Effect of beloved person's voice on chest tube removal pain in patients undergoing open heart surgery: fuzzy logistic regression model

Chest tube removal pain is one of the most important complications after open heart surgery. The removal of a chest tube is a painful and frightening experience and should be managed with as little pain and distress as possible. The aim of this study is to assess the effect of beloved person's voice on chest tube removal pain in patients undergoing open heart surgery. 128 patients were randomly assigned to two groups: one group listened to beloved person's voice during the procedure, and the other did not. Since pain was measured by linguistic terms, a fuzzy logistic regression was applied for modeling. After controlling for the potential confounders, based on fuzzy logistic regression, the beloved person's voice reduced the risk of pain. Therefore, using beloved person's voice could be effective, inexpensive and safe for distraction and reduction of pain

Experiences of nursing students of evidence-based practice education according to rogers' diffusion of innovation model: a directed content analysis

Introduction: Evidence based practice [EBP] education is essential in promoting of clinical care, but an effective educational strategy for teaching EBP in nursing faculties is not available. The aim of this study was to explore the experiences of nursing students of EBP Education according to Rogers' Diffusion of Innovation Model

Methods: This qualitative study was carried out using a directed content analysis method and purposeful sampling. Data were collected until saturation by fourteen semi-structured face-to face individual interviews and two focus group discussions with nursing students from two nursing faculties in Tehran, Iran. Rogers' Model was used in this study

Results: Data were classified into five themes and 11 categories according to the Rogers's Model. Themes and main categories were knowledge [educational enrichment, new strategy for education], persuasion [internalization of education, improvement of motivation], decision [acceptance, use in the future], implementation [objectivity, consolidation of learning] and confirmation [learning and teaching, achieving a goal, self confidence]

Conclusions: EBP Education, based on the teaching strategy of Rogers's Model, leads to an improved EBP learning. All the necessary steps for a better education of it are included in this educational approach which can be used to teach any new subject like EBP

Design and psychometric properties of male adolescent health needs-assessment scale

Background: given the importance of adolescents' health in establishing health in the newly thriving generation of every society, the first step for adolescents' health promotion is health needs assessment. The present study was, therefore, conducted to design a valid and reliable scale for health needs assessment of male adolescents

Methods: this is an exploratory sequential mixed method study [2014 2015]. The qualitative part was performed using content analysis approach and aimed to generate items pool. Data collection was performed by 7 focus group discussions with 51 male adolescents, and 10 semi-structured in-depth interviews with 10 other adolescents. Nine further in-depth interviews were also performed with 9 key informants. Purposive sampling was used and continued until data saturation. In the quantitative part, the designed scale was psychometrically assessed through the examination of the face and content validities using qualitative and quantitative methods and also the construct validity using the exploratory factor analysis along with the tool's internal consistency and stability

Results: the content analysis of the data from the qualitative part led to the extraction of 4 main themes and 103 items, which moved to the quantitative stage. The mean content validity index of the scale was estimated 0.91 and content validity ratio was 0.89. The exploratory factor analysis showed 4 factors for the designed scale [49 items], including physical, psychological, social and sexual health needs. The internal consistency and the stability assessment of the scale showed 0.79 and 0.89, respectively. [P<0.001]

Conclusion: according to the psychometric assessment, MAHNAS is a valid and reliable scale compatible with the Iranian culture that can be used in the health needs assessment of male adolescents

Prediction of the thromboembolic syndrome: an application of artificial neural networks in gene expression data analysis

The aim of this study was to propose a method for improving the power of recognition and classification of thromboembolic syndrome based on the analysis of gene expression data using artificial neural networks

The studied method was performed on a dataset which contained data about 117 patients admitted to a hospital in Durham in 2009. Of all the studied patients, 66 patients were suffering from thromboembolic syndrome and 51 people were enrolled in the study as the control group

The gene expression level of 22277 was measured for all the samples and was entered into the model as the main variable. Due to the high number of variables, principal components analysis and auto-encoder neural network methods were used in order to reduce the dimension of data

The results showed that when using auto-encoder networks, the classification accuracy was 93.12. When using the PCA method to reduce the size of the data, the obtained accuracy was 78.26, and hence a significant difference in the accuracy of classification was observed. If auto-encoder network method is used, the sensitivity and specificity will be 92.58 and 93.68 and when PCA method is used, they will be 0.77 and 0.78 respectively. The results suggested that auto-encoder networks, compared with the PCA method, had a higher level of accuracy for the classification of thromboembolic syndrome status

