500 recruits!

The Bespoke Study has been recruiting cyclists attending the Royal London Hospital with cycling related injuries since April 2016. Cyclists have been recruited from Emergency Department, Outpatient Clinics, Inpatient wards and over the telephone. The aim of the study is to explore the epidemiology of cycling crashes presenting to Barts Health NHS Trust.

We have now successfully recruited 500 cyclists to the study! We would like to thank all of our cyclists who have been involved and all the staff who have helped us in the Emergency Department and across the hospital in both clinics and on the wards. We really couldn’t have done it without your support!

We are continuing to recruit until September 2017, to allow for 18 months of data collection. To keep up to date on our progress follow us on twitter: @bsp0ke.

How can you get involved?

If you would like to get involved in our research please report your cycling hazards and incidents to http://www.bikemaps.org/ or download the FREE app onto your phone “BikeMaps”.

Thank you so much for your ongoing support! Happy cycling!!


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BikeMaps comes to London!

What is BikeMaps and how does it work?

BikeMaps.org is a crowd sourced incident reporting tool. You can log the location of a collision, near miss, hazard or theft on a BikeMaps webmap or through our mobile apps. Once the location is chosen, you will anonymously answer a series of questions about the incident and about you and your riding habits. This should only take a couple of minutes.



Where did the BikeMaps idea come from?

Dr. Trisalyn Nelson had the idea for BikeMaps.org after a near miss on her bike to work. Trisalyn, now at Arizona State University, specializes in spatial analysis, GIScience, and the emerging field of volunteered geographic information. She had the idea for a web-map to collect locations where people had a frustrating experience on their bike. Upon discussing her idea with public health researchers who study bike safety, she discovered that there was a great need for the data that BikeMaps.org could supply.

Why are you collecting this information?

It’s estimated that only 30% of all bike collisions are captured by official data – police reports or insurance claims. In addition, there was a need to collect data on falls as well as collisions not involving a motor vehicle. Near miss reports are also rarely collected, yet can serve as additional data points to proactively highlight problem locations. All of this data is valuable to a wide range of audiences from cities planning safer infrastructure to health researchers studying activity.

What will you do with the data?

The data collected in London will be shared with the Bespoke team. In other locations we have shared the data or analysis with municipalities to assist them with planning. We have graduate students who use the data for graduate research in the fields of Geography and Public Health.

How can the public monitor areas of interest to them?

You can outline a “riding area”, which is a geographic area of interest. First you will need to create an account. Once the account is made, a polygon shape will be visible, which you will use to create your area. You may create more than one area. Once you have an area defined, you will receive notifications whenever someone reports something within that area. Please note that you do not have to have an account to report an incident nor will having an account identify you if you report an incident. Notifications will appear under the bell on the website or as push notifications on the mobile apps.

What other research studies have you been involved in?

Prior to BikeMaps.org, Trisalyn and her research team at the University of Victoria were involved in a wide range of studies involving patterns of data over space and time. These included grizzly bear habitat in Alberta, crime, biodiversity, the mountain pine beetle epidemic in Canada’s boreal forest, and wildfire. Our team member, Dr. Meghan Winters is an assistant professor at Simon Fraser University (British Columbia) whose research has included public bike share, cycling safety, and how the built environment affects the health and mobility of older adults.

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Trauma Symposium Poster

The Bespoke team were honoured to be asked to display a poster at the Pan London Major Trauma System symposium which took place yesterday at the Royal Geographical Society(http://www.c4ts.qmul.ac.uk/london-trauma-system/trauma-care).

The first Pan London Major Trauma System symposium: ‘Sharing trauma innovation from London and the South East’ included presentations covering a wide range of topics by some brilliant speakers including Traumatic Brain injuries, Managing MSK trauma and ideas on how New York manages their trauma, which were all topics of interest to the Bespoke Team.

The poster outlined our protocol for our observational, prospective cohort study exploring the epidemiology of cycling crashes presenting to the Royal London Hospital. The poster included our objectives, inclusion/exclusion criteria, data collection methods, Public and patient involvement and our current recruitment data.

