BACKGROUND Frailty is an important consideration in the assessment of transcatheter aortic valve implantation patients. The documentation of a patient photograph to augment the objective measurement of frailty has been adopted by some transcatheter aortic valve implantation multidisciplinary (TAVI) programmes. METHODS We used a prospective two-part multimethod study design. In part A, we examined the concordance between the Essential Frailty Toolset (EFT) and the score attributed by healthcare professionals based on visual rating of photographs using kappa estimates and linear regression. In part B, we conducted a content analysis qualitative study to elicit information about how the TAVI multidisciplinary team used photographs to form impressions about frailty. FINDINGS Part A: 94 healthcare professionals (registered nurses/allied health 65%; physicians 35%) rated 40 representative photographs (women 42.5%; mean age 83.4±7.5; mobility aid 40%) between 0 (robust) and 5 (very frail). The estimate of weighted kappa was 0.2575 (95% confidence interval 0.082-0.433), indicating fair agreement between median healthcare professional visual and EFT score, especially when the EFT was 1 or 4. There was significant discordance among raters (kappa estimate 0.110, 95% confidence interval 0.079-0.141). Age, sex and mobility aid did not have a significant effect on score discordance. Part B: 12 members of the TAVI multidisciplinary team (registered nurses 27.5%; physicians 72.5%) were shown a series of six representative patient photographs. The following themes emerged from the data: (a) looking at the outside; (b) thinking about the inside; (c) use but with caution; and (d) a better approach. CONCLUSION A patient photograph offers complementary information to the multimodality assessment of TAVI patients.

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你能看出脆弱吗？在经导管主动脉瓣植入计划中使用患者照片的探索性研究

背景虚弱是评估经导管主动脉瓣植入患者的一个重要考虑因素。一些经导管主动脉瓣植入多学科 (TAVI) 项目已采用患者照片记录以增强对虚弱的客观测量。方法 我们使用前瞻性的两部分多方法研究设计。在 A 部分中，我们使用 kappa 估计和线性回归检查了 Essential Frailty Toolset (EFT) 与医疗保健专业人员根据照片的视觉评级所赋予的分数之间的一致性。在 B 部分，我们进行了一项内容分析定性研究，以获取有关 TAVI 多学科团队如何使用照片来形成关于虚弱的印象的信息。调查结果 A 部分：94 名医疗保健专业人员（注册护士/专职医疗人员 65%；医生 35%）对 40 张具有代表性的照片（女性 42.5%；平均年龄 83.4±7.5；助行器 40%）在 0（健壮）和 5（非常虚弱）之间进行评分。加权 kappa 的估计值为 0.2575（95% 置信区间 0.082-0.433），表明医疗保健专业人员视觉和 EFT 评分中位数之间的一致性较好，尤其是当 EFT 为 1 或 4 时。评分者之间存在显着不一致（kappa 估计值为 0.110、95 % 置信区间 0.079-0.141)。年龄、性别和行动辅助对分数不一致没有显着影响。B 部分：向 TAVI 多学科团队的 12 名成员（注册护士 27.5%；医师 72.5%）展示了一系列六张具有代表性的患者照片。从数据中得出以下主题： (a) 向外看；(b) 考虑内部；(c) 谨慎使用；(d) 更好的方法。