Hot flushes: oestrogen still does the most, and non-hormonal options reduce frequency more than severity

The edition in brief

A systematic review of 90 randomised trials for the American College of Physicians found oestrogen, with or without a progestogen, reduced both the frequency and severity of menopausal vasomotor symptoms and improved quality of life, and was judged of high economic value. Neurokinin receptor antagonists, SNRIs, SSRIs, gabapentin and progestogens reduced frequency but not severity; oxybutynin reduced both. Certainty was mostly low to moderate and long-term harms were not addressed. A pragmatic factorial trial of 1,837 patients due for annual lung cancer screening found that pending scan orders for the primary care physician and reminding patients to book raised adherence from 47% to 76% (RR 1.59), while education materials alone slightly lowered it. In a retrospective cohort of food-insecure adults aged 60 or older, two weeks of home-delivered meals after discharge was associated with lower 14-day readmission (aOR 0.31), fading by 30 days. A focus-group study of US hospitalists found phenobarbital now used in many units for alcohol withdrawal, with no consensus on when, which the hospitalists themselves called a wild west.