Wild Boar in Flanders, Belgium: (Dis)agreements Between Key Stakeholders on Wild Boar Management Objectives, Actions, and Legal Provisions

Wild boar (Sus scrofa) reappeared in Flanders, Belgium in 2006 after more than half a century of absence. Besides being a native and highly valued game species in Europe, wild boar are also known to be responsible for car collisions, crop damage, disease transmission, and ecological damage at high densities. The management of wild boar therefore seeks to balance these positive and negative impacts. Given the highly fragmented landscape in Flanders and its multifunctional use, coexistence with wild boar is only possible through integrated management involving relevant stakeholder groups. However, to be successful, this requires that the management objectives, the overall wild boar policy of the Flemish authorities, and management actions are supported by the stakeholders. To assess the support for the current management, we conducted a survey among members of the 3 key stakeholder groups: farmers, hunters, and conservationists. Our survey assessed the importance stakeholders attribute to different management objectives, their support for the current legal provisions, and how desirable the different stakeholder groups considered possible management actions. The potential for conflict index was used to analyze the (dis)agreement between and within stakeholder groups. Reducing or preventing crop damage and the risk for car accidents are indicated as being the most important management objectives by all 3 stakeholder groups. Stakeholder groups differ strongly in their support for the current legal provisions. Those stakeholders that have to implement the legal provisions or are mostly affected by these laws are less supportive than others. The desirability of the possible management actions strongly varied according to the different stakeholder groups. Contrary to other studies, the desirability of a possible management action was hardly influenced by the management objective it tried to achieve

Monitoring enteral nutrition efficacy in ICU patients: is there a place for the Brix value-derived fraction of enteral formula in gastric residual volume?

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Clinical nutrition issues in 2022: What is missing to trust supplemental parenteral nutrition (SPN) in ICU patients?

Clinical nutrition; Intensive care unit; Nutrition careNutrició clínica; Unitat de cures intensives; Cura de la nutricióNutrición Clínica; Unidad de cuidados intensivos; Cuidado de la nutriciónA multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefits, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufficient. The experts agreed on actions needed to increase evidence quality on SPN use in specific patients at a given time point during acute critical illness or recovery.The organization of the Virtual Meeting that motivated this publication was funded by Baxter Healthcare SA. The authors received no financial support for the research, authorship, and/or publication of this article. MPC receives funding from the Research Foundation Flanders (FWO) (Grant No. 1832817N) and Onderzoeksraad, KU Leuven (Grant No. C24/17/070) and from the Private Charity Organization “Help Brandwonden Kids

Bench-to-bedside review: Metabolism and nutrition

Acute kidney injury (AKI) develops mostly in the context of critical illness and multiple organ failure, characterized by alterations in substrate use, insulin resistance, and hypercatabolism. Optimal nutritional support of intensive care unit patients remains a matter of debate, mainly because of a lack of adequately designed clinical trials. Most guidelines are based on expert opinion rather than on solid evidence and are not fundamentally different for critically ill patients with or without AKI. In patients with a functional gastrointestinal tract, enteral nutrition is preferred over parenteral nutrition. The optimal timing of parenteral nutrition in those patients who cannot be fed enterally remains controversial. All nutritional regimens should include tight glycemic control. The recommended energy intake is 20 to 30 kcal/kg per day with a protein intake of 1.2 to 1.5 g/kg per day. Higher protein intakes have been suggested in patients with AKI on continuous renal replacement therapy (CRRT). However, the inadequate design of the trials does not allow firm conclusions. Nutritional support during CRRT should take into account the extracorporeal losses of glucose, amino acids, and micronutrients. Immunonutrients are the subject of intensive investigation but have not been evaluated specifically in patients with AKI. We suggest a protocolized nutritional strategy delivering enteral nutrition whenever possible and providing at least the daily requirements of trace elements and vitamins