NATIONAL RESEARCH COUNCIL (CNR) INSTITUTE OF CLINICAL PHYSIOLOGY (IFC) - Pisa
IFC, the Institute of Clinical Physiology of CNR, from the past to the future.
Since its foundation in 1968, by taking the name of "Clinical Physiology", IFC anticipated the cultural and ethical view of what evidence-based medicine is, today. In fact, the Institute specialises in combining experimental research with clinics, epidemiology and cutting-edge technology, always focussing on the expectations of the patients.
A multidisciplinary team from different academic and scientific backgrounds, including medicine, biology, chemistry, bioengineering, physics, mathematics and IT, has turned the underlying idea into reality, adding the concept of measurement - previously confined to physiological research - to medical practice.
IFC's regular staff consists of over 500 "professionals", 118 of them permanent researchers and technologists, mostly based in Pisa's HQ, and some in Milan, Lecce, Rome, Siena, Massa and Reggio Calabria, along with the satellite units of Catanzaro and Messina. Boosted by its researchers' intensive cooperation with the most important institutions in the world, IFC has managed to achieve unexpected standards of excellence, as well as acting as coordinator or partner in many international projects. Its scientific projects carefully collect experimental data that are then used to build and validate interpretative models in physiopathology, always with the due technological support.
The Institute's work may be aptly defined as a synergism of four key areas of interest:
1) preclinical biology and the mechanisms of illness,
2) clinical physiopathology and risk factors for health,
3) bio-techno-science and "modelling",
4) epidemiology and health promotion.
The working assumptions of research are soundly corroborated by a strict multidisciplinary method. IFC's researchers have thus gained the skills and expertise they need to take part in the design of standard protocols and procedures as well as understanding the complexity of physiology in good health and in many pathological processes.
While now it is not difficult to find many of the skills mentioned in such a research scenario, until 20 years ago IFC was a member of a very restricted elite of international research centres that could use and handle their own technology and procedures: positron emission tomography (PET), single photon emission computed tomography (SPECT), health information technology, echocardiography, magnetic resonance imaging, artificial heart, catheterisation laboratories, etc. An example: in the mid-80s, IFC installed the first PET in Europe, complete with a laboratory for the production of radiopharmaceuticals; it ventured into the first applications of IT to clinical research as well as in the design and development of the most advanced hardware for digital recording, monitoring, filing and analysis of heart signals, and it also stood out for its pioneering experiences in telemedicine and tele-consultation on a broadband digital network. All of the achievements made by IFC through its experience in the first, long chapter of its life have found maximum expression in the project SPERIGEST, a project awarded to IFC in the late Nineties by the then Health Ministry for the development of the very first computer-assisted department of cardiology; the findings of the project, once transferred to other clinical and healthcare facilities in Italy, have become the archetype of the country's hospital IT systems.
Ever since the beginning of its clinical research work, IFC's mission has been to improve patient treatment through the immediate transfer of scientific and technological advancements to medicine (often in a synergism with industrial partners) - after the tests had proven them to be effective - so that the findings of research could be immediately available for the fight against disease. The secret of such an achievement lies in the joint, synergistic work of the researchers who had the opportunity to operate within the national health system; this has set the example for what, in the years to come, could turn out to be the new clinical and educational approach for a new European generation of versatile research workers.
In 2007, the Institute handed its healthcare operations over to Fondazione CNR/Regione Toscana "Gabriele Monasterio", part of which works within the walls of the Research Area of CNR in Pisa, and to "G. Pasquinucci" Hospital in Massa, which excels in adult and paediatric cardiology and heart surgery. Thanks to this new solution, IFC's research workers could focus their efforts better on translational research, expanding their interests to clinical physiopathology, making an in-depth investigation of atherosclerosis, of correlated cardiopulmonary and neuroendocrine illnesses, and heart failure. Experimental medicine too could extend its range of action with the help of new imaging technology such as micro-PET, micro-CT and micro-ultrasound scanners, moving toward the molecular and cellular dimensions, genetics and all of the other "-omics" , through to the interpretation of multi-data in systemic medicine and biology. Techno-sciences applied to e-Health have become one of IFC's focuses via miniaturisation and nano-materials. Not to be forgotten are also the studies in clinical, social, environmental and molecular epidemiology, exploring relations between health and the environment. In addition, its attention to the impact of diagnostic protocols and procedures on clinical practice, in the attempt to understand their effectiveness and the risk/benefit ratio for patients and healthcare professionals, has been remarkable as well.
Bioengineering is central to IFC, as it is involved in multiple areas of research, including clinical data management (data collection, filing, processing and distribution; digitalisation of clinical reports; design and development of personnel monitoring devices; data integration, knowledge extraction and clinical decision support systems); analysis of physiological signals from a multimodal, multivariate perspective (mathematical modelling, pattern recognition, nonlinear dynamics, time-frequency analysis...); IT and computer applications to cardiology and pulmonology; research in physiology in extreme conditions, as when working underwater, at a high altitude, in space or in sports; with a view to developing biotechnology to create biocompatible textiles, IFC's bioengineers have been deeply involved in the development of projects, in the drawing up of standards for biomedical instruments, as well as rules and regulations.
"'Personalised assistance" is the keyword for the new generation of IFC research workers. The principal aspects of these new areas of research are closely linked to promoting health and a good quality of life; monitoring and checking patients and weaker citizens; optimising care and therapies; reducing length of hospitalisation; patient-specific multilevel modelling supported by appropriate simulation and decision-making systems; more attention paid to the interested parties, patients and healthcare professionals; opening new frontiers in multimodal imaging to improve the effectiveness and risk/benefit ratio of healthcare and treatments; and improving diagnostic and therapeutic procedures.
With the founding of the Fondazione Toscana Gabriele Monasterio (FTGM, operational since November 1st, 2007), on the joint resolve of CNR and Regione Toscana to strengthen and institutionalise its specific role as a bridge between the laboratory and the patient, IFC divested itself of its medical operations that have now been taken over by FTGM. Thus, IFC can now benefit from an institutional bond with FTGM, providing preferential access to a whole range of cardiovascular diseases (from congenital heart defects to acute heart failure), but is no longer burdened with the heavy administrative load of clinical routine.
For the IFC staff this is not only a necessary professional undertaking but it is also an essential gateway to a kind of research (necessarily translational, more often bedside-to-bench) that starts from the problems of the patient and to the patient returns with cultural, technological and therapeutic solutions.