{
  "schemaVersion": 1,
  "release": "2026-09-26+19ae990714",
  "repositoryUrl": "https://github.com/clay-good/opensimlab",
  "capabilityVersion": "0.1.0-alpha.48",
  "statements": {
    "notForClinicalUse": "Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.",
    "notClinicallyReviewed": "No clinician has reviewed this content. Every item in this build is published as \"Educational use only. Not clinically reviewed\", the editorial board is empty and published as empty, and the status of every item is listed at https://opensimlab.com/review-status.",
    "notCertification": "Using or completing a scenario in this release, and any record it produces, does not certify competence, satisfy a supervised or external assessment, or authorize clinical work. What Open Sim Lab provides is preparation only.",
    "noAccountRequired": "Evaluating, installing and using this release needs no account, contact or sign-in. Every record named here is a public file in the repository or the build."
  },
  "catalog": [
    {
      "moduleId": "anesthesia",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 39,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "emergency-medicine",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 25,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "critical-care",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 24,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "cardiology",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 17,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "respiratory-medicine",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 15,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "pediatrics",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 16,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "neurology",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 15,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "toxicology",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 15,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "obstetrics",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 15,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "neonatology",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 11,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "endocrine-metabolic",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 12,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "renal-electrolyte",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 12,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "infectious-disease",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 10,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "medical-surgical-nursing",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 9,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "oncology",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 11,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    },
    {
      "moduleId": "surgery-trauma",
      "capabilityVersion": "0.1.0-alpha.48",
      "scenarioCount": 10,
      "completionSchemaVersion": 1,
      "maturitySchemaVersion": 1
    }
  ],
  "reviewedCoverage": {
    "region": null,
    "totalScenarios": 256,
    "reviewed": 0,
    "excluded": 256,
    "byStatus": {
      "draft": 0,
      "preview": 256,
      "source_checked": 0,
      "clinically_reviewed": 0,
      "institution_endorsed": 0,
      "withdrawn": 0
    },
    "overdue": 0,
    "withdrawn": 0
  },
  "excluded": [
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-induction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "rapid-desaturation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "hypotension-after-induction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "bronchospasm",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "unexpected-intraoperative-hemorrhage",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "rapid-sequence-induction",
      "contentVersion": "0.2.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "awareness-under-paralysis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "laryngospasm-after-airway-stimulation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-pediatric-iv-induction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "difficult-airway-supraglottic-rescue",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "local-anesthetic-systemic-toxicity",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "persistent-vf-cardiac-arrest",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "high-spinal-after-epidural-top-up",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "venous-air-embolism-during-line-removal",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "repeated-laryngoscopy-harm",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "capnography-sampling-line-obstruction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "dilutional-coagulopathy",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "arterial-pressure-transducer-artifact",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "circle-system-rebreathing",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-inhalational-maintenance",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "blood-bank-handoff",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-geriatric-induction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "quantitative-neuromuscular-reversal",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-pediatric-inhalational-induction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "obstetric-general-anesthesia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "preeclampsia-urgent-delivery",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "pneumothorax-under-positive-pressure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "aspiration-risk-recognition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "emergence-with-residual-blockade",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "delayed-emergence-differential",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "extubation-readiness",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "post-extubation-obstruction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "opioid-induced-ventilatory-impairment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "hypothermia-and-rewarming",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "perioperative-hyperglycemia",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "pacemaker-and-cautery-planning",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "postoperative-handoff",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "undifferentiated-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "septic-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "hemorrhagic-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "obstructive-shock-tension-pneumothorax",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "cardiac-tamponade",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "anaphylaxis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "adult-asthma",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "copd-exacerbation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "acute-pulmonary-edema",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "pulmonary-embolism-deterioration",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "stemi",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "unstable-narrow-complex-tachycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "unstable-bradycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "persistent-vf-arrest",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "pea-arrest",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "status-epilepticus",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "acute-ischemic-stroke",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "intracranial-hemorrhage-deterioration",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "diabetic-ketoacidosis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "hyperkalemia-with-ecg-change",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "severe-hyponatremia-with-seizure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "opioid-toxicity",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "exertional-heat-stroke",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "trauma-primary-survey",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "emergency-medicine",
      "scenarioId": "acute-aortic-syndrome",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "ards-lung-protective-ventilation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "escalating-hypoxemia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "ventilator-dyssynchrony",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "auto-peep",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "mucus-plugging",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "unplanned-extubation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "spontaneous-breathing-trial",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "post-intubation-hypotension",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "cardiogenic-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "mixed-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "right-ventricular-failure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "massive-pulmonary-embolism",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "upper-gi-hemorrhage",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "status-epilepticus",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "targeted-temperature-management",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "intracranial-hypertension",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "acute-kidney-injury-with-fluid-overload",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "severe-acidemia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "icu-handoff-with-hidden-deterioration",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "ventilator-circuit-disconnection",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "delayed-vasopressor-delivery",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "pulse-oximeter-motion-artifact",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "endotracheal-tube-migration-after-repositioning",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "critical-care",
      "scenarioId": "septic-shock-resuscitation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "stable-chest-pain-evaluation",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "stemi-recognition-and-first-actions",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "nstemi-risk-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "acute-decompensated-heart-failure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "post-infarction-cardiogenic-shock-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "atrial-fibrillation-with-rapid-response",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "regular-narrow-complex-tachycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "wide-complex-tachycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "symptomatic-sinus-bradycardia-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "complete-heart-block",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "torsades-de-pointes",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "hyperkalemic-conduction-disturbance",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "pericardial-tamponade",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "right-ventricular-infarction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "hypertensive-emergency",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "pacemaker-capture-failure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "cardiology",
      "scenarioId": "transcutaneous-pacing-mechanical-capture-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "acute-severe-asthma",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "copd-exacerbation-transition-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "community-acquired-pneumonia-hypoxemia-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "post-pulmonary-embolism-persistent-dyspnea",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "acute-pulmonary-edema-respiratory-support-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "spontaneous-tension-pneumothorax-post-drainage-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "large-unilateral-pleural-effusion-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "bronchiectasis-mucus-plugging-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "chronic-opioid-related-hypoventilation-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "neuromuscular-respiratory-failure-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "obesity-hypoventilation-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "noninvasive-ventilation-selection",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "high-flow-nasal-oxygen-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "oxygen-device-failure",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "respiratory-medicine",
      "scenarioId": "acute-tracheostomy-obstruction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-respiratory-distress",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "bronchiolitis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "croup",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-status-asthmaticus",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-sepsis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-septic-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-dehydration-with-hypovolemia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-diabetic-ketoacidosis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-hypoglycemic-seizure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-febrile-seizure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-status-epilepticus",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-anaphylaxis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-supraventricular-tachycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-bradycardic-arrest",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-foreign-body-airway-obstruction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "pediatrics",
      "scenarioId": "pediatric-injury-safeguarding-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "minor-nondisabling-acute-ischemic-stroke",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "basilar-artery-occlusion-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "spontaneous-cerebellar-intracerebral-hemorrhage",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "aneurysmal-subarachnoid-hemorrhage-deterioration",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "focal-motor-status-epilepticus-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "nonconvulsive-status-epilepticus-recognition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "myasthenic-crisis-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "guillain-barre-respiratory-decline",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "acute-bacterial-meningitis-first-hour",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "suspected-herpes-simplex-encephalitis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "raised-intracranial-pressure-visual-threat",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "acute-transtentorial-herniation-pattern",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "metastatic-spinal-cord-compression",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "acute-delirium-reversible-causes",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neurology",
      "scenarioId": "autonomic-dysreflexia-authored-trigger",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "methemoglobinemia-saturation-gap",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "carbon-monoxide-reassuring-monitor",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "acetaminophen-clock-and-nomogram",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "salicylate-falling-number",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "tricyclic-sodium-channel-cardiotoxicity",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "beta-blocker-cardiogenic-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "calcium-channel-blocker-shock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "digoxin-rhythm-potassium",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "cholinergic-pesticide-respiratory-failure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "anticholinergic-hyperthermia-delirium",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "serotonin-toxicity-hyperthermia-clonus",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "sympathomimetic-hyperadrenergic-hyperthermia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "methanol-visual-acidosis-gaps",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "delayed-local-anesthetic-cns-cardiac-toxicity",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "toxicology",
      "scenarioId": "opioid-xylazine-persistent-sedation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "postpartum-hemorrhage-uterine-atony",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "maternal-sepsis-postpartum-deterioration",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "concealed-placental-abruption-hemorrhage",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "postpartum-severe-preeclampsia-warning-signs",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "eclampsia-first-seizure-response",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "suspected-amniotic-fluid-embolism-pattern",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "maternal-cardiac-arrest-coordinated-response",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "shoulder-dystocia-cognitive-sequence",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "umbilical-cord-prolapse-urgent-birth-coordination",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "suspected-uterine-rupture-recognition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "magnesium-sulfate-toxicity-recognition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "high-neuraxial-block-obstetric-coordination",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "failed-obstetric-intubation-oxygenation-first",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "maternal-to-neonatal-resuscitation-handoff",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "obstetrics",
      "scenarioId": "oxytocin-associated-uterine-tachysystole",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "term-newborn-transition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "neonatal-apnea",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "ineffective-ventilation-correction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "neonatal-bradycardia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "meconium-stained-transition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "preterm-respiratory-distress",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "neonatal-hypoglycemia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "neonatal-sepsis",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "thermoregulation-failure",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "delivery-room-to-nicu-handoff",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "neonatology",
      "scenarioId": "neonatal-tension-pneumothorax",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "dka-resolution-transition",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hhs-osmolality-trajectory",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "severe-hypoglycemia-recurrence",
      "contentVersion": "0.1.3",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "adrenal-crisis-treatment-before-tests",
      "contentVersion": "0.1.2",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "thyroid-storm-hemodynamic-risk",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "myxedema-coma-ventilation-and-steroid-sequence",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hypercalcemic-crisis-volume-and-bridge",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hypocalcemic-tetany-rescue-and-recurrence",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hyponatremia-aquaresis-and-overcorrection",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hypernatremic-dehydration-avp-deficiency",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "refeeding-electrolyte-shift",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "perioperative-diabetes-insulin-continuity",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hyperkalemia-cardioprotection-and-rebound",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypokalemia-magnesium-and-ongoing-losses",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hyponatremia-symptoms-and-reassessment",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypernatremia-water-access-and-losses",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypocalcemia-ionized-calcium-and-ckd",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypermagnesemia-antagonism-and-removal",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypomagnesemia-refractory-potassium-and-the-normal-number",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "contrast-attribution-a-label-that-stopped-the-search",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "rhabdomyolysis-a-number-that-does-not-carry-the-risk",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "estimated-filtration-a-number-she-was-never-measured-by",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "phosphate-target-a-surrogate-that-moved-the-wrong-way",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "proteinuria-a-ratio-that-doubled-and-a-patient-who-did-not",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "meningococcal-sepsis-recognition-and-escalation",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "obstructed-infected-kidney-decompression",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "febrile-neutropenia-blind-examination",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "necrotizing-infection-score-cannot-exclude",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "endocarditis-mechanical-failure-on-a-surgical-clock",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "severe-pneumonia-the-score-answered-another-question",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "toxic-shock-a-definition-that-cannot-close",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "possible-sepsis-a-clock-that-runs-either-way",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "septic-shock-a-label-the-treatment-creates",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "meningitis-imaging-a-rule-that-does-not-agree",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "low-score-what-the-threshold-does-not-exclude",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "counted-rate-a-number-nobody-counted",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "paired-reading-a-number-wrong-in-one-direction",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "afferent-limb-a-threshold-met-and-a-call-not-made",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "quiet-patient-a-screen-that-was-never-done",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "proxy-scale-a-number-without-a-standard",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "last-known-well-a-time-nobody-can-supply",
      "contentVersion": "0.1.1",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "oxygen-target-scale-a-score-that-should-be-lower",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "lost-contingency-a-plan-that-was-not-said",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "delayed-immune-event-a-drug-that-stopped-months-ago",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "incidental-clot-a-decision-the-evidence-cannot-make",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "normal-test-toxicity-the-dose-in-his-bag",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "prognosis-question-a-number-he-asked-for",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "laboratory-tls-a-syndrome-he-does-not-have-yet",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "rare-early-myocarditis-a-base-rate-is-not-a-threshold",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "lowering-the-count-a-number-that-can-be-moved",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "inherited-urgency-an-emergency-that-mostly-is-not-one",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "trial-rule-a-rule-written-for-a-database",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "silent-interaction-a-harm-with-nothing-to-find",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "oncology",
      "scenarioId": "easy-label-a-label-that-fits-too-easily",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "negative-scan-a-scan-that-cannot-say-no",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "rising-requirement-a-number-that-under-calls",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unfinished-survey-a-patient-who-cannot-be-asked",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "transient-response-a-patient-who-will-not-stay-up",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "quiet-chest-an-injury-whose-severity-is-not-yet-visible",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unowned-delay-a-wait-that-nobody-decided",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "third-attendance-a-question-two-people-have-already-answered",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "deferred-step-a-decision-attached-to-a-person",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "known-label-an-explanation-that-excludes-nothing",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unspoken-doubt-an-interval-nobody-else-can-see",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    }
  ],
  "dependencies": [
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "hysteresis-and-effect-site-lag",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "preoxygenation-and-safe-apnea-time",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "hypnotic-opioid-synergy",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "vasodilation-versus-hypovolemia",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "capnogram-morphology",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "airway-assessment-predicts-poorly",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "depth-monitoring-and-its-limits",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "train-of-four-and-residual-blockade",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "malignant-hyperthermia-early-pattern",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "explanation",
      "subjectId": "aspiration-risk-is-more-than-fasting-time",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "drug-card",
      "subjectId": "propofol",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "drug-card",
      "subjectId": "remifentanil",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "drug-card",
      "subjectId": "rocuronium",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "practice-region",
      "subjectId": "US",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    },
    {
      "moduleId": "anesthesia",
      "subjectKind": "practice-region",
      "subjectId": "GB",
      "contentVersion": "0.1.0",
      "status": "preview",
      "reason": "preview",
      "detail": "Its status is \"Educational use only. Not clinically reviewed\". Only current clinically reviewed or institution-endorsed content counts toward reviewed coverage."
    }
  ],
  "scenarios": [
    {
      "moduleId": "anesthesia",
      "scenarioId": "routine-induction",
      "title": "Routine induction of general anaesthesia",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "ASA Standards for Basic Anesthetic Monitoring",
        "Benumof JL, Dagg R, Benumof R. Anesthesiology 1997;87:979-82 (PMID 9357902)",
        "2022 ASA Practice Guidelines for Management of the Difficult Airway (PMID 34762729)"
      ],
      "limitationIds": [
        "no-coagulopathy",
        "acid-base-approximate",
        "bolus-injection-is-instantaneous",
        "no-regional-anaesthesia",
        "fresh-gas-flow-is-a-teaching-model",
        "no-neuromuscular-blockade",
        "interaction-coefficient-calibrated",
        "parameters-unverified"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "rapid-desaturation",
      "title": "Rapid desaturation in the obese patient",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Benumof JL, Dagg R, Benumof R. Anesthesiology 1997;87:979-82 (PMID 9357902)",
        "2022 ASA Practice Guidelines for Management of the Difficult Airway (PMID 34762729)",
        "ASA Standards for Basic Anesthetic Monitoring"
      ],
      "limitationIds": [
        "no-shunt-or-dead-space-dynamics",
        "peep-not-modelled",
        "hypoxic-collapse-is-a-teaching-model",
        "no-resuscitation",
        "bolus-injection-is-instantaneous"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "anesthesia",
      "scenarioId": "hypotension-after-induction",
      "title": "Hypotension after induction",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Salmasi V, et al. Anesthesiology 2017;126:47-65",
        "Walsh M, et al. Anesthesiology 2013;119:507-15",
        "ASA Standards for Basic Anesthetic Monitoring"
      ],
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    },
    {
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      ],
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        "Mutschler M, et al. Injury 2014;45 Suppl 3:S35-8",
        "AABB Circular of Information for the Use of Human Blood and Blood Components, June 2024",
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      ],
      "inReviewedCoverage": false,
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        "ASA Standards for Basic Anesthetic Monitoring"
      ],
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        "Nimmo AF, et al. Guidelines for the safe practice of total intravenous anaesthesia. Anaesthesia 2019;74:211-24",
        "2023 ASA Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade"
      ],
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      ],
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        "Visvanathan T, et al. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care 2005;14:e3. PMID 15933300"
      ],
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    },
    {
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      ],
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        "Harper NJN, et al. Management and outcomes of perioperative anaphylaxis. Br J Anaesth 2018;121:172-88. PMID 29935569",
        "Resuscitation Council UK. Emergency treatment of peri-operative anaphylaxis. Anaesthesia 2024;79:535-41. PMID 38205901"
      ],
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      ],
      "inReviewedCoverage": false,
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        "Malignant Hyperthermia Association of the United States. Managing a Crisis. Current web protocol consulted 2026-08-23.",
        "Glahn KPE, et al. Recognition and management of a malignant hyperthermia crisis: updated 2024 guideline from the European Malignant Hyperthermia Group. Br J Anaesth 2025;134:221-3. PMID 39482150",
        "Hopkins PM, et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia 2021;76:655-64. PMID 33399225",
        "Larach MG, et al. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg 2010;110:498-507. PMID 20081135"
      ],
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        "oxyhaemoglobin-curve-is-fixed",
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        "malignant-hyperthermia-initial-response-only",
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        "no-team-or-communication"
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      "inReviewedCoverage": false,
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        "Absalom A, et al. Accuracy of the Paedfusor in children undergoing cardiac surgery or catheterization. Br J Anaesth 2003;91:507-13. PMID 14504151",
        "Videira RL, et al. Preoxygenation in children: for how long? Acta Anaesthesiol Scand 1992;36:109-11. PMID 1549927",
        "Thorsteinsson A, et al. Functional residual capacity in anesthetized children: normal values and values in children with cardiac anomalies. Anesthesiology 1990;73:876-81. PMID 2240677",
        "Lindahl SG. Oxygen consumption and carbon dioxide elimination in infants and children during anaesthesia and surgery. Br J Anaesth 1989;62:70-6. PMID 2492815",
        "Numa AH, Newth CJL. Anatomic dead space in infants and children. J Appl Physiol 1996;80:1485-9. PMID 8727530",
        "Lindahl SG, et al. Ventilation and gas exchange during anaesthesia and surgery in spontaneously breathing infants and children. Br J Anaesth 1984;56:121-9. PMID 6419754",
        "US DailyMed propofol injectable emulsion prescribing information, current page consulted 2026-08-23."
