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Background: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included.Methods: An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom.Results: Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations.Conclusions: This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the most prolific countries in the field of special education and to discuss the widespread impact of their papers by taking into account the country's h-index. Through a bibliometric analysis, the data were collected in the Web of Science Core Collection category "Education, Special" in the Social Science Citation Index during 2011-2020. The 25 most prolific countries in the field of special education were determined in terms of paper productivity, and it was seen that the leading country was undisputedly the USA (54.42%). Meanwhile, a strong positive correlation was found between the h-index and the number of papers published by the countries (r=0.864). On the other hand, when the ranking in terms of the number of papers was reconfigured by the h-index, it was relatively changed. The possible reasons for this change for the countries with the most changing rankings were discussed by considering some definitive criteria such as the journal quartiles, the percentage of international and domestic, and the percentage of open access papers. This study reports a positive correlation between the quality and quantity in the field of special education for the publications of countries. It has been shown that where the positive correlation deviates, then especially, the journal quartiles, the percentage of international collaboration and the percentage of open access papers have a significant effect. The bibliometric findings may be useful to enrich the discussion about the widespread impact of papers and debate whether the use of h-index is acceptable for cross-national comparisons.

This specially themed ""Getting of Wisdom," Learning in Later Life" Edition of the "Australian Journal of Adult Learning" ("AJAL") is not so much concerned with the issue of ageing itself, but more about quality of life regardless of age. It is about taking, but also giving back as best as possible at any age. This special issue is a result of the one week "The Getting of Wisdom Exchange", a collaboration between around 100 adult education practitioners and researchers from ten countries from Australia, New Zealand, Asia and Europe. In this issue, papers are presented from Sweden, Ireland, Aotearoa/New Zealand, Australia, Slovenia, Poland, Germany, Portugal and the United Kingdom. Papers cover different topics and open questions about various issues in older people's learning.

While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

This report shares the findings and lessons learned from an investigation into the economics of disaggregated models for assessing and accrediting informal learners undertaking post secondary education. It presents some key economic and governance challenges for universities to consider in implementing OER assessment and accreditation policies. It also includes discussion of findings from a small-scale survey conducted by two of the authors on perceptions, practices and policies relating to openness in assessment and accreditation in post secondary institutions, with a particular focus on the "OER universitas" (OERu) concept. [This paper was presented at the OpenCourseWare Consortium Global Conference (Ljubljana, Slovenia, April 23-25, 2014).]

In response to the diverse number of child sexual abuse (CSA) prevention programs currently implemented in school contexts, this paper examines key considerations for selecting such initiatives and the multiplicity of understandings required to inform facilitation of contextually relevant prevention curriculum. First, the paper examines concerns about the lack of explicit professional development for educators concerning child protection, and the need to develop understandings about prevention program best practices within pre-service and in-service training. Second, drawing on a systematic review of literature, the paper identifies five key considerations to inform teachers' selection and facilitation of CSA prevention curriculum in school contexts. Third, the paper advances calls by Wurtele (2009) and presents CSA prevention "best practices" overview and "model programs" list for professionals such as teachers. (Contains 1 table.)

Our paper focuses on delineating and scoping international Women's Sheds, a movement that has emerged within the past decade, mainly in Australia, Ireland and the UK. It addresses two main research questions. Firstly, what is the origin, distribution, nature and intent of Women's Sheds internationally to March 2021? Secondly, how might Women's Sheds be located within a typology inclusive of Men's Sheds and a range of community development models? We employed a systematic search via the internet in 2020-21, followed up by attempted email or phone contact to publicly reported Women's Sheds and like organisations internationally. In the process, we created a publicly shareable blog including a database of 122 existing, previously active, developing or planned Women's Sheds and like organisations to 13 March 2021. We identify four nations where self-identified Women's Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice. Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice.

Education is the core of the factors that improved people for a better lifestyle and increases the level of society' development. Quality education is one of the most vital goals of Sustainable Development Goals (SDGs) due to actualizing these factors. Using relational network data envelopment analysis (DEA), which have three interrelated substages, this current paper computes the educational economy efficiency of the Organisation for Economic Co-operation and Development (OECD) countries bearing in mind the characteristics related to SDGs. The contribution of our study is the use of a novel approach to computing the educational economy efficiency using relational network DEA with GAMS. Even though some interesting differences reveal in the efficiency of the countries, the findings show that countries with high-efficiency scores are clustered around countries like Latvia, Slovenia, and Korea.

