I just run shared_memory.exe when I make DB changes, such as items, etc. I know some use #hotfix, which is one way to run the
shared_memory from in-game, but, I just keep a shortcut to the executable on my desktop when I get into serious editing.
There is sometimes, I end up having to zone, after running shared_memory, more commonly with merchant items, but it
seems to be a random occurence. It's not a big deal to me.
You can also use #reloadstatic, when you make changes to doors, etc. One example, is when I get rid of a port stone in PoK,
I run the #reloadstatic in game and it happens instantly. Everyone has their own way of doing things. My biggest asset is patience.