The easternmost occurrence of Mammut pacificus (Proboscidea: Mammutidae), based on a partial skull from eastern Montana, USA.

Mammut pacificus is a recently described species of mastodon from the Pleistocene of California and Idaho. We report the easternmost occurrence of this taxon based upon the palate with right and left M3 of an adult male from the Irvingtonian of eastern Montana. The undamaged right M3 exhibits the extreme narrowness that characterizes M. pacificus rather than M. americanum. The Montana specimen dates to an interglacial interval between pre-Illinoian and Illinoian glaciation, perhaps indicating that M. pacificus was extirpated in the region due to habitat shifts associated with glacial encroachment.

New middle Eocene omomyines (Primates, Haplorhini) from San Diego County, California.

The Friars Formation of San Diego County, California, has yielded a middle Eocene mammalian fauna from the early part of the Uintan North American Land Mammal Age. Prior research on the primate fauna from the Friars Formation provides evidence of one notharctine and multiple omomyine species, but many specimens collected since the early 1980s remain unstudied. Here we describe three new omomyine genera from the Friars Formation. These new taxa range in estimated body mass from about 119 g to 757 g, and substantially expand the diversity of middle Eocene omomyoids known from Southern California. Resolution of the phylogenetic relationships of the new Friars Formation omomyines is complicated by the fact that different character-taxon matrices and tree building methods produce different results. Nevertheless, all preliminary phylogenetic analyses are congruent in recovering a close relationship between the three new genera and the omomyines Macrotarsius, Omomys, Ourayia, and Utahia. Prior research has documented a shift in omomyoid diversity in North America from the anantomophine-rich Bridgerian to the omomyine-rich Uintan. Our description of three new Uintan omomyine taxa from the Friars Formation further emphasizes these opposite trends in anaptomorphine and omomyine species richness during the middle Eocene. All three of the new taxa are currently known from only the Friars Formation in San Diego County, California. Four of the previously known omomyoid genera from Southern California (Dyseolemur, Chumashius, Yaquius, and Stockia) are also endemic to the region, further highlighting the provincial character of primate faunas in Utah, Southern California, and West Texas during the Uintan.

Implementation of an electronic documentation system using microsystem and quality improvement concepts.

Electronic documentation systems have become integral to improving the quality of healthcare, reducing medical errors, and advancing the delivery of evidence-based medical care. A smooth transition from paper charting to an electronic documentation system is challenging. Using quality improvement tools and building on the clinical microsystems concept can assist with a smooth transition. Specific strategies include involving all stakeholders in the development and implementation of the plan, assessing the culture of the department, and identifying processes and patterns that require attention. Specific steps include developing a statement of aim, formulating a specific path to reach the aim, evaluating the progress of implementation, and creating a template for future process improvement. This article describes the process used in one midwestern NICU to implement an integrated electronic documentation system using a clinical microsystems approach and quality improvement methods. Challenges encountered and lessons learned are discussed.

Evaluation and development of potentially better practices for staffing in neonatal intensive care units.

OBJECTIVE: Five NICUs that participate in the Vermont Oxford Network's Neonatal Intensive Care Quality Improvement Collaborative 2002 attempted to identify potentially better practices that would have a directly impact on nurse recruitment and retention. The group identified nurse recruitment and retention as an important initiative for many hospitals that face a nursing shortage. METHODS: The group analyzed information from hospital demographics, literature reviews, process analysis questionnaires, and site visits. RESULTS: The literature review, process analysis questionnaire, and benchmarking with magnet hospitals identified 5 drivers for retention and recruitment. The drivers evolved into 5 potentially better practices that cover orientation, recognition and rewards, work environment, nurse/physician collaboration, and nursing autonomy. The magnet hospitals, which are known to have the highest retention rate and the lowest turnover rate, have many of these potentially better practices in place. CONCLUSION: The 5 practices described herein have the potential to decrease nursing turnover in NICUs.

Implementation and case-study results of potentially better practices for staffing in neonatal intensive care units.

OBJECTIVE: Five NICUs that participate in the Vermont Oxford Network Quality Improvement Collaborative have implemented several potentially better practices in an attempt to decrease nurse turnover by 50%. These potentially better practices focus on orientation, rewards and recognition, healthy work environment, nurse-physician collaboration, and nursing autonomy. METHODS: Each unit implemented some or all of the potentially better practices. An Excel spreadsheet tool for tracking turnover rates was developed and used to measure the impact of the potentially better practices on retention. Rates were measured quarterly. RESULTS: After implementation of the potentially better practices, turnover rates fell at all of the NICUs ranging from 13% to 64%. CONCLUSIONS: Nurse retention is multifactorial. Implementation of the potentially better practices had a positive influence on nurse satisfaction but a varied impact on nurse retention. The impact of larger issues such as pay and staffing levels is significant and may not be influenced at the unit level.