The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient’s unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.

Patient-reported outcome measures (PROMs) are self-rated scales and indices developed to improve the detection of the patients’ subjective experience. Given that a considerable number of PROMs are available, it is important to evaluate their validity and usefulness in a specific research or clinical setting. Published guidelines, based on psychometric criteria, do not fit in with the complexity of clinical challenges, because of their quest for homogeneity of components and inadequate attention to sensitivity. Psychometric theory has stifled the field and led to the routine use of scales widely accepted yet with a history of poor performance. Clinimetrics, the science of clinical measurements, may provide a more suitable conceptual and methodological framework. The aims of this paper are to outline the major limitations of the psychometric model and to provide criteria for clinimetric patient-reported outcome measures (CLIPROMs). The characteristics related to reliability, sensitivity, validity, and clinical utility of instruments are critically reviewed, with particular reference to the differences between clinimetric and psychometric approaches. Of note is the fact that PROMs, rating scales, and indices developed according to psychometric criteria may display relevant clinimetric properties. The present paper underpins the importance of the clini­metric methodology in choosing the appropriate PROMs. CLIPROM criteria may also guide the development of new indices and the validation of existing PROMs to be employed in clinical settings.

The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were in-cluded. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial. scale exceeds 21,000 on Scopus. Hamilton himself recommended, however, to use only the first 17 items of the HAM-D 21 since the last 4 symptoms (i.e., diurnal variation, depersonalization/derealization, paranoid and obsessional/compulsive symptoms) were either not considered part of the disease, or they were relatively uncommon, or they were not considered features related to depression severity [2,3]. Over the years, a number of modifications of the scale have been proposed and several versions of the HAM-D have been developed and come into use [4,5].

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IntroductionType D personality consists of a mixture of high levels of negative affectivity and social inhibition, resulting in a stable tendency to experience negative emotions, by inhibiting the expression of these emotions. We have reanalyzed the clinically relevant studies examining the role of this personality profile in diabetes, by providing a qualitative synthesis of the data. In this regard, the aim of this study is to provide a systematic review by evaluating the clinical link between Type D personality and diabetes.MethodWhen focusing on PRISMA guidelines, we have performed a comprehensive research of the literature on PubMed, Scopus, ScienceDirect, ISI Web of Science, PsycINFO, and Google Scholar by using search terms as “distressed personality” OR (i.e., Boolean operator) “Type D personality” combined with the Boolean “AND” operator with “diabetes.”ResultsA total of seven research studies were identified and included in the review. Type D was found to be more prevalent in diabetes patients than controls. As regards the specific association with diabetes variables, Type D personality is a significant predictor of both poor medication adherence and unhealthy behaviors, by predicting negative mental health consequences also (i.e., depressed mood, anhedonia, and anxiety).ConclusionOur review emphasized for the first time that Type D personality affects clinical factors in patients with diabetes by provoking adverse outcomes. The core implication of the study comprises the clinical relevance to detect, from a clinimetric point of view, Type D personality in diabetes in order to prevent potentially negative clinical outcomes.