Comparison of generalized estimating equations [GEE], mixed effects models [MEM] and repeated measures ANOVA in analysis of menorrhagia data

Menorrhagia is one of the most common gynecological problem and leading causes of poor quality of life and iron deficiency anemia in women of reproductive age. Research in gynecological field relies heavily on repeated measure designs

Repeated measure studies are helpful in understanding how factors of interest change over time

Our goal is to apply statistical methods which are appropriate for analyzing repeated measure data such as gynecological data. Three statistical methods were performed by data collection from 100 patients with menorrhagia

One-hundred patients were randomly assigned to two groups, i.e. intervention group [Urtica Dioica and mefenamic acid] and control group [placebo and mefenamic acid] with an equal size of 50. In this study, generalized estimating equations [GEE] and mixed effects models [MEM] were used for analyzing menorrhagia data to determine the effect of hydroalcoholic extract of Urtica Dioica on Menorrhagia. Finally, these methods are compared to the conventional repeated measures ANOVA [RM-ANOVA]

Based on the results, the three methods are found to be similar in terms of statistical estimation, the amount of bleeding before and after treatment between and within groups was compared. Results showed the average amount of bleeding was reduced significantly [P=0/001]

The average menorrhagia score in the third month [second cycles after intervention] were 91.38 [71.432] and 149.40 [127.823] in Urtica Dioica and control groups, respectively. The difference between the two groups was statistically significant [p =0.036]

Because their advantages, GEE and MEM should be strongly considered for the analysis of repeated measure data. In particular, GEE should be utilized to explore overall average effects

When in addition to overall average effects, subject-specific effects are of primary interest, MEM should be utilized. With respect to these methods, it seems the extract of Urtica Dioica can be effective in reducing the amount of menstrual bleeding in women of reproductive age with Menorrhagia

Using support vector machines in predicting and classifying factors affecting preterm delivery

Various statistical methods have been proposed in terms of predicting the outcomes of facing special factors. In the classical approaches, making the probability distribution or known probability density functions is ordinarily necessary to predict the desired outcome. However, most of the times enough information about the probability distribution of studied variables is not available to the researcher in practice. In such circumstances, we need that the predictors function well without knowing the probability distribution or probability density. It means that with the minimum assumptions, we obtain predictors with high precision. Support vector machine [SVM] is a good statistical method of prediction. The aim of this study is to compare two statistical methods, SVM and logistic regression. To that end, the data on premature infants born at Tehran Milad Hospital is collected and used

Psychometric properties of the Persian version of self-transcendence scale: adolescent version

Background: Given the greater tendency during adolescence toward risk-taking, identifying and measuring the factors affecting the adolescents' health is highly important to ensure the efficacy of health promoting interventions. One of these factors is self-transcendence. The aim of this study was to assess the psychometric features of the Self-Transcendence Scale [adolescents' version] in students in Tehran, the capital city of Iran

Methods: This research was conducted in 2015. For this purpose, 1210 high school students were selected through the multistage cluster sampling method. After the backward-forward translation, the psychometric properties of the scale were examined through the assessment of the [face and construct] validity and reliability [internal consistency and stability] of the scale. The construct validity was assessed using two methods, factor analysis, and convergence of the scale with the Hopefulness Scale for Adolescents

Results: The result of face validity was minor modifications in some words. The exploratory factor analysis resulted in the extraction of two dimensions, with explaining 52.79% of the variance collectively. In determining the convergent validity, the correlation between hopefulness score and self-transcendence score was r=0.47 [P<0.001]. The internal consistency of the scale was determined using Cronbach's alpha of 0.82 for the whole scale and 0.75 and 0.70 for each of the sub-scales. The stability reliability was found to have an ICC of 0.86 and a confidence interval of 95%

