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Background Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. Methods A scoping review of the literature was conducted based on the Arkesy and O’Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. Results In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). Conclusion Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.

Objectives: The present study was carried out with the aim of identifying ways of collaboration of medical librarians with family physicians in advancing the goals of the family physician program based on the views of experts. Methods: This research was qualitative content analysis. The statistical population included experts in the fields of family physicians. Sampling method was targeted and in order to identify qualified people, snowball sampling was used as well. The data collection tool was semi-structured interview, and the researchers exploited thematic analysis in the data analysis. To determine the validity and reliability, the Lincoln and Guba method was used based on four criteria of credibility, transferability, conformability and dependability. Results: Regarding the common areas of medical librarians and family physicians, four concepts were extracted including helping physicians in scientific and professional mastering, upgrading research methodology, upgrading information literacy, and the content of information resources for patient training. Moreover, 4 concepts were identified: appropriate policy-making, education suitability, participation in clinical research, and promotion of the quality of patient training in addition to 6 components of interaction strategies. Conclusion: Strategies for the interaction of medical librarians with family physicians can become practical in areas such as proper policy-making, suitability of education, participation in clinical research, and the improvement of the quality of patient training.

Background and Objectives The aim of this study was to investigate the correlation between creativity and entrepreneurial skills in health system managers of the educational hospitals. Material and Methods This research is descriptive-analytical and applied in terms of purpose. The study population includes the managers of teaching hospitals in Ahvaz, south west Iran. The data was collected by census method from 110 senior and middle managers by validated questionnaire. Data were analyzed using absolute and relative frequency, mean, standard deviation, independent samples t-test, ANOVA, Pearson correlation coefficient and stepwise linear regression in SPSS software version 22. Results The mean score of creativity for managers was 44.74 7.91. 64.6% of the managers were highly creative and 35.4% of them were considered relatively creative. The average score of entrepreneurial skills of managers was 3 0.67 and was estimated to be appropriate. The correlation between creativity and entrepreneurial skills was 0.645, which showed a positive and strong relationship between these two variables (P <0.001). Simple linear regression showed that managerial skills among entrepreneurial skills determine 44.4% of creativity (P <0.001). Conclusion It is suggested to strengthen the level of managerial skills among managers by training courses Extended Abstract Background and Objectives Since creativity is assumed to be the mainstay of the spirit of entrepreneurship, thereforeit is necessary due measures be taken to establish the degree of creativity of health managers if one is to have any reasonable hope of developing enterepreueship in healthcare organizations. One way to do so might be to assess health managers’ creativity and determine if there is a correlation between their creativity and entrepreurship. Therefore, this study aimed to investigate the correlation between creativity and entrepreneurship skills among managers of educational hospitals in Ahvaz. Material and Methods This research was descriptive-analytical and applied in terms of purpose. The present research population consisted of managers of educational hospitals in Ahvaz city and data were collected by census method from 110 senior (management, metrons, educational assistants of hospitals) and mid-level (Supervisors, Head Nurses, Service Officers, Heads of Finance and Administration, Laboratory and Radiology Officers) managers through a questionnaire. In this study, two questionnaires were used: the Creativity Questionnaire, developed by Dorabjee et al., and the Smith Entrepreneurship Skills Questionnaire. The former consists of 12 five-point Likert scale items indicating the extent of the organization's support for creativity while the latter consists of 16 questions summarized in four components with each component having four questions. The validity of the questionnaire was confirmed in accordance with professors’ and experts’ opinions. The reliability of the questionnaires was estimated using Cronbach's alpha coefficient, which was 0.83 and 0.88 for for creativity questionnaire and entrepreneurial skills questionnaire, respectively. Data were analyzed using absolute and relative frequency, mean, standard deviation, independent samples t-test, ANOVA, Pearson correlation coefficient and stepwise linear regression in SPSS software version 22. Results The mean score of creativity for managers was 44.74±7.91. 64.6% of managers were found to be very creative and 35.4% were relatively creative. The mean score of managers' entrepreneurship skills was 3±0.67 which was considered at an appropriate level. Pearson correlation coefficient was estimated -0.27 (P=0.017) between age and creativity and-0.31 (P=0.04) between work experience and creativity indicating a small size and negative correlation between the former variables and a moderate and negative correlation between the latter ones. Likewise, Pearson correlation coefficient between age and entrepreneurial skills was calculated -0.28 (P=0.01) pointing to a small size and negative correlation between these two variables. As for the correlation coefficient between work experience and entrepreneurial skills was -0.32 (P=0.005) showing that these two variables have a moderate negative correlation. However, creativity and entrepreneurial skills were found to be positively and strongly correlated (r= 0.645, P<0.001). Simple linear regression showed that managerial skills among entrepreneurial skills come to determine 44.4% of creativity (P<0.001). Conclusion Managers of Ahvaz teaching hospitals were found to possess the required level of creativity and entrepreneurial skills as measured by the research tools in the present study with the creativity component showing a strong correlation with entrepreneurial skills. Management skills might be the most important indicators of creativity among hospital managers, it is suggested the barriers to creativity in the organization be removed, a financial system be formulated to encourage entrepreneurs, support creativity and innovation in the organization by formulating the necessary policies and guidelines, as well as holding classes and training courses to strengthen management skills among managers. Also, given the negative correlation between age/work experience on the one hand, and creativy/entrepreneurial skills on the other, it seems reasonable that due measures had best be taken to pave the way for the younger generation taking on managerial responsibilities. Practical implications of research The findings of the present study seem to point toa strong and significant relationship between creativity and entrepreneurial skills. Therefore, appropriate training programs should be designed and implemented to increase the creativity of hospital managers. Also, due to the high level of creativity and entrepreneurial skills of the managers of educational hospitals in Ahvaz, the trustees should take action to provide the best possible conditions for benefiting from this capacity. Ethical considerations Observance of ethical instructions: This study is based on the protocols of the ethics committee in the research of Ahvaz Jundishapur University of Medical Sciences with the code of ethics number IR.AJUMS.REC.1399.269 and also the study was conducted with the consent of the statistical population of the study. Conflict of interest The authors state that there is no conflict of interest in the present study. Aknowledgment This research has been done with the financial support of the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences with the number 99S27. The authors are grateful to all the directors who participated in this study.