Background: A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. Method: We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. Findings: One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. Conclusion: This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care. Plain Language Summary: High-quality health care for women and girls should be provided by health workers who are respectful and caring. Health workers should also work with others as a team and help women and girls make their own decisions about their health care. This approach is called patient-centred care. Female genital mutilation (FGM) is a cultural practice associated with poor health outcomes. Women who have experienced FGM have not always received quality health care. We studied the guidance and tools to help health workers provide care to women and girls with or at risk of FGM. This study aimed to understand how health workers are supported to provide woman and girl-centred health care in these documents. We searched for these documents on the websites of health professional associations, government health departments and organisations working in FGM in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The documents were analysed using a tool that described all the important areas needed to provide patient-centred health care. Of the 124 documents, we found that only 12% contained information about all aspects of patient-centred care. Only one document had details about all the areas that are part of patient-centred care. This study shows that we need to improve the FGM-related guidance provided to health workers to care for and protect women and girls. There is a need for health workers to involve women and girls with or at risk of FGM in designing guidelines and tools and evaluating them to these documents best fit their needs. [ABSTRACT FROM AUTHOR]

Presents the findings of a survey carried out among the financial directors of leading retail companies in Australia, Ireland, New Zealand and the UK. The purpose of the survey was to determine those factors that influence the development of financial services within retail organizations. Considers the introduction of financial services, within the context of retailers' relationships with their customers, and retailers' ability to build closer relationships with existing and potential customers. Financial service provision is, therefore, considered in the context of the relationship marketing paradigm. Considers the opportunities which financial services provide for retailers to move from a transactional to relationship approach to marketing. [ABSTRACT FROM AUTHOR]

The article focuses on the fertility transition in Ireland during 1880-1911. The decline in Irish marital fertility was neither uniform nor universal. Between 1881 and 1911, there were increases in Counties Galway, Mayo, Roscommon and Donegal, while the decline in several other counties was small. Cohort parity analysis (CPA), a fertility measure devised by researcher Paul David and his research associates, provides a means of inferring the extent and timing of birth control within marriage from distributions of married women by number of children born. A key aspect of CPA is the extent to which married couples resort to contraception in order to "space" births. Ireland has played an important part in the development of CPA, because David and his colleagues believe that the rural Irish of 1911 provide a suitable model, not only for urban Ireland in 1911 and the United States around the turn of the century, but also for Western Europe, Canada, Australia, and New Zealand, from the mid-nineteenth through the early twentieth centuries.

The article deals with the recent widespread increase in marriage rates in the Western world. A convenient method of studying aspects of the recent history of marriage is provided by easily available data regarding the proportion of single persons at various dates. The article uses these data to disentangle two effects in the marriage boom: the extent to which the cohorts whose marriages have formed the main contribution to the marriage boom are marrying more, i.e. whether the proportion who will ultimately remain single is likely to be lower than in previous generations, the extent to which the mean age at marriage of these generations is likely to fall below that of their predecessors. The raw material for the computations to be presented consists of the proportions single at two recent dates for each of thirteen countries used in the study. The countries included in the study are Czechoslovakia, Denmark, England and Wales, France, Ireland, Luxembourg, the Netherlands, Norway, Sweden, Switzerland, Australia, New Zealand, and the U.S. The study from the proportion single shows that both reduction in the age at marriage and an increase in the proportion marrying at least once in the course of their lives is occurring in several countries.

Objective: To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.Design: Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.Setting: PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).Participants: None.Intervention(s): None.Main Outcome Measure(s): None.Results: PET-CT service provision has grown over the period 2006-2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.Conclusions: Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to benchmark roles that veterinary librarians at universities and colleges play in systematic reviews (SRs) and scoping reviews that are conducted by faculty and students at their institutions, to benchmark the level of training that veterinary librarians have in conducting SRs, to identify barriers to their participation in SRs, and to identify other types of literature reviews that veterinary librarians participate in. Methods: Sixty veterinary librarians in universities and colleges in Canada, the United States, England, Scotland, Ireland, Australia, and New Zealand were surveyed online about their roles and training in conducting SRs, barriers to participation in SRs, and participation in other types of literature reviews. Results: Veterinary librarians' highest participation was at an advising level in traditional librarian roles as question formulator, database selector, search strategy developer, and reference manager. Most respondents reported pretty good to extensive training in traditional roles and no or some training in less traditional roles. Sixty percent of respondents received few or no requests to participate in SRs, and only half of respondents had participated in SRs as a review team member. Sixty percent of respondents stated that their libraries had no policies regarding librarian roles and participation in SRs. Conclusions: The surveyed veterinary librarians participated in SRs to a lesser degree than human health sciences librarians, experienced low demand from veterinary faculty and students to participate in SRs, and participated as review team members at significantly lower rates than human health sciences librarians. The main barriers to participation in SRs were lack of library policies, insufficient training, and lack of time. [ABSTRACT FROM AUTHOR]

Statistical literacy is complex and multifaceted. In every country, education and numeracy are a function of a multitude of factors including culture, history, and societal norms. Nevertheless, since the launch of the International Statistical Poster Competition (ISLP) in 1994, a number of patterns have emerged to suggest there are some common or universal success factors in running statistical literacy competitions involving schools, universities, statistical offices, and many other institutions. This paper outlines some of those factors, such as institutional cooperation, celebrating participation and success, improvement of statistical literacy in the local schools, support for teachers, the involvement of national statistics institutes, and use of technology. These factors have been identified from our own experience running the competition and from articles submitted to the ISLP newsletters. Statistical literacy is a complex phenomenon, and so this is neither an exhaustive list of key factors nor a formula for success, but rather an overview of recurring themes across countries participating in the competition around the world.

