{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v3004-s2",
  "verdict_number": "3004",
  "title": "Labor VR × analgesic use, cesarean birth and instrumental delivery: precise effects and power unverified",
  "view_version": "1.0",
  "view_created_date": "2026-10-19",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "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": "The population is women in labor. The parent key pain trial involved 40 term nulliparous women before pharmacologic or neuraxial analgesia. Eligibility, at-risk populations and observation/analysis denominators for analgesic use, cesarean birth and instrumental delivery are unverified. Do not copy the representative trial population and sample to every outcome.",
    "intervention": "The original key trial combined immersive VR, nature scenes, distraction and labor-specific audio. Content, devices and epidural status differ across reports; component contributions to the selected outcomes, actual use and discontinuation are unverified. Do not newly establish a device-only effect or use instructions.",
    "dose": "Up to 30 minutes in the key trial and about 10 minutes in the acute crossover are original exposure records. Actual use, discontinuation, repeat exposure and observation periods for the selected outcomes are unverified. Do not turn exposure duration into outcome follow-up or create new VR, labor, analgesic or treatment instructions.",
    "comparator": "Distinguish no added intervention/standard care in the original key trial from non-VR contractions in the crossover. This does not mean absence of clinical care. Concurrent/rescue analgesia, obstetric decision criteria, contact/audio and actual between-group comparisons for each outcome are unverified.",
    "endpoint": "The selection is the existing subclaim of reduced analgesic use, cesarean birth or instrumental delivery. Preserve original grade ? and the note that precise effects and adequate power were not established. Definitions, original event counts, denominators and direct between-group effects/CIs are unverified. Immediate pain, MCID, anxiety, satisfaction and persistence do not substitute for these outcomes.",
    "duration": "Maximum 30-minute parent-trial exposure, about 10 minutes in the crossover, and pain during use/30 minutes later are distinct contexts. Occurrence, decisions, collection times and whole-labor/discharge/later follow-up windows for the selected outcomes are unverified. Do not extend brief pain windows to outcome observation or long-term safety.",
    "excluded_extensions": [
      "Back-calculating CI/SE or standardized effects from original change differences/P, or calculating new MCID responder counts",
      "Combining primary pain with secondary pain, satisfaction, anxiety or medication/obstetric events as one effect",
      "Interchanging within-group reduction, pre/post-epidural and during/immediately-after/30-minutes-later results",
      "Using representative populations, maximum exposure, standard care or total samples as every report/endpoint’s conditions or denominators",
      "Counting same-cohort qualitative reports, shared bibliography or the three questions as new independent trials or participant totals",
      "Certifying in-kind support, reported noninvolvement in analysis or public funding as complete independence/support verification",
      "Inheriting parent C with 50 points, Caution or historical verification as subclaim scores or new clinical/safety certification",
      "Creating new VR use/setup, labor, analgesic or treatment instructions, or medication/surgery replacement recommendations"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which outcome-reduction claim is selected?",
      "needed": "Existing subclaim versus parent pain and persistence questions",
      "role": "Required",
      "role_reason": "This condition connects Existing subclaim versus parent pain and persistence questions with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Existing subclaim versus parent pain and persistence questions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original definitions, reports, registration and protocols for these outcomes are needed. Create no new claim or independence certification. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The selection is the existing subclaim of reduced analgesic use, cesarean birth or instrumental delivery. Distinguish immediate parent-trial pain and the separate persistence question, retaining direct-material gaps for the three selected outcomes separately.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original definitions, reports, registration and protocols for these outcomes are needed. Create no new claim or independence certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original definitions, reports, registration and protocols for these outcomes are needed. Create no new claim or independence certification."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "How do subclaim grade and parent score differ?",
      "needed": "Subclaim ?, original note, absent score/status and parent record",
      "role": "Required",
      "role_reason": "This condition connects Subclaim ?, original note, absent score/status and parent record with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Subclaim ?, original note, absent score/status and parent record must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: A changed original verdict requires complete before/after records. Do not fill absent subclaim score/status with parent values. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The subclaim grade is ?; preserve the original note that precise outcome effects and adequate power were not established. Subclaim score/status are absent; parent C with 50 points and Caution is historical pain-question context.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "A changed original verdict requires complete before/after records. Do not fill absent subclaim score/status with parent values.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "A changed original verdict requires complete before/after records. Do not fill absent subclaim score/status with parent values."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Who is eligible for each outcome question?",
      "needed": "Labor stage, parity, term status, analgesia and outcome eligibility",
      "role": "Required",
      "role_reason": "This condition connects Labor stage, parity, term status, analgesia and outcome eligibility with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Labor stage, parity, term status, analgesia and outcome eligibility must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Recruitment, exclusions, labor stage, obstetric risk and outcome-specific analysis tables are needed. Do not copy representative populations/samples to every report. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent key pain trial involved 40 term nulliparous women before pharmacologic or neuraxial analgesia. Eligibility, exclusions, planned surgery, at-risk populations and denominators for other reports and each outcome are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Recruitment, exclusions, labor stage, obstetric risk and outcome-specific analysis tables are needed. Do not copy representative populations/samples to every report.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Recruitment, exclusions, labor stage, obstetric risk and outcome-specific analysis tables are needed. Do not copy representative populations/samples to every report."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Which VR components are recorded?",
      "needed": "Device, content, audio, actual exposure and discontinuation",
      "role": "Required",
      "role_reason": "This condition connects Device, content, audio, actual exposure and discontinuation with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Device, content, audio, actual exposure and discontinuation must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Intervention specifications, versions, actual use/adherence and discontinuation records are needed. Create no new device-use instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial combined VR, nature scenes, distraction and labor-specific audio. Content, exposure, headsets and epidural status differ across reports; component contributions to outcome reduction are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Intervention specifications, versions, actual use/adherence and discontinuation records are needed. Create no new device-use instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Intervention specifications, versions, actual use/adherence and discontinuation records are needed. Create no new device-use instructions."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "What care is the reduction compared with?",
      "needed": "Standard care, no added intervention, non-VR contractions and decisions",
      "role": "Required",
      "role_reason": "This condition connects Standard care, no added intervention, non-VR contractions and decisions with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Standard care, no added intervention, non-VR contractions and decisions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Comparator care, concurrent/rescue medication, epidural use, contact/audio and obstetric decision criteria are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Distinguish no added intervention/standard care in the key trial from non-VR contractions in Frey. This does not mean absence of clinical care. Concurrent/rescue analgesia, obstetric decisions and attention controls for each outcome are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Comparator care, concurrent/rescue medication, epidural use, contact/audio and obstetric decision criteria are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Comparator care, concurrent/rescue medication, epidural use, contact/audio and obstetric decision criteria are needed."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Are outcome observation periods verified?",
