| Course | PA 502 Evidence Based Medicine |
|---|---|
| Week | 8 |
| Paper type | Journal club brief |
| Length | About 960 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 8
Journal Club Brief: SPRINT in Adults 75 and Older, Its Finding, Whether Our Clinic Should Change and Who Would Have to Agree
Student Name
Chamberlain University
PA 502: Evidence Based Medicine
Instructor Name
Month Day, Year
Journal Club Brief: SPRINT in Adults 75 and Older, Its Finding, Whether Our Clinic Should Change and Who Would Have to Agree
The Position, First
Among ambulatory adults aged 75 or older without diabetes or prior stroke, a systolic goal of 120 instead of 140 cut major cardiovascular events and deaths over about three years, without a higher overall rate of serious adverse events (Williamson et al., 2016). Our clinic should offer the lower target to fit, ambulatory older patients who want it, but only after we measure blood pressure the way the trial did and set up closer follow-up after each medicine change.
What Was Done, Chosen for Relevance
The paper reports the 2,636 participants aged 75 or older in SPRINT, a randomized trial that set a goal of 120 against a goal of 140 in higher-risk adults who did not have diabetes (SPRINT Research Group, 2015). The older participants had a mean age of 79.9 years; 37.9% were women. They were randomized to the intensive target, 1,317 participants, or the standard target, 1,319. The primary outcome was a composite of nonfatal heart attack, acute coronary syndrome, nonfatal stroke, acute decompensated heart failure and cardiovascular death. The trial excluded people in nursing homes and people with dementia, diabetes or prior stroke.
What Was Found
At a median follow-up of 3.14 years, the intensive group had 102 primary events against 148 in the standard group (hazard ratio 0.66 95% confidence interval 0.51 to 0.85). Deaths from any cause were 73 and 107, a hazard ratio of 0.67. The overall rate of serious adverse events was about the same in both groups, 48.4% and 48.3% (Williamson et al., 2016). Put in absolute terms, roughly 29 older patients managed this way for three years spare one of them a primary event.
The Objections, Raised Honestly
Four objections deserve a hearing. First, the trial was stopped early for benefit, and trials stopped early tend to overestimate effects; the true benefit may be smaller. Second, the trial was open-label: participants and clinicians knew the target, which could influence how events were reported, though hard outcomes such as death are less vulnerable. Third, blood pressure was measured with an automated device averaging three readings after rest, often without staff in the room, which gives lower readings than usual clinic measurement; a target of 120 by that method is not the same as 120 on our single readings. Fourth, the trial's older participants were healthier than many older patients in our clinic, since it excluded dementia, nursing home residents and diabetes. Across the full trial, the intensive arm had more serious episodes of low pressure, fainting, salt and potassium disturbances and kidney injury (SPRINT Research Group, 2015), and these harms may be greater in frailer patients than the trial suggests.
Table 1
Objections and How the Clinic Would Respond
| Objection | How serious for our clinic | Response |
|---|---|---|
| Stopped early | Moderate; benefit may be overstated | Present benefit as a range, not a promise |
| Open-label | Low for deaths, moderate for softer outcomes | Rely on events and deaths, not symptoms |
| Measurement method | High; our readings run higher | Adopt the trial's measurement method first |
| Healthier participants | Moderate | Offer only to fit, ambulatory patients without dementia |
Note. Note. Judgments by the presenter for discussion.
Funding on the Page
Public money paid for SPRINT, through the National Heart, Lung, and Blood Institute and other parts of the federal research budget. The funding source does not settle the validity of the results, but readers should know that the trial was publicly funded rather than funded by a drug manufacturer, which reduces one common concern about how outcomes were chosen and reported.
Another View Worth Knowing
Not every guideline accepted the lower target for older adults. A guideline from the American College of Physicians and the American Academy of Family Physicians recommended a target below 150 for most adults aged 60 or older and a target below 140 only for some at high risk, with goals chosen through discussion with the patient (Qaseem et al., 2017). The disagreement is a reason to make the decision with each patient rather than as a clinic-wide rule.
Who Would Have to Agree
Three groups would have to agree for the clinic to change. The medical director would need to approve a protocol for measuring blood pressure with an automated device after five minutes' rest, which takes room time. The medical assistants would need training and a quiet room to do it. And each patient would need to choose the lower target after seeing the numbers. I propose that the clinic pilot the measurement protocol for one month and review how many older patients choose the lower target.
