{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2917-main",
  "verdict_number": "2917",
  "title": "Bilateral internal thoracic artery grafting × Ten-year overall survival after CABG — ART efficacy and sternal-harm evidence sheet",
  "view_version": "1.0",
  "view_created_date": "2026-10-10",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-08-26",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "The entire designated existing review summary was read for preparation. No new access to external abstracts, full texts, registrations, plans or linked verdicts, or separate link testing, was performed.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "ART participants undergoing CABG; original detailed eligibility and baseline information not read",
    "intervention": "Historical surgical conditions of assignment to bilateral internal thoracic artery grafting",
    "dose": "Original details of the actual procedure, technique, devices, conduits and exposure not read; no guidance on individual implementation, selection or treatment",
    "comparator": "Assignment to a single internal thoracic artery; distinguish the original 14% crossover and 22% additional radial-artery grafting",
    "endpoint": "Original ten-year overall-survival question and all-cause mortality endpoint; sternal wounds considered separately",
    "duration": "Distinguish ten-year survival, mortality and censoring from the unverified original wound-observation window",
    "excluded_extensions": [
      "Converting the MAIN claim into a subclaim or a new split",
      "Interpreting a null result or CI as an exact zero effect, equivalence or absence of all harm",
      "Independently adding participants or reports shared across other comparative verdicts or time points",
      "Calculating new survival rates, event counts or differences from mortality rates",
      "Recommendations on individual procedures, surgery, devices, treatment selection or implementation"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Comparative efficacy",
      "question": "Were the selected claim and existing verdict record distinguished?",
      "needed": "Preservation of the existing claim wording, verdict values, history and empty values",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Preservation of the existing claim wording, verdict values, history and empty values",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Link original materials and decisions to the actual MAIN question and root verdict record.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The selected claim is improved ten-year overall survival after CABG; the root grade D, score 34, Warning and axes E−/I2/B0/C0 are preserved. Distinguish the existing history from the current verdict record.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split.",
      "missingness": "Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not turn the MAIN claim into a subclaim or introduce parent-inheritance or missing-subclaim-score explanations. Preserve the actual values, presence or absence and original verdict without a new verdict or split."
    },
    {
      "item_id": "N02",
      "question_type": "Comparative efficacy",
      "question": "What are the CABG population, baseline and eligibility, and how do they differ from other coronary questions?",
      "needed": "Original CABG eligibility, baseline, institutions, surgical conditions and denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original CABG eligibility, baseline, institutions, surgical conditions and denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original population, eligibility, baseline, institution and surgical-condition materials.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "ART is a surgical-technique trial asking whether to use bilateral internal thoracic arteries during CABG.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read.",
      "missingness": "Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not replace this with PCI-versus-CABG questions in diabetic multivessel or left-main disease. Age, eligibility, exclusions, baseline and institution-specific surgical details were not read."
    },
    {
      "item_id": "N03",
      "question_type": "Comparative efficacy",
      "question": "What are the assigned comparison and actual techniques of bilateral versus single internal thoracic artery grafting?",
      "needed": "Original assignment, actual grafting, common CABG procedures, other conduits and concurrent treatment",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original assignment, actual grafting, common CABG procedures, other conduits and concurrent treatment",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original assignment, actual techniques, other conduits, concurrent management and change materials.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "ART assigned bilateral versus single internal thoracic artery grafting; actual surgical crossover and additional radial-artery grafting in the single group occurred.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read.",
      "missingness": "Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not turn the graft-number question into the effect of CABG itself, superiority of all arterial grafting, or surgical-method and selection guidance. Conduit, surgical and concurrent-management details were not read."
    },
    {
      "item_id": "N04",
      "question_type": "Comparative efficacy",
      "question": "Were the 3,102 participants distinguished from original ten-year denominators and death counts?",
      "needed": "Assignment, group-specific analysis, follow-up, censoring, events and denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Assignment, group-specific analysis, follow-up, censoring, events and denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original group-specific assignment, analysis, follow-up, risk sets and event tables.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original source records 3,102 participants and ten-year mortality of 20.3% versus 21.2%.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people.",
      "missingness": "Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not calculate group allocation numbers, death counts, risk sets or new proportions and totals. Do not add multiple assessments or reports as independent people."
