The complexities of patient-centred conversational artificial intelligence

Consumer-facing health chatbots powered by large language models (LLMs) are increasingly used for symptom assessment. However, chatbot development and evaluation often rely on cooperative, articulate, simulated patients. We analysed 2,053 real patient-chatbot conversations and found that communication patterns and expression of emotions vary widely across users. We developed a patient simulator that separately models clinical content, emotional state, conversational strategy, and communication style. In a Turing-inspired evaluation of realism with 15 human graders, simulated conversations were nearly indistinguishable from real ones, with human graders achieving an accuracy of 55%. We used five distinct patient personae, across 1,164 clinician-graded cases, to evaluate the performance of four LLMs in urgency assessment. We found that communication style can significantly alter triage outcomes. Patient-centred conversational artificial intelligence must accommodate communication diversity: systems designed for idealised, rather than realistic, interactions risk underperforming and amplifying health disparities when deployed in the real world.

Quantifying Itch and its Impact on Sleep Using Machine Learning and Radio Signals

Chronic itch affects 13% of the US population, is highly debilitating, and underlies many medical conditions. A major challenge in clinical care and new therapeutics development is the lack of an objective measure for quantifying itch, leading to reliance on subjective measures like patients' self-assessment of itch severity. In this paper, we show that a home radio device paired with artificial intelligence (AI) can concurrently capture scratching and evaluate its impact on sleep quality by analyzing radio signals bouncing in the environment. The device eliminates the need for wearable sensors or skin contact, enabling monitoring of chronic itch over extended periods at home without burdening patients or interfering with their skin condition. To validate the technology, we conducted an observational clinical study of chronic pruritus patients, monitored at home for one month using both the radio device and an infrared camera. Comparing the output of the device to ground truth data from the camera demonstrates its feasibility and accuracy (ROC AUC = 0.997, sensitivity = 0.825, specificity = 0.997). The results reveal a significant correlation between scratching and low sleep quality, manifested as a reduction in sleep efficiency (R = 0.6, p < 0.001) and an increase in sleep latency (R = 0.68, p < 0.001). Our study underscores the potential of passive, long-term, at-home monitoring of chronic scratching and its sleep implications, offering a valuable tool for both clinical care of chronic itch patients and pharmaceutical clinical trials.

Contactless Polysomnography: What Radio Waves Tell Us about Sleep

The ability to assess sleep at home, capture sleep stages, and detect the occurrence of apnea (without on-body sensors) simply by analyzing the radio waves bouncing off people's bodies while they sleep is quite powerful. Such a capability would allow for longitudinal data collection in patients' homes, informing our understanding of sleep and its interaction with various diseases and their therapeutic responses, both in clinical trials and routine care. In this article, we develop an advanced machine learning algorithm for passively monitoring sleep and nocturnal breathing from radio waves reflected off people while asleep. Validation results in comparison with the gold standard (i.e., polysomnography) (n=849) demonstrate that the model captures the sleep hypnogram (with an accuracy of 81% for 30-second epochs categorized into Wake, Light Sleep, Deep Sleep, or REM), detects sleep apnea (AUROC = 0.88), and measures the patient's Apnea-Hypopnea Index (ICC=0.95; 95% CI = [0.93, 0.97]). Notably, the model exhibits equitable performance across race, sex, and age. Moreover, the model uncovers informative interactions between sleep stages and a range of diseases including neurological, psychiatric, cardiovascular, and immunological disorders. These findings not only hold promise for clinical practice and interventional trials but also underscore the significance of sleep as a fundamental component in understanding and managing various diseases.