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Printable quiz template - Activators Patch
Printable quiz template - Activators Patch
Printable quiz template - Activators Patch
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TPA Therapy

Continuing Education Activity

Alteplase (tPA) is a powerful thrombolytic agent used in the lysis of acute thromboembolism. FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters. There are also off-label indications. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, toxicity, and monitoring, of tPA therapy with agents like alteplase, so providers can direct patient therapy where they are indicated as part of the interprofessional team.

Objectives:

  • Identify the indications for initiating therapy with a tPA agent such as alteplase.

  • Review the mechanism of action of tissue plasminogen activators such as alteplase.

  • Summarize the contraindications and adverse event profile of tPA medications such as alteplase.

  • Describe interprofessional team strategies for improving care coordination and communication to properly use tPA agents like alteplase to improve patient outcomes in the varied scenarios where it can be effective.

Access free multiple choice questions on this topic.

Indications

Alteplase (tPA) is a powerful thrombolytic agent used in the lysis of acute thromboembolism.[1][2][3]

FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters.

Common off-label indications include:

  • Treatment of deep venous thrombosis (DVT) and peripheral arterial thrombosis with local administration of a thrombolytic agent in catheter-directed thrombolysis

  • Ischemic stroke when administered more than 3 hours, but no longer than 4.5 hours, after symptom onset

  • Management of prosthetic valve thrombosis

  • Adjunct treatment of a pediatric pleural effusion or empyema.

Mechanism of Action

Alteplase acts within the endogenous fibrinolytic cascade to convert plasminogen to plasmin by hydrolyzing the arginine-valine bond in plasminogen. The activated plasmin then degrades fibrin and fibrinogen, allowing for the dissolution of the clot and re-establishment of blood flow.[4][5]

Administration

The dosing and administration of tPA are specific to the indication.

FDA Approved Indications

Pulmonary Embolism

  • 100 mg over 2 hours; may be administered as a 10 mg bolus followed by 90 mg over 2 hours

Ischemic Stroke: The only blood test that is necessary before tPA usage is the blood glucose level. If the patient is on anticoagulation like coumadin, then only we should do PT, PTT, and INR, etc. The benefit of tPA depends a lot on time. The sooner the patient receives tPA; the better are the outcomes. 

  • Maximum recommended dose is 90mg 

  • Patients less than or equal to 100 kg load with 0.09 mg/kg (10% of 0.9 mg/kg dose) as an IV bolus over 1 minute, followed by 0.81 mg/kg (90% of 0.9 mg/kg dose) as a continuous infusion over 60 minutes.

  • Patients greater than100 kg load with 9 mg (10% of 90 mg) as an IV bolus over 1 minute, followed by 81 mg (90% of 90 mg) as a continuous infusion over 60 minutes.

STEMI

  • Administer within 30 minutes of hospital arrival

  • Adults greater than or equal to 67 kg get 100 mg total dosage administered as a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes

  • Adults less than 67 kg get 15 mg IV bolus, followed by 0.75 mg/kg IV (not to exceed 50 avid pro tools 11 crack & keygen infused over 30 minutes, and then 0.5 mg/kg IV (not to exceed 35 mg) over the next 60 minutes

IV Catheter Occlusion

  • Instill 2 mg of alteplase in the occluded lumen and allow a 2-hour dwell time. This dose is repeatable one time if the first attempt is not successful, the use of greater than 4 mg of alteplase for this indication has not been a topic of research.

Off-Label Indications

Pediatric Pleural Effusions

  • Four mg in 30 mL to 50 mL 0.9% intrapleural sodium chloride injection via chest tube and left to dwell for 1 hour as a single dose or as multiple doses 24 hours apart

Catheter-Directed Therapy

  • 0.1 mg/kg/hr (maximum of 20 mg per 24 hours for up to 96 hours)

Prosthetic Valve Thrombosis

  • Twenty-five mg intravenously over 25 hours repeated as needed until a total dose of 200 mg of alteplase administered or resolution is confirmable by TEE

Alteplase is administered intravenously as a bolus injection or infusion. In emergencies, it is reasonable to administer tPA Wondershare PDFelement Pro 7.6.6.4995 Crack intraosseous access.

Adverse Effects

The most frequent serious adverse events associated with the administration of tPA are related to bleeding.[6][7][8]

Bleeding associated with alteplase therapy can be divided into two broad categories. Internal bleeding includes intracranial bleeding (0.4% to 15.4%), retroperitoneal bleeding (less than 1%), gastrointestinal (GI) bleeding (5%), genitourinary bleeding (4%), and respiratory bleeding. Superficial or surface bleeding is observed mainly at invaded or disturbed sites such as venous cutdowns, arterial punctures, and recent surgical intervention sites. Less serious spontaneous bleeding includes ecchymosis (1%), gingival bleeding (less than 1%), and epistaxis (less than 1%). In clinical studies of adult patients with acute ischemic stroke (n = 624), a higher incidence of intracranial bleeding, especially symptomatic intracranial bleeding, was seen in patients receiving alteplase compared to placebo (total intracranial bleeding 15.4% versus 6.4%, p < 0.01; symptomatic intracranial Offline Explorer Enterprise 7.8.4660 Free Download with Crack 8% versus 1.3%, p < 0.01). However, there was no increase in the incidence of 90-day mortality or severe disability in patients receiving alteplase. Studies indicate that the incidence of intracranial bleeding is dose-related, with the greatest percentage occurring at a dosage of 150 mg (1.3%) compared to 100 mg (0.4%). Rates of adverse events, including bleeding, correlate to the total exposure of tPA.

Cardiac dysrhythmias may occur when tPA is administered for NSTEMI emco msi package builder silent install - Crack Key For U is related to the re-establishment of tissue perfusion rather than drug exposure.

Allergic reactions, including anaphylactic-type reactions, are possible following exposure to tPA. Various sources of tPA have varying levels of antigenicity. See “streptokinase” for further discussion. The rapid conversion of plasminogen to plasmin signals a complement cascade leading to mast cell degranulation and subsequent anaphylactic reaction.  

Contraindications

A 2016 update was published by the American Heart Association to guide tPA inclusion and exclusion criteria for the management of ischemic stroke. The following list includes the most recent absolute and relative contraindications for therapy as determined by the AHA.

Exclusion Criteria

  • Significant head trauma or prior stroke in the previous 3 months

  • Symptoms suggest subarachnoid hemorrhage

  • Arterial puncture at a noncompressible site in previous 7 days

  • History of previous intracranial hemorrhage

  • Intracranial neoplasm, AVM, or an aneurysm

  • Recent intracranial or intraspinal surgery

  • Elevated blood pressure (systolic greater than 185 mmHg or diastolic greater than 110 mmHg)

  • Active internal bleeding

  • Acute bleeding diathesis, including but not limited to

  • Platelet count less than 100 000/mm^3

  • Heparin received within 48 hours resulting in abnormally elevated aPTT above the upper limit of normal

  • Current use of anticoagulant with INR greater than 1.7 or PT greater than 15 seconds

  • Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (e.g., aPTT, INR, platelet count, ECT, TT, or appropriate factor Xa activity assays)

  • Blood glucose concentration less than 50 mg/dL (2.7 mmol/L)

  • CT demonstrates multilobar infarction (hypodensity greater than a one-third cerebral hemisphere)

Relative Exclusion Criteria

Recent experience suggests that under some circumstances, with careful consideration and weighing of risk to benefit, patients may receive fibrinolytic therapy despite 1 or more relative contraindications. Consider the risk to the benefit of intravenous rtPA administration carefully if any of printable quiz template - Activators Patch relative contraindications are present:

  • Only minor or quickly improving stroke symptoms (clearing automatically)

  • Pregnancy

  • Seizure at the onset with postictal residual neurological impairments

  • Major surgery or serious trauma within prior 14 days

  • Recent GI or urinary tract hemorrhage (within previous 21 days)

  • Recent acute myocardial infarction (within preceding 3 months)

Monitoring

There are printable quiz template - Activators Patch therapeutic drug monitoring recommendations that pertain to the efficacy of tPA therapy. If prolonged off-label therapy is occurring in the event of catheter-directed treatment or repeated dosing in valve thrombosis, serial imaging of the thrombus is reasonable. The safety profile is best monitored by prothrombin time (PT), partial windows movie maker crack 2019 - Activators Patch time (PTT), Hemoglobin, and hematocrit to assess ongoing bleeding. Of note, fibrinogen levels may be an indicator of increased bleed risk for values less than 150mg/dL.

