March 16, 2021 Issue of JAMA

March 16, 2021, Vol 325, No. 11, Pages 1025-1118

This Week in JAMA

Audio Highlights

Abstract Full Text

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JAMA. 2021;325(11):e2017845. doi:10.1001/jama.2020.17845

Podcast: Vitamin D and Omega-3 Fatty Acids for Atrial Fibrillation Prevention, Diagnosis and Management of TIA and Acute Ischemic Stroke, and more

Original Investigation

Effect of a Single High Dose of Vitamin D₃ on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial

Igor H. Murai, PhD; Alan L. Fernandes, PhD; Lucas P. Sales, MSc; et al.

Abstract Full Text

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JAMA. 2021;325(11):1053-1060. doi:10.1001/jama.2020.26848

This randomized trial compares the effects of a single 200鈥�000-IU dose of vitamin D₃ vs placebo on length of stay in patients hospitalized with moderate to severe COVID-19.

Editorial
Vitamin D₃ to Treat COVID-19: Different Disease, Same Answer
David E. Leaf, MD, MMSc; Adit A. Ginde, MD, MPH

JAMA

Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial

Christine M. Albert, MD, MPH; Nancy R. Cook, ScD; Julie Pester, BA; et al.

Abstract Full Text

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JAMA. 2021;325(11):1061-1073. doi:10.1001/jama.2021.1489

This 2 脳 2 factorial trial compares the effects of omega-3 fatty acids (460 mg/d of EPA and 380 mg/d of DHA) vs placebo, vitamin D鈧� vs placebo, both, or neither on risk of incident atrial fibrillation (AF) among adults aged 50 years or older over a median of more than 5 years of treatment.

Editor's Note
Omega-3 Fatty Acids and Atrial Fibrillation
Gregory Curfman, MD

JAMA

Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

Leora R. Feldstein, PhD; Mark W. Tenforde, MD; Kevin G. Friedman, MD; et al.

Abstract Full Text

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JAMA. 2021;325(11):1074-1087. doi:10.1001/jama.2021.2091

This case series uses national coronavirus disease 2019 (COVID-19) registry data to describe the epidemiology, clinical characteristics, complications, and hospital and postdischarge outcomes of pediatric patients with multisystem inflammatory syndrome in children (MIS-C) and to compare each in patients with severe COVID-19.

Editorial
SARS-CoV-2鈥揜elated Inflammatory Multisystem Syndrome in Children: Different or Shared Etiology and Pathophysiology as Kawasaki Disease?
Brian W. McCrindle, MD, MPH; Cedric Manlhiot, PhD

JAMA

Research Letter

Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic

Lori Uscher-Pines, PhD, MSc; Jessica Sousa, MSW, MPH; Maggie Jones, MPH; et al.

Abstract Full Text

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JAMA. 2021;325(11):1106-1107. doi:10.1001/jama.2021.0282

This study describes trends in use of in-person, telephone, and video primary care and behavioral health visits to California Federally Qualified Health Centers from 2019 to August 2020 before and during the coronavirus disease 2019 (COVID-19) pandemic.

Editorial
Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19: Unforeseen Opportunity in the Face of Adversity
Donna M. Zulman, MD, MS; Abraham Verghese, MD

JAMA
- Conversations with Dr Bauchner: Ensuring Quality in the Era of Virtual Care

Alcohol-Related Deaths in Poland During a Period of Weakening Alcohol Control Measures

Witold A. Zato艅ski, MD, PhD; Mateusz Zato艅ski, PhD; Kinga Janik-Koncewicz, MSc; et al.

Abstract Full Text

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JAMA. 2021;325(11):1108-1109. doi:10.1001/jama.2020.25879

This population epidemiology study describes trends in overall and age- and sex-specific alcohol-related deaths in Poland between 2002 and 2017, following the weakening in 2001 of policy measures designed to reduce alchohol consumption.

Viewpoint

Health Policy

Improving Health Among Rural Residents in the US

Katy Backes Kozhimannil, PhD, MPA; Carrie Henning-Smith, PhD, MPH, MSW

Abstract Full Text

JAMA. 2021;325(11):1033-1034. doi:10.1001/jama.2020.26372

This Viewpoint summarizes health care challenges faced by US rural residents and suggests how administrative strategies, such as ensuring rural representation in policy development and implementation, and legislative strategies, such as ensuring rural broadband access, could help achieve health equity for residents in rural areas.

