Complex processes can be difficult to keep track of. This flowchart template creates an intuitive visual for multi-step processes. The circular flowchart template changes things up with a different shape, but it also provides a different path structure. For example, in the image above, the template can be used as a decision-making framework.
Social media managers, product marketers, and content strategists may find this template suits their needs. This template has a cleaner appearance than some of the more complex templates and may be better for visual learners.
One example — highlighted above — might be for a nurture stream. In the image, the process ends whether someone signs up for an event or not. A tree-style flowchart template makes the most sense for situations where there are multiple options and when each option has a clear and distinct next step.
This example depicts the various options and next steps a caller can take when contacting a business via telephone. For businesses, this flowchart would be perfect for the support department — which can use this template to map out responses from automated chat support or as outlined above a phone tree.
The final flowchart businesses might want to utilize is an organizational flowchart or org chart template. While not exactly procedural, this visualization helps those within the company quickly understand who reports to whom and who is responsible for what. It can also be used by Human Resources teams to inform team structure and organizational decisions.
Users can see how a team is structured at-a-glance, and can quickly determine who they need to go to for their project or to have their questions answered. The revised Statement has been cited over 1, times and the accompanying explanatory document over times. It has also recently been published as a book for those involved in the planning, conducting and interpretation of clinical trials. These reporting guidelines have been incorporated into the EQUATOR Network initiative to enhance the transparent and accurate reporting of research studies.
A randomized controlled trial is a form of scientific experiment that may be useful when important factors cannot be brought under direct experimental control. In the modern world, the most important examples of RCTs are clinical trials that contrast drugs, surgical techniques, or other medical treatments.
Participants who enroll in these trials differ from one another in many ways that can influence treatment outcomes, and yet cannot be directly controlled. By randomly allocating participants amongst several compared treatments, however, an RCT enables statistical control over these influences. Provided it is designed well, conducted properly, and enrolls enough participants, an RCT may achieve good enough control over these confounding factors to deliver a clinically useful comparison of the treatment alternatives studied.
In modern medicine, RCTs have been important not only for promoting widespread use of beneficial new treatments, but also for ending harmful practices that otherwise tend to persist amid the cognitive biases of uncontrolled clinical practice. In a blind or blinded experiment , information which may influence the participants of the experiment is withheld until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expectations, observer's effect on the participants, observer bias, confirmation bias, and other sources.
A blind can be imposed on any participant of an experiment, including subjects, researchers, technicians, data analysts, and evaluators. In some cases, while blinding would be useful, it is impossible or unethical.
For example, it is not possible to blind a patient to their treatment in a physical therapy intervention. A good clinical protocol ensures that blinding is as effective as possible within ethical and practical constraints.
A serious adverse event SAE in human drug trials is defined as any untoward medical occurrence that at any dose. The relative risk RR or risk ratio is the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group. Together with risk difference and odds ratio, relative risk measures the association between the exposure and the outcome.
In a randomized experiment, allocation concealment hides the sorting of trial participants into treatment groups so that this knowledge cannot be exploited.
Adequate allocation concealment serves to prevent study participants from influencing treatment allocations for subjects. Studies with poor allocation concealment are prone to selection bias. The risk difference RD , excess risk , or attributable risk is the difference between the risk of an outcome in the exposed group and the unexposed group.
It is computed as , where is the incidence in the exposed group, and is the incidence in the unexposed group. If the risk of an outcome is increased by the exposure, the term absolute risk increase ARI is used, and computed as.
Equivalently, if the risk of an outcome is decreased by the exposure, the term absolute risk reduction ARR is used, and computed as. Therefore, some questionnaires are fundamentally incomparable, and the selection of one questionnaire should be based on the purpose of each specific questionnaire. Table 3 summarizes the objective of each questionnaire. Each row represents a sleep questionnaire, and it indicates what does this questionnaire intend to measure.
However, the question remains for those questionnaires with the same number of questions e. This question has motivated several studies to compare their sensitivity true positive rate and specificity true negative rate. Some important studies comparing sleep questionnaires for the identification of sleep apnea are summarized in Table 4.
Each row represents a study that compares 3—5 sleep questionnaires. For each study, the table shows the size of the sample used amount of people that participated in the study and which questionnaire produced the best sensitivity and specificity. The reference to each study is also included. Sleep diaries allow patients to self-assess their sleep. Sleep diaries have one important advantage over sleep questionnaires. While sleep questionnaires are filled in once, sleep diaries are filled in over a period of time usually one or two weeks.
