THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association CONTENTS This Issue in the Journal 4 A summary of the original articles featured in this issue Editorials 6 Obesity revisited, yet again Jim I Mann, Kirsten J Coppell 9 The Canterbury Charity Hospital: facing the challenge of unmet need in healthcare Murray Pfeifer Original Articles 12 A nationwide survey of weight control practices among middle-aged New Zealand women Sook Ling Leong, Clara Madden, Andrew R Gray, Caroline C Horwath 21 Long-term outcomes in gastric bypass patients with and without type 2 diabetes—Waitemata District Health Board experience Annika H L Lam, David D W Kim, Rick Cutfield, Cameron Walker, Michael Booth 31 The Canterbury Charity Hospital: an update (2010–2012) and effects of the earthquakes Philip F Bagshaw, Miriam Maimbo-M’siska, M Gary Nicholls, Carl G Shaw, Randall A Allardyce, Susan N Bagshaw, Angela L McNabb, Stuart S Johnson, Christopher M Frampton, Brian W Stokes 43 Patient-reported outcomes following breast reconstruction surgery in a public hospital: use of the Breast-Q questionnaire Ryan Cha, Estelle Barnes, Michelle B Locke 56 Lack of relationship between obesity and mortality or morbidity after coronary artery bypass grafting Tom Kai Ming Wang, Tharumenthiran Ramanathan, Ralph Stewart, Greg Gamble, Harvey White Review Article 66 Therapeutic options in the management of obesity Richard W Carroll, Rosemary M Hall, Amber Parry-Strong, John M Wilson, Jeremy D Krebs NZMJ 22 November 2013, Vol 126 No 1386; ISSN 1175 8716 Page 1 of 167 URL: http://journal.nzma.org.nz/journal/126-1386/5932/ ©NZMA Viewpoints 82 Improving the New Zealand dairy industry’s contribution to local and global wellbeing: the case of infant formula exports Judith A Galtry 90 A glucose meter evaluation co-designed with both health professional and consumer input Harmony Thompson, Huan Chan, Florence J Logan, Helen F Heenan, Lynne Taylor, Chris Murray, Christopher M Florkowski, Christopher M A Frampton, Helen Lunt Clinical Correspondence 98 Angiostrongylus meningitis associated with intraparenchymal cerebral haemorrhage Nikola Lilic, Ben Addison 103 Portal vein thrombosis as a complication of laparoscopic sleeve gastrectomy Robert Lopez, Richard Flint 106 Pure red cell aplasia associated with recombinant erythropoietin: a case report and brief review of the literature M Atif Mohd Slim, Riaz Shaik 111 Medical image. An unusual case of melaena Judy Huang, Robert Cunliffe Letters 114 Drowning terminology: not what it used to be Peter Jones, Kevin Moran, Jonathon Webber 117 Helmet use by skiers and snowboarders in New Zealand Andrew Gilbey, Kawtar Tani 119 Leading the way with a health research repository Emma Tumilty 121 50th anniversary of the modern use of intravenous regional anaesthesia Penelope Jeffery 123 The elderly locum Roger M Ridley-Smith 124 Missed tobacco tax revenue from ‘foreign’ packs in New Zealand: results from a discarded pack collection study Anna Marshall, Richard Edwards, Nick Wilson, George Thomson, Jo Peace 100 Years Ago in the NZMJ 127 Editorial: dyspepsia or indigestion (part 2) NZMJ 22 November 2013, Vol 126 No 1386; ISSN 1175 8716 Page 2 of 167 URL: http://journal.nzma.org.nz/journal/126-1386/5932/ ©NZMA Proceedings 128 Proceedings of the Rhise Group Symposium, Friday 22 November 2013 161 Proceedings of the 220th Scientific Meeting of the Otago Medical School Research Society, Wednesday 6 November 2013 Methuselah 167 Selected excerpts from Methuselah NZMJ 22 November 2013, Vol 126 No 1386; ISSN 1175 8716 Page 3 of 167 URL: http://journal.nzma.org.nz/journal/126-1386/5932/ ©NZMA THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association This Issue in the Journal A nationwide survey of weight control practices among middle-aged New Zealand women Sook Ling Leong, Clara Madden, Andrew R Gray, Caroline C Horwath The majority of New Zealand middle-aged women reported using weight control practices that were consistent with public health messages. The practices most commonly used were cutting down on meal/snack size and cutting down on fats/sugars. However, the use of smoking and exercising in a driven or compulsive way are of particular concern. Long-term outcomes in gastric bypass patients with and without type 2 diabetes—Waitemata District Health Board experience Annika H L Lam, David D W Kim, Rick Cutfield, Cameron Walker, Michael Booth Gastric bypass surgery is effective in achieving substantial weight loss over the medium to long term. Approximately 60% of patients with diabetes also become diabetes-free after surgery. However, some can have recurrence of diabetes despite initial resolution. Therefore, it is important to have regular testing for diabetes even after bariatric surgery. The Canterbury Charity Hospital: an update (2010–2012) and effects of the earthquakes Philip F Bagshaw, Miriam Maimbo-M’siska, M Gary Nicholls, Carl G Shaw, Randall A Allardyce, Susan N Bagshaw, Angela L McNabb, Stuart S Johnson, Christopher M Frampton, Brian W