Clinical NLP

A key challenge for large language models is token cost per query and overall deployment cost. Clinical inputs are long, heterogeneous, and often redundant, while downstream tasks are short and high stakes. We study budgeted context selection, where a subset of document units is chosen under a strict token budget so an off-the-shelf generator can meet fixed cost and latency constraints. We cast this as a knapsack-constrained subset selection problem with two design choices, unitization that defines document segmentation and selection that determines which units are kept. We propose RCD, a monotone submodular objective that balances relevance, coverage, and diversity. We compare sentence, section, window, and cluster-based unitization, and introduce a routing heuristic that adapts to the budget regime. Experiments on MIMIC discharge notes, Cochrane abstracts, and L-Eval show that optimal strategies depend on the evaluation setting. Positional heuristics perform best at low budgets in extractive tasks, while diversity-aware methods such as MMR improve LLM generation. Selector choice matters more than unitization, with cluster-based grouping reducing performance and other schemes behaving similarly. ROUGE saturates for LLM summaries, while BERTScore better reflects quality differences. We release our code at https://github.com/stone-technologies/ACL_budget_paper.

Text is one of the most common ways to store data in this computerized world. At a glance, it may seem that those data are not interconnected. But in reality, data can have hidden connections. Therefore, in this research, a new model has been presented that can find hidden relationships between two medical concepts by using MetaMap and appropriate text-mining techniques. Specifically, the model creates a new comprehensive index structure and can find cross-document hidden links connecting topics of interest that most existing approaches have ignored. Experiments show the effectiveness of the proposed model in discovering new connections between topics.

How people narrate their experiences offers a window into how the mind organizes them. Computational approaches to therapeutic writing have evolved from lexical counting to neural methods, yet remain fragmented: dictionary tools miss discourse structure, while embeddings conflate local coherence with global organization. No existing framework maps these techniques onto the hierarchical processes through which narratives are constructed. Here we introduce a three-level framework - micro-level lexical features, meso-level semantic embeddings, and macro-level LLM narrative evaluation - and show, across 830 Chinese therapeutic texts spanning depression, anxiety, and trauma, that macro-level evaluation substantially outperforms lexical and embedding features for mental health prediction. This challenges the field's emphasis on word-counting: formal structural features (Labov's story grammar, RST coherence, propositional composition) demonstrate that narrative organization per se carries predictive signal, while clinically-grounded narrative dimensions capture how psychological states are expressed through discourse. Semantic embeddings add minimal independent value but yield incremental gains in multi-level classification. By grounding computational levels in discourse processing theory, this framework identifies macro-structural organization as the primary locus of clinical signal and generates testable hypotheses for intervention design and longitudinal research.

Background: Dutch medical corpora are scarce, limiting NLP development. \ Methods: We translated English datasets, identified medical text in generic corpora, and extracted open Dutch medical resources. \ Results: The resulting corpus comprises $\pm$ 35 billion tokens across the medical domain in about 100 million documents, freely available on Hugging Face. \ Conclusion: This work establishes the first large-scale Dutch medical language corpus for pre-training and downstream NLP tasks.

Depression places substantial pressure on mental health services, and many people describe their experiences outside clinical settings in high-volume user-generated text (e.g., online forums and social media). Automatically identifying clinical symptom evidence in such text can therefore complement limited clinical capacity and scale to large populations. We address this need through sentence-level classification of 21 depression symptoms from the BDI-II questionnaire, using BDI-Sen, a dataset annotated for symptom relevance. This task is fine-grained and highly imbalanced, and we find that common LLM approaches (zero-shot, in-context learning, and fine-tuning) struggle to apply consistent relevance criteria for most symptoms. We propose Symptom Induction (SI), a novel approach which compresses labeled examples into short, interpretable guidelines that specify what counts as evidence for each symptom and uses these guidelines to condition classification. Across four LLM families and eight models, SI achieves the best overall weighted F1 on BDI-Sen, with especially large gains for infrequent symptoms. Cross-domain evaluation on an external dataset further shows that induced guidelines generalize across other diseases shared symptomatology (bipolar and eating disorders).