How We Would Know Whether It Worked
If the clinic adopts the protocol, we would track three things over six months: how many patients aged 75 and older were offered the lower target and how many chose it; how often patients on the lower target had dizziness, falls or a rise in creatinine at the follow-up check; and whether blood pressure measured by the new method differed from our usual readings, which would tell us how much our past measurements overstated patients' pressures. A review at six months would decide whether to continue.
What I Would Ask the Room
Three questions would open the discussion: Do we trust our measurement enough to aim for 120? Which of our older patients would the trial's exclusions rule out? And is the extra follow-up after each change realistic with our current staffing?
References
Qaseem, A., Wilt, T. J., Rich, R., Humphrey, L. L., Frost, J., & Forciea, M. A. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437. https://doi.org/10.7326/M16-1785
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
Reading the PA 502 Week 8 instructions
The final week asks for a brief presenting a study to a journal club. Write it backward compared with the paper: open with what the study found and whether anyone should do anything about it. Choose the methods details that matter for judging the result rather than recounting them all. Report results with absolute as well as relative measures. Raise the strongest objections honestly and say how serious each is. Put the funding source on the page. Mention other evidence or guidance that disagrees. Name who would have to agree for any change to happen, and how the change would be evaluated. End with questions to open discussion. Keep the brief short enough for a room to read before talking.
Inside the PA 502 Week 8 example
The brief opens by stating that in ambulatory adults 75 and older without diabetes or stroke, a goal of 120 cut major events and deaths over about three years without more overall serious adverse events, and that the clinic should offer the lower target only after fixing measurement and follow-up. Methods cover the subgroup's 2,636 participants, mean age 79.9, and the exclusions. Results give 102 versus 148 events, hazard ratio 0.66, and about 29 treated per event avoided. A table weighs early stopping, open-label design, measurement and healthier participants. Funding, the ACP/AAFP view, the director, assistants and patients who must agree, and a six-month review follow.
PA 502 Week 8 rubric: what full points look like
The brief that costs most replays the paper in the paper's own order, so the room reaches the point on the second page and discussion starts late. Second is a recommendation with no one attached, where a change is proposed and nothing says whose agreement it needs. Briefs that hide objections, omit funding, report only relative effects or ignore disagreeing guidance also lose points. Strong briefs open with the finding and the action, choose relevant methods, give absolute results, raise objections with responses, show funding, acknowledge dissent, name who must agree and plan an evaluation. Ending with a few pointed questions for the room turns the brief into the start of a discussion rather than a lecture.
Common PA 502 Week 8 mistakes, and how to avoid them
Journal club briefs are short, which forces hard choices about what to include. If you share the paper you are presenting and your clinic's situation, we can help you write the opening position, choose the methods that matter and raise the strongest objections fairly. We can also help you name who would have to agree to any change and how it would be evaluated. Your reading of the paper and your recommendation remain your own. Clubs that use a structured appraisal form can have the custom sample built into its fields, with the position still in the first two sentences.
Get a PA-502 Week 8 example written to your instructions
Send the paper your section assigned with the assignment instructions and any heading list you were given, since a brief is shaped by the room it is written for and required headings differ widely between classrooms. A custom PA-502 Week 8 journal club brief comes back inside 24-48h, written to your rubric, 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 5: Applicability Write-Up
- PA 502 Week 6: Guideline Comparison
- PA 502 Week 7: Decision Aid Draft
- PA 501 Week 8: Professional Commitment Memo
PA 502 Week 8 questions, answered
Does the brief go out before the meeting or after?
In most classrooms it is written as though it will be read beforehand, which is why the position comes first and the length stays short. Check your section, since some ask for a version accompanying a presentation instead. Where it accompanies slides, the brief carries the detail and the slides carry the shape, and the two should not repeat each other.
What if I think the paper should change nothing?
That is a position and it often makes the better brief, provided it is argued rather than assumed. Say what the study would have had to show, and how far short it fell, then note anything in it worth keeping even so. A brief concluding no change with reasons attached beats one recommending something the evidence cannot support.
How much of the brief should be about the study's limitations?
Only as much as the position needs, which usually means the two or three bearing on it rather than an inventory. A limitation the authors flagged themselves, that changes nothing about the conclusion, is worth a clause. One that undermines the finding deserves a paragraph and probably belongs in the objections block instead.
Where can I find a free PA 502 Week 8 sample paper?
You can read a full PA 502 Week 8 journal club brief on SPRINT in adults 75 and older, with objections and next steps, on this page.
What does the PA 502 Week 8 sample recommend?
Offering the lower target to fit, ambulatory older patients who want it, after the clinic adopts the trial's measurement method and closer follow-up.