搜索结果：Expert review of clinical pharmacology

Mixture-of-Experts (MoE) models increase representational capacity with modest computational cost, but their effectiveness in specialized domains such as medicine is limited by small datasets. In contrast, clinical practice offers rich expert knowledge, such as physician gaze patterns and diagnostic heuristics, that models cannot reliably learn from limited data. Combining data-driven experts, which capture novel patterns, with domain-expert-guided experts, which encode accumulated clinical insights, provides complementary strengths for robust and clinically meaningful learning. To this end, we propose Domain-Knowledge-Guided Hybrid MoE (DKGH-MoE), a plug-and-play and interpretable module that unifies data-driven learning with domain expertise. DKGH-MoE integrates a data-driven MoE to extract novel features from raw imaging data, and a domain-expert-guided MoE incorporates clinical priors, specifically clinician eye-gaze cues, to emphasize regions of high diagnostic relevance. By integrating domain expert insights with data-driven features, DKGH-MoE improves both performance and interpretability.

Utilizing Bayesian methods in clinical trials has become increasingly popular, as they can incorporate historical data and expert opinions into the design and allow for smaller sample sizes to reduce costs while providing reliable and robust statistical results. Sample size determination (SSD) is a key aspect of clinical trial design and various methods for Bayesian sample size determination are available. However, it is unclear how these methods are being used in practice. A systematic literature review was conducted to understand how sample sizes for Bayesian randomized clinical trials (RCTs) are determined and inform the design of future Bayesian trials. We searched five databases in May 2023, and updated in January 2025, including efficacy RCTs in humans which utilized a Bayesian framework for the primary data analysis, published in English, and enrolled participants between 2009 and 2024. The literature search produced 19,182 records, of which 105 studies were selected for data extraction. Results show that the most common method for SSD in Bayesian RCTs was a hybrid approach in which elements of Bayesian and frequentist theory are combined. Many RCTs did not provide a justifi

Mild cognitive impairment (MCI) leading to dementia results in a constellation of psychiatric disorders including depression, mood disorders, schizophrenia and others. With increasing age, mild cognitive impairment leads to increased disability-adjusted life-years and healthcare burden. A huge number of drug trials for the treatment of MCI associated with Alzheimer's disease have undergone failure leading to the development of drugs that could avert the progression of the disease. However, some novel non-drug-based therapies like ultrasound ablation of amyloid plaques have influenced researchers to explore the non-pharmacological modalities for the treatment of mild cognitive impairment. To compensate for neurodegenerative loss resulting in coexisting psychiatric disorders, neurofeedback therapy has also been proven to improve behavioural outcomes by inducing neuroplasticity. The aim of the current review is to highlight the pathophysiological aspects of mild cognitive impairment leading to dementia that could be addressed with no pharmacological interventions and to understand the mechanisms behind the effects of these interventions.

Artificial intelligence (AI)-enabled digital interventions, including Generative AI (GenAI) and Human-Centered AI (HCAI), are increasingly used to expand access to digital psychiatry and mental health care. This PRISMA-ScR scoping review maps the landscape of AI-driven mental health (mHealth) technologies across five critical phases: pre-treatment (screening/triage), treatment (therapeutic support), post-treatment (remote patient monitoring), clinical education, and population-level prevention. We synthesized 36 empirical studies implemented through early 2024, focusing on Large Language Models (LLMs), machine learning (ML) models, and autonomous conversational agents. Key use cases involve referral triage, empathic communication enhancement, and AI-assisted psychotherapy delivered via chatbots and voice agents. While benefits include reduced wait times and increased patient engagement, we address recurring challenges like algorithmic bias, data privacy, and human-AI collaboration barriers. By introducing a novel four-pillar framework, this review provides a comprehensive roadmap for AI-augmented mental health care, offering actionable insights for researchers, clinicians, and poli

By increasing model parameters but activating them sparsely when performing a task, the use of Mixture-of-Experts (MoE) architecture significantly improves the performance of Large Language Models (LLMs) without increasing the inference cost. However, the memory consumption due to the growing number of experts presents a challenge to the deployment of these models in many real world settings. Our empirical study reveals that some experts encode redundant knowledge during pre-training. We thus propose a method of grouping and pruning similar experts to improve the model's parameter efficiency. We validate the effectiveness of our method by pruning three state-of-the-art MoE architectures, including Mixtral, Deepseek-MoE, and Qwen. The evaluation shows that our method outperforms other model pruning methods on a range of natural language tasks. We will release our code to facilitate future research.