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        "2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31-81. PMID 34762729",
        "Frerk C, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827-48. PMID 26556848"
      ],
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        "bolus-injection-is-instantaneous",
        "rocuronium-course-is-a-teaching-model",
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        "difficult-airway-failure-and-mask-ventilation-are-teaching-bounds",
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      "maturity": "preview",
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      ],
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        "Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med 2021;46:81-2. PMID 33148630"
      ],
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    },
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      "moduleId": "anesthesia",
      "scenarioId": "persistent-vf-cardiac-arrest",
      "title": "Persistent ventricular-fibrillation cardiac arrest",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
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        "US",
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      ],
      "inReviewedCoverage": false,
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        "American Heart Association. Adult Cardiac Arrest Algorithm. 2025 AHA Guidelines for CPR and ECC."
      ],
      "limitationIds": [
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        "cardiac-arrest-actions-are-screen-proxies",
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    },
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      "title": "High spinal after epidural top-up",
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      "maturity": "preview",
      "practiceRegions": [
        "US",
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      ],
      "inReviewedCoverage": false,
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        "Obstetric Anaesthetists’ Association. High central neuraxial block. Obstetric Quick Reference Handbook, section 2-7, version 1."
      ],
      "limitationIds": [
        "peep-not-modelled",
        "bolus-injection-is-instantaneous",
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    },
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      "title": "Venous air embolism during line removal",
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      "maturity": "preview",
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        "US",
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      ],
      "inReviewedCoverage": false,
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        "Association of Anaesthetists Quick Reference Handbook, June 2023, 3-5 Circulatory embolus v1.",
        "Hinkelbein et al. Cardiac arrest in the perioperative period: a consensus guideline. European Journal of Trauma and Emergency Surgery. 2023;49:2031–2046. PMID 37430174.",
        "McCarthy et al. Air Embolism: Diagnosis, Clinical Management and Outcomes. Diagnostics. 2017;7:5. PMID 28106717."
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    },
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      "title": "Known difficult airway: stop repeated attempts",
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      "maturity": "preview",
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        "US",
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      ],
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        "2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31-81. PMID 34762729",
        "Ahmad I, et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Br J Anaesth 2026;136:283-307. PMID 41203471"
      ],
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      "title": "Capnography sampling-line obstruction",
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        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
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        "Klein et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 2021;76:1212-23. PMID 34013531",
        "WFSA Minimum Capnometer Specifications 2021. Anesth Analg 2021;133:1132-7. PMID 34427566"
      ],
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    },
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      "title": "Dilutional coagulopathy during ongoing bleeding",
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      "maturity": "preview",
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        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "NICE NG24. Blood transfusion: fresh frozen plasma transfusion. Updated February 26, 2026.",
        "NHS Blood and Transplant. Fresh-Frozen Plasma Dosage poster. Version 1."
      ],
      "limitationIds": [
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    },
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      "title": "Arterial-pressure transducer artifact",
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      "maturity": "preview",
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        "Saugel B, et al. How to measure blood pressure using an arterial catheter: a systematic 5-step approach. Crit Care 2020;24:172. PMID 32331527.",
        "Gardner RM. Direct blood pressure measurement—dynamic response requirements. Anesthesiology 1981;54:227-36. PMID 7469106.",
        "American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring. Last amended October 15, 2025."
      ],
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      "maturity": "preview",
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      "inReviewedCoverage": false,
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        "Verbeke D, et al. When to replace a CO2 absorber? Acta Anaesthesiol Belg 2023;74:43-49. DOI 10.56126/74.1.06.",
        "Feldman JM. Replacing CO2 Absorbent During Surgery—The Risk of Hypoventilation Continues. APSF Newsletter 2024;39(3).",
        "Klein et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 2021;76:1212-23. PMID 34013531."
      ],
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        "bolus-injection-is-instantaneous",
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      ],
      "corrections": [],
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      "sources": [
        "Walsh J, Gittoes N, Selby P, Society for Endocrinology Clinical Committee. Emergency management of acute hypercalcaemia in adult patients. Endocrine Connections. 2016;5:G9–G11. doi:10.1530/EC-16-0055.",
        "El-Hajj Fuleihan G et al. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. 2023. Recommendations 1–3 and Tables 1–2. doi:10.1210/clinem/dgac621."
      ],
      "limitationIds": [
        "hypercalcemia-authored-bridge-states",
        "hypercalcemia-cardiorenal-and-treatment-limits",
        "hypercalcemia-hcm-and-handoff-boundaries"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hypocalcemic-tetany-rescue-and-recurrence",
      "title": "Hypocalcemic tetany: rescue now, prevent recurrence",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Turner J, Gittoes N, Selby P, Society for Endocrinology Clinical Committee. Emergency management of acute hypocalcaemia in adult patients. Endocrine Connections. 2016;5:G7-G8. doi:10.1530/EC-16-0056. Severe hypocalcemia, investigations, and underlying-cause treatment.",
        "Turner J, Gittoes N, Selby P. Emergency management of acute hypocalcaemia in adult patients: addendum. Endocrine Connections. 2019;8:X1. doi:10.1530/EC-16-0056a. Calcium-preparation equivalence and safety.",
        "Bollerslev J et al. Revised European Society of Endocrinology Clinical Practice Guideline: Treatment of Chronic Hypoparathyroidism in Adults. 2025;193:G83-G112. doi:10.1093/ejendo/lvaf222. Recommendations R.1.1, R.2.5, R.3.3 and R.3.8; acute emergency discussion in section 5.3.",
        "Iliff HA et al. Management of haematoma after thyroid surgery: multidisciplinary DAS, BAETS and ENT-UK consensus guidelines. Anaesthesia. 2022;77:82-95; published online 2021. doi:10.1111/anae.15585. Recognition and escalation of postoperative airway risk."
      ],
      "limitationIds": [
        "hypocalcemia-authored-response-and-recurrence",
        "hypocalcemia-qualified-care-and-cause-limits",
        "hypocalcemia-postoperative-airway-and-handoff"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hyponatremia-aquaresis-and-overcorrection",
      "title": "Hyponatremia after rescue: keep correction controlled",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Society for Endocrinology. Emergency management of severe and moderately severely symptomatic hyponatraemia in adult patients. Revised 2022, pp. 3–5: treatment, surveillance, aquaresis, and overcorrection. https://www.endocrinology.org/media/xhrhxhxm/emergency-management-of-severe-and-moderately-severely-symptomatic-hyponatraemia-in-adult-patients-2022.pdf",
        "Sterns RH et al. Treatment Guidelines for Hyponatremia: Stay the Course. Clinical Journal of the American Society of Nephrology. 2024;19:129–135. doi:10.2215/CJN.0000000000000244. pp. 131–133: reaffirmed high-risk correction limits, risk factors, and relowering considerations; not a newly issued guideline.",
        "Spasovski G et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. European Journal of Endocrinology. 2014;170:G1–G47. doi:10.1530/EJE-13-1020. Sections 7.1, 7.4.4 and 7.5: surveillance, potassium contribution, and overcorrection rescue."
      ],
      "limitationIds": [
        "hyponatremia-correction-authored-checkpoints",
        "hyponatremia-correction-high-risk-window",
        "hyponatremia-correction-qualified-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "hypernatremic-dehydration-avp-deficiency",
      "title": "Hypernatremic dehydration: circulation, then water balance",
      "contentVersion": "0.1.1",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Baldeweg SE et al. Society for Endocrinology Clinical Guidance: Inpatient management of cranial diabetes insipidus. Endocrine Connections. 2018;7:G8–G11. doi:10.1530/EC-18-0154. Decompensated CDI sections §§1–6: circulation, fluid replacement, reassessment, desmopressin, and continuing specialist care. Current issuing-body AVP-D page retains this guidance; authored checkpoints are not clinical intervals.",
        "Tomkins M et al. Diagnosis and Management of Central Diabetes Insipidus in Adults. Journal of Clinical Endocrinology & Metabolism. 2022;107:2701–2715. doi:10.1210/clinem/dgac381. Management of chronic CDI and inpatient/perioperative care: medication omission, water access, and coordinated care; review article, not a new guideline."
      ],
      "limitationIds": [
        "avp-deficiency-authored-checkpoints",
        "avp-deficiency-known-diagnosis",
        "avp-deficiency-qualified-water-plan"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.1"
      }
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "refeeding-electrolyte-shift",
      "title": "After nutrition restarts: weakness and falling electrolytes",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "da Silva JSV et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutrition in Clinical Practice. 2020;35:178–195. doi:10.1002/ncp.10474. Table 6 and treatment discussion: coordinated electrolyte, vitamin, nutrition, and monitoring care. Erratum doi:10.1002/ncp.10491 corrects risk tables. Authored responses are not guideline predictions.",
        "Matthews-Rensch K et al. The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome. Nutrition & Dietetics. 2025. doi:10.1111/1747-0080.70003. Sections 3.5.1–3.5.4 and 3.6–3.7 distinguish nutrition risk, established electrolyte deterioration, individualized advancement, supplementation, and surveillance; no universal feeding rate is taught."
      ],
      "limitationIds": [
        "refeeding-authored-contrasts",
        "refeeding-individualized-nutrition",
        "refeeding-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "endocrine-metabolic",
      "scenarioId": "perioperative-diabetes-insulin-continuity",
      "title": "Surgery delayed: protect insulin continuity",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "American Diabetes Association Professional Practice Committee. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S339–S355. doi:10.2337/dc26-S016. Type 1 Diabetes and Perioperative Care: basal coverage while fasting, individualized device and medication plans, and point-of-care monitoring. No dose schedule is reproduced.",
        "Levy NA, El-Boghdadly K, Lobo DN, et al. Peri-operative management of diabetes mellitus: a multidisciplinary consensus statement from the Association of Anaesthetists and the Joint British Diabetes Societies for Inpatient Care group. Anaesthesia. 2026;81(8):1116–1131. doi:10.1111/anae.70181. Table 3, Box 1, and postoperative handover sections: prompt alternative insulin after delivery disruption, device suitability, and continuing-care ownership. Authored clocks are not clinical kinetics."
      ],
      "limitationIds": [
        "perioperative-diabetes-authored-contrasts",
        "perioperative-diabetes-individualized-care",
        "perioperative-diabetes-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hyperkalemia-cardioprotection-and-rebound",
      "title": "Hyperkalemia: protection is not removal",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "UK Kidney Association. Clinical Practice Guideline: Management of Hyperkalaemia in Adults. December 2023. Sections 16–17 and 19: calcium, shifting, elimination, serial potassium and glucose surveillance, and individualized renal or critical-care decisions. No dose or universal schedule is reproduced.",
        "Lindner G, Burdmann EA, Clase CM, et al. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. European Journal of Emergency Medicine. 2020;27:329–337. doi:10.1097/MEJ.0000000000000691. Temporary calcium benefit, shifting without total-body removal, and rebound surveillance; a conference report, not a newly issued guideline.",
        "Resuscitation Council UK. 2025 Resuscitation Guidelines: Special circumstances, Hyperkalaemia. Qualified calcium for severe hyperkalemia with ECG changes, insulin-glucose shifting, elimination, and individualized dialysis consideration for refractory severe hyperkalemia. This lesson concerns a perfusing adult, not cardiac arrest."
      ],
      "limitationIds": [
        "renal-hyperkalemia-authored-contrasts",
        "renal-hyperkalemia-individualized-care",
        "renal-hyperkalemia-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypokalemia-magnesium-and-ongoing-losses",
      "title": "Severe hypokalemia: magnesium and ongoing losses",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "NHS Specialist Pharmacy Service. Hypokalaemia. 2024. https://sps.nhs.uk/articles/hypokalaemia/ Qualified assessment, individualized replacement, monitoring, and underlying-cause review; no dosing table is reproduced.",
        "NHS Specialist Pharmacy Service. Treating acute hypomagnesaemia in adults. 2024. https://sps.nhs.uk/articles/treating-acute-hypomagnesaemia-in-adults/ Concurrent electrolyte assessment, individualized magnesium treatment, and monitoring; no dose, route, or rate is selected by this lesson.",
        "Resuscitation Council UK. 2025 Resuscitation Guidelines: Special circumstances, Hypokalaemia. Severe hypokalemia, ECG change, replacement, magnesium, and continued monitoring. This lesson concerns an awake perfusing adult, not cardiac arrest.",
        "Krogager ML et al. Update on management of hypokalaemia and goals for the lower potassium level in patients with cardiovascular disease: a review in collaboration with the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. 2021. doi:10.1093/ehjcvp/pvab038. Potassium, magnesium, contributors, and reassessment; a collaborative review, not a universal replacement target."
      ],
      "limitationIds": [
        "renal-hypokalemia-authored-contrasts",
        "renal-hypokalemia-individualized-care",
        "renal-hypokalemia-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hyponatremia-symptoms-and-reassessment",
      "title": "Hyponatremia: sodium rises, symptoms persist",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Society for Endocrinology. Emergency management of severe and moderately severely symptomatic hyponatraemia in adult patients. Revised 2022, pp. 3–4 and Figure 2. Selected symptom-led early treatment and persistent-symptom reassessment pathway; no dose or universal regional protocol is reproduced.",
        "Spasovski G et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. European Journal of Endocrinology. 2014;170:G1–G47. doi:10.1530/EJE-13-1020. Sections 6.3 and 7.2: paired serum and urine interpretation, diuretic-related diagnostic caution, and moderately severe symptoms. Its treatment target differs from the selected Society for Endocrinology 2022 path; neither is presented as a universal regional rule.",
        "Sterns RH et al. Treatment Guidelines for Hyponatremia: Stay the Course. Clinical Journal of the American Society of Nephrology. 2024;19:129–135. doi:10.2215/CJN.0000000000000244. Correction-risk review and continuing surveillance; a review of prior recommendations, not a newly issued guideline."
      ],
      "limitationIds": [
        "renal-hyponatremia-authored-contrasts",
        "renal-hyponatremia-persistent-symptoms",
        "renal-hyponatremia-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypernatremia-water-access-and-losses",
      "title": "Hypernatremia: water access and ongoing losses",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Yun G, Baek SH, Kim S. Evaluation and management of hypernatremia in adults: clinical perspectives. Korean Journal of Internal Medicine. 2023;38:290–302. doi:10.3904/kjim.2022.346. Review of volume status, water access, continuing losses, duration uncertainty, and individualized replacement; authored values are not a validated prediction model.",
        "National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. CG174. Published 2013, updated May 5, 2017. Sections 1.1, 1.2, and 1.5: assessment, resuscitation, replacement, and reassessment. No universal fluid product, volume, or rate is selected here.",
        "NHS Ayrshire and Arran. Management of Hypernatraemia. Reviewed January 2026, updated May 2026. Local adult hypernatremia assessment and replacement guidance; not a universal regional correction-rate rule.",
        "Chacon-Palma G, Teixeira JP, Litvinovich I, et al. Relationship between Rate of Hypernatremia Correction and Outcomes in Hospitalized Patients. Kidney360. 2025;6(8):1305–1316. doi:10.34067/KID.0000000785. Retrospective observational evidence, not a guideline; associations do not establish an optimal correction rate or validate this authored response trajectory."
