Assessing and Mitigating Medical Knowledge Drift and Conflicts in Large Language Models

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice.

Memory-Efficient Sparse Pyramid Attention Networks for Whole Slide Image Analysis

Whole Slide Images (WSIs) are crucial for modern pathological diagnosis, yet their gigapixel-scale resolutions and sparse informative regions pose significant computational challenges. Traditional dense attention mechanisms, widely used in computer vision and natural language processing, are impractical for WSI analysis due to the substantial data scale and the redundant processing of uninformative areas. To address these challenges, we propose Memory-Efficient Sparse Pyramid Attention Networks with Shifted Windows (SPAN), drawing inspiration from state-of-the-art sparse attention techniques in other domains. SPAN introduces a sparse pyramid attention architecture that hierarchically focuses on informative regions within the WSI, aiming to reduce memory overhead while preserving critical features. Additionally, the incorporation of shifted windows enables the model to capture long-range contextual dependencies essential for accurate classification. We evaluated SPAN on multiple public WSI datasets, observing its competitive performance. Unlike existing methods that often struggle to model spatial and contextual information due to memory constraints, our approach enables the accurate modeling of these crucial features. Our study also highlights the importance of key design elements in attention mechanisms, such as the shifted-window scheme and the hierarchical structure, which contribute substantially to the effectiveness of SPAN in WSI analysis. The potential of SPAN for memory-efficient and effective analysis of WSI data is thus demonstrated, and the code will be made publicly available following the publication of this work.