    },
    {
      "item_id": "N05",
      "question_type": "Comparative efficacy",
      "question": "Were the overall-survival question and actual ten-year all-cause mortality endpoint distinguished?",
      "needed": "Original death definition, period, overall survival, original denominator and ascertainment",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original death definition, period, overall survival, original denominator and ascertainment",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original death and survival definitions, time points, ascertainment and denominators.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original effect question is improved ten-year overall survival, and the original primary endpoint is all-cause death at ten years.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read.",
      "missingness": "Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not convert death proportions into new survival rates or substitute cardiovascular or sternal mortality, healing or functional improvement. Original follow-up reference points and cause-specific ascertainment details were not read."
    },
    {
      "item_id": "N06",
      "question_type": "Comparative efficacy",
      "question": "Are 20.3%/21.2%, HR 0.96, the 95% CI and −0.9 percentage points preserved?",
      "needed": "Original group order, HR, CI, absolute difference, model and denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original group order, HR, CI, absolute difference, model and denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original time-to-event effects, group risk sets, models, tests and CI.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "Ten-year mortality was 20.3% with bilateral versus 21.2% with single grafting; HR 0.96 (95% CI 0.79–1.17), with an original absolute difference of −0.9 percentage points.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT.",
      "missingness": "Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not fill in or calculate original P values, an absolute-difference CI, adjusted models, death counts, new survival rates or NNT."
    },
    {
      "item_id": "N07",
      "question_type": "Comparative efficacy",
      "question": "What are the null result, CI tails allowing meaningful benefit and harm, and the original warning?",
      "needed": "Original interval, precision, efficacy, harm and clinical boundaries",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original interval, precision, efficacy, harm and clinical boundaries",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original clinical boundaries, precision and separate efficacy and harm interpretations.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original reader answer records remaining possibilities of meaningful benefit and harm, without establishing absence of benefit. The original grade D, score 34 and Warning are preserved.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied.",
      "missingness": "Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not interpret an HR near the null or a null result as an exact zero effect, equivalence or exclusion of all clinical effects. No new MCID, power calculation or examples are supplied."
    },
    {
      "item_id": "N08",
      "question_type": "Comparative efficacy",
      "question": "What are the 14% bilateral-to-single crossover and 22% additional radial-artery grafting in the single group?",
      "needed": "Assignment, actual surgery, crossover, adherence, periods and original denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Assignment, actual surgery, crossover, adherence, periods and original denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original crossover, adherence, actual techniques, reasons, denominators, effects of interest and sensitivity analyses.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original record says that 14% assigned bilateral received a single graft, while 22% assigned single received a radial artery as a second arterial graft.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read.",
      "missingness": "Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not add these two crossovers or convert them into causal effects of the actual surgical groups. Do not newly classify them as allocation failure or completer analysis; the degree of contrast dilution, reasons and denominators were not read."
    },
    {
      "item_id": "N09",
      "question_type": "Comparative efficacy",
      "question": "Were ITT, as-treated analyses, observational associations and the dilution explanation distinguished?",
      "needed": "Assignment effect of interest, actual-treatment models, confounding and sensitivity analyses",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Assignment effect of interest, actual-treatment models, confounding and sensitivity analyses",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original effects of interest, actual-treatment analyses, confounding, sensitivity analyses and denominators.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original text preserves the ITT principle and treatment-contrast dilution, and distinguishes long-term observational benefits from randomized effects.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read.",
      "missingness": "Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not conclude that crossover explains all null findings or newly derive survival superiority for actual-treatment groups. Per-protocol and as-treated model details were not read."
    },
    {
      "item_id": "N10",
      "question_type": "Comparative efficacy",
      "question": "Is censoring of 71 participants (2.3%) with missing ten-year vital status the same as attrition?",
      "needed": "Original vital status, missingness, censoring times, reasons and sensitivity analyses",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original vital status, missingness, censoring times, reasons and sensitivity analyses",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original group-specific censoring, times, reasons, assumptions, sensitivity analyses and risk sets.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original text records that 71 participants (2.3%) with missing ten-year vital status were censored in survival analysis and were not counted as attrition.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read.",
      "missingness": "Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not subtract the 71 participants as new exclusions or a completer analysis, or certify censoring as zero missingness or complete follow-up. Censoring times, assumptions, original effects and group mapping were not read."