      ],
      "limitationIds": [
        "renal-hypernatremia-authored-contrasts",
        "renal-hypernatremia-individualized-care",
        "renal-hypernatremia-observed-findings"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypocalcemia-ionized-calcium-and-ckd",
      "title": "Hypocalcemia: ionized calcium and kidney disease",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Gauci C, Moranne O, Fouqueray B, et al. Pitfalls of measuring total blood calcium in patients with CKD. Journal of the American Society of Nephrology. 2008;19:1592–1598. doi:10.1681/ASN.2007040449. Observational evidence about total, albumin-adjusted, and ionized calcium in kidney disease; no correction formula or authored trajectory is validated here.",
        "Society for Endocrinology. Emergency management of acute hypocalcaemia in adult patients. Endocrine Connections. 2016;5:G7–G8. doi:10.1530/EC-16-0056. Qualified monitored emergency treatment, reassessment, and cause-specific continuing care; no calcium dose or rate is selected here.",
        "Society for Endocrinology. Addendum: Emergency management of acute hypocalcaemia in adult patients. Endocrine Connections. 2019. doi:10.1530/EC-16-0056a. Updated preparation guidance does not make this dose-free simulation a prescribing tool.",
        "U.S. Food and Drug Administration. Boxed Warning for severe hypocalcemia in patients with advanced chronic kidney disease taking Prolia (denosumab). January 19, 2024. Advanced kidney disease, mineral-bone disorder review, specialist involvement, and post-dose monitoring; an association does not prove the sole cause in this fictional patient.",
        "DailyMed. Prolia (denosumab) injection prescribing information. Revised June 2026; checked August 27, 2026. Advanced kidney disease, calcium and activated-vitamin-D support, and monitoring require qualified individualized care. No dose, treatment duration, or future denosumab decision is simulated."
      ],
      "limitationIds": [
        "renal-hypocalcemia-measurement",
        "renal-hypocalcemia-authored-contrasts",
        "renal-hypocalcemia-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypermagnesemia-antagonism-and-removal",
      "title": "Hypermagnesemia: antagonism and removal",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Nishikawa M, et al. The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis. Acute Medicine & Surgery. 2018;5:222–229. doi:10.1002/ams2.334. A 15-patient primary series supports the clinical distinction between toxicity and qualified removal; it is not a treatment protocol or validation of this authored trajectory.",
        "Bansal AD, Negoianu D, Warburton KM. An Unusual yet “Mg”nificent Indication for Hemodialysis. Seminars in Dialysis. 2016;29:247–250. doi:10.1111/sdi.12479. A single Renacidin-associated case, not an oral magnesium protocol; it does not validate the authored calcium-effect duration.",
        "Jou DH, et al. Fatal hypermagnesemia in patients taking magnesium hydroxide. Electrolyte & Blood Pressure. 2023;21:66–71. doi:10.5049/EBP.2023.21.2.66. Two oral magnesium hydroxide cases support exposure and gastrointestinal-context review, not a predicted response curve or universal threshold.",
        "DailyMed. Hospira magnesium sulfate in 5% dextrose injection prescribing information. Revised June 2026; updated August 24, 2026; checked August 27, 2026. Respiratory assessment, calcium antagonism, and renal risk inform safety boundaries; this intravenous-product label is not an oral-toxicity treatment protocol."
      ],
      "limitationIds": [
        "renal-hypermagnesemia-antagonism",
        "renal-hypermagnesemia-authored-contrasts",
        "renal-hypermagnesemia-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "hypomagnesemia-refractory-potassium-and-the-normal-number",
      "title": "Hypomagnesemia: a potassium that will not rise, and a number inside the range",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. Journal of the American Society of Nephrology. 2007;18:2649–2652. doi:10.1681/ASN.2007070792. A mechanistic review of distal potassium secretion, not a trial; its own abstract states that magnesium deficiency alone does not necessarily cause hypokalemia, which is why this lesson keeps the causal claim bounded and prescribes nothing.",
        "Micke O, Vormann J, Kraus A, Kisters K. Serum magnesium: time for a standardized and evidence-based reference range. Magnesium Research. 2021;34:84–89. doi:10.1684/mrh.2021.0486. Supports only the weaker claim used here — an in-range value does not rule out deficiency. Its central proposal, to raise the lower reference limit to 0.85 mmol/L, comes from officers of a magnesium research society with a manufacturer-affiliated author, is contested, and is not adopted.",
        "Okamoto N, Onishi S, Manabe T, Satoh S, Nara S. Vonoprazan-associated hypomagnesemia presenting to the emergency department with altered mental status and a suspected seizure. American Journal of Emergency Medicine. 2026;101:131–134. doi:10.1016/j.ajem.2025.12.034. One retrospectively reported patient. It establishes no threshold, repletion protocol, expected time course, or attribution rule; only the clinical shape is taken."
      ],
      "limitationIds": [
        "renal-hypomagnesemia-repletion",
        "renal-hypomagnesemia-authored-contrasts",
        "renal-hypomagnesemia-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "contrast-attribution-a-label-that-stopped-the-search",
      "title": "A label that stopped the search: attributing a rising creatinine to contrast",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Davenport MS, Perazella MA, Yee J, Dillman JR, et al. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology. 2020;294:660–668. doi:10.1148/radiol.2019192094. A consensus statement rather than a trial. It says the risk has been overstated because historic studies lacked adequate control groups; it does not claim contrast-induced injury never occurs, it retains a small group at genuine risk, and the record lists six published comments on it.",
        "Hinson JS, Ehmann MR, Fine DM, Fishman EK, et al. Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Annals of Emergency Medicine. 2017;69:577–586.e4. doi:10.1016/j.annemergmed.2016.11.021. Single-centre and retrospective. Clinicians chose who received contrast and could see the patient, so the sickest are the least likely to have received it; propensity matching narrows that confounding rather than removing it. Evidence against a strong causal claim, not proof of no effect.",
        "Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING). The Lancet. 2017;389:1312–1322. doi:10.1016/S0140-6736(17)30057-0. Single-centre, open-label, elective procedures only, and it excluded an eGFR below 30 and previous dialysis, so it says nothing about the highest-risk patients. Non-inferiority is not equivalence, and the record lists eleven published comments."
      ],
      "limitationIds": [
        "renal-contrast-attribution-bounds",
        "renal-contrast-authored-contrasts",
        "renal-contrast-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "rhabdomyolysis-a-number-that-does-not-carry-the-risk",
      "title": "Rhabdomyolysis: a number that does not carry the risk",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Internal Medicine. 2013;173:1821–1828. doi:10.1001/jamainternmed.2013.9774. Retrospective, two teaching hospitals in one city, restricted to a creatine kinase above 5,000 U/L within three days, so it says nothing about anyone below that. A C statistic of 0.82–0.83 is discrimination within the cohorts it was built and checked in, not a prediction for an individual, and the record lists two published comments on it.",
        "Sawhney JS, Kasotakis G, Goldenberg A, Abramson S, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. The American Journal of Surgery. 2022;224:196–204. doi:10.1016/j.amjsurg.2021.11.022. The authors rate the quality of evidence very low, note that the vast majority of the literature is retrospective, and open by saying the treatment remains controversial. Absence of demonstrated benefit is not demonstrated absence of benefit, and that cuts against confidence in either direction.",
        "Oh RC, Arter JL, Tiglao SM, Larson SL. Exertional rhabdomyolysis: a case series of 30 hospitalized patients. Military Medicine. 2015;180:201–207. doi:10.7205/MILMED-D-14-00274. Thirty retrospective cases from a military population with trauma, toxin and heat illness excluded, so it generalises to almost nobody. The inverse correlation it reports between creatinine and creatine kinase is one finding in one small series and is not offered here as a rule."
      ],
      "limitationIds": [
        "renal-rhabdomyolysis-number-bounds",
        "renal-rhabdomyolysis-authored-contrasts",
        "renal-rhabdomyolysis-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "estimated-filtration-a-number-she-was-never-measured-by",
      "title": "Estimated filtration: a number she was never measured by",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Inker LA, Eneanya ND, Coresh J, Tighiouart H, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. The New England Journal of Medicine. 2021;385:1737–1749. doi:10.1056/NEJMoa2102953. The accuracy quoted here is a population statistic: 85% within 30% of measured also means up to one value in seven falls outside even that band, and median biases of a few mL/min/1.73 m² in either direction are reported. Accuracy in development and validation cohorts is not a guarantee for an individual.",
        "Iversen E, Bengaard AK, Leegaard Andersen A, Tavenier J, et al. Performance of panel-estimated GFR among hospitalized older adults. American Journal of Kidney Diseases. 2023;82:715–724. doi:10.1053/j.ajkd.2023.05.004. One hundred and six patients at a single Danish hospital, a substudy of a trial rather than a designed accuracy study. The authors state that only White patients were included and that only a subset underwent GFR measurement, so the small biases it reports come from a narrow sample.",
        "Ibe Y, Ishigo T, Aigami T, Fujii S, et al. Effect of discrepancy in estimated renal function on vancomycin area under the blood concentration-time curve. International Journal of Clinical Pharmacy. 2025;47:1458–1466. doi:10.1007/s11096-025-01960-w. Retrospective, one cohort, one drug, and association rather than causation: the patients whose estimates disagreed were also older and longer in hospital, which are the same features that make both markers harder to interpret. It does not establish that either marker is correct."
      ],
      "limitationIds": [
        "renal-estimate-precision-bounds",
        "renal-estimate-authored-contrasts",
        "renal-estimate-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "phosphate-target-a-surrogate-that-moved-the-wrong-way",
      "title": "A phosphate target: the surrogate that moved the wrong way",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Block GA, Wheeler DC, Persky MS, Kestenbaum B, et al. Effects of phosphate binders in moderate CKD. Journal of the American Society of Nephrology. 2012;23:1407–1415. doi:10.1681/ASN.2012030223. One hundred and forty-eight patients over nine months, with the phosphorus change as the primary endpoint and the calcification findings secondary at p values of 0.05 and 0.03. The authors conclude that the safety and efficacy of phosphate binders in CKD remain uncertain, which is the claim used here — not that binders are harmful.",
        "Malberti F. Hyperphosphataemia: treatment options. Drugs. 2013;73:673–688. doi:10.1007/s40265-013-0054-y. A narrative review by a single author, published in 2013, so its comparative reading predates later agents and trials. It is used only for the claim that the comparison between binder classes has not been settled for patient-level outcomes and that the choice should be individualised.",
        "Shimada M, Shutto-Uchita Y, Yamabe H. Lack of awareness of dietary sources of phosphorus is a clinical concern. In Vivo. 2019;33:11–16. doi:10.21873/invivo.11432. A short awareness review rather than a trial: it demonstrates no outcome from education, and its own opening claim that hyperphosphatemia is associated with mortality and cardiovascular events is exactly the associative reasoning this lesson asks a learner to hold at arm’s length."
      ],
      "limitationIds": [
        "renal-phosphate-surrogate-bounds",
        "renal-phosphate-authored-contrasts",
        "renal-phosphate-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "renal-electrolyte",
      "scenarioId": "proteinuria-a-ratio-that-doubled-and-a-patient-who-did-not",
      "title": "Proteinuria: a ratio that nearly doubled, and a patient who did not change",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Waikar SS, Rebholz CM, Zheng Z, Hurwitz S, et al. Biological variability of estimated GFR and albuminuria in CKD. American Journal of Kidney Diseases. 2018;72:538–546. doi:10.1053/j.ajkd.2018.04.023. Fifty clinically stable outpatients, cross-sectional, and the authors state the small sample limits the ability to detect differences. Reference change values describe measurement variation in a stable population; they are not a rule that a smaller change is meaningless in an unstable one.",
        "Fine DM, Ziegenbein M, Petri M, Han EC. A prospective study of protein excretion using short-interval timed urine collections in patients with lupus nephritis. Kidney International. 2009;76:1284–1288. doi:10.1038/ki.2009.344. Patients with lupus nephritis only, so the diurnal pattern may not transfer. The paper concludes by endorsing a 12-hour overnight collection as an excellent surrogate — it argues for better sampling rather than against sampling, which is the position taken here.",
        "Baba Y, Furuta I, Zhai T, Ohkuchi A, et al. Effect of urine creatinine level during pregnancy on dipstick test. Journal of Obstetrics and Gynaecology Research. 2017;43:967–973. doi:10.1111/jog.13327. A pregnant population at one institution with only twenty false-negative samples driving the comparison at p = 0.046. It shows an association between dilution and false negatives in that setting rather than establishing a general threshold."
      ],
      "limitationIds": [
        "renal-proteinuria-variation-bounds",
        "renal-proteinuria-authored-contrasts",
        "renal-proteinuria-continuing-care"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "meningococcal-sepsis-recognition-and-escalation",
      "title": "Meningococcal sepsis with a non-blanching rash",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. NICE guideline NG240. Published 2024-03-19. Recommendations 1.1.9, 1.1.10, 1.1.12, 1.2.3, 1.5.1, 1.5.3, 1.5.4.",
        "National Institute for Health and Care Excellence. Suspected sepsis in under 16s: recognition, diagnosis and early management. NICE guideline NG254. Published 2025-11-19, replacing NG51. Table 3 and recommendations 1.7.2, 1.7.6, 1.7.9, 1.7.10, 1.7.11, 1.9.2.",
        "Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024;331(8):675-686. doi:10.1001/jama.2024.0196."
      ],
      "limitationIds": [
        "meningococcal-sepsis-presentation-and-response-are-authored",
        "meningococcal-sepsis-controls-are-recognition-and-intent-only",
        "meningococcal-sepsis-timing-and-fluid-ceiling-are-regionally-contested"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "obstructed-infected-kidney-decompression",
      "title": "Infected obstructed kidney: drainage is the treatment",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "American Urological Association. Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026). Approved November 2025. Statement 38 (urgent renal drainage; Strong Recommendation, Evidence Level Grade C) and its nephrostomy-or-stent sub-statement (Conditional Recommendation, Evidence Level Grade A).",
        "European Association of Urology. Guidelines on Urolithiasis, limited text update March 2026. Management of sepsis and anuria in the obstructed kidney: urgent decompression and deferral of definitive stone treatment, both Strong.",
        "National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over. NICE guideline NG253. Published 2025-11-19, replacing NG51. Recommendations 1.6.2, 1.6.4, 1.6.5, 1.11.1 to 1.11.4."
      ],
      "limitationIds": [
        "obstructed-kidney-presentation-and-response-are-authored",
        "obstructed-kidney-controls-are-recognition-activation-and-intent-only",
        "obstructed-kidney-timing-and-modality-are-not-established-by-evidence"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "febrile-neutropenia-blind-examination",
      "title": "Febrile neutropenia: a well-looking emergency",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "National Institute for Health and Care Excellence. Neutropenic sepsis: prevention and management in people with cancer. NICE clinical guideline CG151. Published 2012-09-19; surveillance 2019 and 2020 decided not to update. Key priority: treat as an acute medical emergency and offer empiric antibiotic therapy immediately.",
        "Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi:10.1093/cid/cir073. Still the standing comprehensive IDSA document.",
        "Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211. Scope limited to outpatient management of low-risk adults."
      ],
      "limitationIds": [
        "febrile-neutropenia-presentation-and-response-are-authored",
        "febrile-neutropenia-controls-are-recognition-activation-and-intent-only",
        "febrile-neutropenia-timing-and-risk-scores-rest-on-thin-dated-evidence"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "necrotizing-infection-score-cannot-exclude",
      "title": "Cellulitis that is not settling",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Fernando SM, Tran A, Cheng W, et al. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019;269(1):58-65. PMID:29672405. LRINEC at least 6: sensitivity 68.2%, specificity 84.8%; crepitus 25.2%; hypotension 21.0%; CT 88.5%.",
        "Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022;17:3. doi:10.1186/s13017-022-00406-2. States a low LRINEC score does not rule out the diagnosis.",
        "Nawijn F, Smeeing DPJ, Houwert RM, et al. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020;15:4. PMID:31921330. Surgery within 6 hours versus later: odds ratio 0.43 (95% CI 0.26-0.70); patient delay before presentation showed no significant effect."
      ],
      "limitationIds": [
        "necrotizing-infection-presentation-and-progression-are-authored",
        "necrotizing-infection-controls-are-recognition-activation-and-intent-only",
        "necrotizing-infection-score-and-timing-evidence-are-weak-and-confounded"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "endocarditis-mechanical-failure-on-a-surgical-clock",
      "title": "Endocarditis on a surgical clock",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042. doi:10.1093/eurheartj/ehad193. Endocarditis Team and Heart Valve Centre referral; surgical timing tiers of emergency (under 24 hours) for refractory pulmonary oedema or cardiogenic shock, and urgent (about 3 to 5 days) for heart failure or locally uncontrolled infection. Corrigendum Eur Heart J. 2025;46(11):1082.",
        "Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis. Clin Infect Dis. 2023;77(4):518-526. doi:10.1093/cid/ciad271.",
        "Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation. 2015;132:1435-1486. doi:10.1161/CIR.0000000000000296. Still the standing United States statement as of 2026-08-28 and predates the 2023 European guidance."
      ],
      "limitationIds": [
        "endocarditis-presentation-and-decompensation-are-authored",
        "endocarditis-controls-are-recognition-activation-and-referral-intent-only",
        "endocarditis-surgical-timing-tiers-are-consensus-not-trial-validated"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "severe-pneumonia-the-score-answered-another-question",
      "title": "Pneumonia: two scores, one question",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Severe CAP major and minor criteria; three or more minor criteria define severe pneumonia. The 2025 ATS update did not revise the severity definition, and IDSA did not endorse that update.",
        "National Institute for Health and Care Excellence. Pneumonia: diagnosis and management. NICE guideline NG250. Published 2025-09-02, replacing NG138 and NG139 and partially replacing CG191. CURB65 supports place-of-care decisions alongside clinical judgement rather than in isolation; a score of 3 or more indicates inpatient care with referral to critical care services if appropriate.",
        "Marti C, Garin N, Grosgurin O, et al. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Crit Care. 2012;16:R141. Pooled discrimination of about 0.69 for CURB-65 and PSI in predicting critical-care admission; severity criteria and purpose-built tools discriminate better."
