| Course | PA 502 Evidence Based Medicine |
|---|---|
| Week | 5 |
| Paper type | Applicability write-up |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 502 Week 5
Applicability Write-Up: Would My 76-Year-Old Patient Have Been Eligible for SPRINT, and Does the Trial's Result Carry Over to the Way We Measure in Clinic?
Student Name
Chamberlain University
PA 502: Evidence Based Medicine
Instructor Name
Month Day, Year
Applicability Write-Up: Would My 76-Year-Old Patient Have Been Eligible for SPRINT, and Does the Trial's Result Carry Over to the Way We Measure in Clinic?
The Patient and the Study
The patient is 76, with treated hypertension on two medicines, an estimated glomerular filtration rate of 52, no diabetes and no history of stroke or heart failure. Office systolic pressure was 146 mm Hg, measured by me with the patient talking; home readings averaged about 138. Standing systolic pressure one minute after rising was 128. Living alone and walking every day, the patient reports a single fall, a trip on a curb about eight months back. The study is SPRINT, which compared systolic targets below 120 and below 140 mm Hg in adults at increased cardiovascular risk without diabetes (SPRINT Research Group, 2015). This write-up first checks the patient against the trial's criteria, one line at a time, and then argues whether the result applies.
The Rules, One Line Each
Table 1
The Patient Against SPRINT's Main Eligibility Criteria
| Criterion | Rule in the trial | This patient | Verdict |
|---|---|---|---|
| Age | 50 years or older | 76 | Met |
| Systolic pressure at entry | 130 to 180 mm Hg, with a lower ceiling for those on more medicines; up to 170 on two medicines | 146 on two medicines | Met |
| Increased cardiovascular risk | At least one: clinical or subclinical cardiovascular disease other than stroke, chronic kidney disease with eGFR 20 to 59, high calculated 10-year risk, or age 75 or older | eGFR 52 and age 76 | Met on two counts |
| Diabetes | Excluded | None | Met |
| Prior stroke | Excluded | None | Met |
| Symptomatic heart failure or low ejection fraction | Excluded | None known | Met, ejection fraction never measured |
| Standing systolic below 110 mm Hg after one minute | Excluded | 128 | Met |
| eGFR below 20 | Excluded | 52 | Met |
| Nursing home residence or dementia | Excluded | Lives alone, no cognitive diagnosis | Met |
Note. Note. Criteria summarized from the SPRINT trial report and protocol; patient details are composite.
The patient would have been eligible. The only line with uncertainty is heart failure: the patient has no symptoms, but ejection fraction has never been measured, so "cannot tell from what is available" is the honest verdict, though the absence of symptoms makes exclusion unlikely.
By How Much, and Does It Matter
Eligibility is not the end. The patient sits near the middle of the trial's entry range for blood pressure and within its kidney function range. The patient is older than the trial's average participant, but the trial enrolled more than 2,600 participants aged 75 or older and reported their results separately (Williamson et al., 2016). Being older therefore moves the patient into a well-studied subgroup rather than outside the evidence.
The Control Group's Rate Against This Person
The benefit a patient can expect depends on their own risk without the change. In the trial's participants aged 75 or older, 11.2% of the standard-target group had a primary outcome event over a median of 3.14 years (Williamson et al., 2016). My patient, with kidney disease and treated hypertension at 76, probably has a risk in that range, perhaps slightly lower because of good mobility and no other cardiovascular disease, though no risk calculator was used here. If the patient's risk is similar, the absolute benefit would resemble the subgroup's: about 3.5 fewer events per 100 people over three years. If the patient's risk is lower, the benefit would be smaller in absolute terms even if the relative effect were exactly the same.
How the Trial Measured Blood Pressure
This is the point where transfer is most fragile. The trial measured blood pressure with an automated device, averaging three readings taken after the participant had sat quietly for five minutes and, at many sites, alone in the room. Our clinic measures once, with a manual cuff or a single automated reading, often while the patient talks. Readings taken our way are usually higher than readings taken the trial's way. A target of 120 in the trial does not mean 120 by our method; chasing 120 on a single talking reading could lead to overtreatment. Before applying the trial's target, the clinic would need to measure the way the trial did, or use home readings, which for this patient already average about 138, well above the trial's target.
What the Study Supplied and a Clinic Does Not
Trial participants had frequent visits in the first months, monthly while medicines were adjusted, with the study supplying medicines and checking laboratory results. A rural family clinic sees a stable hypertensive patient every three to six months. Lowering the target in usual care would therefore mean planning extra visits or phone checks after each change, and checking kidney function and electrolytes within a few weeks, since acute kidney injury and electrolyte problems were more common with the intensive target.
Verdict
The result applies to this patient in principle: the patient meets the criteria and sits in a subgroup in which the benefit was, if anything, larger. In practice, it applies only if blood pressure is measured as the trial measured it and if the clinic can provide closer follow-up after each medicine change. The next step is a shared decision, with the numbers set out for the patient in a form they can weigh.
What Would Make Me Change the Verdict
Three findings would change this verdict. If the patient's standing blood pressure fell below 110 mm Hg after a dose increase, they would resemble the people SPRINT excluded, and the lower target should be abandoned. If kidney function fell substantially after a medicine change, the harm side would outweigh the modest benefit for this patient. And if the patient developed dizziness or another fall, the risk of injury would weigh more heavily than the trial's average suggests, since injurious falls in the trial were not more common overall but may be in someone with a recent fall.
