Geoffrey Robinson

Publications (12)60.65 Total impact

• Article: Patterns of prescription drug misuse presenting to provincial drug clinics.

  Geoffrey Robinson, Graeme Judson, Richard Loan, Timothy Bevin, Patrick O'Connor
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  ABSTRACT: To survey new patients, presenting to three drug clinics, on the patterns, usage and costs of prescription pharmaceuticals. Consecutive patients seen by the medical staff for assessment had a 7-day history recorded for prescription drug (PD) usage, and the associated costs of these from street sources. There were 37 patients (26 males) with a mean age of 34 years (21-51). Ten reported using only intravenous (IV) morphine, at a median dose of 105 mg/day (40-600), at a mean cost of 56 cents/mg. Another 12 reported methadone as their sole opioid at a median dose of 50 mg/day (27-70), at a mean cost of 81 cents/mg. A further 11 used a mixture of opioids, predominantly morphine and methadone but also dihydrocodeine (3), oxycodone (1), tramadol (1) and codeine (2). Seventeen reported also using hypnosedatives, but did not report high doses of these. The overall weekly expenditure on PDs was $367/week (0-2100). Morphine and methadone remain the predominant street opioid PDs in this region. Street prices have reduced, perhaps reflecting greater drug availability in accordance with increased national prescribing of opioids. There is continuing diversion of PDs to the street which is an ongoing Public Health issue requiring coordinated responses, including improved prescribing training, pain guidelines, drug clinic policy and actions by Medsafe, Police and regulatory bodies to contain this problem.
  The New Zealand medical journal 01/2011; 124(1336):62-7.
• Article: The New Zealand national junior doctors' strike: implications for the provision of acute hospital medical services.

  Geoffrey Robinson, Kieran McCann, Peter Freeman, Richard Beasley
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  ABSTRACT: The New Zealand junior doctors' strike provided an opportunity to consider strategies that might be employed to overcome the international shortage of junior doctors. This article reports the experience of the emergency department (ED) and internal medicine (IM) services at Wellington Hospital during the national strike, in which medical services were primarily provided by specialist consultants in addition to, or as part of, their routine work. During the strike, elective admissions and outpatient clinics were mostly cancelled. In the ED, the waiting times and length of stay were markedly reduced. In IM, the proportion of patients admitted to the short stay unit rather than the general medical wards increased. Notwithstanding the different work circumstances, in both services one senior doctor carried the workload of at least two junior doctors. The deployment of additional senior medical staff to acute hospital services could greatly reduce the total number of doctors required. This strategy would have implications in terms of supporting acute medicine specialty initiatives, training, quality of care and funding.
  Clinical medicine (London, England) 07/2008; 8(3):272-5. · 1.15 Impact Factor
• Source

  Available from: Brian Cox

  Article: Cannabis use and cancer of the head and neck: case-control study.

  Sarah Aldington, Matire Harwood, Brian Cox, Mark Weatherall, Lutz Beckert, Anna Hansell, Alison Pritchard, Geoffrey Robinson, Richard Beasley
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  ABSTRACT: To investigate whether cannabis smoking increases the risk of head and neck cancer. Case-control study. Cases of head and neck cancer < or =55 years identified from hospital databases and the Cancer Registry, and controls randomly selected from the electoral roll completed interviewer-administered questionnaires. Logistic regression was used to estimate the relative risk of head and neck cancer. There were 75 cases and 319 controls. An increased risk of cancer was found with increasing tobacco use, alcohol consumption, and decreased income but not increasing cannabis use. The highest tertile of cannabis use (>8.3 joint years) was associated with a nonsignificant increased risk of cancer (relative risk = 1.6, 95% confidence interval, 0.5-5.2) after adjustment for confounding variables. Cannabis use did not increase the risk of head and neck cancer; however, because of the limited power and duration of use studied, a small or longer-term effect cannot be excluded.
  Otolaryngology Head and Neck Surgery 03/2008; 138(3):374-80. · 1.72 Impact Factor
• Article: Effects of cannabis on pulmonary structure, function and symptoms.