Clinical framing -- the linguistic manner in which clinical information is presented -- can influence patient understanding and decision-making, with important implications for healthcare outcomes. Obstetrics is a high-stakes domain in which physicians counsel patients on delivery mode choices such as vaginal birth after cesarean (VBAC) and repeat cesarean section (RCS), yet counseling language remains underexplored in large-scale clinical text analysis. In this work, we analyze physician counseling language in 2,024 obstetric history and physical narratives for a rigorously defined cohort of patients for whom both VBAC and RCS were clinically viable options. To control for confounding due to medical contraindications, we first construct a VBAC-eligible cohort using structured clinical data supplemented by a large language model (LLM)-based extraction pipeline constrained to grounded, verbatim evidence from free-text narratives. We then apply a zero-shot LLM framework to categorize counseling segments into predefined framing categories capturing how physicians linguistically present delivery options. Our analysis reveals a significant difference in counseling framing distributions between VBAC and RCS notes; risk-focused language accounts for a substantially larger share of counseling segments in RCS documentation than in VBAC, with category-level differences confirmed by statistical testing, highlighting the value of controlled LLM-based framing analysis in obstetric care.

The rapid increase in scientific publications leads to the fact that manual study screening in systematic literature reviews (SLRs) is increasingly resource consuming, inefficient, and inconsistent. Classifying studies that clearly report health-related quality-of-life results, such as EQ-5D data, requires a high level of clinical interpretation and poses challenges for human reviewers. This study investigates the use of Google's Gemini and Gemma large language models (LLMs) in automating EQ-5D detection in the PubMed biomedical database based only on published abstracts. A multi-phase framework is proposed that integrates few-shot prompting, weight ensembling aggregation, and a soft stacking meta-classifier. Nine LLMs are evaluated on a dataset of PubMed studies manually labeled by two experts regarding EQ-5D reporting. The weighted ensemble of gemini-2.5-pro, gemma-3-12b, and gemma-3-27b obtained a 0.74 weighted F1-score and 0.74 accuracy, exceeding individually attained results. The ensembling of top-performing models improved the balance between precision and recall compared to individual models, while the soft stacking approach provided greater reliability and interpretability. Feature analysis shows that the probability results from the models are important in guiding the final predictions. The findings suggest that an ensemble-based LLM setup is a reliable and scalable approach for automating screening in biomedical research.

Patient-trial matching requires reasoning over long, heterogeneous electronic health records (EHRs) and complex eligibility criteria, posing significant challenges for scalability, generalization, and computational efficiency. Existing approaches either rely on full-document processing with large language models (LLMs), which is computationally expensive, or use traditional machine learning methods that struggle to capture unstructured clinical narratives. In this work, we propose a lightweight framework that combines retrieval-augmented generation and large language model-based modeling for scalable patient-trial matching. The framework explicitly separates two key components: retrieval-augmented generation is used to identify clinically relevant segments from long EHRs, reducing input complexity, while large language models are used to encode these selected segments into informative representations. These representations are further refined through dimensionality reduction and modeled using lightweight predictors, enabling efficient and scalable downstream classification. We evaluate the proposed approach on multiple public benchmarks (n2c2, SIGIR, TREC 2021/2022) and a real-world multimodal dataset from Mayo Clinic (MCPMD). Results show that retrieval-based information selection significantly reduces computational burden while preserving clinically meaningful signals. We further demonstrate that frozen LLMs provide strong representations for structured clinical data, whereas fine-tuning is essential for modeling unstructured clinical narratives. Importantly, the proposed lightweight pipeline achieves performance comparable to end-to-end LLM approaches with substantially lower computational cost.

Protecting patient privacy in clinical narratives is essential for enabling secondary use of healthcare data under regulations such as GDPR and HIPAA. While manual de-identification remains the gold standard, it is costly and slow, motivating the need for automated methods that combine privacy guarantees with high utility. Most automated text de-identification pipelines employed named entity recognition (NER) to identify protected entities for redaction. Although methods based on differential privacy (DP) provide formal privacy guarantees, more recently also large language models (LLMs) are increasingly used for text de-identification in the clinical domain. In this work, we present the first comparative study of DP, NER, and LLMs for Dutch clinical text de-identification. We investigate these methods separately as well as hybrid strategies that apply NER or LLM preprocessing prior to DP, and assess performance in terms of privacy leakage and extrinsic evaluation (entity and relation classification). We show that DP mechanisms alone degrade utility substantially, but combining them with linguistic preprocessing, especially LLM-based redaction, significantly improves the privacy-utility trade-off.