      "needed": "Exposure/pain assessments versus outcome collection/follow-up",
      "role": "Required",
      "role_reason": "This condition connects Exposure/pain assessments versus outcome collection/follow-up with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Exposure/pain assessments versus outcome collection/follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Outcome-specific start/end, labor completion and discharge/later follow-up records are needed. Do not turn exposure duration into outcome follow-up. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Up to 30 minutes in the key trial, about 10 minutes in the crossover, and Correia pain during use/30 minutes later are original records. Whole-labor/discharge collection and observation periods for the selected outcomes are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Outcome-specific start/end, labor completion and discharge/later follow-up records are needed. Do not turn exposure duration into outcome follow-up.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Outcome-specific start/end, labor completion and discharge/later follow-up records are needed. Do not turn exposure duration into outcome follow-up."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "What defines reduced analgesic use?",
      "needed": "Drug categories, neuraxial/epidural and rescue use, dose/frequency/onset",
      "role": "Required",
      "role_reason": "This condition connects Drug categories, neuraxial/epidural and rescue use, dose/frequency/onset with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Drug categories, neuraxial/epidural and rescue use, dose/frequency/onset must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Drug categories, outcome definitions, original administration records, registration/SAP, doses, frequency and onset times are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original question includes reduced analgesic use; the parent also says reduced epidural use is unproven. The stored summary lacks definitions for specific drugs, totals and rescue/neuraxial-use outcomes.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Drug categories, outcome definitions, original administration records, registration/SAP, doses, frequency and onset times are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Drug categories, outcome definitions, original administration records, registration/SAP, doses, frequency and onset times are needed."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Is there a direct between-group analgesic effect?",
      "needed": "Arm-specific use/dose, direct effects, adjustment and CIs",
      "role": "Required",
      "role_reason": "This condition connects Arm-specific use/dose, direct effects, adjustment and CIs with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Arm-specific use/dose, direct effects, adjustment and CIs must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original arm-specific counts/doses, tables, models, adjustment, CIs and analysis units are needed. Symptom values do not substitute for outcome effects. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original records leave precise medication-outcome effects unverified. The four reports summarize pain, anxiety, satisfaction and persistence; between-group analgesic effects/CIs are not preserved.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original arm-specific counts/doses, tables, models, adjustment, CIs and analysis units are needed. Symptom values do not substitute for outcome effects.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original arm-specific counts/doses, tables, models, adjustment, CIs and analysis units are needed. Symptom values do not substitute for outcome effects."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What are analgesic denominators and missingness?",
      "needed": "At-risk populations, allocation/follow-up/analysis, missing records and repeat dosing",
      "role": "Required",
      "role_reason": "This condition connects At-risk populations, allocation/follow-up/analysis, missing records and repeat dosing with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for At-risk populations, allocation/follow-up/analysis, missing records and repeat dosing must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Outcome flow diagrams, missingness, ITT/PP and crossover exposure/dosing rules are needed. Calculate no new event or attrition counts from original samples. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial records all 40 participants analyzed. Denominators, missingness, handling of unmedicated/already-medicated women and repeat-dose units for analgesic outcomes are separately unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Outcome flow diagrams, missingness, ITT/PP and crossover exposure/dosing rules are needed. Calculate no new event or attrition counts from original samples.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Outcome flow diagrams, missingness, ITT/PP and crossover exposure/dosing rules are needed. Calculate no new event or attrition counts from original samples."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Are direct comparative cesarean results available?",
      "needed": "Arm-specific events/denominators, effects/CIs and observation windows",
      "role": "Required",
      "role_reason": "This condition connects Arm-specific events/denominators, effects/CIs and observation windows with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Arm-specific events/denominators, effects/CIs and observation windows must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original surgery tables, birth types, denominators, effects/CIs, registration and analysis plans are needed. Unverified findings do not establish exact no effect. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original question and parent records preserve the boundary that cesarean/operative reduction is unproven. Arm-specific cesarean counts, direct effects, CIs and time windows are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original surgery tables, birth types, denominators, effects/CIs, registration and analysis plans are needed. Unverified findings do not establish exact no effect.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original surgery tables, birth types, denominators, effects/CIs, registration and analysis plans are needed. Unverified findings do not establish exact no effect."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Are planned/emergency surgery and decision criteria distinguished?",
      "needed": "Indications, decision-makers, baseline risk and exposure/decision timing",
      "role": "Required",
      "role_reason": "This condition connects Indications, decision-makers, baseline risk and exposure/decision timing with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Indications, decision-makers, baseline risk and exposure/decision timing must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Surgical indications, decision records, baseline obstetric risk and allocation/exposure/decision timelines are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent provides context that studies were not powered for major clinical outcomes. Planned/emergency surgery, decision-makers, indications and whether VR preceded events are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Surgical indications, decision records, baseline obstetric risk and allocation/exposure/decision timelines are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Surgical indications, decision records, baseline obstetric risk and allocation/exposure/decision timelines are needed."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Are direct instrumental-delivery results available?",
      "needed": "Types, arm-specific events/denominators and effects/CIs",
      "role": "Required",
      "role_reason": "This condition connects Types, arm-specific events/denominators and effects/CIs with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Types, arm-specific events/denominators and effects/CIs must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original instrumental-delivery tables, types, prespecified definitions, denominators and effects/CIs are needed. Do not transfer other-endpoint values. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original question includes instrumental delivery, but the four reports contain no instrumental-delivery numbers. Precise effects and adequate power for these outcomes are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original instrumental-delivery tables, types, prespecified definitions, denominators and effects/CIs are needed. Do not transfer other-endpoint values.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original instrumental-delivery tables, types, prespecified definitions, denominators and effects/CIs are needed. Do not transfer other-endpoint values."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "What population and unit define instrumental delivery?",
      "needed": "All allocated/vaginal-birth risk sets, attempts/completion, types and missingness",
