Audit: QRS - ANKTIVA to Treat Cancer
Audit conducted on 25/06/2026 20:31 using AI4L / Opus 4.8
Summary
| Items | Count |
|---|---|
| Total | 91 |
| Passed | 85 |
| Failed | 0 |
| N/A | 6 |
| 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. | 🟢 | All protocol values, magnitudes, contraindications, interactions, and monitoring markers trace to ER Protocol, Risks, Interactions, and Monitoring sections. |
| 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. | 🟢 | Speculative tiers (“Activity in other tumor types”, “Long-term and rare systemic risks”) preserve the ER’s tentative framing. |
| 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”). | 🟢 | No strengthening or softening detected. |
| 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. | 🟢 | Contraindications and Key Interactions both drawn from ER’s Key Interactions & Contraindications section under correct categories. |
| 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. | 🟢 | No PMIDs, NCT IDs, or expert names introduced. Brand names (BCG, ANKTIVA) match the ER. |
| 1.6 | The QRS does not introduce new attributions. | 🟢 | No new attributions present. |
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. | 🟢 | Objective, data-aware tone consistent with the ER. |
| 2.2 | The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging. | 🟢 | Expert yet accessible throughout. |
| 2.3 | The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor. | 🟢 | Presents evidence, does not prescribe. |
| 2.4 | The QRS avoids language that implies medical or clinical advice. | 🟢 | No advisory language. |
| 2.5 | The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”. | 🟢 | Information-presenting voice maintained. |
| 2.6 | The QRS never addresses “the reader” directly — it presents evidence, not guidance. | 🟢 | No second-person address. |
| 2.7 | The QRS is written in plain language, avoiding unnecessary medical jargon. | 🟢 | Plain language used; at-a-glance avoids acronyms. |
| 2.8 | Information is presented in a concise and very compact manner. | 🟢 | Compact bullets and cells throughout. |
| 2.9 | It DOES NOT address the reader directly. | 🟢 | No direct reader address. |
| 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. | 🟢 | Framing fits a risk-aware audience weighing bladder-sparing options. |
| 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. | 🟢 | Cost and multi-year burden surfaced without dismissal. |
| 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. | 🟢 | Content presumes an engaged audience. |
| 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. | 🟢 | Weighting reflects the target audience. |
| 2.14 | The document’s own voice frames usage in longevity terms, not “anti-aging”. Proper names that contain “anti-aging” are quoted verbatim. | 🟢 | No “anti-aging” language present. |
| 2.15 | The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language. Direct quotes from sources are exempt. | 🟢 | Formal terminology used (e.g., “intravesical”, “adverse events”, “instillation”). |
3. Template Integrity
| # | Description | Result | Comments |
|---|---|---|---|
| 3.1 | The following labels and headings on the QRS are fixed and not modified (card/section headings, gate headings, tier labels, Monitoring column headers). | 🟢 | All fixed headings/labels present unchanged. |
| 3.2 | All “…” from the [qrs_template] are present in the QRS. | 🟢 | All template spans present, including hidden time_2/time_3 sets. |
| 3.3 | Spans that are not addressed in a checklist item are left unchanged. | 🟢 | No unaddressed spans modified. |
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. | 🟢 | No empty ER sections requiring empty-state phrasing; unused sets hidden. |
| 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. | 🟢 | Tier and protocol labels match the ER. |
| 4.3 | Labels are not paraphrased, abbreviated, or invented. | 🟢 | Labels faithful to the ER. |
| 4.4 | The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). | 🟢 | No emoji indicators found in the QRS body. |
| 4.5 | The QRS is designed to render on one A4 page. Any section with more content in the ER than fits is condensed, not extended onto a second page. | 🟢 | Content condensed to a single sheet. |
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 is the first element after doctype (lines 2-14). |
| 5.2 | Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. | 🟢 | YAML delimited by — at lines 3 and 13. |
| 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. | 🟢 | Enclosed in an HTML comment; not rendered. |
| 5.4 | All frontmatter values are trimmed: no leading/trailing whitespace, no surrounding quotes unless YAML requires. | 🟢 | Values clean; duration: "00:03" quoted because it contains a colon. |
| 5.5 | The filename of the source ER is stated as “er_filename: [er_filename]”. | 🟢 | er_filename: anktiva_cancer_2026-0625-1925_Opus_ER.md (line 4). |
| 5.6 | Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”. | 🟢 | qrs_prompt_version: 26.5.18 matches the prompt version. |
| 5.7 | Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]”. | 🟢 | qrs_creation_date: 2026-0625-1925 (line 6). |
