Audit: QRS - Tretinoin for Skin Rejuvenation

Audit conducted on 30/09/2026 06:56 using AI4L / Opus 5.5

Iterations

Summary

Items	Count
Total	94
Passed	86
Failed	0
N/A	8
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

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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.	🟢
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.	🟢
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”).	🟢
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.	🟢
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.	🟢	Atralin, Griffiths scale, and drug names all appear in the ER for the same facts
1.6	The QRS does not introduce new attributions.	🟢

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 simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢
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	🟢
2.8	Information is presented in a concise and very compact manner	🟢
2.9	It DOES NOT address the reader directly	🟢
2.10	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.	🟢
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢
2.12	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.	🟢
2.13	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.	🟢
2.14	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.	🟢
2.15	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.	🟢

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”	🟢
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	Diff against template: all spans present; marker_# and qualitative_item_# expanded to 1-5 and 1-4
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	Diff against template shows only data-qrs-var content changed; website spans and fixed text untouched

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	🟢	ER Medium risk tier states “No risk reaches Medium”; span hidden per 13.5
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.	🟢
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢
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. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢

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.	🟢	Metadata comment immediately follows <!doctype html> (lines 2-14)
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.	🟢
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]”	🟢
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 just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢
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 [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢
5.13	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.	🟢

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 &)	🟢
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]	🟢	2026-0930-0631 -> 09/30/2026
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 “Tretinoin, a prescription form of vitamin A applied topically at night, is used to reverse visible sun damage”
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	🟢	All six “Populations who should avoid” plus the two ER label contraindications (photosensitizing drugs, oral retinoids)
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).	🟢
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 Contraindications use no ranking notation inside parens
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 populated (8 items), 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 Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	Eight remaining ER interactions, excluding the two surfaced as Contraindications
9.3	Individual [caution_items] are formatted as <li></li>	🟢
9.4	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.	🟢
9.5	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).	🟢
9.6	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 interactions use no ranking notation inside parens
9.7	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.	🟢
9.8	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. E.g.	N/A	Section is populated (8 items), not empty

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	ER Protocol provides more than three actionable aspects; all three sets used
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol 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	🟢
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	ER provides more than three time-to-effect aspects (Practical Considerations); all three sets used
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 does not provide any information on time to effect, the section is removed completely from the Protocol Panel	N/A	ER provides time-to-effect information

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 no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four ER benefit tiers contain items

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 no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	🟢	risks_medium set to display: none (line 579)

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All 5 ER table biomarkers listed
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty.	🟢

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All 4 ER qualitative markers listed verbatim

Issues 30/09/2026 06:56

Pass rate 100.00%. No issues found.

Issues 30/09/2026 06:53

1. 8.4 — Breastfeeding item carries rationale: The Breastfeeding contraindication (line 543) includes the rationale and elaboration “(limited safety data; use typically follows clinician review and excludes breast skin)” rather than only a concise scope qualifier.

Fixes 30/09/2026 06:53

1. 8.4 — Breastfeeding item rationale removed: Changed “Breastfeeding (limited safety data; use typically follows clinician review and excludes breast skin)” to “Breastfeeding (after clinician review; excluding breast skin)”, dropping the rationale while keeping the scope qualifiers.

Issues 30/09/2026 06:50

1. 1.2 — Breastfeeding cautious phrasing dropped: ER line 290 states “Breastfeeding: limited safety data; use typically follows clinician review and excludes breast skin”, but QRS line 543 omits “limited safety data”.

Fixes 30/09/2026 06:50

1. 1.2 — Breastfeeding cautious phrasing restored: Changed the Breastfeeding contraindication from “Breastfeeding (use typically follows clinician review and excludes breast skin)” to “Breastfeeding (limited safety data; use typically follows clinician review and excludes breast skin)”, matching ER line 290.

Issues 30/09/2026 06:48

1. 2.6 / 2.9 — Imperatives address the reader: Monitoring Target cells instruct the reader directly: “track at least 1-point improvement from own baseline” (line 619), “compare against own baseline” (line 630), and “track return to own pre-treatment values” (line 652).