We introduce SoftTiger, a clinical large language model (CLaM) designed as a foundation model for healthcare workflows. The narrative and unstructured nature of clinical notes is a major obstacle for healthcare intelligentization. We address a critical problem of structuring clinical notes into clinical data, according to international interoperability standards. We collect and annotate data for three subtasks, namely, international patient summary, clinical impression and medical encounter. We then supervised fine-tuned a state-of-the-art LLM using public and credentialed clinical data. The training is orchestrated in a way that the target model can first support basic clinical tasks such as abbreviation expansion and temporal information extraction, and then learn to perform more complex downstream clinical tasks. Moreover, we address several modeling challenges in the healthcare context, e.g., extra long context window. Our blind pairwise evaluation shows that SoftTiger outperforms other popular open-source models and GPT-3.5, comparable to Gemini-pro, with a mild gap from GPT-4. We believe that LLMs may become a step-stone towards healthcare digitalization and democratization.

The competency of any intelligent agent is bounded by its formal account of the world in which it operates. Clinical AI lacks such an account. Existing frameworks address evaluation, regulation, or system design in isolation, without a shared model of the clinical world to connect them. We introduce the Clinical World Model, a framework that formalizes care as a tripartite interaction among Patient, Provider, and Ecosystem. To formalize how any agent, whether human or artificial, transforms information into clinical action, we develop parallel decision-making architectures for providers, patients, and AI agents, grounded in validated principles of clinical cognition. The Clinical AI Skill-Mix operationalizes competency through eight dimensions. Five define the clinical competency space (condition, phase, care setting, provider role, and task) and three specify how AI engages human reasoning (assigned authority, agent facing, and anchoring layer). The combinatorial product of these dimensions yields a space of billions of distinct competency coordinates. A central structural implication is that validation within one coordinate provides minimal evidence for performance in another, re

Modeling a system's temporal behaviour in reaction to external stimuli is a fundamental problem in many areas. Pure Machine Learning (ML) approaches often fail in the small sample regime and cannot provide actionable insights beyond predictions. A promising modification has been to incorporate expert domain knowledge into ML models. The application we consider is predicting the progression of disease under medications, where a plethora of domain knowledge is available from pharmacology. Pharmacological models describe the dynamics of carefully-chosen medically meaningful variables in terms of systems of Ordinary Differential Equations (ODEs). However, these models only describe a limited collection of variables, and these variables are often not observable in clinical environments. To close this gap, we propose the latent hybridisation model (LHM) that integrates a system of expert-designed ODEs with machine-learned Neural ODEs to fully describe the dynamics of the system and to link the expert and latent variables to observable quantities. We evaluated LHM on synthetic data as well as real-world intensive care data of COVID-19 patients. LHM consistently outperforms previous works,

Expert domain writing, such as scientific writing, typically demands extensive domain knowledge. Although large language models (LLMs) show promising potential in this task, evaluating the quality of automatically generated scientific writing is a crucial open issue, as it requires knowledge of domain-specific criteria and the ability to discern expert preferences. Conventional automatic evaluation metrics and LLM-as-a-judge systems, primarily designed for mainstream NLP tasks, are insufficient to grasp expert preferences and domain-specific quality standards. To address this gap and support realistic human-AI collaborative writing, we focus on related work generation, one of the most challenging scientific tasks, as an exemplar. We propose GREP, a multi-turn evaluation framework that integrates classical related work evaluation criteria with expert-specific preferences. GREP decomposes the evaluation into smaller fine-grained dimensions. This localized evaluation is further augmented with contrastive examples to provide detailed contextual guidance for the evaluation dimensions. Empirical investigation reveals that GREP is able to assess the quality of related work sections in a m

This paper is dedicated to the design and evaluation of the first AMR parser tailored for clinical notes. Our objective was to facilitate the precise transformation of the clinical notes into structured AMR expressions, thereby enhancing the interpretability and usability of clinical text data at scale. Leveraging the colon cancer dataset from the Temporal Histories of Your Medical Events (THYME) corpus, we adapted a state-of-the-art AMR parser utilizing continuous training. Our approach incorporates data augmentation techniques to enhance the accuracy of AMR structure predictions. Notably, through this learning strategy, our parser achieved an impressive F1 score of 88% on the THYME corpus's colon cancer dataset. Moreover, our research delved into the efficacy of data required for domain adaptation within the realm of clinical notes, presenting domain adaptation data requirements for AMR parsing. This exploration not only underscores the parser's robust performance but also highlights its potential in facilitating a deeper understanding of clinical narratives through structured semantic representations.