We would like to say a big thank you to the Centre for Trauma Sciences and the London Major Trauma System for giving us the opportunity in being involved in such a fantastic day!


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Barts’ Bike Service Success!!

Over the last couple of months we have supported several free bike servicing events at Whipps Cross Hospital, Barts Hospital and Newham Hospital for all Barts Staff. This was organised by the Barts Sustainability team, and we had an excellent mechanic from Dr Bike sorting out all sorts of bike problems as well as completing secure bike marking for Barts Staff. We wanted to get out to as many sites as possible- to ensure everyone had a chance to get their bike ready for winter cycling!

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All events were a success, with a steady stream of cyclists keen to get their bike checked – hats off to those who waited in a cold queue for their bike service! It’s great to see the huge number of cyclists working within Barts Health NHS Trust. We will be looking to host similar events at the beginning of next year so keep an eye out for posters!!

If you are interested in supporting our study please let us know about any cycling near misses/collisions you have. Simply send us a screenshot of your map location using a pin to identify the specific geo-location, with a brief description of the event to twitter or instagram, or drop us an e-mail! Happy cycling!!!

Twitter: @bsp0ke

Email: bespoke@bartshealth.nhs.uk

Facebook: The Bespoke Study

Instagram: Bespoke Study

Website: www.bespokestudy.co.uk

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5 minutes with Tim Harris, Professor of Emergency Medicine

stafftimharrisTell us about your day to day work at the Royal London Hospital/Barts health NHS Trust?

It is a huge privilege to work at QMUL and BH. I work as part of a world class team in a world class health care facility. No day is remotely similar – keeps the brain fresh I hope. I work in research and teaching as well as the clinical side and enjoy each part of my work. I work in the ED and pre-hospital arena (with paramedics in a HEMS service based near Cambridge), so I am involved in the care of injured cyclists each day. I also previously worked in ICU – and I miss it very much but there are just not enough hours of the day. Job variety is hugely important in this field – it helps in maintaining perspective and balance.

What led you to develop the Bespoke study? 

We need to better understand cycle injuries and how/why they occur, and how they affect people. Hospital statistics are surprisingly inaccurate – indeed the coding of illness remains a highly variable. We hope that this will change in the future. Thus to really understand a specific set of injuries or disease processes health care researchers usually need to create specific databases. Bepsoke will provide a huge amount of data into a multitude of factors which surround cycling injuries. We obviously hope that this will improve safety for cyclists.

Do you cycle yourself?

After a night shift I was cycling home and fell asleep. I woke up under the wheels of a large 4 wheel drive. That unnerved me. I also was unlucky enough to have two bikes stolen (locked and security coded). The near miss and the lack of any perceived interest for the law enforcement in their recovery means I do not cycle now. I did actually find my last bike but the elderly man using it looked like his need was greater than mine so I did not try to claim it! I guess that says a lot about how untrendy my bikes were. I take the tube to work now and run home. I still think cycling is the fastest and best way to travel in London so hopefully I will again in the future.

What kind of cycling injuries have you managed previously?

Over the past 25 year I have been involved in a huge range of cycling injuries. I tend to be much more involved in critical illness these days

What can Londons cyclists do to help?

We are trying to capture the location of cyclists near misses and collisions across London. Please upload a screenshot of your map location with a brief description of the event to our twitter/instagram or facebook and #crashitmapit


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New York Inspiration

The Bespoke Study was designed with careful consideration of previous research relating to traffic safety, and ways to make the roads safer for all road users. This is an example of another study that has successfully used data collection to highlight urban “hotpots” to help make recommendations for improving the safety on the streets of New York.

“A community traffic safety analysis of pedestrian and bicycle injuries based on the catchment area of a trauma center” Slaughter et al (2014)

An epidemiological study took place in New York investigating the characteristics of pedestrian and cyclists’ collisions with motor vehicles within New York City’s high density hub between December 2008 and June 2011. The primary objectives were to map crash locations and identify hotspots within this injury cluster. The secondary objective was to quantify differences in injury severity based on road type and user behaviours.