Editorial
Health Care Is a Right, Not a Privilege: A New Series on US Health Care and Health Policy
Howard Bauchner, MD; Phil B. Fontanarosa, MD, MBA; Karen Joynt Maddox, MD, MPH

JAMA
- Video: Health Care Reform in the Biden Era
- Conversations with Dr Bauchner: Health Care Reform in the Biden Era

Health Policy

Improving the Health of the American Indian and Alaska Native Population

Thomas D. Sequist, MD, MPH

Abstract Full Text

JAMA. 2021;325(11):1035-1036. doi:10.1001/jama.2021.0521

This Viewpoint reviews evidence of poor health outcomes experienced by American Indian/Alaska Native persons owing to structural disadvantage and proposes an aggressive agenda to improve their health and well-being by addressing social determinants of health, improving access to and quality of care, and improving data availability and transparency.

Editorial
Health Care Is a Right, Not a Privilege: A New Series on US Health Care and Health Policy
Howard Bauchner, MD; Phil B. Fontanarosa, MD, MBA; Karen Joynt Maddox, MD, MPH

JAMA
- Video: Health Care Reform in the Biden Era
- Conversations with Dr Bauchner: Health Care Reform in the Biden Era

SARS-CoV-2 Variants of Concern in the United States鈥擟hallenges and Opportunities

Rochelle P. Walensky, MD, MPH; Henry T. Walke, MD, MPH; Anthony S. Fauci, MD

Abstract Full Text

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JAMA. 2021;325(11):1037-1038. doi:10.1001/jama.2021.2294

This Viewpoint from directors at the CDC and NIH describes measures that federal agencies are taking to rapidly characterize emerging coronavirus variants and monitor their implications for national pandemic response and control, including assessment of ongoing effectiveness of current diagnostics, therapeutics, and vaccines.

Video: Coronavirus Variants and Vaccines
Video: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD
Video: Coronavirus Update With CDC Director Rochelle Walensky - February 17, 2021

Conversations with Dr Bauchner: Coronavirus Update With CDC Director Rochelle Walensky - February 17, 2021
Conversations with Dr Bauchner: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD

Editorial
SARS-CoV-2 Viral Variants鈥擳ackling a Moving Target
John R. Mascola, MD; Barney S. Graham, MD, PhD; Anthony S. Fauci, MD

JAMA
- Video: Coronavirus Variants and Vaccines
- Video: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD
- Video: Coronavirus Update With CDC Director Rochelle Walensky - February 17, 2021
- Conversations with Dr Bauchner: Coronavirus Update With CDC Director Rochelle Walensky - February 17, 2021
- Conversations with Dr Bauchner: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD

COVID-19 Vaccination in Pregnant and Lactating Women

Emily H. Adhikari, MD; Catherine Y. Spong, MD

Abstract Full Text

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JAMA. 2021;325(11):1039-1040. doi:10.1001/jama.2021.1658

This Viewpoint discusses the need for shared decision-making when counseling pregnant and nursing women about the unstudied benefits and risks COVID-19 vaccination, calling for rigorously designed studies with real-time, proactive data collection to establish evidence as quickly as possible about coronavirus vaccine safety in mothers and their infants.

Video: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals

Conversations with Dr Bauchner: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals

Invited Commentary
Protecting Pregnant Women and Their Infants From COVID-19: Clues From Maternal Viral Loads, Antibody Responses, and Placentas
Denise J. Jamieson, MD, MPH; Sonja A. Rasmussen, MD, MS

JAMA Netw Open

Involving Pregnant Individuals in Clinical Research on COVID-19 Vaccines

Diana W. Bianchi, MD; Lisa Kaeser, JD; Alison N. Cernich, PhD

Abstract Full Text

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JAMA. 2021;325(11):1041-1042. doi:10.1001/jama.2021.1865

This Viewpoint from the National Institute of Child Health and Human Development emphasizes the need to use existing data sources and develop partnerships, infrastructure, and ethical and regulatory standards to generate data about the safety and efficacy of COVID-19 vaccination in pregnant individuals.