    },
    {
      "item_id": "N11",
      "question_type": "Comparative efficacy",
      "question": "Were secure web allocation, unmasked surgery, event adjudication and the B0 history distinguished?",
      "needed": "Allocation, concealment, surgeons and patients, assessment, adjudication and analysis",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Allocation, concealment, surgeons and patients, assessment, adjudication and analysis",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original allocation, adjudication, assessor, analyst and data-collection procedures.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original text records secure web randomization, inability to mask surgeons and patients, adjudication of all events including adverse events, and ITT as the historical basis for B0.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias.",
      "missingness": "Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not certify event adjudication as adjudicator blinding absent from the source or as a new review establishing absence of all bias."
    },
    {
      "item_id": "N12",
      "question_type": "Comparative efficacy",
      "question": "What was accessed regarding registration, prespecified ten-year mortality, subgroups and hierarchy?",
      "needed": "Original registration, protocol, SAP, prespecified endpoints, changes and multiplicity",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original registration, protocol, SAP, prespecified endpoints, changes and multiplicity",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original registration, plans, hierarchy, subgroups, interactions and changes.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The history of the original registration identifier ISRCTN46552265 and its consistency with prespecified ten-year all-cause mortality is preserved.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques.",
      "missingness": "No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "No new registration or plan reading was performed. Do not create prespecified subgroups, α, multiplicity, changes or test P values for specific populations or actual techniques."
    },
    {
      "item_id": "N13",
      "question_type": "Supplementary harm evidence",
      "question": "Were sternal wounds of 3.5%/1.9%, efficacy, harm and periods distinguished?",
      "needed": "Wound definition, severity and collection, people and events, periods and denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Wound definition, severity and collection, people and events, periods and denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original wound definitions, periods, group-specific people, events, denominators, CI and tests.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original source says that sternal wound complications increased to 3.5% with bilateral versus 1.9% with single grafting. This is a separate harm outcome from ten-year mortality.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read.",
      "missingness": "Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not fill in a ten-year wound-observation period or calculate original event counts, CI, P values, RR, NNH or differences. Definitions, collection, relatedness and original denominators were not read."
    },
    {
      "item_id": "N14",
      "question_type": "Supplementary harm evidence",
      "question": "What are the increased wound harm and gaps concerning rare or other harms and long-term safety?",
      "needed": "Other harms, collection, actual techniques, relatedness, periods and denominators",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Other harms, collection, actual techniques, relatedness, periods and denominators",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original overall-harm, actual-technique, collection, relatedness, period and denominator materials.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original safety warning and increased sternal wounds are preserved, together with the original description of adjudication of all events.",
      "condition_status": "Unverified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read.",
      "missingness": "Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not extend the warning to established harm of every kind or established harm to survival. Other harms, reoperations, rare events, relatedness and original exposure details were not read."
    },
    {
      "item_id": "N15",
      "question_type": "Comparative efficacy",
      "question": "What is the information level for MRC/BHF funding, in-kind support, affiliations and external analysis?",
      "needed": "Public or nonprofit funding, devices, in-kind support, affiliations, analysis and writing",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Public or nonprofit funding, devices, in-kind support, affiliations, analysis and writing",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain original disclosures on cash, in-kind support, affiliations, design, analysis and writing.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "UK MRC and British Heart Foundation support and the original I2 are preserved.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read.",
      "missingness": "Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not turn public funding into certification of no company in-kind support, no employees or fully independent analysis. Details of each disclosed role were not read."
    },
    {
      "item_id": "N16",
      "question_type": "Comparative efficacy",
      "question": "What are the 1822/2859 cross-citations and relationships with the same ART report and follow-up?",
      "needed": "Reports, related verdicts, populations, comparators, shared cohorts and independence relationships",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Reports, related verdicts, populations, comparators, shared cohorts and independence relationships",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Link new reports using original identifiers, shared cohorts and time points, and separate questions.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "Verdict 1822 concerns CABG strategy in diabetic multivessel disease, and 2859 concerns PCI versus CABG in left-main disease; both differ from ART's graft-number question.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null.",
      "missingness": "Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Linked targets and original papers were not newly read or used as direct replication or additional participants. Do not count the same ART ten-year report or assessments as new independent trials; independent counts and total participants remain null."