  Sarah Aldington, Mathew Williams, Mike Nowitz, Mark Weatherall, Alison Pritchard, Amanda McNaughton, Geoffrey Robinson, Richard Beasley
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  ABSTRACT: Cannabis is the most widely used illegal drug worldwide. Long-term use of cannabis is known to cause chronic bronchitis and airflow obstruction, but the prevalence of macroscopic emphysema, the dose-response relationship and the dose equivalence of cannabis with tobacco has not been determined. A convenience sample of adults from the Greater Wellington region was recruited into four smoking groups: cannabis only, tobacco only, combined cannabis and tobacco and non-smokers of either substance. Their respiratory status was assessed using high-resolution CT (HRCT) scanning, pulmonary function tests and a respiratory and smoking questionnaire. Associations between respiratory status and cannabis use were examined by analysis of covariance and logistic regression. 339 subjects were recruited into the four groups. A dose-response relationship was found between cannabis smoking and reduced forced expiratory volume in 1 s to forced vital capacity ratio and specific airways conductance, and increased total lung capacity. For measures of airflow obstruction, one cannabis joint had a similar effect to 2.5-5 tobacco cigarettes. Cannabis smoking was associated with decreased lung density on HRCT scans. Macroscopic emphysema was detected in 1/75 (1.3%), 15/92 (16.3%), 17/91 (18.9%) and 0/81 subjects in the cannabis only, combined cannabis and tobacco, tobacco alone and non-smoking groups, respectively. Smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation. In contrast, cannabis smoking was seldom associated with macroscopic emphysema. The 1:2.5-5 dose equivalence between cannabis joints and tobacco cigarettes for adverse effects on lung function is of major public health significance.
  Thorax 01/2008; 62(12):1058-63. · 6.84 Impact Factor
• Article: Is it time to change the approach to oxygen therapy in the breathless patient?

  Richard Beasley, Sarah Aldington, Geoffrey Robinson
  Thorax 11/2007; 62(10):840-1. · 6.84 Impact Factor
• Article: Hemochromatosis gene mutations, liver function tests and iron status in alcohol-dependent patients admitted for detoxification.

  Geoffrey Robinson, Seshasayee Narasimhan, Mark Weatherall, Richard Beasley
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  ABSTRACT: Screening of target populations for hemochromatosis (HFE) gene allele status has been recommended. Alcoholic liver disease may be associated with iron overload and there is evidence of excessive alcohol consumption among patients with hereditary hemochromatosis. This study determined the HFE gene allele status in alcohol-dependent patients and explored the associations between iron status, liver enzymes, and HFE status. A total of 151 consecutive patients admitted for alcohol detoxification were tested for HFE mutations, iron status, and liver function tests. The prevalence data were compared with those from a New Zealand population. manova was used to compare liver function tests and iron status for subjects with different HFE mutations. Three compound heterozygotes, one homozygote for C282Y, and one homozygote for H63D were found among the 151 patients. For the remaining 146 patients, there was no difference in the distribution of heterozygote status by allele, compared to the general New Zealand population. No HFE mutation: general population 64.4%, alcohol-dependent patients 64.4%; H63D: general population 23.6%, alcohol-dependent patients 28.1%; C282Y: general population 11.9%, alcohol-dependent patients 7.5% (P = 0.20). There was no relationship between liver function tests or iron status and HFE mutation status among the study group. No evidence has been found in the present that HFE allele status prevalence is different from the general population or associated with different liver function or iron status among alcohol-dependent patients. The cause of altered iron status among alcohol-dependent patients does not appear to be related to HFE status.
  Journal of Gastroenterology and Hepatology 07/2007; 22(6):852-4. · 2.87 Impact Factor
• Article: Oxygen therapy in myocardial infarction: an historical perspective.