This means that sleep diaries contain more information, and also that the information contained is more precise. Contrarily, the sleep diary collects data every day, so that good and bad days are recorded. Moreover, the sleep diary is not so dependent on memory, because they are often filled in just after waking up. We have been collecting sleep diaries from hospitals, sleep centres and different studies. In our repository, there are more than 25 sleep diaries. The most representative are shown in Table 5.
Each row represents a sleep diary, and it indicates the number of questions included in the diary and the scale used to complete the answers. The Pittsburgh Sleep Diary Monk et al.
After it was proposed, many other diaries have been defined by researchers, hospitals, and sleep centres. In March , 25 researchers attending the Pittsburgh Assessment Conference developed an initiative to compare a collection of sleep diaries in order to extract the best from each diary studied and integrate all together, producing an improved sleep diary.
The diaries included in Table 5 are classified according to the information required from the user. In particular, they include different questions about their sleep such as time used to fall asleep, the amount and kind of food in the dinner, or use of drugs, etc.
There is also the existence of sleep diaries that are distributed as mobile apps. The most used and better valued sleep diaries according to Google Play are Sleep Diary Pro reviews with a mark of 4. Contactless methods to assess sleep use one or more of the following technologies: Microphone in Nakano et al.
However, currently the most used device to assess the sleep is the smartphone. Because a smartphone contains a microphone, a camera, and an accelerometer, it can use these hardware features to monitor sleep.
This has promoted the appearance of many mobile apps to assess sleep. The main contactless sleep detection apps according to the number of reviews in Google Play are shown in Table 6. Each row shows a sleep app. Rows are sorted in descending order according to the average review mark. Contact hardware devices to assess sleep are small devices that can be attached to the wrist, chest, ankle, or head.
Some of these devices use the Cartesian representation to record the activity of the body and thus they are known as actigraphs.
Most actigraphs use an accelerometer to register movements. The information collected is used to analyse sleep. Even though contemporary actigraph devices are electronic, the first actigraphs were mechanical contrary to common belief. Due to the usefulness of the information collected by actigraphs, the use of actigraphy has been included in the ICSD-3 diagnostic criteria for several circadian sleep-wake rhythm disorders. Even though there is a clear continual improvement in the precision of sensors, and in the accuracy of algorithms, the use of actigraphs for clinical diagnosis should be considered when the device and algorithm used have been validated.
In particular, the algorithm used to interpret the data is of major importance, because many proprietary algorithms do not pass enough quality controls, and some of them are even worse than the human inspection of the actigraphy data see, e. Each sleep detection method has its own level of reliability and precision. If we place the presented methods in order of accuracy, as reported in the literature Boyne et al.
It is important to note that this formulation does not pretend to sort the methods according to their usefulness. It would be erroneous to state that self-reporting is inferior or less useful to more objective measures. This would fail to appreciate that data based on patient perception may be valuable in understanding sleep problems.
Being both mostly subjective, there is an important difference in the way that sleep diaries and questionnaires are completed. Questionnaires are filled in once, usually before the interview with the sleep therapist, thus, not just after waking up. In contrast, sleep diaries 1 are filled in every day, and 2 they are completed just after waking up. Hence, they are potentially more accurate and less influenced by the memory of the patient.
Therefore, the amount of information and accuracy of sleep diaries is objectively superior to that of questionnaires. Here again, the superiority in precision of sleep diaries does not substitute the global assessment of sleep questionnaires, and the latter may be the relevant data therefore making the questionnaire more pertinent.
The accuracy of sleep questionnaires has been widely studied see, e. The sensitivity reported was in the interval These studies are definitely useful, and provide good indicators, but our selection of a specific questionnaire must consider the specific illness and population targeted. Precisely because they target different populations the results of these studies are not always directly comparable. For instance, the study in Silva et al. The effectiveness of sleep diaries has been evaluated in Jungquist et al.
These studies also compare paper diaries and electronic diaries using an actigraph as the gold standard. Both studies found that, statistically, paper and electronic diaries collect the same data; thus, their accuracy and reliability is similar.
The main difference between contact and contactless devices is their underlying technology. In general, contact devices are more accurate because most of the sensors used to monitor sleep are strongly dependent on their distance from the patient the closer the better.
A good example are the accelerometers, which are sensors used in both contact devices such as wrist watches, and contactless devices such as mattress or pillow clips. It is fairly evident that it is much more reliable to directly measure the movements of the body than approximating them by measuring the movements of the mattress or pillow. The same happens with sonars, for example. Of course, the results are more precise as the patient is closer.