Toxicity

There is no direct reversal agent for the potentially major bleeding that may occur during tPA therapy. Commonly employed strategies include anti-fibrinolytic therapy such as tranexamic acid or aminocaproic acid though there is no research on specific dosages. If fibrinogen levels are less than 150mg/dL, there may be added benefit from fresh frozen plasma or cryoprecipitate. Cryoprecipitate should be used without any delay and monitor the fibrinogen level closely.  

Enhancing Healthcare Team Outcomes

There is no longer any question about the effectiveness of thrombolytic agents for the treatment of several medical disorders, but nurses, pharmacists, and radiologists must be fully aware of their indications and contraindications. For these agents to be effective, not only do they require administration within a certain timeframe, but one also has to ensure that the patient has no condition that contraindicates the therapy. Also, the nurse should educate the patient about the procedure, the need to remain at bed rest for several hours after the procedure, and the need to constantly monitor for bleeding.  Plus, the pharmacist must be familiar with the recent novel anticoagulants and any possible interactions with the thrombolytic drugs. Only through close communication and constant vigilance between the various healthcare professionals can the serious complications of these drugs be prevented. [2][9] [Level V]

Outcomes

There have been many clinical trials undertaken to determine the effectiveness of thrombolytic agents in patients with acute myocardial infarction, pulmonary embolism, acutely ischemic limb, and an embolic stroke. When used to treat acute MI, embolic stroke, and pulmonary embolism, the outcomes are fair to good. The biggest drawback to this therapy is a patient delay in arriving at the emergency room or a delay in diagnosis. These drugs have saved many lives and are cost-effective and reduce hospital stays.[10][11][7] [Level II]

References

1.

Grossberg JA, Rebello LC, Haussen DC, Bouslama M, Bowen M, Barreira CM, Belagaje SR, Frankel MR, Nogueira RG. Beyond Large Vessel Occlusion Strokes: Distal Occlusion Thrombectomy. Stroke. 2018 Jul;49(7):1662-1668. [PubMed: 29915125]

2.

Benoit JL, Khatri P, Adeoye OM, Broderick JP, McMullan JT, Scheitz JF, Vagal AS, Eckman MH. Prehospital Triage of Acute Ischemic Stroke Patients to an Intravenous tPA-Ready versus Endovascular-Ready Hospital: A Decision Analysis. Prehosp Emerg Care. 2018 Nov-Dec;22(6):722-733. [PubMed: 29847193]

3.

Mac Grory B, Yaghi S. Updates in Stroke Treatment. R I Med J (2013). 2018 Mar 01;101(2):30-33. [PubMed: 29490322]

4.

Imbarrato G, Bentley J, Gordhan A. Clinical Outcomes of Endovascular Thrombectomy in Tissue Plasminogen Activator versus Non-Tissue Plasminogen Activator Patients at Primary Stroke Care Centers. J Neurosci Rural Pract. 2018 Apr-Jun;9(2):240-244. [PMC free article: PMC5912031] [PubMed: 29725176]

5.

Knecht T, Story J, Liu J, Davis W, Borlongan CV, Dela Peña IC. Adjunctive Therapy Approaches for Ischemic Stroke: Innovations to Expand Amazing slow downer for mac free Window of Treatment. Int J Mol Sci. 2017 Dec 19;18(12) [PMC free article: PMC5751355] [PubMed: 29257093]

6.

Liu H, Zheng H, Cao Y, Pan Y, Wang D, Zhang R, You S, Zhang X, Li S, Tong X, Liu CF, Wang Y. Low- versus Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: An Updated Meta-Analysis. J Stroke Cerebrovasc Dis. 2018 Apr;27(4):988-997. [PubMed: 29224744]

7.

Gilliland C, Shah J, Martin JG, Miller MJ. Acute Limb Ischemia. Tech Vasc Interv Radiol. 2017 Dec;20(4):274-280. [PubMed: 29224661]

8.

Vivien D. Can the benefits of rtPA treatment for stroke be improved? Rev Neurol (Paris). 2017 Nov;173(9):566-571. [PubMed: 28797689]

9.

Kepplinger J, Barlinn K, Deckert S, Scheibe M, Bodechtel U, Schmitt J. Safety www filehorse com anti virus - Crack Key For U efficacy of thrombolysis in telestroke: A systematic review and meta-analysis. Neurology. 2016 Sep 27;87(13):1344-51. [PubMed: 27566746]

10.

Aoki J, Suzuki K, Suda S, Okubo S, Mishina M, Nishiyama Y, Sakamoto Y, Kimura K. In Hyperacute Recanalization Therapy, Early Hospital Arrival Improves Outcome in Patients with Large Artery Occlusion. Eur Neurol. 2018;79(5-6):335-341. [PubMed: 29986341]

11.

Man S, Zhao X, Uchino K, Hussain MS, Smith EE, Bhatt DL, Xian Y, Schwamm LH, Shah S, Khan Y, Fonarow GC. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circ Cardiovasc Qual Outcomes. 2018 Jun;11(6):e004512. [PMC free article: PMC5978771] [PubMed: 29794035]

Источник: https://www.ncbi.nlm.nih.gov/books/NBK482376/

Frequently asked questions

Up to two courses per admissions cycle

You can apply for up to two courses in an academic year.

We will consider your application for Master's courses in the order they are submitted so it is important to list your preferred course as your first choice and your reserve course as your second choice.

Your second choice application will only be considered if you are unsuccessful at gaining a place on your first choice programme. 

If you are applying for two Master's or Postgradaute Certificate/Diploma courses you should put both your first and second choice on one application form. You should not submit two separate applications.

If you are applying for two Doctoral courses, you should submit two seperate applications, one for each of your choices. We process your applications for Doctoral study simultaneously, so you do not need to specify a preference if you are applying for more than one. 

Business School courses

If you are applying to the Business School, you may only be considered for one programme per admissions cycle. Applicants to the Finance Master's acronis true image crack - Activators Patch, willbe able to indicate their areas of interest in finance when applying. If the Business School cannot make you an offer for the finance programme you applied for, they may consider your suitablity for other areas of finance that are offered in line with the areas of interest you express.

Источник: https://www.imperial.ac.uk/study/pg/apply/contact/faq/
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Old Question Papers

Guidelines to fill up the Application Form Online

Please click here for Hindi Guidelines

INSTRUCTIONS FOR SUBMISSION OF APPLICATION FORM OF UET/PET-2020:

Following is required to fillup the online application form:
  1. An Identification Document [(i) Advanced uninstaller pro portable - Crack Key For U Card; (ii) Passport; (iii) Voter ID issued by the Election Commission of India; (iv) Bank Passbook affixed with the photograph (v) Driving License; (vi) Pan Card; (vii) any other valid Government ID and (viii) Admit Card issued by the concerned Boards (students appearing in Class 12)]
  2. E-mail ID for registration and for receiving all future correspondence till the admission process is over and subsequently, if admitted.
  3. Mobile Number (in use) to receive SMS based notifications/communications related to the online application, Admit card, Entrance Test Result, Admission Counselling etc till the admission process is over and subsequently, if admitted.
  4. Recent passport size colour unity pro patch 2019 (for scanning and uploading in "jpeg" format only. File size of scanned photograph should not be more than 100KB).
  5. Your signature using Blue/Black pen on white sheet (for scanning and uploading in "jpeg" format only. File size of scanned signature should not be more than 100KB).
  6. Access to an online payment facility / service such as-Net Banking/ Credit card/ ATM-cum-Debit card
    If you do not have Net Banking facility/Credit Card or ATM-cum Debit Card, you can pay the fee in cash at any branch of HDFC Bank through the Challan downloaded from the Entrance Test Portal. You will be able to download the duly filled up HDFC Bank challan from the Entrance Test Portal only when you select the "cash payment" option while filling the application form online.
2. Online Application Process
The online application making process will have following six stages:
1: Registration on the Portal [www.bhuonline.in]

This step involves authentication of Candidate's email id and mobile number. As all important communications related to Entrance Test and Admission will be sent to the registered email id and mobile number, candidates are advised to give their correct email id/ mobile number (in use).

