The 2030 Agenda for Sustainable Development-including 17 interconnected Sustainable Development Goals (SDGs) and 169 Targets-is a global plan of action for people, planet and prosperity. SDG7 calls for action to ensure access to affordable, reliable, sustainable and modern energy for all. Here we characterise synergies and trade-offs between efforts to achieve SDG7, and delivery of the 2030 Agenda as a whole. We identify 113 Targets requiring actions to change energy systems, and published evidence of relationships between 143 Targets and efforts to achieve SDG7. Synergies and trade-offs exist in three key domains, where decisions about SDG7 affect humanity's ability to: (1) realise aspirations of greater welfare and wellbeing; (2) build physical and social infrastructures for sustainable development; and (3) achieve sustainable management of the natural environment. There is an urgent need to better organise, connect and extend this evidence, to help all actors work together to achieve sustainable development.

Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ dysfunction and death. The purpose of the present study is to determine clinical characteristics associated with 28 day inhospital survival in patients with coronavirus disease 2019 (COVID-19) that received tocilizumab. This was a retrospective observational cohort study conducted at a five hospital health system in Michigan, United States. Adult patients with confirmed COVID-19 that were admitted to the hospital and received tocilizumab for cytokine storm from March 1, 2020 through April 3, 2020 were included. Patients were grouped into survivors and non-survivors based on 28 day in-hospital mortality. Study day 0 was defined as the day tocilizumab was administered. Factors independently associated with in-hospital survival at 28 days after tocilizumab administration were assessed. Epidemiologic, demographic, laboratory, prognostic scores, treatment, and outcome data were collected and analyzed. Clinical response was collected and defined as a decline of two levels on a six-point ordinal scale of clinical status or discharged alive from the hospital. Of the 81 patients included, the median age was 64 (58-71) years and 56 (69.1%) were male. The 28 day in-hospital mortality was 43.2%. There were 46 (56.8%) patients in the survivors and 35 (43.2%) in the non-survivors group. On study day 0 no differences were noted in demographics, clinical characteristics, severity of illness scores, or treatments received between survivors and non-survivors. C-reactive protein was significantly higher in the non-survivors compared to survivors. Compared to non-survivors, recipients of tocilizumab within 12 days of symptom onset was independently associated with survival (adjusted OR: 0.296, 95% CI: 0.098-0.889). SOFA score ≥8 on day 0 was independently associated with mortality (adjusted OR: 2.842, 95% CI: 1.042-7.753). Clinical response occurred more commonly in survivors than non-survivors (80.4% vs. 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Early receipt of tocilizumab in patients with severe COVID-19 was an independent predictor for in-hospital survival at 28 days.

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Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT. Case 2 involved a 55-year-old male with worsening cardiogenic shock which resulted in left ventricle Impella support. Due to decreased purge flow rates and concerns for clotting, argatroban was added to the purge solution. Both patients' total argatroban regimens were monitored and adjusted by pharmacy, resulting in therapeutic anticoagulation without any major bleeding or thrombotic events. Subsequently, a protocol was designed and implemented. These case reports appear to demonstrate the safe and effective use of argatroban purge solutions for the necessary anticoagulation with an Impella device. Further studies are needed to confirm these results and determine the optimal dosing regimen.

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Apixaban in patients with impaired renal function is supported by limited data. Landmark clinical trials evaluating apixaban in patients with atrial fibrillation and/or acute venous thromboembolism excluded patients with creatinine clearance (CrCl) &lt;25 mL/min. This multicenter, retrospective chart review was conducted to evaluate the safety and effectiveness of apixaban compared with warfarin in patients with CrCl &lt;25 mL/min. Included patients were newly initiated on apixaban or warfarin for at least 45 days with a CrCl &lt;25 mL/min. Patients were evaluated for thrombosis and bleeding outcomes 6 months following initiation of anticoagulation. The primary outcome was the time to first bleeding or thrombosis event. A total of 128 patients met inclusion criteria in the apixaban group and 733 patients in the warfarin group. Time to first bleeding or thrombosis event was significantly different between the apixaban and warfarin groups. Cox proportional hazards model was conducted to control for potential confounding factors for the primary outcome. After controlling for atrial fibrillation and coronary artery bypass grafting, risk of thrombotic and bleeding events was lower in the apixaban group (hazard ratio, 0.47; 95% confidence interval, 0.25-0.92). There was not a statistical difference between time to thrombosis (83 days vs 54 days, P = .648), rate of thrombosis (5.5% vs 10.3%, P = .08), time to bleeding (46 days vs 54 days, P = .886), or rate of bleeding (5.5% vs 10.9%, P = .06). The severity of bleeding and thrombotic events was not different between groups. Apixaban may serve as a reasonable alternative compared with warfarin in patients with severe renal dysfunction.

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Introduction The use of antipsychotics reduces the duration of intensive care unit (ICU) delirium. Continuation of antipsychotics prescribed for ICU delirium at hospital discharge has been an increasingly reported phenomenon with risk factors for continuation upon discharge identified. Objective To evaluate a pharmacist‐driven discontinuation protocol on the rate of patients with an antipsychotic continued at hospital discharge for ICU delirium. Methods This was a single‐center, retrospective quasi‐experimental study of patients admitted to the medical, surgical, or cardiac ICU started on antipsychotics for delirium. A protocol was developed for pharmacists to discontinue scheduled antipsychotics once delirium had resolved. The pre‐ and post‐protocol groups included patients between November 2015 to April 2016 and November 2017 to April 2018, respectively. The primary outcome was the rate of antipsychotic continuation at hospital discharge in the pre‐ and postprotocol groups. Secondary outcomes were related to antipsychotic use and adverse events. Chi‐square, Fisher's exact test, Mann‐Whitney U test, and t‐test were used as appropriate. Results A total of 158 patients were included. There were no differences in baseline demographics including age, gender, ICU type, baseline QTc, ICU length of stay (LOS) or hospital LOS (25 [13, 34] vs 19 [13, 30] days; P > .05). There was a significant reduction in the rate of antipsychotics continued at hospital discharge with 26 (32.9%) and 6 (7.6%) patients having therapy continued in the pre‐ and postprotocol groups, respectively (P < .001). No differences were noted in antipsychotic continuation upon transfer to floor, QTc prolongation, or recurrence of delirium within 7 days of antipsychotic discontinuation. Conclusions Implementation of a pharmacist‐driven antipsychotic discontinuation protocol for delirium was associated with a significant decrease in antipsychotic continuation at hospital discharge. The protocol did not result in a significantly higher incidence of QTc prolongation or recurrence of delirium. Future studies are needed to assess antipsychotic discontinuation in the ICU setting.