Reverse Image Retrieval Cues Parametric Memory in Multimodal LLMs

Despite impressive advances in recent multimodal large language models (MLLMs), state-of-the-art models such as from the GPT-4 suite still struggle with knowledge-intensive tasks. To address this, we consider Reverse Image Retrieval (RIR) augmented generation, a simple yet effective strategy to augment MLLMs with web-scale reverse image search results. RIR robustly improves knowledge-intensive visual question answering (VQA) of GPT-4V by 37-43%, GPT-4 Turbo by 25-27%, and GPT-4o by 18-20% in terms of open-ended VQA evaluation metrics. To our surprise, we discover that RIR helps the model to better access its own world knowledge. Concretely, our experiments suggest that RIR augmentation helps by providing further visual and textual cues without necessarily containing the direct answer to a query. In addition, we elucidate cases in which RIR can hurt performance and conduct a human evaluation. Finally, we find that the overall advantage of using RIR makes it difficult for an agent that can choose to use RIR to perform better than an approach where RIR is the default setting.

Almanac Copilot: Towards Autonomous Electronic Health Record Navigation

Clinicians spend large amounts of time on clinical documentation, and inefficiencies impact quality of care and increase clinician burnout. Despite the promise of electronic medical records (EMR), the transition from paper-based records has been negatively associated with clinician wellness, in part due to poor user experience, increased burden of documentation, and alert fatigue. In this study, we present Almanac Copilot, an autonomous agent capable of assisting clinicians with EMR-specific tasks such as information retrieval and order placement. On EHR-QA, a synthetic evaluation dataset of 300 common EHR queries based on real patient data, Almanac Copilot obtains a successful task completion rate of 74% (n = 221 tasks) with a mean score of 2.45 over 3 (95% CI:2.34-2.56). By automating routine tasks and streamlining the documentation process, our findings highlight the significant potential of autonomous agents to mitigate the cognitive load imposed on clinicians by current EMR systems.

AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments

Diagnosing and managing a patient is a complex, sequential decision making process that requires physicians to obtain information -- such as which tests to perform -- and to act upon it. Recent advances in artificial intelligence (AI) and large language models (LLMs) promise to profoundly impact clinical care. However, current evaluation schemes overrely on static medical question-answering benchmarks, falling short on interactive decision-making that is required in real-life clinical work. Here, we present AgentClinic: a multimodal benchmark to evaluate LLMs in their ability to operate as agents in simulated clinical environments. In our benchmark, the doctor agent must uncover the patient's diagnosis through dialogue and active data collection. We present two open benchmarks: a multimodal image and dialogue environment, AgentClinic-NEJM, and a dialogue-only environment, AgentClinic-MedQA. We embed cognitive and implicit biases both in patient and doctor agents to emulate realistic interactions between biased agents. We find that introducing bias leads to large reductions in diagnostic accuracy of the doctor agents, as well as reduced compliance, confidence, and follow-up consultation willingness in patient agents. Evaluating a suite of state-of-the-art LLMs, we find that several models that excel in benchmarks like MedQA are performing poorly in AgentClinic-MedQA. We find that the LLM used in the patient agent is an important factor for performance in the AgentClinic benchmark. We show that both having limited interactions as well as too many interaction reduces diagnostic accuracy in doctor agents. The code and data for this work is publicly available at https://AgentClinic.github.io.

Style-Aware Radiology Report Generation with RadGraph and Few-Shot Prompting

Automatically generated reports from medical images promise to improve the workflow of radiologists. Existing methods consider an image-to-report modeling task by directly generating a fully-fledged report from an image. However, this conflates the content of the report (e.g., findings and their attributes) with its style (e.g., format and choice of words), which can lead to clinically inaccurate reports. To address this, we propose a two-step approach for radiology report generation. First, we extract the content from an image; then, we verbalize the extracted content into a report that matches the style of a specific radiologist. For this, we leverage RadGraph -- a graph representation of reports -- together with large language models (LLMs). In our quantitative evaluations, we find that our approach leads to beneficial performance. Our human evaluation with clinical raters highlights that the AI-generated reports are indistinguishably tailored to the style of individual radiologist despite leveraging only a few examples as context.

