Having weakness and lethargy and feeling the need for hospital emergency services is one of the most important reasons for patients to go to hospital emergency rooms. The aim of the present study was to investigate the relationship between morbidity and mortality of patients with weakness and lethargy.

The present study was conducted in an observational and prospective manner in the emergency department of Rasool Akram and Firouzgar hospitals. The patients were divided into 5 groups by the evaluation team in the emergency triage unit using the international valid triage tool "Emergency Severity Index (ESI)". The patients were followed up for 2 months after the time of discharge and the patient's condition was examined in terms of illness, health or death.

Between levels 1 and 2 (patients with high severity conditions) and 3 (patient needs two or more emergency facilities in case of no disturbance in vital signs), level 3 had the highest frequency of referrals (61.9%). 90.7% had an underlying disease and 66.1% of the patients were taking medication at the time of visit. 11% of patients died in the first visit. In the initial follow-up, 23.7% of people were still sick, 40.7% had recovered and 17.8% had died.

According to results in the final follow-up, 3.9% of people were still sick; the rate of recovered patients in the final follow-up was 44.1% and the percentage of deaths in the final follow-up was 24.6%. The high mortality rate indicates that the patients' concern was not due to weakness and lethargy, but due to a dangerous underlying disease that forced them to go to the hospital.

Since the health and treatment staff are constantly exposed to critical and stressful situations during the outbreak of the Covid-19 pandemic, the present study aims to investigate the relationship between spiritual health and resilience in the personnel of hospitals accepting patients with the corona virus affiliated to Tehran University of medical Sciences.

The current study is a descriptive and analytical study that was conducted cross-sectionally in 2019. The study population included medical staff, including doctors, nurses, paramedics, and service personnel who participated in the fight against Covid-19. In order to measure resilience, Connor and Davidson's questionnaire was used, and Polotzin and Ellison's spiritual health questionnaire was used to measure spiritual health. 145 questionnaires were included in the study. Statistical tests of mean, standard deviation, Pearson correlation coefficient, analysis of variance and independent t were used to analyze the data.

The average resilience score among the subjects was 64.3. The results showed that resilience in the field of spiritual effects with an average of 3.07 was the highest and in the field of tolerance of negative effects and strength against stress with an average of 2.33 had the lowest average. Spiritual health in 55.9% of the studied units was at a moderate level and none of them had a low level of spiritual health. Resilience and all its domains had a statistically significant positive correlation with spiritual health and its domains.

Managers' attention to the spiritual health of health center staff can reduce stress and pressures caused by work in critical situations and be an effective step towards greater productivity of human resources.

Brand citizenship behavior is one of the new concepts in branding with emphasis on the role of employees. This study aims to provide a model for development of brand citizenship behavior in a way that is compatible with the local environment of medical tourism in Iran.

The present qualitative research is based on the systematic database method. The required data were collected through semi-structured interviews with 16 experts in medical tourism and academic experts using judgmental, snowball, and accessible sampling methods, following the saturation rule. Data analysis was done using the Strauss and Corbin model and in three stages of open, central and selective coding.

The results indicated that the causal conditions of factors related to employees, organization and medical tourism and intervening factors of organizational structure, management performance, characteristics of the treatment industry, environmental factors, career history and quality of personal life in the framework of social capital of the organization, organizational justice, quality of work life, competitive atmosphere of the work environment, and social responsibility of the organization form the central phenomenon and it is implemented with human resources support strategies and comprehensive planning of marketing and branding, and affects the medicine, organization, employees and  has extra-organizational results.

The model obtained from this research shows the influence of several factors in the formation of brand citizenship behavior of medical staff, which, if paid attention to by managers, will lead to the satisfaction and attraction of tourists and gain a competitive advantage.

The present study qualitatively investigated the main components that should be considered for the implementation of the referral system in Bojnord city.

In this study, data were collected through doing interviews with experts, and finally, the importance of all the extracted components was evaluated using a researcher-made questionnaire. Also, the exploratory factor analysis method was used to classify the components in main sets. Kolmogorov-Smirnov, one-sample t-test, performed in Excel and SPSS software, was used for statistical analysis.

The most frequent noted components by the experts included "empowerment (knowledge, skill, psychological) of human resources involved in the referral system", "paying attention to the motivation of human resources involved in the referral system", and "developing suitable processes for the referral system and re-engineering the processes to meet the conditions". Finally, the main requirements in the referral system of Bojnord city were divided into three categories included organizational and management, manpower, and technology-based requirements.

Briefly, some components may lead to improvement of the referral system, which can be categorized into organizational and management, manpower, and technology-based requirements. Detailed planning to improve the referral system can lead to the improvement of the health system.

Global statistics shows that health tourism grew significantly before the outbreak of Covid-19, but with the beginning of the pandemic and the closure of countries' borders to immigrants, this trend has declined significantly. The present study aimed to identify the bottlenecks of health medical tourism in the context of the outbreak of Covid-19 and to present scientific solutions for its development using two stages of content analysis and surveying.

This research is exploratory in terms of purpose and descriptive in terms of type, which was conducted by field method. Study population was selected in two stages; the first stage consisted of 20 physicians with more than 15 years of experience in Ardabil province who were chosen by snowball sampling method and the second stage consisted of 200 employees of the province's University of Medical Sciences who were randomly selected. In order to analyze the data in the first stage, the content analysis  was used in 6 stages and in the second stage, the first and second order confirmatory factor analysis test was used.

The research findings showed that 9 main themes and 29 sub-themes were identified as barriers and bottlenecks in health medical tourism and 23 scientific solutions were presented to reduce barriers and bottlenecks in health medical tourism in the event of COVID-19 outbreak.

The adaptive fit indices are good and the RMSEA value is 0.047 which indicates that the model has a good fit.