Background. Cancers are showing a rising trend in developing countries. In Iran, cancer is the third leading cause of death after cardiovascular diseases and accidents. The cost of cancer diagnosis and treatment places heavy financial burden on health systems, requiring accurate financial assessments and evaluations. Therefore, this study aimed to determine the direct medical expenses of cancer patients undergoing surgery in Ahvaz, Iran, teaching hospitals. Methods. This descriptive-analytical cross-sectional study was conducted in 2021. The research population included cancer patients undergoing surgery in Ahvaz teaching hospitals. Data collection was done using clinical records of the hospital. Quantitative statistical indicators such as frequency, mean, standard deviation, and tables were used for data analysis. In addition, analytical statistical indicators such as independent samples t-test, one-way analysis of variance (ANOVA), Pearson correlation coefficient, and regression were used with SPSS22 software. Results. The overall mean costs for cancer surgery were calculated at 77,994,903 (SD= 111,224,332) Iranian Rials (IRR). The most expensive cancer surgery was colorectal cancer with an average of 193,558,434 (SD= 266,162,757) IRR, and the lowest cost was pancreatic cancer surgery with an average of 29,284,226 (SD= 23,057,425) IRR. There was a significant positive relationship between the type of cancer (p= 0.000) and the length of hospital stay (p= 0.041) and the cost of hospitalized patients. Conclusion. The economic costs of treating all types of cancer are very high. Any therapeutic and administrative measure that can reduce the cost of cancer treatment or the duration of treatment will contribute significantly to reducing patients' sufferings, improving their quality of life, and reducing the imposed costs.