In Natural Language Processing (NLP) classification tasks where a lack of labeled data is an issue, continued pretraining (CPT) of transformer models on unlabeled data is an established approach. In this paper, we have two aims. (1) We describe our observations from continued pretraining of the Finnish BERT transformer model (FinBERT) on a Finnish histopathological dataset (below, the Histopathology data). (2) Since the Histopathology data has no classification labels, we gather public Finnish datasets as proxy data to analyze whether the signals observed in (1) are associated with downstream classification gains. We observe that CPT train-time loss curves differ strongly by domain, and that, in an exploratory analysis, certain CPT-derived features correlate with proxy classification improvement. In particular, this report contributes to the limited literature on NLP for Finnish healthcare data.

Clinical value set authoring -- the task of identifying all codes in a standardized vocabulary that define a clinical concept -- is a recurring bottleneck in clinical quality measurement and phenotyping. A natural approach is to prompt a large language model (LLM) to generate the required codes directly, but structured clinical vocabularies are large, version-controlled, and not reliably memorized during pretraining. We propose Retrieval-Augmented Set Completion (RASC): retrieve the $K$ most similar existing value sets from a curated corpus to form a candidate pool, then apply a classifier to each candidate code. Theoretically, retrieve-and-select can reduce statistical complexity by shrinking the effective output space from the full vocabulary to a much smaller retrieved candidate pool. We demonstrate the utility of RASC on 11,803 publicly available VSAC value sets, constructing the first large-scale benchmark for this task. A cross-encoder fine-tuned on SAPBert achieves AUROC0.852 and value-set-level F10.298, outperforming a simpler three-layer Multilayer Perceptron (AUROC0.799, F10.250) and both reduce the number of irrelevant candidates per true positive from 12.3 (retrieval-only) to approximately 3.2 and 4.4 respectively. Zero-shot GPT-4o achieves value-set-level F1~0.105, with 48.6% of returned codes absent from VSAC entirely. This performance gap widens with increasing value set size, consistent with RASC's theoretical advantage. We observe similar performance gains across two other classifier model types, namely a cross-encoder initialized from pre-trained SAPBert and a LightGBM model, demonstrating that RASC's benefits extend beyond a single model class. The code to download and create the benchmark dataset, as well as the model training code is available at: https://github.com/mukhes3/RASC.

Women with polycystic ovary syndrome (PCOS) face substantially elevated risks of body image distress, disordered eating, and metabolic challenges, yet existing natural language processing approaches for detecting these conditions lack transparency and cannot identify co-occurring presentations. We developed small, open-source language models to automatically detect this triple burden in social media posts with grounded explainability. We collected 1,000 PCOS-related posts from six subreddits, with two trained annotators labeling posts using guidelines operationalizing Lee et al. (2017) clinical framework. Three models (Gemma-2-2B, Qwen3-1.7B, DeepSeek-R1-Distill-Qwen-1.5B) were fine-tuned using Low-Rank Adaptation to generate structured explanations with textual evidence. The best model achieved 75.3 percent exact match accuracy on 150 held-out posts, with robust comorbidity detection and strong explainability. Performance declined with diagnostic complexity, indicating their best use is for screening rather than autonomous diagnosis.