Following are the steps for Registration on the portal (www.bhuonline.in):

Step 1: Please click on "Apply for Admission" button given on the home page of the BHU Entrance Test Portal (www.bhuonline.in).

guidline01

Step 2: On clicking the link, you will be directed to a new page having an Applicant Login Box. Below the login fields there is a link "Register Yourself". Please click on this link.

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Step 3: When you click the link you will be shown a Registration Form asking for various details. Fields for information marked with "Red coloured bullets" are to be essentially filled up. These fields cannot be left blank. Once you fill the details, you can click on the "Sign up" button at the bottom for completing the registration process.

guidline03

Step 4: Activation and validation of Registration

  1. On successful submission of registration details, you would be shown a confirmation message on the screen. You will also receive an e-mail on the e-mail ID provided by you in the Registration Form and a validation code on your registered mobile number. This email will contain an activation link. You need to click on this activation link to confirm and complete your registration process.

    Note: This confirmation and activation link e-mail might land up in your "Spam Folder" or "Junk Folder". So, in case you do not find the registration confirmation e-mail in your "Inbox", please check your "Spam Folder" or "Junk Folder". If you find the e-mail from [email protected] in your "Spam Folder" or "Junk Folder', please report it as "Not Spam" and/or add the same to your contact list so that the subsequent e-mails from [email protected] always come in your Inbox. Always check your "Spam Folder" or "Junk Folder' for e-mails from the BHU Entrance Test Portal.

  2. Click on this activation link received in PC Cleaner Pro 2021 Crack + License Code Free Download e-mail. You account will not be activated until you have clicked on this activation link, so do not forget this important step.
  3. On clicking the activation link, you will be directed to the validation page in which you are required to give the validation code sent on your email and registered mobile number. Enter the validation code received to complete the registration process.

2. Filling up of Online Identification Details Form

On successful validation, you will be allowed login and directed to Identification Details Form.In this section of the Application Form,the candidates would be required to fill up an Identification Form giving particulars of the documents for their identification. For the purposes, following photo identification documents are allowed: (i) Aadhaar Card; (ii) Passport; (iii) Voter ID issued by the Election Commission of India; (iv) Bank Passbook affixed with the photograph (v) Driving License; (vi) Pan Card; (vii) any other valid Government ID Number and (viii) Admit Card issued by the concerned Boards (students appearing in Class 12). Candidate should carefully write the correct spelling of their names as carried in their identification document (as applicable).

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Step 2:After carefully filling up the "Identification Details Form", submit your identification details.

NOTE: The candidates shall be compulsorily required to carry their identification document (as provided in the application process) to the examination centre for their identification alongwith the Entrance Test Admit Card, failing which such candidate shall not be allowed in the examination hall.

3: Course Selection

After filling up the "Identification Details Form", candidates would be able to see the following page with the title "Status of Submitted Applications" :

guidline04

Step 1: Select course type and course name from the drop down boxes given at the bottom. Check the eligibility and in case you are eligible for the course click the checkbox given below regarding confirmation of the terms and conditions and the eligibility to proceed further for filling up the application form by clicking "Add Course" button.

guidline04
4. Filling up Online Application Form after course selection

After adding the course of your choice, following screen will appear showing status of submitted application. On the left panel, various other buttons such as 'Applicant Details', 'Select Test Mode (for UET-2020 only)', 'Test Centre Preference', 'Upload Photograph and Signature' etc are given. These are various sections of the form. Application Status section shows which sections of the form is complete and which is incomplete. You can click the left panel button to go to the section of the form which are incomplete.

guidline04

Step 1: After you have added the first course of your choice and come to the above screen, all the four sections of the Application Form would be shown as incomplete. Click on the 'Applicant Details' button on the left panel. On clicking, following form will appear on the printable quiz template - Activators Patch. Some of its fields would be pre-filled with the details you gave at the time of registration. Fill up other required details correctly.
Note: Mandatory fields have been marked with red asterix. They are to be essentially filled up before you will be allowed to 'Save' the form.

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Step 2: After you have filled up all the required fields of the 'Application form', Click on the 'Save' button given at the bottom of the page (as shown above).
Note: For details related to specific fields in the application form, eligibility condition, number of seats, fee etc please refer to the Information Bulletin available on the BHU's Entrance Test Printable quiz template - Activators Patch (www.bhuonline.in).


Step 3:Uploading scanned photograph Offline Explorer Enterprise 7.8.4660 Free Download with Crack signature (in jpeg format; size limit 100kb)
To upload the image file of scanned passport size colour photograph and signature, click the button 'Upload Photograph and Signature' button available on the left panel. On clicking, you will see the following screen:

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(Your scanned passport photo should be within 3.5 x 4.5 cm in size, scanning resolution should be within 100 dpi & file size should be less than 100 KB.)

guidline10If you are facing any problem to upload your photo or the photo is rejected by the system then you are required to resize your photo as per the sample images shown here.

To Resize your scanned photo, follow the following steps:

  1. Right click on the scaned photo file → Open with → Microsoft Office Picture Manager
  2. Then look at the top menus, Click Picture → Resize
  3. Now look at the right pannel, Select the radio button Custom width x height, And write width = 138px, height = 177px. Then Click OK to complete.
  4. If you are not able to do this properly, then you can try 'Crop' feature for the 'Picture' menu
  5. The save the file.

Step 4: Select Test Mode (For applicants of UET 2020 only)
UET-2020 will be conducted both in the pen - paper (OMR based) and Computer Based Test (CBT) modes for both UET & PET 2020 would be conducted on the same date and at the same time with the same question paper. Test in CBT mode only will be conducted in 202 cities accross the country.

In this section, an applicant of UET-2020 shall have to opt either the Pen-Paper Mode or the CBT mode of test.

NOTE: Option once exercised by a candidate shall be final; no change under any circumstances shall be permitted.

Step 5: Filling up preference for Test Centres
For applicants of UET & PET 2020:All the tests will be conducted in CBT mode only in 202 cities across the country. The details of cities can be seen at Section 11 of the URT/PET 2020 Information Bulletin available on the Entrance Test Portal (www.bhuonline.in). To fill up your preference of Test Centre, click the button 'Test Centre Preference' available on the left panel.

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Step 6: Atleast one City in most of the States of the Country have been identified where centres would be available. Select the State from the drop down menu and then select the City in that State as the Test Centre of your choice. You may fillupupto 5 test centres, in order of your preference:

guidline11

Step 7: After filling up all your preferences click the 'Save and Continue' Button given at the bottom.

5. Preview and submission of filled up Online Application Form
Upto this stage, you have completed all stages of the Application Form. Now, click the ' Preview before Confirmation' button given at the bottom of the page. This will help you see entries made in various sections of the Application Form. In case you want to edit some details, you should do so before clicking 'I confirm the above' checkbox and clicking the 'Confirm and Submit' button because once you confirm and submit an application form, it cannot be edited further.

NOTE: If you are sure that all details are correct and you wish to submit the application, click on the button "Proceed for submission and payments". When you click on the button, you would be shown a page which lists the various applications which are completed. There is also a small declaration which is to be confirmed. Select the applications you want to submit and click on the declaration after reading it thoroughly. This is important.

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6. Payment of Application Processing Fee to successfully submit Application Form(s)
After you have confirmed and submitted your application, you will be come to 'My Application' Section. On this page, you can add other courses you wish to apply for. For every course selected under UET 2020, you will have to opt for mode of test and test centres as per process given in above sections.

This page will also contain details of the applications filled by you and the application status.

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Step 1: For making payment of application processing fee, click the 'Make Payments' Icon on above page or from the 'Dashoard'. On clicking you will see the following screen.

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Step 2: You can select the applications for which you want to pay the Entrance Test Fee by clicking the checkbox given in the extreme right column with printable quiz template - Activators Patch column heading 'Select to Pay'.You have option of paying Entrance Test Fee online (using Netbanking, Credit Card/ Debit Card) through payment gateway available on the Portal [by clicking 'Continue for online Payment'] or to pay in cash at any branch of HDFC through challan printed from the portal [by clicking the 'Cash Payment through' HDFC Bank' button on the right side].

Step 3: On clicking 'Continue for online Payment', following screen will appear:

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Step 4: On clicking 'Cash Payment through' HDFC Bank', following screen will appear:

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Step 5: Step 5:On clicking 'generate and Print Challan', HDFC Challan containing all details can be printed:

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7. How do I know that my Application Form is successfully submitted?

