)”), example lists trimmed with ER words kept; tier labels drop only qualifiers per 12.3/13.3 |
| 4.4 | The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels. | 🟢 | |
| 4.5 | The QRS is designed to render on one A4 page. It fails this item only for one of four things: a trailing clause after a dash, an optional gloss, an example list left untrimmed, or a repetition. Nothing else is cut to fit. | 🟢 | No trailing dash clauses, no untrimmed example lists, no optional glosses or repetitions found |
5. Metadata
| # | Description | Result | Comments |
|---|---|---|---|
| 5.1 | The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content. | 🟢 | |
| 5.2 | Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML. | 🟢 | |
| 5.3 | The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet. | 🟢 | |
| 5.4 | All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. | 🟢 | duration “00:02” quoted because it contains a colon |
| 5.5 | The filename of the source ER is stated as “er_filename: [er_filename]” | 🟢 | |
| 5.6 | Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]” | 🟢 | 26.10.25 matches QRS.md version |
| 5.7 | Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430) | 🟢 | |
| 5.8 | The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]” | 🟢 | |
| 5.9 | The nickname of the AI is the full name without the version number, with all remaining words joined by hyphens (e.g., Opus, Sonnet, Grok, Gemini-Flash, GPT); when the full name has no version number or is “Unknown”, the nickname equals the full name | 🟢 | |
| 5.10 | The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]” | 🟢 | |
| 5.11 | The full name of the AI consists of the model name (the word or words directly before the version number, leaving out the first if there is more than one, e.g., Claude Opus 5.5 → Opus 5.5), the model version number and the variant (if any) as stated in the system prompt or developer instructions of the creating model, with every word capitalized and without product, effort or pricing names (e.g., Opus X.Y, Sonnet X.Y, Grok X.Y, Gemini X.Y Flash, GPT X.Y), the model name alone when the system prompt or developer instructions name a model without a version number (e.g., Grok), or “Unknown” when neither the system prompt nor the developer instructions of the creating model name a model | 🟢 | Opus 5.5 |
| 5.12 | The filename of the document is stated as “qrs_filename: [filename of this document]” | 🟢 |
6. Page Title & Header
| # | Description | Result | Comments |
|---|---|---|---|
| 6.1 | [page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &) |
🟢 | “Ezetimibe to Lower LDL - Quick Reference Sheet” |
| 6.2 | [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &) |
🟢 | |
| 6.3 | [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY] | 🟢 | 2026-1031-1507 → 10/31/2026 |
| 6.4 | [header_subline_model] is set to [qrs_creator_ai_fullname] | 🟢 | |
| 6.5 | No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. | 🟢 |
7. At-A-Glance Section
| # | Description | Result | Comments |
|---|---|---|---|
| 7.1 | [at_a_glance] opens by saying what the intervention is — its kind (e.g., dietary supplement, prescription medication, peptide, plant, procedure, practice) — and what it is used for, in plain language, before any verdict on the evidence | 🟢 | Opens “Ezetimibe is a once-daily oral prescription medication that lowers harmful cholesterol by blocking its uptake in the gut” |
| 7.2 | [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section |
🟢 | |
| 7.3 | [at_a_glance] is no longer than 70 words | 🟢 | 70 words (script count) |
| 7.4 | Every fact in [at_a_glance] is supported by a distinct passage in the ER. | 🟢 | |
| 7.5 | It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead | 🟢 | |
| 7.6 | It DOES NOT cite specific trials (names, years, sample sizes, p-values) | 🟢 | |
| 7.7 | It DOES NOT cite effect sizes, relative risks, or statistical results | 🟢 |
8. Contraindications
| # | Description | Result | Comments |
|---|---|---|---|
| 8.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | |
| 8.2 | [stop_items] represent the Contraindications from the ER | 🟢 | Five ER populations plus “Fibrates other than fenofibrate” (ER: “Avoid.”) |
| 8.3 | Individual [stop_items] are formatted as <li></li> | 🟢 | |
| 8.4 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | |
| 8.5 | Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | “(Child-Pugh B or C, score 7–15)” preserved |
| 8.6 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | N/A | ER uses no ranking notation in contraindication parentheses |
| 8.7 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision. |
🟢 | |
| 8.8 | If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. | N/A | Section is not empty |
9. Key Interactions
| # | Description | Result | Comments |
|---|---|---|---|
| 9.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | |
| 9.2 | [caution_items] represent the ER’s documented interactions — the items under its “Documented interactions:” label — excluding any that are already listed as Contraindications and any entry phrased as no interaction found | 🟢 | 11 documented interactions listed; gemfibrozil/bezafibrate excluded as contraindication; tacrolimus/sirolimus, telmisartan, digoxin/glipizide/OCs, levothyroxine, antacids/cimetidine and soluble fiber excluded as no-interaction entries |
| 9.3 | [caution_theoretical_items] represent the ER’s theoretical interactions — the items under its “Theoretical interactions (inferred from mechanism, not studied in humans):” label | 🟢 | “Alcohol (heavy intake)” |
| 9.4 | The ER placeholder “None identified” is never an item: it means that group is empty | 🟢 | |
| 9.5 | Individual [caution_items] and [caution_theoretical_items] are formatted as <li></li>. The template’s bold “Theoretical (inferred from mechanism)” sub-heading is the only marker of the second list’s status: no item carries “(theoretical)”, “inferred from” or a mechanism clause | 🟢 | |
| 9.6 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | |
