Propagating construction-time knowledge quality into medical question answering: A framework grounded in clinical guidelines

Large language models have facilitated knowledge graph (KG) construction from clinical guidelines, but extracted triples vary in structural validity and evidential support. Meanwhile, graph-augmented question answering (QA) systems typically optimize query relevance during retrieval, with limited reuse of quality information produced during KG construction. This creates a disconnect between construction-time quality control and inference-time evidence use. We investigate whether construction-time triple quality can serve as a persistent signal for downstream evidence selection and presentation. We propose a quality-aware framework that models structural conformance (SchemaConf) and evidential support (EvidScore) as complementary dimensions and fuses them into a per-triple quality signal, Q(t). Rather than using quality solely for filtering, the framework retains Q(t) and derived quality tiers as graph attributes and propagates them into quality-weighted subgraph retrieval and tier-conditioned evidence prompting, while preserving passage-level provenance. Experiments on Chinese diabetes clinical guidelines show that the utility of the quality signal is distribution dependent. Under cross-version and cross-model shift, the fused Q(t) provides stronger triple-quality discrimination than either component alone (AUC 0.748 vs. 0.703 for EvidScore and 0.645 for SchemaConf). In guideline-grounded QA, propagating construction-time quality reduces required-knowledge omission from 16.3% to 5.3% and conflicting outputs from 16.3% to 2.7%, with an evidence-grounded precision of 81.6% and near-zero invalid citations. Blinded clinician ratings favor the full framework over no retrieval (4.68 vs. 4.21 on a five-point scale) and approach the oracle condition (4.80), while cross-generator experiments show consistent trends.

BanglaMed-QA: A Question Answering System for Healthcare Support in Bangla

Medical question answering (QA) systems have become crucial tools for providing reliable health information. But they remain very unexplored for low-resource languages like Bangla due to limited datasets and systems tailored to these languages. To address this, we introduce BanglaMed-QA, a robust QA system specifically designed for the Bangla medical domain. The process begins with building a structured medical knowledge base that includes 4,493 QA pairs in 9 categories under 506 diseases. To improve semantic comprehension, domain-specific root word dictionaries and synonym sets are proposed, in addition to part-of-speech tagging for anaphora resolution. We adopt supervised machine learning models in which SVM is found to be the best model to categorize questions. Multiple similarity metrics, including cosine, Jaccard, BM25, and Levenshtein, are applied with soft and hard voting methods for query matching. The performance of the QA system has been evaluated in two aspects, with a 95% F1 score in an automated evaluation and an average human satisfaction rating of 0.9 out of 1.0. This validates the real-world application of BanglaMed-QA in closing the healthcare information gap for Bangla speakers.

A knowledge-guided agentic framework for mitigating patient-context ambiguity in health queries

Patients often submit short, underspecified queries to healthcare chatbots that lack the patient-specific information needed to determine an appropriate response. Although these queries may be linguistically clear, they can support multiple plausible answers depending on undisclosed factors such as symptoms, diagnoses, medications, allergies, or dietary restrictions. A language model answering such a query directly may therefore rely on unsupported assumptions about the patient. We introduce a knowledge-guided agentic framework for mitigating patient-context ambiguity before final response generation. The framework operates between the patient and an otherwise unchanged downstream language model. It interprets the initial query, uses a task-specific knowledge graph to construct a set of plausible hypotheses, identifies the missing patient-context variables needed to distinguish among them, and asks targeted follow-up questions. The original query and the acquired context are then combined into a clarified prompt for the downstream model. We evaluated the framework across five language models using two controlled ambiguity-mitigation benchmarks: diagnosis retrieval from 1,034 symptom queries with clinically relevant evidence systematically masked, and dietary-safety classification from 487 queries with decisive health context omitted. The framework was compared with direct answering of the underspecified query and with rephrasing the same query without acquiring new patient information. In diagnosis retrieval, it increased overall exact Top-1 accuracy by at least 57.1 percentage points and selective exact Recall@5 by at least 77.7 percentage points across the five evaluated models compared with direct prompting. In dietary-safety classification, it improved accuracy across all five models and achieved the highest Matthews correlation coefficient for four...

From Manuals to Maintenance: Fine-Tuning MedGemma for Multi-Modal Imaging System Support in Low-Resource Settings

Imaging device downtime is a major barrier to healthcare delivery in low- and middle-income countries (LMICs), often driven by limited access to specialized biomedical engineering support. We present a multi-modality medical equipment maintenance question-answering (QA) framework and demonstrate the fine-tuning of a medical foundation model for specialized technical troubleshooting tasks. Guided by a multi-country survey across nine LMICs, we curated technical manuals from MRI and ultrasound systems to generate the INGENZI_DatasetV1, containing 10,294 high-quality, filtered QA-context pairs. Using QLoRA-based parameter-efficient fine-tuning, we adapted the MedGemma-4b-it model to interpret system error logs and generate step-by-step equipment repair instructions. Compared to the baseline model, the fine-tuned system achieved substantial improvements across metrics, including F1 score (0.22 to 0.38), ROUGE-2 (0.18 to 0.41), and BERTScore F1 (0.86 to 0.91). These metric gains demonstrate that the model generates significantly more precise and procedurally accurate technical responses to new troubleshooting queries. This work establishes a reliable foundation for AI-assisted diagnostic and maintenance tools in resource-constrained settings.

