Building a medical practice for a DIETitian is harder than ever. Many general practitioners and other specialties have entered to DIET THERAPY and competition in this field is increasing. Patients are becoming increasingly involved in making choices through them. Health care Markets will become segmented and there will be other health professionals ready and willing to answer the needs of those new markets with skills and information DIETitians have not yet learned or rejected as unnecessary.With what seems to be a competitive field, marketing is vital for every medical practice, new or established, small or large, to succeed. DIETitians today must take an entrepreneurial approach to marketing, actively seeking out new patients and referral sources. Presently, the marketing window of opportunity for nutrition is wide open and Career avenues for DIETitians who distinguish themselves will abound. Competing successfully in this market may require experience and education outside the required nutrition curriculum and traditional career settings. In this competitive market, it is important for a DIETitian to use good health service marketing plan before beginning a medical practice to better understand the practice’s patients, competition, operational performance and its impact on patients, and the healthcare environment in which it operates. Attracting and keeping clients is necessary to survive in business. As with all types of service marketing, whether the conventional customer-seller relationship or the more complex patient-physician association, there are fundamental principles and aspects that are imperative in creating customer satisfaction and building loyalty.in fact, Health Service Marketing a medical practice is a way to attract and retain patients. A review of the strategic health care service market planning being implemented by other professional groups, practical successful guidelines, understanding concepts such as service marketing mix, levels of consumer satisfaction, the branding of services, entrepreneurship approach of Nutrition, skills and case studies and all their relation with DIETetic profession, provides perspective for those beginning DIETitians or in the midst of their practice growth.

Background: Irritable Bowel Syndrome (IBS) has the most common functional gastrointestinal disease and has among the most common reasons for outpatients doctor visit both in primary and specialty clinics. Patients suffer from lifelong chronic abdominal pain, diarrhea, constipation, bloating and flatus often associated with anxiety depression which significant opposing effect on the quality of life and have to use the patients to use the healthcare system and induce a huge cost for health care system. It has also result in abstinence from work and its economic consequences. Treatment of irritable bowel syndrome has symptom base which were most challenging aspect of clinical practice. Recently there was accumulating evidence in favor of DIETary THERAPY as one of the cheapest and most effective THERAPY for IBS. However, there was need for a review which concludes these results.Purpose of this study was to look at the recent literatures about the role of DIET in controlling IBS symptoms.Materials and Methods: Studies published in recent 5 years in Pub med and SID databases were searched with relevant keywords. Human studies, English or Persian and original articles were included. Studies which were not relevant to medical nutrition THERAPY were excluded. From 81 studies, 31 studies were included.Results: Foods containing gluten, lactose, fructose, galactane, sorbitol, fructane and allergen foods should be limited or omitted.Patients should be advised to use fibers, prebiotics and probiotics more often.Conclusion: Medical nutrition THERAPY is a useful method for controlling symptoms of these patients and should be advised.

Background: Vitiligo is an acquired multifactorial disorder. Different treatments are used for it and all of them have adverse side-effects. Vitiligo is an autoimmune disease associated with other autoimmune diseases such as hypothyroidism, hyperthyroidism, rheumatoid arthritis, diabetes mellitus, and so on. In these diseases, deficiency of vitamin D and B12 are proposed. So in this study, treatment response and remission in patients taking oral vitamin D and B12 was administered.Methods: 60 patients with active vitiligo were randomly divided into three groups. Group I received topical PUVA for 6 months; group II received topical PUVA and 1 cc oral drops of vitamin D3 daily for 2 months, and then topical PUVA alone for following 4 months; and group III received topical PUVA and 1 cc oral drops of vitamin D3 daily and sublingual tablets of vitamin B12 daily for 2 months, and then treated with topical PUVA for following 4months. Cure rate and side effects were evaluated using Vitiligo Area Scoring Index (VASI) at the third and sixth months. Findings: In each of the three treated groups at different times, the average changes in the area and extent of the lesion were not significantly different. Pruritus and erythema occurred in some patients.Conclusion: In this study, the reduction in the extent and area of lesions in the group receiving vitamin D compared to the control group were higher that indicated the role of vitamin D in preventing progression of active vitiligo.

Background: Chronic diabetes is substantially associated with circulatory disorders in lower limbs. Vacuum-Compression THERAPY (VCT) has been commonly used in treatment of peripheral circulatory disorders. VCT is based on intermittent alteration of Positive- Negative pressure phases. The purpose of this study was to determine effects of VCT on diabetic subjects' peripheral blood flow.Methods: In this Before-After and case-series study, 18 type 2 diabetic subjects with diabetic neuropathy and/or peripheral vascular disease (PVD) completed the study. Subjects received 45 min of VCT for 10 sessions three times weekly. Blood flow (calf+foot) was measured via venous occlusion plethysmography.Results: Among Variables of "Arterial Inflow", "Venous Outflow", "Venous Capacity", "Postischemic Reactive Hyperemia" and "Peak Flow of Reactive Hyperemia", only "Venous Outflow" significantly improved after 10 sessions treatment via VCT (P<0.05).Conclusions: Arterial blood inflow, which was the most important determinant evaluated in this study, was not increased via VCT. Additional studies are required to investigate the effective VCT parameters and duration of each session and number of sessions, considering progressive and deteriorative natural history of diabetes.

Introduction: Although it is obvious that nutrition has a clear impact on incidence, prevention, and treatment of many diseases, it has not been addressed properly in medical education. Therefore, physicians’ educational needs assessment is the first step of improving physicians’ skills in nutrition and DIET THERAPY.Methods: It is a cross-sectional study. In this study, a focus group was hold. Then essential topics for training physicians was developed using the job analysis approach (Including determining the tasks; sub tasks; skills and items that can be corrected through training).Result: Five main tasks that must be learned were achieved. They were nutritional status assessment, patient’s data analysis, determining the DIET suitable for patient’s condition, planning the DIET THERAPY, its implementation, and evaluation.19 sub tasks were defined for these main duties.Conclusion: There was a well consistency between our findings and earlier studies around the world. These results can be used to raise the nutritional knowledge of general practitioners whether through academic courses included in their curricula, or continuing education programs.

BACKGROUND AND OBJECTIVE: Thiopental sodium is not an ideal intravenous drug for inducing general anesthesia and compared to intravenous anesthetic drugs like propofol has a long standing recovery time. The aim of this study was to compare the recovery duration of propofol and thiopental sodium in ECT (Electroconvulsive THERAPY).METHODS: In a clinical trial, 70 patients aged between 15-40 years old in A.S.A class I & II were selected for ECT.They were randomly divided into two groups of 35 patients. After patient monitoring, 2-3 mg/kg thiopental sodium or 1-1.5 mg/kg propofol (randomly in each patient) and then 0.5 mg/kg succinylcholine were administered. Patients were ventilated with mask and oxygen (%100). After ECT, seizure and recovery durations were recorded. During these procedures, blood pressure and heart rate were recorded before and after anesthetic induction and 1 and 5 min after ECT.FINDINGS: Mean recovery duration of propofol and thiopental sodium were 5.49±2.57 min and 6.4±3.69 min, respectively (p=0.233). Also, seizure duration of propofol and thiopental sodium were 32.06±13.78 sec and 35.06±10.08 sec (P=0.302). Hemodynamic changes (systolic blood pressure) in two groups were not significant except at 1 minute after seizure (p<0.05).CONCLUSION: According to the results, there was not a significant difference between two groups in seizure and recovery duration. But propofol can prevent increasing hemodynamic response to ECT better than thiopental sodium. In patients with hypertension or restriction of thiopental sodium, propofol can be a suitable replacement.