      ],
      "limitationIds": [
        "severe-pneumonia-presentation-and-deterioration-are-authored",
        "severe-pneumonia-controls-are-recognition-activation-and-intent-only",
        "severe-pneumonia-triage-tools-have-no-randomised-outcome-evidence"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "toxic-shock-a-definition-that-cannot-close",
      "title": "Toxic shock: a definition that cannot close",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists. Toxic Shock Syndrome (Other Than Streptococcal), 2011 Case Definition. Fever at or above 38.9 C, diffuse macular erythroderma, desquamation 1 to 2 weeks after onset of rash, systolic blood pressure at or below 90 mmHg, and multisystem involvement in at least 3 of 7 organ systems; laboratory criteria include negative blood and cerebrospinal fluid cultures, with blood permitted to be positive for Staphylococcus aureus. Confirmed requires all 5 clinical findings including desquamation unless the patient dies first.",
        "Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists. Streptococcal Toxic Shock Syndrome, 2010 Case Definition. Hypotension plus at least 2 of renal impairment, coagulopathy, hepatic involvement, acute respiratory distress syndrome, generalized erythematous macular rash, or soft-tissue necrosis; confirmed requires isolation of group A Streptococcus from a normally sterile site, probable from a non-sterile site.",
        "World Health Organization. Increased incidence of scarlet fever and invasive Group A Streptococcus infection, multi-country. Disease Outbreak News, 15 December 2022. The documented international rise changed alerting and contact management rather than the case definitions, which remain at their 2010 and 2011 versions."
      ],
      "limitationIds": [
        "toxic-shock-presentation-and-deterioration-are-authored",
        "toxic-shock-controls-are-recognition-activation-and-intent-only",
        "toxic-shock-definitions-are-surveillance-instruments-not-bedside-rules"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "possible-sepsis-a-clock-that-runs-either-way",
      "title": "Possible sepsis: a clock that runs either way",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. Published 2026-03-23. doi:10.1097/CCM.0000000000007075. Tiered antimicrobial timing: septic shock and probable or definite sepsis without shock, immediately and ideally within 1 hour, strong recommendation, very low certainty; possible sepsis without shock, a time-limited course of rapid investigation and, if concern persists, antimicrobials within 3 hours, conditional recommendation, very low certainty; low likelihood of infection without shock, defer while continuing close monitoring, conditional. Sepsis is a clinical diagnosis and should not be ruled in or out using a single biomarker or diagnostic test. Statement numbers were not retrievable; wording taken from the issuing society guideline page.",
        "Infectious Diseases Society of America. Practice guideline listing: Surviving Sepsis Campaign 2026 adult and children guidelines, endorsed. IDSA declined to endorse the 2016 edition and published a position paper in 2021 seeking to restrict the SEP-1 measure to septic shock; it endorses the 2026 edition, whose tiered structure addresses that objection.",
        "Rhee C, Chiotos K, Cosgrove SE, et al. Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021;72(4):541-552. doi:10.1093/cid/ciaa059. Argues the time-zero definition is not evidence based and is prone to inter-observer variation, and that the measure risks driving antimicrobial overuse because it ignores sepsis overdiagnosis."
      ],
      "limitationIds": [
        "possible-sepsis-presentation-and-resolution-are-authored",
        "possible-sepsis-controls-are-recording-and-bounded-intent-only",
        "possible-sepsis-tiers-rest-on-very-low-certainty-and-a-contested-measure"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "septic-shock-a-label-the-treatment-creates",
      "title": "Septic shock: a label the treatment creates",
      "contentVersion": "0.1.1",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. Box 3: septic shock is identified by a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >= 65 mmHg and a serum lactate > 2 mmol/L despite adequate volume resuscitation. The task force states that criteria for adequate fluid resuscitation and for need for vasopressor therapy could not be explicitly specified because these are highly user dependent.",
        "Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. Published 2026-03-23. doi:10.1097/CCM.0000000000007075. Initial MAP target 65 mmHg over higher targets, strong recommendation, moderate certainty; for adults 65 or older an initial range of 60 to 65 mmHg, conditional, low certainty; at least 30 mL/kg crystalloid in the first 3 hours, conditional, low certainty; initial crystalloid followed by vasopressor support if hypotension persists, conditional, very low certainty, with a carve-out for concurrent vasopressors in unstable shock; serial lactate to guide resuscitation, conditional, low certainty, individualized after the initial bolus by lactate decrement rather than continuing fluids until normalization. Statement numbers were not retrievable; wording taken from the issuing society guideline page.",
        "Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006. PMID 18323749. Hyperlactatemia in sepsis is substantially driven by epinephrine-stimulated aerobic glycolysis in skeletal muscle and by reduced hepatic clearance, so an elevated lactate is not a direct reading of tissue oxygen debt."
      ],
      "limitationIds": [
        "septic-shock-presentation-and-trial-response-are-authored",
        "septic-shock-controls-are-recording-and-bounded-intent-only",
        "septic-shock-targets-are-comparative-and-low-certainty"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "infectious-disease",
      "scenarioId": "meningitis-imaging-a-rule-that-does-not-agree",
      "title": "Meningitis imaging: a rule that does not agree",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. NICE guideline NG240. Published 2024-03-19, last reviewed 2024-03-19. Antibiotics within 1 hour of arrival; blood tests and lumbar puncture before antibiotics if safe and not causing clinically significant delay; do not routinely perform neuroimaging before lumbar puncture; image for new focal neurological features, abnormal pupillary reactions, GCS 9 or less or a progressive and sustained or rapid fall, or risk factors for an evolving space-occupying lesion; do not rule out bacterial meningitis on a normal CRP, procalcitonin, or white cell count.",
        "World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Published 2025-04-10. Cranial imaging should not be performed routinely, strong recommendation on very low certainty; where imaging is readily accessible, image before lumbar puncture for GCS below 10, focal neurological signs, cranial nerve deficits, papilloedema, new-onset seizures in adults, or a severe immunocompromised state; treatment should not be delayed for cranial imaging. None of the included peripheral blood tests can confirm or exclude the diagnosis.",
        "Glimåker M, Johansson B, Grindborg Ö, et al. Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture. Clin Infect Dis. 2018;66(3):321-328. doi:10.1093/cid/cix806. Indications for neuroimaging before lumbar puncture existed in 7%, 32%, and 65% of the same cohort under Swedish, ESCMID, and IDSA criteria respectively. Lumbar puncture without previous computed tomography was associated with mortality of 14 of 323 (4%) versus 37 of 378 (10%). Observational, and confounding by indication is not excluded.",
        "Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clin Infect Dis. 2004;39(9):1267-1284. Marked ARCHIVED by the Infectious Diseases Society of America, with data published through May 2004. Recommends computed tomography before lumbar puncture for an immunocompromised state, an abnormal level of consciousness, age 60 or over, a history of central nervous system disease, a seizure within one week, or specific focal findings."
      ],
      "limitationIds": [
        "meningitis-imaging-presentation-and-scan-result-are-authored",
        "meningitis-imaging-controls-are-recording-and-comparison-only",
        "meningitis-imaging-criteria-disagreement-is-the-lesson-not-a-verdict"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "low-score-what-the-threshold-does-not-exclude",
      "title": "A low score: what the threshold does not exclude",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Prytz M, et al. Diagnostic accuracy of NEWS2 for sepsis among patients with bacteraemia. APMIS. 2025;133(12):e70129. Sensitivity of a NEWS2 of 5 or more for sepsis 86.6% (95% CI 83.0-89.7), specificity 51.5%; approximately 13% of patients with sepsis and a positive blood culture scored below 5. The authors state that a NEWS2 below 5 cannot definitively rule out sepsis.",
        "Evans L, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Strong recommendation against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock, on moderate-quality evidence.",
        "Difonzo M. Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review. Crit Care Res Pract. 2019;2019:6902420. Afferent limb failure and delayed activation are common; staff believed the situation was under control in 51.8% of missed activations, and calling a physician rather than the response team was the more frequent first action."
      ],
      "limitationIds": [
        "low-score-presentation-and-review-outcome-are-authored",
        "low-score-controls-are-recording-and-escalation-only",
        "low-score-sensitivity-figures-are-population-statistics"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "counted-rate-a-number-nobody-counted",
      "title": "A number nobody counted",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Cretikos MA, Bellomo R, Hillman K, et al. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188(11):657-659. A respiratory rate above 27 per minute was the strongest predictor of in-hospital cardiac arrest; more than half of serious adverse events had a rate above 24 identifiable up to 24 hours beforehand at greater than 95% specificity; respiratory rate was documented in only about 30% of ward patients before an early-warning score was introduced.",
        "Palmer J, et al. How registered nurses measure and record respiratory rate: an integrative review. J Clin Nurs. 2023. Documents over-representation of the values 16, 18, and 20 in charted respiratory rates and rates recorded without being counted."
      ],
      "limitationIds": [
        "counted-rate-charted-trend-and-counted-value-are-authored",
        "counted-rate-controls-are-counting-recording-and-escalation-only",
        "counted-rate-monitor-equivalence-is-not-claimed"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "paired-reading-a-number-wrong-in-one-direction",
      "title": "A number wrong in one direction",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Parr B, Beech A, Young M, Valley TS. Racial and ethnic disparities in occult hypoxemia prevalence and clinical outcomes among hospitalized patients: a systematic review and meta-analysis. J Gen Intern Med. 2024;39(13):2543-2553. doi:10.1007/s11606-024-08852-1. Moderate certainty. Across 732,505 paired measurements, the prevalence ratio for occult hypoxaemia was 1.67 (95% CI 1.47-1.90) in Black compared with white patients, and 1.39 (95% CI 1.19-1.64) for other groups.",
        "Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement. N Engl J Med. 2020;383:2477-2478. doi:10.1056/NEJMc2029240. Where oxygen saturation by pulse oximetry read 92 to 96 percent, arterial saturation was below 88 percent in 12 percent of Black patients compared with 4 percent of white patients in one cohort, and 17 percent compared with 6 percent in another.",
        "United States Food and Drug Administration. Draft guidance on pulse oximeters for medical purposes, January 2025. Applies to devices submitted for premarket review after issuance; it does not recall, recalibrate, or replace devices already in clinical service."
      ],
      "limitationIds": [
        "paired-reading-presentation-and-arterial-value-are-authored",
        "paired-reading-controls-are-recording-and-escalation-only",
        "paired-reading-prevalence-ratios-are-population-statistics"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "afferent-limb-a-threshold-met-and-a-call-not-made",
      "title": "A threshold met, and a call not made",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Difonzo M. Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review. Crit Care Res Pract. 2019;2019:6902420. Afferent limb failure in 22.8% and delayed calls in 30.2% of adverse events in the studies reviewed; staff believed the situation was under control in 51.8% of missed activations; 75.9% of nurses called a physician first rather than the rapid response team.",
        "Johnston MJ, Arora S, King D, et al. A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery. 2015;157(4):752-763. Failure-to-rescue incidence 8.0% to 16.9%; delayed escalation reported in 20.7% to 47.1% of cases."
      ],
      "limitationIds": [
        "afferent-limb-presentation-and-team-response-are-authored",
        "afferent-limb-controls-are-recording-and-calling-only",
        "afferent-limb-system-findings-are-not-causal-claims"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "quiet-patient-a-screen-that-was-never-done",
      "title": "A screen that was never done",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Shenkin SD, Fox C, Godfrey M, et al. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Med. 2019;17:138. doi:10.1186/s12916-019-1367-9. 4AT sensitivity 76% (95% CI 61-87) and specificity 94% (92-97); CAM sensitivity 40% (26-57) and specificity 100% (98-100) under routine conditions.",
        "Krewulak KD, Stelfox HT, Leigh JP, et al. Scoping review of delirium motor subtype prevalence. Hypoactive delirium 50.3% (95% CI 46.0-54.7), mixed 27.7%, hyperactive 22.7%.",
        "Peritogiannis V, Bolosi M, Lixouriotis C, Rizos DV. Recent Insights on Prevalence and Corelations of Hypoactive Delirium. Behav Neurol. 2015;2015:416792. Hypoactive delirium is substantially under-recognised and is frequently misread as depression or fatigue."
      ],
      "limitationIds": [
        "quiet-patient-presentation-and-screen-result-are-authored",
        "quiet-patient-controls-are-screening-and-escalation-only",
        "quiet-patient-a-positive-screen-is-not-a-diagnosis"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "proxy-scale-a-number-without-a-standard",
      "title": "A number without a standard",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31(2):170-192. Concluded that no tool could then be recommended for broad adoption, with the instruments in early stages of development and testing.",
        "Herr K, Coyne PJ, Key T, et al. Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs. 2006;7(2):44-52. American Society for Pain Management Nursing. Sets out the hierarchy of pain assessment: attempt self-report, consider potential causes, observe behaviours, obtain a proxy report from a person who knows the patient, and attempt an analgesic trial. Behavioural scores are not intensity scores, and physiologic indicators are placed at the bottom of the hierarchy.",
        "Pain in non-communicative older adults beyond dementia: a narrative review. Front Med. 2024;11:1393367. Notes that behavioural item sets are non-comprehensive and that subtle behavioural change may be missed."
      ],
      "limitationIds": [
        "proxy-scale-presentation-and-behaviours-are-authored",
        "proxy-scale-controls-are-assessment-and-bounded-intent-only",
        "proxy-scale-no-validated-intensity-conversion-exists"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "last-known-well-a-time-nobody-can-supply",
      "title": "A time nobody can supply",
      "contentVersion": "0.1.1",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset (WAKE-UP). N Engl J Med. 2018;379(7):611-622. doi:10.1056/NEJMoa1804355. Randomised trial in 503 of a planned 800 patients with stroke of unknown onset, stopped when funding ended; favourable outcome 53.3% versus 41.8%, adjusted odds ratio 1.61 (95% CI 1.09-2.36), P=0.02; death 4.1% versus 1.2% (P=0.07) and parenchymal haematoma 4.0% versus 0.4% (adjusted OR 10.46, 95% CI 1.32-82.77, P=0.03). Eligibility rested on imaging as a surrogate for lesion age rather than on a remembered time of onset, and the trial was never powered to measure harm.",
        "Difonzo M. Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review. Crit Care Res Pract. 2019;2019:6902420. At least one vital sign was missing in 77% of patients with adverse events, supporting the general finding that gaps in observation precede unrecognised deterioration."
      ],
      "limitationIds": [
        "last-known-well-timeline-and-assessment-response-are-authored",
        "last-known-well-controls-are-recording-and-activation-only",
        "last-known-well-trial-evidence-describes-a-population"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "oxygen-target-scale-a-score-that-should-be-lower",
      "title": "A score that should be lower",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017. Chart 1 publishes both SpO2 scales: Scale 1 scores 91% or below as 3, 92-93% as 2, 94-95% as 1, and 96% or above as 0; Scale 2 scores 88-92%, or 93% or above on air, as 0. Recommendation 25 confines Scale 2 to patients with hypercapnic respiratory failure confirmed on blood gas who require supplemental oxygen, with a prescribed target of 88-92%. The requirement is a property of the admission rather than of the current minute, which is why Scale 2 carries a band for 93% or above on air. Recommendation 26 requires the decision to be made by a competent clinical decision maker and recorded in the notes. The chart directs that the section not being used is crossed out.",
        "O’Driscoll BR, Howard LS, Earis J, Mak V; British Thoracic Society Emergency Oxygen Guideline Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(Suppl 1):ii1-ii90. doi:10.1136/thoraxjnl-2016-209729. States the 88-92% target for patients at risk of hypercapnic respiratory failure (Grade A for chronic obstructive pulmonary disease, evidence level 1+), that it is not known whether 88-92% is the ideal range, and that patients within 88-92% score points on the earlier early-warning score and that this may prompt nursing staff to increase the inspired oxygen and put the patient at risk.",
        "Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462. doi:10.1136/bmj.c5462. Cluster-randomised by paramedic rather than by patient; intention-to-treat mortality 21/226 (9%) with high-flow oxygen versus 7/179 (4%) with titrated oxygen, relative risk 0.42 (95% CI 0.20-0.89), P=0.02. Thirty-seven percent of the confirmed cases received non-protocol treatment, and in the per-protocol analysis the difference did not reach significance.",
        "Tirkkonen J, Karlsson S, Skrifvars MB. National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study. Scand J Trauma Resusc Emerg Med. 2019;27:111. doi:10.1186/s13049-019-0691-6. In 886 rapid-response reviews, applying Scale 2 to the 11.7% with confirmed hypercapnic respiratory failure did not improve discrimination for either immediate or in-hospital outcome."
