AFP Clinical Answers
Nausea in Pregnancy, Knee Osteoarthritis, Hormone Replacement Therapy, Shingles
Am Fam Physician. 2019 Jan 1;99(1):10.
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Sumi M. Sexton, MD
What treatments are recommended for nausea and vomiting in pregnancy?
Treatment of nausea and vomiting in pregnancy should begin with lifestyle modifications, such as eating frequent small meals throughout the day to keep the stomach from becoming too empty or full, and avoiding foods that further slow gastric emptying (high-protein or fatty foods) or have intense smells or tastes. Other treatments, including P6 acupressure, vitamin B6 (pyridoxine), doxylamine, and prescription antiemetics, can be added as needed. https://www.aafp.org/afp/2018/1101/p595.html
What is the clinical effectiveness of various therapies for knee osteoarthritis?
For short-term (four to 12 weeks) pain relief and/or functional improvement, beneficial interventions include transcutaneous electrical nerve stimulation (TENS), tai chi, and home-based exercise and self-management programs (strength, agility, and pain-coping skills). Platelet-rich plasma injections and home-based and self-management programs reduce pain in the medium term (12 to 26 weeks). Glucosamine and chondroitin supplements have medium-term but not long-term benefits. Shoe inserts are ineffective. For long-term (more than 26 weeks) outcomes, beneficial interventions include weight loss, agility training, combined exercise programs, and manual therapy (i.e., massage, self-massage, and acupressure). https://www.aafp.org/afp/2018/1101/p603.html
Is hormone replacement therapy effective for primary prevention of cardiovascular disease in postmenopausal women?
A 2015 Cochrane review found no benefits for primary prevention of heart attack, angina, revascularization, or death from any cause. However, there were increases in the risk of stroke (number needed to harm [NNH] = 165), blood clot in a leg or lung (NNH = 118), and blood clot in a lung (NNH = 242) in patients receiving hormone therapy for at least six months. https://www.aafp.org/afp/2018/1001/od1.html
What is the effectiveness of recombinant zoster vaccine compared with the live vaccine for the prevention of shingles?
Recombinant zoster vaccine (Shingrix) will prevent shingles in 96% of persons 50 to 59 years of age, 97% of persons 60 to 69 years of age, and 91% of persons 70 years and older for at least three years (number needed to treat = 33). It is 91% effective at preventing postherpetic neuralgia in patients 50 to 69 years of age and 89% effective in those 70 years and older. In comparison, zoster vaccine live (Zostavax) is only 51% effective in preventing shingles and 67% effective in preventing postherpetic neuralgia. https://www.aafp.org/afp/2018/1015/p539.html
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