arXiv subjects

Donghua Zhang

Publications and source records attributed to Donghua Zhang.

4 recordsLinked to original sources

arXiv2026

MedGraph: Maintaining Patient State with Graph Memory for Long-Term Medical Dialogue

LLM-based medical assistants that follow a patient across visits need a memory that keeps the patient's clinical state correct as it changes. We examine the errors of five memory systems on longitudinal medical dialogue and find three recurring causes: the retrieved evidence gives an outdated state, includes another person's health facts, or lacks a safety fact the answer depends on. We present MedGraph, a graph memory built for these three cases. Construction extracts dated facts from each session, attributes each fact to the person it describes, and links medication, diagnosis, and measurement records into chains that keep earlier states. Retrieval ranks the patient's chains as units, reads each chain at the time the question asks about, and adds the original dialogue text; a patient profile lists every recorded safety fact with every question. On MedMemoryBench, MedGraph has the highest overall accuracy with both a GPT and a Qwen backbone, 10.5 and 10.4 points above the strongest of five baselines, with efficient memory construction and answering in the GPT setting.

cs.CL↗

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↗

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↗