IntelliCare: Improving Healthcare Analysis with Variance-Controlled Patient-Level Knowledge from Large Language Models

While pioneering deep learning methods have made great strides in analyzing electronic health record (EHR) data, they often struggle to fully capture the semantics of diverse medical codes from limited data. The integration of external knowledge from Large Language Models (LLMs) presents a promising avenue for improving healthcare predictions. However, LLM analyses may exhibit significant variance due to ambiguity problems and inconsistency issues, hindering their effective utilization. To address these challenges, we propose IntelliCare, a novel framework that leverages LLMs to provide high-quality patient-level external knowledge and enhance existing EHR models. Concretely, IntelliCare identifies patient cohorts and employs task-relevant statistical information to augment LLM understanding and generation, effectively mitigating the ambiguity problem. Additionally, it refines LLM-derived knowledge through a hybrid approach, generating multiple analyses and calibrating them using both the EHR model and perplexity measures. Experimental evaluations on three clinical prediction tasks across two large-scale EHR datasets demonstrate that IntelliCare delivers significant performance improvements to existing methods, highlighting its potential in advancing personalized healthcare predictions and decision support systems.

KnowPO: Knowledge-aware Preference Optimization for Controllable Knowledge Selection in Retrieval-Augmented Language Models

By integrating external knowledge, Retrieval-Augmented Generation (RAG) has become an effective strategy for mitigating the hallucination problems that large language models (LLMs) encounter when dealing with knowledge-intensive tasks. However, in the process of integrating external non-parametric supporting evidence with internal parametric knowledge, inevitable knowledge conflicts may arise, leading to confusion in the model's responses. To enhance the knowledge selection of LLMs in various contexts, some research has focused on refining their behavior patterns through instruction-tuning. Nonetheless, due to the absence of explicit negative signals and comparative objectives, models fine-tuned in this manner may still exhibit undesirable behaviors such as contextual ignorance and contextual overinclusion. To this end, we propose a Knowledge-aware Preference Optimization strategy, dubbed KnowPO, aimed at achieving adaptive knowledge selection based on contextual relevance in real retrieval scenarios. Concretely, we proposed a general paradigm for constructing knowledge conflict datasets, which comprehensively cover various error types and learn how to avoid these negative signals through preference optimization methods. Simultaneously, we proposed a rewriting strategy and data ratio optimization strategy to address preference imbalances. Experimental results show that KnowPO outperforms previous methods for handling knowledge conflicts by over 37\%, while also exhibiting robust generalization across various out-of-distribution datasets.

TC-RAG:Turing-Complete RAG's Case study on Medical LLM Systems

In the pursuit of enhancing domain-specific Large Language Models (LLMs), Retrieval-Augmented Generation (RAG) emerges as a promising solution to mitigate issues such as hallucinations, outdated knowledge, and limited expertise in highly specialized queries. However, existing approaches to RAG fall short by neglecting system state variables, which are crucial for ensuring adaptive control, retrieval halting, and system convergence. In this paper, we introduce the TC-RAG through rigorous proof, a novel framework that addresses these challenges by incorporating a Turing Complete System to manage state variables, thereby enabling more efficient and accurate knowledge retrieval. By leveraging a memory stack system with adaptive retrieval, reasoning, and planning capabilities, TC-RAG not only ensures the controlled halting of retrieval processes but also mitigates the accumulation of erroneous knowledge via Push and Pop actions. In the case study of the medical domain, our extensive experiments on real-world healthcare datasets demonstrate the superiority of TC-RAG over existing methods in accuracy by over 7.20\%. Our dataset and code have been available at https://https://github.com/Artessay/SAMA.git.