  Richard Beasley, Sarah Aldington, Mark Weatherall, Geoffrey Robinson, David McHaffie
  Journal of the Royal Society of Medicine 04/2007; 100(3):130-3. · 1.41 Impact Factor
• Article: Poppy seed tea and opiate abuse in New Zealand.

  Klare Braye, Thomas Harwood, Rachel Inder, Richard Beasley, Geoffrey Robinson
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  ABSTRACT: The opium poppy Papaver somniferum contains an array of opiates. There is a variety of methods of preparation that can be used by people with opiate dependence, with patterns of use determined by numerous factors including cost, safety, potency and legal status. The objective of this study was to determine the frequency and nature of poppy seed tea (PST) use by opiate-dependent patients in the form of a written questionnaire. The study took place at the Community Alcohol and Drug Clinic, Wellington, New Zealand, and comprised 24 opiate-dependent patients attending the clinic. A total of 11 of 24 (46%) patients reported having used PST. In five patients currently using PST it represented the major source of opiates, and two had managed to withdraw from use of other opiates with regular PST use. Patients reported a median onset of action of 15 minutes and an effect lasting a median of 24 hours. The major limitation of PST use was the foul taste. PST is used commonly by opiate-dependent patients attending an alcohol and drug clinic in New Zealand. The use of PST as the major source of opiates could be considered favourably within 'harm reduction' philosophies, because of its low cost, legal availability and oral route of administration. Conversely, there is the potential for PST to act as a 'gateway drug' by inducing opioid dependence and introducing people to the culture of drug abuse.
  Drug and Alcohol Review 04/2007; 26(2):215-9. · 1.55 Impact Factor
• Source

  Available from: nzma.org.nz

  Article: New hospital consultant: surviving a difficult period.

  Geoffrey Robinson, Johan Morreau, Marion Leighton, Richard Beasley
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  ABSTRACT: The first years of consultant practice are amongst the most stressful in a medical specialist's career. Recognising the likely difficulties is essential if measures are to be put in place to lessen their impact. In this article, recommendations are made on how to balance clinical and non-clinical duties and to obtain the support required for professional development. Self-care of mental and physical health is vital and planning is necessary to ensure that both personal health and a work/life balance are maintained.
  The New Zealand medical journal 02/2007; 120(1259):U2662.
• Article: New look at the oxyhaemoglobin dissociation curve.

  Richard Beasley, Amanda McNaughton, Geoffrey Robinson
  The Lancet 05/2006; 367(9517):1124-6. · 38.28 Impact Factor
• Article: Improving the use and interpretation of diagnostic tests in pulmonary embolism.

  Sarah Aldington, Geoffrey Robinson, Richard Beasley
  The New Zealand medical journal 02/2006; 119(1237):U2057.
• Article: Raised plasma homocysteine levels in alcoholism: increasing the risk of heart disease and dementia?

  Geoffrey Robinson, Seshasayee Narasimhan, Mark Weatherall, Richard Beasley
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  ABSTRACT: Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in alcohol-dependent male subjects. In this study, we measured plasma homocysteine levels in 20 female and 31 male alcoholic subjects admitted to hospital for detoxification. Nutritional status and clinical factors that might predict plasma homocysteine levels were assessed by measurement of red cell folate, vitamin B12, blood alcohol, and liver function tests. The median (interquartile range) plasma homocysteine level on admission was 15.4 micromol/L (11.1 to 19.7), with 27 (53%) subjects having a raised homocysteine level, greater than 15 micromol/L. There was no difference in admission plasma homocysteine levels between the male and female subjects (difference, male versus female 1.9 micromol/L, 95% CI=2.4 to 6.0, p=0.4). Red cell folate, vitamin B12 levels, and blood alcohol level on admission were not significant predictors of admission homocysteine level. Severe alcohol dependence is associated with markedly raised plasma homocysteine levels in both females and males. The common condition of alcohol dependence may be an under-recognised risk factor contributing to raised plasma homocysteine levels and the associated risk of vascular and intellectual impairment.
  The New Zealand medical journal 07/2005; 118(1216):U1490.