Conclusion: The Persian version of the Adolescents' Self-Transcendence Scale showed an acceptable validity and reliability and can be used in the assessment of self-transcendence in Iranian adolescents

effect of wheat germ extract on premenstrual syndrome symptoms

Pre-menstrual syndrome is one of the most common disorders in women and impairs work and social relationships. Several treatment modalities have been proposed including herbal medicines. Considering the properties of wheat germ, this study aimed to determine the effects of wheat germ extract on the symptoms of premenstrual syndrome. This triple blind clinical trial was conducted on 84 women working in hospitals affiliated to Hamadan University of Medical Sciences. Subjects completed daily symptom record form for two consecutive months. After definitive diagnosis of premenstrual syndrome, they were randomly divided into two groups of 50 people. Then, for two consecutive months, 400 mg capsules of wheat germ extract or placebo were used three times a day, from day 16 until day 5 of the next menstrual cycle. Wheat germ significantly reduced physical symptoms [63.56%], psychological symptoms [66.30%], and the general score [64.99%]. Although the severity of symptoms decreased in both groups, this reduction was more significant in the wheat germ extract group [p < 0.001]. On the other hand, physical symptoms decreased only in the wheat germ extract [p < 0.001] and there was no statistically significant difference in the placebo group. No complications were observed in any of the groups. It seems that using wheat germ extract reduces general, psychological and physical symptoms

Comparison of the therapeutic effects of Garcin(®) and fluconazole on Candida vaginitis

<p><b>INTRODUCTION</b>This study aimed to determine and compare the effects of garlic tablets (Garcin(®)) and fluconazole on Candida vaginitis in women who presented to a health centre in Koohdasht, Iran, from August 2011 to March 2012.</p><p><b>METHODS</b>The clinical trial was conducted on 110 married women (aged 18-44 years) who had complaints of itching or a burning sensation in the vaginal area. Candida vaginitis was diagnosed by pH measurement of vaginal secretions, direct microscopic evaluation and Sabouraud dextrose agar cultures of the vaginal discharge. On confirmation of diagnosis, the patients were randomly divided into two groups (n = 55). One group received 1,500 mg of Garcin tablets daily and the other received fluconazole tablets 150 mg daily, over a period of seven days. Four to seven days after the completion of treatment, patients were examined for treatment response and possible side effects.</p><p><b>RESULTS</b>Complaints related to the disease improved by about 44% in the Garcin group and 63.5% in the fluconazole group (p < 0.05). The overall symptoms of the disease (i.e. redness of vulva and vagina, cheesy discharge, pustulopapular lesions and abnormal cervix) improved by about 60% in the Garcin group and 71.2% in the fluconazole group (p > 0.05). Results of microscopic evaluation and vaginal discharge culture showed significant differences before and after intervention in both groups (p < 0.05).</p><p><b>CONCLUSION</b>The present study shows that Garcin tablets could be a suitable alternative to fluconazole for the treatment of Candida vaginitis.</p>

Cox models survival analysis based on breast cancer treatments

The aim of this study is to evaluate the association between different treatments and survival time of breast cancer patients using either standard Cox model or stratified Cox model. The study was conducted on 15830 women diagnosed with breast cancer in British Columbia, Canada. They were divided into eight groups according to patients' ages and stage of disease Either Cox's PH model or stratified Cox model was fitted to each group according to the PH assumption and tested using Schoenfeld residuals. The data show that in the group of patients under age 50 years old and over age 50 with stage ? cancer, the highest hazard was related to radiotherapy [HR= 3.15, CI: 1.85-5.35] and chemotherapy [HR= 3, CI: 2.29- 3.93] respectively. For both groups of patients with stage ?? cancer, the highest risk was related to radiotherapy [HR=3.02, CI: 2.26-4.03] [HR=2.16, CI: 1.85-2.52]. For both groups of patients with stage III cancer, the highest risk was for surgery [HR=0.49, CI: 0.33-0.73], [HR=0.45, CI: 0.36-0.57]. For patients of age 50 years or less with stage IV cancer, none of the treatments were statistically significant. In group of patients over age 50 years old with stage ?V cancer, the highest hazard was related to surgery [HR=0.64, CI: 0.53-0.78]. The results of this study show that for patients with stage I and II breast cancer, radiotherapy and chemotherapy had the highest hazard; for patients with stage III and IV breast cancer, the highest hazard was associated with treatment surgery