KaPO: Knowledge-aware Preference Optimization for Controllable Knowledge Selection in Retrieval-Augmented Language Models

By integrating external knowledge, Retrieval-Augmented Generation (RAG) has become an effective strategy for mitigating the hallucination problems that large language models (LLMs) encounter when dealing with knowledge-intensive tasks. However, in the process of integrating external non-parametric supporting evidence with internal parametric knowledge, inevitable knowledge conflicts may arise, leading to confusion in the model's responses. To enhance the knowledge selection of LLMs in various contexts, some research has focused on refining their behavior patterns through instruction-tuning. Nonetheless, due to the absence of explicit negative signals and comparative objectives, models fine-tuned in this manner may still exhibit undesirable behaviors in the intricate and realistic retrieval scenarios. To this end, we propose a Knowledge-aware Preference Optimization, dubbed KaPO, aimed at achieving controllable knowledge selection in real retrieval scenarios. Concretely, we explore and simulate error types across diverse context combinations and learn how to avoid these negative signals through preference optimization methods. Simultaneously, by adjusting the balance between response length and the proportion of preference data representing different behavior patterns, we enhance the adherence capabilities and noise robustness of LLMs in a balanced manner. Experimental results show that KaPO outperforms previous methods for handling knowledge conflicts by over 37%, while also exhibiting robust generalization across various out-of-distribution datasets.

Is larger always better? Evaluating and prompting large language models for non-generative medical tasks

The use of Large Language Models (LLMs) in medicine is growing, but their ability to handle both structured Electronic Health Record (EHR) data and unstructured clinical notes is not well-studied. This study benchmarks various models, including GPT-based LLMs, BERT-based models, and traditional clinical predictive models, for non-generative medical tasks utilizing renowned datasets. We assessed 14 language models (9 GPT-based and 5 BERT-based) and 7 traditional predictive models using the MIMIC dataset (ICU patient records) and the TJH dataset (early COVID-19 EHR data), focusing on tasks such as mortality and readmission prediction, disease hierarchy reconstruction, and biomedical sentence matching, comparing both zero-shot and finetuned performance. Results indicated that LLMs exhibited robust zero-shot predictive capabilities on structured EHR data when using well-designed prompting strategies, frequently surpassing traditional models. However, for unstructured medical texts, LLMs did not outperform finetuned BERT models, which excelled in both supervised and unsupervised tasks. Consequently, while LLMs are effective for zero-shot learning on structured data, finetuned BERT models are more suitable for unstructured texts, underscoring the importance of selecting models based on specific task requirements and data characteristics to optimize the application of NLP technology in healthcare.

Adaptive Activation Steering: A Tuning-Free LLM Truthfulness Improvement Method for Diverse Hallucinations Categories

Recent studies have indicated that Large Language Models (LLMs) harbor an inherent understanding of truthfulness, yet often fail to express fully and generate false statements. This gap between "knowing" and "telling" poses a challenge for ensuring the truthfulness of generated content. To address this, we introduce Adaptive Activation Steering (ACT), a tuning-free method that adaptively shift LLM's activations in "truthful" direction during inference. ACT addresses diverse categories of hallucinations by utilizing diverse steering vectors and adjusting the steering intensity adaptively. Applied as an add-on across various models, ACT significantly improves truthfulness in LLaMA ($\uparrow$ 142\%), LLaMA2 ($\uparrow$ 24\%), Alpaca ($\uparrow$ 36\%), Vicuna ($\uparrow$ 28\%), and LLaMA2-Chat ($\uparrow$ 19\%). Furthermore, we verify ACT's scalability across larger models (13B, 33B, 65B), underscoring the adaptability of ACT to large-scale language models.

SMART: Towards Pre-trained Missing-Aware Model for Patient Health Status Prediction

Electronic health record (EHR) data has emerged as a valuable resource for analyzing patient health status. However, the prevalence of missing data in EHR poses significant challenges to existing methods, leading to spurious correlations and suboptimal predictions. While various imputation techniques have been developed to address this issue, they often obsess unnecessary details and may introduce additional noise when making clinical predictions. To tackle this problem, we propose SMART, a Self-Supervised Missing-Aware RepresenTation Learning approach for patient health status prediction, which encodes missing information via elaborated attentions and learns to impute missing values through a novel self-supervised pre-training approach that reconstructs missing data representations in the latent space. By adopting missing-aware attentions and focusing on learning higher-order representations, SMART promotes better generalization and robustness to missing data. We validate the effectiveness of SMART through extensive experiments on six EHR tasks, demonstrating its superiority over state-of-the-art methods.

