Prodrugs: Do They Have Advantages in Clinical Practice?

This is the published version, also available from the publisher at http://adisonline.com/drugs/Abstract/1985/29050/Prodrugs__Do_They_Have_Advantages_in_Clinical.2.aspxProdrugs are pharmacologically inactive chemical derivatives of a drug molecule that require a transformation within the body in order to release the active drug. They are designed to overcome pharmaceutical and/or pharmacokinetically based problems associated with the parent drug molecule that would otherwise limit the clinical usefulness of the drug. The scientific rationale, based on clinical pharmaceutical and chemical experience, for the design of various currently used prodrugs is presented in this review. The examples presented are by no means comprehensive, but are representative of the different ways in which the prodrug approach has been used to enhance the clinical efficacy of various drug molecules

The Transition to Peer Learning

Problem Description: Historically, peer review has been compelled by regulatory and legislative mandates, such as the Joint Commission Ongoing Professional Practice Evaluation (OPPE) requirement and the Health Care Quality Improvement Act (HCQIA) enacted by Congress in 1986. [1] However, these external mandates were focused on quality assurance, generally carrying punitive connotations and practically translated into rote compliance without the benefit of learning and improvement. In fact, the lack of quality improvement focus prompted the Institute of Medicine (IOM) to release its 2015 report, “Improving Diagnosis in Health Care,” stating that a “critical type of error in health care—diagnostic error—has received relatively little attention.” [2] The IOM report alarmingly reports that 5% of the US population experience diagnostic error annually, most experience diagnostic error in the course of a lifetime and diagnostic error contributes to 10% patient deaths and 6-17% of adverse events in hospitals. The IOM report framed a number of recommendations that potentially informs peer review and learning activities more broadly (Figure 1).https://jdc.jefferson.edu/radiologyposters/1011/thumbnail.jp