Functional and Performance Characteristics Including Principles of Placing the Elements of Voice Alarm Systems on the Market

Aim: The aim of the article was to present voice alarm systems and discuss the legitimacy of their use in fire alarm systems. The article presents the principles of introducing the elements of voice alarm systems to the market and their functional and operational properties. The article was written on the basis of a master’s thesis entitled “The analysis of the functional and operational properties of voice alarm systems” submitted at the Faculty of Safety and Civil Protection Engineering of the Main School of Fire Service. Introduction: Voice alarm system is one of the methods of warning the users of facilities about a threat, but there are many methods of alerting, e.g. sounders or optic signalling devices. Each of the above-mentioned systems has its advantages and disadvantages, so the application of the appropriate system, regardless of whether the regulations impose this obligation on the investor or it will be done on investor's own require deep consideration. Methods: There are several legal acts in force in Poland that define various aspects of voice alarm systems. Facilities in which the use of voice alarm systems (VAS) is mandatory are listed in the Regulation of the Minister of Interior and Administration of 7 June 2010 on fire protection of buildings, other construction facilities and areas. In turn, the specification of the documents required for individual VAS elements is specified in the Regulation (EU) No 305/2011 of the European Parliament and of the Council of 9 March 2011 establishing harmonized conditions for the marketing of construction prod- ucts and repealing Council Directive 89/106/EEC and additionally in Poland in the annex to the regulation of the Minister of Interior and Administration of 20 June 2007 on the list of products used to ensure public safety or protection of health and life and property, as well as the rules for issuing admittance for use of these products. Results: It has been found that many elements of voice alarm systems require careful analysis. Starting with the conformity assessment of the system components through its parameters, such as speech intelligibility, coverage angles or the appropriate sound pressure level. It is also important to select the system for the intended functional use of the rooms and to verify the correct operation of the system after changing the arrangement. Conclusions: Voice alarm systems are a very good, but relatively expensive system. They allow for a very diverse operation and facilitate appropriate evacuation. However, despite the high costs, it is worth considering their installation due to the invaluable action in terms of ensuring the safety of the users of the facility and the protection of their lives. Keywords: voice alarm systems, loudspeakers, maintenance, conformity assessment, phased evacuation Type of article: review article

ISSUES OF INTERACTION BETWEEN PERSONS INVOLVED IN THE ELECTRONIC DOCUMENT FLOW IN THE NOTARIAL SPHERE

The given article is devoted to certain legal issues arising in information field during participants’ communication on electronic document management while performing notarial acts. In the presented study the key legal acts establishing the major regulations of interdepartmental cooperation of notary and governmental bodies and organizations as well as corresponding contractual acts on information communication in the notary field have been analyzed. Some difficulties in information exchange confirmed by specific examples from notarial practice have been defined which enabled introduction of some legislative proposals on improvements in remote electronic document management communication format. In conclusion the importance of information cooperation expansion has been underlined alongside with importance of remote notarial service introduction requiring additional legal regulation, particularly in the field of electronic infrastructure specification.

Results of the reform of the emergency medical service in the Pavlodar Region

Improving the organization of medical care allows providing standardized and timely medical care of higher quality not only to residents of cities, but also to the population living in rural areas. This is achieved by the gradual reorganization of the emergency medical service, introduction of innovative technologies, 100 % provision of ambulances with medical equipment, and training of medical personnel of emergency medical teams.

Outsourced management service to guarantee safety and cost-effectiveness in pediatric cardiac surgery

Background Children’s hospitals deal with young patients, who have greater variability than adults, therefore size of the medical devices ranges from the newborn to the adult-like patient. This complexity is associated with higher costs to ensure safety and logistics. In June 2014 Bambino Gesù Children’s Hospital (OPBG) adopted an outsourced service for medical device acquisition and stock records for the execution of cath-lab and heart surgery interventions. Goal To evaluate the services effectiveness multi-dimensionally in terms of cost saving, safety, outcomes and operator satisfaction. We measured costs and indicators in pre and post intervention. Materials and methods. We compared the years from 2013 to 2017 in terms of cost-related device and prosthesis consumption, including mean costs per intervention using ANOVA with Tukey’s Post-hoc test. To evaluate the clinical proxy outcome we calculated the pediatric index of mortality for each year. Results In 2013-2017 we performed a mean of 1985 (ds 140) procedures per year with devices, the sample is homogeneous in size and clinical complexity. The trend shows a solid decrease of expenses after the service introduction: we observed a reduction of 20% of the mean consumption per intervention between year 2013 and year 2017 (1707€ vs 1391€) P < 0.001. For what concerns outcomes we noticed a reduction of Standardized Mortality Ratio index from 0.51 to 0.27 (CI 0.18-0.42) in 2014-2017. Discussion Outcome indicators excludes any increase of risk following the adoption of the service. The hospital pharmacy did not receive any reports regarding incidents attributable to the service. The nurses evaluated the service positively regarding the availability, traceability of the devices and decrease of the warehouse work. Conclusions Outsourced service has been cost saving, safe and well accepted by operators and in our opinion is replicable also in other highly complex pediatric hospital settings. Key messages Children hospitals are associated with higher costs to ensure safety and logistics in surgery and cath-lab with medical devices. Outsourced management service can promote cost saving and safety.