LoRA Dropout as a Sparsity Regularizer for Overfitting Control

Parameter-efficient fine-tuning methods, represented by LoRA, play an essential role in adapting large-scale pre-trained models to downstream tasks. However, fine-tuning LoRA-series models also faces the risk of overfitting on the training dataset, and yet there's still a lack of theoretical guidance and practical mechanism to control overfitting on LoRA-based PEFT methods. In this paper, we propose a LoRA Dropout mechanism for the LoRA-based methods by introducing random noises to the learnable low-rank matrices and increasing parameter sparsity. We then demonstrate the theoretical mechanism of our LoRA Dropout mechanism from the perspective of sparsity regularization by providing a generalization error bound under this framework. Theoretical results show that appropriate sparsity would help tighten the gap between empirical and generalization risks and thereby control overfitting. Furthermore, based on the LoRA Dropout framework, we introduce a test-time ensemble strategy and provide theoretical evidence demonstrating that the ensemble method can further compress the error bound, and lead to better performance during inference time. Extensive experiments on various NLP tasks provide practical validations of the effectiveness of our LoRA Dropout framework in improving model accuracy and calibration.

LightM-UNet: Mamba Assists in Lightweight UNet for Medical Image Segmentation

UNet and its variants have been widely used in medical image segmentation. However, these models, especially those based on Transformer architectures, pose challenges due to their large number of parameters and computational loads, making them unsuitable for mobile health applications. Recently, State Space Models (SSMs), exemplified by Mamba, have emerged as competitive alternatives to CNN and Transformer architectures. Building upon this, we employ Mamba as a lightweight substitute for CNN and Transformer within UNet, aiming at tackling challenges stemming from computational resource limitations in real medical settings. To this end, we introduce the Lightweight Mamba UNet (LightM-UNet) that integrates Mamba and UNet in a lightweight framework. Specifically, LightM-UNet leverages the Residual Vision Mamba Layer in a pure Mamba fashion to extract deep semantic features and model long-range spatial dependencies, with linear computational complexity. Extensive experiments conducted on two real-world 2D/3D datasets demonstrate that LightM-UNet surpasses existing state-of-the-art literature. Notably, when compared to the renowned nnU-Net, LightM-UNet achieves superior segmentation performance while drastically reducing parameter and computation costs by 116x and 21x, respectively. This highlights the potential of Mamba in facilitating model lightweighting. Our code implementation is publicly available at https://github.com/MrBlankness/LightM-UNet.

Learnable Prompt as Pseudo-Imputation: Reassessing the Necessity of Traditional EHR Data Imputation in Downstream Clinical Prediction

Analyzing the health status of patients based on Electronic Health Records (EHR) is a fundamental research problem in medical informatics. The presence of extensive missing values in EHR makes it challenging for deep neural networks to directly model the patient's health status based on EHR. Existing deep learning training protocols require the use of statistical information or imputation models to reconstruct missing values; however, the protocols inject non-realistic data into downstream EHR analysis models, significantly limiting model performance. This paper introduces Learnable Prompt as Pseudo Imputation (PAI) as a new training protocol. PAI no longer introduces any imputed data but constructs a learnable prompt to model the implicit preferences of the downstream model for missing values, resulting in a significant performance improvement for all EHR analysis models. Additionally, our experiments show that PAI exhibits higher robustness in situations of data insufficiency and high missing rates. More importantly, in a real-world application involving cross-institutional data with zero-shot evaluation, PAI demonstrates stronger model generalization capabilities for non-overlapping features.