Go to 'My Applications' section using the dashboard. The Section will show as follows. You can see that after successful submission (only after payment of Entrance Test Fee), Application Status column shows 'OK' and a payment id has appeared under 'Payment Id column'. This shows that application has been successfully submitted. Also note that after this stage, the 'Delete' column is blank. This means that after this stage you will not be able to delete an application.

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NOTE:
The candidate is required to check the status of fee payment at BHU website (www.bhuonline.in) and if the status is 'OK', then only candidate will be able to take printout of Application Form. In case, the fee payment status does not show the payment id/ OK status, the candidate is advised to act as follows:
(i) If the fee is paid through e-challan by depositing cash in designated bank, the candidate should immediately contact the concerned bank to update his/her fee status on the website within the last date for submission of online application form.
(ii) If the fee is paid through credit/debit card and status is not OK, it means the transaction is cancelled and the amount will, automatically, be refunded to concerned credit/debit card within 7 – 10 days. Therefore, such candidate has to pay the fee once again and ensure the OK status within the last date for submission of online application form.

Online Support Services
BHU Online Admissions

Источник: http://bhuonline.in/guidline01.html
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Web interface

The CUPS server can be fully administered through the web interface, available on http://localhost:631/.

Note: If an HTTPS connection to CUPS is used, it may take a very long time before the interface appears the first time it is accessed. This is because the first request triggers the generation of SSL certificates which can be a time-consuming job.

To perform administrative tasks from the web interface, authentication is required; see #Permissions.

Add a queue

Go to the Administration page.

Modify existing queues

Go to the Printers page, and select a queue to modify.

Test a queue

Go to the Printers page, and select a queue.

GUI applications

If your user does not have sufficient privileges to administer CUPS, the applications will request the root password when they start. To give users administrative privileges without needing root access, see #Configuration.

  • Deepin Print Manager — Printer configuration interface for Deepin desktop.
https://github.com/linuxdeepin/dde-printer

MyChart is a secure, online patient portal that makes it easy for you to access your health information from anywhere, at any time and at Avast Secure Browser 80.1.3902.163 Free Download cost. Using MyChart can help you to manage and engage in your health care.

If you are accessing MyChart from outside Canada, please be advised that your Personal Health Information may be transferred over and maintained on computer servers outside of Printable quiz template - Activators Patch where the privacy laws may not be as protective.

Click on a subject to see FAQs.

General Information

Who will have access to MyChart?

All patients who receive care at these health-care partners will have access to MyChart:

  • The Ottawa Hospital
  • Hawkesbury and District General Hospital
  • Renfrew Victoria Hospital
  • Francis Memorial Hospital (in Barry’s Bay)
  • The Ottawa Hospital Academic Family Health Team
  • The University of Ottawa Heart Institute

Together, these health-care partners make up the Atlas Alliance.

Why use MyChart?

By actively participating in your health care, where possible, evidence suggests that care is safer, and better health outcomes are possible. MyChart is one way that patients can engage in their own care.

With MyChart, you can see your:

  • after-visit summaries
  • upcoming appointments
  • test results
  • progress reports
  • discharge summaries
  • medical imaging reports and more!

You can add your medications, allergies and health measurements, such as blood pressure and weight when ordered by your care provider.

For more information, please refer to the Engaging in Your Heath Care brochure.

Signing Up

How do I sign up?

You can sign up for MyChart through any of the following options:

  • Ask the clerk at your clinic to send you an email with an activation code.
  • Ask clinic staff to sign you up when you are in the exam room.
  • Use the MyChart activation code on your After-Visit Summary.
  • Complete a paper form and present government issued photo ID to Health Records to request an activation code. Your activation code will then be emailed to you.

I don’t have an activation code. How do I get one?

You can get an activation code through the same ways you would sign up for MyChart:

  • Ask the clerk at your clinic to send you an email with an activation code.
  • Ask clinic staff to sign you up when you are in the exam room.
  • Use the MyChart activation code on your After-Visit Summary.
  • Complete a paper form and present government issued photo ID to Health Records to request an activation code. Your activation code will then be emailed to you.

I just received my activation code. Now what?

  1. From the MyChart login page, click Sign Up Now in the New User section.
  2. Enter your activation code (if not automatically entered) and other personal verification items, such as your health card number and your date of birth. Click Next.
  3. On the next page, choose the following:
    • MyChart username. This should be something that others wouldn’t be likely to guess but easy for you to remember.
    • Password. This should be a unique combination of numbers and letters, using both uppercase and lowercase letters. Your password must be at least eight characters long and include at least one character or number and must be different from your MyChart username. Choose a printable quiz template - Activators Patch that you don’t use for other websites.
    • Security question. This question will be used to verify your identity if you forget your MyChart password. Choose a security question from the list and enter your answer. Your answer cannot include your MyChart password.
  4. On the next page, choose whether you want to receive notification messages in your personal email when there is new information available in your MyChart account. If you opt to receive email alerts, enter your email address.

How do I login?

  1. In your web browser, search for Epic MyChart to access the login page.
  2. Enter your MyChart username and password and click Sign In.

What do I need to view MyChart?

You will need access to a computer or mobile device connected to the Internet with an up-to-date browser. You can access MyChart from Apple or Android devices if you have installed the MyChart app.

How do I download the MyChart app?

You can printable quiz template - Activators Patch the MyChart app for your Apple or Android device to manage your health information on the go! To install the MyChart app, go to the App Store or Google Play Store and search for “MyChart.” The mobile apps contain many of the same features as the MyChart website. Please ensure the hospital where you receive care is selected before signing in. If you selected the wrong organization, click “Switch organization” above the log in details.

Troubleshooting

I forgot my MyChart ID/password. What should I do?

Click the “Forgot password?” or “Forgot username?” link below the login field for assistance. You will have to enter your username, date of birth and health card number or medical record number. The next screen will explain the process to regain access. You will be sent a code by email that you will have to enter. Once this is done, you will be logged in. If you are still having trouble logging in, you can contact the support team at the hospital where you typically receive care.

I am not getting email alerts about new information in MyChart. Why?

The Ottawa Hospital MyChart is connected to your health record. If you have notifications turned on, you will get a message via email or notification on your phone when tests, labs and reports are ready and available to view on your MyChart. .

If you are not getting alerts:

  • Check your Junk Mail folder for email alerts. If you see messages there, change the settings on your email filter to allow these messages
  • Check your notification preferences in MyChart. Click on “Profile” and select “Personal Information” to make sure your correct email address is entered. Select “Communications” to confirm the notifications you want to receive.
  • If you have checked these settings and you still are not receiving email alerts, please contact [email protected] or call 613-737-8800 option 1.

Your Health Record

What do I see in MyChart?

Your Personal Health Information from the health-care partners in the Atlas Alliance can be viewed in your MyChart account. Health information from other hospitals is not available in MyChart.

You will see:

  • after-visit summaries
  • upcoming appointments
  • test results
  • progress notes
  • discharge summaries
  • medical imaging reports and more!

You can add your medications, allergies and health measurements, such as blood pressure and weight when ordered by your care provider.

How far back will my medical information go in MyChart?

MyChart will show your medical information back to January 2016.
To access your entire health record, you will need to visit Health Records at the location where you received care and request a complete copy of your record.

How do I see my test results?

In MyChart, click on “Health” and select “Test Results.” On the “Test Results” page, click anywhere within the row to display the results for that test. Your lab results, diagnostic imaging and pathology results will be available after the completion of the reporting on the studies. Results are presented in reverse chronological order based on date of test. Please note that some results will not be available in MyChart.

When will test results be available to me?

It is likely that you will be able to see your results before your health-care team as they are reviewing results for many patients. Your results and any questions you may have about them will be reviewed with you at your next appointment. If your results are more medically urgent, someone from your health-care team will call you sooner to discuss.

The only results you will see in MyChart are those that are marked Final, Completed or Corrected/Amended. Physicians and nurses need time to contact patients about sensitive test results before they are shown in MyChart. Some records are delayed, even after the results are final.

Results without delays:

  • Lab and microbiology
  • Pathology and medical imaging reports

You will not be able to see:

Why are some test results not available in MyChart?

Some test results are only given in person or over the phone. These kinds of tests results are not normally available on MyChart. If you feel that your test results should be available, but you don’t see them, please contact your health care team.

