[The access of independent midwives to maternity ward technical facilities: the experimentation of a level-1 department]. / Accès des sages-femmes libérales au plateau technique: l'expérimentation d'une maternité de type 1.

OBJECTIVES: The first aim of this study was to evaluate the access of independent midwives to the technical facilities of a level-1 maternity hospital, with a follow-up of 2 years. The second aim was to evaluate the transfer of clinical responsibility, when a patient stops being managed by the independent midwife to be taken care of by the hospital team. PATIENTS AND METHODS: A retrospective study including 51 patients. Analysis of maternal and perinatal data. RESULTS: Of the 51 births, there were 42 vaginal deliveries without intervention (82.35%), 3 instrumental deliveries (5.88%), 6 caesarean sections (11.76%). The midwife-led care was completed in 70.59% of cases. The rate of transfer of clinical responsibility during labor was 25.49%. We conducted a neonatal transfer due to a respiratory distress syndrome. DISCUSSION AND CONCLUSION: The access to technical support appears as an opportunity for independent midwives to establish a special relationship with their patients. However, this device preserves the possibility of a traditional hospital care when needed. This way, access to the technical support is a safe alternative that has the consent of the users (patients and midwives) as well as of the entire hospital team. Moreover, such device allowed an increase of 5% per year of our obstetrical activity with an estimated increase of 10% per year.

Evidence of nutriceutical effectiveness in the treatment of osteoarthritis.

Several entities have been carefully investigated for the symptomatic and structural management of osteoarthritis. The most compelling evidence of a potential for inhibiting the structural progression of osteoarthritis has been obtained with glucosamine sulfate, while some preliminary results also suggest that chondroitin sulfate could be used in the same indication. At any rate, these two compounds have clearly demonstrated a symptomatic action, mainly in osteoarthritis of the lower limbs. Symptomatic effect on pain relief and improvement of functional disability was also reported with the use of avocado/soybean extracts. Other nutriceuticals, including ginger extracts, should be more extensively investigated. An important issue is that all the conclusive studies with such chemical entities resulted from the use of prescription medicines, and not over-the-counter pills or food supplements.