What I Could Not Check
I could not check the patient's ejection fraction, cognitive screening or frailty with a standard measure, all of which bear on whether they resemble the trial's participants. The trial's older participants had their gait speed measured, and a quick gait speed test in our clinic would tell us whether the patient is closer to the fitter or frailer end of the subgroup, which matters for how much weight to give the harms.
References
SPRINT Research Group. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103-2116. https://doi.org/10.1056/NEJMoa1511939
Williamson, J. D., Supiano, M. A., Applegate, W. B., Berlowitz, D. R., Campbell, R. C., Chertow, G. M., Fine, L. J., Haley, W. E., Hawfield, A. T., Ix, J. H., Kitzman, D. W., Kostis, J. B., Krousel-Wood, M. A., Launer, L. J., Oparil, S., Rodriguez, C. J., Roumie, C. L., Shorr, R. I., Sink, K. M., . . . Pajewski, N. M. (2016). Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years or older: A randomized clinical trial. JAMA, 315(24), 2673-2682. https://doi.org/10.1001/jama.2016.7050
What the PA 502 Week 5 assignment asks for
In the fifth week you assess whether the results of a study apply to a particular patient. Take the study's inclusion and exclusion criteria in order and give a short verdict for each: met, not met or cannot tell. Where the patient falls outside a criterion, ask by how much and whether it matters, rather than ending the analysis. Compare the patient's likely baseline risk with the control group's event rate. Examine how the study measured key variables and whether your setting measures the same way. Note what the study provided, such as visits or medicines, that a usual clinic does not. Reach a verdict and say what findings would change it.
How the PA 502 Week 5 example is put together
The write-up describes the patient and then a table of nine criteria, from age and entry pressure on two medicines to exclusions for diabetes, stroke, heart failure, standing pressure below 110, low kidney function, nursing home residence and dementia. All are met, with heart failure marked as uncertain because ejection fraction was never measured. The patient falls in the trial's 75-and-older subgroup, whose standard arm had an 11.2% event rate. Measurement is the fragile point: the trial averaged automated readings after rest, while the clinic takes one reading while patients talk. Closer follow-up and laboratory checks are named, and a closing section names the findings that would overturn it.
Where the points sit in the PA 502 Week 5 rubric
The heaviest loss is a list of criteria reproduced and never applied, with the patient described above them and no line saying which rule the patient meets or breaks. Close behind is the single mismatch treated as fatal, such as an age two years past a limit ending the document, when the real question is whether the difference matters. Write-ups that ignore baseline risk, measurement methods or what the trial supplied also lose points. Strong write-ups apply each criterion with a verdict, weigh differences by size and relevance, compare the patient's risk with the control group, examine measurement, note what a clinic lacks and reach a verdict with conditions. Saying which missing data would most change the verdict shows careful judgment.
Common PA 502 Week 5 mistakes, and how to avoid them
Applicability write-ups ask you to hold a study and a patient side by side, which takes more care than summarizing either. Share the study and an anonymized description of your patient, and we can help you apply each criterion with a verdict, judge whether any mismatch matters and compare the patient's risk with the trial's control group. We can also help you examine how the study measured its key variables. Your patient and your verdict remain your own. If the study includes a run-in period or other screening step, we can help you judge whether your patient would have passed it.
Get a PA-502 Week 5 example written to your instructions
Send the case your section supplied along with the trial it named and your rubric, since this write-up is an argument about one specific pairing and an example built from another patient and another study transfers nothing. A custom PA-502 Week 5 applicability write-up comes back to your requirements within 24-48h, the first one free.
More PA 502 papers and MPAS samples
- PA 502 Week 1: Clinical Question Post
- PA 502 Week 2: Bedside Question Brief
- PA 502 Week 3: NNT Calculation
- PA 502 Week 4: Surrogate Outcome Critique
- PA 502 Week 6: Guideline Comparison
- PA 502 Week 7: Decision Aid Draft
- PA 502 Week 8: Journal Club Brief
- PA 501 Week 5: Supervision Model Comparison
PA 502 Week 5 questions, answered
The case is missing a fact the study screened on. What then?
Write cannot tell and move on, which is a legitimate entry and often the honest one. Then say what you would need and how much it would change the position, since some unknowns are decisive and most are not. A write-up that invents a value to complete the table is worse than one leaving three lines open and explaining why they stay open.
Is a patient outside the criteria automatically excluded from the result?
No, and saying so is what separates this assignment from a form-filling exercise. Entry rules are set to make a study run cleanly, not to mark the edge of who a treatment works in. What matters is whether the reason behind a rule bears on the effect, so a cut-off protecting a trial from missing data is different from one protecting people from a real hazard.
Does the write-up need sources besides the trial?
Often one or two. Something establishing the patient's own risk level is the most useful, because the whole comparison against the control group depends on it, and a risk calculator or a cohort study gives a defensible figure. Check what your section allows. Beyond that, the argument runs on the trial's own methods section rather than on outside reading.
Where can I find a free PA 502 Week 5 sample paper?
This page holds a full PA 502 Week 5 applicability write-up checking a 76-year-old against SPRINT's criteria and measurement.
What is the weakest point of transfer in the PA 502 Week 5 sample?
Blood pressure measurement: the trial averaged automated readings after rest, while the clinic takes one reading while patients talk, which runs higher.