American family physician
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According to the literature, 12 to 16 percent of children in the United States have at least one developmental delay, yet as many as one-half of affected children will not be identified by the time they enter kindergarten. If developmental delays are detected too late, opportunities for early intervention may be lost. Empirical literature on clinical recommendations for developmental delay screening in primary care is inconsistent and often insufficient to direct the family physician. ⋯ The most extensively evaluated parent-completed tools are the Parents' Evaluation of Developmental Status and the Ages and Stages Questionnaire. Family physicians should be familiar with currently available screening tools, as well as their limitations and strengths. Additional evaluations and referrals are recommended if developmental delay is identified or suspected.
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Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. It results from an inadequate physiologic response to postural changes in blood pressure. Orthostatic hypotension may be acute or chronic, as well as symptomatic or asymptomatic. ⋯ Treatment includes correcting reversible causes and discontinuing responsible medications, when possible. Nonpharmacologic treatment should be offered to all patients. For patients who do not respond adequately to nonpharmacologic treatment, fludrocortisone, midodrine, and pyridostigmine are pharmacologic therapies proven to be beneficial.