The difference between a good Learning Session and an extraordinary one comes down to a team effort across the entire Network. I consider each of our participating centers and team members to be Learning Session co-designers. Co-designers from the time we begin to brainstorm an agenda, to when we invite presenters, all the way through to the opening remarks at the Learning Session reminding everyone that we are all teachers and all students and that, as always, each of us needs to "share seamlessly and steal shamelessly" so we can work together to improve care for more patients.

In reflecting on our April Learning Session, which many stated was indeed the 'best ever', these to me are key examples of how our team came together to create a truly unique and inspiring weekend:   

• With each Learning Session, the diversity of participants is growing. ImproveCareNow knows that in order to get the best outcomes we must involve parents and patients in the work. We are thrilled that 18 parents and 3 patients were able to join us in April!

• Several sessions were planned with parents and patients. A well-attended breakout session on self-management support focused on adherence and featured in-person and video presentations from PAC members.  Not only did they present, but they co-designed right alongside the QI consultants, clinicians, and researchers. Imagine if every talk you attended about improving care for kids with chronic illnesses actually incorporated the patient voice from the very beginning!

• Guest faculty speakers included Chris Forrest, MD, PhD - a nationally recognized comparative effectiveness researcher - who told us how we can and must take advantage of the extraordinary data that is available in our ICN2 registry to teach others how to provide optimal care for kids with IBD. The REACH replication study, which Forrest co-authored, was presented orally at Digestive Diseases Week earlier this month. 

• We designed work sessions for professional groups that are represented on core QI teams. Research/Improvement Coordinators, Nurses, Physicians and other providers met in small groups, spent time discussing issues relevant to their work, and most importantly, began to develop action plans for becoming QI leaders within the Network.

• We launched a new QI support and curriculum structure called the ImproveCareNow Learning Labs. Each learning lab consists of seven to eight care centers with size, geography, organizational structure, or focal areas in common. These labs will aim to capture the close-knit, collaborative feeling that has become more challenging to maintain as the Network has grown. Labs will have small group conference calls, interact virtually to share ideas, and report back to the Network about the usefulness of this approach.

• We ended the session with inspirational calls to action from our parent and patient partners. They reflected on the importance of the work that had already begun and challenged us to go even further, faster. I cannot begin to describe what it was like to be in a room full of clinicians and other colleagues who were moved to tears...and to action!   Read the speech that made everyone cry >> 

Planning Learning Sessions is a part of my job, but I am not exaggerating when I say that it's a joy and that I learn so much from everyone involved. As we look toward our Fall Learning Session (which is just about four months away!), we will continue to build upon the partnerships formed at the April Learning Session; engaging patients, parents, and QI team members in planning earlier and in even more meaningful ways.

• "The energy!  And the meaningful inclusion of parents & patients in the weekend."
• "Such a dedicated, motivated and helpful group of people. So lucky to be part of this amazing group!!"
• "That FINALLY nursing issues were addressed.  We are at the front lines with these patients.  We are often the ones who inform the physicians of problems or concerns"
• "The entire weekend was a joy!! Initiating the small groups is an exciting new adventure."

Enteral therapy refers to providing nutrition as a formula rather than by eating a regular diet. Enteral therapy has been shown to be effective in inducing, and perhaps maintaining, remission for pediatric patients with Crohn's disease. Enteral therapy does not have the side effects seen with drug treatment, and can improve growth, unlike corticosteroids, which have many known side effects. Although used very little in the United States, enteral therapy is commonly used abroad, including many European countries and Japan.

Over the years, several methods of administering enteral therapy have been evaluated, leading to variation in treatment. In 2012, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) formed the Enteral Nutrition Working Group to review the use of enteral nutrition therapy in pediatric Crohn's disease, which summarized previous research and offered recommendations for physicians.

Historically, enteral therapy was given through a feeding tube, and this is still done at many centers. However, drinking the formula is also an effective option. Studies have used both specialized nutrition formulas (in which the protein has been broken down to into smaller pieces) and non-prescription over-the-counter formulas (in which protein is not broken down). Both approaches appear to be equally effective, an important finding since over-the-counter formulas taste better and are less expensive.

The majority of the research has shown that enteral therapy is effective when taken as the sole source of nutrition (that means the patient can't eat any food), and this approach was recommended by the NASPGHAN Enteral Nutrition Working Group. However, recently a study published by Children's Hospital of Philadelphia showed that enteral therapy protocol is still effective when a small amount of food (less than 20% of the calories) is taken at the same time.

The way enteral therapy works is unclear. Theories include that it may help to provide the body with important nutrients and better overall nutrition, eliminate an unknown dietary substance that causes an immune response, or alter the bacteria found in the intestines.