I have a test result which is higher or lower than the normal. Why is that?

You may see a result which is higher or lower than the normal reference ranges for that test. Depending on your medical conditions and the medications you might be taking, this result could be considered acceptable by your doctor.

It is likely that you will be able to see your results before your health-care team as they are reviewing results for many patients. Your results and any questions you may have about them will be reviewed with you at your next appointment. If your results are more medically urgent, someone from your health-care team will call you sooner to discuss. Your health-care team is there to support you so that you printable quiz template - Activators Patch understand the results and can make informed decisions about your care.

For more information, please refer to the Engaging in Your Health Care brochure.

How do I see clinical notes in MyChart?

To view clinical notes, log on to MyChart and click on the “Health” tab and select “Appointments and Visits.” If applicable, clinical notes will be available under “After Visit Summary” or “Notes” tab.

What can I view in clinical notes?

In clinical notes you can view:

  • After-visit summaries
  • Operative notes
  • Discharge summaries

Psychology, psychiatry, mental health, social work and spiritual care documentation are not available in MyChart.

Some of my health information on MyChart is incorrect. What should I do?

Your health-care provider reviews and updates your health information in Epic, the hospital’s digital health network, during and after each visit. Ask your health-care provider to correct any incorrect information at your next clinic visit. You may also contact Health Records at the hospital where you received care.

Patients and proxies can add and update information about allergies and medications through MyChart. Once this information is added, your health-care provider will verify it during your next visit.

Sharing MyChart access

Can my spouse and I share one MyChart account?

No. Due to the sensitive nature of medical information, each adult must establish their own MyChart account. If you wish to share your health information with your spouse, you can assign proxy access directly through your MyChart account.

Security and Privacy

Is MyChart secure?

We take great care to ensure your health information is kept private and secure. Access to information is controlled through secure activation codes, personal usernames and passwords. Health-care providers in the hospital can only access medical information for the patients they are treating through their own username and password in Epic, not MyChart. Health care providers and hospital staff are unable to access your MyChart account.

If you need to access MyChart from a public or shared device and you cannot verify the security of the device, visit the Government of Canada Get Cyber Safe website for more information to help keep your information as secure as possible.

If you are accessing MyChart from outside Canada, please be advised that your Personal Health Information may be transferred over and maintained on computer servers outside of Canada where the privacy laws may not be as protective.

What is your Privacy Policy?

The health information that you have in MyChart is from the hospitals that gave you care. The information is protected by the policies of the hospitals that gave you care. It is also protected by Ontario’s health privacy laws. Call the privacy office of the hospital that gave you care if you want to see the policy or have other questions.

Last updated on: November 10th, 2021

Источник: https://www.ottawahospital.on.ca/en/patients-visitors/mychart/
system-config-printer

Configuration

The CUPS server configuration is located in and (see cupsd.conf(5) and cups-files.conf(5)). After editing either file, restart to apply any changes. The default configuration is sufficient for most users.

Permissions

User groups with printer administration privileges are defined in in the. The and and groups are used by default.

CUPS helper programs are run as the user and group. This allows the helper programs to access printer devices and read configuration files inprintable quiz template - Activators Patch are owned by the group.

Note: Prior to cups 2.2.6-2, the group was used instead. After the upgrade, the files in should be owned by the group and and set in .

Default paper size

cups is built with libpaper support and libpaper defaults to the Letter paper size (called in ). To avoid having to change the paper size for each print queue you add, edit and set your system default paper size. See papersize(5).

Log files

By default, all logs are sent to files in. By changing the values of the, and directives in toCUPS can be made to log to the systemd journal instead. See Fedora:Changes/CupsJournalLogging for information on the original proposed change.

cups-browsed

Tango-view-refresh-red.pngThis article or section is out of date.Tango-view-refresh-red.png

Reason: is not required to discover printers advertised over DNS-SD, that is done by. The service is only required to discover printers on an LDAP server and those using the legacy CUPS protocol (CUPS servers ≤ 1.5). (Discuss in Talk:CUPS)

CUPS can use Avahi browsing to discover unknown shared printers in your network. This can be useful in large setups where the server is unknown. To use this feature, set up .local hostname resolution, and start both and. Jobs are sent directly to the printer without any processing so the created queues may not work, however driverless printers such as those supporting IPP Everywhere or AirPrint should work out of the box.

Print servers and remote administration

See CUPS/Printer sharing and CUPS/Printer sharing#Remote administration.

Allowing admin authentication through PolicyKit

PolicyKit can be configured to allow users to configure printers using a GUI without the admin password.

Note: You may need to install cups-pk-helper for working this rules.

Here is an example that allows members of the wheel user group to administer printers without a password:

/etc/polkit-1/rules.d/49-allow-passwordless-printer-admin.rulespolkit.addRule(function(action, subject) { if (action.id == "org.opensuse.cupspkhelper.mechanism.all-edit" && subject.isInGroup("wheel")){ return polkit.Result.YES; } });

Without a local CUPS server

CUPS can be configured to directly connect to remote printer servers instead of running a local print server. This requires installation of the libcups package. Some applications will still require the cups package for printing.

Warning: Accessing remote printers without a local CUPS server is not recommended by the developers. [3]

To use a remote CUPS server, set the environment variable to. For instance, if you want to use a different print server for a single Firefox instance (substitute with your print server name/port):

$ CUPS_SERVER=printserver.mydomain:port firefox

To make this configuration permanent create configuration file and add a hostname of the remote CUPS server to it:

ServerName server

You can also specify a custom port:

ServerName server:port

See [4] for details.

Troubleshooting

See CUPS/Troubleshooting.

See also

Источник: https://wiki.archlinux.org/title/CUPS

Similar video

Interactive True-or-False QUIZ GAME in PowerPoint - Download Free PowerPoint Quiz Template

Printable quiz template - Activators Patch -

Childrens Connect - Your secure online health connection

Children's Connect Frequently Asked Questions

Enrollment Questions
What is Children's Connect?
Is there a fee to use Children's Connect?
How do I sign up?
Who do I contact if I have further questions?
Your Medical Record
When can I see my child's test results in Children's Connect?
Why are certain test results not shared electronically via Children's Connect?
If some of my health information on Children's Connect is not correct, what should I do?
If I send a message to my child's medical care team, when can I expect a reply?
Where can I find my child's school physical form?
Where can I find a copy of the messages I have sent to my child's medical care team?
Where do I find my child's immunization record?
Where do I find the print button?
It says Inactive next to my child's name. What do I do?
Why don't I see all of my child's test results?
Why won't the system let me schedule an appointment?
After I Have Enrolled
I forgot my password. What should I do?
Can you send me a new activation code if I lost it, let it expire or did not receive it?
How do I update my personal information (e.g., home address, e-mail or change my password)?
Technical Questions
Is Children's Connect secure?
What is your Privacy Policy?
I was unexpectedly logged out of Children's Connect. What happened?
What equipment will I need to use Children's Connect?
My activation code does not work. What should I do?
Is my activation code my user ID?
Is there mobile device access?



What is Children's Connect?

Children's Connect offers parents or guardians secure online access to portions of their child's medical records until the child reaches age 19. It enables parents/guardians to securely use the Internet to help manage and receive information about a child's health. With Children's Connect, you can use the Internet to:

  • Request medical appointments.
  • View your child's health summary from the Children's Connect electronic health record.
  • View certain test results.
  • Request prescription renewals.
  • Access trusted health information resources.
  • Communicate electronically and securely with your Children's pediatrician or specialist's office.
  • Bill Pay.
  • Receive Requested Medical Records online.

Yes, you can. This is called proxy access and allows a parent (or guardian) to log in to their personal Children's Connect account and then connect to information regarding their family member. Complete a Proxy Consent Form and return it to one of our medical facilities to request access to this convenient service or select Share My Record from the Health menu. From there you can select "Friends and family access" and modify or add new access to your health record.


Is there a fee to use Children's Connect?

Children's Connect is a free service offered to all Children's Hospital & Medical Center patients and families.


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How do I sign up?

Parent/Guardian proxy access allows a parent/guardian to create a Children's Connect account to access certain information about a minor child until the child reaches age 19.

In Person: Complete the Consent Form and return it to your Children's Provider office to request access.
Online: Use the “Request Activation Code” feature on the web site to complete and submit the consent form.

Any patients age 19 and older may complete a Consent Form on their own behalf and return it to their Children's Provider.