| 9.7 | Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | “(rifampicin)”, “(cholestyramine, colesevelam)”, “(simvastatin, rosuvastatin)”, “(extended-release)”, “(with monacolin K)”, “(heavy intake)” kept |
| 9.8 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | N/A | ER uses no ranking notation in interaction parentheses |
| 9.9 | If the ER’s theoretical group is empty, the whole Theoretical block — the caution_theoretical span with its sub-heading and list — is hidden with style="display:none", not removed: its spans stay in place, empty. |
N/A | ER theoretical group is not empty (Alcohol, heavy intake); block shown |
| 9.10 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used. |
🟢 | |
| 9.11 | If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on, and the Theoretical block is hidden per 9.9. E.g. | N/A | Section is not empty |
10. Protocol
| # | Description | Result | Comments |
|---|---|---|---|
| 10.1 | The section is derived from the ER Therapeutic Protocol section |
🟢 | |
| 10.2 | The three sets of [action] items cover the three most important actionable implementation aspects from that section | 🟢 | Standard dose, U.S. guideline target approach, up-front combination |
| 10.3 | If fewer than three distinct actionable implementation aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing. |
N/A | ER Therapeutic Protocol has more than three actionable aspects |
| 10.4 | All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from that section. | 🟢 |
11. Time to Effect
| # | Description | Result | Comments |
|---|---|---|---|
| 11.1 | The three sets of [time] items cover the three most important time-to-effect aspects from the ER | 🟢 | ER gives two time-to-effect aspects (LDL lowering within 2 weeks; event reduction over years); third set hidden |
| 11.2 | The sets are picked and ordered by the magnitude of the related benefit | 🟢 | |
| 11.3 | If fewer than three distinct time-to-effect aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing. |
🟢 | time_3 spans empty and hidden with display:none |
| 11.4 | All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. | 🟢 | |
| 11.5 | If the ER provides no information on time to effect at all, the whole Time to effect block (its subhead and all three sets) is hidden with style="display:none", not removed: its spans stay in place, empty. |
N/A | ER provides time-to-effect information (Practical Considerations, Discontinuation & Cycling) |
12. Benefits
| # | Description | Result | Comments |
|---|---|---|---|
| 12.1 | The section is derived from the ER Expected Benefits section |
🟢 | |
| 12.2 | Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative] | 🟢 | |
| 12.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | |
| 12.4 | Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | |
| 12.5 | If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing. |
🟢 | benefits_medium hidden |
13. Risks
| # | Description | Result | Comments |
|---|---|---|---|
| 13.1 | The section is derived from the ER Potential Risks & Side Effects section |
🟢 | |
| 13.2 | Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative] | 🟢 | |
| 13.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | |
| 13.4 | Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | |
| 13.5 | If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing. |
🟢 | risks_high, risks_medium, risks_speculative hidden |
14. Monitoring
| # | Description | Result | Comments |
|---|---|---|---|
| 14.1 | The section is derived from the ER Monitoring Protocol & Defining Success section |
🟢 | |
| 14.2 | All measurable/quantifiable biomarkers from that section are listed, one table row per marker; the template’s # row is the pattern, repeated with # replaced by 1, 2, 3 … in the data-qrs-var names |
🟢 | Six markers: LDL, ApoB, Non-HDL, ALT/AST, CK, sitosterol/campesterol |
| 14.3 | [marker_#name] is the marker, [marker#target] its target value or range as given in the ER, [marker#_why] its purpose in a few words; a target the ER does not give is written “Not specified in the ER” | 🟢 | |
| 14.4 | [monitoring_cadence] is populated with the monitoring cadence/frequency derived from that section. It is not left with placeholder text or empty. | 🟢 | |
| 14.5 | If the ER names no measurable biomarker, the table is hidden with style="display:none" and the single # row is left as in the template |
N/A | ER names six measurable biomarkers |
15. Qualitative Assessment
| # | Description | Result | Comments |
|---|---|---|---|
| 15.1 | The section is derived from the ER Monitoring Protocol & Defining Success section |
🟢 | |
| 15.2 | All subjective/qualitative markers from that section are listed, one <li> per marker; the template’s # item is the pattern, repeated with # replaced by 1, 2, 3 … |
🟢 | All five ER qualitative markers listed |
| 15.3 | If the ER names no qualitative marker, the card’s list is hidden with style="display:none" and the single # item is left as in the template |
N/A | ER names five qualitative markers |
Issues 10/31/2026 15:17
Pass rate 100.00%. No issues found.
Issues 10/31/2026 15:14
- 7.5 — Specialist term in lede: The At-A-Glance text at QRS line 439 says “a small bowel-cancer signal remains open”; “signal” is an epidemiological term a non-specialist would not read exactly, and needs a plain-language phrasing.
Fixes 10/31/2026 15:14
- 7.5 — Specialist term in lede: Replaced “a small bowel-cancer signal remains open” with “a small, possible bowel-cancer risk remains unresolved” in the At-A-Glance text, and dropped “but” before “not fewer deaths” to keep the lede at 70 words.
Issues 10/31/2026 15:10
- 2.7 — Avoidable jargon in Monitoring: The ALT/AST Why cell at line 662 uses the unexpanded abbreviation “3× ULN”, and the non-HDL Why cell at line 651 uses “atherogenic cholesterol”; neither is an ER label the QRS must carry verbatim, so plain terms (“upper limit of normal”, “plaque-forming”) are available.
Fixes 10/31/2026 15:10
- 2.7 — Monitoring jargon replaced: Changed marker_4_why “3× ULN” to “3× the upper limit of normal” and marker_3_why “atherogenic cholesterol” to “plaque-forming cholesterol”.