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2019

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Articles 511 - 540 of 873

Full-Text Articles in Diseases

A Rare Case Of A Non- Functioning Pancreatic Neuroendocrine Tumor, Yaser Khalid, Neethi Dasu, Richard Gordon May 2019

A Rare Case Of A Non- Functioning Pancreatic Neuroendocrine Tumor, Yaser Khalid, Neethi Dasu, Richard Gordon

Rowan-Virtua Research Day

Pancreatic neuroendocrine tumors (PNET) are very rare and represent about 1–2% of all pancreatic tumors. Non-functional PNET (NF-PNET) is incidentally discovered in most cases. Most NF-PNETs are found at an advanced stage because patients are mostly asymptomatic. We present a case of 32-yr-old female who initially presented with increasing abdominal girth, decreased mobility, and lower extremity swelling up to the hip and was found to have an advanced NF-PNET with metastatic disease to the pelvis and liver. There have been few studies directed toward early detection and management; Computed tomography (CT) is the imaging modality of choice as well as …


Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz May 2019

Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz

Rowan-Virtua Research Day

Purpose: Panniculectomy is a common procedure in plastic surgery, often performed following massive weight loss and in morbidly obese patients. It can be performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates.1, 2, 3 These studies fail to provide proof of these claims for reasons including study design and the lack of inclusion of both morbidly obese and non-morbidly obese patients. Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving towards penalizing practices which increase complications.

Methods/Results:We reviewed the NSQIP database to assess …


Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari, Amelia K. Boehme, E. Sander Connolly, Alexander M. Friedman, Mitchell S.V. Elkind, Joshua Z. Willey, Eliza C. Miller May 2019

Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari, Amelia K. Boehme, E. Sander Connolly, Alexander M. Friedman, Mitchell S.V. Elkind, Joshua Z. Willey, Eliza C. Miller

Rowan-Virtua Research Day

Background: Pregnancy is associated with an increased risk of stroke in young women. Idiopathic moyamoya syndrome (IMMS) is a rare condition characterized by progressive narrowing of large cerebral arteries resulting in flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS. We hypothesized that IMMS would be associated with increased pregnancy morbidity, including stroke.

Conclusion: Pregnancies within 1 year prior or any time after IMMS diagnosis did not have increased maternal morbidity compared to unexposed pregnancies after adjusting for age and clustering of women with multiple pregnancies. Prospective studies are needed to better …


Cardio-Metabolic Disease Risk Factors Among South Asian Labour Migrants To The Middle East: A Scoping Review And Policy Analysis, Shiva Raj Mishra, Saruna Ghimire, Chandni Joshi, Bishal Gyawali, Archana Shrestha, Dinesh Neupane, Sudesh Raj Sharma, Yashashwi Pokharel, Salim S. Virani May 2019

Cardio-Metabolic Disease Risk Factors Among South Asian Labour Migrants To The Middle East: A Scoping Review And Policy Analysis, Shiva Raj Mishra, Saruna Ghimire, Chandni Joshi, Bishal Gyawali, Archana Shrestha, Dinesh Neupane, Sudesh Raj Sharma, Yashashwi Pokharel, Salim S. Virani

School of Public Health Faculty Research

This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly …


Caspases And Cancer: Connections Through Circular Dichroism Spectroscopy, Sarah M. Hethcox May 2019

Caspases And Cancer: Connections Through Circular Dichroism Spectroscopy, Sarah M. Hethcox

Honors College Theses

While excessive cell death inevitably leads to negative effects, the endurance of damaged cells in the presence of death signals can be equally detrimental to health. Apoptosis, or programmed cell death, is a highly regulated process in which cues from within or from outside a cell can trigger an irreversible sequence of signals that carry out cell destruction known as the apoptotic cascade. A group of enzymes called caspases play a vital role in this cascade with some participating as initiators and others acting as effectors of protein cleavage and intracellular breakdown. Although it is normal for the activity of …


