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Intervention Makes it Easier for Children to Complete MRI Scanning Without Sedation

By MedImaging International staff writers
Posted on 12 Sep 2012

A US children’s research hospital reported success using a targeted educational strategy to teach young patients to remain motionless during magnetic resonance imaging (MRI) scans, making the process safer and less scary for the child.

Sitting still is difficult for children, which makes MRI scanning a challenge. The scans require that patients remain motionless for extended periods. New findings revealed that a short-term, targeted intervention dramatically increases the likelihood that children as young as five years old will be able to undergo scanning without sedation.

That is promising news for children with sickle cell disease, who were the focus of this study. Patients with sickle cell disease frequently undergo brain and liver MRI scans to monitor for complications related to their disease or treatment. However, the blood disorder puts patients at increased risk for serious anesthesia-related complications; therefore, sedation is avoided when possible.

This study of 71 patients with sickle cell disease ages 5 through 12 found that children who completed the short preparation program prior to their MRI scan were eight times more likely to complete the scans without being sedated than patients of the same age who did not receive the preparation. The study’s findings were published online September 2012 in the journal Pediatric Radiology.

The intervention implemented by the Child Life Program at St. Jude Children’s Research Hospital (Memphis, TN, USA) involves educating patients and families about exactly what to expect during an MRI, assigning patients jobs to focus on during the scans and working to identify strategies to help them remain motionless during the scanning process. “Some patients chose to listen to music or to squeeze a ball to help them remember not to move,” said Dr. Katherine Cejda, a St. Jude Child Life specialist and the study’s first author. “Some patients had the option of watching movies or having parents or other adults in the room with them during the test.”

This study is the first designed to determine the effectiveness of this approach and the first to focus on children with sickle cell disease. Dr. Cejda reported that similar programs are used by child life specialists throughout the United States to help prepare children for MRI scanning and other medical procedures. The article’s senior author, Jane Hankins, MD, an associate member of the St. Jude department of hematology, reported that avoiding sedation reduces the risk to the patients, especially those with sickle cell disease.

Sickle cell disease is caused by a mutation in the gene for assembling hemoglobin. Hemoglobin is the protein red blood cells use to transport oxygen throughout the body. While red blood cells are typically pliable discs, the inherited error results in red blood cells becoming stiff and assuming a banana shape that can trigger intense pain and lead to organ damage. Dr. Hankins noted that the disease also makes anesthesia riskier.

General anesthesia can lead to a decrease in temperature, blood oxygen levels, and dehydration. In patients with sickle cell disease, dehydration can result in a painful and hazardous accumulation of sickled cells. Patients can end up hospitalized, occasionally in the intensive care unit, for treatment of severe pain or acute chest syndrome, a pneumonia-like illness, according to Dr. Hankins. To reduce that risk, a sickle cell patient scheduled for anesthesia is hospitalized overnight to receive extra fluids and possibly a blood transfusion.

The combination of factors creates problems and added risk for the patient. It also adds to health care costs. Whereas no family ever pays St. Jude for the care their child receives, controlling costs remains important to the hospital. The program could also be adopted by other health care institutions worldwide to help manage cost. The intervention is now routinely offered to all St. Jude patients undergoing MRIs. Dr. Cejda noted that the program has been used to help children as young as age four complete scans without sedation. “This preparation program offers a real advantage to patients,” Dr. Hankins added.

The study included children scheduled for brain or liver MRI scans that usually last 30 to 60 minutes. Researchers reported that 30 of the 33 children, or 91%, in the intervention group underwent successful MRI scans without sedation. That compares to 71%, or 27 of 33 patients, who did not participate in the program prior to undergoing MR scanning without sedation.

St. Jude Children’s Research Hospital has played a pivotal role in pushing overall US pediatric cancer survival rates from 20%-80%. No family ever pays St. Jude for the care their child receives.

Related Links:
St. Jude Children’s Research Hospital

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57 (!!!!! 1451.0154724121): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

58 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

59 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

60 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

61 (79.870223999023): 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 (457.0484161377): SELECT fid FROM jos_deeppockets WHERE id=294742504 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742504 AND published='1' LIMIT 1

63 (42.915344238281): 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 (39.815902709961): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE id=294742504 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742504 AND published='1' LIMIT 1

69 (35.04753112793): 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 (423.90823364258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (275.85029602051): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): 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 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (54.836273193359): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (53.167343139648): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (38.14697265625): 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 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

105 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

106 (51.021575927734): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (150.20370483398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

109 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

110 (94.175338745117): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (712.15629577637): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (560.99891662598): 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 (350.9521484375): 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 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

115 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

116 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

117 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

118 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

119 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

120 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

122 (246.04797363281): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 20054.10194397): 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 (509.97734069824): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742504 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742504 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7115.8409118652): ( 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 (71.048736572266): ( 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 (39.100646972656): 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 (29.802322387695): 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 (58.174133300781): 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 (30.040740966797): 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 (281.09550476074): 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 (515.93780517578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (360.96572875977): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=212

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=212

139 (570.05882263184): 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 (480.89027404785): 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 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

142 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

143 (!!!!! 7972.0020294189): TRUNCATE TABLE jos_trademed_module

144 (119.92454528809): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (60.796737670898): 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=294742504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (783.92028808594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

149 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

150 (!!!!! 1189.9471282959): 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 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

152 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

153 (49.829483032227): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742504 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742504 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (42.200088500977): 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 (36.954879760742): 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 (40.054321289062): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

158 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742504 AND published='1' LIMIT 1

159 (63.896179199219): select jos_twitters.link from jos_twitters where cat=10

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

161 (30.994415283203): 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 (286.81755065918): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1116.9910430908): insert into jos_banners_delta values (14615,'2025-06-26 04:22:13','216.73.216.249','view'),(14202,'2025-06-26 04:22:13','216.73.216.249','view'),(14203,'2025-06-26 04:22:13','216.73.216.249','view')

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