Oumaima El Khettari

Oumaima El Khettari, Virgile Barthet, Guillaume Hocquet et al.

Accurate short-term mortality prediction in heart failure (HF) remains challenging, particularly when relying on structured electronic health record (EHR) data alone. We evaluate transformer-based models on a French HF cohort, comparing text-only, structured-only, multimodal, and LLM-based approaches. Our results show that enriching clinical text with entity-level representations improves prediction over CLS embeddings alone, and that supervised multimodal fusion of text and structured variables achieves the best overall performance. In contrast, large language models perform inconsistently across modalities and decoding strategies, with text-only prompts outperforming structured or multimodal inputs. These findings highlight that entity-aware multimodal transformers offer the most reliable solution for short-term HF outcome prediction, while current LLM prompting remains limited for clinical decision support.

Ikram Belmadani, Oumaima El Khettari, Carlos Ramisch et al.

The development of large language models (LLMs) has led to an increased focus on their adaptation to specialized domains and languages, yet the effectiveness of domain adaptation strategies remains unclear. We present a study of medical domain adaptation using French medical question-answering (QA) as a case study. We compare continual pretraining (CPT), supervised fine-tuning (SFT), and their combination across three model families, multiple sizes, and three initialization types, explicitly disentangling adaptation effects from base model choice. We evaluate both multiple-choice (MCQA) and open-ended QA (OEQA) under greedy and constrained decoding using automatic metrics and LLM-as-a-Judge evaluation. For MCQA, CPT+SFT most often achieves the best scores, but gains over SFT are small and frequently not statistically significant, making SFT a strong and cost-effective default. For OEQA, CPT consistently improves overlap-based metrics, while SFT often degrades generation quality; instruction tuning and CPT+SFT are preferred by LLM-based evaluation. Cross-lingual experiments further show effective transfer from French adaptation to English benchmarks. Overall, we provide practical guidelines for selecting adaptation strategies under computational constraints.