Video: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals

Conversations with Dr Bauchner: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals

Scientific Discovery and the Future of Medicine

New Insights Into Plaque Erosion as a Mechanism of Acute Coronary Syndromes

Dhaval Kolte, MD, PhD; Peter Libby, MD; Ik-Kyung Jang, MD, PhD

Abstract Full Text

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JAMA. 2021;325(11):1043-1044. doi:10.1001/jama.2021.0069

This Viewpoint summarizes the pathophysiology and clinical features of atherosclerotic plaque erosion as an underlying mechanism of acute coronary syndromes (ACS) distinct from plaque rupture and reviews evidence that antithrombotic therapy without PCI and stenting may be optimal treatment.

Conversations with Dr Bauchner: New Insights Into Plaque Erosion as a Mechanism of Acute Coronary Syndromes

A Piece of My Mind

Somebody鈥檚 Sunshine

Emily Pinto Taylor, MD

Abstract Full Text

JAMA. 2021;325(11):1045-1046. doi:10.1001/jama.2021.1549

In this narrative medicine essay a geriatrics fellow describes the experience of preparing for and meeting her foster son and discusses her feelings of uncertainties that (mostly) melt away when sharing her new child's photo with a colleague the day after bringing him home.

Editorial

Vitamin D₃ to Treat COVID-19: Different Disease, Same Answer

David E. Leaf, MD, MMSc; Adit A. Ginde, MD, MPH

Abstract Full Text

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JAMA. 2021;325(11):1047-1048. doi:10.1001/jama.2020.26850

The Reporting of Race and Ethnicity in Medical and Science Journals: Comments Invited

Annette Flanagin, RN, MA; Tracy Frey, BA; Stacy L. Christiansen, MA; et al.

Abstract Full Text

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JAMA. 2021;325(11):1049-1052. doi:10.1001/jama.2021.2104

Editorial
To JAMA Authors, Reviewers, and Especially Physician Readers鈥擜 Profound Thank You
Phil B. Fontanarosa, MD, MBA; Howard Bauchner, MD; Robert Golub, MD

JAMA
Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals
Annette Flanagin, RN, MA; Tracy Frey, BA; Stacy L. Christiansen, MA; AMA Manual of Style Committee

JAMA

Review

Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review

Scott J. Mendelson, PhD, MD; Shyam Prabhakaran, MD, MS

Abstract Full Text

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JAMA. 2021;325(11):1088-1098. doi:10.1001/jama.2020.26867

This narrative review provides an update on management of transient ischemic attack (TIA) and acute ischemic stroke, emphasizing advances in use of dual antiplatelet therapy and fibrinolysis vs mechanical thrombectomy for secondary and tertiary prevention.

Podcast: Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke

JAMA Insights

Women's Health

Pregnancy, Postpartum Care, and COVID-19 Vaccination in 2021

Sonja A. Rasmussen, MD, MS; Denise J. Jamieson, MD, MPH

Abstract Full Text

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JAMA. 2021;325(11):1099-1100. doi:10.1001/jama.2021.1683

This JAMA Insights review summarizes the epidemiology of SARS-CoV-2 infection in pregnant and lactating women, its effects on perinatal outcomes, and compiles guidance from the CDC, FDA, and obstetrics-gynecology specialty organizations on the safety of coronavirus vaccines during pregnancy and while breastfeeding.

Video: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals

Conversations with Dr Bauchner: Coronavirus Vaccination in Pregnant and Breastfeeding Individuals
Podcast: COVID-19 and Pregnancy: Disease Outcomes and Prevention With Vaccination

Invited Commentary
Protecting Pregnant Women and Their Infants From COVID-19: Clues From Maternal Viral Loads, Antibody Responses, and Placentas
Denise J. Jamieson, MD, MPH; Sonja A. Rasmussen, MD, MS

JAMA Netw Open

Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US鈥擠ecember 14, 2020-January 18, 2021

Tom T. Shimabukuro, MD, MPH, MBA; Matthew Cole, MPH; John R. Su, MD, PhD, MPH

Abstract Full Text

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JAMA. 2021;325(11):1101-1102. doi:10.1001/jama.2021.1967

This JAMA Insights review provides clinical details of anaphylactic reactions reported to and verified by the CDC in the first month of use of the Pfizer-BioNTech and Moderna COVID-19 vaccines in the US, December 14, 2020-January 18, 2021.