Stokes The Canterbury Charity Hospital Trust provides free secondary healthcare to some of those patients who cannot access the care they need in the public hospital system and cannot afford private care. It is funded solely by public giving; there is no government funding. It functions as an expanding day hospital facility and is staffed almost exclusively by volunteers. Trust members are very concerned about the level of unmet need and argue strongly that an independent mechanism should exist for its regular measurement. Patient-reported outcomes following breast reconstruction surgery in a public hospital: use of the Breast-Q questionnaire Ryan Cha, Estelle Barnes, Michelle B Locke Breast cancer is the most common cancer in women, and a proportion of women who have a mastectomy for breast cancer choose to undergo reconstruction. The success (or otherwise) of breast reconstruction is most appropriately assessed by the patients NZMJ 22 November 2013, Vol 126 No 1386; ISSN 1175 8716 Page 4 of 167 URL: http://journal.nzma.org.nz/journal/126-1386/5926/ ©NZMA themselves, rather than by the surgeons. The BreastQ is a quality of life questionnaire completed by breast reconstruction patients to provide meaningful outcome data from the patient’s perspective. We have administered this questionnaire to patients undergoing breast reconstruction in a busy public hospital plastic surgery department. Overall, our results show global patient satisfaction with outcomes, regardless of the type or timing of the reconstructive surgery. Lack of relationship between obesity and mortality or morbidity after coronary artery bypass grafting Tom Kai Ming Wang, Tharumenthiran Ramanathan, Ralph Stewart, Greg Gamble, Harvey White We examined the outcomes of obese patients, i.e. those with a body mass index (BMI) >30 (kg/m 2), compared to normal weight patients undergoing the coronary artery bypass grafting (CABG) operation. 38% of patients were obese. Mortality up to 1.4 years and complications were not increased in obese patients. Obesity should not prevent someone receiving the CABG operation. Therapeutic options in the management of obesity ((review article)) Richard W Carroll, Rosemary M Hall, Amber Parry-Strong, John M Wilson, and Jeremy D Krebs Over 1 in 4 New Zealand adults now classify as obese, while nearly 2 in 3 adults are overweight. In this article we look at the treatment options to achieve weight loss, with a focus on changes to diet and exercise that are fundamental to any weight loss program. We also review the available medications to aid weight loss, and discuss the role of weight loss (bariatric) surgery which is increasingly recognised as an effective method of achieving weight loss in appropriate people. Improving the New Zealand dairy industry’s contribution to local and global wellbeing: the case of infant formula exports ((viewpoint article)) Judith A Galtry This article looks at some of the high profile dairying incidents in recent years and questions whether NZ’s dairy industry is also undermining global best practice infant feeding practices through massive infant formula export marketing. I argue that while there is support for increased trade and exports, there are few voices promoting global infant health. Discussion is needed on this issue by the NZ public health community. NZMJ 22 November 2013, Vol 126 No 1386; ISSN 1175 8716 Page 5 of 167 URL: http://journal.nzma.org.nz/journal/126-1386/5926/ ©NZMA THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association Obesity revisited, yet again Jim I Mann, Kirsten J Coppell Two papers in this issue of the NZMJ serve as reminders of the many complexities of managing the real and perceived problems of excess body fatness, and that an overarching strategy, including public health initiatives, is essential for the management of this global epidemic. In October 2013, the BMJ published a systematic review and meta-analysis of the 11 randomised controlled trials of bariatric surgery with at least 6 months of follow-up, versus non-surgical treatment for obesity.1 Those allocated to surgery lost more body weight (mean difference -25 [95% confidence interval -31, -21] kg) and had a higher remission rates of type 2 diabetes (relative risk 22.1 [3.2, 154.3]) and the metabolic syndrome (relative risk 2.4 [1.6, 3.6]) after a maximum of 2 years, compared with those receiving nonsurgical treatment. Information regarding long-term outcomes is not available from randomised controlled trials and can only be derived from case series. Variable findings regarding remission and relapse rates for type 2 diabetes mellitus (T2DM) have emerged from such reports 2–4 so the findings of Lam and colleagues, in this issue of the Journal ,5 are of considerable interest. They report on their experience of 126 patients who had been followed for at least 4 years following gastric bypass surgery (GBP) at Waitemata District Health Board (WDHB), one of the few centres in New Zealand offering publically funded bariatric surgery.