Introduction

The fundamental principles governing international law are changing dramatically. International law, which traditionally has regulated the conduct between and among countries, has had as its core the respect for state sovereignty. However, the latter part of the twentieth century witnessed fundamental changes to the way in which the international community operates that are based upon a deep interdependence among states and their openness to international actors. This is often labeled the process of globalization. This process has had a significant impact on states' sovereignty and on the way in which international law regulates the interaction among states. This phenomenon includes the way in which international trade law (spearheaded by the World Trade Organization) dictates how member states' trade policies may operate; the way in which international financial law (led by the International Monetary Fund) determines financial policies of member states; and the way in which international environmental law regulates actions with transboundary effects. Thus, international law is no longer restricted to areas of interstate concern but it has also come to regulate states' domestic actions as well. Opponents to this view may hold that states are still sovereign in that they are not forced to take part in these international legal regimes. However, this view fails to take account of the political and economic realities of international relations where the voluntary nature of this regulation for most states (particularly weaker or poorer states) is a legal fiction. Copyright © 2010 University of Pennsylvania Press All rights reserved

The right to food in international law with case studies from The Netherlands and Belgium

In this chapter, the enforceability of the right to adequate food is discussed in the context of industrialized countries. The right to food as a human right can be considered the fundament of food law. Human rights in themselves occupy a special position in the field of law. On the one hand they encompass rights of a high moral value which goes beyond the boundaries of a State or the consent of a State to be bound by it. On the other hand, human right agreements are put in the form of international treaties, whose effect is greatly depending on the willingness of its member States to act in compliance with their commitments. Therefore, enforcing an international human right in a domestic court, such as the right to adequate food, is not per se a matter of course. Two issues appear to be highly influential in determining whether an international human right can be effectively invoked in a domestic court. The first is the alleged difference between civil and political rights on the one hand, and economic, social and cultural rights on the other hand. Traditionally, it is assumed that the first type of rights require govern- ment abstaining and are therefore enforceable. The latter type implies government action and are not enforceable due to a margin of discretion the national govern- ments enjoy in implementing these rights. However, there are sound arguments to oppose this traditional approach in human rights typology. These arguments are frequently pointed out in the context of the United Nation's specialized institutions as well as in literature. The second issue is the working of the domestic constitution that usually regulates the effect of international law in the domestic legal order. A case study of two industrialized countries who are favorable to human rights-the Netherlands and Belgium-was conducted. Where normally the right to food is addressed in the context of developing countries, poverty and large scale hunger, the selected countries do not suffer such constraints. Instead, the circumstances within these countries would allow an enforceable right to food to work. The case study reveals that the coincidental constitutional context of a country may be of greater influence to the enforceability of internationally recognized human rights, rather than the content of the rights in itself. In both countries the right to food can hardly be enforced through the domestic courts, in contrast to what these countries communicate in the international arena

Design of antimicrobial stewardship care bundles on the high dependency unit

Background Antimicrobial guidelines aim to optimise treatment and minimise development of resistance. Care bundles support the implementation of local guidelines. Objective Pharmacist identification of where in the prescribing, monitoring and documentation process, the quality of antimicrobial management in a High Dependency Unit of a large teaching hospital could be improved and design of antimicrobial care bundles for initiation and de-escalation of therapy to standardise care and improve practice. Setting This study was conducted in a 10-bed, mixed medical-surgical HDU in a large Scottish (UK) teaching hospital. Methods Quality indicators (n = 30) were agreed through multidisciplinary team review with reference to the evidence base, national strategy and local policy. Adherence to these quality indicators was measured before and after the pharmacist’s contributions. Areas of non-adherence to quality indicators were used to design the care bundles. Main outcome measure Adherence to the quality indicators before and after the pharmacist’s action. Categorisation of pharmaceutical care issues (‘check’, ‘change in drug therapy’ and ‘change in drug therapy process’) were quantified. Results From 134 prescriptions, the pharmacist undertook 1,447 actions to ensure adherence to the 30 indicators. Adherence was very good (85.3 % CI 83.5, 87.1), but would have been unsatisfactory (53.5 % CI 50.9, 56.1) without the pharmacist’s action (p < 0.001). Change in drug therapy process or change in drug therapy initiated by the pharmacist accounted for 31.9 % (CI 29.5, 34.3) of adherence. Non-adherence was related to documentation of past allergic reactions, bacteriological specimen results, indication and length of course of treatment (both at initiation and de-escalation). Care bundles were designed to target areas of non-adherence to local guidelines. Conclusion The pharmacist made a significant contribution to improving adherence to evidence based antimicrobial prescribing quality indicators agreed by the multidisciplinary team. Prompts have been identified from the pharmaceutical care process and applied in the design of two antimicrobial care bundles proposed to support adherence with antimicrobial prescribing policies and guidelines