      ],
      "limitationIds": [
        "oxygen-target-scale-observation-and-documents-are-authored",
        "oxygen-target-scale-controls-are-reading-and-recording-only",
        "oxygen-target-scale-a-corrected-score-is-not-reassurance"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "medical-surgical-nursing",
      "scenarioId": "lost-contingency-a-plan-that-was-not-said",
      "title": "A plan that was not said",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff. Qual Saf Health Care. 2009;18(4):248-255. doi:10.1136/qshc.2008.028654. Audiotape study of 88 sessions and 503 sign-outs; median 35 seconds per patient; anticipatory guidance 0.42 to 0.56 statements per patient; 298 of 503 sign-outs included no questions from the receiver; and 46 of 211 second sign-outs, 22%, omitted or mischaracterised information from the first, the published example being a plan to call the team on a defined trigger becoming, one handover later, that there is nothing to do tonight.",
        "Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755-1760. doi:10.1001/archinte.168.16.1755. Same cohort; 24 verified sign-out-related problems, 7.5 per 100 patient-days (95% CI 4.6-10.5); omissions of anticipatory guidance in 9 sign-outs and of a plan of action in 14. The authors report that failure to provide anticipatory guidance for likely overnight events produced some of the most serious problems observed. Categories overlap and counts are of omissions rather than of harms.",
        "Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803-1812. doi:10.1056/NEJMsa1405556. Prospective pre-post study in nine hospitals, 10,740 admissions; medical errors 24.5 to 18.8 per 100 admissions and preventable adverse events 4.7 to 3.3 (both P<0.001), non-preventable adverse events unchanged (P=0.79), significant reductions at six of nine sites, handoff duration unchanged. No control group.",
        "Starmer AJ, O’Toole JK, Rosenbluth G, et al. Implementation of the I-PASS handoff program in diverse clinical environments. J Hosp Med. 2023;18(1):5-14. doi:10.1002/jhm.12979. Direct observation across 32 hospitals; verbal contingency plans present in 29% before and 78% after; receiver synthesis 31% to 83%. Adverse-event outcomes are resident-reported in an uncontrolled pre-post design, and several authors disclose equity in a company selling handoff training.",
        "Huber A, Moyano B, Blondon K. Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic. BMC Med Educ. 2024;24(1):1046. doi:10.1186/s12909-024-05880-7. Simulation with 30 physicians and 177 sign-outs; the situation-awareness element including anticipations was absent from 54% of sign-outs, and one participant of 30 spontaneously rephrased what they received.",
        "Jorro-Barón F, Suarez-Anzorena I, Burgos-Pratx R, et al. Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial. BMJ Qual Saf. 2021;30(10):782-791. doi:10.1136/bmjqs-2020-012370. Cluster-randomised stepped-wedge trial in six units, 1,465 records; compliance with verbal and written items was significantly higher while preventable adverse events per 1000 days did not change, risk ratio 1.0 (95% CI 0.74-1.34).",
        "McCarthy S, Motala A, Lawson E, Shekelle PG. Use of structured handoff protocols for within-hospital unit transitions: a systematic review from Making Healthcare Safer IV. BMJ Qual Saf. 2025;34(10):680-690. doi:10.1136/bmjqs-2024-018385. Grades the evidence that I-PASS reduces medical errors and adverse events as moderate certainty across roughly ten implementations, and the evidence for other tools as low certainty or single-setting.",
        "Allen-Dicker J, Kerwin M, Wallins JS, et al. Physician inpatient handoffs — patient and physician outcomes: a systematic review. J Hosp Med. 2025;20(6):607-622. doi:10.1002/jhm.13583. Forty-two studies, six randomised; adverse events improved in 3 of 16 studies and medical errors in 3 of 7; mortality was examined in four studies and improved in none. Sixty-seven percent of studies were in academic centres and 64% involved residents only."
      ],
      "limitationIds": [
        "lost-contingency-handover-and-notes-are-authored",
        "lost-contingency-controls-are-reading-and-recording-only",
        "lost-contingency-completeness-is-not-a-harm-reduction",
        "lost-contingency-evidence-is-not-from-nursing-handover"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
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    },
    {
      "moduleId": "oncology",
      "scenarioId": "delayed-immune-event-a-drug-that-stopped-months-ago",
      "title": "A delayed immune event: a drug that stopped months ago",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Couey MA, Bell RB, Patel AA, et al. Delayed immune-related events (DIRE) after discontinuation of immunotherapy: diagnostic hazard of autoimmunity at a distance. J Immunother Cancer. 2019;7(1):165. DIRE defined as new immune-related adverse events manifesting 90 days or more after discontinuation; 23 qualifying cases; median off-treatment interval to DIRE 6 months (range 3 to 28); median cumulative exposure 4 doses (range 3 to 42); misattribution can lead to unnecessary or harmful interventions.",
        "Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021;9(6):e002435. Immune-related adverse events can occur at any point during or after cessation of treatment, beyond 6 to 12 months. Diagnostic evaluation should attempt to rule out other etiologies, such as diarrhea or colitis associated with Clostridium difficile infection, but treatment for immune-related adverse events should be initiated as is deemed clinically appropriate. Additional workup at grade 2 or above includes stool infectious analysis with C. difficile and cytomegalovirus testing by polymerase chain reaction.",
        "Wang DY, Salem JE, Cohen JV, et al. Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis. JAMA Oncol. 2018;4(12):1721-1728. Of 193 reported anti-CTLA-4 deaths, 135 (70%) were usually from colitis; colitis itself carried reported fatalities of only 2% to 5%; anti-PD-1/PD-L1 fatalities were more often pneumonitis, hepatitis, and neurotoxic effects."
      ],
      "limitationIds": [
        "delayed-immune-event-presentation-and-service-response-are-authored",
        "delayed-immune-event-controls-are-recording-and-escalation-only",
        "delayed-immune-event-series-figures-are-not-an-incidence"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "incidental-clot-a-decision-the-evidence-cannot-make",
      "title": "An incidental clot: a decision the evidence cannot make",
      "contentVersion": "0.1.0",
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        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021;5(4):927-974. Recommendation 26: for patients with cancer and incidental (unsuspected) pulmonary embolism, the panel suggests short-term anticoagulation treatment rather than observation (conditional recommendation, very low certainty in the evidence of effects). No systematic review or randomised trial addressed the question; certainty judged very low for risk of bias, inconsistency and imprecision; named a research priority. Mortality RR 0.81 (95% CI 0.67-0.98), 89 fewer per 1000; symptomatic PE RR 0.36 (0.18-0.72), 77 fewer per 1000; major bleeding RR 3.00 (1.21-7.47), 128 more per 1000. Good practice statement 1: consideration of treatment should rest on the individual risk of thrombosis and major bleeding after full discussion of the potential benefits and harms.",
        "van der Hulle T, den Exter PL, Planquette B, et al. Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients. J Thromb Haemost. 2016;14(1):105-113. Incidental pulmonary embolism is defined as pulmonary embolism diagnosed on computed tomography not performed for suspected pulmonary embolism, estimated to occur in 3.1% of all cancer patients. Weighted pooled six-month risks across 11 cohorts: recurrent VTE 5.8%, major haemorrhage 4.7%, mortality 37%. Recurrence 12% in untreated patients. Recurrence risk after subsegmental incidental embolism comparable to more proximal (HR 1.1, 95% CI 0.50-2.4).",
        "Peris M, Jiménez D, Maestre A, et al. Outcome during and after anticoagulant therapy in cancer patients with incidentally found pulmonary embolism. Eur Respir J. 2016;48(5):1360-1368. In 715 RIETE registry patients, during anticoagulation the rate of major bleeding exceeded the rate of symptomatic pulmonary embolism (10.1 versus 3.17 per 100 patient-years) and fatal bleeding exceeded fatal pulmonary embolism; the authors conclude the risk-benefit ratio of anticoagulant therapy in these patients is uncertain and must be evaluated in further studies."
      ],
      "limitationIds": [
        "incidental-clot-presentation-and-service-response-are-authored",
        "incidental-clot-controls-are-recording-and-escalation-only",
        "incidental-clot-figures-are-population-estimates-on-very-low-certainty"
      ],
      "corrections": [],
      "review": {
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    },
    {
      "moduleId": "oncology",
      "scenarioId": "normal-test-toxicity-the-dose-in-his-bag",
      "title": "A normal test: the dose still in his bag",
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      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Henricks LM, Lunenburg CATC, de Man FM, et al. DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol. 2018;19(11):1459-1467. Fluoropyrimidine treatment can result in severe toxicity in up to 30% of patients. Of 1103 evaluable patients, 85 (8%) were heterozygous DPYD variant carriers and 1018 (92%) were wild type; severe fluoropyrimidine-related toxicity occurred in 33 (39%) of 85 variant carriers receiving reduced doses and in 231 (23%) of 1018 wild-type patients (p=0.0013).",
        "Meulendijks D, Henricks LM, Sonke GS, et al. Clinical relevance of DPYD variants c.1679T>G, c.1236G>A/HapB3, and c.1601G>A as predictors of severe fluoropyrimidine-associated toxicity: a systematic review and meta-analysis of individual patient data. Lancet Oncol. 2015;16(16):1639-1650. Across 7365 patients from eight studies, adjusted relative risks for severe fluoropyrimidine-associated toxicity were 4.40 (95% CI 2.08-9.30) for c.1679T>G, 2.85 (1.75-4.62) for DPYD*2A and 3.02 (2.22-4.10) for c.2846A>T; c.1601G>A was not significantly associated (1.52, 0.86-2.70)."
      ],
      "limitationIds": [
        "normal-test-toxicity-presentation-and-service-response-are-authored",
        "normal-test-toxicity-controls-are-withholding-and-escalation-only",
        "normal-test-toxicity-genotype-figures-are-not-this-patients-risk"
      ],
      "corrections": [],
      "review": {
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "prognosis-question-a-number-he-asked-for",
      "title": "A question with a number in it",
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      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469-472. 343 doctors provided survival estimates for 468 terminally ill patients at hospice referral; median survival 24 days; only 20% of predictions accurate to within 33% of actual survival, 63% over-optimistic, 17% over-pessimistic; survival overestimated by a factor of 5.3. As the duration of the doctor-patient relationship increased and time since last contact decreased, prognostic accuracy decreased.",
        "Weeks JC, Catalano PJ, Cronin A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367(17):1616-1625. 69% of patients with lung cancer and 81% with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. Patients who rated communication with their physician most favourably were more likely to hold inaccurate beliefs (odds ratio highest versus lowest third 1.90, 95% CI 1.33-2.72).",
        "Kiely BE, Martin AJ, Tattersall MHN, et al. The median informs the message: accuracy of individualized scenarios for survival time based on oncologists’ estimates. J Clin Oncol. 2013;31(28):3565-3571. 21 oncologists estimated survival for 114 patients with advanced cancer; median survival 11 months. Observed survival was between half and double the estimate in 63%, a quarter of it or less in 6%, and three times it or more in 14%. Estimates were imprecise: 29% fell within 0.67 to 1.33 times observed survival."
      ],
      "limitationIds": [
        "prognosis-question-conversation-and-readback-are-authored",
        "prognosis-question-controls-are-conversation-only",
        "prognosis-question-figures-describe-estimators-not-this-patient"
      ],
      "corrections": [],
      "review": {
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        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "laboratory-tls-a-syndrome-he-does-not-have-yet",
      "title": "A syndrome he does not have yet",
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      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin’s lymphoma. Am J Med. 1993;94(2):133-139. 102 patients receiving combination chemotherapy. \"Laboratory tumor lysis\" defined as two of a 25% rise in serum phosphate, potassium, uric acid or urea nitrogen, or a 25% fall in calcium, within 4 days of treatment. \"Clinical tumor lysis\" defined as laboratory tumor lysis plus one of potassium above 6 mmol/L, creatinine above 221 micromol/L, calcium below 1.5 mmol/L, a life-threatening arrhythmia, or sudden death. Laboratory tumor lysis occurred in 42% and clinical in 6%; clinical tumor lysis occurred more frequently in patients with pretreatment renal insufficiency.",
        "Annemans L, Moeremans K, Lamotte M, et al. Incidence, medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin’s lymphoma in four European countries. Leuk Lymphoma. 2003;44(1):77-83. 788 patients screened retrospectively in Belgium, the Netherlands, Spain and the UK. Hyperuricaemia occurred in 18.9% of patients, and 27.8% of those fulfilled tumour-lysis criteria. The authors note the observed incidence rates were lower than earlier reports.",
        "Duminuco A, Del Fabro V, De Luca P, Leotta D. Emergencies in Hematology: Why, When and How I Treat? J Clin Med. 2024;13(24):7572. A narrative review. Laboratory data may be present in the first 6 to 24 hours after chemotherapy starts, and the first clinical signs appear in the first 48 to 72 hours. This review restates Annemans et al. as a laboratory tumour-lysis incidence of 18.9% with clinical at 5%, which is not what that study reported."
      ],
      "limitationIds": [
        "laboratory-tls-bloods-and-team-response-are-authored",
        "laboratory-tls-controls-are-recording-and-escalation-only",
        "laboratory-tls-published-rates-disagree-and-none-is-his"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "rare-early-myocarditis-a-base-rate-is-not-a-threshold",
      "title": "A base rate is not a threshold",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Fan Y, Xu Y, Liu X, Liu G. Immune checkpoint inhibitor-related myocarditis: a comprehensive analysis of clinical manifestations and prognostic factors. Oncologist. 2025;30(10). Multicentre retrospective study of 161 patients with biopsy-proven or clinically diagnosed ICI-myocarditis. Onset a median of 4 weeks after initiation, at a median of the second cycle, with mortality occurring mainly within 60 days. Reported incidence 0.1% to 1% in clinical trials, higher with combination regimens; historical mortality quoted at 30% to 50%. Predictors of cardiotoxicity-related death included initial left ventricular ejection fraction below 50%, alanine aminotransferase, creatine kinase-MB, and concomitant ICI-myositis.",
        "Wang DY, Salem JE, Cohen JV, et al. Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis. JAMA Oncol. 2018;4(12):1721-1728. Myocarditis had the highest fatality rate of any checkpoint-inhibitor toxicity reported, at 52 (39.7%) of 131 reported cases, against 2% to 5% for colitis and endocrine events."
      ],
      "limitationIds": [
        "rare-early-myocarditis-presentation-and-conduction-are-authored",
        "rare-early-myocarditis-controls-are-monitoring-and-escalation-only",
        "rare-early-myocarditis-incidence-and-fatality-answer-different-questions"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "lowering-the-count-a-number-that-can-be-moved",
      "title": "A number that can be moved",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Bewersdorf JP, Giri S, Tallman MS, Zeidan AM, Stahl M. Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia — a systematic review and meta-analysis. Transfusion. 2020;60(10):2360-2369. Up to 20% of patients with acute myeloid leukemia present with hyperleukocytosis, usually defined as a white blood cell count greater than 100 x 10^9/L; given the high early mortality rate, emergent cytoreduction is indicated but the optimal strategy is unknown. Across 13 two-arm retrospective studies with 1743 patients (486 leukapheresis, 1257 not), leukapheresis did not improve early mortality (risk ratio 0.88, 95% CI 0.69-1.13, P=.321). Patients presenting with clinical leukostasis tended to be more likely to undergo leukapheresis (odds ratio 2.01, 95% CI 0.99-4.08, P=.052). The authors argue against routine use.",
        "Duminuco A, Del Fabro V, De Luca P, Leotta D. Emergencies in Hematology: Why, When and How I Treat? J Clin Med. 2024;13(24):7572. A narrative review. Clinical choices in hyperleukocytosis are crucial within the first hours, and a recent systematic review found no evidence of standardised guidelines for managing it. Pulmonary and neurological signs are the manifestations most strongly linked to early mortality."
      ],
      "limitationIds": [
        "lowering-the-count-presentation-and-deterioration-are-authored",
        "lowering-the-count-controls-are-recording-and-escalation-only",
        "lowering-the-count-absence-of-benefit-is-not-proof-of-uselessness"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "inherited-urgency-an-emergency-that-mostly-is-not-one",
      "title": "An emergency that mostly is not one",
      "contentVersion": "0.1.0",
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      "maturity": "preview",
      "practiceRegions": [
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        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Straka C, Ying J, Kong FM, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. SpringerPlus. 2016;5:229. \"Although only 5 % of SVCS patients present with grade 4 disease, any of the aforementioned complications would be an indication for emergent venogram, stent placement, and thrombolytic therapy if indicated.\" \"Death is very rarely caused by SVCS. In one series of 1986 patients with SVCS, only 1 death was reported.\" \"accumulating evidence has suggested that accurate diagnosis and biopsy should precede emergent therapeutic intervention in most cases\"; \"obtaining an accurate histologic diagnosis prior to starting RT allows for optimum treatment of the causative malignancy\"; and that the syndrome is a medical emergency if associated with laryngeal or cerebral oedema.",
        "Yu JB, Wilson LD, Detterbeck FC. Superior vena cava syndrome — a proposed classification system and algorithm for management. J Thorac Oncol. 2008;3(8):811-814. A grading scale proposed on the basis of symptom severity rather than derived from outcomes. Grade 4 denotes life-threatening disease due to significant cerebral oedema with confusion or obtundation, significant laryngeal oedema with stridor, or significant haemodynamic compromise."