Research Assistant: AstraZeneca's Agentic System for R&D

We describe Research Assistant, an internal LLM-based system developed at AstraZeneca to help scientists and clinicians explore biomedical questions across a broad range of data sources. The system provides a chat-style interface that brings together evidence from scientific literature, knowledge graphs, chemistry, clinical trials, safety resources, expression data, and internal experimental systems. It supports both a fast mode for direct question answering and a multi-step mode for more complex research tasks. Responses are grounded in retrieved evidence and linked back to the original sources, allowing users to review and further explore the underlying data. In this technical note, we outline the system architecture, the main design choices behind the product, and lessons learned from deploying it at scale to support day-to-day R&D workflows across AstraZeneca.

CLARA: Clarification of Language Ambiguity through Result Analysis for Natural-Language Cancer Genomics Queries

A natural language interface can be used to make cancer genomics databases easier to use, but even if a question is perfectly fluent, its scientific meaning can be ambiguous. We propose CLARA, a framework that represents a question as a typed scientific query specification, considers a few possible interpretations, executes them, and asks for clarification when the estimates diverge. CLARA was assessed on mutation-prevalence contrasts among eight TCGA PanCancer Atlas cohorts and a 30-gene panel. This benchmark consisted of 330 unique executable contrasts varying in mutation scope, assay denominator, and sample context; 115 contrasts were result-sensitive and 215 were result-stable, per the preregistered definition of relative divergence greater than 0.10 or absolute divergence greater than 5 percentage points. An independently implemented pandas execution engine perfectly replicated all 660 results from the SQLite engine. In a separate 120-question LLM-generated, manually vetted language stress test, CLARA recognized all 60 result-sensitive contrasts and needlessly clarified 13 of 60 stable contrasts (accuracy 89.2%, sensitivity/recall 100%, specificity 78.3%). Standalone machine learning had superior overall accuracy (97.5%) but missed one critical contrast. This demonstrates that downstream execution can distinguish consequential from inconsequential ambiguity and reveal an explicit trade-off between safety and burden.

A Cost-Effective Multimodal LLM Reasoning Framework for Question Answering over Irregular Clinical Time Series

Question answering (QA) over irregular clinical time series (ICTS) plays a pivotal role in a wide range of healthcare applications. Although recent multimodal time-series large language models (LLMs) have shown considerable promise in general-purpose time-series QA, they remain poorly equipped to model the sparsity, asynchrony, and irregular sampling patterns of clinical observations. To fill this gap, we propose ClinPRISM, a cost-effective multimodal LLM reasoning framework for question answering over ICTS data. First, we devise an irregularity-aware multi-scale encoder to capture sparse clinical evidence at diverse temporal scales. Then, we propose a temporal evidence distiller to integrate representations across these scales and compress them into a small number of LLM-compatible tokens. Moreover, we introduce a progressive alignment strategy that sequentially aligns the irregular trajectories with the LLM's textual embedding space. To facilitate training, we construct 30,000 clinical time series paired with multi-scale descriptions, together with 41,000 instruction-tuning instances spanning 11 tasks. Using a 4-billion-parameter LLM backbone, ClinPRISM achieves state-of-the-art performance on the held-out evaluation benchmark while using only 16 time-series tokens and achieving an average inference latency of 0.15 seconds per question.

CLIR-Bench: Benchmarking Multimodal Question Answering over Irregular Clinical Time Series

Clinical time series are central to patient monitoring, risk assessment, and clinical decision support. However, they are often sparse, irregularly sampled, and asynchronous, making it difficult for models to identify the temporal evidence required for clinical Question Answering (QA). Existing benchmarks primarily focus on regularly sampled time-series QA or medical QA over static data, and therefore rarely assess whether models can faithfully ground their answers in irregular temporal observations. To fill this gap, we introduce CLIR-Bench, a benchmark for irregular clinical time series QA constructed from de-identified ICU records through a principled four-stage pipeline. CLIR-Bench contains 6,600 QA instances spanning 11 clinical variables, organized into four capability dimensions and 11 tasks. Each question is linked to explicit temporal evidence and task-specific answer derivation rules, enabling evaluation of both answer accuracy and evidence use. Experiments show that existing generalist models struggle to retrieve and reason over sparse clinical evidence, highlighting the need for stronger irregular time-series reasoning methods. Our code and data are available at https://huggingface.co/datasets/winall/CLIR-Bench.

