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Table 3 Suitability of workflow control patterns for CPGs

From: Leveraging workflow control patterns in the domain of clinical practice guidelines

Pattern

Suitable

Explanation

Example

1. Sequence

yes

-

Stabilize on tocolytics before transfer mother to appropriate level of care if possible [ 27 ]

2. Parallel split (AND split)

yes

-

The maternal pulse should be felt simultaneously to differentiate between maternal and fetal heart rate [ 27 ]

3. Synchronization (AND join)

yes

explicit/implicit in a sequencing after a parallel split

Zidovudin for one hour and single dose of Nevirapine 30 min before the skin incision. Afterwards give Retrovir until birth [ 27 ].

4. Exclusive choice (XOR split)

yes

-

If diastolic blood pressure >140 mmHg occurs on two readings 5 min apart, then start a continuous IV infusion of an antihypertensive agent [ 28 ]

5. Simple merge (XOR join)

yes

explicit/implicit in a sequencing after an exclusive choice

… locoregional postoperative radiotherapy (after BCT or MRM) [ 29 ]

6. Multi-choice (OR split)

yes

-

Add regular treatment with one or more bronchodilators [ 30 ].

7. Structured synchronizing merge (OR join)

yes

explicit/implicit in a sequencing after a multi-choice

(see example above)

8. Multi-merge

no

multiple activation of a task only in structured loops

 

9. Structured discriminator

unknown

synchronization of 2 or more branches waiting for the first incoming branch has not been found in guidelines

 

10. Arbitrary cycles

no

multiple activation of a task only in structured loops

 

11. Implicit termination

yes

by definition

 

12. MIs without synchronization

no

no multiple, concurrent instances of a task

 

13. MIs with a priori design-time knowledge

no

14. MIs with a priori run-time knowledge

no

15. MIs without a priori run-time knowledge

no

16. Deferred choice

yes

-

Surgery to reduce tumour load. It is unclear whether limited or radical surgery is better [ 29 ] .

17. Interleaved parallel routing

unknown

WCP-40 with the possibility of adding partial ordering constraints has not been found in sample guidelines

 

18. Milestone (deadline)

yes

WITH or WITHOUT activity disablement beyond the milestone

In patients hypoxemic during a COPD exacerbation, arterial blood gases and/or pulse oximetry should be evaluated prior to hospital discharge (WITH) [ 30 ]

ICD implantation is reasonable in selected patients with LVEF < 30-35 %, not within 40 days of a myocardial infarction, on optimal background therapy … (WITHOUT) [ 31 ]

19. Cancel activity

yes

 

If renal function deteriorates substantially, stop treatment [ 31 ]

20. Cancel case

yes

-

Patients with apparent exacerbations of COPD that do not respond to treatment should be re-evaluated for other medical conditions [ 30 ]

21. Structured loop

yes

typically in follow-up activities

Follow-up: first year: once every three months; second year: once every six months; subsequently: annually [ 29 ].

22. Recursion

no

multiple activation of a task only in structured loops

 

23. Transient trigger

yes

interpreted as triggers to be acted on immediately

Administer controlled oxygen therapy and repeat arterial blood gas measurement after 30–60 min [ 30 ].

24. Persistent trigger

yes

interpreted as triggers to be acted on either immediately or at some future time

Spirometry should be performed if there is a substantial increase in symptoms or a complication [ 30 ] .

25. Cancel region

yes

-

Discontinue drugs that may lower heart rate in presence of bradycardia [ 31 ].

26. Cancel MI activity

no

no multiple, concurrent instances of a task

 

27. Complete MI activity

no

28. Blocking discriminator

no

29. Cancelling discriminator

no

no concurrent execution of tasks within cancelation

 

30. Structured partial join

unknown

synchronization of 2 or more branches waiting for the first N incoming ones has not been found in guidelines

 

31. Blocking partial join

no

no multiple execution threads

 

32. Cancelling partial join

no

no concurrent execution of tasks with cancelation

 

33. Generalized AND join

no

no multiple execution threads

 

34. Static partial join for MIs

no

no multiple, concurrent instances of a task

 

35. Cancelling partial join for MIs

no

36. Dynamic partial join for MIs

no

37. Acyclic synchronizing merge

no

useful for non-structured models only

 

38. General synchronizing merge

no

multiple activation of a task only in structured loops

 

39. Critical section

yes

-

The simultaneous administration of radiotherapy and chemotherapy … is discouraged [ 29 ]

40. Interleaved routing

yes

-

Based on ‘expected survival benefit’ no statement can be made. Regarding the optimum sequence of radiotherapy and chemotherapy … The simultaneous administration of radiotherapy and chemotherapy … is discouraged [ 29 ]

41. Thread merge

no

no multiple execution threads

 

42. Thread split

no

43. Explicit termination

yes

-

Discharge with planned follow-up [ 32 ]

  1. Legend of ‘Suitable’ column: ‘yes’ indicates that the pattern has been found in sample CPGs; ‘unknown’ that it has not been found in sample CPGs; and ‘no’ that there exist strong reasons to dismiss the applicability of the pattern in the CPG domain. Bold rows present the workflow control patterns that were finally deemed suitable