      ],
      "limitationIds": [
        "inherited-urgency-presentation-and-its-stability-are-authored",
        "inherited-urgency-controls-are-recording-and-escalation-only",
        "inherited-urgency-a-proportion-is-not-this-patient"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "trial-rule-a-rule-written-for-a-database",
      "title": "A rule written for a database",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Seymour L, Bogaerts J, Perrone A, et al; RECIST working group. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017;18(3):e143-e152. The guideline modifies RECIST 1.1 for immunotherapy trials to ensure consistent design and data collection and to permit the ongoing collection of trial data and ultimate validation of the guideline. Unconfirmed progression allows continued treatment beyond RECIST 1.1 progression if the patient is clinically stable, with confirmatory imaging repeated 4 to 8 weeks later. The RECIST working group states that these are recommendations for data handling rather than patient management, and that they are not validated response criteria.",
        "Onesti CE, Frères P, Jerusalem G. Atypical patterns of response to immune checkpoint inhibitors: interpreting pseudoprogression and hyperprogression in decision making for patients’ treatment. J Thorac Dis. 2019;11(1):35-38. \"Overall, the rate of pseudoprogression do not exceed 10% in patients treated with immune checkpoint inhibitors\", with small numbers behind the favourable series. Hyperprogressive disease incidence in patients receiving immunotherapy ranges from 4% to 29% across studies, including 13.8% on immunotherapy against 5.1% on chemotherapy in one non-small-cell lung cancer series, with no effective treatment after hyperprogression reported in the literature. \"It is crucial to recognize pseudoprogression from a real progression, to avoid both a premature discontinuation of an effective treatment and the delay of starting a new line of therapy.\""
      ],
      "limitationIds": [
        "trial-rule-presentation-and-the-document-are-authored",
        "trial-rule-controls-are-recording-and-escalation-only",
        "trial-rule-neither-rate-decides-this-patient"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "silent-interaction-a-harm-with-nothing-to-find",
      "title": "A harm with nothing to find",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Lee CH, Shen MC, Tsai MJ, Chang JS, Huang YB, Yang YH, Hsieh KP. Proton pump inhibitors reduce the survival of advanced lung cancer patients with therapy of gefitinib or erlotinib. Sci Rep. 2022;12:7002. A retrospective cohort study using the Taiwan Cancer Registry, National Health Insurance and Death Registry databases from 1 January 2010 to 30 December 2018, covering 4,340 gefitinib and 1,635 erlotinib users. Concurrent proton pump inhibitor use was associated with worse overall survival: median 14.35 against 21.87 months with gefitinib, adjusted hazard ratio 1.58 (95% CI 1.42-1.76), and 16.97 against 23.92 months with erlotinib, adjusted hazard ratio 1.54 (95% CI 1.30-1.82). Time to next treatment was used as a surrogate for progression because progression data were unavailable. The authors state association rather than causation.",
        "Raoul JL, Hansten PD. Proton pump inhibitors and cancer treatments: emerging evidence against coadministration. Cancer Treat Rev. 2024;129:102794. Most tyrosine kinase inhibitors depend on gastric acidity for absorption, and retrospective studies indicate that concurrent proton pump inhibitor use reduces the survival benefit of drugs including erlotinib, gefitinib and pazopanib. The authors recommend informing patients and clinicians of these interactions and suggest antacids or H2 blockers as alternatives for those requiring acid suppression."
      ],
      "limitationIds": [
        "silent-interaction-presentation-and-the-records-are-authored",
        "silent-interaction-controls-are-reconciliation-and-escalation-only",
        "silent-interaction-association-is-not-this-patient-s-lost-benefit"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "oncology",
      "scenarioId": "easy-label-a-label-that-fits-too-easily",
      "title": "A label that fits too easily",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Li H, Fu ZY, Arslan ME, Cho D, Lee H. Differential diagnosis and management of immune checkpoint inhibitor-induced colitis: a comprehensive review. World J Exp Med. 2021;11(6):79-92. \"The diagnosis of ICI-induced colitis is one of exclusion and requires exclusion of other competing etiologies\", including cytomegalovirus and Clostridioides difficile, whose clinical presentation is described as indistinguishable from that of ICI-induced colitis. \"microbiological studies and/or stool culture should be performed first to exclude the common infectious etiologies\" before immunosuppressive therapy, and ICI-induced colitis patients are at increased risk for infectious colitis. \"current guidelines universally recommend corticosteroids as initial management for ICI-induced colitis that is grade 2 or of higher grade\".",
        "Dougan M, Wang Y, Rubio-Tapia A, Lim JK. AGA clinical practice update on diagnosis and management of immune checkpoint inhibitor colitis and hepatitis: expert review. Gastroenterology. 2021;160(4):1384-1393. An expert review providing best practice advice on the diagnosis and management of the gastrointestinal and hepatic toxicities of immune checkpoint inhibitors, cited here as the existence of a formal practice statement on this problem rather than for any figure."
      ],
      "limitationIds": [
        "easy-label-presentation-and-the-record-are-authored",
        "easy-label-controls-are-recording-and-escalation-only",
        "easy-label-exclusion-first-is-not-treatment-later"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "negative-scan-a-scan-that-cannot-say-no",
      "title": "A negative scan: a scan that cannot say no",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Erb L, Hyman NH, Osler T. Abnormal vital signs are common after bowel resection and do not predict anastomotic leak. J Am Coll Surg. 2014;218(6):1195-9. 452 consecutive patients undergoing intestinal anastomosis, July 2009 to July 2011; 141 (31.2%) suffered 271 complications including 19 anastomotic leaks; tachycardia and tachypnea were almost routine, occurring in more than half of patients frequently throughout the postoperative period; the positive predictive value of any aberrant vital sign or white blood cell count ranged between 4% and 11%.",
        "Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D. Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis. 2014;29(4):445-51. 524 patients with a leakage rate of 10.9% (n=57) and mortality after leakage of 21.1% (n=12); CT sensitivity 0.59 (95% CI 0.43-0.73), specificity 0.88 (95% CI 0.75-0.95), positive predictive value 0.82 (95% CI 0.64-0.92), negative predictive value 0.70 (95% CI 0.57-0.81), accuracy 74%; delayed reintervention due to a false-negative CT outcome resulted in death in 62.5% (n=5).",
        "Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol. 2017;21(9):709-714. 628 patients reviewed, CT performed in 127, leakage in 49 (7.8%); positive and negative predictive values 78% and 88%, sensitivity 73%, specificity 91%; mortality after a false-negative scan 5/11 (45.5%) against 1/24 (4.2%) (p<0.005), with a significant increase in length of stay."
      ],
      "limitationIds": [
        "negative-scan-presentation-and-team-response-are-authored",
        "negative-scan-controls-are-recording-and-escalation-only",
        "negative-scan-single-centre-figures-are-not-a-decision-rule"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "rising-requirement-a-number-that-under-calls",
      "title": "A rising requirement: a number that under-calls",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572-7. Systematic review; 1,932 titles screened, 433 abstracts reviewed, 104 articles examined, 4 studies eligible; sensitivity of clinical findings 13% to 19%; specificity and negative predictive value each 97% to 98%; positive predictive value 11% to 15%; probability of the diagnosis approximately 25% with one clinical finding and 93% with three; clinical features are more useful by their absence in excluding the diagnosis than when present in confirming it.",
        "McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996;78(1):99-104. Prospective study of 116 patients with tibial diaphyseal fractures, continuous anterior compartment monitoring for 24 hours; 3 patients (2.6%) had acute compartment syndrome; in the first 12 hours 53 patients had absolute pressures over 30 mmHg and 30 had pressures over 40 mmHg, four higher than 50; only one patient had a differential pressure (diastolic minus compartment) of less than 30 mmHg and had a fasciotomy; two more fell below that differential in the second 12 hours and had fasciotomies; no sequelae in any of the 116 at review at least six months after injury.",
        "McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95(8):673-7. 850 tibial diaphyseal fractures over ten years; estimated sensitivity 94%, specificity 98%, positive predictive value 93%, negative predictive value 99%; of 152 fasciotomies 141 were confirmed acute compartment syndrome and 6 were false positives, with 5 false negatives; of 698 patients without fasciotomy, 689 had no late sequelae at a mean of 59 weeks."
      ],
      "limitationIds": [
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        "rising-requirement-controls-are-recording-and-escalation-only",
        "rising-requirement-tibial-fracture-figures-are-not-a-threshold"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unfinished-survey-a-patient-who-cannot-be-asked",
      "title": "An unfinished survey: a patient who cannot be asked",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
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      "sources": [
        "Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990;30(6):666-9; discussion 669-70. An initial review of trauma registry data yielded a modest 2% incidence of missed injuries in a 90% blunt trauma population; a tertiary survey was performed prospectively on all injured patients (N=399) admitted during a 3-month period, with patients reexamined immediately before ambulation or, in head-injured patients, upon regaining consciousness; 41 missed injuries were found in 36 patients (9%), including 21 extremity fractures, five spinal fractures, two facial fractures, five thoracic injuries, six abdominal injuries (including five splenic lacerations), and two vascular injuries; the most common reason for injuries to be missed was altered level of consciousness due to head injury or alcohol; none of the missed injuries resulted in death, but one caused serious disability and seven required operative correction.",
        "Keijzers GB, Giannakopoulos GF, Del Mar C, Bakker FC, Geeraedts LM Jr. The effect of tertiary surveys on missed injuries in trauma: a systematic review. Scand J Trauma Resusc Emerg Med. 2012;20:77. Ten observational studies met inclusion criteria; none was randomized and none reported long-term health outcomes; risk of bias varied considerably. Nine studies assessed Type I missed injury (missed at primary and secondary survey and detected by the tertiary survey) and found an overall rate of 4.3%; a single study reported Type II missed injury (missed at primary and secondary survey and by the tertiary survey, detected during hospital stay) with a rate of 1.5%. Three studies reported both control and intervention cohorts, two reporting an increase in Type I missed injuries (3% vs 7%, P<0.01) and one a decrease in Type II (2.4% vs 1.5%, P=0.01). The authors conclude the evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias.",
        "Keijzers GB, Campbell D, Hooper J, Bost N, Crilly J, Steele MC, Del Mar C, Geeraedts LM Jr. A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. World J Surg. 2014;38(1):222-32. Prospective before-and-after cohort study in a single regional level II trauma hospital; 487 trauma patients (pre-formalisation n=235; post- n=252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8% vs 4.8%, P=0.61), as were postdischarge missed injury rates at 1 month (13.7% vs 11.5%, P=0.43) and 6 months (3.8% vs 3.3%, P=0.84). Tertiary survey performance was substantially higher in the post-group (27% vs 42%, P<0.001). Cumulative missed injury rates exceeded 15%; although performance was significantly improved by formalising the process, this did not decrease missed injury rates."
      ],
      "limitationIds": [
        "unfinished-survey-presentation-and-team-response-are-authored",
        "unfinished-survey-controls-are-recording-and-escalation-only",
        "unfinished-survey-observational-figures-are-not-a-decision-rule"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "transient-response-a-patient-who-will-not-stay-up",
      "title": "A transient response: a patient who will not stay up",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
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        "US",
        "GB"
      ],
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      "sources": [
        "Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52(3):420-5. Patients in the Pennsylvania Trauma Systems Foundation trauma registry with isolated abdominal vascular, solid organ, or wall injuries grade 3 to 6 and hypotension; 243 patients met the criteria, with systolic blood pressure ranging from 30 to 90 mmHg, time to the emergency department 7 to 185 minutes and time in the department 7 to 915 minutes; 98 patients died (40%). The risk ratio for time spent in the department before laparotomy increased until 90 minutes and then significantly decreased below all earlier values. Logistic regression on the 165 patients spending 90 minutes or less showed the probability of death increased with time in the department, by as much as 0.35% per minute — approximately 1% for each 3 minutes.",
        "Meizoso JP, Ray JJ, Karcutskie CA 4th, Allen CJ, Zakrison TL, Pust GD, Koru-Sengul T, Ginzburg E, Pizano LR, Schulman CI, Livingstone AS, Proctor KG, Namias N. Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: The golden 10 minutes. J Trauma Acute Care Surg. 2016;81(4):685-91. Retrospective review of 309 hypotensive adults with torso gunshot wounds requiring immediate operation, January 2004 to September 2013, at a single centre; resuscitative thoracotomies, traumatic brain injury, transfers, and operations more than 1 hour after arrival excluded. Mean systolic blood pressure 81 ± 29 mmHg, Injury Severity Score 24 ± 15, overall mortality 27%, mean time to operation 19 ± 13 minutes. After controlling for organ injury, arrival in the operating room after 10 minutes carried a hazard ratio of 1.89 (95% CI 1.10-3.26; p=0.02), and 2.67 (95% CI 0.97-7.34; p=0.05) in those with systolic blood pressure of 70 mmHg or less. The time associated with 50% cumulative mortality was 16 minutes. Level of evidence IV; the paper’s own conclusion describes the 1.89 hazard ratio as an almost threefold increase.",
        "Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373(9673):1455-61. Retrospective multicentre study of 4,621 blunt trauma patients in the German Trauma Society registry, of whom 1,494 (32%) received whole-body CT; mean age 42.6 years, mean injury severity score 29.7. Standardised mortality ratio based on TRISS 0.745 (95% CI 0.633-0.859) with whole-body CT versus 1.023 (0.909-1.137) without (p<0.001); based on the RISC score 0.865 (0.774-0.956) versus 1.034 (0.959-1.109) (p=0.017); relative mortality reduction 25% (14-37) by TRISS and 13% (4-23) by RISC; number needed to scan 17 by TRISS and 32 by RISC. Multivariate adjustment for hospital level, year of trauma and centre effects confirmed whole-body CT as an independent predictor for survival (p<=0.002)."
      ],
      "limitationIds": [
        "transient-response-presentation-and-team-response-are-authored",
        "transient-response-controls-are-recording-and-escalation-only",
        "transient-response-retrospective-figures-are-not-a-stopwatch"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "quiet-chest-an-injury-whose-severity-is-not-yet-visible",
      "title": "A quiet chest: an injury whose severity is not yet visible",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-6; discussion 1046-7. Retrospective cohort of all 277 patients aged 65 or over with rib fractures admitted to a Level I trauma center over 10 years, against a control group of 187 randomly selected patients aged 18 to 64 admitted over the same period. The groups had a similar mean number of rib fractures (3.6 elderly vs 4.0 young), mean chest Abbreviated Injury Score (3.0 vs 3.0) and mean Injury Severity Score (20.7 vs 21.4), but mean ventilator days (4.3 vs 3.1), intensive care days (6.1 vs 4.0) and length of stay (15.4 vs 10.7 days) were all longer in the elderly. Pneumonia occurred in 31% of elderly versus 17% of young (p<0.01) and mortality was 22% versus 10% (p<0.01). Mortality and pneumonia rates increased as the number of rib fractures increased, with an odds ratio for death of 1.19 and for pneumonia of 1.16 per additional rib fracture (p<0.001); the conclusion states that for each additional rib fracture in the elderly mortality increases by 19% and the risk of pneumonia by 27%, which does not match the 1.16 reported in the results. Epidural analgesia in the elderly staying more than 2 days was associated with 10% mortality versus 16% without (p=0.28). The authors call for prospective study of epidural analgesia in this population.",
        "Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J, Martin M. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478-85. Consecutive adult blunt trauma admissions with rib fractures to a tertiary care trauma centre, April 1993 to March 2000, extracted from the trauma registry. Among 4,325 blunt trauma admissions there were 405 (9.4%) with rib fractures, of whom 113 were aged 65 or over; Injury Severity Score was 16 or above in 54.8%, mean hospital stay 26.8 ± 43.7 days, and 28.6% required mechanical ventilation. Mortality (19.5% vs 9.3%; p<0.05), comorbidity (61.1% vs 8.6%; p<0.0001) and falls as mechanism (14.6% vs 0.7%; p<0.0001) were higher in those aged 65 or over despite significantly lower Injury Severity Score (p=0.031), higher Glasgow Coma Scale score (p=0.0003) and higher Revised Trauma Score (p<0.0001). After adjusting for severity, comorbidity and multiple rib fractures, patients aged 65 or over had five times the odds of dying compared with those under 65.",
        "Duch P, Møller MH. Epidural analgesia in patients with traumatic rib fractures: a systematic review of randomised controlled trials. Acta Anaesthesiol Scand. 2015;59(6):698-709. Systematic review with meta-analysis and trial sequential analysis of randomised controlled trials comparing continuous epidural analgesia with other analgesic interventions in traumatic rib fractures. Six trials totalling 223 patients were included and all were judged as having a high risk of bias. There was no statistically significant difference in mortality (RR 2.18, 95% CI 0.21-22.42; p=0.51; I2=0%), duration of mechanical ventilation (MD -7.53, 95% CI -16.32 to 1.26; p=0.09; I2=91%) or pneumonia (RR 0.49, 95% CI 0.19-1.25; p=0.13; I2=0%); subgroup, sensitivity and trial sequential analyses confirmed the results. The authors conclude that the quality and quantity of evidence is low and that there is no firm evidence of benefit or harm."
