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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1: Where it read: […]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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ORIGINAL ARTICLE08-07-2023
King’s Parkinson’s Disease Pain Questionnaire: reliability and convergent construct validity
Revista Brasileira de Enfermagem. 2023;76(3):e20220379
Abstract
ORIGINAL ARTICLEKing’s Parkinson’s Disease Pain Questionnaire: reliability and convergent construct validity
Revista Brasileira de Enfermagem. 2023;76(3):e20220379
DOI 10.1590/0034-7167-2022-0379
Views0See moreABSTRACT
Objectives:
to assess the evidence of reliability and convergent construct validity of the King’s Parkinson’s Disease Pain Questionnaire.
Methods:
psychometric study of 75 older adults with Parkinson’s disease. The instrument was applied by two researchers separately and reapplied by one researcher 15 days later. In terms of reliability, internal consistency was assessed using the Cronbach’s alpha test and stability using the intraclass correlation coefficient. Scores of the King’s Parkinson’s Disease Pain Questionnaire were compared to those of the Geriatric Pain Measure in the assessment of construct validity.
Results:
the mean Cronbach’s alpha obtained between the three assessments was above 0.60, the intraclass correlation between the three assessments was above 0.90, and there was a weak but significant correlation between the two applied scales.
Conclusions:
the instrument showed adequate evidence of convergent construct validity and reliability, and can be used in clinical practice.
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ORIGINAL ARTICLE08-07-2023
The relationship of general, physical, and psychological violence with depressive symptoms and cognition in elders (cross-sectional study)
Revista Brasileira de Enfermagem. 2023;76(3):e20220375
Abstract
ORIGINAL ARTICLEThe relationship of general, physical, and psychological violence with depressive symptoms and cognition in elders (cross-sectional study)
Revista Brasileira de Enfermagem. 2023;76(3):e20220375
DOI 10.1590/0034-7167-2022-0375
Views0See moreABSTRACT
Objectives:
to analyze the relationship of general, physical, and psychological violence with depressive symptoms and cognition in the elderly.
Methods:
quantitative, cross-sectional study, carried out with 323 elders from the Brazilian northeast. Data collection used a sociodemographic instrument; the Conflict Tactics Scales Form R; the Geriatric Depression Scale; and the Mini-Mental State Examination. The analysis employed descriptive and inferential statistics.
Results:
as violence increases, so do the depressive symptoms; the opposite was true when comparing violence with cognitive involvement. There is a correlation between physical and psychological violence and depressive symptoms; more depressive elders are from 1.96 to 3.00 times more likely to be the victims of psychological and physical violence, respectively.
Conclusions:
general, physical, and psychological violence is associated with depressive symptoms; those with less cognitive alterations are more vulnerable to abuse. Elders with depressive symptoms are more likely to suffer psychological and physically violence.
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ORIGINAL ARTICLE08-07-2023
Professional burnout and patient safety culture in Primary Health Care
Revista Brasileira de Enfermagem. 2023;76(3):e20220311
Abstract
ORIGINAL ARTICLEProfessional burnout and patient safety culture in Primary Health Care
Revista Brasileira de Enfermagem. 2023;76(3):e20220311
DOI 10.1590/0034-7167-2022-0311
Views0ABSTRACT
Objectives:
to analyze the association between the risk of occupational exhaustion (burnout) and safety culture in Primary Health Care.
Methods:
ross-sectional study conducted in 18 Primary Health Care Units in the Northeast of Brazil. Three questionnaires were used: sociodemographic, Maslach Burnout Inventory, and the Medical Office Survey on Patient Safety Culture. The study was approved by the Research Ethics Committee.
Results:
seventy-eight healthcare workers participated, of which 64.1% presented a reduced risk of burnout; and 11.5%, a high risk (p=0.000). The following were identified as weakened dimensions of safety culture: Work pressure and pace; Owner, managing partners, leadership support; Overall ratings on quality; and Overall rating on patient safety.
Conclusions:
an association was found between low risk of developing burnout syndrome and positive evaluation of safety culture.
