搜索结果：Patient preference and adherence

Chronic diseases constitute the principal burden of morbidity, mortality, and healthcare costs worldwide, yet current health systems remain fragmented and predominantly reactive. Patient Medical Digital Twins (PMDTs) offer a paradigm shift: holistic, continuously updated digital counterparts of patients that integrate clinical, genomic, lifestyle, and quality-of-life data. We report early implementations of PMDTs via ontology-driven modeling and federated analytics pilots. Insights from the QUALITOP oncology study and a distributed AI platform confirm both feasibility and challenges: aligning with HL7 FHIR and OMOP standards, embedding privacy governance, scaling federated queries, and designing intuitive clinician interfaces. We also highlight technical gains, such as automated reasoning over multimodal blueprints and predictive analytics for patient outcomes. By reflecting on these experiences, we outline actionable insights for software engineers and identify opportunities, such as DSLs and model-driven engineering, to advance PMDTs toward trustworthy, adaptive chronic care ecosystems.

Motivation: Patient-generated text contains critical information on patients' lived experiences, social context, and care engagement, but remains largely unstructured, limiting its use in patient-centered outcomes research. Prior work introduced the PV-Miner benchmark and PVMinerLLM models for structured extraction. However, supervised fine-tuning (SFT) alone struggles with rare, fine-grained, and unevenly distributed errors, particularly in token-critical structured outputs. Results: We present PVminerLLM2, an improved set of LLMs for structured patient voice extraction that applies preference optimization to address token-critical errors beyond the reach of supervised fine-tuning. Our method introduces (i) a preference objective with token-level gated stabilization term that prevents degradation of absolute token likelihood under preference optimization, and (ii) confusion-aware preference pair construction to better capture low-separation distinctions. We further incorporate token-importance weighting and inverse-frequency reweighing to address token imbalance and class skew. Across multiple model sizes, PVMinerLLM2 consistently outperforms strong baselines, achieving gains of u

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM mo

Multi-modal large language models (MLLMs) have achieved remarkable success on complex multi-modal tasks. However, it remains insufficiently explored whether they exhibit $\textbf{modality preference}$, a tendency to favor one modality over another when processing multi-modal contexts. To study this question, we introduce $\textbf{MC\textsuperscript{2}}$ benchmark, which constructs controlled evidence-conflict scenarios to systematically evaluate modality preference in decision-making. Extensive experiments reveal that all 20 tested MLLMs generally demonstrate clear modality preferences, and such preferences can serve as a useful indicator of downstream task performance of MLLMs. Further analysis shows that modality preference can be controlled by instruction guidance and captured within the latent representations of MLLMs. Built on these insights, we propose a probing and steering method based on representation engineering to explicitly control modality preference without requiring additional fine-tuning. This method effectively amplifies modality preference toward a desired direction and demonstrates promising improvements across multiple multi-modal understanding and reasoning ta

Language models serve as proxies for human preference judgements in alignment and evaluation, yet they exhibit systematic miscalibration, prioritizing superficial patterns over substantive qualities. This bias manifests as overreliance on features like length, structure, and style, leading to issues like reward hacking and unreliable evaluations. However, the connection between training data artifacts and the miscalibrated preferences exhibited by models remains poorly understood. In this work, we systematically investigate the relationship between training data biases and preference model miscalibration across five idiosyncratic features of language model generations: length, structure, jargon, sycophancy and vagueness. Using controlled counterfactual pairs, we first quantify the extent to which preference models favor responses with artificially magnified biases (skew), finding this preference occurs in $>60\%$ of instances, and model preferences show high miscalibration ($\approx 40\%$) compared to human preferences. Notably, bias features only show mild negative correlations to human preference labels (mean $r_{\mathrm{human}} = -0.12$) but show moderately strong positive co