      "role": "Required",
      "role_reason": "This condition connects All allocated/vaginal-birth risk sets, attempts/completion, types and missingness with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for All allocated/vaginal-birth risk sets, attempts/completion, types and missingness must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Birth-pathway flow diagrams, risk sets, instrument types, attempts/completion, denominators, missingness and analysis plans are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The stored material does not verify vaginal-birth risk-set denominators, analysis of all allocated women, instrument types, repeated attempts or final-outcome units.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Birth-pathway flow diagrams, risk sets, instrument types, attempts/completion, denominators, missingness and analysis plans are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Birth-pathway flow diagrams, risk sets, instrument types, attempts/completion, denominators, missingness and analysis plans are needed."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "How were the selected outcomes prespecified?",
      "needed": "Registration/protocol/SAP hierarchy, times, denominators and power",
      "role": "Required",
      "role_reason": "This condition connects Registration/protocol/SAP hierarchy, times, denominators and power with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Registration/protocol/SAP hierarchy, times, denominators and power must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Registration, protocols, SAPs and outcome-specific original reports are needed. An identifier alone does not verify prespecified plans. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial concerns between-group pre-post pain change; Carus concerns primary satisfaction and secondary pain. Prespecified endpoint hierarchy, times, denominators, analyses and power for the selected outcomes are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Registration, protocols, SAPs and outcome-specific original reports are needed. An identifier alone does not verify prespecified plans.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Registration, protocols, SAPs and outcome-specific original reports are needed. An identifier alone does not verify prespecified plans."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are Wong pain values outcome effects?",
      "needed": "Original pain change/CIs versus medication and birth outcomes",
      "role": "Required",
      "role_reason": "This condition connects Original pain change/CIs versus medication and birth outcomes with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original pain change/CIs versus medication and birth outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original pain/outcome tables, direct CIs, denominators and models are needed. Do not back-calculate new CIs/SEs from changes/P. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve Wong control +0.58, VR -0.52, original change difference -1.10, P=.03. The 95% CI is unverified. These are between-group pre-post pain changes, not the selected outcome effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original pain/outcome tables, direct CIs, denominators and models are needed. Do not back-calculate new CIs/SEs from changes/P.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original pain/outcome tables, direct CIs, denominators and models are needed. Do not back-calculate new CIs/SEs from changes/P."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Does complete analysis establish each outcome denominator?",
      "needed": "Allocated samples versus outcome-specific observation/analysis denominators",
      "role": "Required",
      "role_reason": "This condition connects Allocated samples versus outcome-specific observation/analysis denominators with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Allocated samples versus outcome-specific observation/analysis denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Key-trial flow diagrams, outcome-specific denominators and original tables are needed. Do not extend all analyzed to complete data for every outcome/harm. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Wong records 40 participants, 21 VR/19 control, with all analyzed. Observation/analysis denominators and missingness for analgesic use, cesarean birth and instrumental delivery are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Key-trial flow diagrams, outcome-specific denominators and original tables are needed. Do not extend all analyzed to complete data for every outcome/harm.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Key-trial flow diagrams, outcome-specific denominators and original tables are needed. Do not extend all analyzed to complete data for every outcome/harm."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Is MCID pain response an outcome reduction?",
      "needed": "Original proportions, threshold and intervals versus event rates",
      "role": "Required",
      "role_reason": "This condition connects Original proportions, threshold and intervals versus event rates with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original proportions, threshold and intervals versus event rates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Threshold definitions, external validation, original response tables, exact denominators and intervals are needed. Calculate no new responder or event counts. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original MCID response was 0% versus 23.8%, P=.049. Preserve the original interpretation that it was not added as a separate strength because external threshold validation and CIs were unverified. These are not medication/birth event rates.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Threshold definitions, external validation, original response tables, exact denominators and intervals are needed. Calculate no new responder or event counts.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Threshold definitions, external validation, original response tables, exact denominators and intervals are needed. Calculate no new responder or event counts."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Is Wong linked to official registration?",
      "needed": "Original bibliography, official registration identity, dates and outcome plans",
      "role": "Required",
      "role_reason": "This condition connects Original bibliography, official registration identity, dates and outcome plans with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original bibliography, official registration identity, dates and outcome plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Official registration linked to the paper, protocols, prespecified endpoints, dates and change histories are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Wong records that the paper-official-registration link could not be verified. Preserve PMID 32485759 and DOI 10.1055/s-0040-1708851; infer no new registration linkage or reading.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Official registration linked to the paper, protocols, prespecified endpoints, dates and change histories are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Official registration linked to the paper, protocols, prespecified endpoints, dates and change histories are needed."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "What is the scope of Frey pain/anxiety findings?",
      "needed": "Original sensory-pain/anxiety effects/intervals versus outcomes",
      "role": "Required",
      "role_reason": "This condition connects Original sensory-pain/anxiety effects/intervals versus outcomes with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original sensory-pain/anxiety effects/intervals versus outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original crossover pain/anxiety tables and outcome-specific direct effects, denominators and CIs are needed. Do not inherit intervals from another endpoint. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve sensory pain -1.5 (95% CI -2.2 to -0.8) and anxiety -1.5 (-2.3 to -0.8). Original independent acute support is pain context, not outcome-replication certification. Do not newly assign an interval level to anxiety.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original crossover pain/anxiety tables and outcome-specific direct effects, denominators and CIs are needed. Do not inherit intervals from another endpoint.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original crossover pain/anxiety tables and outcome-specific direct effects, denominators and CIs are needed. Do not inherit intervals from another endpoint."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "How do crossover samples differ from repeated contractions?",
      "needed": "Order, periods, carryover information and within-person analysis",
      "role": "Required",
      "role_reason": "This condition connects Order, periods, carryover information and within-person analysis with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Order, periods, carryover information and within-person analysis must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Crossover protocols, order/periods, carryover, paired denominators, within-person models and outcome tables are needed. Do not count contractions as new independent participants. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Frey is an order-randomized acute crossover with 27 participants comparing VR/non-VR contractions for about 10 minutes. Details of order, carryover, repeated contractions and birth-outcome analyses are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Crossover protocols, order/periods, carryover, paired denominators, within-person models and outcome tables are needed. Do not count contractions as new independent participants.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Crossover protocols, order/periods, carryover, paired denominators, within-person models and outcome tables are needed. Do not count contractions as new independent participants."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "What is the satisfaction/pain hierarchy?",
