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877add7 | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 | """Constrained candidate action generation."""
from __future__ import annotations
from app.common.enums import ActionType, DecisionMode, DoseBucket
from app.common.types import CandidateAction, PolyGuardAction, PolyGuardState
from app.env.verifier import verify_action_legality
from app.knowledge.ddi_knowledge import top_risky_pairs
from app.knowledge.hepatic_rules import is_hepatic_unsafe
from app.knowledge.renal_rules import is_renal_unsafe
from app.knowledge.substitution_rules import get_substitutions
def _base_candidate(
idx: int,
action_type: ActionType,
target_drug: str | None = None,
replacement_drug: str | None = None,
mode: DecisionMode = DecisionMode.REGIMEN_OPT,
) -> CandidateAction:
return CandidateAction(
candidate_id=f"cand_{idx:02d}",
mode=mode,
action_type=action_type,
target_drug=target_drug,
replacement_drug=replacement_drug,
dose_bucket=DoseBucket.NA,
taper_days=14 if action_type == ActionType.TAPER_INITIATE else None,
monitoring_plan="repeat_labs_7d" if action_type == ActionType.ORDER_MONITORING_AND_WAIT else None,
estimated_safety_delta=0.02,
burden_delta=0.0,
disease_stability_estimate=0.85,
uncertainty_score=0.45,
rationale_tags=["rule_based_seed"],
required_monitoring=[],
legality_precheck=True,
)
def _to_action(candidate: CandidateAction) -> PolyGuardAction:
return PolyGuardAction(
mode=candidate.mode,
action_type=candidate.action_type,
target_drug=candidate.target_drug,
replacement_drug=candidate.replacement_drug,
dose_bucket=candidate.dose_bucket,
taper_days=candidate.taper_days,
monitoring_plan=candidate.monitoring_plan,
evidence_query=candidate.evidence_query,
new_drug_name=candidate.new_drug_name,
candidate_components=candidate.candidate_components,
candidate_id=candidate.candidate_id,
confidence=max(0.45, 1.0 - candidate.uncertainty_score),
rationale_brief="candidate_precheck",
)
def build_candidates(state: PolyGuardState) -> list[CandidateAction]:
meds = state.patient.medications
candidates: list[CandidateAction] = []
risky_pairs = top_risky_pairs([m.drug for m in meds])
target_risky_drug = risky_pairs[0][0] if risky_pairs else (meds[0].drug if meds else None)
keep = _base_candidate(1, ActionType.KEEP_REGIMEN)
keep = keep.model_copy(update={"estimated_safety_delta": -0.02, "uncertainty_score": 0.5})
candidates.append(keep)
if meds:
first = target_risky_drug or meds[0].drug
stop = _base_candidate(2, ActionType.STOP_DRUG, target_drug=first)
stop = stop.model_copy(
update={
"estimated_safety_delta": 0.26,
"burden_delta": 0.12,
"disease_stability_estimate": 0.68 if first == "warfarin_like" else 0.81,
"uncertainty_score": 0.42,
"rationale_tags": ["ddi_reduction", "deprescribing"],
}
)
candidates.append(stop)
dose_candidate = _base_candidate(3, ActionType.REDUCE_DOSE_BUCKET, target_drug=first)
candidates.append(
dose_candidate.model_copy(
update={
"mode": DecisionMode.DOSE_OPT,
"dose_bucket": DoseBucket.LOW,
"estimated_safety_delta": 0.16,
"burden_delta": 0.03,
"uncertainty_score": 0.33,
"rationale_tags": ["dose_deintensification"],
}
)
)
subs = get_substitutions(first)
if subs:
preferred = subs[0]
candidates.append(
_base_candidate(
4,
ActionType.SUBSTITUTE_WITHIN_CLASS,
target_drug=first,
replacement_drug=preferred,
).model_copy(
update={
"estimated_safety_delta": 0.22,
"burden_delta": 0.05,
"uncertainty_score": 0.36,
"rationale_tags": ["therapeutic_substitution"],
}
)
)
for med in meds:
if is_renal_unsafe(med.drug, state.patient.labs.egfr) or is_hepatic_unsafe(med.drug, state.patient.labs.ast, state.patient.labs.alt):
hold = _base_candidate(5, ActionType.DOSE_HOLD, target_drug=med.drug, mode=DecisionMode.DOSE_OPT).model_copy(
update={
"monitoring_plan": "repeat_labs_72h",