Heart failure (HF) treatment relies heavily on pharmacotherapy, particularly combining multiple therapies as recommended by clinical guidelines. However, non-adherence to prescribed regimens remains a significant challenge, contributing to increased hospitalizations and poorer patient outcomes. This study introduces a novel methodological pipeline that integrates Latent Markov Models (LMM) with dynamic adherence modeling to evaluate adherence behaviors and their impact on HF rehospitalization. Using administrative healthcare data from Lombardy, Italy, we analyzed 6,818 patients hospitalized for HF between July and December 2020. Adherence was assessed monthly over a six-month observation period, and adherence profiles were linked to clinical outcomes using Cox regression. Seven latent behavioral profiles were identified, reflecting varying levels and trajectories of adherence. The findings revealed that higher adherence levels significantly reduced the risk of rehospitalization. Patients with consistently high adherence exhibited a 56% lower risk of HF rehospitalization compared to those with low adherence. Importantly, improving adherence during the observation period was associat

The discharge summary is a one of critical documents in the patient journey, encompassing all events experienced during hospitalization, including multiple visits, medications, tests, surgery/procedures, and admissions/discharge. Providing a summary of the patient's progress is crucial, as it significantly influences future care and planning. Consequently, clinicians face the laborious and resource-intensive task of manually collecting, organizing, and combining all the necessary data for a discharge summary. Therefore, we propose "NOTE", which stands for "Notable generation Of patient Text summaries through an Efficient approach based on direct preference optimization". NOTE is based on Medical Information Mart for Intensive Care- III dataset and summarizes a single hospitalization of a patient. Patient events are sequentially combined and used to generate a discharge summary for each hospitalization. In the present circumstances, large language models' application programming interfaces (LLMs' APIs) are widely available, but importing and exporting medical data presents significant challenges due to privacy protection policies in healthcare institutions. Moreover, to ensure optim

Objective: Subcutaneous Immunotherapy (SCIT) is the long-lasting causal treatment of allergic rhinitis (AR). How to enhance the adherence of patients to maximize the benefit of allergen immunotherapy (AIT) plays a crucial role in the management of AIT. This study aims to leverage novel machine learning models to precisely predict the risk of non-adherence of AR patients and related local symptom scores in three years SCIT. Methods: The research develops and analyzes two models, sequential latent-variable model (SLVM) of Stochastic Latent Actor-Critic (SLAC) and Long Short-Term Memory (LSTM) evaluating them based on scoring and adherence prediction capabilities. Results: Excluding the biased samples at the first time step, the predictive adherence accuracy of the SLAC models is from 60\% to 72\%, and for LSTM models, it is 66\% to 84\%, varying according to the time steps. The range of Root Mean Square Error (RMSE) for SLAC models is between 0.93 and 2.22, while for LSTM models it is between 1.09 and 1.77. Notably, these RMSEs are significantly lower than the random prediction error of 4.55. Conclusion: We creatively apply sequential models in the long-term management of SCIT with p

Preference elicitation leverages AI or optimization to learn stakeholder preferences in settings ranging from marketing to public policy. The online robust preference elicitation procedure of arXiv:2003.01899 has been shown in simulation to outperform various other elicitation procedures in terms of effectively learning individuals' true utilities. However, as with any simulation, the method makes a series of assumptions that cannot easily be verified to hold true beyond simulation. Thus, we propose to validate the robust method's performance using real users, focusing on the particular challenge of selecting policies for prioritizing COVID-19 patients for scarce hospital resources during the pandemic. To this end, we develop an online platform for preference elicitation where users report their preferences between alternatives over a moderate number of pairwise comparisons chosen by a particular elicitation procedure. We recruit 193 Amazon Mechanical Turk (MTurk) workers to report their preferences and demonstrate that the robust method outperforms asking random queries by 21%, the next best performing method in the simulated results of arXiv:2003.01899, in terms of recommending p

Patient similarity computation (PSC) is a fundamental problem in healthcare informatics. The aim of the patient similarity computation is to measure the similarity among patients according to their historical clinical records, which helps to improve clinical decision support. This paper presents a novel distributed patient similarity computation (DPSC) technique based on data transformation (DT) methods, utilizing an effective combination of time series and static data. Time series data are sensor-collected patients' information, including metrics like heart rate, blood pressure, Oxygen saturation, respiration, etc. The static data are mainly patient background and demographic data, including age, weight, height, gender, etc. Static data has been used for clustering the patients. Before feeding the static data to the machine learning model adaptive Weight-of-Evidence (aWOE) and Z-score data transformation (DT) methods have been performed, which improve the prediction performances. In aWOE-based patient similarity models, sensitive patient information has been processed using aWOE which preserves the data privacy of the trained models. We used the Dynamic Time Warping (DTW) approach

