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In This Issue of JAMA
December 25, 2018


JAMA. 2018;320(24):2499-2501. doi:10.1001/jama.2017.12691

There is concern that financial penalties for higher-than-expected hospital readmission rates may have unintended consequences for patient care. Wadhera and colleagues compared mortality rates for 8.3 million hospitalizations and found that announcement and implementation of the Hospital Readmissions Reduction Program were associated with increases in 30-day postdischarge mortality following hospitalization for heart failure and pneumonia. In an Editorial, Fonarow suggests that the Hospital Readmissions Reduction Program should be reconsidered and other strategies should be developed to reduce avoidable readmissions while improving patient care.


The waist-to-hip ratio is associated with type 2 diabetes and coronary disease independently of body mass index. In a series of studies of 452 302 participants of European ancestry, Lotta and colleagues found that genetic mechanisms linked to gluteofemoral and abdominal fat distribution may improve risk assessment and treatment of diabetes and coronary disease.

Reviews of treatments for osteoarthritis typically emphasize short-term pain control and seldom address long-term outcomes. Gregori and colleagues analyzed long-term outcomes of 47 randomized clinical trials of medications for knee osteoarthritis and found that estimates of therapeutic efficacy were uncertain, suggesting the need for larger long-term trials.


Clinical Review & Education

Physicians, nurses, or other health care professionals may be asked to provide assistance during in-flight medical emergencies. Martin-Gill and colleagues review the pathophysiology of symptom development after prolonged positioning in a hypoxic and pressurized environment and recommend a clinical approach to the management of in-flight medical emergencies.

CME and Author Audio Interview

This JAMA Clinical Challenge by Mukaigawara and Sugita presents a man with cough, coryza, fever, conjunctivitis, and a generalized maculopapular rash. He recently traveled to a nearby island. What would you do next?

This JAMA Diagnostic Test Interpretation article by Eule and colleagues presents a 68-year-old woman with chronic lymphocytic leukemia and a 2-day history of dyspnea on exertion. Laboratory results suggested a hemolytic process. How do you interpret the test results?