      ],
      "limitationIds": [
        "quiet-chest-presentation-and-team-response-are-authored",
        "quiet-chest-controls-are-recording-and-escalation-only",
        "quiet-chest-retrospective-cohorts-are-not-an-admission-rule"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unowned-delay-a-wait-that-nobody-decided",
      "title": "An unowned delay: a wait that nobody decided",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson RJ, Wodchis WP. Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery. JAMA. 2017;318(20):1994-2003. Population-based retrospective cohort of adults undergoing hip fracture surgery between April 2009 and March 2014 at 72 hospitals in Ontario, Canada. Among 42,230 patients (mean age 80.1 years, 70.5% women), overall 30-day mortality was 7.0%. Risk-adjusted restricted cubic splines placed the inflection point at which complications began to increase at a wait greater than 24 hours, irrespective of the complication considered. Compared with 13,731 propensity-score matched patients operated earlier, the 13,731 operated after 24 hours had 30-day mortality of 6.5% versus 5.8% (absolute risk difference 0.79%; 95% CI 0.23-1.35) and a composite of mortality or medical complications of 12.2% versus 10.1% (absolute risk difference 2.16%; 95% CI 1.43-2.89).",
        "Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-16. Systematic review of prospective studies of early surgery in hip fracture; 1,939 citations screened and 16 observational studies met inclusion criteria, with 13,478 patients for whom mortality data were complete and 1,764 total deaths. Based on the five studies reporting adjusted risk of death (4,208 patients, 721 deaths), and irrespective of whether the cut-off for delay was 24, 48 or 72 hours, earlier surgery was associated with a significant reduction in mortality (relative risk 0.81, 95% CI 0.68-0.96, p=0.01). Unadjusted data indicated earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93) and pressure sores (RR 0.48, 95% CI 0.34-0.69). All included studies were observational.",
        "HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet. 2020;395(10225):698-708. International randomised controlled trial at 69 hospitals in 17 countries; patients aged 45 or older with a hip fracture requiring surgery were randomly assigned 1:1 to accelerated surgery (goal of surgery within 6 hours of diagnosis) or standard care. Of 27,701 patients screened and 7,780 eligible, 2,970 were enrolled (1,487 accelerated, 1,483 standard care). Median time from diagnosis to surgery was 6 hours (IQR 4-9) in the accelerated group and 24 hours (10-42) in the standard-care group (p<0.0001). Mortality at 90 days was 140 (9%) versus 154 (10%), hazard ratio 0.91 (95% CI 0.72-1.14), absolute risk reduction 1% (-1 to 3; p=0.40). Major complications occurred in 321 (22%) versus 331 (22%), hazard ratio 0.97 (0.83-1.13), absolute risk reduction 1% (-2 to 4; p=0.71). The authors conclude that accelerated surgery did not significantly lower the risk of mortality or major complications."
      ],
      "limitationIds": [
        "unowned-delay-presentation-and-team-response-are-authored",
        "unowned-delay-controls-are-recording-and-escalation-only",
        "unowned-delay-the-randomised-trial-does-not-license-the-wait"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "third-attendance-a-question-two-people-have-already-answered",
      "title": "A third attendance: a question two people have already answered",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Mahajan P, Basu T, Pai CW, Singh H, Petersen N, Bellolio MF, Gadepalli SK, Kamdar NS. Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department. JAMA Netw Open. 2020;3(3):e200612. Retrospective cohort of commercially insured claims (Clinformatics Data Mart) for patients presenting to an emergency department with undifferentiated symptoms associated with appendicitis between January 2010 and December 2017. Of 187,461 patients with a diagnosis of appendicitis, 123,711 were eligible (101,375 adults, 22,336 children). The frequency of potentially missed appendicitis — diagnosis 1 to 30 days after an initial emergency department presentation with associated symptoms — was 6.0% in adults and 4.4% in children. Women had higher adjusted odds of missed diagnosis across symptom strata, including abdominal pain (AOR 1.68; 95% CI 1.58-1.78), nausea and/or vomiting (AOR 1.68; 95% CI 1.52-1.85) and fever (AOR 1.32; 95% CI 1.10-1.59), as did patients with a comorbidity index of 2 or greater. Patients with abdominal pain and constipation were more likely to be missed (adults AOR 1.51; 95% CI 1.31-1.75); those with isolated abdominal pain were less likely (adults AOR 0.65; 95% CI 0.62-0.69).",
        "Drapkin Z, Dunnick J, Madsen TE, Bryce M, Schunk JE. Pediatric Appendicitis: Association of Chief Complaint With Missed Appendicitis. Pediatr Emerg Care. 2020;36(4):e204-e207. Retrospective chart review of 1,680 patients diagnosed with appendicitis in a paediatric emergency department over five years, reviewing the record for additional emergency department visits in the seven preceding days. In 67 cases (4%) there had been at least one additional visit in the preceding week. Patients diagnosed at the initial visit and after multiple visits did not differ in age (9.9 vs 10.1 years), sex, white cell count (14.4 vs 12.3 x 10^3/L) or presence of fever. Of patients whose triage chief complaint was suggestive of appendicitis, 3.8% were missed at the initial visit, against 8.8% of those with a nonspecific triage complaint (odds ratio 2.46; 95% CI 1.1-5.6). The authors describe this as confirming the potential impact of anchoring bias by triage chief complaint. This is a study of children in a single paediatric department and is quoted for its mechanism rather than its rate.",
        "Sabbatini AK, Kocher KE, Basu A, Hsia RY. In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department. JAMA. 2016;315(7):663-71. Retrospective analysis of 9,036,483 index adult emergency department visits to 424 acute care hospitals in Florida and New York in 2013, using Healthcare Cost and Utilization Project data. Among the 7,278,124 patients discharged at the index visit, 598,404 (8.2%) returned within 7 days and 86,012 (14.4% of returners) were then admitted. Those 86,012 patients had significantly lower in-hospital mortality than the 1,609,145 admitted at the index visit without a return (1.85% vs 2.48%; odds ratio 0.73, 95% CI 0.69-0.78), lower intensive care admission (23.3% vs 29.0%; odds ratio 0.73, 95% CI 0.71-0.76), lower mean costs ($10,169 vs $10,799) and longer lengths of stay. The authors conclude that hospital admissions associated with return visits may not adequately capture deficits in the quality of care delivered during an emergency department visit."
      ],
      "limitationIds": [
        "third-attendance-presentation-and-team-response-are-authored",
        "third-attendance-controls-are-recording-and-escalation-only",
        "third-attendance-a-return-visit-is-not-evidence-of-error"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
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      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "deferred-step-a-decision-attached-to-a-person",
      "title": "A deferred step: a decision attached to a person",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Lack WD, Karunakar MA, Angerame MR, Seymour RB, Sims S, Kellam JF, Bosse MJ. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma. 2015;29(1):1-6. Retrospective prognostic study at a level 1 trauma centre; 137 patients after exclusions, with deep infection within 90 days as the outcome. Age, smoking, diabetes, injury severity score, type IIIA versus IIIB/C injury, and time to surgical debridement were not associated with infection on univariate analysis. More than 5 days to wound coverage (p<0.001) and more than 66 minutes to antibiotics (p<0.01) were univariate predictors; on multivariate analysis wound coverage beyond 5 days (odds ratio 7.39; 95% CI 2.33-23.45; p<0.001) and antibiotics beyond 66 minutes (odds ratio 3.78; 95% CI 1.16-12.31; p=0.03) independently predicted infection. Immediate antibiotics with early coverage gave 1 infection in 36 (2.8%), against 6 in 59 (10.2%) with delay in one factor and 17 in 42 (40.5%) with delay in both. Prognostic level II. The authors note the therapeutic window is within an hour of injury.",
        "Roddy E, Patterson JT, Kandemir U. Delay of Antibiotic Administration Greater than 2 Hours Predicts Surgical Site Infection in Open Fractures. Injury. 2020;51(9):1999-2003. Consecutive open fracture patients at a level 1 trauma centre with a minimum 30-day follow-up, identified from an orthopaedic registry 2013-2017; surgical site infection within 90 days was the primary endpoint, with the threshold determined by receiver-operator analysis and a Cox model adjusted for age, smoking and drug use. Ten percent of 230 patients developed a surgical site infection. There was a trend for patients who did not develop infection to receive antibiotics earlier than those who did (median 61 minutes, IQR 33-107, versus 83 minutes, IQR 40-186; p=0.053). Intravenous antibiotic administration more than 120 minutes after presentation to the emergency department was significantly associated with a 2.4-fold increased hazard of surgical site infection within 90 days (p=0.036). Note that this study measures from arrival while the study above measures from injury.",
        "Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;(243):36-40. Seventy-seven infections in 1,104 open fracture wounds were evaluated to identify factors predisposing to infection, grouped as increased risk, no effect, and inconclusive. The single most important factor in reducing the infection rate was the early administration of antibiotics providing activity against both gram-positive and gram-negative organisms. Surgical debridement was performed on all open fracture wounds in the study. No threshold time is reported in the indexed abstract, and none is quoted from it here."
      ],
      "limitationIds": [
        "deferred-step-presentation-and-team-response-are-authored",
        "deferred-step-controls-are-recording-and-escalation-only",
        "deferred-step-two-thresholds-measured-from-two-clocks"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "known-label-an-explanation-that-excludes-nothing",
      "title": "A known label: an explanation that excludes nothing",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018;8(2):e018292. Large population-based cross-sectional study in the geographical area of one Scottish Health Board; all adults aged 16 and over known to general practitioners to have intellectual disabilities or receiving intellectual disabilities services were eligible, and 1,023 of 1,562 took part (65.5%), 562 men and 461 women, mean age 43.9 years, of whom 186 had Down syndrome. At comprehensive health assessment the mean number of physical health conditions per participant was 11.04 and 98.7% had multimorbidity. The five most prevalent conditions were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differed from that in the general population and was spread across the entire adult life course.",
        "Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L. The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. Lancet. 2014;383(9920):889-95. Population-based confidential inquiry reviewing the deaths of 247 people with intellectual disabilities aged 4 and over registered with a general practitioner in five Primary Care Trust areas of southwest England who died between June 2010 and May 2012, with a comparator group of people without intellectual disabilities matched for age, sex, cause of death and general practice. Nearly a quarter (22%, 54) were younger than 50 at death; median age at death was 64 years, against 78 for men and 83 for women in the general population of England and Wales. Deaths from causes amenable to change by good quality health care were more common in people with intellectual disabilities (37%, 90 of 244) than in the general population (13%). Contributory factors that differed significantly from the comparator group included problems in advanced care planning (p=0.0003), adherence to the Mental Capacity Act (p=0.0008), living in inappropriate accommodation (p<0.0001), adjusting care as needs changed (p=0.009), and carers not feeling listened to (p=0.006).",
        "Lee AC, Herrieven E, Harrower NA. Health inequalities for people with learning disabilities: why it matters and what emergency physicians need to know. Br J Hosp Med (Lond). 2024;85(2):1-7. Narrative review for emergency physicians. It reports that people with learning disabilities in England die on average 16 years earlier than the general population, describes premature deaths with contributory healthcare causes, and names diagnostic overshadowing leading to delayed or missed diagnoses alongside a lack of reasonable adjustments, polypharmacy, and inappropriate use of do-not-resuscitate orders. It states that carers and family can be vital informants, helping clinicians interpret subtle signs, and that clinicians should be aware of subtle or atypical presentations of illness. This is a narrative review rather than a measurement study, and is quoted here for its framing rather than as evidence of effect size."
      ],
      "limitationIds": [
        "known-label-presentation-and-team-response-are-authored",
        "known-label-controls-are-recording-and-escalation-only",
        "known-label-the-evidence-supports-the-label-it-warns-about"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    },
    {
      "moduleId": "surgery-trauma",
      "scenarioId": "unspoken-doubt-an-interval-nobody-else-can-see",
      "title": "An unspoken doubt: an interval nobody else can see",
      "contentVersion": "0.1.0",
      "capabilityVersion": "0.1.0-alpha.48",
      "maturity": "preview",
      "practiceRegions": [
        "US",
        "GB"
      ],
      "inReviewedCoverage": false,
      "sources": [
        "Pattni N, Arzola C, Malavade A, Varmani S, Krimus L, Friedman Z. Challenging authority and speaking up in the operating room environment: a narrative synthesis. Br J Anaesth. 2019;122(2):233-244. Narrative synthesis of the literature on challenging authority in the operating room, searching Medline, EBM reviews and PsycINFO for terms related to challenging authority, speaking up, communication, patient safety, gradients and hierarchy. The initial search identified 4,822 publications, of which 31 studies were included, grouped by meta-aggregation into discussion and review articles, observational or qualitative studies, and studies of specific barriers or educational interventions. Hierarchy, organisational culture and education were the most frequently observed and tested themes; simulation research successfully elicited and confirmed the role of specific barriers. The authors state that barriers and enablers are largely modifiable within institutions, but that education about the importance of speaking up must accompany those modifications for significant change to occur.",
        "Toy S, Daly Guris RJ, Duarte SS, Dwivedi P. Development of a scale to measure intrapersonal factors influencing speaking up in the operating room. Perspect Med Educ. 2019;8(4):253-260. Scale development study among postgraduate year 2, 3 and 4 anaesthesiology residents and practising faculty anaesthesiologists at a large quaternary care academic hospital. Exploratory factor analysis indicated a three-factor solution accounting for 73% of the variance: a four-item self-efficacy subscale (Cronbach’s alpha 0.86), and three-item social outcome expectations (alpha 0.86) and assertive attitude (alpha 0.67) subscales. Training level was significantly associated with self-efficacy (p<0.001) and assertive attitude (p<0.001) scores, and multiple ordinal regressions indicated that these intrapersonal factors predicted participants’ likelihood of speaking up in hypothetical scenarios. The authors note the instrument needs validation in other cohorts.",
        "O’Donovan R, McAuliffe E. A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour. BMC Health Serv Res. 2020;20(1):101. Systematic review with narrative synthesis, PROSPERO CRD42018100659, searching PsycINFO, ABI/Inform, Academic Search Complete, PubMed and grey literature. Fourteen interventions were reviewed, falling into five categories: educational interventions using simulation, video presentations, case studies and workshops, and non-educational approaches using holistic facilitation, forum play and action research meetings. Mixed results were found for efficacy or effectiveness; while some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. The authors attribute this to a lack of objective outcome measures and to the limited ability of educational interventions alone to change deeply rooted speaking-up behaviours, and call for longitudinal and multifaceted interventions."