A critical challenge facing clinicians managing chronic disease interventions is sustaining long-run patient health given limited information and resources. Digital therapeutics (DTs) provide a cost-effective way to manage interventions at scale through repeated interactions (e.g. daily treatment recommendations), but patient success is highly dependent on their adherence. Behavioral psychology suggests that both treatment recommendations and past adherence affect future adherence, yet existing decision support frameworks for DTs model only recommendation effects or treat adherence as exogenous context, leaving a key gap in model and algorithm development. To address this gap, we present a DT decision support framework that captures both recommendation and adherence effects, allowing clinicians to better plan treatment recommendations. We model a patient's time-varying capacity for engagement with treatment using a linear dynamical system (LDS) that captures both recommendation and adherence effects, endogenously connected to adherence behavior with a logit link. We establish finite-time identification guarantees for this model, extending LDS results to our setting. Next, we propos

Liver tumor segmentation and classification are important tasks in computer aided diagnosis. We aim to address three problems: liver tumor screening and preliminary diagnosis in non-contrast computed tomography (CT), and differential diagnosis in dynamic contrast-enhanced CT. A novel framework named Pixel-Lesion-pAtient Network (PLAN) is proposed. It uses a mask transformer to jointly segment and classify each lesion with improved anchor queries and a foreground-enhanced sampling loss. It also has an image-wise classifier to effectively aggregate global information and predict patient-level diagnosis. A large-scale multi-phase dataset is collected containing 939 tumor patients and 810 normal subjects. 4010 tumor instances of eight types are extensively annotated. On the non-contrast tumor screening task, PLAN achieves 95% and 96% in patient-level sensitivity and specificity. On contrast-enhanced CT, our lesion-level detection precision, recall, and classification accuracy are 92%, 89%, and 86%, outperforming widely used CNN and transformers for lesion segmentation. We also conduct a reader study on a holdout set of 250 cases. PLAN is on par with a senior human radiologist, showing

Intermediate Respiratory Care Units (IRCUs) are vital during crises like COVID-19. This study evaluated clinical outcomes and operational dynamics of a new Spanish IRCU with specialized staffing. A prospective cohort study (April-August 2021) included 249 adult patients with COVID-19 respiratory failure (UHVN IRCU, Granada). Data on demographics, Non-Invasive Ventilation (NIV), length of stay (LOS), and outcomes (ICU transfer, exitus, recovery) were analyzed. Patient flow was simulated using a data-calibrated deterministic compartmental model (Ordinary Differential Equations, ODEs) that represented state transitions, and an empirical LOS-based stochastic convolution model that incorporated admission variability. The median age was 51; 31% of patients required NIV. NIV patients were older (median 61 vs 42, p<0.001). Overall, 8% needed ICU transfer; 3% experienced in-IRCU exitus. Notably, no ICU transfers or deaths occurred among 172 non-NIV patients. Of 77 high-risk NIV patients, 68% recovered in IRCU without ICU escalation. The ODE model, based on transition rates between patient states, reflected aggregate outcomes. Both modeling approaches demonstrated system strain during adm

Medication adherence is of utmost importance for many chronic conditions, regardless of the disease type. Engaging patients in self-tracking their medication is a big challenge. One way to potentially reduce this burden is to use reminders to promote wellness throughout all stages of life and improve medication adherence. Chatbots have proven effectiveness in triggering users to engage in certain activity, such as medication adherence. In this paper, we discuss "Roborto", a chatbot to create an engaging interactive and intelligent environment for patients and assist in positive lifestyle modification. We introduce a way for healthcare providers to track patients adherence and intervene whenever necessary. We describe the health, technical and behavioural approaches to the problem of medication non-adherence and propose a diagnostic and decision support tool. The proposed study will be implemented and validated through a pilot experiment with users to measure the efficacy of the proposed approach.