Video: Coronavirus mRNA Vaccine Safety and Efficacy

Podcast: COVID-19 Vaccine Safety鈥揂naphylaxis and Allergic Reactions

JAMA Clinical Challenge

Pruritic Rash and Diarrhea

Hiroyuki Yano, MD; Mitsuyo Kinjo, MD, MPH

Abstract Full Text

JAMA. 2021;325(11):1103-1104. doi:10.1001/jama.2020.24066

An 82-year-old woman reported 2 months of diarrhea and 2 weeks of pruritic rash on her extremities as well as a recent left radius fracture; she was malnourished but most laboratory parameters were normal except mild hyponatremia and levels of copper and zinc well below normal. What is the diagnosis and what would you do next?

Editor's Note

Omega-3 Fatty Acids and Atrial Fibrillation

Gregory Curfman, MD

Abstract Full Text

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JAMA. 2021;325(11):1063. doi:10.1001/jama.2021.2909

Medical News & Perspectives

Quick Uptakes

Pregnant People鈥檚 Paradox鈥擡xcluded From Vaccine Trials Despite Having a Higher Risk of COVID-19 Complications

Rita Rubin, MA

Abstract Full Text

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JAMA. 2021;325(11):1027-1028. doi:10.1001/jama.2021.2264

This Medical News Quick Uptake discusses the evidence in favor of administering COVID-19 vaccines to pregnant individuals.

Video: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD

Conversations with Dr Bauchner: Coronavirus Vaccine Update From the CDC With Nancy E. Messonnier, MD

News From the Food and Drug Administration

CAR-T Therapy Is Approved for Non-Hodgkin Lymphoma

Mary Chris Jaklevic, MSJ

Abstract Full Text

JAMA. 2021;325(11):1032. doi:10.1001/jama.2021.3004

Device Uses Electrical Stimulation to Control Snoring

Mary Chris Jaklevic, MSJ

Abstract Full Text

JAMA. 2021;325(11):1032. doi:10.1001/jama.2021.2622

Helping Manufacturers Navigate Novel Coronavirus Variants

Mary Chris Jaklevic, MSJ

Abstract Full Text

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JAMA. 2021;325(11):1032. doi:10.1001/jama.2021.3006

The JAMA Forum

2020 Revealed How Poorly the US Was Prepared for COVID-19鈥攁nd Future Pandemics

Gail R. Wilensky, PhD

Abstract Full Text

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JAMA. 2021;325(11):1029-1030. doi:10.1001/jama.2021.1046

Global Health

Saving Tens of Thousands of Lives by Cutting Air Pollution

Bridget M. Kuehn, MSJ

Abstract Full Text

JAMA. 2021;325(11):1031. doi:10.1001/jama.2021.2292

Most Patients Hospitalized With COVID-19 Have Lasting Symptoms

Bridget M. Kuehn, MSJ

Abstract Full Text

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JAMA. 2021;325(11):1031. doi:10.1001/jama.2021.2974

New WHO Guideline for Treating Chronic Pain in Children

Bridget M. Kuehn, MSJ

Abstract Full Text

JAMA. 2021;325(11):1031. doi:10.1001/jama.2021.2976

Poetry and Medicine

A Fib

Ellen Steinbaum

Abstract Full Text

JAMA. 2021;325(11):1114. doi:10.1001/jama.2020.25268

JAMA Revisited

The Achievement of the Army Medical Department in the World War

Abstract Full Text

JAMA. 2021;325(11):1115. doi:10.1001/jama.2020.17846

JAMA Patient Page

Spontaneous Bacterial Peritonitis

Grace Zhang, BS; Alison Jazwinski Faust, MD

Abstract Full Text

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JAMA. 2021;325(11):1118. doi:10.1001/jama.2020.10292

This JAMA Patient Page explains the causes, symptoms, diagnosis, and treatment of spontaneous bacterial peritonitis, an infection of fluid (ascites) that accumulates in the abdomen in liver disease and other conditions.

Comment & Response