The Teen Vaping Crisis, Jayavignesh Ganesan '21, Cynthia Mu '21, Carolina Seoane '21 May 2019

The Teen Vaping Crisis, Jayavignesh Ganesan '21, Cynthia Mu '21, Carolina Seoane '21

Student Leadership Exchange (SLX)

In today’s society, many teens have the idea that is is cool to vape. This has led to an exponential increase in the number of teenagers addicted to nicotine. This increase is directly caused by nicotine companies, specifically vape companies, presenting their products with appealing and misleading packaging. Indeed, nicotine packages are required to have a warning. However, the warning is usually not taken into consideration, as the warning is not eye-catching. Because of this, we propose that all products containing nicotine, including e-cigarettes, must follow plain packaging regulations. Under plain packaging regulations, companies would be required to have the …


Acute Promyelocytic Leukemia: A Case Study Correlating Cytogenetic Abnormality With Prognosis, Alyssa Lamond, Theresa Tellier-Castellone May 2019

Acute Promyelocytic Leukemia: A Case Study Correlating Cytogenetic Abnormality With Prognosis, Alyssa Lamond, Theresa Tellier-Castellone

Senior Honors Projects

Advancements in medical technology today have positively impacted the diagnosis, treatment, and prognosis of cancers. Particularly acute promyelocytic leukemia (APL) has completely improved from having the poorest prognosis to one of the best. Acute promyelocytic leukemia is a malignant disease of hematopoietic tissue classified by WHO as leukemia with >20% blasts from the myeloid lineage, specifically promyelocytes. Determined in 1976, FAB classified AML subtypes M1-M7, with APL being M3. Specific characteristics classify the subtype of AML, with each resulting from a different genetic abnormality. The focus of APL diagnosis, treatment, and prognosis occurs around the known PML-RARα fusion gene. Flow …


The Physiology And Hormonal Control Of Calcium, Phosphate And Vitamin D, Uri Alon May 2019

The Physiology And Hormonal Control Of Calcium, Phosphate And Vitamin D, Uri Alon

Presentations

Describes calcium, phophate, and vitamin D in the context of pediatric rickets.


Treatment Options For Post Treatment Lyme Disease Syndrome, Barbara Bowman May 2019

Treatment Options For Post Treatment Lyme Disease Syndrome, Barbara Bowman

Physician Assistant Scholarly Project Papers

With the high incidence of Lyme disease in the endemic areas of North America, it is important to appropriately diagnosis and treat this condition to prevent post treatment Lyme disease syndrome (PTLDS). Background information regarding Lyme disease is given. The purpose of this paper is to discuss the treatment options available for those patients that fit the case definition of PTLDS. A literature review was conducted using several different electronic databases finding peer reviewed research articles pertaining to the treatment options available for PTLDS. Extended antibiotic use is shown to be not beneficial in most cases. Alternative treatment options listed …


Selling Childhood: How The Middle Class Used Children In The Anti-Tuberculosis Movement (1930s-1940s), Hannah Fisher May 2019

Selling Childhood: How The Middle Class Used Children In The Anti-Tuberculosis Movement (1930s-1940s), Hannah Fisher

Senior Theses

During the anti-tuberculosis movement of the 1930s and 1940s, children were chosen as focal points, with their roles shaped by society’s changing view of childhood, the emergence of the middle class, and the socioeconomic and political climate. Children were used by middle-class reformers as conduits through which to disseminate information and enact controls on the working class. Health education in schools had two main goals: (1) for educated children to become educated adults, and (2) for educated children to transform the behaviors of adults around them. Although researchers have studied middle-class interventions into children’s health, few have analyzed the role …


Notch Inhibitors And The Bet Inhibitor Jq-1 Decrease The Growth Of Primary Tumor Cells Derived From A Novel Mouse Model Of C11orf95-Rela Induced Brain Tumor, Ericka Randazzo, Jesse Dunnack, Justin Fang, Joseph Loturco Phd May 2019