| 5.8 | The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: […]”. | 🟢 | qrs_creator_ai_nickname: Opus (line 7). |
| 5.9 | The nickname of the AI is just a single word model name without version, etc. | 🟢 | “Opus” is a single word. |
| 5.10 | The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: […]”. | 🟢 | qrs_creator_ai_fullname: Opus 4.8 (line 8). |
| 5.11 | The full name of the AI consists of the nickname and the model version number and no additional qualifier. | 🟢 | “Opus 4.8” is nickname plus version only. |
| 5.12 | The filename of the document is stated as “qrs_filename: [filename of this document]”. | 🟢 | qrs_filename: anktiva_cancer_2026-0625-1925_Opus_QRS.html (line 9). |
| 5.13 | All frontmatter values are trimmed: no leading/trailing whitespace, no surrounding quotes unless YAML requires. | 🟢 | All values trimmed and consistent. |
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”. The canonical_topic is HTML-entity-encoded as needed. | 🟢 | “ANKTIVA to Treat Cancer - Quick Reference Sheet” (line 22); no entities required. |
| 6.2 | [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed. | 🟢 | “ANKTIVA to Treat Cancer” (line 417). |
| 6.3 | [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]. | 🟢 | “06/25/2026” matches creation date 2026-0625. |
| 6.4 | [header_subline_model] is set to [qrs_creator_ai_fullname]. | 🟢 | “Opus 4.8” (line 425). |
| 6.5 | No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. | 🟢 | Header contains only title, date, AI4L/model attribution; no extra content. |
7. At-A-Glance Section
| # | Description | Result | Comments |
|---|---|---|---|
| 7.1 | [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section. |
🟢 | Summarizes the ER Conclusion (ER lines 443-445). |
| 7.2 | [at_a_glance] is no longer than 60 words. | 🟢 | 52 words. |
| 7.3 | Every fact in [at_a_glance] is supported by a distinct passage in the ER. | 🟢 | Mechanism, indication, response, tolerability, cost, and unproven-in-other-cancers all trace to the Conclusion. |
| 7.4 | It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead. | 🟢 | No acronyms (BCG, NMIBC, IL-15); plain language used. |
| 7.5 | It DOES NOT cite specific trials (names, years, sample sizes, p-values). | 🟢 | No trial references. |
| 7.6 | It DOES NOT cite effect sizes, relative risks, or statistical results. | 🟢 | No statistics cited. |
8. Contraindications
| # | Description | Result | Comments |
|---|---|---|---|
| 8.1 | The section is derived from the ER Key Interactions & Contraindications section. |
🟢 | Derived from ER line 300 (“Populations who should avoid this intervention”). |
| 8.2 | [stop_items] represent the Contraindications from the ER. | 🟢 | All eight avoidance/deferral items from ER line 300 represented. |
| 8.3 | Individual [stop_items] are formatted as <li></li>. | 🟢 | Each item is a separate <li> (lines 542-549). |
| 8.4 | Items are as concise as possible. No trailing explanations, attributions, citations, or content after a dash. | 🟢 | All items are concise key facts; no trailing clauses. |
| 8.5 | Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved. | 🟢 | “Muscle-invasive disease (≥ stage T2)” and “Immunocompromised states (…)” preserved. |
| 8.6 | When the ER uses ranking notation inside parens, normalize to a plain comma-separated list rather than carrying the bare symbol. | 🟢 | No ranking symbols present; parentheticals are plain lists. |
| 8.7 | If no [stop_items] are present the section is left empty. | N/A | Contraindications are present, so the empty-state condition does not apply. |
9. Key Interactions
| # | Description | Result | Comments |
|---|---|---|---|
| 9.1 | The section is derived from the ER Key Interactions & Contraindications section. |
🟢 | Derived from ER lines 288-298. |
| 9.2 | [caution_items] represent the Key Interactions from the ER, excluding any already listed as Contraindications. | 🟢 | Four interactions listed; none duplicate the contraindications. |
| 9.3 | Individual [caution_items] are formatted as <li></li>. | 🟢 | Each item is a separate <li> (lines 557-560). |
| 9.4 | Items are as concise as possible. No trailing explanations, attributions, citations, or content after a dash. | 🟢 | Items are concise; severity/mitigation clauses dropped. |
| 9.5 | Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, etc. — ARE preserved. | 🟢 | Example drug lists preserved (prednisone/methotrexate/tacrolimus/TNF inhibitors; ciprofloxacin/antituberculous agents; pembrolizumab/nivolumab). |
| 9.6 | When the ER uses ranking notation inside parens, normalize to a plain comma-separated list. | 🟢 | No ranking symbols; lists are plain. |
| 9.7 | If no [caution_items] are present the section is left empty. | N/A | Key interactions are present, so the empty-state condition does not apply. |
10. Protocol
| # | Description | Result | Comments |
|---|---|---|---|
| 10.1 | The section is derived from the ER Protocol section. |
🟢 | Derived from ER lines 324-328. |
| 10.2 | The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section. |
🟢 | Induction, Maintenance, Route — the three core actionable aspects. |
