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BackgroundThe Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations.MethodsPatient data (n¿=¿768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were pooled. Post hoc application of DRS-R98 item scores were used to rate DSM-5 criteria. `Strict¿ and `relaxed¿ DSM-5 criteria to ascertain delirium were compared to rates determined by DSM-IV.ResultsUsing DSM-IV by clinical assessment, delirium was found in 510/768 patients (66%). Strict DSM-5 criteria categorized 158 as delirious including 155 (30%) with DSM-IV delirium, whereas relaxed DSM-5 criteria identified 466 as delirious, including 455 (89%) diagnosed by DSM-IV (P <0.001). The concordance between the different diagnostic methods was: 53% (¿¿=¿0.22) between DSM-IV and the strict DSM-5, 91% (¿¿=¿0.82) between the DSM-IV and relaxed DSM-5 criteria and 60% (¿¿=¿0.29) between the strict versus relaxed DSM-5 criteria. Only 155 cases were identified as delirium by all three approaches. The 55 (11%) patients with DSM-IV delirium who were not rated as delirious by relaxed criteria had lower mean DRS-R98 total scores than those rated as delirious (13.7¿±¿3.9 versus 23.7¿±¿6.0; P <0.001). Conversely, mean DRS-R98 score (21.1¿±¿6.4) for the 70% not rated as delirious by strict DSM-5 criteria was consistent with suggested cutoff scores for full syndromal delirium. Only 11 cases met DSM-5 criteria that were not deemed to have DSM-IV delirium.ConclusionsThe concordance between DSM-IV and the new DSM-5 delirium criteria varies considerably depending on the interpretation of criteria. Overly-strict adherence for some new text details in DSM-5 criteria would reduce the number of delirium cases dia

At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to 15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers both globally and in Malaysia. Numerous studies have shown significant relationships between various dietary components and the risks for colorectal cancer. Meanwhile, several theories have been suggested as etiological explanations, one of which is the influence of dietary factors on the cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk of colorectal cancer. However, evidence of a significant relationship between diet and colorectal adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers are developed from these polyps. Studying the modifiable risk factors related to polyps will provide an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers of published studies are limited, of which most are concentrated in Western countries, there is a need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between diet and colorectal adenomas.

At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to 15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers both globally and in Malaysia. Numerous studies have shown significant relationships between various dietary components and the risks for colorectal cancer. Meanwhile, several theories have been suggested as etiological explanations, one of which is the influence of dietary factors on the cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk of colorectal cancer. However, evidence of a significant relationship between diet and colorectal adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers are developed from these polyps. Studying the modifiable risk factors related to polyps will provide an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers of published studies are limited, of which most are concentrated in Western countries, there is a need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between diet and colorectal adenomas.