Ample evidence indicates that a person's human capital is important for success on the labor market in terms of both wages and employment prospects. However, unlike the efforts to identify the impact of school attainment on labor-market outcomes, the literature on returns to cognitive skills has not yet provided convincing evidence that the estimated returns can be causally interpreted. Using the PIAAC Survey of Adult Skills, this paper explores several approaches that aim to address potential threats to causal identification of returns to skills, in terms of both higher wages and better employment chances. We address measurement error by exploiting the fact that PIAAC measures skills in several domains. Furthermore, we estimate instrumental-variable models that use skill variation stemming from school attainment and parental education to circumvent reverse causation. Results show a strikingly similar pattern across the diverse set of countries in our sample. In fact, the instrumental-variable estimates are consistently larger than those found in standard least-squares estimations. The same is true in two "natural experiments," one of which exploits variation in skills from changes in compulsory-schooling laws across U.S. states. The other one identifies technologically induced variation in broadband Internet availability that gives rise to variation in ICT skills across German municipalities. Together, the results suggest that least-squares estimates may provide a lower bound of the true returns to skills in the labor market.

This paper discusses the emergence of assessment for learning (AfL) across the globe with particular attention given to Western educational jurisdictions. Authors from Australia, Canada, Ireland, Israel, New Zealand, Norway, and the USA explain the genesis of AfL, its evolution and impact on school systems, and discuss current trends in policy directions for AfL within their respective countries. The authors also discuss the implications of these various shifts and the ongoing tensions that exist between AfL and summative forms of assessment within national policy initiatives.

The UK has long experienced a shortage of social workers and has recruited internationally to meet demand. There have been few specific data quantifying the scale of social work mobility to the UK through which such experiences can be set in context. The analysis reported in this article uses data from October 2008, relating to registered social workers working in England. As part of a wider study of migrant social care workers in England, the article reports analysis of data records of over 7,000 non-UK social workers registered to work in England and compares their characteristics to UK-qualified social workers. These analyses are supplemented by analysis of more recent application and registration data from the General Social Care Council pertaining to social workers qualified within and outside the European Union during 2008 and 2009. The findings highlight several important observations in terms of non-UK-qualified social workers' profile as well as some possible trends in migration and variations in rates of qualification verification. Over half of all international social workers in England were trained in four countries: Australia, South Africa, India and the USA. Findings are contextualised with qualitative data obtained from the wider study and policy debates. [ABSTRACT FROM PUBLISHER]

The job description for legislators in western democracies includes constituency-focused activities such as casework and district visits. Unfortunately we have a limited theoretical and empirical understanding of the factors affecting legislators' constituency-oriented activities, in large part because most studies focus on single nations; even studies that are comparative do not span a variety of electoral systems. In this article we examine the constituency focus of MPs in six chambers that do provide such variance: the Australian House and Senate, Canadian House, Irish Dáil, New Zealand House, and the British House of Commons. We find that electoral considerations and incentives provided by different electoral systems, as well as other factors, affect the priority that MPs place on constituency service. [ABSTRACT FROM AUTHOR]

The "Journal of the Experimental Analysis of Behavior" was founded in 1958 by a group of male psychologists, mainly from the northeastern USA and connected with either Harvard or Columbia. Fifty years later about 20% of both editors and authors reside outside this country and almost the same proportion is women. Other changes in the journal include having its own website for more than a decade and now publishing online as well as on paper. A recent connection with PubMed Central of the National Library of Medicine has made possible the completely free electronic presentation of the entire archive of about 3,800 articles. (Contains 5 tables and 3 figures.)

The evaluation of government-financed research has become increasingly important in the last few decades in terms of increasing the quality of, and payoff from, the research that is done, reducing the cost of doing it, and lending public credibility to the manner in which research is funded. But there are very large differences throughout the world in the extent to which systems used promote these results. This paper briefly presents the dimensional results of a study designed to comparatively evaluate the national-level research evaluation models in sixteen countries on five merit-defining dimensions. (Contains 6 figures.)

