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Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece’s ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.

The presence of gas and free air in the extraluminal space of the intestines is known as pneumatosis intestinalis (PI). There are many different causes of this finding, including gastrointestinal, pulmonary, autoimmune, and many more. It is often difficult to differentiate the etiology and clinical importance of the radiographic evidence on pneumatosis intestinalis due to the unclear pathophysiology causing the disease. To complicate things further, the ominous sign of portal venous gas poses the question of whether surgical intervention is needed. We report two cases both with clinical and radiographic evidence of secondary pneumatosis intestinalis with an associated sinister finding of portal venous gas. The cases differ by urgent surgical intervention versus observation before surgery. In this case series, we emphasize the importance of recognizing the radiographic finding and stress the need for further research to standardize a plan of care, including indications for surgery. We encourage more cases like this to be reported to aid in diagnosing and treating this condition early on with the aim of improving the mortality associated with it.

Background and contextCreativity and innovation remain vital ingredients to the success of any organisation. Working in silo can stifle teams from maintaining interest in the activities of the wider hospice workforce. A challenge for many clinical teams is to encourage and stimulate the generation of new ideas and innovations that can benefit and sustain a wider and future workforce including addressing the needs of pre-registration nursing students.The hospice in-patient unit established the need for a means of communicating key information/resources to highlight the practices beyond the IPU.AimTo create a resource tool for clinical staff and student nurses to share and disseminate information, forging links and engagement with the wider palliative care teams.For the tool to support the future re-validation process for Registered Nurses.ApproachesDevelopment of a colourful, attractive “pick n mix” resource board incorporatingthe hospice logo detailing 26 varied opportunities for staff to engage with the wider multi-disciplinary team, and experience local and national services allied to our care.This tool was developed by a qualified member of the nursing team in the In-Patient Unit and is updated by its originator on a weekly basis to reflect the varied and changing learning opportunities in the Hospice and the wider community.In addition, the board identifies mandatory training and clinical competencies. This acts as a prompt for staff to acknowledge their personal responsibility to the Hospice and the NMC.OutcomesThe ‘pick n mix' board raised awareness of the diverse ways in which we deliver evidence based end of life care. It enhanced creative thinking and encouraged nurses to remain updated.Formal evaluations of the number of study leave applications pertaining to the 26 learning opportunities will be audited. A six month review of the success of the tool will take place through group discussions and an anonymised evaluation form.

The United States has the world's highest per capita health care costs, and tax-funded expenditures accounted for nearly 64.3% of US health care spending [1]. Although hospital associated costs continue to rise, the US government sought a way to control costs while encouraging hospitals to provide care more efficiently [2]. Starting in the 1980's, The Centers for Medicare and Medicaid Services, developed a coding system using Diagnosis-Related Group (DRG) to provide guidelines for reimbursement of funds to physicians and medical organizations for services rendered [2]. Diagnosis-Related Group (DRG) is a statistical system of classifying any inpatient stay into groups for the purposes of payment [2]. Rather than paying the hospital for what it spent caring for a hospitalized patient, Medicare pays the hospital a fixed amount based on the patient's DRG or diagnosis [2].Background: Nurses play a vital role as clinical documentation improvement (CDI) specialists to facilitate the coordination of patient care by providing a concurrent review of medical records for every hospitalized patient. They serve as liaisons between physicians and medical coders to ensure accurate coding, improve reimbursements, patient safety and outcomes. CDI specialist may provide support to a more transparent healthcare team by making recommendations for care based upon patient findings after thorough investigation of all laboratory and diagnostic tests along with the physicians' narrative.Method: This paper used two case studies to describe the role of a nurse CDI specialist in a hospital setting. Information from the case studies were used to show the importance of a collaboration between a nurse CDI specialist and physician to improve patient care and provide accurate coding. Discussion/Conclusion: CDI specialist provide additional oversight to help prevent billing and coding mistakes that may lead to federal investigations and or poor patient outcomes. Nurses may be optimal CDI specialists because their education and clinical experience helps them evaluate many aspects of the medical record to make recommendations for care based upon best evidence-based practice. They are able to understand the patients diagnoses and ensure that the patient's course of hospitalization is aligned with accurate treatment. Thus, providing a bridge between clinical coders and physicians by interpreting and coding narrative data concurrently so reimbursements are accurate when completed post discharge.