Notch Inhibitors And The Bet Inhibitor Jq-1 Decrease The Growth Of Primary Tumor Cells Derived From A Novel Mouse Model Of C11orf95-Rela Induced Brain Tumor, Ericka Randazzo, Jesse Dunnack, Justin Fang, Joseph Loturco Phd

University Scholar Projects

Brain tumors are the most common childhood solid malignancy, and because of remarkable advances in treating many cancers outside of the brain, they have become the leading cause of cancer mortality in children. Ependymomas are a class of brain tumors which can be further subdivided into three groups based upon their location and genetic features. Of the three classes, supratentorial ependymomas are the only subgroup known to be marked by an oncogenic driver gene, which consists of a fusion mutation between the C11orf95 and RELA genes. C11orf95-RELA positive tumors are the most aggressive and lethal of …


Simulating Alternative Tuberculosis Diagnosis Methods In Underdeveloped Countries, Luke Turner May 2019

Simulating Alternative Tuberculosis Diagnosis Methods In Underdeveloped Countries, Luke Turner

Industrial Engineering Undergraduate Honors Theses

Tuberculosis is the deadliest infectious disease in the world; it is especially rampant in underdeveloped countries because they do not have the infrastructure, technology, or funding to properly combat the infection. However, the development of portable point-of-care diagnosis machines can reverse this epidemic as they far surpass conventional laboratory identification. The question now is where to place these machines, which is a difficult decision with a lack of data. Therefore, a flexible simulation model is created to test the implementation of these machines with different countries and configurations. The simulation tests the baseline model and three proposed implementations of the …


A Unique Model For Palliative Care In A Level Iv Neonatal Intensive Care Unit, Kelstan L. Ellis Do, Megan Tucker, Jennifer Linebarger May 2019

A Unique Model For Palliative Care In A Level Iv Neonatal Intensive Care Unit, Kelstan L. Ellis Do, Megan Tucker, Jennifer Linebarger

Posters

This poster describes a review of the relationship between the Fetal Health Center and the Palliative Care team as the Palliative Care Team follows the patient family from prenatal through neonatal intensive care.


Data Visualization Of Treatment Outcomes For Tuberculosis Patients, Joy Jenkins May 2019

Data Visualization Of Treatment Outcomes For Tuberculosis Patients, Joy Jenkins

Industrial Engineering Undergraduate Honors Theses

Tuberculosis is an infectious disease, and different treatments have been discovered over the years. However, patients may develop various drug resistance levels that affect the likelihood of becoming cured or dying. In this study, we sought to employ data visualization to explore the relationship between treatment trajectory, as indicated by smear and culture results in the follow-up tests and patient outcomes. A large sample of patients have been broken down by demographics including age, gender, and drug resistance status. Sankey diagrams were used to visualize the pathway progression of the patients over time split between two time periods- months 0-6 …


Improving Nicu Referrals To The Missouri Early Intervention Program (First Steps), Luke Prest, Lauren Fenstermann, Ayman Khmour May 2019

Improving Nicu Referrals To The Missouri Early Intervention Program (First Steps), Luke Prest, Lauren Fenstermann, Ayman Khmour

Posters

First Steps is the statewide early intervention program in Missouri, but a review of referrals from the Truman neonatal intensive care unit revealed that only 24% of eligible patients were being referred. This poster describes efforts to increase awareness among residents and to refer all eligible patients to First Steps upon discharge.