      "needed": "Carus primary satisfaction, secondary pain and outcome plans",
      "role": "Required",
      "role_reason": "This condition connects Carus primary satisfaction, secondary pain and outcome plans with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Carus primary satisfaction, secondary pain and outcome plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Registration, SAP, endpoint hierarchy and original satisfaction/pain/outcome tables are needed. Satisfaction P or within-group reduction is not a between-group outcome effect. This records needed materials; no new research was executed.",
      "current_reports": [
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Carus has primary satisfaction and secondary pain; original results are satisfaction P=.04, within-group early-pain reduction and no post-epidural change. Outcome hierarchy, effects, denominators and intervals are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Registration, SAP, endpoint hierarchy and original satisfaction/pain/outcome tables are needed. Satisfaction P or within-group reduction is not a between-group outcome effect.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Registration, SAP, endpoint hierarchy and original satisfaction/pain/outcome tables are needed. Satisfaction P or within-group reduction is not a between-group outcome effect."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Does post-epidural pain answer reduced medication use?",
      "needed": "Epidural selection/timing, use/dose and denominators",
      "role": "Required",
      "role_reason": "This condition connects Epidural selection/timing, use/dose and denominators with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Epidural selection/timing, use/dose and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Pre/post-epidural population flow, original medication-use records, outcome tables and outcome-specific denominators are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Carus records 42 participants, 21 versus 21, with no post-epidural pain change. Who selected epidural use, timing, rates, doses, onset and medication-outcome denominators are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Pre/post-epidural population flow, original medication-use records, outcome tables and outcome-specific denominators are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Pre/post-epidural population flow, original medication-use records, outcome tables and outcome-specific denominators are needed."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Are Correia persistence findings outcome effects?",
      "needed": "During/follow-up pain, total allocation and outcomes",
      "role": "Required",
      "role_reason": "This condition connects During/follow-up pain, total allocation and outcomes with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for During/follow-up pain, total allocation and outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original during/post-use pain and birth-outcome tables, direct effects/CIs, denominators and registration are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Correia records 61 participants, 32 versus 29, in pain contexts during use and 30 minutes later. The during-use signal was not sustained 30 minutes later; exact CIs and registration are unverified. Effects on the selected outcomes are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original during/post-use pain and birth-outcome tables, direct effects/CIs, denominators and registration are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original during/post-use pain and birth-outcome tables, direct effects/CIs, denominators and registration are needed."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Can different reports be combined as outcome replication?",
      "needed": "Content, populations, scales, epidural status, times and outcome definitions",
      "role": "Required",
      "role_reason": "This condition connects Content, populations, scales, epidural status, times and outcome definitions with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Content, populations, scales, epidural status, times and outcome definitions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Report-specific conditions, outcome tables, common definitions, inclusion relationships, family identity and participant overlap are needed. Create no unique-trial/participant totals. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Content, exposure, headsets and epidural status differ across reports. Pain, anxiety, satisfaction and post-use pain are distinct contexts; common definitions of medication, operative and instrumental-delivery effects are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Report-specific conditions, outcome tables, common definitions, inclusion relationships, family identity and participant overlap are needed. Create no unique-trial/participant totals.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Report-specific conditions, outcome tables, common definitions, inclusion relationships, family identity and participant overlap are needed. Create no unique-trial/participant totals."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "What is verified about randomization and concealment?",
      "needed": "Sequence generation/concealment, recruitment order and analysis units",
      "role": "Required",
      "role_reason": "This condition connects Sequence generation/concealment, recruitment order and analysis units with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Sequence generation/concealment, recruitment order and analysis units must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Allocation procedures, flow diagrams, recruitment order and baseline obstetric-risk/arm-balance tables are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original designs: open randomization for Wong, order-randomized acute crossover for Frey, and randomized controlled trials for Carus/Correia. Actual generation, concealment, selection procedures and effects on outcome analyses are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Allocation procedures, flow diagrams, recruitment order and baseline obstetric-risk/arm-balance tables are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Allocation procedures, flow diagrams, recruitment order and baseline obstetric-risk/arm-balance tables are needed."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Who recorded and decided outcomes?",
      "needed": "Medication/birth records, extractors, adjudicators and allocation awareness",
      "role": "Required",
      "role_reason": "This condition connects Medication/birth records, extractors, adjudicators and allocation awareness with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Medication/birth records, extractors, adjudicators and allocation awareness must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Medication/birth-record collection, extraction, adjudication, masking and decision criteria are needed. Do not turn pain-bias explanations into a confirmed magnitude of outcome bias. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent describes limitations of unblinded patient-reported pain. Data sources, extractors, adjudicators, clinicians' allocation awareness and decision procedures for the selected outcomes are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Medication/birth-record collection, extraction, adjudication, masking and decision criteria are needed. Do not turn pain-bias explanations into a confirmed magnitude of outcome bias.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Medication/birth-record collection, extraction, adjudication, masking and decision criteria are needed. Do not turn pain-bias explanations into a confirmed magnitude of outcome bias."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "Are attention effects separated from concurrent care?",
      "needed": "Active controls, contact/audio, rescue analgesia and concurrent procedures",
      "role": "Required",
      "role_reason": "This condition connects Active controls, contact/audio, rescue analgesia and concurrent procedures with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Active controls, contact/audio, rescue analgesia and concurrent procedures must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Active-control, contact/audio, common-care, rescue-analgesia and concurrent-procedure records are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent states that active controls separating attention effects were absent. Detailed material separating audio/contact from rescue analgesia and obstetric-care differences is unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Active-control, contact/audio, common-care, rescue-analgesia and concurrent-procedure records are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Active-control, contact/audio, common-care, rescue-analgesia and concurrent-procedure records are needed."
