ABSTRACT
PROBLEM ADDRESSED: Individuals with severe mental illness have an increased burden of physical comorbidities. Physical concerns of patients admitted to hospital for mental health reasons might be addressed by multiple specialists, leading to fragmented care and high costs to the system, when many of these concerns could be addressed by primary care. OBJECTIVE OF PROGRAM: The Family Doctor Outreach Clinic (FDOC) aims to provide rapid consultations for common concerns, to provide consultations for complex chronic disease and addictions, and to identify gaps in community care that contribute to patients' potential readmission to hospital. The FDOC is a simple and novel collaborative program of care in a tertiary care setting. PROGRAM DESCRIPTION: Members of the Department of Family Medicine at St Paul's Hospital in Vancouver, BC, have been providing consultation services for patients admitted to the 4 mental health wards (total of 108 beds). Using a prospective cohort of consecutive consultations (N = 104) from July to August 2014, the study team collected data on details of current admissions, connections to community primary care, and reasons for consultations. CONCLUSION: Including family physicians in the care of mental health inpatients, as is done at the FDOC, might avert referrals to specialist services and provide a bridge between acute care and community family practice.
Subject(s)
Community Mental Health Services/organization & administration , Family Practice/methods , Mental Disorders/therapy , Physicians, Family , Primary Health Care/organization & administration , Tertiary Care Centers , Adult , British Columbia , Chronic Disease/psychology , Female , Humans , Interprofessional Relations , Male , Middle Aged , Program Evaluation , Prospective Studies , Referral and Consultation/organization & administrationABSTRACT
Generation of center-surround antagonistic receptive fields in the outer retina occurs via inhibitory feedback modulation of presynaptic voltage-gated calcium channels in cone photoreceptor synaptic terminals. Both conventional and unconventional neurotransmitters, as well as an ephaptic effect, have been proposed, but the intercellular messaging that mediates the inhibitory feedback signal from postsynaptic horizontal cells (HCs) to cones remains unknown. We examined the possibility that proton concentration in the synaptic cleft is regulated by HCs and that it carries the feedback signal to cones. In isolated, dark-adapted goldfish retina, we assessed feedback in the responses of HCs to light and found that strengthened pH buffering reduced both rollback and the depolarization to red light. In zebrafish retinal slices loaded with Fluo-4, depolarization with elevated K(+) increased Ca signals in the synaptic terminals of cone photoreceptors. Kainic acid, which depolarizes HCs but has no direct effect on cones, depressed the K(+)-induced Ca signal, whereas CNQX, which hyperpolarizes HCs, increased the Ca signals, suggesting that polarization of HCs alters inhibitory feedback to cones. We found that these feedback signals were blocked by elevated extracellular pH buffering, as well as amiloride and divalent cations. Voltage clamp of isolated HCs revealed an amiloride-sensitive conductance that could mediate modulation of cleft pH dependent on the membrane potential of these postsynaptic cells.
