arXiv subjects

Donghua Zhang

Publications and source records attributed to Donghua Zhang.

3 recordsLinked to original sources

arXiv2026

DIASENTINEL: An Auditable Multi-Agent System for Guideline-Grounded Diabetes Risk Screening

Large language models (LLMs) offer promising clinical decision support but remain vulnerable to hallucinated facts, unsupported recommendations, and citation errors. We present DIASENTINEL, a fully on-premise multi-agent system for one-year type 2 diabetes mellitus (T2DM) risk screening and guideline-grounded report generation from electronic health records (EHRs). The system integrates calibrated risk prediction, deterministic clinical signal extraction, Reciprocal Rank Fusion over American Diabetes Association (ADA) guidelines, and a hybrid verification layer combining rule-based checks with LLM entailment. The demonstration provides a real-time batch-screening dashboard and an interactive patient report interface with cited recommendations, verification results, and raw EHR comparison. DIASENTINEL demonstrates a practical framework for reliable, auditable, and privacy-preserving LLM-based clinical decision support.

cs.CL↗

arXiv2026

Self-Mined Hardness for Safety Fine-Tuning

Safety fine-tuning of language models typically requires a curated adversarial dataset. We take a different approach: score each candidate prompt's difficulty by how often the target model's own rollouts are judged harmful, then fine-tune on the hardest prompts paired with the model's own non-jailbroken rollouts. On Llama-3-8B-Instruct and Llama-3.2-3B-Instruct, this approach cuts the WildJailbreak attack success rate from 11.5% and 20.1% down to 1-3%, but pushes refusal on jailbreak-shaped benign prompts from 14-22% to 74-94%. Interleaving the same hard prompts 1:1 with adversarially-framed benign prompts (prompts that look like jailbreaks but have benign intent) cuts that refusal back down to 30-51% on 8B and 52-72% on 3B, at a cost of 2-6 percentage points of attack success rate. Within the mixed regime, training on the hardest half of the eligible pool rather than a random half cuts the remaining ASR by 35-50% (about 3 percentage points) on both models.

cs.LG↗

arXiv2026

MedAction: Towards Active Multi-turn Clinical Diagnostic LLMs

Most existing LLM diagnoses are evaluated on static, single-turn settings where complete patient information is provided upfront, an oversimplification of real clinical practice. We study active diagnosis: the real-life clinical process of starting from initial observation, ordering tests, interpreting results, and updating a differential diagnosis across multiple turns. Through systematic analysis, we identify three recurring failure modes in current LLMs: ungrounded test ordering, unreliable diagnostic update, and degraded multi-turn coherence. Together, these failures reveal a core deficit: existing medical training data teaches models to reason from complete information but not to act under evolving, partial evidence. To address this gap, we introduce MedAction, a tree-structured distillation pipeline that synthesizes diverse and high-quality multi-turn diagnostic trajectories via LLM-environment interaction. We propose two knowledge-graph-grounded metrics to filter trajectory quality: Disease Trajectory Consistency (DTC), which tracks whether the model's hypothesis converges toward the correct diagnosis, and Reasoning-Action Consistency (RAC), which verifies that belief updates are driven by gathered evidence. Using this pipeline, we construct MedAction-32K, a dataset of 32,681 trajectories from 2,896 PMC cases. Fine-tuning an 8B model on MedAction-32K achieves state-of-the-art performance among open-source models on both MedR-Bench and our curated MedAction-300-Hard benchmark, pushing the edge for open-source medical LLMs.

cs.CL↗