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December 7, 2021, Vol 326, No. 21, Pages 2105-2223

In This Issue of JAMA

Audio Highlights

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JAMA. 2021;326(21):e2018253. doi:10.1001/jama.2020.18253
Original Investigation

Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial

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JAMA. 2021;326(21):2141-2149. doi:10.1001/jama.2021.20750

This clinical trial compares the safety of a strategy that combines the YEARS rule with the pulmonary embolism rule-out criteria (PERC) rule and an age-adjusted D-dimer threshold vs a conventional diagnostic strategy for venous thromboembolism (VTE) among emergency department patients with suspected pulmonary embolism (PE).

Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals: The IMPACT BCN Randomized Clinical Trial

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JAMA. 2021;326(21):2150-2160. doi:10.1001/jama.2021.20178

This study investigates whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction in high-risk pregnancies can reduce the percentage of newborns born small for gestational age (SGA) and other adverse pregnancy outcomes.

Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial

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JAMA. 2021;326(21):2161-2171. doi:10.1001/jama.2021.20714

This randomized trial assesses the effect of high-flow oxygen therapy through a nasal cannula vs conventional oxygen therapy on 28-day intubation rates and time to clinical recovery among patients with respiratory distress due to COVID-19.

Research Letter

Racial and Ethnic Representation in US Clinical Trials of New Drugs and Biologics, 2015-2019

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JAMA. 2021;326(21):2201-2203. doi:10.1001/jama.2021.16680

This study reviews the participation of racial and ethnic populations at US sites in 2015-2019 to understand the extent to which US trial participation represents the diversity of the US population.

Antibody Titers Before and After a Third Dose of the SARS-CoV-2 BNT162b2 Vaccine in Adults Aged ≥60 Years

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JAMA. 2021;326(21):2203-2204. doi:10.1001/jama.2021.19885

This study assesses antispike (anti-S) IgG antibody titers before and after a third BNT162b2 dose (booster) in individuals aged 60 years and older in Israel.

US Preventive Services Task Force

Recommendation Statement

Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement

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JAMA. 2021;326(21):2172-2178. doi:10.1001/jama.2021.20007

This 2021 Recommendation Statement from the US Preventive Services Task Force recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride (B recommendation) and apply fluoride varnish to the primary teeth of all children starting at the age of primary tooth eruption (B recommendation) and concludes that current evidence is insufficient to assess the benefits and harms of routine primary care dental caries screening in children younger than 5 years (I statement).

Evidence Report

Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

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JAMA. 2021;326(21):2179-2192. doi:10.1001/jama.2021.15658

This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on screening and interventions to prevent dental caries in children summarizes published evidence on the benefits and harms of screening and interventions provided by primary care clinicians to prevent dental caries in children younger than 5 years.

Viewpoint

Diagnostic Excellence

Diagnostic Excellence Through the Lens of Patient-Centeredness

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JAMA. 2021;326(21):2127-2128. doi:10.1001/jama.2021.19513

This Viewpoint in JAMA’s Diagnostic Excellence series explores the diagnosis of conditions from the patient’s perspective.

How to Measure Progress in Addressing Physician Well-being: Beyond Burnout

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JAMA. 2021;326(21):2129-2130. doi:10.1001/jama.2021.20175

This Viewpoint offers options on how to measure systems improvement in alleviating burnout among physicians and clinical staff.

Strengthening the FDA’s Enforcement of ClinicalTrials.gov Reporting Requirements

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JAMA. 2021;326(21):2131-2132. doi:10.1001/jama.2021.19773

This Viewpoint discusses ways in which the FDA could harness its enforcement tools to bring important missing clinical trial results information to light and demonstrate its commitment to protecting patients through clinical trial transparency.

A Piece of My Mind

Three Stories About the Value of Advance Care Planning

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JAMA. 2021;326(21):2133-2134. doi:10.1001/jama.2021.21075

In this narrative medicine essay, a critical care palliative care physician shares how 2 family members could not communicate their end of life wishes but had engaged in discussions to help guide the family's decisions on their care, which brought comfort, and how as he now faces life-limiting illness these same discussions help him focus on joy rather than fear and grief.