Over the last 25 years there has been a growing corpus of literature internationally on the history of teachers. During the 1980s, educational historians in the United States became particularly active in developing this general field. However, the general field of the history of Catholic teachers' lives is still much under-researched internationally. Furthermore, what little accounts there are tend towards being heroic and centre on the lives of those teachers who were priests, brothers and nuns, and who were collectively known as "the teaching religious". The emphasis in many of the histories of Catholic education on the lives of the members of religious teaching orders is hardly surprising given that for over one hundred years up to the mid 1960s they dominated the Catholic teaching force in the English-speaking world, particularly in the United States, England and Wales, Ireland, Australia and New Zealand. The Catholic school came to be seen by the Church as one of its instruments for holding on to, and re-establishing its control over, the faithful. The staffing of Catholic schools with members of religious orders ensured that Catholic education could be provided for the "masses" since the labour provided was cheap. It also ensured that young Catholics were shaped in a manner which served the Church's interests, the most crucial of which were to ensure the teaching of religion, the infusion of the various subjects on the secular curriculum with Catholic principles and ideals, and the creation of a religious atmosphere in the schools which was all-pervasive. Providing a basic elementary education in the 3Rs for the great mass of Catholic children was also motivated by a desire to break down the link between being Catholic and being poor. While most of the work in Catholic schools was conducted by teaching religious, in their midst were lay teachers. These constitute a much under-researched group in Catholic education internationally. This paper is offered as one attempt to provoke some thought on this neglected group in the historiography of the Catholic teacher and, hopefully, stimulate research, in an attempt to fill the lacuna which exists.

Objective: To map key policy documents worldwide and establish how they address the treatment and care needs of children and young people (CYP) who are suicidal., Design: We conducted a scoping review to systematically identify relevant key policy documents following a pre-established published protocol., Data Sources: Four databases (CINAHL; Medline; PsycINFO; The Cochrane Database of Systematic reviews) and the websites of key government, statutory and non-statutory agencies were searched. Google and Google Scholar were used to identify other policy documents and relevant grey literature. Leading experts were consulted by email., Eligibility Criteria for Selected Studies: Policies, policy guidance, strategies, codes of conduct, national service frameworks, national practice guidance, white and green papers, and reviews of policy-concerned with indicated suicide prevention approaches for children up to 18 years old. Limited by English language and published after 2000., Data Extraction and Synthesis: Data were extracted using a predetermined template. Second reviewers independently extracted 25%. Documents were categorised as international guidance, national policy and national guidance, and presented in a table providing a brief description of the policy, alongside how it specifically addresses suicidal CYP. Findings were further expressed using narrative synthesis., Results: 35 policy documents were included in the review. Although many recognise CYP as being a high-risk or priority population, most do not explicitly address suicidal CYP. In general, national guidance documents were found to convey that suicidal children should be assessed by a child and adolescent mental health practitioner but offer no clear recommendations beyond this., Conclusion: The lack of specific reference within policy documents to the treatment and care of needs of children who are suicidal highlights a potential gap in policy that could lead to the needs of suicidal children being overlooked, and varying interpretations of appropriate responses and service provision., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Treatment with new and/or innovative drugs with uncertain safety and efficacy profile is associated with substantial ethical concerns. The main objective of this paper is to present guidance on the use of such drugs contained in: (i) major international codes and guidelines pertaining to medical ethics and biomedical research; (ii) national codes of medical ethics and professional conduct of the USA, Canada, Australia, New Zealand, the UK, Ireland, France and Germany. Out of the four international codes and guidelines analysed, only the Declaration of Helsinki addresses the question of the use of unproven drugs. Among national codes, only two (USA and New Zealand) explicitly allow for use of new or innovative drugs. Moreover, treatment with unproven drugs seems to be permissible under the French code, though this is not stated explicitly. The remaining codes do not contain any articles on the use of new and innovative drugs. An update of existing articles, as well as the addition of new guidelines to the codes, should be considered in view of the rapid pace of development and introduction to clinical practice of new drugs. This work is relevant to innovative off-label applications of approved drugs and expanded access to investigational drugs., (© 2018 The British Pharmacological Society.)

Objective: This paper aims to address two questions related to the implementation of the ISO 9000 Quality Management System standard in the acute health care sector: which countries have developed specific nationwide guidelines/interpretations? and what variances exist between the different interpretations of the ISO 9002 standard?, Design: The study was carried out via an assessment of the available guideline documents for the use of ISO 9000 in the acute health care sector. The interpretation of each document was examined for common elements and deviations from the commonly agreed terms., Setting: Worldwide in the acute health care sector (excluding that of laboratories)., Study Participants: Eighty-two international ISO members and/or quality health care organizations., Results: The results showed variation in the interpretations of the ISO 9000 standard. In total, 16 of the clauses/subclauses note distinct variations, between one or more of the documents, which could alter the perception of the system., Conclusion: From examination of the six identified guideline documents, the claim that ISO 9000 introduces quality systems which are comparable from one country to another is unfounded in the acute health care sector.