Tim Fazio

• MBBS (Hons) MIS (Health) FRACP FAIDH CHIA
• Medical Doctor at The Royal Melbourne Hospital

Hyperammonaemia during stem cell transplant is a distinct biochemical and clinical entity. It has a different pathological driver from other common forms of hyperammonaemia. Early recognition of this pathology and an understanding of its biochemical, pathological and microbiological aspects inform an aggressive management algorithm.

Purpose As part of the Breast Cancer Survivorship program in the Royal Melbourne Hospital, a newly developed electronic platform, Care Companion, is designed to facilitate remote monitoring of breast cancer patients within the patient portal; this platform is linked to the Epic Electronic Medical Record (EMR). This study aims to investigate the fea...

Background The healthcare disparities of sexual and gender minority (SGM) people are globally recognised. Research from the United States has advocated for sexual orientation and gender identity (SOGI) information capture via the electronic medical record (EMR) to support the generation of knowledge regarding SGM people’s healthcare needs and the a...

Introduction This protocol outlines a mixed methods study evaluating a new Digital Coordination Centre (DCC) at the Royal Melbourne Hospital (RMH), Melbourne, Australia. While coordination centres show potential for impact, evidence on effective implementation in the Australian context remains scarce. This study aims to address this gap. Methods a...

Objective: To assess the impact of implementing telehealth in outpatient clinics on the carbon emissions associated with the delivery of health care. Design & Setting: Retrospective cohort study in large metropolitan quaternary referral health service from January 2021- December 2022. Participants: All patients who attended an outpatient clinic app...

This study examines patient experiences of an inpatient portal's information affordances, including access to results, notes, vital signs, medication information and a schedule. Patient participants were recruited from an inpatient ward primarily catering to patients with haematological malignancies including leukaemia and bone marrow transplant re...

Objective This study aimed to evaluate the feasibility of a workplace-delivered outpatient multidisciplinary service (ReCOV) for staff experiencing post COVID-19 condition (‘Long COVID’). Methods A mixed-methods study of staff at a large, tertiary hospital with Long COVID who attended the service was conducted. Participants completed questionnaires...

Background: A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. Methods: A single-group observational c...

Objectives Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste. Design Prospective, randomized, parallel group, noninferiority clinical trial. Setting Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022. Patients Patients...

Context Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care–associated infection (HAI), acute kidney injury (AKI), and stroke is unclear. Objective To investigate the relationship between hyperglycemia and adverse clinical o...

To establish the feasibility of embedding an RCT into EMR in the ICU, we evaluated the route of phosphate replacement. The EMR screened 207 patients who met the inclusion criteria from 20 April 2022 to 30 June 2022. 162 patients were randomised and 145 patients allocated to treatment. Our study showed that it was feasible to embed screening, random...

Background: The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. Methods: A retrospective cohort study was conducted using hospital an...

BACKGROUND Research exploring perspectives on inpatient portals reports patients desire the informational affordances of inpatient portals and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study that explores the psychosocial dimension of clinician re...

Background Research exploring perspectives on inpatient portals reports that patients desire the information affordances of inpatient portals, and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study contributed to the existing literature on inpatient...

Background/Aims: We aimed to evaluate the characteristics, predictors for, and outcomes of Medical Emergency Team (MET) activated events, and identify associations with Goals of Care (GOC) changes across the General Medical admission. Methods: A 12-month retrospective observational study was conducted at Royal Melbourne Hospital (January-December-2...

Background Mitochondrial disorders can manifest in stroke-like episodes which can pose several diagnostic and management challenges in the acute setting. Presentation We present the case of a 45-year-old female, presenting with bilateral cerebral infarcts on a background of cerebral atrophy, cognitive decline, ataxia, sensorineural hearing loss, p...

Funding Acknowledgements Type of funding sources: None. Background The risk of medication-induced QT prolongation can be mitigated by reviewing electrocardiograms (ECG) in a hospital inpatient setting. Currently, within the Electronic Medical Record (EMR), decision support tools do not exist to conduct ECG monitoring when prescribing multiple QT p...