      ],
      "limitationIds": [
        "unspoken-doubt-presentation-and-team-response-are-authored",
        "unspoken-doubt-controls-are-stating-and-escalation-only",
        "unspoken-doubt-the-evidence-questions-this-exercise"
      ],
      "corrections": [],
      "review": {
        "reviewer": "UNSIGNED",
        "credential": "UNSIGNED",
        "reviewedOn": "1970-01-01",
        "reviewBy": "1970-01-01",
        "contentVersion": "0.1.0"
      }
    }
  ],
  "reviewers": [],
  "endorsements": [],
  "conflicts": [],
  "expirations": [],
  "competency": {
    "disclaimer": "These mappings are Open Sim Lab's own reading of published framework documents. No accrediting or certifying body has reviewed, endorsed or recognised them, and time spent in this simulator does not count toward any case requirement, clinical hour or supervised experience. A programme documenting accreditation should read the source documents.",
    "frameworks": [
      {
        "id": "nbcrna-nce",
        "name": "National Certification Examination content outline",
        "body": "National Board of Certification and Recertification for Nurse Anesthetists",
        "version": "Content outline as published for the current examination",
        "url": "https://www.nbcrna.com/",
        "fidelity": "summarised"
      },
      {
        "id": "coa-standards",
        "name": "Standards for Accreditation of Nurse Anesthesia Programs — Practice Doctorate",
        "body": "Council on Accreditation of Nurse Anesthesia Educational Programs",
        "version": "Practice doctorate standards, revised May 2025, effective January 2026",
        "url": "https://www.coacrna.org/",
        "fidelity": "summarised"
      },
      {
        "id": "acgme-anesthesiology-milestones-2",
        "name": "Anesthesiology Milestones 2.0",
        "body": "Accreditation Council for Graduate Medical Education",
        "version": "2.0",
        "url": "https://www.acgme.org/specialties/anesthesiology/milestones/",
        "fidelity": "summarised"
      }
    ],
    "mappings": [
      {
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          "ventilate-before-desaturation"
        ]
      },
      {
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      },
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      },
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      },
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      },
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      },
      {
        "scenarioId": "rapid-desaturation",
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        "domainId": "pc-preanesthetic-evaluation",
        "objectiveIds": [
          "preoxygenate"
        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
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          "dose-for-the-patient",
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        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
        "frameworkId": "nbcrna-nce",
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        "objectiveIds": [
          "read-the-mechanism"
        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
        "frameworkId": "coa-standards",
        "domainId": "physiology-and-pathophysiology",
        "objectiveIds": [
          "read-the-mechanism",
          "manage-hypotension"
        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
        "frameworkId": "coa-standards",
        "domainId": "clinical-decision-making",
        "objectiveIds": [
          "read-the-mechanism",
          "dose-for-the-patient"
        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
        "frameworkId": "coa-standards",
        "domainId": "pharmacology-of-anesthetic-agents",
        "objectiveIds": [
          "dose-for-the-patient"
        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
        "frameworkId": "acgme-anesthesiology-milestones-2",
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          "dose-for-the-patient",
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        ]
      },
      {
        "scenarioId": "hypotension-after-induction",
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        "objectiveIds": [
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      },
      {
        "scenarioId": "hypotension-after-induction",
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        "domainId": "mk-applied-foundational-science",
        "objectiveIds": [
          "read-the-mechanism"
        ]
      },
      {
        "scenarioId": "bronchospasm",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-sciences",
        "objectiveIds": [
          "read-the-capnogram",
          "ventilate-before-desaturation"
        ]
      },
      {
        "scenarioId": "bronchospasm",
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          "read-the-capnogram"
        ]
      },
      {
        "scenarioId": "bronchospasm",
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        "objectiveIds": [
          "ventilate-before-desaturation",
          "deepen-before-reaching-for-anything-else",
          "give-first-line-bronchodilator"
        ]
      },
      {
        "scenarioId": "bronchospasm",
        "frameworkId": "nbcrna-nce",
        "domainId": "advanced-principles",
        "objectiveIds": [
          "deepen-before-reaching-for-anything-else",
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          "give-first-line-bronchodilator"
        ]
      },
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        "scenarioId": "bronchospasm",
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        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "bronchospasm",
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          "deepen-before-reaching-for-anything-else",
          "give-first-line-bronchodilator"
        ]
      },
      {
        "scenarioId": "bronchospasm",
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        ]
      },
      {
        "scenarioId": "bronchospasm",
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        ]
      },
      {
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          "give-first-line-bronchodilator"
        ]
      },
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      },
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        ]
      },
      {
        "scenarioId": "bronchospasm",
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      },
      {
        "scenarioId": "unexpected-intraoperative-hemorrhage",
        "frameworkId": "nbcrna-nce",
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        "objectiveIds": [
          "recognize-hemorrhage",
          "temporize-volume-loss",
          "manage-hypotension"
        ]
      },
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        "scenarioId": "unexpected-intraoperative-hemorrhage",
        "frameworkId": "coa-standards",
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        "objectiveIds": [
          "recognize-hemorrhage",
          "avoid-full-dose-induction"
        ]
      },
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        "scenarioId": "unexpected-intraoperative-hemorrhage",
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        "scenarioId": "blood-bank-handoff",
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          "request-blood-bank-release",
          "use-released-red-cells",
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        ]
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        "scenarioId": "blood-bank-handoff",
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        ]
      },
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        "scenarioId": "blood-bank-handoff",
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          "request-blood-bank-release",
          "use-released-red-cells",
          "reassess-red-cell-response"
        ]
      },
      {
        "scenarioId": "dilutional-coagulopathy",
        "frameworkId": "nbcrna-nce",
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        "objectiveIds": [
          "identify-dilutional-coagulopathy",
          "give-lab-guided-plasma",
          "reassess-coagulation-response"
        ]
      },
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        "scenarioId": "dilutional-coagulopathy",
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          "identify-dilutional-coagulopathy",
          "give-lab-guided-plasma",
          "reassess-coagulation-response"
        ]
      },
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          "give-lab-guided-plasma",
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        ]
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          "protect-the-apnea-margin"
        ]
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        "scenarioId": "capnography-sampling-line-obstruction",
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        "domainId": "equipment-instrumentation-technology",
        "objectiveIds": [
          "cross-check-capnography-loss",
          "preserve-stable-ventilation",
          "restore-capnography-sampling"
        ]
      },
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        "scenarioId": "arterial-pressure-transducer-artifact",
        "frameworkId": "nbcrna-nce",
        "domainId": "equipment-instrumentation-technology",
        "objectiveIds": [
          "verify-invasive-pressure-independently",
          "correct-transducer-level",
          "assess-arterial-dynamic-response"
        ]
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        "scenarioId": "circle-system-rebreathing",
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        "objectiveIds": [
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          "bridge-with-fresh-gas-flow",
          "replace-exhausted-absorbent"
        ]
      },
      {
        "scenarioId": "circle-system-rebreathing",
        "frameworkId": "coa-standards",
        "domainId": "clinical-decision-making",
        "objectiveIds": [
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          "bridge-with-fresh-gas-flow",
          "replace-exhausted-absorbent"
        ]
      },
      {
        "scenarioId": "circle-system-rebreathing",
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        "objectiveIds": [
          "recognize-inspired-carbon-dioxide",
          "bridge-with-fresh-gas-flow",
          "replace-exhausted-absorbent"
        ]
      },
      {
        "scenarioId": "routine-inhalational-maintenance",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-principles",
        "objectiveIds": [
          "maintain-bounded-depth",
          "anticipate-surgical-stimulus",
          "reassess-when-stimulus-falls"
        ]
      },
      {
        "scenarioId": "routine-inhalational-maintenance",
        "frameworkId": "coa-standards",
        "domainId": "pharmacology-of-anesthetic-agents",
        "objectiveIds": [
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          "anticipate-surgical-stimulus",
          "reassess-when-stimulus-falls"
        ]
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      {
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        "objectiveIds": [
          "anticipate-surgical-stimulus",
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        "objectiveIds": [
          "preoxygenate-older-adult",
          "titrate-geriatric-propofol",
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        ]
      },
      {
        "scenarioId": "routine-geriatric-induction",
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        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "quantitative-neuromuscular-reversal",
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        "domainId": "basic-principles",
        "objectiveIds": [
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          "reverse-recovering-block",
          "confirm-quantitative-recovery",
          "maintain-anesthesia-during-block"
        ]
      },
      {
        "scenarioId": "quantitative-neuromuscular-reversal",
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        "domainId": "pharmacology-of-anesthetic-agents",
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      },
      {
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        "objectiveIds": [
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          "confirm-quantitative-recovery",
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        ]
      },
      {
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        ]
      },
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      },
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        ]
      },
      {
        "scenarioId": "emergence-with-residual-blockade",
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          "defer-extubation-during-residual-blockade",
          "separate-recovery-from-extubation-readiness"
        ]
      },
      {
        "scenarioId": "emergence-with-residual-blockade",
        "frameworkId": "acgme-anesthesiology-milestones-2",
        "domainId": "pc-anesthetic-plan-and-conduct",
        "objectiveIds": [
          "review-emergence-quantitative-monitor",
          "recognize-emergence-residual-blockade",
          "defer-extubation-during-residual-blockade",
          "separate-recovery-from-extubation-readiness"
        ]
      },
      {
        "scenarioId": "routine-geriatric-induction",
        "frameworkId": "coa-standards",
        "domainId": "clinical-decision-making",
        "objectiveIds": [
          "preoxygenate-older-adult",
          "titrate-geriatric-propofol",
          "protect-geriatric-perfusion",
          "ventilate-geriatric-induction"
        ]
      },
      {
        "scenarioId": "routine-geriatric-induction",
        "frameworkId": "acgme-anesthesiology-milestones-2",
        "domainId": "pc-anesthetic-plan-and-conduct",
        "objectiveIds": [
          "preoxygenate-older-adult",
          "titrate-geriatric-propofol",
          "protect-geriatric-perfusion",
          "ventilate-geriatric-induction"
        ]
      },
      {
        "scenarioId": "routine-geriatric-induction",
        "frameworkId": "acgme-anesthesiology-milestones-2",
        "domainId": "pc-pharmacologic-management",
        "objectiveIds": [
          "titrate-geriatric-propofol",
          "protect-geriatric-perfusion"
        ]
      },
      {
        "scenarioId": "routine-inhalational-maintenance",
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        "domainId": "pc-anesthetic-plan-and-conduct",
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          "maintain-bounded-depth",
          "anticipate-surgical-stimulus",
          "reassess-when-stimulus-falls"
        ]
      },
      {
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        ]
      },
      {
        "scenarioId": "arterial-pressure-transducer-artifact",
        "frameworkId": "coa-standards",
        "domainId": "clinical-decision-making",
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          "correct-transducer-level",
          "assess-arterial-dynamic-response"
        ]
      },
      {
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          "assess-arterial-dynamic-response"
        ]
      },
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        "scenarioId": "capnography-sampling-line-obstruction",
        "frameworkId": "coa-standards",
        "domainId": "clinical-decision-making",
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          "preserve-stable-ventilation",
          "restore-capnography-sampling"
        ]
      },
      {
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        "domainId": "pc-crisis-management",
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          "restore-capnography-sampling"
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      },
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        "domainId": "advanced-principles",
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          "secure-and-confirm",
          "reverse-observed-block"
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      },
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      },
      {
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        "domainId": "airway-management",
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          "secure-and-confirm"
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      },
      {
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        ]
      },
      {
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        "domainId": "pc-preanesthetic-evaluation",
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        "domainId": "advanced-principles",
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      },
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      },
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      },
      {
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          "start-preeclampsia-seizure-prophylaxis",
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        ]
      },
      {
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      },
      {
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        ]
      },
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        "domainId": "pc-preanesthetic-evaluation",
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        ]
      },
      {
        "scenarioId": "awareness-under-paralysis",
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        "domainId": "advanced-principles",
        "objectiveIds": [
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          "restore-hypnotic-delivery",
          "recognize-paralysis-risk"
        ]
      },
      {
        "scenarioId": "awareness-under-paralysis",
        "frameworkId": "nbcrna-nce",
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      },
      {
        "scenarioId": "awareness-under-paralysis",
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        "domainId": "basic-sciences",
        "objectiveIds": [
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      },
      {
        "scenarioId": "awareness-under-paralysis",
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        ]
      },
      {
        "scenarioId": "awareness-under-paralysis",
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        ]
      },
      {
        "scenarioId": "awareness-under-paralysis",
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        ]
      },
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        ]
      },
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        ]
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        "objectiveIds": [
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      },
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        "scenarioId": "laryngospasm-after-airway-stimulation",
        "frameworkId": "nbcrna-nce",
        "domainId": "advanced-principles",
        "objectiveIds": [
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          "deepen-during-laryngospasm"
        ]
      },
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        "scenarioId": "laryngospasm-after-airway-stimulation",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-principles",
        "objectiveIds": [
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          "protect-oxygenation-during-laryngospasm"
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      },
      {
        "scenarioId": "laryngospasm-after-airway-stimulation",
        "frameworkId": "nbcrna-nce",
        "domainId": "equipment-instrumentation-technology",
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      {
        "scenarioId": "laryngospasm-after-airway-stimulation",
        "frameworkId": "coa-standards",
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      },
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        "frameworkId": "coa-standards",
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      },
      {
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      },
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        "scenarioId": "laryngospasm-after-airway-stimulation",
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      },
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        "domainId": "pc-monitoring-and-equipment",
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      },
      {
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      },
      {
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        "domainId": "mk-applied-foundational-science",
        "objectiveIds": [
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      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
        "frameworkId": "nbcrna-nce",
        "domainId": "advanced-principles",
        "objectiveIds": [
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          "give-initial-epinephrine",
          "support-anaphylaxis-circulation"
        ]
      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-sciences",
        "objectiveIds": [
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          "support-anaphylaxis-circulation"
        ]
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      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
        "frameworkId": "nbcrna-nce",
        "domainId": "equipment-instrumentation-technology",
        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
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        "domainId": "pharmacology-of-anesthetic-agents",
        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
        "frameworkId": "coa-standards",
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        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
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      {
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        ]
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      {
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      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
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          "support-anaphylaxis-circulation"
        ]
      },
      {
        "scenarioId": "perioperative-anaphylaxis-after-antibiotic",
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        "domainId": "mk-applied-foundational-science",
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        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "nbcrna-nce",
        "domainId": "advanced-principles",
        "objectiveIds": [
          "recognize-mh-hypermetabolism",
          "give-initial-dantrolene",
          "reassess-mh-response"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-sciences",
        "objectiveIds": [
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          "reassess-mh-response"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "nbcrna-nce",
        "domainId": "equipment-instrumentation-technology",
        "objectiveIds": [
          "stop-trigger-and-hyperventilate"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "coa-standards",
        "domainId": "pharmacology-of-anesthetic-agents",
        "objectiveIds": [
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        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "coa-standards",
        "domainId": "physiology-and-pathophysiology",
        "objectiveIds": [
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          "reassess-mh-response"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "coa-standards",
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          "stop-trigger-and-hyperventilate",
          "give-initial-dantrolene"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "coa-standards",
        "domainId": "anesthesia-equipment-and-monitoring",
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          "reassess-mh-response"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
        "frameworkId": "acgme-anesthesiology-milestones-2",
        "domainId": "pc-pharmacologic-management",
        "objectiveIds": [
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      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
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          "reassess-mh-response"
        ]
      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
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      },
      {
        "scenarioId": "early-malignant-hyperthermia-during-volatile-anesthesia",
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      },
      {
        "scenarioId": "routine-pediatric-iv-induction",
        "frameworkId": "nbcrna-nce",
        "domainId": "basic-principles",
        "objectiveIds": [
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          "dose-pediatric-propofol",
          "ventilate-child-by-weight",
          "avoid-pediatric-desaturation"
        ]
      },
      {
        "scenarioId": "routine-pediatric-iv-induction",
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      },
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      },
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        ]
      },
      {
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        "domainId": "basic-principles",
        "objectiveIds": [
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          "settle-pediatric-volatile-depth"
        ]
      },
      {
        "scenarioId": "routine-pediatric-inhalational-induction",
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        ]
      },
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        "scenarioId": "routine-pediatric-inhalational-induction",
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        ]
      },
      {
        "scenarioId": "routine-pediatric-inhalational-induction",
        "frameworkId": "coa-standards",
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          "settle-pediatric-volatile-depth"
        ]
      },
      {
        "scenarioId": "routine-pediatric-inhalational-induction",
        "frameworkId": "acgme-anesthesiology-milestones-2",
        "domainId": "pc-anesthetic-plan-and-conduct",
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    "critical-care/quality": "/catalog/critical-care-quality-audit.json",
    "critical-care/maturity": "/catalog/critical-care-maturity.json",
    "cardiology/completion": "/catalog/cardiology-completion-audit.json",
    "cardiology/quality": "/catalog/cardiology-quality-audit.json",
    "cardiology/maturity": "/catalog/cardiology-maturity.json",
    "respiratory-medicine/completion": "/catalog/respiratory-medicine-completion-audit.json",
    "respiratory-medicine/quality": "/catalog/respiratory-medicine-quality-audit.json",
    "respiratory-medicine/maturity": "/catalog/respiratory-medicine-maturity.json",
    "pediatrics/completion": "/catalog/pediatrics-completion-audit.json",
    "pediatrics/quality": "/catalog/pediatrics-quality-audit.json",
    "pediatrics/maturity": "/catalog/pediatrics-maturity.json",
    "neurology/completion": "/catalog/neurology-completion-audit.json",
    "neurology/quality": "/catalog/neurology-quality-audit.json",
    "neurology/maturity": "/catalog/neurology-maturity.json",
    "toxicology/completion": "/catalog/toxicology-completion-audit.json",
    "toxicology/quality": "/catalog/toxicology-quality-audit.json",
    "toxicology/maturity": "/catalog/toxicology-maturity.json",
    "obstetrics/completion": "/catalog/obstetrics-completion-audit.json",
    "obstetrics/quality": "/catalog/obstetrics-quality-audit.json",
    "obstetrics/maturity": "/catalog/obstetrics-maturity.json",
    "neonatology/completion": "/catalog/neonatology-completion-audit.json",
    "neonatology/quality": "/catalog/neonatology-quality-audit.json",
    "neonatology/maturity": "/catalog/neonatology-maturity.json",
    "endocrine-metabolic/completion": "/catalog/endocrine-metabolic-completion-audit.json",
    "endocrine-metabolic/quality": "/catalog/endocrine-metabolic-quality-audit.json",
    "endocrine-metabolic/maturity": "/catalog/endocrine-metabolic-maturity.json",
    "renal-electrolyte/completion": "/catalog/renal-electrolyte-completion-audit.json",
    "renal-electrolyte/quality": "/catalog/renal-electrolyte-quality-audit.json",
    "renal-electrolyte/maturity": "/catalog/renal-electrolyte-maturity.json",
    "infectious-disease/completion": "/catalog/infectious-disease-completion-audit.json",
    "infectious-disease/quality": "/catalog/infectious-disease-quality-audit.json",
    "infectious-disease/maturity": "/catalog/infectious-disease-maturity.json",
    "medical-surgical-nursing/completion": "/catalog/medical-surgical-nursing-completion-audit.json",
    "medical-surgical-nursing/quality": "/catalog/medical-surgical-nursing-quality-audit.json",
    "medical-surgical-nursing/maturity": "/catalog/medical-surgical-nursing-maturity.json",
    "oncology/completion": "/catalog/oncology-completion-audit.json",
    "oncology/quality": "/catalog/oncology-quality-audit.json",
    "oncology/maturity": "/catalog/oncology-maturity.json",
    "surgery-trauma/completion": "/catalog/surgery-trauma-completion-audit.json",
    "surgery-trauma/quality": "/catalog/surgery-trauma-quality-audit.json",
    "surgery-trauma/maturity": "/catalog/surgery-trauma-maturity.json"
  }
}