Viral Whole Genome Sequencing For Antiviral Resistance In A Child With Dock8 Deficiency And Recurrent Hsv-1, Sean Stout, A. L. Greninger, Rangaraj Selvarangan, A. F. Freeman, Brandon D. Newell, Erin Stahl, Dwight Yin May 2019

Viral Whole Genome Sequencing For Antiviral Resistance In A Child With Dock8 Deficiency And Recurrent Hsv-1, Sean Stout, A. L. Greninger, Rangaraj Selvarangan, A. F. Freeman, Brandon D. Newell, Erin Stahl, Dwight Yin

Posters

We present the case of a child with dedicator of cytokinesis 8 (DOCK8) deficiency and chronic, resistant HSV-1 mucocutaneous infections to illustrate the clinical utility of viral whole genome sequencing to detect active and latent HSV resistance mutations.


Investigating Virus Clearance Via Ph Inactivation During Biomanufacturing, Wenbo Xu May 2019

Investigating Virus Clearance Via Ph Inactivation During Biomanufacturing, Wenbo Xu

Biomedical Engineering Undergraduate Honors Theses

In the processing of biopharmaceuticals, viral clearance and viral safety are important for the development of monoclonal antibodies. Murine xenotropic leukemia virus (XMuLV) is one of the retroviruses, recommended by Food and Drug Administration (FDA) as a model virus for viral clearance via inactivation from therapeutics derived from Chinese hamster ovary cells (CHO). A robust and effective method was investigated to clear or inactivate endogenous viruses by low pH inactivation. The effects of different conductivity and inactivated time on XMuLV clearance was determined. Acetate buffer was prepared with different conductivity, and 2% XMuLV was spiked into acetate buffer. XMuLV virus …


Geospatial Analysis Of Rickettsial Species, Amy Frank May 2019

Geospatial Analysis Of Rickettsial Species, Amy Frank

Animal Science Undergraduate Honors Theses

Rickettsia species are obligate intracellular, arthropod-borne bacteria with a potential to cause multiple diseases including Rocky Mountain spotted fever (RMSF). Fleas, mites, and ticks serve as vectors for Rickettsia, but ticks are the primary vector of interest. RMSF and other rickettsial diseases have continued to gain importance in both human and veterinary medicine as RMSF is the most common tick-borne disease within the United States according to the Lyme and Tick-Borne Disease Research Center. A statewide citizen science project was utilized to determine the prevalence of Spotted Fever Group (SFG) Rickettsia in Arkansas. This project yielded results in 64 …


Seeing Eye To Eye: A Machine Learning Approach To Automated Saccade Analysis, Maigh Attre May 2019

Seeing Eye To Eye: A Machine Learning Approach To Automated Saccade Analysis, Maigh Attre

Honors Scholar Theses

Abnormal ocular motility is a common manifestation of many underlying pathologies particularly those that are neurological. Dynamics of saccades, when the eye rapidly changes its point of fixation, have been characterized for many neurological disorders including concussions, traumatic brain injuries (TBI), and Parkinson’s disease. However, widespread saccade analysis for diagnostic and research purposes requires the recognition of certain eye movement parameters. Key information such as velocity and duration must be determined from data based on a wide set of patients’ characteristics that may range in eye shapes and iris, hair and skin pigmentation [36]. Previous work on saccade analysis has …


Reducing The Risk: Psychological And Technological Approaches For Improving Handwashing Practices In The Foodservice Industry, Jeffrey Allan Clark May 2019

Reducing The Risk: Psychological And Technological Approaches For Improving Handwashing Practices In The Foodservice Industry, Jeffrey Allan Clark

Graduate Theses and Dissertations

As Americans are spending greater portions of their dollar on food consumed outside the home, the foodservice industry plays more of an integral part of daily existence compared to previous generations. Given the numerous annual foodborne illness outbreaks that threaten human lives while undermining confidence in the food supply, food safety is a pertinent issue for industry stakeholders, government regulators, and consumers. Food worker handwashing reduces the risk of foodborne illness transmission, yet compliance with this simple behavior is a complex problem. This dissertation addresses, predominantly, the issue of sub-optimal handwashing practices through applying psychology and technology, including wearable computers …


