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  1. Lee DS, Abdullah KL, Subramanian P, Bachmann RT, Ong SL
    J Clin Nurs, 2017 Dec;26(23-24):4065-4079.
    PMID: 28557238 DOI: 10.1111/jocn.13901
    AIMS AND OBJECTIVES: To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses.

    BACKGROUND: Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care.

    DESIGN: Integrated literature review.

    METHODS: The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review.

    RESULTS: Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results.

    CONCLUSIONS: Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors.

    RELEVANCE TO CLINICAL PRACTICE: This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making is still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making.

  2. Lee DSK, Abdullah KL, Chinna K, Subramanian P, Bachmann RT
    J Contin Educ Nurs, 2020 Mar 01;51(3):109-117.
    PMID: 32119105 DOI: 10.3928/00220124-20200216-05
    BACKGROUND: Previous studies of nurses' critical thinking skills that included demographic characteristics as determinants have been inconclusive. This study explored demographic determinants of critical thinking skills among nurses from public hospitals in Peninsular Malaysia.

    METHOD: This cross-sectional study included 549 nurses recruited via multistage cluster sampling. Nurses completed the demographic questionnaire and Health Sciences Reasoning Test (HSRT).

    RESULTS: The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (SD = 3.4). Educational qualifications (p = .003) and clinical specialties (p = .022) were significantly related to nurses' critical thinking skills. Years of clinical experience, age, and job ranking were not significant CONCLUSION: The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. [J Contin Educ Nurs. 2020;51(3):109-117.].

  3. Bai Y, Rafiq MK, Li S, Degen AA, Mašek O, Sun H, et al.
    J Hazard Mater, 2021 02 05;403:123647.
    PMID: 33264862 DOI: 10.1016/j.jhazmat.2020.123647
    Yak dung is used as fuel in Tibetan homes; however, this use is hazardous to health. An alternative use of the dung that would be profitable and offset the loss as a fuel would be very beneficial. Sweet sorghum silage with yak dung biochar as an additive was compared with a control silage with no additives and three silages with different commercial additives, namely Lactobacillus buchneri, Lactobacillus plantarum and Acremonium cellulase. Biochar-treated silage had a significantly greater concentration of water-soluble carbohydrates than the other silages (76 vs 12.4-45.8 g/kg DM) and a greater crude protein content (75.5 vs 61.4 g/kg DM), lactic acid concentration (40.7 vs 27.7 g/kg DM) and gross energy yield (17.8 vs 17.4 MJ/kg) than the control silage. Biochar-treated and control silages did not differ in in vitro digestibility and in total gas (507 vs 511 L/kg DM) and methane production (57.9 vs 57.1 L/kg DM). Biochar inhibited degradation of protein and water-soluble carbohydrates and enhanced lactic acid production, which improved storability of feed. It was concluded that yak dung biochar is an efficient, cost-effective ensiling additive. The profit could offset the loss of dung as fuel and improve the health of Tibetan people.
  4. Rafiq MK, Bachmann RT, Rafiq MT, Shang Z, Joseph S, Long R
    PLoS One, 2016;11(6):e0156894.
    PMID: 27327870 DOI: 10.1371/journal.pone.0156894
    This study examined the influence of pyrolysis temperature on biochar characteristics and evaluated its suitability for carbon capture and energy production. Biochar was produced from corn stover using slow pyrolysis at 300, 400 and 500°C and 2 hrs holding time. The experimental biochars were characterized by elemental analysis, BET, FTIR, TGA/DTA, NMR (C-13). Higher heating value (HHV) of feedstock and biochars was measured using bomb calorimeter. Results show that carbon content of corn stover biochar increased from 45.5% to 64.5%, with increasing pyrolysis temperatures. A decrease in H:C and O:C ratios as well as volatile matter, coupled with increase in the concentration of aromatic carbon in the biochar as determined by FTIR and NMR (C-13) demonstrates a higher biochar carbon stability at 500°C. It was estimated that corn stover pyrolysed at 500°C could provide of 10.12 MJ/kg thermal energy. Pyrolysis is therefore a potential technology with its carbon-negative, energy positive and soil amendment benefits thus creating win- win scenario.
  5. Rafiq MK, Bai Y, Aziz R, Rafiq MT, Mašek O, Bachmann RT, et al.
    Sci Total Environ, 2020 May 15;717:135296.
    PMID: 31839318 DOI: 10.1016/j.scitotenv.2019.135296
    Previous biochar research has primarily focused on agricultural annual cropping systems with very little attention given to highly fragile, complex and diverse natural alpine grassland ecosystems. The present study investigated the effect of biochar on the growth of alpine meadows and soil health. This study was conducted in the Qinghai Tibetan Plateau over a three year period to investigate the effect of three rice husk biochar application rates alone and combination with high and low NPK fertilizer dosages on alpine meadow productivity, soil microbial diversity as well as pH, carbon and nitrogen content at 0-10 cm and 10-20 cm depth. At the end of the 3rd year soil samples were analysed and assessed by combined analysis of variance. The results showed that biochar application in combination with nitrogen (N), phosphorus (P) and potassium (K) fertilizer had a significant increase in fresh and dry biomass during the second and third year of the study as compared to control and alone biochar application (p ≤ 0.05). Biochar alone and in combination with NPK fertilizer resulted in a significant increase in the soil pH and carbon contents of the soil. XPS results, the SEM imaging and EDS analysis of aged biochar demonstrated that the biochar has undergone complex changes over the 3 years as compared to fresh biochar. This research suggests that biochar has positive effect on alpine meadow growth and soil health and may be an effective tool for alpine meadow restoration.
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