"estimated_safety_delta": 0.2,
"disease_stability_estimate": 0.74,
"uncertainty_score": 0.28,
"required_monitoring": ["renal_or_hepatic_panel"],
"rationale_tags": ["organ_function_guardrail"],
}
)
candidates.append(hold)
break
monitoring = _base_candidate(8, ActionType.ORDER_MONITORING_AND_WAIT, mode=DecisionMode.DOSE_OPT).model_copy(
update={
"monitoring_plan": "vitals_labs_7d",
"estimated_safety_delta": 0.1,
"disease_stability_estimate": 0.88,
"uncertainty_score": 0.26,
"rationale_tags": ["monitor_before_change"],
"required_monitoring": ["cbc", "cmp"],
}
)
candidates.append(monitoring)
pharm = _base_candidate(9, ActionType.REQUEST_PHARMACIST_REVIEW, mode=DecisionMode.REVIEW).model_copy(
update={"estimated_safety_delta": 0.04, "uncertainty_score": 0.18, "rationale_tags": ["abstain_for_review"]}
)
spec = _base_candidate(10, ActionType.REQUEST_SPECIALIST_REVIEW, mode=DecisionMode.REVIEW).model_copy(
update={"estimated_safety_delta": 0.04, "uncertainty_score": 0.2, "rationale_tags": ["abstain_for_review"]}
)
candidates.extend([pharm, spec])
if state.sub_environment.value == "BANDIT_MINING" and meds:
bandit = _base_candidate(6, ActionType.KEEP_REGIMEN).model_copy(
update={
"candidate_id": "cand_06",
"mode": DecisionMode.REGIMEN_OPT,
"estimated_safety_delta": 0.08,
"burden_delta": 0.01,
"uncertainty_score": 0.31,
"rationale_tags": ["contextual_bandit_exploration"],
}
)
candidates.append(bandit)
if state.sub_environment.value == "WEB_SEARCH_MISSING_DATA":
candidates.append(
_base_candidate(7, ActionType.FETCH_EXTERNAL_EVIDENCE, mode=DecisionMode.REVIEW).model_copy(
update={
"candidate_id": "cand_07",
"evidence_query": "https://www.nih.gov",
"estimated_safety_delta": 0.11,
"disease_stability_estimate": 0.84,
"uncertainty_score": 0.22,
"rationale_tags": ["missing_data_recovery", "external_evidence_fetch"],
}
)
)
if state.sub_environment.value == "ALTERNATIVE_SUGGESTION" and meds:
alt_target = meds[0].drug
alt_replacements = get_substitutions(alt_target)
if alt_replacements:
candidates.append(
_base_candidate(
11,
ActionType.RECOMMEND_ALTERNATIVE,
target_drug=alt_target,
replacement_drug=alt_replacements[0],
mode=DecisionMode.REGIMEN_OPT,
).model_copy(
update={
"candidate_id": "cand_11",
"estimated_safety_delta": 0.24,
"burden_delta": 0.04,
"uncertainty_score": 0.29,
"rationale_tags": ["alternative_suggestion", "safer_addition_or_swap"],
}
)
)
if state.sub_environment.value == "NEW_DRUG_DECOMPOSITION":
candidates.append(
_base_candidate(12, ActionType.DECOMPOSE_NEW_DRUG, mode=DecisionMode.REVIEW).model_copy(
update={
"candidate_id": "cand_12",
"new_drug_name": "novel_combination_x",
"candidate_components": ["novel_component_a", "novel_component_b"],
"estimated_safety_delta": 0.14,
"disease_stability_estimate": 0.8,
"uncertainty_score": 0.24,
"rationale_tags": ["new_drug_component_analysis"],
}
)
)
priority_by_subenv = {
"WEB_SEARCH_MISSING_DATA": ActionType.FETCH_EXTERNAL_EVIDENCE,
"ALTERNATIVE_SUGGESTION": ActionType.RECOMMEND_ALTERNATIVE,
"NEW_DRUG_DECOMPOSITION": ActionType.DECOMPOSE_NEW_DRUG,
}
priority_action = priority_by_subenv.get(state.sub_environment.value)
if priority_action is not None:
prioritized = [item for item in candidates if item.action_type == priority_action]
non_prioritized = [item for item in candidates if item.action_type != priority_action]
candidates = prioritized + non_prioritized
# Strict 3..10.
limited = candidates[:10]
if len(limited) < 3:
limited.extend([_base_candidate(i + 10, ActionType.KEEP_REGIMEN) for i in range(3 - len(limited))])
validated: list[CandidateAction] = []
for candidate in limited:
legal = verify_action_legality(state, _to_action(candidate)).legal
validated.append(candidate.model_copy(update={"legality_precheck": legal}))
return validated
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