    },
    {
      "item_id": "N28",
      "question_type": "Evidence condition",
      "question": "Do original samples differ from missing outcome data?",
      "needed": "Allocation to observation to analysis, discontinuation and outcome-specific omissions/exclusions",
      "role": "Required",
      "role_reason": "This condition connects Allocation to observation to analysis, discontinuation and outcome-specific omissions/exclusions with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Allocation to observation to analysis, discontinuation and outcome-specific omissions/exclusions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Outcome flow diagrams, denominators, missingness, analysis exclusions, discontinuation reasons and missing-data rules are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Outcome-specific missingness/follow-up beyond Wong's all-analyzed statement is unverified. Frey 27, Carus 42 and Correia 61 are original samples, not outcome-specific analysis samples or exclusion reasons.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Outcome flow diagrams, denominators, missingness, analysis exclusions, discontinuation reasons and missing-data rules are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Outcome flow diagrams, denominators, missingness, analysis exclusions, discontinuation reasons and missing-data rules are needed."
    },
    {
      "item_id": "N29",
      "question_type": "Evidence condition",
      "question": "Which effect do outcome analyses estimate?",
      "needed": "ITT/PP, actual use, baseline-risk adjustment and models",
      "role": "Required",
      "role_reason": "This condition connects ITT/PP, actual use, baseline-risk adjustment and models with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for ITT/PP, actual use, baseline-risk adjustment and models must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Outcome-specific SAPs, estimands, ITT/PP, denominators, actual use, covariates, models and estimates are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Report summaries concern acute symptoms, satisfaction and persistence. Allocation/actual-use effects, analgesic/surgical selection, baseline-risk/epidural adjustment, repeated-data handling and models for the selected outcomes are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Outcome-specific SAPs, estimands, ITT/PP, denominators, actual use, covariates, models and estimates are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Outcome-specific SAPs, estimands, ITT/PP, denominators, actual use, covariates, models and estimates are needed."
    },
    {
      "item_id": "N30",
      "question_type": "Evidence condition",
      "question": "Are outcome-specific CIs and power available?",
      "needed": "Effects/CIs, event counts, sample-size planning, importance and follow-up",
      "role": "Required",
      "role_reason": "This condition connects Effects/CIs, event counts, sample-size planning, importance and follow-up with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Effects/CIs, event counts, sample-size planning, importance and follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Outcome-specific effects/CIs, planned effects, event counts, sample-size/power plans and importance thresholds are needed. Calculate no new power. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original subclaim note says precise outcome effects and adequate power were not established. The parent also describes studies not powered for major clinical outcomes or medication sparing. Outcome-specific CIs and sample-size planning are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Outcome-specific effects/CIs, planned effects, event counts, sample-size/power plans and importance thresholds are needed. Calculate no new power.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Outcome-specific effects/CIs, planned effects, event counts, sample-size/power plans and importance thresholds are needed. Calculate no new power."
    },
    {
      "item_id": "N31",
      "question_type": "Evidence condition",
      "question": "How are same-cohort related reports counted?",
      "needed": "Primary, qualitative/support reports, registration and cohort identity",
      "role": "Required",
      "role_reason": "This condition connects Primary, qualitative/support reports, registration and cohort identity with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Primary, qualitative/support reports, registration and cohort identity must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Detailed primary/qualitative/support-report identities, registration, recruitment dates and outcome links are needed. Do not add new independent trials. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "A same-cohort Wong report describes AppliedVR support. The original verdict did not double-count same-cohort qualitative research as replication. Separate bibliographies, registration and overlap scope of related reports are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed primary/qualitative/support-report identities, registration, recruitment dates and outcome links are needed. Do not add new independent trials.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed primary/qualitative/support-report identities, registration, recruitment dates and outcome links are needed. Do not add new independent trials."
    },
    {
      "item_id": "N32",
      "question_type": "Evidence condition",
      "question": "Are registration identifiers separated from content verification?",
      "needed": "Original identifiers, official content, dates, changes and outcome links",
      "role": "Required",
      "role_reason": "This condition connects Original identifiers, official content, dates, changes and outcome links with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original identifiers, official content, dates, changes and outcome links must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Official registration, protocols, change histories and links to prespecified outcome endpoints/dates for each report are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve Frey NCT02926469 and Carus NCT05032456 strings. Retain unverified Wong linkage and Correia registration. Original registration content was not read in this work.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Official registration, protocols, change histories and links to prespecified outcome endpoints/dates for each report are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Official registration, protocols, change histories and links to prespecified outcome endpoints/dates for each report are needed."
