Jennifer Perry

Walking humans respond to pulls or pushes on their upper body by changing where they place their foot on the next step. Usually, they place their foot further along the direction of the upper body perturbation. Here, we examine how this foot placement response is affected by the average step width during walking. We performed experiments with humans walking on a treadmill, both normally and at five different prescribed step widths. We prescribed step widths by requiring subjects to step on lines drawn on the treadmill belt. We inferred a linear model between the torso marker state at mid-stance and the next foot position. The coefficients in this linear model (which are analogous to feedback gains for foot placement) changed with increasing step width as follows. The sideways foot placement response to a given sideways torso deviation decreased. The fore–aft foot placement response to a given fore–aft torso deviation also decreased. Coupling between fore–aft foot placement and sideways torso deviations increased. These changes in foot placement feedback gains did not significantly affect walking stability as quantified by Floquet multipliers (which estimate how quickly the system corrects a small perturbation), despite increasing foot placement variance and upper body motion variance (kinematic variability).

SUMMARY Health Education England’s 2014 report Broadening the Foundation Programme has led to a rapid increase in the number of psychiatry placements for foundation doctors. This will have implications for existing psychiatrists in that they will start to teach, train and supervise foundation doctors. This article outlines how to develop high-quality foundation posts and how to support doctors in meeting the foundation curriculum competencies, which include experience of working in multidisciplinary teams and developing communication skills. The knowledge and skills gained in psychiatry placements will be valuable to all doctors, no matter what their future career intentions.

Aims and method: A service evaluation was undertaken to examine outcomes in patients who were street homeless (‘rough sleepers’) and who were compulsorily admitted to hospital under the Mental Health Act 1983. The data were collected from the patients' case notes.Results: At 1-year follow-up, patients had positive outcomes in areas such as accommodation status, registration with a general practitioner and engagement with the clinical team.Clinical implications: The study shows that the intervention of a Mental Health Act assessment and compulsory hospital admission in homeless people on the street is associated with positive outcomes at 1 year.

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry. Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects. Clinical implications Those developing foundation placements will need to ensure they are of high quality.

Summary: The Broadening the Foundation Programme report has led to an expansion in the number of psychiatry foundation placements. This change will have far-reaching benefits for foundation doctors doing psychiatry, no matter what their future career intentions. Doctors will develop a better understanding of mental illness, they will improve their communication skills and they will gain experience of working within multidisciplinary teams. Recruitment into psychiatry is also likely to improve. The Royal College of Psychiatrists is putting in place a number of measures to ensure that placements are of a high quality so that foundation doctors have a good experience of psychiatry.

The GMC Survey June 2011 highlighted that trainees in Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) were dissatisfied with the Trust's handover process. At this time there were no Trust guidelines on handovers. A quality improvement project was developed to create a consistent out of hours handover process and to improve staff satisfaction thereafter. Handover guidelines were implemented throughout the Trust on 1/2/12. An audit was carried out to measure staff compliance with handovers. A questionnaire was sent out to staff before and after implementation of the guidelines to assess satisfaction with handovers. The audit results highlighted that handovers occurred relatively consistently across the Trust following implementation of the guidelines. The questionnaire results showed an improvement in staff satisfaction with the handover process. The clinical implication of this project is an improved process of out of hours handover across BEH-MHT.

Psychoeducation for patients with schizophrenia can improve a range of outcomes. Our aim was to test a workshop intervention enabling service users to learn more about mental illness and their medication. A Quality Improvement Project was undertaken to create a workshop for patients with a diagnosis of schizophrenia within the Haringey Community Rehabilitation Team (HCRT) . The response was tested using anonymous questionnaires after each workshop. We held ten workshops (total of 47 participants), after which 83% of patients felt that the workshop had helped them to understand more about their mental health, 77% felt they were able to understand the purpose of their medication, 79% felt they were able to understand the side effects, and 70% felt they could have a say in prescribing. Objectives for the Quality Improvement Project were met. This workshop will be used for other patients within the HCRT and is transferable to other community mental health teams.