Fixes 30/09/2026 06:48

1. 2.6 / 2.9 — Removed reader-directed imperatives: Reworded the Monitoring targets as neutral statements: “track at least 1-point improvement” became “at least 1-point improvement”, “compare against own baseline” became “compared against own baseline”, and “track return to own pre-treatment values” became “return to own pre-treatment values”.

Issues 30/09/2026 06:42

1. 2.7 — Unexplained technical monitoring term: Monitoring marker_5_name (QRS line 650) reads “Skin hydration and transepidermal water loss”; the ER glosses the term as “water evaporating through the skin”, but the QRS drops the plain-language explanation.
2. 8.4 — Rationale in contraindication item: The Breastfeeding contraindication (QRS line 543) includes the explanatory rationale “limited safety data” inside its parenthetical, an elaboration beyond the decision-gate qualifier.

Fixes 30/09/2026 06:42

1. 2.7 — Unexplained technical monitoring term: Changed marker_5_name from “Skin hydration and transepidermal water loss” to “Skin hydration and water loss through the skin”, using the ER’s plain-language wording.
2. 8.4 — Rationale in contraindication item: Removed the rationale “limited safety data” from the Breastfeeding item, keeping only the qualifier “(use typically follows clinician review and excludes breast skin)”.

Issues 30/09/2026 06:38

1. 1.2 — Breastfeeding hedge dropped: The Breastfeeding contraindication (QRS line 543) omits the ER’s cautious qualifier “limited safety data” (ER line 290).
2. 7.2 — Conclusion verdict missing: The at-a-glance (QRS line 433) omits the Conclusion’s bottom line (ER line 408: “a modest but well-documented, low-cost improvement … with a demanding routine and a manageable side-effect profile”), so no execution-oriented takeaway is given.

Fixes 30/09/2026 06:38

1. 1.2 — Breastfeeding hedge restored: Added the ER’s cautious qualifier “limited safety data” to the Breastfeeding contraindication.
2. 7.2 — Conclusion verdict added: Condensed the at-a-glance and appended the Conclusion’s bottom line (“a modest, well-documented, low-cost improvement with a demanding routine”), staying within 70 words.

Issues 30/09/2026 06:36

1. 8.4 — Breastfeeding item carries rationale: The Breastfeeding contraindication (QRS line 543) includes the ER’s rationale “limited safety data”, an elaboration that should be stripped from a gate item.
2. 13.3 / 13.4 — Dermatitis symptom list preserved: risks_high (QRS line 577) reads “Retinoid dermatitis: redness, peeling, dryness, burning, pigment changes”, carrying over the ER heading’s parenthetical symptom list (ER line 223) instead of stripping it.

Fixes 30/09/2026 06:36

1. 8.4 — Breastfeeding rationale removed: Changed “Breastfeeding (limited safety data; use typically follows clinician review and excludes breast skin)” to “Breastfeeding (use typically follows clinician review and excludes breast skin)”.
2. 13.3 / 13.4 — Dermatitis symptom list stripped: Changed risks_high from “Retinoid dermatitis: redness, peeling, dryness, burning, pigment changes” to “Retinoid dermatitis”.

Issues 30/09/2026 06:33

1. 1.2 / 1.3 — Cautious target phrasing dropped: marker_2_target (line 619) and marker_5_target (line 652) omit the ER’s “No universal target” / “No established target”, presenting tracking goals as fixed targets.
2. 1.2 / 1.3 — Breastfeeding hedge removed: The Breastfeeding contraindication (line 543) drops the ER’s “limited safety data” and changes “use typically follows clinician review” to “use follows clinician review”.
3. 2.15 — Lay route phrasing in lede: at_a_glance (line 433) describes the route as “applied to the skin” rather than formal route terminology such as “applied topically”.

Fixes 30/09/2026 06:33

1. 1.2 / 1.3 — Cautious target phrasing restored: Prefixed marker_2_target with “No universal target; track” and marker_5_target with “No established target; track”, matching the ER Monitoring table.
2. 1.2 / 1.3 — Breastfeeding hedge restored: Changed “(use follows clinician review; excludes breast skin)” to “(limited safety data; use typically follows clinician review and excludes breast skin)”, per the ER wording.
3. 2.15 — Formal route phrasing: Changed “applied to the skin at night” to “applied topically at night” in at_a_glance.