Objective: Integrating EHR data with other resources is essential in rare disease research due to low disease prevalence. Such integration is dependent on the alignment of ontologies used for data annotation. The International Classification of Diseases (ICD) is used to annotate clinical diagnoses; the Human Phenotype Ontology (HPO) to annotate phenotypes. Although these ontologies overlap in biomedical entities described, the extent to which they are interoperable is unknown. We investigate how well aligned these ontologies are and whether such alignments facilitate EHR data integration. Materials and Methods: We conducted an empirical analysis of the coverage of mappings between ICD and HPO. We interpret this mapping coverage as a proxy for how easily clinical data can be integrated with research ontologies such as HPO. We quantify how exhaustively ICD codes are mapped to HPO by analyzing mappings in the UMLS Metathesaurus. We analyze the proportion of ICD codes mapped to HPO within a real-world EHR dataset. Results and Discussion: Our analysis revealed that only 2.2% of ICD codes have direct mappings to HPO in UMLS. Within our EHR dataset, less than 50% of ICD codes have mapping

The large-scale development of large language models (LLMs) in medical contexts, such as diagnostic assistance and treatment recommendations, necessitates that these models possess accurate medical knowledge and deliver traceable decision-making processes. Clinical knowledge, encompassing the insights gained from research on the causes, prognosis, diagnosis, and treatment of diseases, has been extensively examined within real-world medical practices. Recently, there has been a notable increase in research efforts aimed at integrating this type of knowledge into LLMs, encompassing not only traditional text and multimodal data integration but also technologies such as knowledge graphs (KGs) and retrieval-augmented generation (RAG). In this paper, we review the various initiatives to embed clinical knowledge into training-based, KG-supported, and RAG-assisted LLMs. We begin by gathering reliable knowledge sources from the medical domain, including databases and datasets. Next, we evaluate implementations for integrating clinical knowledge through specialized datasets and collaborations with external knowledge sources such as KGs and relevant documentation. Furthermore, we discuss the

Given the large number of publications in software engineering, frequent literature reviews are required to keep current on work in specific areas. One tedious work in literature reviews is to find relevant studies amongst thousands of non-relevant search results. In theory, expert systems can assist in finding relevant work but those systems have primarily been tested in simulations rather than in application to actual literature reviews. Hence, few researchers have faith in such expert systems. Accordingly, using a realistic case study, this paper assesses how well our state-of-the-art expert system can help with literature reviews. The assessed literature review aimed at identifying test case prioritization techniques for automated UI testing, specifically from 8,349 papers on IEEE Xplore. This corpus was studied with an expert system that incorporates an incrementally updated human-in-the-loop active learning tool. Using that expert system, in three hours, we found 242 relevant papers from which we identified 12 techniques representing the state-of-the-art in test case prioritization when source code information is not available. These results were then validated by six other g

Background Concept extraction, a subdomain of natural language processing (NLP) with a focus on extracting concepts of interest, has been adopted to computationally extract clinical information from text for a wide range of applications ranging from clinical decision support to care quality improvement. Objectives In this literature review, we provide a methodology review of clinical concept extraction, aiming to catalog development processes, available methods and tools, and specific considerations when developing clinical concept extraction applications. Methods Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was conducted for retrieving EHR-based information extraction articles written in English and published from January 2009 through June 2019 from Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and the ACM Digital Library. Results A total of 6,686 publications were retrieved. After title and abstract screening, 228 publications were selected. The methods used for developing clinical concept extraction applications were discussed in this review