Med-Flamingo: a Multimodal Medical Few-shot Learner

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

Zero-shot causal learning

Predicting how different interventions will causally affect a specific individual is important in a variety of domains such as personalized medicine, public policy, and online marketing. However, most existing causal methods cannot generalize to predicting the effects of previously unseen interventions (e.g., a newly invented drug), because they require data for individuals who received the intervention. Here, we consider zero-shot causal learning: predicting the personalized effects of novel, previously unseen interventions. To tackle this problem, we propose CaML, a causal meta-learning framework which formulates the personalized prediction of each intervention's effect as a task. Rather than training a separate model for each intervention, CaML trains as a single meta-model across thousands of tasks, each constructed by sampling an intervention and individuals who either did or did not receive it. By leveraging both intervention information (e.g., a drug's attributes) and individual features (e.g., a patient's history), CaML is able to predict the personalized effects of unseen interventions. Experimental results on real world datasets in large-scale medical claims and cell-line perturbations demonstrate the effectiveness of our approach. Most strikingly, CaML zero-shot predictions outperform even strong baselines which have direct access to data of considered target interventions.

Predicting sepsis in multi-site, multi-national intensive care cohorts using deep learning

Despite decades of clinical research, sepsis remains a global public health crisis with high mortality, and morbidity. Currently, when sepsis is detected and the underlying pathogen is identified, organ damage may have already progressed to irreversible stages. Effective sepsis management is therefore highly time-sensitive. By systematically analysing trends in the plethora of clinical data available in the intensive care unit (ICU), an early prediction of sepsis could lead to earlier pathogen identification, resistance testing, and effective antibiotic and supportive treatment, and thereby become a life-saving measure. Here, we developed and validated a machine learning (ML) system for the prediction of sepsis in the ICU. Our analysis represents the largest multi-national, multi-centre in-ICU study for sepsis prediction using ML to date. Our dataset contains $156,309$ unique ICU admissions, which represent a refined and harmonised subset of five large ICU databases originating from three countries. Using the international consensus definition Sepsis-3, we derived hourly-resolved sepsis label annotations, amounting to $26,734$ ($17.1\%$) septic stays. We compared our approach, a deep self-attention model, to several clinical baselines as well as ML baselines and performed an extensive internal and external validation within and across databases. On average, our model was able to predict sepsis with an AUROC of $0.847 \pm 0.050$ (internal out-of sample validation) and $0.761 \pm 0.052$ (external validation). For a harmonised prevalence of $17\%$, at $80\%$ recall our model detects septic patients with $39\%$ precision 3.7 hours in advance.

Topological Graph Neural Networks

Graph neural networks (GNNs) are a powerful architecture for tackling graph learning tasks, yet have been shown to be oblivious to eminent substructures, such as cycles. We present TOGL, a novel layer that incorporates global topological information of a graph using persistent homology. TOGL can be easily integrated into any type of GNN and is strictly more expressive in terms of the Weisfeiler--Lehman test of isomorphism. Augmenting GNNs with our layer leads to beneficial predictive performance, both on synthetic data sets, which can be trivially classified by humans but not by ordinary GNNs, and on real-world data.

Learning Individualized Treatment Rules with Estimated Translated Inverse Propensity Score

Randomized controlled trials typically analyze the effectiveness of treatments with the goal of making treatment recommendations for patient subgroups. With the advance of electronic health records, a great variety of data has been collected in clinical practice, enabling the evaluation of treatments and treatment policies based on observational data. In this paper, we focus on learning individualized treatment rules (ITRs) to derive a treatment policy that is expected to generate a better outcome for an individual patient. In our framework, we cast ITRs learning as a contextual bandit problem and minimize the expected risk of the treatment policy. We conduct experiments with the proposed framework both in a simulation study and based on a real-world dataset. In the latter case, we apply our proposed method to learn the optimal ITRs for the administration of intravenous (IV) fluids and vasopressors (VP). Based on various offline evaluation methods, we could show that the policy derived in our framework demonstrates better performance compared to both the physicians and other baselines, including a simple treatment prediction approach. As a long-term goal, our derived policy might eventually lead to better clinical guidelines for the administration of IV and VP.

Path Imputation Strategies for Signature Models of Irregular Time Series

The signature transform is a 'universal nonlinearity' on the space of continuous vector-valued paths, and has received attention for use in machine learning on time series. However, real-world temporal data is typically observed at discrete points in time, and must first be transformed into a continuous path before signature techniques can be applied. We make this step explicit by characterising it as an imputation problem, and empirically assess the impact of various imputation strategies when applying signature-based neural nets to irregular time series data. For one of these strategies, Gaussian process (GP) adapters, we propose an extension~(GP-PoM) that makes uncertainty information directly available to the subsequent classifier while at the same time preventing costly Monte-Carlo (MC) sampling. In our experiments, we find that the choice of imputation drastically affects shallow signature models, whereas deeper architectures are more robust. Next, we observe that uncertainty-aware predictions (based on GP-PoM or indicator imputations) are beneficial for predictive performance, even compared to the uncertainty-aware training of conventional GP adapters. In conclusion, we have demonstrated that the path construction is indeed crucial for signature models and that our proposed strategy leads to competitive performance in general, while improving robustness of signature models in particular.