4. AREAS OF RESEARCH
This brief summary of the main directions and methodological approaches adopted by the
Department provides a synopsis of the activities and competence available. This information must be
integrated with that of section 5, where the ongoing projects are presented in greater detail.
- 4.1. Experimental Pharmacology
Experimental cardiovascular research deals with the short and long-term effects on left ventricular function and structure of myocardial ischemia/reperfusion. Effects of cardiovascular drugs are studied in models of acute and chronic ischemia both in vivo
and in rats and mice. The research activities are usually planned and developed in collaboration with clinical groups in order to test (a) new drugs and (b) pathophysiologic hypotheses derived from clinical trials.
More recent fields of research are (a) neurohormonal alterations induced by congestive heart failure post-myocardial infarction and (b) cellular mechanisms leading to LV remodelling during senescence.
- 4.2. Clinical Pharmacology
Clinical pharmacology is one of the core know-how of many members of the group. Besides the facilities for conducting classical studies on pharmacokinetics and on biochemical markers or mediators, the Department employs methods and instruments of drug epi
demiology tailored to its specific fields of interest.
- 4.3. Controlled Clinical Studies
Three approaches are grouped under this heading:
* ad hoc in depth studies within the frameworks and on subpopulations of large-scale clinical trials;
* experimental and observational investigations of clinical and pathophysiological problems;
* pilot and small scale trials on pharmacological interventions.
- 4.4. Large Scale Clinical Trials
The tradition of the GISSI studies (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto, endorsed by the Istituto Mario Negri and by the Associazione Nazionale Medici Cardiologi Ospedalieri, ANMCO) on acute myocardial infarction (AMI), with the
establishment of countrywide research networks representing the routine care of the National Health Service, has been expanded to the fields of acute coronary syndromes, congestive heart failure, primary and secondary prevention of vascular events, peri
pheral artery diseases.
- 4.5. Clinical Epidemiology
Strategies under this heading include:
* the epidemiological analysis (risk factors, prognostic indicators, etc.) of the large data bases generated by the population trials;
* case-control studies;
* meta-analyses of randomized controlled trials;
* prospective outcome studies.
- 4.6. Health Care Research
A relatively new area of interest which encompasses the following main topics: the assessment of the role of care settings in affecting clinical outcomes; health economy analysis; the components, the determinants, the implications of the medical decision
processes with respect to controversial interventions/ technologies; prospective surveys of the quality of care.
- 4.7. Technology Transfer and International Health
The know-how developed over the years in supporting WHO policy on essential drugs and clinical pharmacology in developing countries, and the broader interest on the transferability of advanced results into clinical practice, are the basis for the activiti
es of close cooperation mainly with countries of Latino-America, and for the participation in multinational epidemiological studies on cardiovascular risk factors.
- 4.8. Nursing Research
The increasingly central role of nurses in the conduction of clinical studies, has led over the last several years to the establishment of research networks (including coronary care units, neurological departments, departments of vascular medicine and sur
gery) coordinated with (but fully autonomous from) the medical groups in the formulation and implementation of specific studies. The main interests focus on: assessment of health-related quality of life of patients; epidemiology of nursing interventions a
nd their implications for patients' well being and outcomes.
- 4.9. Medical Informatics and Statistics
The medical informatics and statistics team is actively involved in the management and analyses of most of the clinical and epidemiological studies of the Department. Besides this activity, the team is conducting research in the following fields:
* design and implementation of clinical trial database management systems;
* use of the Internet in the management of clinical trials;
* training on the use of the Internet in cardiology;
* development of prognostic indexes;
* development of flexible regression models.
- 4.10. Scientific Communication and Training
The activities grouped under this heading occupy an important fraction of the time and resources of the Department:
* to establish and support the clinical research networks;
* to favour the appropriate and timely transfer of knowledge to the National Health Service, via publications of bulletins and regular training courses directed to hospital physicians, GPs and other health professionals;
* to produce and circulate educational material to the general public in the fields of interest of the Department, with special emphasis on prevention.