Following a stroke, patients may have deficits that affect their ability to drive. The Royal College of Physicians recommend that health professionals provide advice to promote adherence to Driver and Vehicle Licensing Agency (DVLA) guidelines. The authors surveyed 46 participants who had had a stroke at least 1year ago to determine whether they received and complied with current advice. When compared to those who did not receive advice, those who did were significantly more likely to obtain medical permission before driving, but there were no significant differences in the frequency with which they complied with other recommendations. Many who notified the DVLA benefited from an assessment. Driving status and advice should be recorded in medical records and hospital staff should emphasize the positive benefits that may follow assessments and compliance with current guidance.

Sleep problems in older adults are so common that nearly half of all hypnotic prescriptions written are for persons over 65 years old. Although normal aging affects sleep, the practitioner should evaluate the many factors that cause insomnia: medical illness, psychiatric illness, dementia, alcohol and/or polypharmacy, restless legs syndrome, periodic leg movements, and sleep apnea syndrome. Nonpharmacologic treatment of sleep disorders is preferred. The nurse practitioner can assess and manage elderly patients with sleep disorders, but they need to refer those who can benefit from evaluation to a sleep disorder center.

No abstract

No abstract

Late Honorary Surgeon to Bolton Infirmary ; Author of "Wastage of Child Life," etc. AMONG the causes which contribute to the deplorable wastage of child life, so demonstrably evident in this country, that of alcoholism must be assigned a high place. At two stages of the child's existence may alcohol be introduced into its circulationviz. (1) pre-natal, and (2) post-natal, the former indirectly via the mother's blood, the latter by direct ingestion. PRE-NATAL ALCOHOLISM. In order to realize something of the gravity of this, it is only necessary to review our knowledge of the action of alcohol upon the adult human body. It is provedly a poison to protoplasm and to all cell-life-including even the germ-cells-checking the vitality and the activity not only of the life-protecting, but also of the tissue-producing, cells, thus interfering with the vital processes at their very beginning-poisoning the life-stream at its sourceand stunting tissue development at its start and at everysubsequent stage. In confirmation of this, the classic experiments of the late Dr. J. J. Ridge upon plants may be cited, as also those of Rauber upon animal forms, some of the latter showing that hens' eggs, when incubated in alcohol-impregnated air, hatched out slowl~, the chicks afterwards developing abnormally, other experiments showing that many of the puppies born of mothers to whom a small amount of alcohol had been given daily died within a few days, others becoming epileptic and few attaining to healthy maturity. These conclusions have since been confirmed by the experiments upon pregnant animals by Hodge, Mariet, and Combemale. Further, it has been proved that not only the VOL. VI.