Objective This article aims to quantify prevalence of patient aggression or threatened/actual violence during critical illness. Design This is a retrospective cohort study. Setting This study was conducted in single adult trauma intensive care unit (ICU). Participants Patients aged 18 years or over, admitted between January 2015 and December 202...

https://link.springer.com/epdf/10.1007/s13760-022-02134-5?sharing_token=2I-4zkXjQCV-T2QzFXktRve4RwlQNchNByi7wbcMAY4npX6BAlCO07cTNUAqpxFJ86ZGJmw51KFHFAieWVUSBsoo2jOEwZokrOrgkEfnY9bb6-7pj9OsJpARP9qClp2VWvx_PzfFL1gp8WMfgaJOWbQrFC-b9ZVQXqtLJyh1x60%3D

Objective: Sodium-glucose co-transporter-2 inhibitors (SGLT2-I's) are novel oral hypoglycaemic agents, with proven decreased MACE and re-hospitalisation risk in type 2 diabetic patients with concomitant heart failure. This study aimed to assess the current practice in the use of SGLT2-I's in general medical units at a large metropolitan health ser...

Objective: To investigate the relationship between hyperglycemia and adverse in-hospital outcomes in patients with and without known diabetes Research Design and Methods: The Diabetes IN-hospital: Glucose and Outcomes (DINGO) prospective cohort study was conducted over 26 weeks between Oct-20 and Mar-2020 at The Royal Melbourne Hospital. Admissions...

Objective: To determine incidence and outcomes of community-acquired (CA-AKI) and hospital-acquired acute kidney injury (HA-AKI) among inpatients in the Australian healthcare setting utilising modern health information systems. Design: A retrospective cohort study of adult patients admitted to a quaternary hospital in Melbourne, Australia, betwe...

Ornithine transcarbamylase deficiency (OTCD) is an X‐linked urea cycle disorder characterised by reduced or absent OTC enzyme activity, resulting in the accumulation of neurotoxic ammonia. Approximately 80%–90% of the causative variants are identified by Sanger sequencing or multiplex ligation‐dependent probe amplification (MLPA) of the OTC gene. A...

Background Hospital acquired infections are common, costly, and potentially preventable adverse events. This study aimed to determine the effect of the COVID-19 pandemic-related escalation in infection prevention and control measures on the incidence of hospital acquired infection in surgical patients in a low COVID-19 environment in Australia. Me...

Importance There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. Objective To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital le...

Objective: Traumatic brain injury (TBI) patients with prolonged intensive care unit (ICU) stay are at risk of secondary intracranial haemorrhage (ICH) and venous thromboembolism (VTE). We aimed to study VTE prophylaxis, secondary ICH, and VTE prevalence and outcomes in this population. Design: Retrospective observational study. Setting: Level 1 tra...

Background Phenylketonuria (PKU) is an autosomal recessive inherited disorder characterised by a deficiency in phenylalanine hydroxylase. Untreated, PKU is associated with a wide range of cognitive and psychiatric sequelae. Contemporary management guidelines recommend lifetime dietary control of phenylalanine (Phe) levels, however many individuals...

Background Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. Method This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients we...

Achieving dietary adherence in individuals with late diagnosed Phenylketonuria (PKU) can be challenging due to external factors. Identified barriers to care led to the development of the PKU Carers' Compendium. We describe the development and launch of the PKU Carers' Compendium and the effectiveness of this project.

We report the case of a father and son from a consanguineous Pakistani family who had homozygous variants in the GALC gene and biochemical testing consistent with a diagnosis of Krabbe disease. The son was diagnosed with Mucopolysaccharidosis type I at the age of 11 months after presenting with coarse facial features, conductive and sensorineural h...

Background The COVID-19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 Adult Major Trauma Service, and a designated COVID-19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response. M...

