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Background The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02041-4.

A growing body of evidence indicates that effective medical treatment depends on personalized care. However, to focus on the person, to consider the other as a “person”, requires a special commitment, which corresponds to our expectations and it is mandatory for an effective medical approach, but it is not spontaneous and it does not hold automatically. The entire discussion on humanization of medicine relates to this question. At present, we are observing a cultural shift which risks destroying some essential aspects of the medical profession that contribute to high-quality health care. How to overcome this cultural shift which substantially impairs a personalized approach? Starting from a question posed by an editorial of the Journal and describing our teaching experience, we analyze recent Literature to contribute to this discussion.

The medical field is becoming the sphere of a quite peculiar confrontation, a sort of test of tension between two different approaches: on one side self-referencing, the concept that the whole set of knowledge and capabilities generated by medical science establishes self-sufficiency of our field; on the other, the quest to broaden our concept of reason overcoming this self-imposed limitation of reason. At stake is the need to overcome the dissatisfaction and the crisis our field is currently going through. This article will go over some aspects of what we believe to be a paradigm of a much general and crucial cultural problem.

In HIV-1 infected patients, increase of liver enzymes may be mainly due to viral coinfections, alcohol intake, hepatotoxic drugs or autoimmune diseases. Three cases of aminotransferase elevation occurred during a phase of uncontrolled viral replication combined with a severe immunodeficiency and resolved by an effective HAART are described, focusing on the etio-pathogenetic role possibly played by HIV-1 infection.