Christopher W. Kerr

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BACKGROUND Delirium is one of the most distressing and difficult to manage problems in advanced illness. Family caregivers have a unique view of the progression of delirium. OBJECTIVE This study examined precursors to delirium from the perspective of family caregivers. DESIGN This study utilized a two-stage concept mapping design that began with(More)
CONTEXT Fatigue is highly prevalent in populations with advanced illness and is often associated with depressed mood. The role of psychostimulant therapy in the treatment of these conditions remains ill defined. OBJECTIVES To evaluate the response of fatigue and depression in patients with advanced illness to titrated doses of methylphenidate (MP) as(More)
BACKGROUND Metastatic breast cancer patients have many options for therapy and may be at risk for late or absent hospice referrals, which make meaningful improvements in symptoms and quality of life difficult to achieve. OBJECTIVE We aimed to examine hospice utilization, status of patients on admission, and quality of care of patients treated for(More)
End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their(More)
BACKGROUND End-of-life dreams and visions (ELDVs) have been well documented throughout history and across cultures. The impact of pre-death experiences on dying individuals and their loved ones can be profoundly meaningful. OBJECTIVE Our aim was to quantify the frequency of dreams/visions experienced by patients nearing the end of life, examine the(More)
CONTEXT Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs(More)
BACKGROUND In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and(More)
The benefits of ketamine in reducing pain are largely based on case reports and small clinical trials. We present a case series describing the application and efficacy of subanesthetic doses of ketamine in the treatment of complex pain syndromes poorly responsive to escalating doses of opioids. The discussion that follows suggests that subanesthetic(More)
BACKGROUND Inpatient palliative care (IPC) has been associated with numerous clinical benefits. Observational and randomized studies of cost savings associated with IPC provide conflicting results, and the association with readmission is not well understood. OBJECTIVE We aimed to estimate the influence of IPC on hospitalization costs and readmission(More)
Many recently bereaved persons experience vivid and deeply meaningful dreams featuring the presence of the deceased that may reflect and impact the process of mourning. The present study surveyed 278 bereaved persons regarding their own perspective of the relationship between dreams and the mourning process. Fifty eight percent of respondents reported(More)