Clinical text classification requires choosing between specialized fine-tuned models (BERT variants) and general-purpose large language models (LLMs), yet neither dominates across all instances. We introduce Learning to Defer for clinical text (L2D-Clinical), a framework that learns when a BERT classifier should defer to an LLM based on uncertainty signals and text characteristics. Unlike prior L2D work that defers to human experts assumed universally superior, our approach enables adaptive deferral-improving accuracy when the LLM complements BERT. We evaluate on two English clinical tasks: (1) ADE detection (ADE Corpus V2), where BioBERT (F1=0.911) outperforms the LLM (F1=0.765), and (2) treatment outcome classification (MIMIC-IV with multi-LLM consensus ground truth), where GPT-5-nano (F1=0.967) outperforms ClinicalBERT (F1=0.887). On ADE, L2D-Clinical achieves F1=0.928 (+1.7 points over BERT) by selectively deferring 7% of instances where the LLM's high recall compensates for BERT's misses. On MIMIC, L2D-Clinical achieves F1=0.980 (+9.3 points over BERT) by deferring only 16.8% of cases to the LLM. The key insight is that L2D-Clinical learns to selectively leverage LLM strengths while minimizing API costs.

Ambient AI documentation systems generate clinical note drafts that clinicians frequently revise before signing off into electronic health records, yet how these edits alter hedging language remains unclear. We conducted paired analysis of clinician-edited portions of ambient AI drafts and final notes to examine (1) whether these edits change the prevalence of hedging language, (2) whether these edits exhibit a systematic shift toward greater certainty or uncertainty, and (3) whether these changes in hedging prevalence and directionality differ by ambient AI vendors and clinical specialties. Among 62,811 paired note sections, hedging terms were more often introduced into previously non-hedged text than removed from previously hedged text, and post-edit text contained more hedging mentions than pre-edit text. Directionality analyses showed a significant overall tendency toward greater uncertainty in hedging-related replacement edits. Vendor and specialty analyses revealed substantial heterogeneity in hedging prevalence, pre-to-post changes in hedging mentions, and directionality.

Human immunodeficiency virus (HIV)-related stigma is a critical psychosocial determinant of health for people living with HIV (PLWH), influencing mental health, engagement in care, and treatment outcomes. Although stigma-related experiences are documented in clinical narratives, there is a lack of off-the-shelf tools to extract and categorize them. This study aims to develop a large language model (LLM)-based tool for identifying HIV stigma from clinical notes. We identified clinical notes from PLWH receiving care at the University of Florida (UF) Health between 2012 and 2022. Candidate sentences were identified using expert-curated stigma-related keywords and iteratively expanded via clinical word embeddings. A total of 1,332 sentences were manually annotated across four stigma subscales: Concern with Public Attitudes, Disclosure Concerns, Negative Self-Image, and Personalized Stigma. We compared GatorTron-large and BERT as encoder-based baselines, and GPT-OSS-20B, LLaMA-8B, and MedGemma-27B as generative LLMs, under zero-shot and few-shot prompting. GatorTron-large achieved the best overall performance (Micro F1 = 0.62). Few-shot prompting substantially improved generative model performance, with 5-shot GPT-OSS-20B and LLaMA-8B achieving Micro-F1 scores of 0.57 and 0.59, respectively. Performance varied by stigma subscale, with Negative Self-Image showing the highest predictability and Personalized Stigma remaining the most challenging. Zero-shot generative inference exhibited non-trivial failure rates (up to 32%). This study develops the first practical NLP tool for identifying HIV stigma in clinical notes.

Existing prompt-based fine-tuning methods typically learn task-specific prompts independently, imposing significant computing and storage overhead at scale when deploying multiple clinical natural language processing (NLP) systems. We present a multitask prompt distillation and decomposition framework that learns a single shared metaprompt from 21 diverse clinical source tasks and adapts it to unseen target tasks with fewer than 0.05% trainable parameters. Evaluated across five clinical NLP task types (named entity recognition, relation extraction, question answering, natural language inference, and summarization) on 10 held-out target datasets using three backbone models (LLaMA 3.1 8B, Meditron3 8B, gpt-oss 20B), our framework consistently outperforms LoRA by 1.51.7% despite using orders of magnitude fewer parameters, and exceeds single-task prompt tuning by 6.16.6%. The gpt-oss 20B model achieves the highest overall performance, particularly on clinical reasoning tasks. The strong zero- and few-shot performance demonstrates better transferability of the shared prompt representation.

This paper presents a transformer-based approach to solving the SympTEMIST named entity recognition (NER) and entity linking (EL) tasks. For NER, we fine-tune a RoBERTa-based (1) token-level classifier with BiLSTM and CRF layers on an augmented train set. Entity linking is performed by generating candidates using the cross-lingual SapBERT XLMR-Large (2), and calculating cosine similarity against a knowledge base. The choice of knowledge base proves to have the highest impact on model accuracy.