    },
    {
      "item_id": "N33",
      "question_type": "Evidence condition",
      "question": "What funding and interests are recorded?",
      "needed": "Funding, devices, roles, COI and related reports",
      "role": "Required",
      "role_reason": "This condition connects Funding, devices, roles, COI and related reports with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Funding, devices, roles, COI and related reports must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original funding, device, COI, design/analysis/publication-role and investigator-role documents and related reports are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve same-cohort Wong AppliedVR device/software support and reported no analysis role; Frey NIH AR054115/GM042725; Carus reported funding not applicable/no COI; and Correia unverified. This is no new independence verdict.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original funding, device, COI, design/analysis/publication-role and investigator-role documents and related reports are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original funding, device, COI, design/analysis/publication-role and investigator-role documents and related reports are needed."
    },
    {
      "item_id": "N34",
      "question_type": "Evidence condition",
      "question": "Which materials were actually read?",
      "needed": "Stored summary versus external abstracts/full texts/registration/plans",
      "role": "Required",
      "role_reason": "This condition connects Stored summary versus external abstracts/full texts/registration/plans with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Stored summary versus external abstracts/full texts/registration/plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Needed original abstracts/full texts, registration, protocols and SAPs are required. Do not turn unattempted access into access failure or full-text reading. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the complete parent stored JSON and the four reports' original bibliographies/summaries. The summary was read; external papers, abstracts, registration and plans remain unread. External access was not attempted.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Needed original abstracts/full texts, registration, protocols and SAPs are required. Do not turn unattempted access into access failure or full-text reading.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Needed original abstracts/full texts, registration, protocols and SAPs are required. Do not turn unattempted access into access failure or full-text reading."
    },
    {
      "item_id": "N35",
      "question_type": "Evidence condition",
      "question": "How do historical verification and production dates differ?",
      "needed": "Original evidence date, empty change history and current scope",
      "role": "Required",
      "role_reason": "This condition connects Original evidence date, empty change history and current scope with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original evidence date, empty change history and current scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: New corrections/evidence updates require complete originals, events, before/after values and reasons. Do not fill an unrecorded review date with the production date. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original evidence date is 2026-09-07; correction and deliberation records are empty. Historical parent cross-checking/grade decisions do not establish completed content review in this production.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "New corrections/evidence updates require complete originals, events, before/after values and reasons. Do not fill an unrecorded review date with the production date.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "New corrections/evidence updates require complete originals, events, before/after values and reasons. Do not fill an unrecorded review date with the production date."
    },
    {
      "item_id": "N36",
      "question_type": "Evidence condition",
      "question": "Are Korean/English question boundaries preserved?",
      "needed": "Original subclaim wording/notes versus parent pain/safety wording",
      "role": "Required",
      "role_reason": "This condition connects Original subclaim wording/notes versus parent pain/safety wording with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original subclaim wording/notes versus parent pain/safety wording must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Detailed comparison with external originals/corrections remains unverified. Preserve complete relevant originals and comparison records when needed. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original English claim concerns reduced analgesic use, cesarean birth or instrumental delivery, with a note that precise effects/adequate power were not established. Parent English separately describes immediate pain and whole-labor/epidural/cesarean limitations.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Detailed comparison with external originals/corrections remains unverified. Preserve complete relevant originals and comparison records when needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Detailed comparison with external originals/corrections remains unverified. Preserve complete relevant originals and comparison records when needed."
    },
    {
      "item_id": "N37",
      "question_type": "Evidence condition",
      "question": "Are parent axes inherited as a subclaim verdict?",
      "needed": "Original axes, unrecorded precision/override and absent subclaim fields",
      "role": "Required",
      "role_reason": "This condition connects Original axes, unrecorded precision/override and absent subclaim fields with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original axes, unrecorded precision/override and absent subclaim fields must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Changed axes/subclaim records require complete change events. Do not fill parent values or empty fields as new outcome verdicts/certification. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent records B/P/R1/I1/E+/B2 with unrecorded precision and all four Boolean flags false. Preserve derived grade C and empty override reasons. Subclaim score, status and axes are absent.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Changed axes/subclaim records require complete change events. Do not fill parent values or empty fields as new outcome verdicts/certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Changed axes/subclaim records require complete change events. Do not fill parent values or empty fields as new outcome verdicts/certification."
    },
    {
      "item_id": "N38",
      "question_type": "Evidence condition",
      "question": "How were harms collected?",
      "needed": "Symptoms, maternal/neonatal definitions and active/passive collection",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Symptoms, maternal/neonatal definitions and active/passive collection with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Symptoms, maternal/neonatal definitions and active/passive collection must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Harm definitions, active/passive collection, assessors, discontinuation/symptom records and original maternal/neonatal tables are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original caution wording describes possible dizziness, motion sickness, discomfort and visual obstruction. These are not counts/rates or direct comparative harm tables; definitions, collection methods and assessors are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Harm definitions, active/passive collection, assessors, discontinuation/symptom records and original maternal/neonatal tables are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Harm definitions, active/passive collection, assessors, discontinuation/symptom records and original maternal/neonatal tables are needed."
    },
    {
      "item_id": "N39",
      "question_type": "Evidence condition",
      "question": "When did harms, discontinuation and follow-up occur?",
      "needed": "Exposure start/end, symptoms and post-birth/discharge follow-up",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Exposure start/end, symptoms and post-birth/discharge follow-up with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Exposure start/end, symptoms and post-birth/discharge follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Exposure, symptom, discontinuation, clinical-event, birth/discharge/later follow-up timelines are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve maximum 30-minute key-trial exposure and acute-assessment context, but harm onset, discontinuation times and maternal/neonatal follow-up windows are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Exposure, symptom, discontinuation, clinical-event, birth/discharge/later follow-up timelines are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Exposure, symptom, discontinuation, clinical-event, birth/discharge/later follow-up timelines are needed."