Unfortunately, the movements of the sonar can negatively affect its measurements and results, hence it is preferable putting it on a bedside table, lying still, instead of putting it on the mattress.
As a consequence, the sonar is often at least 0. This problem also happens with similar radio frequency technology used to monitor the body movements and breathing.
One of the main factors that influence the accuracy of sleep detection devices is the quality of their sensors.
Another important factor is the software that process the data collected by the sensor. Currently, there are more than , health apps in the Apple and Google Play app stores Research 2 Guidance, Many of these apps focus on sleep, and a large proportion of them implement proprietary sleep detection algorithms. As a consequence, the same device e.
It is therefore very important to highlight that most of the publicly available sleep apps have not been clinically validated.
Most of them are implemented and maintained by independent non-clinical programmers and, thus, their clinical use is not recommended. Of course, there have been many studies devoted to validating hardware devices and reporting on their accuracy and precision. Some studies devoted to validating actigraphs are Sivertsen et al. They all study the correlation between one commercial actigraph and a PSG the patient wore the actigraph during the PSG.
Other works study the precision of actigraphy with specific populations children, adults, old women, mentally disordered, etc. Blackwell et al. The review of the state of the technology together with the review of the validation studies advise against using contactless devices in the clinical study of sleep. Their low precision renders them far from being a reliable method. This does not mean that they are useless. They are good sleep indicators, and a good resource for patients to monitor and be aware of their own sleep quality.
But their use as a definitive diagnostic tool is to be discouraged. In the case of contact devices, their precision is acceptable for many populations.
However, these numbers are on the increase because the advances in technology are continuously improving such devices. This is also observable in the continuous increment of precision reported over time by validation studies. The first conclusion of this review is that a perfect sleep assessment method does not exist. All methods have advantages and disadvantages, thus, they should be combined and adapted to the specific applicable needs.
In terms of accuracy, the PSG is the best method, reporting the most complete and precise information e. Nevertheless, PSGs are expensive, exclusive they require special hardware and medical support , can only be administered once, or for a few days, and they assess sleep in a stressful context e. For these reasons, sleep diaries and questionnaires are often used to complement the PSG. They provide information that is gathered over medium to long periods of time, including information about sleep habits.
Because they are mostly subjective, they have been erroneously considered as unreliable. In the specific case of electronic diaries, the studies demonstrate that they produce the same results as their paper counterparts, but also that they provide functional advantages: automatic data processing, metadata such as information about when the patient filled in the diary, alerts, etc.
The literature review shows that the accuracy of hardware devices is superior to that of questionnaires. This superiority, however, must be considered only in terms of precision, but not in terms of diagnostic usefulness. The information provided by questionnaires regarding self-perception of sleep quality is essential and cannot be replaced by hardware measures.
The adherence of hardware devices is also superior, because they require less effort from the patient e. The accuracy and reliability of hardware devices have been continuously increased with the advances of the technology. The continuous improvement of sensors and the appearance of new technologies good examples are the imminent use of infrared thermometers and lidars clearly improve the sleep detection devices.
We have presented a taxonomy of sleep methods that comprises all methods presented. This taxonomy classifies hardware devices into contact and contactless devices, because their functionality, accuracy, and reliability are different. In both cases, many studies reach the similar conclusion that current sleep trackers are useful tools to assess sleep and have been used successfully in many sleep studies.
Nevertheless, the studies also report that the results obtained are particularly influenced by the patient that wears the actigraphy, which can produce bad results in many cases. Therefore, the use of actigraphy as a diagnostic tool should be complemented and contrasted with other methods to produce a more definitive diagnostic.
Finally, sleep apps are another important tool to assess sleep, especially in smartphones, where they are becoming very common nowadays. We have shown the most significant apps with regard to their number of reviews, and to their overall mark given by users. It is important to highlight that, contrasted with hardware, software apps are often implemented by independent non-clinical developers, and they do not pass any quality test.
Therefore, they must be validated, at least before they are applied in clinically. The few scientific validation studies that have compared smartphone apps against PSG report that they are still not accurate enough to be used as clinical tools. The authors would like to thank Roger Nolan for reviewing a preliminary version of this article.
His help to improve our work is greatly appreciated. Competing Interests The authors declare there are no competing interests. Data Availability The following information was supplied regarding data availability:. Etsy is the home to thousands of handmade, vintage, and one-of-a-kind products and gifts related to your search. Custom Cards Any Size. We offer a variety of free online printing templates for all your projects. The section provides support for schools and parents on reporting in primary schools.
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