Keywords:Health PersonnelOccupational BurnoutOrganizational CulturePatient SafetyPrimary Health CareSee more -
ORIGINAL ARTICLE08-07-2023
Undergraduate nursing students’ knowledge and experience in infusion therapy and peripheral vascular acces
Revista Brasileira de Enfermagem. 2023;76(3):e20220219
Abstract
ORIGINAL ARTICLEUndergraduate nursing students’ knowledge and experience in infusion therapy and peripheral vascular acces
Revista Brasileira de Enfermagem. 2023;76(3):e20220219
DOI 10.1590/0034-7167-2022-0219
Views0ABSTRACT
Objectives:
to analyze the knowledge and experience of undergraduate nursing students regarding infusion therapy and peripheral vascular access.
Methods:
descriptive, cross-sectional, analytical study with 123 undergraduate nursing students who answered a semi-structured instrument.
Results:
the majority were women, with a median age of 51 years old; 87% considered the teaching received insufficient to perform in clinical practice. The mean overall knowledge score was 78.1 (SD± 8.97). The themes catheter flushing and lock (38.1%), catheter selection (34.2%), infusion equipment (30.9%) and insertion site (30.9%) presented a significant number of errors.
Conclusions:
practical classes and execution of procedures in health services were predictors for a better knowledge about infusion therapy and vascular access by undergraduate nursing students.
Keywords:Education, NursingEducation, Nursing, Diploma ProgramsKnowledgeNursingVascular Access DevicesSee more -
EDITORIAL07-31-2023
Primeira graduada do Mestrado em Enfermagem em Prática Avançada em Oncologia no Chile
Revista Brasileira de Enfermagem. 2023;76:e76suppl401
Abstract
EDITORIALPrimeira graduada do Mestrado em Enfermagem em Prática Avançada em Oncologia no Chile
Revista Brasileira de Enfermagem. 2023;76:e76suppl401
DOI 10.1590/0034-7167.202376suppl401pt
Views0Em 2020, as diretrizes para a implementação da Prática Avançada de Enfermagem (EPA)() foram publicadas pelo Conselho Internacional de Enfermagem (ICN). Na ocasião, fui convocada para comentar a realidade das enfermeiras especialistas no Chile, expressando a expectativa de implantação de um programa de EPA, especificamente o de Enfermeira Clínica Especialista (ECE). A ECE é uma […]See more -
EDITORIAL07-31-2023
First graduate of the Master of Nursing in Advanced Practice in Oncology in Chile
Revista Brasileira de Enfermagem. 2023;76:e76suppl401
Abstract
EDITORIALFirst graduate of the Master of Nursing in Advanced Practice in Oncology in Chile
Revista Brasileira de Enfermagem. 2023;76:e76suppl401
DOI 10.1590/0034-7167.202376suppl401
Views0In 2020, the guidelines for Advanced Nursing Practice (APN) implementation() were published by the International Council of Nursing (ICN). On that occasion, I was invited to comment on the reality of specialist nurses in Chile, expressing the expectation of implementing an APN program, specifically Clinical Nurse Specialists (CNS). CNS are one of the most internationally […]See more -
ORIGINAL ARTICLE07-31-2023
Sociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital
Revista Brasileira de Enfermagem. 2023;76:e20220730
Abstract
ORIGINAL ARTICLESociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital
Revista Brasileira de Enfermagem. 2023;76:e20220730
DOI 10.1590/0034-7167-2022-0730
Views0See moreABSTRACT
Objectives:
to analyze the sociodemographic profile, diagnoses and nursing care of post-COVID-19 patients admitted to a university hospital in southern Brazil.
Methods:
a retrospective cohort study. The sample consisted of 1,467 medical records, from January 2020 to January 2021.
Results:
from the analyzed medical records, the most prevalent profiles, respectively, included: males (52.9%); white (81.1%); with Impaired Physiological Balance Syndrome* Nursing Diagnosis (77.3%); nursing care implementing aerosol precautions (94.5%); implementing droplet precautions (93.4%); checking vital signs (91.9%); applying standard disinfectant to equipment and surfaces (89.6%).
Conclusions:
the analysis of the sociodemographic profile, diagnoses and nursing care of patients in this study may contribute to implementing the Nursing Process in the coronavirus pandemic context.
