# Fine-Tuning a Personalized OpenBioLLM Using Offline Reinforcement Learning
## 4 Experiment
### Personalization and Accuracy Analysis  
In Section 3.5, we found that sometimes, the treatment recommendations given by OpenBioLLM and the final treatment decisions are inconsistent. This experiment demonstrates the personalization and accuracy of the treatment model by comparing the different responses generated by the initial prompt input and the prompt input after adding personalized information. The personalized content of each patient is extracted from the noteevents table in the MIMIC-III database. For the case of the chain of thought template cot_2 and the personalized content of the patient, the following prompt input can be obtained. * **cot_2 with personalized content**  
There is a patient in the ICU, and their physiological indicators are as follows: Demographics: Age: 65 years old Sex: male Weight: 75 kg Readmission to ICU: yes Elixhauser score: 12 points Vital signs: SOFA (Sequential Organ Failure Assessment): 6 points SIRS (Systemic Inflammatory Response Syndrome): yes GCS (Glasgow Coma Scale): 14 Heart rate: 110 beats/min SysBP (Systolic Blood Pressure): 95 mmHg DiaBP (Diastolic Blood Pressure): 60 mmHg MeanBP (Mean Blood pressure): 75 mmHg Shock index: 1.5 Respiratory rate: 28 times/min Temperature: 37.8 \({}^{\circ}\)C SpO2 (peripheral capillary oxygen saturation): 88% Laboratory values: Potassium: 4.0 mmol/L Sodium: 135 mmol/L Chloride: 98 mmol/L Glucose : 120 mg/dL BUN (blood urea nitrogen): 45 mg/dL Creatinine: 2.0 mg/dL Magnesium: 1.8 mg/dL CO2 (carbon dioxide): 32 mmol/L Hemoglobin: 10 g/dL WBC (white blood cell count): 15,000/mm Platelets: 150,000/mm\({}^{3}\) PTT (Partial Thromoplasatin Time): 40 s PT (Prothrombin Time): 15 s INR (International Normalized Ratio): 1.5 pH : 7.45 PaCO2 (Partial Pressure of Carbon Dioxide in Arterial Blood): 50 mmHg  
Base Excess: 4 mEq/L  
Bicarbonate: 28 mmol/L  
**The following is a portion of the physician's text note to the patient:**  
Underlying Medical Conditions:  
65-year-old male, acute myocardial infarction, catheterized, currently in CCU for cardiogenic shock  
Reason for this exam: Check endotracheal tube position, PNA, CHF  
Clinical Indications: Assess endotracheal tube position in a patient with congestive heart failure. Compare with previous studies from the previous day. The endotracheal tube is present and in a satisfactory position. The SwanGanz catheter terminates in the proximal left pulmonary artery and has been removed within the septum. The intra-aortic balloon pump terminates approximately 3.3 cm below the superior aortic aneurysm and the nasogastric tube terminates at the gastroduodenal junction. The cardiac and mediastinal contours are stable within the septum and the pulmonary vascular distribution is within technically normal limits. The left retrocardiac opacity has improved, and the right basal opacity is still patchy and slightly increased. A small amount of fluid is visible in the small fissures. Impression:  
1 The lines and tubing are in a satisfactory position, as described above, and there is no evidence of pneumothorax. 2 The left posterior cardiac opacity improved and the right lower lobe opacity worsened, probably due to atelectasis. Please analyze the patient's condition and give a treatment plan and reason. The treatment plan should be a definite value. Please attach a treatment plan template in the following format at the end:  
PEEP:?cmH2O  
tidal volume:?mL  
FiO2:? OpenBioLLM will get the following output. The treatment plan it provides is not limited to the adjustment of ventilator parameters. It can also provide other matters that need attention for clinicians to refer to based on the patient's personalized information, and the analysis of the recommendations for ventilator parameter settings is more detailed. The answer of CCU 2 with personalized content as p treatment  
Based on the patient's physiological indicators, the following is my analysis of the patient's condition and the treatment plan and reasons I gave:  
1.