| 10.3 | If less than three distinct actionable implementation aspects are mentioned, the unused sets are left empty and made invisible, not filled with placeholder text. | N/A | Three actionable aspects are present, so the condition does not apply. |
| 10.4 | All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section. |
🟢 | All three sets filled with ER-derived content. |
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. | 🟢 | The ER provides a single time-to-effect anchor (~3-month cystoscopy); it is captured and the remaining sets are hidden. |
| 11.2 | The sets are picked and ordered by the magnitude of the related benefit. | 🟢 | Single set tied to the primary complete-response outcome. |
| 11.3 | If less than three distinct time-to-effect aspects are mentioned, the unused sets are left empty and made invisible. | 🟢 | time_2 and time_3 sets are empty and set to display:none (lines 492-513). |
| 11.4 | All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. | 🟢 | time_1 set filled from ER lines 375/399. |
| 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 | The ER provides time-to-effect information, so removal does not apply. |
12. Benefits
| # | Description | Result | Comments |
|---|---|---|---|
| 12.1 | The section is derived from the ER Expected Benefits section. |
🟢 | Derived from ER lines 153-196. |
| 12.2 | Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]. | 🟢 | All four tier variables populated. |
| 12.3 | Items are as concise as possible. No explanations, effect sizes, qualifiers, attributions, citations, or mechanistic explanations. | 🟢 | Concise tier facts; no effect sizes or mechanism. |
| 12.4 | Parenthetical content — effect sizes, sample notes, mechanistic hints, example studies — is stripped, NOT preserved. | 🟢 | No parentheticals carried into the benefits. |
| 12.5 | If no items of a specific sub-section are present the respective SPAN is set to display=none, not filled with empty-state phrasing. | N/A | All four benefit tiers have content, so the empty-state condition does not apply. |
13. Risks
| # | Description | Result | Comments |
|---|---|---|---|
| 13.1 | The section is derived from the ER Potential Risks & Side Effects section. |
🟢 | Derived from ER lines 221-264. |
| 13.2 | Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]. | 🟢 | All four tier variables populated. |
| 13.3 | Items are as concise as possible. No explanations, effect sizes, qualifiers, attributions, citations, or mechanistic explanations. | 🟢 | Concise tier facts only. |
| 13.4 | Parenthetical content — frequencies, severity grades, sample notes, mechanistic hints, example studies — is stripped, NOT preserved. | 🟢 | No parentheticals carried into the risks. |
| 13.5 | If no items of a specific sub-section are present the respective SPAN is set to display=none, not filled with empty-state phrasing. | N/A | All four risk tiers have content, so the empty-state condition does not apply. |
14. Monitoring
| # | Description | Result | Comments |
|---|---|---|---|
| 14.1 | The section is derived from the ER Monitoring section. |
🟢 | Derived from ER Monitoring Protocol table (lines 401-407). |
| 14.2 | All measurable/quantifiable biomarkers from the Monitoring section are listed. |
🟢 | All five markers listed (cystoscopy+biopsy/cytology, urine cytology, serum creatinine, urinalysis, CBC). |
| 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. |
🟢 | Cadence populated (cystoscopy ~3 and 6 months, then periodic; labs through the up-to-37-month course). |
15. Qualitative Assessment
| # | Description | Result | Comments |
|---|---|---|---|
| 15.1 | The section is derived from the ER Monitoring section. |
🟢 | Derived from the ER qualitative markers (lines 411-415). |
| 15.2 | All subjective/qualitative biomarkers from the Monitoring section are listed. |
🟢 | All three listed (urinary symptom burden, systemic symptoms, functional well-being). |
Issues 25/06/2026 20:31
Pass rate 100.00%. No issues found.
Issues 25/06/2026 20:27
- 9.2 — Contraindication duplicated as interaction: The Key Interactions gate lists “Recent transurethral resection or traumatic catheterization” (QRS line 560), but “Recent traumatic catheterization” is already a Contraindication (QRS line 548); 9.2 requires Key Interactions to exclude items already listed as Contraindications.
Fixes 25/06/2026 20:27
- 9.2 — Contraindication duplicated as interaction: Narrowed the Key Interactions item from “Recent transurethral resection or traumatic catheterization” to “Recent transurethral resection”, removing the “traumatic catheterization” portion already listed as a Contraindication.
Issues 25/06/2026 20:23
- 7.4 — Unexpanded acronym BCG in At-A-Glance: [at_a_glance] (line 433) uses the specialist acronym “BCG” twice (“the older BCG treatment”, “returned after BCG”) without plain-language explanation; a non-specialist would not know its exact meaning.
Fixes 25/06/2026 20:23
- 7.4 — Removed unexpanded BCG acronym: Replaced both uses of “BCG” in [at_a_glance] with plain-language wording (“an older bacteria-based bladder treatment” / “after that treatment”), keeping the meaning faithful to the ER while removing the specialist acronym.