The paper presents an approach for the recognition of toxic habits named entities in Spanish clinical texts. The approach was developed for the ToxHabits Shared Task. Our team participated in subtask 1, which aims to detect substance use and abuse mentions in clinical case reports and classify them in four categories (Tobacco, Alcohol, Cannabis, and Drug). We explored various methods of utilizing LLMs for the task, including zero-shot, few-shot, and prompt optimization, and found that GPT-4.1's few-shot prompting performed the best in our experiments. Our method achieved an F1 score of 0.65 on the test set, demonstrating a promising result for recognizing named entities in languages other than English.

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Electronic Patient Record (EPR) systems contain valuable clinical information, but much of it is trapped in unstructured text, limiting its use for research and decision-making. Large language models can extract such information but require substantial computational resources to run locally, and sending sensitive clinical data to cloud-based services, even when deidentified, raises significant patient privacy concerns. In this study, we develop a resource-efficient semi-automated annotation workflow using small language models (SLMs) to extract structured information from unstructured EPR data, focusing on paediatric histopathology reports. As a proof-of-concept, we apply the workflow to paediatric renal biopsy reports, a domain chosen for its constrained diagnostic scope and well-defined underlying biology. We develop the workflow iteratively with clinical oversight across three meetings, manually annotating 400 reports from a dataset of 2,111 at Great Ormond Street Hospital as a gold standard, while developing an automated information extraction approach using SLMs. We frame extraction as a Question-Answering task grounded by clinician-guided entity guidelines and few-shot examples, evaluating five instruction-tuned SLMs with a disagreement modelling framework to prioritise reports for clinical review. Gemma 2 2B achieves the highest accuracy at 84.3%, outperforming off-the-shelf models including spaCy (74.3%), BioBERT-SQuAD (62.3%), RoBERTa-SQuAD (59.7%), and GLiNER (60.2%). Entity guidelines improved performance by 7-19% over the zero-shot baseline, and few-shot examples by 6-38%, though their benefits do not compound when combined. These results demonstrate that SLMs can extract structured information from specialised clinical domains on CPU-only infrastructure with minimal clinician involvement. Our code is available at https://github.com/gosh-dre/nlp_renal_biopsy.

In this article, we present a gold-standard benchmark dataset for Biomedical Urdu Named Entity Recognition (BioUNER), developed by crawling health-related articles from online Urdu news portals, medical prescriptions, and hospital health blogs and websites. After preprocessing, three native annotators with familiarity in the medical domain participated in the annotation process using the Doccano text annotation tool and annotated 153K tokens. Following annotation, the proposed BioiUNER dataset was evaluated both intrinsically and extrinsically. An inter-annotator agreement score of 0.78 was achieved, thereby validating the dataset as gold-standard quality. To demonstrate the utility and benchmarking capability of the dataset, we evaluated several machine learning and deep learning models, including Support Vector Machines (SVM), Long Short-Term Memory networks (LSTM), Multilingual BERT (mBERT), and XLM-RoBERTa. The gold-standard BioUNER dataset serves as a reliable benchmark and a valuable addition to Urdu language processing resources.

Mental health text classification has rapidly adopted modern adaptation methods, yet practical guidance on which optimization strategy to use, when, and why remains limited. This paper presents a systematic comparative study of optimization pathways for a joint mental-health classification task, moving from strong vanilla baselines to progressively more specialized techniques. We first establish classical and encoder references, then examine parameter-efficient supervised fine-tuning with LoRA/QLoRA under multiple objective and optimization settings, and finally evaluate preference-based optimization with DPO, ORPO, and KTO, including class-rebalanced training. Rather than emphasizing a single headline score, we focus on methodological insight: how performance changes with objective formulation, adapter choice, optimizer behavior, context windowing, and class-balance intervention. The results show that optimization effects are highly method-dependent: some approaches deliver stable, transferable gains, while others are sensitive to configuration and data balance. Preference optimization, in particular, exhibits large variation across objectives, indicating that method selection is more consequential than simply adding a preference-training stage. The central contribution is a clear optimization narrative for mental health NLP: start from transparent baselines, apply controlled tuning, and use preference optimization selectively where its gains are demonstrable. This provides a reproducible and practically grounded framework for choosing effective training strategies beyond architecture choice alone.

