Ankit Sakhuja

Mohammadreza Ghaffarzadeh-Esfahani, Mahdi Ghaffarzadeh-Esfahani, Arian Salahi-Niri et al.

This study compared the performance of classical feature-based machine learning models (CMLs) and large language models (LLMs) in predicting COVID-19 mortality using high-dimensional tabular data from 9,134 patients across four hospitals. Seven CML models, including XGBoost and random forest (RF), were evaluated alongside eight LLMs, such as GPT-4 and Mistral-7b, which performed zero-shot classification on text-converted structured data. Additionally, Mistral- 7b was fine-tuned using the QLoRA approach. XGBoost and RF demonstrated superior performance among CMLs, achieving F1 scores of 0.87 and 0.83 for internal and external validation, respectively. GPT-4 led the LLM category with an F1 score of 0.43, while fine-tuning Mistral-7b significantly improved its recall from 1% to 79%, yielding a stable F1 score of 0.74 during external validation. Although LLMs showed moderate performance in zero-shot classification, fine-tuning substantially enhanced their effectiveness, potentially bridging the gap with CML models. However, CMLs still outperformed LLMs in handling high-dimensional tabular data tasks. This study highlights the potential of both CMLs and fine-tuned LLMs in medical predictive modeling, while emphasizing the current superiority of CMLs for structured data analysis.

Akhil Vaid, Joshua Lampert, Juhee Lee et al.

Generative Large Language Models (LLMs) hold significant promise in healthcare, demonstrating capabilities such as passing medical licensing exams and providing clinical knowledge. However, their current use as information retrieval tools is limited by challenges like data staleness, resource demands, and occasional generation of incorrect information. This study assessed the potential of LLMs to function as autonomous agents in a simulated tertiary care medical center, using real-world clinical cases across multiple specialties. Both proprietary and open-source LLMs were evaluated, with Retrieval Augmented Generation (RAG) enhancing contextual relevance. Proprietary models, particularly GPT-4, generally outperformed open-source models, showing improved guideline adherence and more accurate responses with RAG. The manual evaluation by expert clinicians was crucial in validating models' outputs, underscoring the importance of human oversight in LLM operation. Further, the study emphasizes Natural Language Programming (NLP) as the appropriate paradigm for modifying model behavior, allowing for precise adjustments through tailored prompts and real-world interactions. This approach highlights the potential of LLMs to significantly enhance and supplement clinical decision-making, while also emphasizing the value of continuous expert involvement and the flexibility of NLP to ensure their reliability and effectiveness in healthcare settings.