From Voting to Agent Collaboration: Answer-Type-Aware LLM Pipelines for BioASQ 14b

Biomedical question answering requires not only accurate extraction of information from scientific literature but also reliable integration of evidence across multiple documents. This study presents a question-type-specific large language model (LLM) framework for BioASQ 14b Task B, designed to improve answer robustness and evidence grounding in biomedical question answering. Rather than applying a single prompting strategy to all questions, the framework selects different inference procedures for yes/no, factoid, and list questions according to their distinct reasoning and evaluation requirements. For yes/no questions, snippet shuffling and self-reflection are used to reduce sensitivity to evidence ordering and improve decision stability. For factoid questions, full-snippet input is combined with chain-of-thought-based in-context learning to support accurate biomedical entity identification. For list questions, a multi-agent architecture is employed, in which evidence extraction, candidate generation, answer verification, and final aggregation are handled collaboratively. Preliminary experiments on BioASQ 13b were used to identify effective inference strategies for each question type, and the resulting framework was subsequently evaluated in the official BioASQ 14b Task B challenge. In the official evaluation, our framework showed competitive performance across multiple batches and achieved first place in the factoid subtask of Batch 4. These results demonstrate the effectiveness of combining question-type-specific inference, ensemble prediction, and agent-based verification for reliable biomedical question answering.

Dynamic Bidirectional Pattern Memory: A Production-Scale Empirical Characterisation of Inference-Time Gating in Clinical NLP

We study inference-time pattern-memory gating in a production-scale clinical natural language processing (NLP) pipeline. The pipeline pairs a generator (Llama-3.3 70B) proposing extractions with a verifier (MMed-Llama-3.1 70B) accepting or rejecting them, over 167,034 PMC-Patients narratives, and adds a lightweight memory that learns at deployment which extractions to filter, so the verifier need not re-examine candidates already seen to fail. We report four findings. First, learning filtering rules directly from the verifier's rejections failed at full scale: the relation-extraction filter stayed empty despite 785,797 logged rejections, because they were spread too thinly across too many distinct forms to accumulate. Second, a simpler rule using a fixed clinical ontology produced the same filtering without the verifier, capturing 49,734 ontology-violating relations on a held-out 5,000-patient set. Third, of five versions of the question-answering filter, four failed for distinct, instructive reasons; the fifth succeeded by checking whether a patient's extracted entities support the question asked, and where it applies was 1.84 times likelier to flag an answer the verifier would reject than one it would accept. Fourth, one pattern held across all five: a filter is selective only when it tests the same evidence the verifier weighs, not when it imitates the verifier's output. Together these give a transferable result for any generator-verifier pipeline: the most natural memory design can fail silently at scale, and whether a pre-generation gate is selective is decided before any engineering effort, by whether its signal probes the question the verifier itself answers. Throughout, the system flags suspect extractions rather than deleting them, so every decision stays visible for clinical review. All code and test artefacts are released openly.

WEQA: Wearable hEalth Question Answering with Query-Adaptive Agentic Reasoning

Language models are remarkably capable at medical question answering, in some cases surpassing the accuracy of general physicians. However, answering questions about wearable health data remains challenging and understudied, as these ubiquitous sensors produce continuous, high-dimensional, and longitudinal data, which is non-trivial to align with text-centric distributions in LLM pretraining. The diversity of sensor modalities and user intents cannot be effectively handled by a fixed reasoning workflow or a single pretrained foundation model. To address these challenges, we propose WEQA, a query-adaptive agent framework that unifies LLM reasoning with specialized wearable analytical and modeling tools. An LLM controller is employed to synthesize execution plans and dynamically route each query to the appropriate combination of sensor analysis and pretrained models, and perform grounded response auditing with external knowledge. We also curate a benchmark spanning four open wearable datasets comprising analytic and predictive tasks in three different health domains. Experiments show that our framework is 24% more accurate than LLM and agentic baselines, and a blinded study with 12 medical experts and 8 users shows substantial gains in usefulness and clinical soundness.

HealthNLP_Retrievers at ArchEHR-QA 2026: Cascaded LLM Pipeline for Grounded Clinical Question Answering

Patient portals now give individuals direct access to their electronic health records (EHRs), yet access alone does not ensure patients understand or act on the complex clinical information contained in these records. The ArchEHR-QA 2026 shared task addresses this challenge by focusing on grounded question answering over EHRs, and this paper presents the system developed by the HealthNLP_Retrievers team for this task. The proposed approach uses a multi-stage cascaded pipeline powered by the Gemini 2.5 Pro large language model to interpret patient-authored questions and retrieve relevant evidence from lengthy clinical notes. Our architecture comprises four integrated modules: (1) a few-shot query reformulation unit which summarizes verbose patient queries; (2) a heuristic-based evidence scorer which ranks clinical sentences to prioritize recall; (3) a grounded response generator which synthesizes professional-caliber answers restricted strictly to identified evidence; and (4) a high-precision many-to-many alignment framework which links generated answers to supporting clinical sentences. This cascaded approach achieved competitive results. Across the individual tracks, the system ranked 1st in question interpretation, 5th in answer generation, 7th in evidence identification, and 9th in answer-evidence alignment. These results show that integrating large language models within a structured multi-stage pipeline improves grounding, precision, and the professional quality of patient-oriented health communication. To support reproducibility, our source code is publicly available in our GitHub repository