The data was collected from pedestrians and cyclists struck by motor vehicles and brought to Bellevue Hospital in New York City. ISS (Injury severity score) and collisions locations were extracted from the database. A total of 1457 patients were enrolled, with collision locations known for 97.5%. Geomaps were then created to identify “hotspots” areas where higher volumes of crashed occurred.

The results demonstrated pedestrians crossing avenues had higher ISS’s than those crossing streets and were more likely to die.  This demonstrated that the wider avenues resulted in more serious injuries than the narrower streets. Pedestrians who were crossing mid-block had higher ISS’s than those crossing with a signal at a crosswalk. The geo-map data showed that hotspots of pedestrian collisions were detected in mid-town Manhattan whereas cyclists’ hot spots were detected in tunnel portals and bridges; spatial analysis demonstrated showed these were not random events. These results could then be taken forward to help make changes to road layouts, town planning and prevention strategies.

The Bespoke Study is collecting data of cyclists’ near misses, slight incidents and serious incidents across London between April 2016 – September 2017. This data is collected via cyclists attending the Royal London Hospital who are recruited to the study, and also cyclists reporting to the website Collideoscope.

What can you do to help?

We need all cyclists in London to be actively using Collideoscope to report near misses, slight and serious incidents so we are able to collect data on where cycling incidents are happening. Is it vital that we collect data covering the whole injury pyramid – from the near misses to the more serious incidents… all reports are vital!

Massive thanks to all those who have reported so far!


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Start cycling!

In response to a lack of physical activity in the UK, Public Health England have developed The Physical Activity tool. This combines data of physical activity and related risk factors such as obesity and diabetes. The tool compares local data to national data to develop better understanding and therefore promotion of physical activity, such as walking and cycling.

Physical inactivity contributes to 1 in 6 deaths in the UK, there have been slow improvements over the past few years but the UK remains behind many other countries including the USA.

Physical inactivity costs the NHS approximately £0.9 billion per year

Physical activity reduces risk of multiple diseases such as cardiovascular disease, coronary heart disease, stroke, diabetes, obesity, osteoporosis, colon/breast cancer as well as improving mental health.

Completing 30 minutes of moderate physical activity can make a big difference to health and well-being

Table showing overview of physical activity

Table showing overview of physical activity

  • In London 57.8% of adults complete 150 minutes of physical activity per week, this is better than the national benchmark
  • In London 5.4% of adults cycle at least 3 times a week
  • In London 14.7% of adults cycle at least once per month, this is less than the national benchmark

Physical activity should be encouraged as part of everyday life to improve health and mental well-being, reduce risk factors for disease as well as promote a healthier and more active community. Public Health England has developed the Everybody active, everyday framework to help all sectors to promote physical activity, such as cycling.. We need more people to start!

Make a change and start cycling!

Wednesday 14th September is National Cycle to Work day!

Check their website for more information and tips https://www.cycletoworkday.org/

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5 minutes with Manoj Ramachandran, Orthopaedic Consultant

Can you tell us about your day to day work at the Royal London Hospital/Barts Health NHS Trust?manojrcropoutsid

I’m mainly a children and young adult trauma and orthopaedic consultant surgeon, looking after injuries and chronic conditions of bones and joints in these age groups. On top of that, I head up a research team in orthopaedics that is focused on innovative clinical and translational research projects in all kinds of important subject areas, from common injuries to medical devices to digital health.

What led you to develop the Bespoke study?

It was on the back of the numbers of cycling related injuries that we were seeing at the Royal London Hospital on a background of the high-profile deaths reported in the media. I wanted to really take a granular look at the mass of injuries that presented to our Emergency Department, including minor injuries, to really understand what patterns and types of injuries we were seeing, how and why they had happened, and what the effect on an individual patient was in the short-, medium- and long-term.

Do you cycle yourself?

