大语言模型增强技术在临床药学中的应用与挑战:多维增强框架视角

Applications and Challenges of Large Language Models Augmentation Technologies in Clinical Pharmacy: A Review Based on a Multidimensional Augmentation Framework

  • 摘要: 大语言模型(large language model,LLM)在临床药学多场景中的应用近年来发展迅速,但特定任务中表现不佳、幻觉现象及患者隐私安全风险等问题仍较突出。LLM增强技术作为一类可从多维度提升模型性能、应用安全性及数据隐私保护能力的方法,对于突破以LLM为核心的技术架构在临床药学领域的应用瓶颈、推动其向临床实践转化方面具有重要意义。本文阐述了近年来LLM增强技术在临床药学中应用的相关研究,其中药物警戒场景应用最多(占58.3%),关键词词云图分析表明研究者更关注患者的临床用药及不良反应。LLM增强技术主要分为三类:模型层知识注入、模型推理阶段知识增强和模型系统级增强,单一或多种技术可结合LLM构建多维增强框架。研究表明,上述增强技术在提升LLM性能、优化临床应用效果及降低潜在安全风险等方面均具有积极作用。然而,LLM增强技术在当前发展阶段仍存在数据与知识基础局限、跨场景应用与复杂推理能力不足等问题,同时面临评价体系不完善、监管标准缺失及临床部署安全性等挑战。未来针对上述关键问题与挑战,有待开展深入研究,进一步推动LLM增强技术框架在多场景临床药学服务中的安全规范应用与转化落地。

     

    Abstract: Applications of large language models (LLMs) across multiple clinical pharmacy scenarios have expanded rapidly in recent years. However, issues such as suboptimal performance on specific tasks, hallucinations, and risks related to patient privacy and data security remain prominent. As a class of methods capable of enhancing model performance, application safety, and data privacy protection from multiple dimensions, LLMs augmentation technologies are of great significance for overcoming the application bottlenecks of LLM-centered technical architectures in the field of clinical pharmacy and promoting their translation into clinical practice. This article reviewed recent studies on the application of LLMs augmentation technologies in clinical pharmacy. Among the included studies, pharmacovigilance was the most frequently investigated scenario (58.3%). Keyword cloud analysis indicated that researchers focused primarily on patients’ clinical medication use and adverse drug reactions. LLMs augmentation technologies can generally be categorized into three types: knowledge injection at the model level, knowledge augmentation during the model reasoning stage, and model system-level augmentation. Single or multiple augmentation technologies can be integrated with LLMs to construct a multidimensional augmentation framework. Existing studies have demonstrated that the augmentation technologies exert varying degrees of positive effects on improving LLM performance, optimizing clinical utility, and reducing potential safety risks. Nevertheless, at the current stage of development, LLMs augmentation technologies remain constrained by limitations in data and knowledge foundations, inadequate cross-scenario generalizability, and insufficient capabilities for complex reasoning. Furthermore, challenges persist regarding the lack of well-established evaluation frameworks and regulatory standards, as well as concerns over the safety of clinical deployment. Future research is warranted to address these critical issues and challenges, thereby further promoting the safe, standardized application and translational implementation of LLM-augmented frameworks in multi-scenario clinical pharmacy services.

     

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