If you wish to participate, you will be issued a Children's Connect activation code. This code will enable you to log in and create your own user ID and password. If you were not issued an activation code, you may either sign up online or request to sign up during your next visit.


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Who do I contact if I have further questions?

You can call the support line at 1-844-296-4615, your Children's Primary provider office or email at [email protected] making sure to provide the patient name and date of birth. (please allow 2 business days for an email response).


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When can I see my child's test results in Children's Connect?

Your child's test results that can be viewed in Children's Connect are released to your Children's Connect account after the physician has reviewed them. The test results will generally be posted within three days after the date of the test.

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Why are certain test results not shared electronically via Children's Connect?

Tests of a very sensitive nature are not released to Children's Connect. Your physician will determine which types of test results can be accessed through Children's Connect and which should be discussed directly with you.

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If some of my child's health information on Children's Connect is not correct, what should I do?

Your child's Children's Connect information comes directly from his or her electronic medical record. Ask your physician to correct any inaccurate information during your next office visit. Your child's health information is reviewed and updated in the electronic medical record during each visit.

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If I send a message to my child's medical care team, when can I expect a reply?

You will generally receive an answer within two business days. Please do not use Children's Connect messaging for urgent situations. Call your Children's pediatrician or specialist's office office directly if the situation requires immediate attention, or dial 911 if it is an emergency.


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Where can I find my child's school physical form?

This feature is only available for families who use a Children’s Physicians pediatrician for their pediatric primary care needs.

If you are a Children’s Physicians family:

When you are logged into your child's account, "Visits" then select the date your child had the physical. When the document appears on the screen, click on the "Printer Friendly" icon to print the document.

If the physical form is not there, then look at the top under the "Messaging" section until you see the "Letters" link. Select "Letters," then select the "Health Exam" form letter. When the document appears on the screen, click the "Printer Friendly" icon to print the document.


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Where can I find a copy of the messages I have sent to my child's medical care team??

You can find a running log of all your sent messages at the top of the screen. Simply click on the "Sent Messages" link located under the "Messaging" tab and "Message Center".


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Where do I find my child's immunization record?

Once you are logged in and choose an individual child's account, the "Immunizations" link will be located on the top of the screen under "Health." To print your child's immunizations, click on the "Printer Friendly" icon located in the upper right-hand corner of the "Immunizations" page.


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Where do I find the print button?

There is a "Printer Friendly" icon located either in the upper right-hand corner of the page or in the center/top of the document, depending on what page you have open in Children's Connect. Click this "Printer Friendly" icon to print the page or document.

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Why don't I see all of my child's test results?

If you are looking for the results of a test ordered by your Children's primary care pediatrician or specialist, the result will be released in Children's Connect after the physician has had a chance to review the results and ok its release. Once released, the lab and radiology results can be found under the “Health” tab along the top of the screen. To see test results from a Hospital admission, Emergency Room Visit or Urgent Care visit, select the box marked “Show Hospital Results.”


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Why won't the system let me schedule an appointment?

If the system won't let you schedule an appointment, could be one of two reasons. First, this feature is only available for certain appointment types. However, families may “Request an Appointment” through Children’s Connect. If you are a Children’s Physicians patient family, you may not be able to schedule an appointment because your pediatrician doesn't have any available appointments in the dates/times you have selected. Try changing your dates/times to make more options available or select the box to view the provider's team to find other available providers.


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I forgot my password. What should I do?

You may click the "Forgot password" link located on the Children's Connect sign-in page to reset your password online. You may also call the support line at 1-844-296-4615, contact your Children's Primary provider office or email at [email protected] being sure to provide the patient name and date of birth. (please allow 2 business days for an email response)to request a new, secure password.

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Can you send me a new activation code if I lost it, let it expire or did not receive it?

Call the support line at 1-844-296-4615, your Children's Primary provider office during normal business hours or email at [email protected] being sure to provide the patient name and date of birth to request a new activation code. After we verify your information, a new code will be generated for you.

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How do I update my personal information (e.g., home address, e-mail or change my password)?

Log on to Children's Connect and from the top menu, select "Demographics" found under the "Health" tab and select the appropriate option.

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Is Children's Connect secure?

We take great care to ensure your health information is kept private and secure. Access to information is controlled through secure access codes, personal ID's, and passwords. Each person controls their password, and the account cannot be accessed without that password. Further, Children's Connect uses the latest 128-bit SSL encryption technology with no caching to automatically encrypt your session with Children's Connect. Unlike conventional e-mail, all Children's Connect messaging is done while you are securely logged on to our website.

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What is your Privacy Policy?

Children's Connect is owned and operated by Children's Hospital & Medical Center and is fully compliant with federal and state laws pertaining to privacy. Your name and e-mail address will be treated with the same care and privacy as your child's health records.

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I was unexpectedly logged out of Children's Connect. What happened?

We aim to protect the privacy and security of your child's information from being seen by anybody but you. While logged into Children's Connect, if your keyboard remains idle for 15 minutes or more, you will be automatically logged out of Children's Connect. We recommend that you always log out of your Children's Connect session whenever you leave your computer, even if only for a short period of time.

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What equipment will I need to use Children's Connect?

You need a computer connected to the Internet and an up-to-date browser (Firefox or Internet Explorer versions 6.0 or greater).

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My activation code does not work. What should I do?

For security reasons, your activation code expires if not used within 60 days of the date you received it. An activation code is only valid the first time it is used to access Children's Connect. If you are having problems, you can call the support line at 1-844-296-4615, your Children's Primary provider office or email [email protected] being sure to provide the patient name and date of birth.

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Is my activation code my user ID?

No, your activation code is not your Children's Connect ID or password. You use your activation code only once to log on to Children's Connect for the first time. Once used, the activation code becomes obsolete. When you log on to Children's Connect the first time, you will be asked to create your own unique Children's Connect ID and password. Please remember your password as you will use it each time you log on to the site. If you forget your password, see FAQ "I forgot my password. What should I do?"

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Is there mobile device access?

Yes, there is access to limited features of Children’s Connect via your mobile device. If you are an iPhone or Android user, download the Children’s Connect app to manage your child’s health care needs right from your cell phone.

To download:

  1. Visit your app store and search for “Children's Connect.” Download and install the app.
  2. Once downloaded, open the app and agree to the Terms and Conditions.
  3. It will then ask where you see your current provider. You can search by state (NE) or by zip code.
  4. Select Children’s Connect, which will then take you to the login page. Accept the Terms and Conditions again.
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Источник: https://connect.childrensomaha.org/MyChart/Authentication/Login?mode=stdfile&option=faq
lpr -p # print the result of a command. The -p switch adds a header.
Check the queue
$ lpq $ lpq -a # on all queues
Clear the queue
# lprm # remove last entry only # lprm - # remove all entries
View ink levels

Install inkAUR.

Note: See list of supported printers.

Add your user to the user group:

# usermod -aG lp <user>

Log out and log in again.

For usage information, use:

$ ink

Web interface

The CUPS server can be fully administered through the web interface, available on http://localhost:631/.

Note: If an HTTPS connection to CUPS is used, it may take a very long time before the interface appears the first time it is accessed. This is because the first request triggers the generation of SSL certificates which can be a time-consuming job.

To perform administrative tasks from the web interface, authentication is required; see #Permissions.

Add a queue

Go to the Administration page.

Modify existing queues

Go to the Printers page, and select a queue to modify.

Test a queue

Go to the Printers page, and select a queue.

GUI applications

If your user does not have sufficient privileges to administer CUPS, the applications will request the root password when they start. To give users administrative privileges without needing root access, see #Configuration.

  • Deepin Print Manager — Printer configuration interface for Deepin desktop.
https://github.com/linuxdeepin/dde-printer print-manager
  • system-config-printer — GTK printer configuration tool and status applet.
https://github.com/OpenPrinting/system-config-printer
Technical Questions
How is MyChart secure?
What is your privacy policy?
I was logged out of MyChart, what happened?
What do I need to use MyChart?
My activation code does not work, what should I do?
I have found an outside program/application (app) to import my own patient data from my Denver Health Chart. What’s my next step to integrate my health information with this app?

What is MyChart?

What is MyChart?