Yes, I love cycling but I stopped cycling as a commuter in London around twelve years ago when I was knocked off my bike a few weeks before my wedding and suffered some facial injuries. I have got back on my bike since but not for commuting. I don’t want in any way to discourage cycling as I think it’s an amazingly healthy activity and we should all be out there on our bikes but I just want to understand why we are seeing so many injuries clinically and to help in the process to make cycling safer and prevent injuries in the first place.

What kind of cycling injuries have you managed previously?

All kinds from minor to severe in children and young adults. These have ranged from simple bruises to severe life threatening injuries brought in by the London Air Ambulance. I’m positive that if we understand how these injuries are happening in incredible quantitative detail we can really start to make cycling completely safe.

What can London’s cyclists do to help?

Please please please report any cycling incidents at http://www.collideoscope.org.uk/  these can be near misses, minor or major incidents. It will really help us build a picture of where problems are happening in London.

And finally, please spread the word to everyone you know who cycles and help us build a robust study!

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5 minutes with Chris Bridle, Oral & Maxillofacial surgeon

chris bridle
Can you tell us about your day to day work at the Royal London Hospital for Barts Health NHS Trust?
I am a Consultant Oral & Maxillofacial Surgeon at Barts Health NHS Trust. I have been working in the trust for the last 13 years and was appointed as a Consultant 8 years ago with an interest in facial trauma. In my years as a consultant my primary focus has been dealing with patients who have sustained injuries to their face from a variety of different accidents, assaults and mishaps. My week is based around the assessment and treatment of these patients such that we run an all-day trauma clinic at the beginning of the week and then schedule the surgery for our two all-day operating lists on Tuesday and Wednesday. Over the years I have noticed an increase in the number of cycling related injuries. This is undoubtedly due to the increased popularity of cycling in London as a means of getting about the city but also the increased popularity of the sport itself. The impact of facial injuries on people’s lives can be profound and I am passionate about encouraging prevention as well as treating those unfortunate to be the victims of facial trauma.

Do you cycle yourself?

I was a very keen cyclist as a teenager and younger adult years. As a kid my main mode of transport was my Raleigh Racing bike rather than the dad taxi. Many a weekend during my junior training I would spend on the mountain bike, riding through the North Yorkshire Moors. More recently I have tried the delights of the ‘Boris’ bikes as means of getting around and with a young son we often get out on our bikes around the parks of South London.

What kind of cycling injuries do you manage?
We see on a weekly basis a number of patients who have been involved in some form of bicycle related accidents. This includes bicycle riders and pedestrians who have stepped out in front of cyclists. The main type of injury is soft tissue injury where the rider hits the floor and sustains nasty grazes and ‘road rash’. These are really important to treat well as any dirt left in the wound will tattoo the face with an unsightly scar. The other types of injury are those to the bony facial skeleton where fractures of the lower jaw, cheek bone, eye socket and skull are not uncommon. In those riders wearing helmets we see more lower facial injuries compared to those not wearing helmets who show a wider range of facial injuries.

What can Londons cyclists do to help?
From our experience dealing with facial injuries amongst the cycling community, the biggest piece of advice is to be vigilant and aware of everything around you

Please make your crash count by reporting any near misses and incidents to http://collideoscope.org.uk/ and help build a map of collision hotspots in London

Happy & safe cycling!

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NipNip Bike Service Success!!!

We hosted our NipNip FREE bike servicing afternoon on Wednesday, which was a huge success! One of the talented NipNip bike mechanics serviced bikes from 3-7pm outside the Royal London Hospital, managing to service 40 bikes in total – an incredible 10 per hour! We were really encouraged by the amount of cyclists turning out to ensure their bikes were road safe. We also had The Met police attending to complete bike markings to aid bike security. The Leigh Day Cycling Team were also here to help, and share their cycling knowledge with fellow cyclists which was an added bonus!

We used this opportunity to tell people about the Bespoke Study and promote cyclists to help the study by reporting their cycling near misses/incidents to http://collideosco.pe/ to help us see what’s happening on the London roads.

We would like to thank NipNip, the Met Police and the Leigh Day Cycling Team for their support in making it such a fantastic day! We hope to hold further servicing dates so keep an eye on our Twitter or website!

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