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Many Stroke Patients Undergo Possible Redundant MRI and CT Neuromaging

By MedImaging International staff writers
Posted on 27 Mar 2012

Neuroimaging for stroke patients may be unnecessarily expensive and redundant, contributing to rising costs for stroke care, according to recent research.

The research, published in the February 2012 issue of the journal Annals of Neurology, found that 95% of stroke patients who received magnetic resonance imaging (MRI) also had a computed tomography (CT) scan. “Compared to CT, MRI is a more accurate test for stroke,” said James F. Burke, MD, lead author of the study and a clinical lecturer in the University of Michigan Medical School’s (Ann Arbor, USA) department of neurology. “But our results showed that MRI is not replacing CT as the primary stroke neuroimaging study--instead, patients are getting both. Minimizing the use of multiple studies could be a viable strategy to reduce costs.”

The costs of inpatient stroke care have climbed by 42% between 1997 and 2007, an increase of USD 3,800 per case, Dr. Burke and his University of Michigan found. Neuroimaging--MRIs and CTs--were the largest driver of costs.

Diagnostic imaging has been the fastest growing component of total hospital costs, increasing 213% t from 1999 to 2007. “The data show that neuroimaging practices in stroke are neither standardized nor efficient,” Dr. Burke noted. “This represents an area where we have an opportunity to substantially reduce the cost of care without adversely affecting the quality of care.”

Dr. Burke’s research spurred an accompanying editorial in the same issue of the journal, written by the journal editors S. Clairborne Johnson, MD, PhD, and Stephen L. Hauser, MD. “The issue of duplicative imaging in stroke is just one example of wasteful care,” the editors wrote. “Quite simply, it is very easy to order more test and to treat with more expensive therapies . “We should track waste as another measure of quality care...The failure to find a political solution to rising healthcare costs only increases our responsibility to become leaders and not victims.”

Burke and his coauthors studied patients diagnosed with stroke from 1999 to 2008 in 11 states, studying 624,842 patients. They found wide geographic variation for the use of MRI, but overall the use of MRI jumped dramatically. “There currently is not evidence-based guidelines that preferentially recommend either MRIs or CT,” Dr. Burke remarked. “Understanding trends like these presented in this study are essential to determining efficient and consistent neuroimaging strategies.”

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63 (54.121017456055): 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 (66.995620727539): select jos_twitters.link from jos_twitters where cat=10

65 (39.815902709961): select jos_facebook.link from jos_facebook where cat=10

66 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.14697265625): select jos_linkedin.link from jos_linkedin where cat=10

68 (90.122222900391): SELECT fid FROM jos_deeppockets WHERE id=294739952 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739952 AND published='1' LIMIT 1

69 (46.014785766602): 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 (426.05400085449): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (353.09791564941): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (50.067901611328): 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 (84.877014160156): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (87.976455688477): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (49.829483032227): 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 (146.86584472656): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (72.956085205078): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3694.0574645996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

105 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

106 (85.115432739258): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (681.87713623047): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

109 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

110 (69.856643676758): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (811.10000610352): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (772.95303344727): 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 (!!!!! 2377.986907959): 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 (337.83912658691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

115 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

116 (648.02169799805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

117 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

118 (332.11708068848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

119 (226.97448730469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

120 (710.01052856445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

121 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

122 (590.08598327637): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 54204.940795898): 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 (!!!!! 7009.0293884277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739952 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739952 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 11384.010314941): ( 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 (!!!!! 4221.9161987305): ( 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 (43.869018554688): 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 (89.168548583984): 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 (500.91743469238): 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 (42.915344238281): 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 (230.07392883301): 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 (35.04753112793): 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 (34.093856811523): 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 (108.95729064941): 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 (674.00932312012): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1384.973526001): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=212

138 (41.961669921875): SELECT name FROM jos_deeppockets WHERE id=212

139 (671.1483001709): 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 (672.1019744873): 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 (499.01008605957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

142 (!!!!! 1680.1357269287): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

143 (!!!!! 14797.925949097): TRUNCATE TABLE jos_trademed_module

144 (92.983245849609): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (48.160552978516): 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=294739952 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1331.090927124): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (585.07919311523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (751.01852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

149 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

150 (!!!!! 2873.8975524902): 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 (435.11390686035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

152 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

153 (144.00482177734): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739952 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739952 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (664.94941711426): 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 (183.10546875): 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 (269.17457580566): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (621.08039855957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

158 (949.85961914062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739952 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739952 AND published='1' LIMIT 1

159 (348.09112548828): select jos_twitters.link from jos_twitters where cat=10

160 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10

161 (212.19253540039): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

163 (247.95532226562): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 3183.126449585): insert into jos_banners_delta values (14615,'2025-06-26 08:59:11','216.73.216.249','view'),(14202,'2025-06-26 08:59:11','216.73.216.249','view'),(14203,'2025-06-26 08:59:11','216.73.216.249','view')

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