After COVID-19 crisis in Italy, serious restrictions have been introduced for relatives, with limitations or prohibitions on hospital visits. To partially overcome these issues ''WhatsApp'' has been adopted to get family members to participate in clinical rounds. Family members of patients admitted to the acute palliative care unit and hospice were screened for a period of two weeks. Four formal questions were posed: 1) Are you happy to virtually attend the clinical round? 2) Are you happy with the information gained in this occasion? 3) Do you think that your loved one was happy to see you during the clinical rounds? 4) This technology may substitute your presence during the clinical rounds? The scores were 0 ¼ no, 1 ¼ a little bit, 2 ¼ much, 3 ¼ very much. Relatives were free to comment about these points. Sixteen of 25 screened family members were interviewed. Most family members had a good impression, providing scores of 2 or 3 for the first three items. However, the real presence bedside (forth question) was considered irreplaceable. They perceived that their loved one, when admitted to hospice, had to say goodbye before dying.

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ObjectiveTo report data of the use of high-flow nasal therapy (HFNT) in the palliative care setting.MethodsFive hypoxaemic patients were treated by HFNT in a 1-year period in a palliative care setting, either in the last days of life or as part of an intensive treatment for a reversible cause of hypoxic dyspnoea.ResultsFour patients had a similar clinical pattern. After starting HFNT, dyspnoea intensity decreased and oxygen saturation improved, providing a clinical improvement for a duration of 2–3 days, but after 48–72 hours, their conditions deteriorated and patients underwent palliative sedation. Indeed, one patient with pulmonary embolism and pneumonia was treated by HFNT successfully and was discharged home 2 weeks after admission.ConclusionsHFNT may be helpful for severely hypoxaemic patients who are unresponsive to common measures adopted in the last weeks/days of life of patients with advanced cancer or to treat reversible conditions. The findings of this case series showed the ethical and psychological aspects of end of life, particularly for caregivers. Future studies should assess an early use of this device in combination with lower doses of opioids or as an alternative to their use.

ObjectivesThe aim of this paper is to illustrate how to manage a very difficult pain condition.MethodsThis is a clinical note of a complex approach using multiple analgesic regimens to effectively afford challenging pain situations.ResultsA man underwent an opioid dose titration, followed by dose stabilisation for some months. Then he underwent two opioid substitutions, unsuccessfully. A spinal analgesia provided good analgesia for a prolonged period of time, necessitating variable interventions to counteract the evolving, challenging clinical situation.ConclusionsThe description of this case illustrates the need of a high level of experience and knowledge to elaborate complex strategies step by step every time the pain syndrome was worsening. Recommendations are unlikely in these extreme circumstances, and treatment should be based on continuous clinical counteraction to the evolving clinical conditions.