What is a Medline (Medical Literature Analysis and Retrieval System Online) shift?

From the Guidelines

The Medline shift is not a recognized term in the provided evidence, and therefore, its implementation or specifics cannot be directly recommended based on the given studies. The provided study 1 focuses on genomic health literacy interventions in pediatrics and does not address scheduling approaches in healthcare or the concept of a "Medline shift."

Key Considerations

• The study 1 discusses a scoping review on genomic health literacy interventions in pediatrics, which does not relate to healthcare scheduling systems.
• There is no mention of the "Medline shift" or any similar concept in the provided evidence.
• Implementing any scheduling system in healthcare should prioritize reducing handoffs, enhancing provider well-being, and increasing continuity of care.

Recommendations for Scheduling Systems

• When considering scheduling approaches, prioritize systems that reduce handoffs and enhance provider well-being.
• Ensure adequate overlap between shifts for proper handoffs and limit consecutive night shifts to prevent burnout.
• Providers should be allowed sufficient time off after completing night blocks to recover.
• Preparation for night shifts should include gradual adjustment of sleep schedules, maintenance of a dark sleeping environment during daylight hours, and strategic caffeine consumption.

From the Research

Medline Shift

• Medline shift is not directly mentioned in the provided studies, however, the concept of metabolic acidosis and its treatment is discussed in detail.
• Metabolic acidosis is characterized by a primary reduction in serum bicarbonate (HCO(3)(-)) concentration, a secondary decrease in the arterial partial pressure of carbon dioxide (PaCO(2)) of approximately 1 mmHg for every 1 mmol/l fall in serum HCO(3)(-) concentration, and a reduction in blood pH 2.
• The treatment of metabolic acidosis with sodium bicarbonate is controversial due to the lack of definitive benefit and potential complications, but it may be beneficial in certain cases, such as severe metabolic acidosis or chronic kidney disease 3, 2, 4.
• Isotonic sodium bicarbonate-based continuous hemodiafiltration is a novel method to correct severe metabolic acidosis by eliminating chloride and supplementing bicarbonate 5.
• The mechanisms of generation, maintenance, and treatment of metabolic alkalosis are also discussed in the context of renal bicarbonate reabsorption and acid excretion 6.

Key Findings

• Treatment of metabolic acidosis with sodium bicarbonate may improve kidney and patient survival in chronic kidney disease 4.
• Isotonic sodium bicarbonate-based continuous hemodiafiltration effectively corrects metabolic acidosis without inducing sodium and water overload 5.
• Measurement of urinary pCO2 in maximally alkaline urine is a useful qualitative method to assess distal acidification 6.

Treatment Considerations

• The indication for sodium bicarbonate therapy requires a risk-benefit assessment, considering its complications such as hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis 3.
• The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium 3.