Promotion of self-transcendence in a multiple sclerosis peer support groups

Self-transcendence can organize the challenges of multiple sclerosis patients to achieve and maintain a constant state of well-being and sense of integrity in the disease process. As a research based on self-transcendence didn't done in Iran, the present study was conducted to evaluate the effectiveness of peer groups on promoting self-transcendence level in multiple sclerosis [MS] patients. This study is a before and after quasi-experimental study that was conducted on 33 patients with confirmed MS participated in three peer support groups: 10 men in male group, 11 women in female group and 12 men and women in mixed group. Eight weekly sessions and each session was 2 hours were held. Data collection tool was Self-Transcendence Scale [STS] with 15 item and Cronbach's coefficient was 0.68 that after modifying, it increased to 0.81. Patients completed self administered questionnaires pre- and post of sessions. Results showed that peer support groups promote the self-transcendence [p=0.001] with increases in mean self-transcendence scores in all 3 groups [men group: 0.008, women group 0.005 and mixed group: 0.003]. Comparing scores before and after intervention demonstrated that self-transcendence increased equally in all groups. The results showed an improving in self-transcendence in peer support group participants at the end of the intervention. The results can be used in areas of nursing education and management. It is proposed that the self-transcendence assessment to be done in other chronic disease in order to evaluate its efficiency

[ evaluation of recognize of clinical factors and microscopy examination vaginal discharge in vaginal candidias diagnostic among the women who reffered to kohasht health -medical center in 2011]

The reproductive system infections are most common womens reasons for repetitive refers to gynecological clinic and the second problem is vulvovaginal candidiasis. since, distribution of patients and clinical signs may cause the wrong diagnose and treatment, in this study clinical signs and examination microscopy and vaginal discharge were compared. In this descriptive study that has done among 18-44 married women years with complain from vaginal itching or irritation [july-may 2011]. After diagnose the vaginite associate of patients complains and rigest the clinical signs, three sampling were done from every women. Two of them for wet mount with saline /KOH 10% and the other sample for sending to lab to culture purpose[golden standard test]. data analysis was performed by spss 17 soft ware. Among the factors that evaluate the most sensitivity belong to vulval erythema [89/1%] and the less sensitivity belong to cottage discharge[74/3%] and in the microscopic examination, the most specificity [100%] and the less specificity belong to themselves in vaginal candidiases diagnose between studied factors Using the lab method [culture] and microscopic study on vaginite diagnose

Details of content validity and objectifying it in instrument development

Researchers in the nursing science study complex constructs for which valid and reliable instruments are needed. When an instrument is created, psychometric testing is required, and the first-step is to study the content validity of the instrument. This article focuses on the process used to assess the content validity. This article examines the definition, importance, conceptual basis, and functional nature of content validity in instrument development. The conditional and dynamic nature of content validity is discussed, and multiple elements of content validity along with quantitative and qualitative methods of content validation are reviewed. In content validity process, content representativeness or content relevance of the items of an instrument is determined by the application of a two- stage [development and judgment] process. In this review, we demonstrate how to conduct content validity process, to collect specific data for items generation and calculation of content validity ratio, content validity index, modified Kappa coefficient, and to guide for interpreting these indices. Face validity through suggestions of expert panel and item impact scores is also discussed in paper. Understanding content validity is important for nursing researchers because they should realize if the instruments they use for their studies are suitable for the construct, population under study, and sociocultural background in which the study is carried out, or there is a need for new or modified instruments

Vitamin D Deficiency is Associated with the Metabolic Syndrome in Subjects with Type 2 Diabetes

There is convincing evidence that subjects concomitantly affected by type 2 diabetes [T2D] and metabolic syndrome [MeS] are at greater risk for cardiovascular disease [CVD]. Many metabolic derangements in T2D might be attributed to poor vitamin D status. The purpose of this study was to investigate the associations among vitamin D status, MeS and glycemic status in subjects with T2D. A total of 101 known cases of T2D [39 males, 62 females] were enrolled in a cross-sectional study by convenient sampling. Serum 25[OH]D3, glycemic markers and lipid profile were assessed. Mean concentration of serum 25[OH]D3 was 42.2 +/- 33.8 nmol/L. Prevalence of undesirable vitamin D status [25[OH]D < 50nmol/L] was significantly higher among the subjects with MeS as compared to those without MeS [p=0.020]. The subjects with sufficient vitamin D status had 50% lower risk for MeS compared to those who had vitamin D deficiency, and this association remained significant even after additional adjustment for body mass index [BMI], percent of fat mass or waist circumference. Our data showed that firstly higher vitamin D status is inversely associated with fasting glycemia, and secondly serum 25[OH]D3 predicts MeS risk in the subjects with T2D. Demonstrating the association of hypovitaminosis D with disorders of glucose metabolism and higher risk for development of further complications, notably CVD, may lead to a new target for preventive efforts at the population level