    },
    {
      "item_id": "N17",
      "question_type": "Comparative efficacy",
      "question": "What are the applicability gaps for observational benefits, other techniques or populations and longer periods?",
      "needed": "Original follow-up and direct efficacy and harm by population, conduit and technique",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original follow-up and direct efficacy and harm by population, conduit and technique",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Obtain direct efficacy, harm, plans and denominators by population, technique, exposure and period.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The original core question is ten-year overall survival under assignment to bilateral internal thoracic arteries. The source treats observational advantages separately.",
      "condition_status": "Unverified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment.",
      "missingness": "Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not transfer effects from other conduits, selected subgroups, actual surgical groups or other CABG indications, or create guidance on surgical selection, implementation or treatment."
    },
    {
      "item_id": "N18",
      "question_type": "Comparative efficacy",
      "question": "Were the summary, paper and related-verdict URLs, registration identifier and actual access distinguished?",
      "needed": "Original bibliography, URLs, registration, material-specific access and cross-citations",
      "role": "Required",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original bibliography, URLs, registration, material-specific access and cross-citations",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Link user-provided original materials by material type and actual access.",
      "current_reports": [
        "R01",
        "R02",
        "R03"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "The entire stored summary of the designated existing verdict was read for preparation, and the original source links and registration identifier were linked.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information.",
      "missingness": "External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "External abstracts, full texts, registrations, protocols, SAP and related-verdict targets were not read, and no separate link testing was performed. Do not create new URLs, DOI or original-study information."
    },
    {
      "item_id": "N19",
      "question_type": "Comparative efficacy",
      "question": "Were MAIN languages, dates, corrections, empty arrays, false/null, empty values and candidate history preserved?",
      "needed": "Original root verdict, Korean and English, cut-off, corrections, history and presence or absence",
      "role": "Supplementary",
      "role_reason": "An individual preparation condition recording the population, endpoint, denominator, period, efficacy, harm and report relationships of the existing native MAIN claim",
      "application_exception": "Do not use unread materials, other questions, institutions or periods, or out-of-scope outcomes as substitutes for meeting a condition, a zero effect or safety.",
      "criterion": "Original root verdict, Korean and English, cut-off, corrections, history and presence or absence",
      "basis": "Selected claim: Improved ten-year overall survival after CABG",
      "condition_origin": "Individual preparation condition; completed review or automatic fulfillment of a common definition is not implied",
      "proposed_research": "Link user materials and decisions to full original preservation and separate events.",
      "current_reports": [
        "R01"
      ],
      "existence": "Material information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "observation": "Preserve 2026-08-26, empty corrections/subclaims arrays, the empty deliberation string, root grade/score/safety/axes, Korean and English, false/null and empty values unchanged.",
      "condition_status": "Partly verified",
      "status_reason": "Only the relevant stored-summary information is recorded; detailed original materials and user review remain outstanding. This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical.",
      "missingness": "This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical.",
      "uncertainty": "Unread or unverified does not mean a zero effect, zero events, safety or new clinical certification",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "This root record is not a case of missing subclaim scores or parent inheritance. Original verification and path checks, B0, support and safety assessments are historical, not a completed current review. Original candidate pending/eligible states are also historical."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Taggart DP, et al. N Engl J Med. 2019;380:437-446. PMID: 30699314.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/30699314/",
      "report_type": "Original RCT paper report",
      "existence": "Citation and evidence information in the existing review summary",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "study_family": "F01",
      "independent_replication": false,
      "observed_result": "20.3% versus 21.2%; HR 0.96 (95% CI 0.79–1.17); absolute difference −0.9 percentage points",
      "result_level": "Existing review summary; external papers were not compared during this preparation",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Original URL preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Report-specific summary links within the same stored summary"
        },
        {
          "material_type": "External abstract",
          "public_status": "Original URL preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External full paper",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External registration",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External protocol and SAP",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/30699314/"
        }
      ]
    },
    {
      "report_id": "R02",