Introduction: While the origin and evolution of proteins remain mysterious, advances in evolutionary genomics and systems biology are facilitating the historical exploration of the structure, function and organization of proteins and proteomes. Molecular chronologies are series of time events describing the history of biological systems and subsystems and the rise of biological innovations. Together with time-varying networks, these chronologies provide a window into the past. Areas covered: Here, we review molecular chronologies and networks built with modern methods of phylogeny reconstruction. We discuss how chronologies of structural domain families uncover the explosive emergence of metabolism, the late rise of translation, the co-evolution of ribosomal proteins and rRNA, and the late development of the ribosomal exit tunnel; events that coincided with a tendency to shorten folding time. Evolving networks described the early emergence of domains and a late big bang of domain combinations. Expert opinion: Two processes, folding and recruitment appear central to the evolutionary progression. The former increases protein persistence. The later fosters diversity. Chronologically,

This review systematically examines the progression of the You Only Look Once (YOLO) object detection algorithms from YOLOv1 to the recently unveiled YOLOv12. Employing a reverse chronological analysis, this study examines the advancements introduced by YOLO algorithms, beginning with YOLOv12 and progressing through YOLO11 (or YOLOv11), YOLOv10, YOLOv9, YOLOv8, and subsequent versions to explore each version's contributions to enhancing speed, detection accuracy, and computational efficiency in real-time object detection. Additionally, this study reviews the alternative versions derived from YOLO architectural advancements of YOLO-NAS, YOLO-X, YOLO-R, DAMO-YOLO, and Gold-YOLO. Moreover, the study highlights the transformative impact of YOLO models across five critical application areas: autonomous vehicles and traffic safety, healthcare and medical imaging, industrial manufacturing, surveillance and security, and agriculture. By detailing the incremental technological advancements in subsequent YOLO versions, this review chronicles the evolution of YOLO, and discusses the challenges and limitations in each of the earlier versions. The evolution signifies a path towards integrating

Detecting duplicate patient participation in clinical trials is a major challenge because repeated patients can undermine the credibility and accuracy of the trial's findings and result in significant health and financial risks. Developing accurate automated speaker verification (ASV) models is crucial to verify the identity of enrolled individuals and remove duplicates, but the size and quality of data influence ASV performance. However, there has been limited investigation into the factors that can affect ASV capabilities in clinical environments. In this paper, we bridge the gap by conducting analysis of how participant demographic characteristics, audio quality criteria, and severity level of Alzheimer's disease (AD) impact the performance of ASV utilizing a dataset of speech recordings from 659 participants with varying levels of AD, obtained through multiple speech tasks. Our results indicate that ASV performance: 1) is slightly better on male speakers than on female speakers; 2) degrades for individuals who are above 70 years old; 3) is comparatively better for non-native English speakers than for native English speakers; 4) is negatively affected by clinician interference,

Recently natural language processing (NLP) tools have been developed to identify and extract salient risk indicators in electronic health records (EHRs). Sentiment analysis, although widely used in non-medical areas for improving decision making, has been studied minimally in the clinical setting. In this study, we undertook, to our knowledge, the first domain adaptation of sentiment analysis to psychiatric EHRs by defining psychiatric clinical sentiment, performing an annotation project, and evaluating multiple sentence-level sentiment machine learning (ML) models. Results indicate that off-the-shelf sentiment analysis tools fail in identifying clinically positive or negative polarity, and that the definition of clinical sentiment that we provide is learnable with relatively small amounts of training data. This project is an initial step towards further refining sentiment analysis methods for clinical use. Our long-term objective is to incorporate the results of this project as part of a machine learning model that predicts inpatient readmission risk. We hope that this work will initiate a discussion concerning domain adaptation of sentiment analysis to the clinical setting.

In this paper we define Clinical Data Intelligence as the analysis of data generated in the clinical routine with the goal of improving patient care. We define a science of a Clinical Data Intelligence as a data analysis that permits the derivation of scientific, i.e., generalizable and reliable results. We argue that a science of a Clinical Data Intelligence is sensible in the context of a Big Data analysis, i.e., with data from many patients and with complete patient information. We discuss that Clinical Data Intelligence requires the joint efforts of knowledge engineering, information extraction (from textual and other unstructured data), and statistics and statistical machine learning. We describe some of our main results as conjectures and relate them to a recently funded research project involving two major German university hospitals.