MyChart offers patients personalized and secure on-line access to portions of their medical records. It enables you to securely use the Internet to help manage and receive information about your health. With MyChart, you can use the Internet to:

  • Request medical appointments.
  • View your health summary from the MyChart electronic health record.
  • View test results.
  • Request prescription renewals.
  • Access trusted health information resources.
  • Communicate electronically and securely with your medical care team.
Return to Top

Is there a fee to use MyChart?

Is there a fee to use MyChart?

MyChart is a free service offered to our patients.

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How do I sign up?

Patients who wish to participate will be issued a MyChart activation code during their clinic visit. This code will enable you to log in and create your own username and password. If you were not issued an activation code, you may call your primary care clinic to get one or ask to sign up during your next office visit.

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Who do I contact if I have further questions?

You may e-mail us at [email protected], or you can call our MyChart Patient Support Line at 303-602-4380.

Other Relevant Phone Numbers: Patient billing -> 303-602-2200

Appointment Center -> 303-436-4949

Nurseline -> 303-739-1211

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When can I see my test results in MyChart?

Most test results are released to your MyChart account immediately after they have been finalized by the lab or radiology department. Certain sensitive test results may not be available in MyChart and may require contacting your provider’s office. Your provider’s office will contact you either via MyChart or by phone if your results need follow up or need to be discussed further, this may take 2-3 business days after the results are back.

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Why are certain test results not shared electronically via MyChart?

Your provider is able to determine which types of test results are able to be accessed through MyChart. Further, tests of a very sensitive nature may not be released to MyChart.

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If some of my health information on MyChart is not correct, what should I do?

If some of my health information on MyChart is not correct, what should I do?

Your MyChart information comes directly from your electronic medical record at your doctor's office. Ask your doctor to correct any inaccurate information at your next clinic visit. Your health information is reviewed and updated in your electronic medical record each visit.

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If I send a message to my doctor or nurse, when can I expect a reply?

You will generally receive an answer within 1-3 business days. Please note that MyChart should not be used for urgent situations. Please contact your medical center if the situation requires immediate attention or dial 911 if it is an emergency.

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Can I view a family member's health record in MyChart?

Can I view a family member's health record in MyChart?

Yes, you can. This is called proxy access and allows a parent (or guardian) to log in to their personal MyChart account and then connect to information regarding their family member. Complete a Proxy Consent Form and return it to one of our medical facilities to request access to this convenient service or select Share My Record from the Health menu. From there you can select "Friends and family access" and modify or add new access to your health record.

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Can I ask questions regarding a family member from my MyChart account?

Can I ask questions regarding a family member from my MyChart account?

MyChart offers direct access to your personal health record and communicating about another individual's information would be placed in your health record. This information would not appear in the correct health record and could potentially jeopardize medical care.

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Can my spouse and I share one MyChart account?

Can my spouse and I share one MyChart account?

No, due to the sensitive nature of medical information, each adult must sign and submit a Release of Information request and establish their own MyChart account.

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I forgot my password. What should I do?

You may contact our MyChart Patient Support Line at 303-602-4380 to request a new, secure password. You may also click the "Forgot password" link on the sign-in page to reset your password online.

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Can you send me a new activation code as I have lost it, let it expire or did not receive it?

Contact us at [email protected] and after we verify your information, a new code will be sent via U.S. Postal Mail. Privacy issues prevent us from e-mailing a new activation code to you.

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Where can I update my personal information (e.g., home address, e-mail or change my password)?

Log into MyChart and from the left menu, go to the Preferences section and select the appropriate option.

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How is MyChart secure?

How is MyChart secure?

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Источник: https://mychart.denverhealth.org/MyChart/Authentication/Login?mode=stdfile&option=faq

TPA Therapy

Continuing Education Activity

Alteplase (tPA) is a powerful thrombolytic agent used in the lysis of acute thromboembolism. FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters. There are also off-label indications. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, toxicity, and monitoring, of tPA therapy with agents like alteplase, so providers can direct patient therapy where they are indicated as part of the interprofessional team.

Objectives:

  • Identify the indications for initiating therapy with a tPA agent such as alteplase.

  • Review the mechanism of action of tissue plasminogen activators such as alteplase.

  • Summarize the contraindications and adverse event profile of tPA medications such as alteplase.

  • Describe interprofessional team strategies for improving care coordination and communication to properly use tPA agents like alteplase to improve patient outcomes in the varied scenarios where it can be effective.

Access free multiple choice questions on this topic.

Indications

Alteplase (tPA) is a powerful thrombolytic agent used in the lysis of acute thromboembolism.[1][2][3]

FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters.

Common off-label indications include:

  • Treatment of deep venous thrombosis (DVT) and peripheral arterial thrombosis with local administration of a thrombolytic agent in catheter-directed thrombolysis

  • Ischemic stroke when administered more than 3 hours, but no longer than 4.5 hours, after symptom onset

  • Management of prosthetic valve thrombosis

  • Adjunct treatment of a pediatric pleural effusion or empyema.

Mechanism of Action

Alteplase acts within the endogenous fibrinolytic cascade to convert plasminogen to plasmin by hydrolyzing the arginine-valine bond in plasminogen. The activated plasmin then degrades fibrin and fibrinogen, allowing for the dissolution of the clot and re-establishment of blood flow.[4][5]

Administration

The dosing and administration of tPA are specific to the indication.

FDA Approved Indications

Pulmonary Embolism

  • 100 mg over 2 hours; may be administered as a 10 mg bolus followed by 90 mg over 2 hours

Ischemic Stroke: The only blood test that is necessary before tPA usage is the blood glucose level. If the patient is on anticoagulation like coumadin, then only we should do PT, PTT, and INR, etc. The benefit of tPA depends a lot on time. The sooner the patient receives tPA; the better are the outcomes. 

  • Maximum recommended dose is 90mg 

  • Patients less than or equal to 100 kg load with 0.09 mg/kg (10% of 0.9 mg/kg dose) as an IV bolus over 1 minute, followed by 0.81 mg/kg (90% of 0.9 mg/kg dose) as a continuous infusion over 60 minutes.

  • Patients greater than100 kg load with 9 mg (10% of 90 mg) as an IV bolus over 1 minute, followed by 81 mg (90% of 90 mg) as a continuous infusion over 60 minutes.

STEMI

  • Administer within 30 minutes of hospital arrival

  • Adults greater than or equal to 67 kg get 100 mg total dosage administered as a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes

  • Adults less than 67 kg get 15 mg IV bolus, followed by 0.75 mg/kg IV (not to exceed 50 mg) infused over 30 minutes, and then 0.5 mg/kg IV (not to exceed 35 mg) over the next 60 minutes

IV Catheter Occlusion

  • Instill 2 mg of alteplase in the occluded lumen and allow a 2-hour dwell time. This dose is repeatable one time if the first attempt is not successful, the use of greater than 4 mg of alteplase for this indication has not been a topic of research.

Off-Label Indications

Pediatric Pleural Effusions

  • Four mg in 30 mL to 50 mL 0.9% intrapleural sodium chloride injection via chest tube and left to dwell for 1 hour as a single dose or as multiple doses 24 hours apart

Catheter-Directed Therapy

  • 0.1 mg/kg/hr (maximum of 20 mg per 24 hours for up to 96 hours)

Prosthetic Valve Thrombosis

  • Twenty-five mg intravenously over 25 hours repeated as needed until a total dose of 200 mg of alteplase administered or resolution is confirmable by TEE

Alteplase is administered intravenously as a bolus injection or infusion. In emergencies, it is reasonable to administer tPA through intraosseous access.

Adverse Effects

The most frequent serious adverse events associated with the administration of tPA are related to bleeding.[6][7][8]

Bleeding associated with alteplase therapy can be divided into two broad categories. Internal bleeding includes intracranial bleeding (0.4% to 15.4%), retroperitoneal bleeding (less than 1%), gastrointestinal (GI) bleeding (5%), genitourinary bleeding (4%), and respiratory bleeding. Superficial or surface bleeding is observed mainly at invaded or disturbed sites such as venous cutdowns, arterial punctures, and recent surgical intervention sites. Less serious spontaneous bleeding includes ecchymosis (1%), gingival bleeding (less than 1%), and epistaxis (less than 1%). In clinical studies of adult patients with acute ischemic stroke (n = 624), a higher incidence of intracranial bleeding, especially symptomatic intracranial bleeding, was seen in patients receiving alteplase compared to placebo (total intracranial bleeding 15.4% versus 6.4%, p < 0.01; symptomatic intracranial bleeding 8% versus 1.3%, p < 0.01). However, there was no increase in the incidence of 90-day mortality or severe disability in patients receiving alteplase. Studies indicate that the incidence of intracranial bleeding is dose-related, with the greatest percentage occurring at a dosage of 150 mg (1.3%) compared to 100 mg (0.4%). Rates of adverse events, including bleeding, correlate to the total exposure of tPA.