Epilepsy and psychogenic non-epileptic seizures often present with similar seizure-like manifestations but require fundamentally different management strategies. Misdiagnosis is common and can lead to prolonged diagnostic delays, unnecessary treatments, and substantial patient morbidity. Although prolonged video-electroencephalography is the diagnostic gold standard, its high cost and limited accessibility hinder timely diagnosis. Here, we developed a low-cost, effective approach, EpiScreen, for early epilepsy detection by utilizing routinely collected clinical notes from electronic health records. Through fine-tuning large language models on labeled notes, EpiScreen achieved an AUC of up to 0.875 on the MIMIC-IV dataset and 0.980 on a private cohort of the University of Minnesota. In a clinician-AI collaboration setting, EpiScreen-assisted neurologists outperformed unaided experts by up to 10.9%. Overall, this study demonstrates that EpiScreen supports early epilepsy detection, facilitating timely and cost-effective screening that may reduce diagnostic delays and avoid unnecessary interventions, particularly in resource-limited regions.

Clinical notes contain valuable unstructured information. Named entity recognition (NER) enables the automatic extraction of medical concepts; however, benchmarks for Portuguese remain scarce. In this study, we aimed to evaluate BERT-based models and large language models (LLMs) for clinical NER in Portuguese and to test strategies for addressing multilabel imbalance. We compared BioBERTpt, BERTimbau, ModernBERT, and mmBERT with LLMs such as GPT-5 and Gemini-2.5, using the public SemClinBr corpus and a private breast cancer dataset. Models were trained under identical conditions and evaluated using precision, recall, and F1-score. Iterative stratification, weighted loss, and oversampling were explored to mitigate class imbalance. The mmBERT-base model achieved the best performance (micro F1 = 0.76), outperforming all other models. Iterative stratification improved class balance and overall performance. Multilingual BERT models, particularly mmBERT, perform strongly for Portuguese clinical NER and can run locally with limited computational resources. Balanced data-splitting strategies further enhance performance.

We present GS-BrainText, a curated dataset of 8,511 brain radiology reports from the Generation Scotland cohort, of which 2,431 are annotated for 24 brain disease phenotypes. This multi-site dataset spans five Scottish NHS health boards and includes broad age representation (mean age 58, median age 53), making it uniquely valuable for developing and evaluating generalisable clinical natural language processing (NLP) algorithms and tools. Expert annotations were performed by a multidisciplinary clinical team using an annotation schema, with 10-100% double annotation per NHS health board and rigorous quality assurance. Benchmark evaluation using EdIE-R, an existing rule-based NLP system developed in conjunction with the annotation schema, revealed some performance variation across health boards (F1: 86.13-98.13), phenotypes (F1: 22.22-100) and age groups (F1: 87.01-98.13), highlighting critical challenges in generalisation of NLP tools. The GS-BrainText dataset addresses a significant gap in available UK clinical text resources and provides a valuable resource for the study of linguistic variation, diagnostic uncertainty expression and the impact of data characteristics on NLP system performance.

Despite their strong linguistic capabilities, Large Language Models (LLMs) are computationally demanding and require substantial resources for fine-tuning, which is unadapted to privacy and budget constraints of many healthcare settings. To address this, we present an experimental analysis focused on Biomedical Named Entity Recognition using lightweight LLMs, we evaluate the impact of different output formats on model performance. The results reveal that lightweight LLMs can achieve competitive performance compared to the larger models, highlighting their potential as lightweight yet effective alternatives for biomedical information extraction. Our analysis shows that instruction tuning over many distinct formats does not improve performance, but identifies several format consistently associated with better performance.