Editorial

Diagnostic Strategies for Suspected Pulmonary Embolism

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JAMA. 2021;326(21):2135-2136. doi:10.1001/jama.2021.19282

Mindfulness-Based Stress Reduction, Mediterranean Diet, and Fetal Growth

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JAMA. 2021;326(21):2137-2138. doi:10.1001/jama.2021.19923

Promotion of Oral Health and Prevention of Dental Caries Among Children in Primary Care

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JAMA. 2021;326(21):2139-2140. doi:10.1001/jama.2021.20396
JAMA Clinical Guidelines Synopsis

Cervical Cancer Screening Guideline for Individuals at Average Risk

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JAMA. 2021;326(21):2193-2194. doi:10.1001/jama.2021.13448

This JAMA Clinical Guidelines Synopsis summarizes guidance from the American Cancer Society regarding cervical cancer screening, including when to initiate screening, the frequency of testing, and which modality to use.

JAMA Clinical Challenge

Pharyngitis and Tonsillar Exudates in an 18-Year-Old Woman

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JAMA. 2021;326(21):2195-2196. doi:10.1001/jama.2021.19023

An 18-year-old woman with no significant medical history and no history of sexual intercourse had pharyngitis and white tonsillar exudates of 1 week duration. She had neck swelling and occasional dry cough but no fevers, chills, or fatigue; results of a rapid strep test, throat culture, and heterophile antibody test were negative. What is the diagnosis and what would you do next?

Medical News & Perspectives

Thousands of US Youths Cope With the Trauma of Losing Parents to COVID-19

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JAMA. 2021;326(21):2117-2119. doi:10.1001/jama.2021.20846

This Medical News article discusses the stress and grief reactions that children and teens face after losing a parent or close caregiver to COVID-19.

News From the JAMA Network

Preterm Delivery Is a Long-term Hypertension Risk Factor

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JAMA. 2021;326(21):2120. doi:10.1001/jama.2021.21429

Methylphenidate Treats Apathy in Alzheimer Disease

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JAMA. 2021;326(21):2120. doi:10.1001/jama.2021.20775

Preemptive Treatment Reduced Autism Symptom Severity

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JAMA. 2021;326(21):2120. doi:10.1001/jama.2021.21430

Statin Use Is Associated With Diabetes Progression

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JAMA. 2021;326(21):2120. doi:10.1001/jama.2021.21431
News From the Food and Drug Administration

Public-Private Partnership Sets Its Sights on New Gene Therapies

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JAMA. 2021;326(21):2121. doi:10.1001/jama.2021.21553

Asbestos Wasn’t Found in Cosmetics Containing Talc

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JAMA. 2021;326(21):2121. doi:10.1001/jama.2021.21151

US, Canada, and UK Collaborate on New Guidance for Machine Learning

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JAMA. 2021;326(21):2121. doi:10.1001/jama.2021.21554
Poetry and Medicine

A Short Flight in a Small Room

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JAMA. 2021;326(21):2216. doi:10.1001/jama.2021.14293
JAMA Revisited

Current Comment

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JAMA. 2021;326(21):2217. doi:10.1001/jama.2020.18254
JAMA Patient Page

Screening and Interventions to Prevent Dental Caries in Young Children

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JAMA. 2021;326(21):2223. doi:10.1001/jama.2021.21302

This JAMA Patient Page describes the US Preventive Services Task Force’s recommendations on screening and interventions to prevent dental caries in young children.

Comment & Response

Preconception Care to Optimize Pregnancy Outcomes

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JAMA. 2021;326(21):2204-2205. doi:10.1001/jama.2021.16759

Preconception Care to Optimize Pregnancy Outcomes—Reply

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JAMA. 2021;326(21):2205. doi:10.1001/jama.2021.16762

Clinical Update on Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk

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JAMA. 2021;326(21):2205. doi:10.1001/jama.2021.17992

Clinical Update on Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk—Reply

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JAMA. 2021;326(21):2205-2206. doi:10.1001/jama.2021.17980

A Review of Chronic Pelvic Pain in Women

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JAMA. 2021;326(21):2206. doi:10.1001/jama.2021.17977

A Review of Chronic Pelvic Pain in Women

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JAMA. 2021;326(21):2206-2207. doi:10.1001/jama.2021.17986

A Review of Chronic Pelvic Pain in Women

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JAMA. 2021;326(21):2207. doi:10.1001/jama.2021.17983

A Review of Chronic Pelvic Pain in Women—Reply

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JAMA. 2021;326(21):2207-2208. doi:10.1001/jama.2021.17989
Correction

Misspelled Surname

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JAMA. 2021;326(21):2208. doi:10.1001/jama.2021.20219
JAMA Masthead

JAMA

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JAMA. 2021;326(21):2105-2106. doi:10.1001/jama.2020.18251
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