Xerostomia: A Comprehensive Review, Danevin Putrus May 2019

Xerostomia: A Comprehensive Review, Danevin Putrus

Honors College Theses

This thesis will be highlighting the condition known as Xerostomia. Xerostomia is the condition also known as “dry mouth”. This condition affects many people all throughout the world with symptoms causing bad breath, discomfort, difficulty speaking and many other. The seriousness of this condition can lead to cardiovascular disease, dementia, respiratory infections, diabetes mellitus, rheumatoid arthritis, and even cancer (Absolutedental.com). Currently there is not any one specific solution for the condition although many have been proposed. Throughout the thesis I will closely examine former research studies, current solutions proposed, and propose my own study and solution based on research and …


An Integrative Approach To Mindfulness-Based Symptom Management For Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Lisa Barer May 2019

An Integrative Approach To Mindfulness-Based Symptom Management For Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Lisa Barer

Mindfulness Studies Theses

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic health condition; its etiology is poorly understood, and treatment options are limited to management of symptoms. Current recommended treatment options are controversial, and evidence of effectiveness is limited. This paper proposes a novel model for symptom management of ME/CFS using mindfulness-based interventions, cognitive behavioural therapy (CBT), and relaxation techniques. A comprehensive review of available evidence is used to support this approach. The idea is that, working synergistically, these three approaches, grounded by mindfulness-based principles, can address many of the symptoms of the illness and help patients better cope and manage their day-to-day …


Correlation Between Myostatin And Lean Muscle Mass In Older Adults, Mishann Luedders May 2019

Correlation Between Myostatin And Lean Muscle Mass In Older Adults, Mishann Luedders

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Correlation Between Myostatin and Lean Muscle Mass in Older Adults.

Luedders, M., Gray, M., Patton, S., Washington, T., Binns, A. Exercise Science Research Center, University of Arkansas, Fayetteville, AR.

Background: Our older adult population is growing exponentially and with it, the number of falls and debilitating injuries that afflict their population grows as well. A fall brings with it many possible injuries, healthcare costs, fear and increased mortality. There seems to be a lack of preventative measures in our healthcare system to help protect our elders. One possible measure is a simple blood test that looks at the level of …


Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed May 2019

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.


Gonadotropin Releasing Hormone (Gnrh) Agonist Improves Hyperandrogenism In An Adolescent Female With A Novel Insulin Receptor Gene Mutation, Emily Paprocki, Romina Barral, Heidi Vanden Brink, Maria E. Lujan, Tania S. Burgert May 2019

Gonadotropin Releasing Hormone (Gnrh) Agonist Improves Hyperandrogenism In An Adolescent Female With A Novel Insulin Receptor Gene Mutation, Emily Paprocki, Romina Barral, Heidi Vanden Brink, Maria E. Lujan, Tania S. Burgert

Posters

We describe a case of an adolescent female with Type A insulin resistance whose severe hirsutism and hyperandrogenism were improved with leuprolide, despite extreme hyperinsulinemia. Ovarian volume decreased in association with the resolution of hyperandrogenism, consistent with ovarian size reflecting hyperandrogenism in adolescents.

This case allowed us to examine the frequently debated bidirectional relationship between insulin and hyperandrogenism, often deemed independent of gonadotropin activity.


Fetal Ventricular Measurement In Determination For Intrauterine Closure Of Myelomeningoceles, Paige Lundy, Emanuel Vlastos, Paul A. Grabb May 2019

Fetal Ventricular Measurement In Determination For Intrauterine Closure Of Myelomeningoceles, Paige Lundy, Emanuel Vlastos, Paul A. Grabb

Posters

Prenatal closure of myelomeningoceles for fetuses with ventricular width of greater than 15 mm at the time of intrauterine screening (19-25 weeks) has been discouraged, but little is documented regarding the details of ventricle measurement, modality, and timing. This study concludes that ultrasound and MRI provide different results in regards to fetal ventricle size. If treatment recommendations are going to be offered or withheld based on the 15 mm "rule" the method of fetal imaging must be taken into account.