61 Impact of Dedicated Geriatrician Involvement on National Emergency Laparotomy Audit Standards and Outcomes

Background Older patients undergoing emergency laparotomy (EmLap) have high levels of mortality and morbidity. The National Emergency Laparotomy Audit (NELA) in the United Kingdom records processes and outcome measures for patients undergoing EmLap. Recent data shows that geriatrician review is associated with reduced post-surgical mortality (Oliver C.M. et al., British Journal of Anaesthesia 2018). Geriatrician review of all patients aged ≥70 years is a NELA standard. However, the most recent national report shows only 23% compliance, falling short of the target of 80% and consistently the poorest performing standard. Methods In August 2018, we established a dedicated gastrointestinal surgery liaison service to replace ad hoc geriatrician reviews. We evaluated the impact on NELA standard compliance and patient outcomes. Data were extracted from the local NELA database on all patients aged ≥70 years, for the first six months of the service (September to February). These were compared to the same time period in the preceding year prior to service launch. Results Following service introduction, increased numbers of patients aged ≥70 years underwent EmLap: 50 (2018-9) vs 31 (2017-8). Geriatrician review occurred in 86% (n=43) in 2018-9, compared to 16% (n=5) in 2017-8. Inpatient mortality fell from 23% (n=7) in 2017-8 to 14% (n=7) in 2018-9. Discharge to own home rose to 76% (n=38) in 2018-9 from 68% (n=21) in 2017-8. One patient in each cohort was newly discharged to a nursing home. Mean length of stay was 17.9 days in 2018-9 (range 3-75), versus 17.6 in 2017-8 (range 3-94). Conclusion Introduction of a dedicated geriatric surgical liaison service is associated with increased compliance with NELA standards. Despite more emergency laparotomies being performed on older patients, this was associated with improved mortality and rates of home discharge, consistent with published data. Targeted investment in surgical liaison services may therefore be warranted.

148 Orthogeriatrics, Just the Beginning

Background The most common cause of admission to the orthopaedic ward are low trauma falls resulting in a hip fracture. These fragility fractures occur in older, frail, multi-morbid patients and they are associated with a high mortality rate and significant loss of independence. The Irish Hip Fracture Database is a national clinical audit that aims to improve hip fracture care and patient outcomes. Using the Irish Hip Fracture Standards, we aimed to audit the care of hip fracture patients in an Irish Model 3 Hospital pre- and post- implementation of an orthogeriatrics service. Methods Local Irish Hip Fracture Database was reviewed to assess the six Irish Hip Fracture Standards prior and 4 months following the introduction of a consultant-led dedicated orthogeriatrics service. Results There were 63 hip fracture patients (mean age 81) in the pre-service group and 69 (mean age 81) in the post-service group. Standard 1: 3.2% of hip fractures were admitted to the orthopaedic ward within 4 hours in the pre-service group versus 18.8% post-service introduction (national average 11%, 2017). Standard 2: 67.9% underwent surgery within 48 hours and during working hours versus 67.8% (national average 69%, 2017). Standard 3: 3.5% developed a pressure ulcer during their stay pre-service versus 1.6% post-service (national average 3%, 2017). Standard 4: 4.8% were assessed by a Geriatrician pre-service versus 84% post-service (national average 50%, 2017). Standard 5: 24.6% received a bone health assessment versus 87.5% post-service (national average 73%, 2017). Standard 6: 1.8% received a falls assessment prior to discharge versus 82.8% post-service (national average 47%, 2017). Conclusion The introduction of a dedicated orthogeriatrics service has led to a more collaborative multi-disciplinary approach to patient care with evidence of improvements in all Irish Hip Fracture Standards. Commitment to a resourced orthogeriatric service providing rapid comprehensive geriatric assessments is essential to advance improvements in older patients’ care.

DETERMINANTS OF CLOUD COMPUTING ADOPTION BY ROMANIAN SMES IN THE DIGITAL ECONOMY

The purpose of this paper is to explore the process of Cloud Computing adoption within Romanian Small and Medium sized Enterprises in the digital age. Most of the scientific papers related to this topic examine the general outlook of cloud computing implementation in Romania and focus on the use of the afore-mentioned technologies by large scale companies. In order to identify the factors that have an influence over the choice of Romanian SMEs to adopt cloud computing technology, a conceptual model has been set forth. The model’s dependent variable is the choice of the company’s management to implement cloud computing technologies. Five different independent types of variable structures which have an effect on the adoption of cloud computing within SMEs were identified. The five categories of variables are competition & government, ICT providers & firm departments, employee, manager and technological factors. Each of these categories of determinants encompasses at their turn two or more constructs. An online survey tested the model based on the responses of managers and directors from 198 Romanian SMEs from the cities of Bucharest and Cluj. The validity of the model was performed by completing factor analysis and reliability tests of the data; a logistic regression analysis was deployed to test the research hypotheses. The results emphasized that the managers’ know-how on cloud computing and the perceived costs of implementing the technology represent the main components influencing the spreading of cloud computing among Romanian SMEs. This study makes a valuable contribution to the academic environment but to businesses as well. The model can be used to examine the implementation of different innovative applications. Companies which offer cloud computing services could take advantage of the outcomes of this study to expand the degree of cloud service introduction among SMEs.