Objective: The cost of providing care in an intensive care unit (ICU) after brain death to facilitate organ donation is unknown. The objective of this study was to estimate expenditure for the care delivered in the ICU between the diagnosis of brain death and subsequent organ donation. Design: Cohort study of direct and indirect costs using bottom-...

Objectives The threat of a pandemic, over and above the disease itself, may have significant and broad effects on a healthcare system. We aimed to describe the impact of the SARS-CoV-2 pandemic (during a relatively low transmission period) and associated societal restrictions on presentations, admissions and outpatient visits. Design We compared h...

Background: A rise and/or fall in high sensitivity cardiac troponin (hs-Tn) is critical in defining acute myocardial injury and therefore the diagnosis of acute myocardial infarction. A significant rise in hs-Tn is not well defined in current guidelines. Calculation of a z-score for two consecutive hs-Tn measurements is a method-independent measur...

Wearable sensors are being used in clinical settings to monitor the condition of patients as well as in recreational environments for routine health monitoring. Some of the most advanced clinical applications include monitoring patients with Parkinson's disease through wearable inertial measuring units (IMUs) and patients with diabetes by means of...

Background Phenylketonuria (PKU) is an autosomal recessive inherited disorder characterised by a deficiency in phenylalanine hydroxylase (PAH). Untreated, PKU is associated with a wide range of cognitive and psychiatric sequelae. Contemporary management guidelines recommend lifetime dietary control of phenylalanine (Phe) levels, however many indivi...

Background & aims: Chronic viral hepatitis is a leading cause of worldwide liver-related morbidity and mortality, despite the availability of effective treatments that reduce or prevent complications in most patients. Electronic-health (eHealth) technologies have potential to intervene along the whole cascade of care. We aimed to summarize availab...

Introduction The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health-care system both in Australia and internationally, and has rapidly transformed the delivery of health care in hospitals and the community. Implementation of social isolation and distancing measures to stop the spread of the disease and to reduce pote...

Objective: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients. Design: A single centre observational study over 15 months. Setting: Intensive care unit (ICU). Participants: Patients admitted during this period. Main outcome measures: Freque...

Background: Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medic...

Atrial myxomas are the most common primary neoplasms of the heart. Clinical presentation varies from asymptomatic incidental masses to serious life-threatening cardiovascular complications. We describe the case of a 37-year-old man who presented with both coronary and cerebral embolisation secondary to an atrial myxoma in the context of a recent no...

Phenylketonuria (PKU) is a recessive disorder of phenylalanine metabolism due to mutations in the gene for phenylalanine hydroxylase (PAH). Reduced PAH activity results in significant hyperphenylalaninemia, which leads to alterations in cerebral myelin and protein synthesis, as well as reduced levels of serotonin, dopamine, and noradrenaline in the...

Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision making, and timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setti...

Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision making, and timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setti...

Purpose Prophylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications. Material and Methods We conducted a cluster-...

Royal Melbourne Hospital (RMH) performs over 140 kidney transplant operations annually. Kidney transplant recipients require regular medical review, which results in loss of time and costs from travel, particularly for regional patients, and places high demand on the hospital outpatient service. The RMH renal transplant unit initiated a telehealth...

Mitochondrial diseases are rare, heterogeneous conditions affecting organs dependent on high aerobic metabolism. Presenting symptoms and signs vary depending on the mutation and mutant protein load. Diabetes mellitus is the most common endocrinopathy, and recognition of these patients is important due to its impact on management and screening of fa...

People with severe mental illness (SMI) have a reduced life expectancy. A major cause of mortality is cardiovascular disease. The aims of this study were to document the prevalence of cardiovascular risk factors in people with SMI engaged in community psychiatric rehabilitation and compare prevalence rates to the general and Aboriginal and Torres S...

Liver abscess due to Klebsiella pneumoniae infection has been widely reported in Asia, but rarely reported in Australia until now. We describe four previously well Asian-born patients who presented across Australia with community-acquired K. pneumoniae liver abscesses. With prompt recognition, appropriate antibiotics and early drainage, outcome is...