Problems of Clinical Nurse Performance Appraisal System: A Qualitative Study

PURPOSE: The purpose of this study is to explore problems of clinical nurse performance appraisal system. METHODS: This study employed a descriptive qualitative approach. The participants were purposively selected from clinical nurses working across all of the hospital units in a large metropolitan teaching hospital in Tehran, Iran in 2012. Data were collected using five focus group interviews, which were audio taped. The number of participants in each group ranged from 7 to 10. The semi-structured interviews were guided by a set of nondirective questions, and continued until the data reached saturation. Data were analyzed using framework analysis. RESULTS: Four major themes regarding the problems of clinical nurse performance appraisal system emerged from the analysis of textual data. These themes were contextual problems, problems related to performance appraisal structure, problems related to performance appraisal process and those related to performance appraisal results. CONCLUSION: The findings of this study reveal that the nurse performance appraisal system confronts with various problems. Some of these problems are related to organizational context while the others concerned structure, process and results of the performance appraisal system. In order to achieve high quality of patient care as the final goal of performance appraisal, changing and revision of this system is necessary.

diagnostic value of the lactate level in the vaginal fluid for determining the premature rupture of membranes

To determine the diagnostic value of the lactate concentration in vaginal secretions in determining the premature rupture of membranes. One hundred 100 pregnant women with single pregnancy of gestational age 20-41 weeks were divided to two groups of 50 each. One group comprised of women with premature rupture of membranes, and the other [control group] of women with intact membranes. To verify the premature rupture of membranes in both groups, the speculum, fern, and nitrazine tests were done. Lactate Pro manual instrument was used to measure the lactate levels in vaginal fluid via enzymatic staining which was displayed on the instrument's liquid crystal display after 60 seconds. Descriptive analytic statistics and SPSS 17 software were used to analyze the data. The lactate concentration of 4.6 mM in the vaginal fluid was diagnostic for premature rupture of membranes. It had a sensitivity of 96%, specificity of 98.8%, accuracy of 97%, positive predictive value of 97.9%, and negative predictive value of 96%. Testing lactate levels in the vaginal fluid is an easy, rapid and reliable method for the diagnosis of premature rupture of membranes in pregnancy

[ study of inhalation of peppermint aroma on the pain and anxiety of the first stage of labor in nulliparous women: a randomized clinical trial]

Considering the painfulness of labor and its resulting anxiety, and also, complications such as uterine dysfunction, prolonged labor, and unpleasant memories, the present study was performed aimed to investigate the effect of peppermint aroma on the level of pain and anxiety in the first stage of labor in nulliparous women. This research was done as a clinical trial study on 128 nulliparous women assigned into two groups [64 subjects in aromatherapy group and 64 subjects in control group]. In aromatherapy group, mixtures containing 0.2ml essence of peppermint and 2ml normal saline impregnated gauze, and in the control group, only 2ml normal saline impregnated gauze were attached to their dress collar, and the administration was repeated every 30 minutes. Level of anxiety was measured in dilatations 3-4 and 8-10cm and the intensity of pain in dilatations 4-5, 6-7, and 8-10cm. The data were collected through demographic and obstetric questionnaire, observation checklist, spielberger anxiety questionnaire, and pain numerical rating scale. In this study, the age, job, education, and gestational age were the same in both groups. Also, the level of anxiety was the same in both groups before the intervention, but after the intervention, anxiety level decreased in intervention group compared to control group [p<0.001]. The mean pain score in the dilatations 4-5, 6-7, and 8-10cm decreased in intervention group compared to control group [p<0.001 for all]. Aromatherapy with peppermint essence is recommended for the reduction of pain and anxiety level during labor due to its inexpensiveness, ease and non-invasiveness

estimation of survival function for colon cancer data in Tehran using non-parametric Bayesian model