Automatic depression detection from doctor-patient conversations has gained momentum thanks to the availability of public corpora and advances in language modeling. However, interpretability remains limited: strong performance is often reported without revealing what drives predictions. We analyze three datasets: ANDROIDS, DAIC-WOZ, E-DAIC and identify a systematic bias from interviewer prompts in semi-structured interviews. Models trained on interviewer turns exploit fixed prompts and positions to distinguish depressed from control subjects, often achieving high classification scores without using participant language. Restricting models to participant utterances distributes decision evidence more broadly and reflects genuine linguistic cues. While semi-structured protocols ensure consistency, including interviewer prompts inflates performance by leveraging script artifacts. Our results highlight a cross-dataset, architecture-agnostic bias and emphasize the need for analyses that localize decision evidence by time and speaker to ensure models learn from participants' language.

Clinical trials require strict adherence to medication protocols, yet dosing errors remain a persistent challenge affecting patient safety and trial integrity. We present an automated system for detecting dosing errors in unstructured clinical trial narratives using gradient boosting with comprehensive multi-modal feature engineering. Our approach combines 3,451 features spanning traditional NLP (TF-IDF, character n-grams), dense semantic embeddings (all-MiniLM-L6v2), domain-specific medical patterns, and transformer-based scores (BiomedBERT, DeBERTa-v3), used to train a LightGBM model. Features are extracted from nine complementary text fields (median 5,400 characters per sample) ensuring complete coverage across all 42,112 clinical trial narratives. On the CT-DEB benchmark dataset with severe class imbalance (4.9% positive rate), we achieve 0.8725 test ROC-AUC through 5-fold ensemble averaging (cross-validation: 0.8833 + 0.0091 AUC). Systematic ablation studies reveal that removing sentence embeddings causes the largest performance degradation (2.39%), demonstrating their critical role despite contributing only 37.07% of total feature importance. Feature efficiency analysis demonstrates that selecting the top 500-1000 features yields optimal performance (0.886-0.887 AUC), outperforming the full 3,451-feature set (0.879 AUC) through effective noise reduction. Our findings highlight the importance of feature selection as a regularization technique and demonstrate that sparse lexical features remain complementary to dense representations for specialized clinical text classification under severe class imbalance.

Medical conversations offer insights into clinical communication often absent from Electronic Health Records. However, developing reliable clinical Natural Language Processing (NLP) models is hampered by the scarcity of domain-specific datasets, as clinical data are typically inaccessible due to privacy and ethical constraints. To address these challenges, we present a pipeline for generating synthetic Dutch medical dialogues using a Dutch fine-tuned Large Language Model, with real medical conversations serving as linguistic and structural reference. The generated dialogues were evaluated through quantitative metrics and qualitative review by native speakers and medical practitioners. Quantitative analysis revealed strong lexical variety and overly regular turn-taking, suggesting scripted rather than natural conversation flow. Qualitative review produced slightly below-average scores, with raters noting issues in domain specificity and natural expression. The limited correlation between quantitative and qualitative results highlights that numerical metrics alone cannot fully capture linguistic quality. Our findings demonstrate that generating synthetic Dutch medical dialogues is feasible but requires domain knowledge and carefully structured prompting to balance naturalness and structure in conversation. This work provides a foundation for expanding Dutch clinical NLP resources through ethically generated synthetic data.

Large Language Models (LLMs) offer transformative solutions across many domains, but healthcare integration is hindered by strict data privacy constraints. Clinical narratives are dense with ambiguous acronyms, misinterpretation these abbreviations can precipitate severe outcomes like life-threatening medication errors. While cloud-dependent LLMs excel at Acronym Disambiguation, transmitting Protected Health Information to external servers violates privacy frameworks. To bridge this gap, this study pioneers the evaluation of small-parameter models deployed entirely on-device to ensure privacy preservation. We introduce a privacy-preserving cascaded pipeline leveraging general-purpose local models to detect clinical acronyms, routing them to domain-specific biomedical models for context-relevant expansions. Results reveal that while general instruction-following models achieve high detection accuracy (~0.988), their expansion capabilities plummet (~0.655). Our cascaded approach utilizes domain-specific medical models to increase expansion accuracy to (~0.81). This novel work demonstrates that privacy-preserving, on-device (2B-10B) models deliver high-fidelity clinical acronym disambiguation support.