Moshiokuri, or explaining what one did to one's successor before calling it a day, has long been regarded as a practice indispensable for the smooth continuation of nursing business. However, there has been much to be done in terms of efficiency. In our hospital, moshiokuri was taken up as a problem because it took long and prevented nurses from getting down to work by bedsides without delay. In 1994 the nursing record committee started to examine the practice and improvedthe roster. Later, the card indexing system for individuals was abolished. In 1998, the nursing department made the abolishment of moshiokuri practice its chief aim to improve nursing efficiency. For the attainment of the aim, the nursing record committee played an important role as a prime mover. While exchanges of information between wards were being promoted, study sessions were frequently held to enrich nursing records and improve the efficiency of nursing work. Thus, moshiokuri was partlydiscontinued and abolished totally in March, 1999. Now, the nurses have plenty of timecaring bed-ridden patients. Improvement has been made on the nursing record.

OBJECTIVETo explore the diagnostic feasibility of noninvasive assessment of coronary atherosclerotic plaques with MSCT in comparison with IVUS.

METHODSContrast-enhanced MSCT angiography (Sensation 64, Siemens Medical Solutions) was performed before percutaneous coronary intervention (PCI), and three-vessel IVUS (Boston Scientific, Natick, MA) was performed during procedure in 12 patients with stable angina pectoris. Complete investigation was digitally stored, and assessed offline with EchoPlaque (Indec Systems, Mountain View, CA). The comparison of MSCT with IVUS was performed based on segment at plaque site (American Heart Association 15-segment model).

RESULTSA total of 88 segments in 31 vessels (left anterior descending: 12, left circumflex: 10, and right coronary artery: 9) were investigated by both IVUS and MSCT. Among 68 assessable segments (54 proximal-middle segments and 14 distal segments) by MSCT (20 segments were excluded for poor image quality: 16 for severe calcification, 2 for motion artifact, 2 for poor opacification), MSCT correctly detected 47 of the 51 segments with plaques (sensitivity: 92%), and correctly evaluated 16 of 17 segments without plaques (specificity: 94%). Concerning plaque quantification, MSCT correlated well with IVUS in grading whether the vessel obstruction was less or more than 50% (simple kappa: 0.63, 95% CI: from 0.47 to 0.78). Plaque area by MSCT also correlated with that by IVUS (r = 0.53, P < 0.01), but overestimated plaque area [(9.09 +/- 3.89) mm(2) vs. (6.80 +/- 2.81) mm(2), P < 0.01]. In addition, 30 of 43 hypoechoic compositions were detected as low-density compositions by MSCT with average CT number as 67.39 HU.

CONCLUSIONSIn segments without severe calcification, contrast-enhanced 64-slice CT angiography could detect plaques in coronary artery with high accuracy. Plaque area quantification by MSCT correlated with that of IVUS though with limited accuracy.

Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; Humans ; Tomography, X-Ray Computed ; methods ; Ultrasonography, Interventional