    },
    {
      "item_id": "N40",
      "question_type": "Evidence condition",
      "question": "Were harms compared under equivalent observation conditions?",
      "needed": "Comparator care, common collection/observation and occurrence/discontinuation tables",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Comparator care, common collection/observation and occurrence/discontinuation tables with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Comparator care, common collection/observation and occurrence/discontinuation tables must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Comparator harm-collection, observation-period, discontinuation and original-table records and common procedures are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent includes standard-care/non-VR comparisons. Whether harms were collected identically over the same periods in both conditions, and direct comparative results, are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Comparator harm-collection, observation-period, discontinuation and original-table records and common procedures are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Comparator harm-collection, observation-period, discontinuation and original-table records and common procedures are needed."
    },
    {
      "item_id": "N41",
      "question_type": "Evidence condition",
      "question": "Are event counts and denominators available for harm frequency?",
      "needed": "Exposure/observation/analysis, maternal/neonatal units, discontinuation and missingness",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Exposure/observation/analysis, maternal/neonatal units, discontinuation and missingness with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Exposure/observation/analysis, maternal/neonatal units, discontinuation and missingness must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original harm tables, exposure/follow-up flow, maternal/neonatal units and discontinuation reasons are needed. Do not newly calculate/certify event counts, rates or absence of harm. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve the original limitation that all 40 key-trial participants were analyzed but the trial was too small for rare maternal/neonatal harms. Harm counts, exposure/follow-up denominators, maternal/neonatal units and missingness are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original harm tables, exposure/follow-up flow, maternal/neonatal units and discontinuation reasons are needed. Do not newly calculate/certify event counts, rates or absence of harm.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original harm tables, exposure/follow-up flow, maternal/neonatal units and discontinuation reasons are needed. Do not newly calculate/certify event counts, rates or absence of harm."
    },
    {
      "item_id": "N42",
      "question_type": "Evidence condition",
      "question": "Are concurrent care and alternative causes distinguished?",
      "needed": "Analgesia/neuraxial use, labor progression, obstetric risk and clinical observation",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Analgesia/neuraxial use, labor progression, obstetric risk and clinical observation with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Analgesia/neuraxial use, labor progression, obstetric risk and clinical observation must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Event timing, concurrent drugs/procedures, baseline risk, actual interference records and independent adjudication material are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent describes visual obstruction, clinical monitoring/communication and small-study limitations. Actual monitoring-interference events, contributions from other care, obstetric-risk adjustment and causal assessments are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Event timing, concurrent drugs/procedures, baseline risk, actual interference records and independent adjudication material are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Event timing, concurrent drugs/procedures, baseline risk, actual interference records and independent adjudication material are needed."
    },
    {
      "item_id": "N43",
      "question_type": "Evidence condition",
      "question": "Were discomfort, discontinuation or follow-up losses omitted?",
      "needed": "Device refusal/discontinuation, reporting omissions and post-birth follow-up",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Device refusal/discontinuation, reporting omissions and post-birth follow-up with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Device refusal/discontinuation, reporting omissions and post-birth follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Refusal/discontinuation reasons, harm logs, outcome-publication scope and post-birth/discharge follow-up losses are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial records all analyzed, but details of device discontinuation, discomfort, missing harm reports and maternal/neonatal follow-up loss are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Refusal/discontinuation reasons, harm logs, outcome-publication scope and post-birth/discharge follow-up losses are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Refusal/discontinuation reasons, harm logs, outcome-publication scope and post-birth/discharge follow-up losses are needed."
    },
    {
      "item_id": "N44",
      "question_type": "Evidence condition",
      "question": "Have rare maternal/neonatal harms been excluded?",
      "needed": "Independent related harms, vulnerable groups and follow-up beyond brief observation",
      "role": "Supplementary; required for extending safety conclusions",
      "role_reason": "This condition connects Independent related harms, vulnerable groups and follow-up beyond brief observation with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Independent related harms, vulnerable groups and follow-up beyond brief observation must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Related harm reports, unique-event/family links, exposure/follow-up and vulnerable-group results are needed. Do not extend brief observation to overall safety. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original records state that small trials cannot adequately assess/exclude rare maternal/neonatal harms. Independent recurrence of the same harms, vulnerable groups and post-birth material are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Related harm reports, unique-event/family links, exposure/follow-up and vulnerable-group results are needed. Do not extend brief observation to overall safety.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Related harm reports, unique-event/family links, exposure/follow-up and vulnerable-group results are needed. Do not extend brief observation to overall safety."
    },
    {
      "item_id": "N45",
      "question_type": "Evidence condition",
      "question": "How are conditions and new materials updated?",
      "needed": "Originals, criterion versions, creation/application order and update events",
      "role": "Required",
      "role_reason": "This condition connects Originals, criterion versions, creation/application order and update events with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Originals, criterion versions, creation/application order and update events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: New reports, registration, outcome tables or corrections require complete originals linked to events, versions, before/after values and reasons. Distinguish criterion revisions from verdict changes. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Connect preserved methods and application conditions. Retain the original sequence of recording observations separately after conditions were frozen; existing content/boundary review remains incomplete. No new external material was applied and no official-method certification occurred now.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "New reports, registration, outcome tables or corrections require complete originals linked to events, versions, before/after values and reasons. Distinguish criterion revisions from verdict changes.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "New reports, registration, outcome tables or corrections require complete originals linked to events, versions, before/after values and reasons. Distinguish criterion revisions from verdict changes."
