Great Green Transition and Finance.

European governments are struggling to regain economic strength in the coronavirus pandemic as in many countries the number of new infections seems to gradually subside. Growth rates deep in the red call for a reconstruction programme when the crisis is finally manageable and economic activity can resume. Amidst this, there are again influential groups that claim "this is not the time to insist on strict climate protection goals". On the contrary, the ongoing COVID-19 crisis has clearly illustrated what climate disasters, often occurring locally, could do to the life of citizens. The reconstruction programme needs to initiate the great green transition. The transformation from a climate-distorting to a climate-protecting economy opens up investment opportunities and points to financing needs comparable with those necessary for the rebuilding of the European economy after World War II. The great green transition is a unique chance to pursue policies for a new and sustainable growth regime.

Comparison of neonatal skin sensor temperatures with axillary temperature: does skin sensor placement really matter?

PURPOSE: Appropriate thermoregulation affects both morbidity and mortality in the neonatal setting. Nurses rely on information from temperature sensors and radiant warmers or incubators to appropriately maintain a neonate's body temperature. Skin temperature sensors must be repositioned to prevent skin irritation and breakdown. This study addresses whether there is a significant difference between skin sensor temperature readings from 3 locations on the neonate and whether there is a significant difference between skin sensor temperatures compared with digital axillary temperatures. SUBJECTS: The study participants included 36 hemodynamically stable neonates, with birth weight of 750 g or more and postnatal age of 15 days or more, in a neonatal intensive care unit. Gestational age ranged from 29.6 to 36.1 weeks at the time of data collection. DESIGN: A method-comparison design was used to evaluate the level of agreement between skin sensor temperatures and digital axillary thermometer measurements. METHODS: When the neonate's skin sensor was scheduled for routine site change, 3 new skin sensors were placed-1 each on the right upper abdomen, left flank, and right axilla. The neonate was placed in a supine position and redressed or rewrapped if previously dressed or wrapped. Subjects served as their own controls, with temperatures measured at all 3 skin sensor sites and followed by a digital thermometer measurement in the left axilla. The order of skin sensor temperature measurements was randomly assigned by a computer-generated number sequence. MAIN OUTCOME MEASURES: An analysis of variance for repeated measures was used to test for statistical differences between the skin sensor temperatures. The difference in axillary and skin sensor temperatures was calculated by subtracting the reference standard temperature (digital axillary) from the test temperatures (skin temperatures at 3 different locations), using the Bland-Altman method. The level of significance was set at P < .05. PRINCIPAL RESULTS: No statistically significant differences were found between skin temperature readings obtained from the 3 sites (F2,70 = 2.993, P = .57). Differences between skin temperature readings and digital axillary temperature were also not significant when Bland-Altman graphs were plotted. CONCLUSIONS: For hemodynamically stable neonates in a supine position, there were no significant differences between skin sensor temperatures on abdomen, flank, or axilla or between skin sensor temperatures and a digital axillary temperature. This may increase nurses' confidence that various sites will produce accurate temperature readings.

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.