      "title": "Chamgap 1822 CABG × Diabetic multivessel disease",
      "url": "https://chamgap.com/verdicts/heart/cabg-diabetes-multivessel-coronary-disease-major-events/",
      "report_type": "Cross-citation of an existing verdict; original trial bibliography and contents not obtained",
      "existence": "Only an original cross-citation is present; linked target not read",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "study_family": "F02",
      "independent_replication": false,
      "observed_result": "Although also concerning CABG, this asks about treatment strategy in diabetic multivessel disease.",
      "result_level": "Original cross-citation concerning another population or comparator; not direct MAIN evidence or independent replication",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Original URL preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Report-specific summary links within the same stored summary"
        },
        {
          "material_type": "Original related-verdict link",
          "public_status": "Original URL preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External full paper",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External registration",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External protocol and SAP",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        }
      ],
      "links": [
        {
          "label": "Official source",
          "url": "https://chamgap.com/verdicts/heart/cabg-diabetes-multivessel-coronary-disease-major-events/"
        }
      ]
    },
    {
      "report_id": "R03",
      "title": "Chamgap 2859 Stent versus CABG × Left-main disease",
      "url": "https://chamgap.com/verdicts/heart/everolimus-eluting-stent-pci-cabg-left-main-three-year-noninferiority/",
      "report_type": "Cross-citation of an existing verdict; original trial bibliography and contents not obtained",
      "existence": "Only an original cross-citation is present; linked target not read",
      "acquired_read": "Summary read; external materials and linked targets not read",
      "study_family": "F03",
      "independent_replication": false,
      "observed_result": "PCI versus CABG is a different question from comparing numbers of graft vessels.",
      "result_level": "Original cross-citation concerning another population or comparator; not direct MAIN evidence or independent replication",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Original URL preserved",
          "access_status": "Summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-08-26",
          "qualification": "Report-specific summary links within the same stored summary"
        },
        {
          "material_type": "Original related-verdict link",
          "public_status": "Original URL preserved",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External full paper",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External registration",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        },
        {
          "material_type": "External protocol and SAP",
          "public_status": "No separate original URL",
          "access_status": "Not read",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-08-26",
          "qualification": "External materials and related-verdict targets not read; a URL does not certify reading or review"
        }
      ],
      "links": [
        {
          "label": "Official source",
          "url": "https://chamgap.com/verdicts/heart/everolimus-eluting-stent-pci-cabg-left-main-three-year-noninferiority/"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing"
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing"
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08",
      "section": "§8.1–8.2.3, Table 8.2.a",
      "official_principle": "Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.",
      "review_level": "Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing"
    },
    {
      "id": "M15",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15",
      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing"
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19",
      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Existing stored methodological links reused for preparation; no current review, reassessment of methodological content or external-link testing"
    }
  ],
  "status_dictionary": {
    "Partly verified": "Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified",
    "Unverified": "Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety",
    "Review incomplete": "Awaiting user review",
    "Met": "Use only within the relevant condition's scope after user review; no automatic display in this preparation",
    "Not reported": "Distinguish only within materials actually read; do not turn unread external materials into unreported findings",
    "Inaccessible": "Not applied during this preparation because actual access was not tested",
    "Not applicable": "Use with a reason for non-applicability based on an explicit question boundary",
    "Conflicting data": "Judge after actual material comparison; review was not performed during this preparation",
    "Insufficient evidence for the conditions": "Do not use as a clinical grade encompassing currently unread materials"
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "Family IDs link relationships and do not certify independent counts; reports, periods, events, institutions, cross-citations and participants are not independently added. F01: the same RCT, efficacy, harm and cohort shared by the designated MAIN claim. F02: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified. F03: an existing-verdict cross-citation concerning another population or comparator; target not read and independent replication not certified."
  },
  "history": [
    {
      "date": "2026-10-10",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "Public pages and materials were prepared from the existing 19 items. No new clinical search, verification-status changes or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-10"
}