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EDITORIAL01-01-2015
A Pesquisa em Enfermagem e os novos rumos a partir do SENPE
Revista Brasileira de Enfermagem. 2015;68(4):571-572
Abstract
EDITORIALA Pesquisa em Enfermagem e os novos rumos a partir do SENPE
Revista Brasileira de Enfermagem. 2015;68(4):571-572
DOI 10.1590/0034-7167.2015680401i
Views0Após quase meio século do início da pesquisa em Enfermagem no Brasil, ainda há necessidade de investimentos para considerá-la consolidada. Os seminários nacionais que discutem a investigação nesta área demonstram esta afirmação ao longo de 17 eventos, por seus resultados e participação da categoria de pesquisadores e prestadores de serviço.O 18º Seminário Nacional de Pesquisa […]See more -
REFLECTION01-01-2015
Comprehensive health care: dilemmas and challenges in nursing
Revista Brasileira de Enfermagem. 2015;68(2):333-338
Abstract
REFLECTIONComprehensive health care: dilemmas and challenges in nursing
Revista Brasileira de Enfermagem. 2015;68(2):333-338
DOI 10.1590/0034-7167.2015680221i
Views0See moreABSTRACT
Objective:
this article discusses comprehensive care as a guiding tenet of the Brazilian Unifi ed Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge.
Methods:
this is a theoretical refl ection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects.
Conclusion:
care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.
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REVIEW01-01-2015
Gender and violence against women in nursing literature: a review
Revista Brasileira de Enfermagem. 2015;68(2):325-332
Abstract
REVIEWGender and violence against women in nursing literature: a review
Revista Brasileira de Enfermagem. 2015;68(2):325-332
DOI 10.1590/0034-7167.2015680220i
Views0See moreABSTRACT
Objective:
considering the potential of nursing to expand understanding on this theme, this study aims to learn what is being published on gender and violence against women in the main Brazilian nursing journals.
Method:
an integrative review of online publications between 2000 and 2012 was conducted. Of the 138 articles selected, 25 addressed gender and violence against women as social constructs.
Results:
there was a predominance of qualitative approaches (60%), empirical research (60%), academic (100%), authors who were nurses (96%), spousal violence (32%) and domestic violence (20%). Violence against women in the light of gender was associated in only 32% of the articles.
Conclusion:
there is a need for increased studies in partnership with the public health care service, and to expand discussions on the dynamics of power and resistance, which are the basis of the concept of gender.
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RESEARCH01-01-2015
Nasal colonization in nursing professionals from units specialized in HIV/AIDS
Revista Brasileira de Enfermagem. 2015;68(2):320-324
Abstract
RESEARCHNasal colonization in nursing professionals from units specialized in HIV/AIDS
Revista Brasileira de Enfermagem. 2015;68(2):320-324
DOI 10.1590/0034-7167.2015680119i
Views0See moreABSTRACT
Objective:
to investigate the presence of microorganisms in the nostrils of the nursing professionals of a Brazilian teaching hospital.
Method:
cross-sectional study in two inpatient units specialized in HIV/AIDS. Nasal secretion samples of nursing professionals were collected in one month. The samples were processed at the microbiology laboratory of the institution and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19.0. Ethical aspects were abided.
Results:
from the 73 members of the nursing staff, samples of nasal secretions were collected from 61 (80.2%). Six types of microorganisms were isolated in 22 (41.0%) positive cultures. It is noteworthy that Staphylococcus aureus accounted for 22.9%, four of them oxacillin-resistant (MRSA).
Conclusion:
Staphylococcus aureus microorganism accounted for the largest prevalence in individuals of this study.
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RESEARCH01-01-2015
Evaluation of nursing students about learning with clinical simulation
Revista Brasileira de Enfermagem. 2015;68(2):311-319
Abstract
RESEARCHEvaluation of nursing students about learning with clinical simulation
Revista Brasileira de Enfermagem. 2015;68(2):311-319
DOI 10.1590/0034-7167.2015680218i
Views0See moreABSTRACT
Objective:
to describe the contributions of clinical simulation for learning cognitive and procedural attributes through debriefi ng, from the perspective of nursing students.
Method:
descriptive exploratory study. Twenty nursing undergraduate students from a university in the interior of the state of São Paulo participated in this study. Data collection was performed at the debriefi ng stage. Student’s perceptions about the simulation, positive aspects and what they could have done differently were registered. The students’ statements were grouped according to the central themes and the framework of Bardin’s content analysis (2011) and were analyzed using descriptive statistics.