Ride-hailing platforms frequently face spatiotemporal supply-demand imbalances caused by uneven passenger demand and decentralized driver decision-making. Existing vehicle rebalancing methods typically assume drivers always follow repositioning recommendations or model adherence using static probabilities. In practice, adherence evolves through repeated interactions with the platform. We propose the Adherence-Aware Vehicle Rebalancing (AAVR) model, which generates simultaneous fleet-wide repositioning recommendations while explicitly accounting for driver preferences and dynamically evolving adherence. The resulting optimization problem is computationally intractable, so we derive a tractable upper-bound reformulation that enables real-time recommendation generation for large-scale systems. Simulations on the NYC taxi dataset under dynamic adherence updates show that AAVR consistently outperforms state-of-the-art methods, improving served demand by 26.72%, reducing passenger waiting time by 26.45%, increasing platform and driver profits by 25.90% and 28.75%, respectively, and improving fleet adherence by 30.06%. These results demonstrate that modeling evolving driver adherence impr

Personalization and contextual coherence are two essential components in building effective persona-grounded dialogue systems. These aspects play a crucial role in enhancing user engagement and ensuring responses are more relevant and consistent with user identity. However, recent studies indicate that open-source large language models (LLMs) continue to struggle to generate responses that are both contextually grounded and aligned with persona cues, despite exhibiting strong general conversational abilities like fluency and naturalness. We present PersoDPO, a scalable preference optimisation framework that uses supervision signals from automatic evaluations of responses generated by both closed-source and open-source LLMs to fine-tune dialogue models. The framework integrates evaluation metrics targeting coherence and personalization, along with a length-format compliance feature to promote instruction adherence. These signals are combined to automatically construct high-quality preference pairs without manual annotation, enabling a scalable and reproducible training pipeline. Experiments on the FoCus dataset show that an open-source language model fine-tuned with the PersoDPO fra

Tuberculosis (TB), an infectious bacterial disease, is a significant cause of death, especially in low-income countries, with an estimated ten million new cases reported globally in $2020$. While TB is treatable, non-adherence to the medication regimen is a significant cause of morbidity and mortality. Thus, proactively identifying patients at risk of dropping off their medication regimen enables corrective measures to mitigate adverse outcomes. Using a proxy measure of extreme non-adherence and a dataset of nearly $700,000$ patients from four states in India, we formulate and solve the machine learning (ML) problem of early prediction of non-adherence based on a custom rank-based metric. We train ML models and evaluate against baselines, achieving a $\sim 100\%$ lift over rule-based baselines and $\sim 214\%$ over a random classifier, taking into account country-wide large-scale future deployment. We deal with various issues in the process, including data quality, high-cardinality categorical data, low target prevalence, distribution shift, variation across cohorts, algorithmic fairness, and the need for robustness and explainability. Our findings indicate that risk stratification

In this paper, we use the adherence semigroup to describe finite-sums configurations in topological dynamical systems. We establish a correspondence between exact finite sumsets and powers of adherence elements. As applications, we give dynamical formulations of density finite-sums results, characterize total minimality through the density of adherence-power orbits, and give a positive answer to the ultrafilter question in [Question~8.9, 6]. We also characterize the sets that belong to the common sum of two commuting nonprincipal ultrafilters.

Mental health communication in India is linguistically fragmented, culturally diverse, and often underrepresented in clinical NLP. Current health ontologies and mental health resources are dominated by diagnostic frameworks centered on English or Western culture, leaving a gap in representing patient distress expressions in Indian languages. We propose cross-linguistic graphs of patient stress expressions (CL-PDE), a framework for building cross-lingual mental health ontologies through graph-based methods that capture culturally embedded expressions of distress, align them across languages, and link them with clinical terminology. Our approach addresses critical gaps in healthcare communication by grounding AI systems in culturally valid representations, allowing more inclusive and patient-centric NLP tools for mental health care in multilingual contexts.