    },
    {
      "item_id": "N46",
      "question_type": "Evidence condition",
      "question": "Is pain extrapolated to medication/surgery replacement?",
      "needed": "Original advertising boundary, outcome gaps and use/treatment guidance",
      "role": "Required",
      "role_reason": "This condition connects Original advertising boundary, outcome gaps and use/treatment guidance with definitions, timing, actual comparisons, denominators, effects/CIs, power or harms for analgesic use, cesarean birth and instrumental delivery separately, distinguishing original acute-pain and other-endpoint results.",
      "application_exception": "Preserve original subclaim ? and unverified precise outcome effects/adequate power. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not turn pain, anxiety, satisfaction, MCID, persistence or representative samples into outcome effects/denominators. Unverified findings do not establish no effect, equivalence or safety certification. Create no new effects, CIs, event counts, totals, independence certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original advertising boundary, outcome gaps and use/treatment guidance must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Link added original direct-outcome results in separate records. Do not establish unverified outcome reduction, whole-labor effects or replacement comparisons. This records needed materials; no new research was executed.",
      "current_reports": [],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent describes how VR instead of epidural or surgery-free birth claims extend momentary pain signals to medication replacement/obstetric-event prevention. Record direct outcome gaps here without new use, labor, analgesic or treatment instructions.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Link added original direct-outcome results in separate records. Do not establish unverified outcome reduction, whole-labor effects or replacement comparisons.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Link added original direct-outcome results in separate records. Do not establish unverified outcome reduction, whole-labor effects or replacement comparisons."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Wong MS, Spiegel BMR, Gregory KD. Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial. Am J Perinatol. 2021;38(S01):e167-e172. PMID: 32485759. DOI: 10.1055/s-0040-1708851.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/32485759/",
      "report_type": "Open randomized controlled trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.",
      "observed_result": "Control +0.58, VR -0.52; difference in change -1.10, P=.03",
      "result_level": "Primary between-group pre-post pain change from 40 participants, 21 VR/19 control. Direct intervals, scales/models and endpoint-specific denominators are unverified. All analyzed and MCID-response statements do not establish complete data at all times/for harms or separate confirmation. Do not promote this context to a direct effect or replication for the selected medication/birth outcomes.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "External abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "External full text",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "Registration material",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "Protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "Analysis plan and original tables",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "Intervention and harms",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "Support and interests",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/32485759/"
        }
      ]
    },
    {
      "report_id": "R02",
      "title": "Frey DP, et al. Virtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women. Anesth Analg. 2019;128:e93-e96. PMID: 31094789. DOI: 10.1213/ANE.0000000000003649.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/31094789/",
      "report_type": "Order-randomized acute crossover trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.",
      "observed_result": "Sensory pain -1.5 (95% CI -2.2 to -0.8); anxiety -1.5 (-2.3 to -0.8)",
      "result_level": "Order-randomized acute crossover context with 27 participants. Keep original sensory-pain and anxiety values separate without newly assigning an interval level to anxiety. Order, periods, carryover, paired denominators and differing content/scales are unverified. Do not promote this context to a direct effect or replication for the selected medication/birth outcomes.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
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        },
        {
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          "qualification": "Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification."
        },
        {
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          "qualification": "Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification."
        },
        {
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        },
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          "qualification": "Preserve original PMID 31094789, DOI 10.1213/ANE.0000000000003649 and NCT02926469. PMCID is unrecorded. The identifier and original funding wording do not establish current registration/full-text reading, prospective status or complete support verification."
        },
        {
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        {
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        {
          "label": "PubMed",
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    {
      "report_id": "R03",
      "title": "Carus EG, Albayrak N, Bildirici HM, Gur Ozmen S. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22:354. PMID: 35461248. PMCID: PMC9034564. DOI: 10.1186/s12884-022-04598-y.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/35461248/",
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      "observed_result": "Satisfaction P=.04; within-group early-pain reduction and no post-epidural change",
      "result_level": "42 participants, 21 versus 21, distinguishing primary satisfaction from secondary pain. Do not turn early within-group reduction or no post-epidural change into a direct between-group primary pain effect. Exact intervals, time-specific denominators and medication status are unverified. Do not promote this context to a direct effect or replication for the selected medication/birth outcomes.",
      "source_evidence_date": "2026-09-07",
      "materials": [
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        },
        {
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        {
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    {
      "report_id": "R04",
      "title": "Correia MCG, et al. Virtual Reality in Labor Pain Management: A Randomized Controlled Trial. Pain Manag Nurs. 2026;27:e708-e714. PMID: 41896140. DOI: 10.1016/j.pmn.2026.02.005.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/41896140/",
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      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.",
      "observed_result": "The during-use signal was not sustained 30 minutes later",
      "result_level": "Pain-persistence context during use/30 minutes later from 61 participants, 32 versus 29. Exact pain effects/CIs, time-specific denominators, registration and support are unverified. Do not transfer this to direct effects or denominators for analgesic use, cesarean birth or instrumental delivery.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
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          "qualification": "Preserve original PMID 41896140, DOI 10.1016/j.pmn.2026.02.005 and unverified registration/support. PMCID and case/citation registration annotations are unrecorded. Retain the original bibliographic year and evidence date; infer no new URLs or original-material acquisition."
        },
        {
          "material_type": "External abstract",
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        {
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        },
        {
          "material_type": "Analysis plan and original tables",
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        },
        {
          "material_type": "Intervention and harms",
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        },
        {
          "material_type": "Support and interests",
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        }
      ],
      "links": [
        {
          "label": "PubMed",
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      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
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    "Unverified": "Required direct values, definitions or materials have not been established within the current storage and reading scope. This does not mean zero effect, no papers or failed access.",
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    "Not reported": "Used only when original materials were actually read and the outcome was judged unreported. Not used for external materials unread in this work.",
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    "Insufficient evidence for the conditions": "Indicates insufficient direct materials for the relevant scope or conditions; it is not a new grade.",
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    "Conflicting data": "Retains the scope of conflicting statements in original materials; it is not an arbitrary reassessment."
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      "date": "2026-10-19",
      "kind": "Separation of public-facing pages and materials",
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}