Results:
enhancement of active, critical and refl ective learning (47.5%) was identifi ed due to the closeness to reality in nursing care (20.3%), manifestation of feelings experienced during the simulation (15.3%) and composition of the scenario (15.3%).
Conclusion:
the clinical simulation followed by debriefi ng promotes the understanding of the link between action and achievements in learning.
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RESEARCH01-01-2015
Risk assessment of patient falls while taking medications ordered in a teaching hospital
Revista Brasileira de Enfermagem. 2015;68(2):305-310
Abstract
RESEARCHRisk assessment of patient falls while taking medications ordered in a teaching hospital
Revista Brasileira de Enfermagem. 2015;68(2):305-310
DOI 10.1590/0034-7167.2015680217i
Views0See moreABSTRACT
Objective:
to stratify prescribed medication in a fall risk scale, identifying subgroups of drugs and inpatient units with higher risk of falls.
Method:
retrospective study on prescription order forms given by medical clinic, surgical clinic, and general intensive care unit. Risk factors under consideration: 1) orthostatic hypotension; 2) arterial hypotension; 3) arterial hypertension; 4) bradycardia; 5) psychomotor agitation; 6) mental confusion; 7) dizziness; 8) drowsiness/sedation; 9) reduced eyesight; 10) seizures; 11) atonia/dystonia/muscle weakness; 12) hypoglycemia; 13) urgent urination and 14) urgent defecation/diarrhea. Risk levels adopted: 0: 0 factor; I: 1-2 factors; II: 3-5 factors; III: 6-9 factors; IV: 10-14 factors.
Results:
3893 drugs were analyzed and stratifi ed in levels: 0 22.7%; I 33.5%; II 28%; III 15.1%; IV 0.7%. Levels III and IV more often refer to drugs for stomach acid disorders, 22.6%, and psycholeptics, 100%.
Conclusion:
knowing the risk factors associated with medication may help prevent and reduce falls, especially when therapeutic regimens cannot be modifi ed.
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RESEARCH01-01-2015
Knowledge and practice of the nurse about leprosy: actions of control and elimination
Revista Brasileira de Enfermagem. 2015;68(2):297-304
Abstract
RESEARCHKnowledge and practice of the nurse about leprosy: actions of control and elimination
Revista Brasileira de Enfermagem. 2015;68(2):297-304
DOI 10.1590/0034-7167.2015680216i
Views0See moreABSTRACT
Objective:
to assess the knowledge and practice of primary health care nurses about control and elimination actions of leprosy.
Method:
evaluation study with qualitative approach, using the Discourse of the Collective Subject, data were collected through semi-structured interviews conducted with 16 nurses.
Results:
the data collected revealed that health professionals have suffi cient knowledge about the National Policy on Control and Elimination of Leprosy (NPCEL) and that the main actions preconized were applied, however, notifi cation of suspected or confi rmed cases and social reintegration of the patient were not mentioned.
Conclusion:
keeping patients in treatment, overload of work, lack of interdisciplinarity and treatment performed at other locations outside of the community were diffi culties reported by professionals. Nurses know the actions addressed at assistance of leprosy patients, however, the study points to the need for a practice which is more aligned to what advocates NPCEL.
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RESEARCH01-01-2015
Weaknesses of vaccine storage in Primary Healthcare Centers
Revista Brasileira de Enfermagem. 2015;68(2):291-296
Abstract
RESEARCHWeaknesses of vaccine storage in Primary Healthcare Centers
Revista Brasileira de Enfermagem. 2015;68(2):291-296
DOI 10.1590/0034-7167.2015680215i
Views0See moreABSTRACT
Objective:
assessment through qualitative approach of vaccine storage in Primary Healthcare Centers.
Method:
assessment study of qualitative approach in which 30 interviews were conducted with nurses, nursing technicians or assistants and technical reference in immunization, in 12 vaccine rooms that had 100% of the structural criteria evaluated. Recorded testimonials of the subjects were organized and analyzed using thematic Content Analysis.
Results:
the assessment pointed to absence of knowledge on the parts of nurses and nursing technicians and assistants with respect to the effects of low temperature on vaccines. Barriers were also encountered in relation to the supervision of nurses in the vaccine room activities and in relation to the knowledge needed by workers to care for preservation of vaccines.
Conclusion:
vaccine storage is inadequate and may compromise the quality of the immunobiologicals dispensed to the populace.
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