Novel Pharmacological Therapy In Type 2 Diabetes Mellitus With Established Cardiovascular Disease: Current Evidence, Leonardo Pozo, Fatimah Bello, Andres Suarez, Francisco E. Ochoa-Martinez, Yamely Mendez, Chelsea H. Chang, Salim Surani May 2019

Novel Pharmacological Therapy In Type 2 Diabetes Mellitus With Established Cardiovascular Disease: Current Evidence, Leonardo Pozo, Fatimah Bello, Andres Suarez, Francisco E. Ochoa-Martinez, Yamely Mendez, Chelsea H. Chang, Salim Surani

School of Medicine Publications

Cardiovascular diseases (CVDs) remain the leading cause of death in the world and in most developed countries. Patients with type 2 diabetes mellitus (T2DM) suffer from both microvascular and macrovascular diseases and therefore have higher rates of morbidity and mortality compared to those without T2DM. If current trends continue, the Center for Disease Control and Prevention estimates that 1 in 3 Americans will have T2DM by year 2050. As a consequence of the controversy surrounding rosiglitazone and the increasing prevalence of diabetes and CVDs, in 2008 the Food and Drug Administration (FDA) established new expectations for the evaluation of new …


The Re-Emerging Association Between Tuberculosis And Diabetes: Lessons From Past Centuries, Jose Cadena, Selvalakshmi Rathinavelu, Juan Carlos Lopez Alvarenga, Blanca I. Restrepo May 2019

The Re-Emerging Association Between Tuberculosis And Diabetes: Lessons From Past Centuries, Jose Cadena, Selvalakshmi Rathinavelu, Juan Carlos Lopez Alvarenga, Blanca I. Restrepo

School of Medicine Publications

The association between tuberculosis (TB) and diabetes mellitus (DM) had a common place in the literature up to the first half of the 20th century, but virtually disappeared with the discovery of insulin to treat DM and antibiotics to cure TB. In the late 1990s the literature began to re-emerge with the worldwide increase in type 2 DM, particularly in TB-endemic countries. Today, type 2 DM is the most prevalent comorbidity among TB patients and the World Health Organization considers it a threat to TB control. We summarize the literature on TB and DM up to the 1960s. Then we …


Defects In Fetal Mouth Movement And Pharyngeal Patterning Underlie Cleft Palate Caused By Retinoid Deficiency., Regina Friedl May 2019

Defects In Fetal Mouth Movement And Pharyngeal Patterning Underlie Cleft Palate Caused By Retinoid Deficiency., Regina Friedl

Electronic Theses and Dissertations

Cleft palate is a common birth defect. Etiologic mechanisms of palate cleft include defects in palate morphogenesis, mandibular growth, or spontaneous fetal mouth movement. Cleft palate linked to deficient fetal mouth movement has been demonstrated directly only in a single experimental model of loss of neurotransmission. Here, using retinoid deficient mouse embryos, we demonstrate directly for the first time that deficient fetal mouth movement and cleft palate occurs as a result of mis-patterned development of pharyngeal peripheral nerves and cartilages. Retinoid deficient embryos were generated by inactivation of retinol dehydrogenase 10 (Rdh10), which is critical for production of …


Quality Improvement: Implementing A Foot Exam To Improve Care For Patients With Diabetes Mellitus, Emily Paprocki, Ryan Mcdonough, Tiffany Musick, Joseph Cernich May 2019

Quality Improvement: Implementing A Foot Exam To Improve Care For Patients With Diabetes Mellitus, Emily Paprocki, Ryan Mcdonough, Tiffany Musick, Joseph Cernich

Posters

The American Diabetes Association guidelines recommend an annual foot exam in patients with type 1 and 2 diabetes who are ten years old or older and who have been diagnosed with diabetes at least five years. Quality improvement tools were used to improve the care provided to our patients by implementing an annual food exam.