Cardiac dysrhythmias may occur when tPA is administered for NSTEMI and is related to the re-establishment of tissue perfusion rather than drug exposure.

Allergic reactions, including anaphylactic-type reactions, are possible following exposure to tPA. Various sources of tPA have varying levels of antigenicity. See “streptokinase” for further discussion. The rapid conversion of plasminogen to plasmin signals a complement cascade leading to mast cell degranulation and subsequent anaphylactic reaction.  

Contraindications

A 2016 update was published by the American Heart Association to guide tPA inclusion and exclusion criteria for the management of ischemic stroke. The following list includes the most recent absolute and relative contraindications for therapy as determined by the AHA.

Exclusion Criteria

  • Significant head trauma or prior stroke in the previous 3 months

  • Symptoms suggest subarachnoid hemorrhage

  • Arterial puncture at a noncompressible site in previous 7 days

  • History of previous intracranial hemorrhage

  • Intracranial neoplasm, AVM, or an aneurysm

  • Recent intracranial or intraspinal surgery

  • Elevated blood pressure (systolic greater than 185 mmHg or diastolic greater than 110 mmHg)

  • Active internal bleeding

  • Acute bleeding diathesis, including but not limited to

  • Platelet count less than 100 000/mm^3

  • Heparin received within 48 hours resulting in abnormally elevated aPTT above the upper limit of normal

  • Current use of anticoagulant with INR greater than 1.7 or PT greater than 15 seconds

  • Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (e.g., aPTT, INR, platelet count, ECT, TT, or appropriate factor Xa activity assays)

  • Blood glucose concentration less than 50 mg/dL (2.7 mmol/L)

  • CT demonstrates multilobar infarction (hypodensity greater than a one-third cerebral hemisphere)

Relative Exclusion Criteria

Recent experience suggests that under some circumstances, with careful consideration and weighing of risk to benefit, patients may receive fibrinolytic therapy despite 1 or more relative contraindications. Consider the risk to the benefit of intravenous rtPA administration carefully if any of these relative contraindications are present:

  • Only minor or quickly improving stroke symptoms (clearing automatically)

  • Pregnancy

  • Seizure at the onset with postictal residual neurological impairments

  • Major surgery or serious trauma within prior 14 days

  • Recent GI or urinary tract hemorrhage (within previous 21 days)

  • Recent acute myocardial infarction (within preceding 3 months)

Monitoring

There are no therapeutic drug monitoring recommendations that pertain to the efficacy of tPA therapy. If prolonged off-label therapy is occurring in the event of catheter-directed treatment or repeated dosing in valve thrombosis, serial imaging of the thrombus is reasonable. The safety profile is best monitored by prothrombin time (PT), partial thromboplastin time (PTT), Hemoglobin, and hematocrit to assess ongoing bleeding. Of note, fibrinogen levels may be an indicator of increased bleed risk for values less than 150mg/dL.

Toxicity

There is no direct reversal agent for the potentially major bleeding that may occur during tPA therapy. Commonly employed strategies include anti-fibrinolytic therapy such as tranexamic acid or aminocaproic acid though there is no research on specific dosages. If fibrinogen levels are less than 150mg/dL, there may be added benefit from fresh frozen plasma or cryoprecipitate. Cryoprecipitate should be used without any delay and monitor the fibrinogen level closely.  

Enhancing Healthcare Team Outcomes

There is no longer any question about the effectiveness of thrombolytic agents for the treatment of several medical disorders, but nurses, pharmacists, and radiologists must be fully aware of their indications and contraindications. For these agents to be effective, not only do they require administration within a certain timeframe, but one also has to ensure that the patient has no condition that contraindicates the therapy. Also, the nurse should educate the patient about the procedure, the need to remain at bed rest for several hours after the procedure, and the need to constantly monitor for bleeding.  Plus, the pharmacist must be familiar with the recent novel anticoagulants and any possible interactions with the thrombolytic drugs. Only through close communication and constant vigilance between the various healthcare professionals can the serious complications of these drugs be prevented. [2][9] [Level V]

Outcomes

There have been many clinical trials undertaken to determine the effectiveness of thrombolytic agents in patients with acute myocardial infarction, pulmonary embolism, acutely ischemic limb, and an embolic stroke. When used to treat acute MI, embolic stroke, and pulmonary embolism, the outcomes are fair to good. The biggest drawback to this therapy is a patient delay in arriving at the emergency room or a delay in diagnosis. These drugs have saved many lives and are cost-effective and reduce hospital stays.[10][11][7] [Level II]

References

1.

Grossberg JA, Rebello LC, Haussen DC, Bouslama M, Bowen M, Barreira CM, Belagaje SR, Frankel MR, Nogueira RG. Beyond Large Vessel Occlusion Strokes: Distal Occlusion Thrombectomy. Stroke. 2018 Jul;49(7):1662-1668. [PubMed: 29915125]

2.

Benoit JL, Khatri P, Adeoye OM, Broderick JP, McMullan JT, Scheitz JF, Vagal AS, Eckman MH. Prehospital Triage of Acute Ischemic Stroke Patients to an Intravenous tPA-Ready versus Endovascular-Ready Hospital: A Decision Analysis. Prehosp Emerg Care. 2018 Nov-Dec;22(6):722-733. [PubMed: 29847193]

3.

Mac Grory B, Yaghi S. Updates in Stroke Treatment. R I Med J (2013). 2018 Mar 01;101(2):30-33. [PubMed: 29490322]

4.

Imbarrato G, Bentley J, Gordhan A. Clinical Outcomes of Endovascular Thrombectomy in Tissue Plasminogen Activator versus Non-Tissue Plasminogen Activator Patients at Primary Stroke Care Centers. J Neurosci Rural Pract. 2018 Apr-Jun;9(2):240-244. [PMC free article: PMC5912031] [PubMed: 29725176]

5.

Knecht T, Story J, Liu J, Davis W, Borlongan CV, Dela Peña IC. Adjunctive Therapy Approaches for Ischemic Stroke: Innovations to Expand Time Window of Treatment. Int J Mol Sci. 2017 Dec 19;18(12) [PMC free article: PMC5751355] [PubMed: 29257093]

6.

Liu H, Zheng H, Cao Y, Pan Y, Wang D, Zhang R, You S, Zhang X, Li S, Tong X, Liu CF, Wang Y. Low- versus Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: An Updated Meta-Analysis. J Stroke Cerebrovasc Dis. 2018 Apr;27(4):988-997. [PubMed: 29224744]

7.

Gilliland C, Shah J, Martin JG, Miller MJ. Acute Limb Ischemia. Tech Vasc Interv Radiol. 2017 Dec;20(4):274-280. [PubMed: 29224661]

8.

Vivien D. Can the benefits of rtPA treatment for stroke be improved? Rev Neurol (Paris). 2017 Nov;173(9):566-571. [PubMed: 28797689]

9.

Kepplinger J, Barlinn K, Deckert S, Scheibe M, Bodechtel U, Schmitt J. Safety and efficacy of thrombolysis in telestroke: A systematic review and meta-analysis. Neurology. 2016 Sep 27;87(13):1344-51. [PubMed: 27566746]

10.

Aoki J, Suzuki K, Suda S, Okubo S, Mishina M, Nishiyama Y, Sakamoto Y, Kimura K. In Hyperacute Recanalization Therapy, Early Hospital Arrival Improves Outcome in Patients with Large Artery Occlusion. Eur Neurol. 2018;79(5-6):335-341. [PubMed: 29986341]

11.

Man S, Zhao X, Uchino K, Hussain MS, Smith EE, Bhatt DL, Xian Y, Schwamm LH, Shah S, Khan Y, Fonarow GC. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circ Cardiovasc Qual Outcomes. 2018 Jun;11(6):e004512. [PMC free article: PMC5978771] [PubMed: 29794035]

Источник: https://www.ncbi.nlm.nih.gov/books/NBK482376/