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MRI Availability May Lead to Back Surgery Excess

By MedImaging International staff writers
Posted on 06 Nov 2009

Patients reporting new low-back pain are more likely to undergo surgery if treated in an area with a higher-than-average concentration of magnetic resonance imaging (MRI) scanners, according to recent research.

This may be bad news for patients, since previous studies have found that increased surgery rates do not improve patient outcomes. "The worry is that many people will not benefit from the surgery, so heading in this direction is concerning,” said senior author Laurence Baker, Ph.D., professor of health research and policy at the Stanford University School of Medicine (Stanford, CA, USA).

In their new study, published online October 14, 2009, in the journal Health Affairs, Dr. Baker and first author Jacqueline Baras correlate areas with high numbers of MRI machines to an increased probability that MRI scans will be performed on new low-back pain patients. In turn, high local MRI availability correlates with increased rates of low-back surgery. "It is important that policymakers recognize that infrastructure matters, and that the number of MRI machines in any particular area may affect the volume and quality of health care that patients receive,” said Ms. Baras, a Stanford medical student with a master's degree in health services research.

Low-back pain was the fifth-most common reason for physician visits in the United States, with 26.4% of adults reporting low-back pain for a day or more during a three-month period in 2002. More than 80% of low-back pain was diagnosed as nonspecific, a category that includes lumbar strains and sprains, spinal instability, and degenerative disk disease.

MRI scans visualize the body's internal structure and allow doctors to rule out some specific causes of back pain. However, MRI scans may also detect anomalies unrelated to back pain, prompting clinicians to perform surgery that may not benefit the patient, the authors noted. To determine how MRI technology influences patient treatment, the researchers collected data on traditional U.S. Medicare patients who received care for nonspecific low-back pain from 1998 through 2005. Patient data were linked with the number of MRI machines in the area. The areas of MRI availability were then divided into four groups, from high to low, and the incidence of MRI scans and surgeries were determined in each group.

The researchers projected that in 2004 there would have been 5.4% fewer low-back MRI scans and 9% fewer back surgeries if all Medicare patients reporting new-onset low-back pain had been living in the areas of lowest MRI availability. Two-thirds of the MRI scans that appear to result from increased availability happened within the first month of onset. Clinical guidelines recommend delaying MRI use until four weeks after onset, during which time most low-back pain patients show spontaneous improvement. "Not only are patients in high-availability areas getting more MRIs, but they are getting them earlier,” stated Dr. Baras.

Between the years 2000 and 2005, the MRI availability in the United States more than tripled, from 7.6 machines per 1 million persons to 26.6 machines. Each machine costs more than US$2 million, and one low-back scan costs $1,500. Increased rates of scans and surgeries are increasing the cost to treat low-back pain, according to the investigators.

Doctors and patients face difficult decisions when using high-tech medical equipment, such as MRI scans. "The big issue is how we handle new and exciting technologies in ways that allow us to reap the benefits of medical advances, without letting all of our new things generate waste or, worse, actual reductions in patient well-being,” noted Dr. Baker.

John Birkmeyer, M.D., a professor of surgery and a health policy researcher at the University of Michigan (Ann Arbor, USA), who was not involved in the Stanford study, stated that the research confirms fears that greater access to MRI technology leads to more back surgeries. "The net result is increased risks of unnecessary surgery for patients and increased costs for everybody else,” Dr. Birkmeyer said.

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59 (169.99244689941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

60 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

61 (123.02398681641): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (688.07601928711): SELECT fid FROM jos_deeppockets WHERE id=294726286 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726286 AND published='1' LIMIT 1

63 (416.99409484863): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (60.081481933594): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

68 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294726286 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726286 AND published='1' LIMIT 1

69 (31.948089599609): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (344.99168395996): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (293.01643371582): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (70.095062255859): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (43.153762817383): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (43.869018554688): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

105 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

106 (66.995620727539): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

109 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

110 (72.956085205078): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (689.98336791992): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (903.84483337402): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (599.14588928223): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (182.15179443359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

115 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

116 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

117 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

118 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

119 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

120 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

121 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

122 (432.96813964844): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 23597.002029419): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (539.06440734863): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726286 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726286 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8219.0036773682): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (73.19450378418): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (65.803527832031): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (43.153762817383): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (411.03363037109): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (52.928924560547): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (473.97613525391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (342.84591674805): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (281.09550476074): SELECT name FROM jos_deeppockets WHERE id=212

138 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=212

139 (632.04765319824): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (595.0927734375): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

142 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

143 (!!!!! 8776.1878967285): TRUNCATE TABLE jos_trademed_module

144 (130.89179992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726286 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (902.89115905762): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

149 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

150 (!!!!! 1621.0079193115): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

152 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

153 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726286 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726286 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (30.994415283203): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (63.896179199219): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

158 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726286 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726286 AND published='1' LIMIT 1

159 (38.14697265625): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

163 (385.99967956543): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1305.103302002): insert into jos_banners_delta values (14615,'2025-06-28 18:17:24','216.73.216.249','view'),(14202,'2025-06-28 18:17:24','216.73.216.249','view'),(14203,'2025-06-28 18:17:24','216.73.216.249','view')

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