Colon cancer is the third cause of cancer deaths. Although colon cancer survival time has increased in recent years, the mortality rate is still high. The Cox model is the most common regression model often used in medical research in survival analysis, but most of the time the effect of at least one of the independent factors changes over time, so the model cannot be used. In the current study, the survival function for colon cancer patients in Tehran is estimated using non-parametric Bayesian model. In this survival study, 580 patients with colon cancer who were recorded in the Cancer Research Center of Shahid Beheshti University of Medical Sciences since April 2005 to November 2006 were studied and followed up for a period of 5 years. Survival function was plotted with non-parametric Bayesian model and was compared with the Kaplan-Meier curve. Of the total of 580 patients, 69.9% of patients were alive. 45.9% of patients were male and the mean age of cancer diagnosis was 65.12 [SD= 12.26] and 87.7 of the patients underwent surgery. There was a significant relationship between age at diagnosis and sex and the survival time while there was a non-significant relationship between the type of treatment and the survival time. The survival functions corresponding to the two treatment groups cross, in comparison with the patients who had no surgery in the first 30 months, showed a higher level of risk in the patients who underwent a surgery. After that, the survival probability for the patients undergoing a surgery has increased. The study showed that survival rate has been higher in women and in the patients who were below 60 years at the time of diagnosis

[Effect of foot reflexology on physical and psychological symptoms of premenstrual syndrome]

Premenstrual syndrome [PMS] is a set of physical, mental and behavioral symptoms with different severity that cause disorders in individual and social relationships. This syndrome occurs during luteal phase of menstrual cycle with complicated reasons. It is one of the most common disorders of childbearing ages. Because of unclear and complicated causes of this syndrome, different treatment methods have been presented. Reflexology is a non-drug method of prevention and treatment of premenstrual syndrome. It is an old, mild and non-invasive method, but there is not enough researches about its effect on symptoms of premenstrual syndrome. This research was carried out in order to determine the effect of foot reflexology on symptoms of premenstrual syndrome in students of dormitories of Jahrom University in 2011-12. This study was a single-blind controlled clinical trial of 90 students with premenstrual syndrome who were resident in dormitory of Jahrom University. The students were randomly divided into two groups of foot reflexology and control. Intensity of premenstrual syndrome was recorded by subjects in two cycles: pre - intervention cycle and intervention cycle. The tools of data gathering consisted of data gathering forms of temporary diagnosis of PMS, and Beck depression test. Descriptive and inferential statistics were used in order to analyze data. There was no statistically significant difference between research variables such as age and menarche age, and the severity of the symptoms before intervention. The average reduction of general severity of PMS symptoms was 23.39% in foot reflexology group while it was -9.68% in the control group [p<0.0001]. There was signification difference between the average of physical and mental symptoms in reflexology group compared to the control group [p<0.0001]. It seems that, foot reflexology is effective in improvement of physical and metal symptoms of PMS. Therefore, it is possible to achieve a main midwifery aim which is to decrease the intensity of PMS symptoms by teaching this simple technique which doesn't need specialists in order to be done.

Diagnosis of premature rupture of membranes by assessment of urea and creatinine in vaginal washing fluid

Background: rupture of fetal membranes can occur at any gestational age. Premature rupture of membranes [PROM] means rupture of fetal membranes before the onset of labor

Objective: the purpose of this study was to evaluate and compare the reliability of the vaginal washing fluid urea and creatinine for the diagnosis of PROM and to determine cut-off values

Materials and Methods: a total of 179 pregnant women were recruited. All patients underwent different examinations. These included nitrazine paper test, fern test, amniotic fluid pooling, vaginal washing fluid urea and creatinine sampling. The one group consisted of 126 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. Patients who had positive pooling, nitrating paper test and fern test were considered as confirmed PROM group [group 1]. On the other side, patients with pooling [-] and/or nitrazine paper test [-] and/or fern test [-] were taken as suspected unconfirmed PROM cases [group 2]. The control group consisted of 53 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. We conducted one-way ANOVA test on the urea and creatinine measures and post-hoc comparison test. Cut-off value was determined by receiver operating characteristic [ROC] curve

Results: vaginal fluid concentrations of urea and creatinine were significantly different between the three groups [p<0.001]. The sensitivity, specificity, positive and negative predictive values and accuracy were all 100% in detecting premature rupture of membranes by evaluation of vaginal fluid creatinine concentration with a cut-off value of 0.45 mg/dl, respectively

Conclusion: this study demonstrates that of two markers investigated creatinine has the higher diagnostic power