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Some Stroke Victims Not Receiving Rapid Diagnosis, Care in Emergency Departments

By MedImaging International staff writers
Posted on 21 May 2012

The key refrain in stroke care is “time is brain.” As time passes, more brain cells are irreversibly lost, and because of this, timely diagnosis and treatment is crucial to increase the likelihood for recovery. While considerable advances have been made to improve the response time of caregivers, a new study revealed that a crucial step in the process--imaging of the brain to determine the nature of the stroke--is still happening too gradually at too many hospitals.

A study published May 2012 in the journal Stroke showed that only 41.7% of stroke patients underwent brain imaging within the recommended 25 minutes of their arrival at a hospital. It also found that certain individuals, including people with diabetes, those over 75 years of age, women, those that did not arrive by ambulance, nonwhites, and those with specific cardiac conditions were less likely to receive a timely brain scan. These delays mean that treatment frequently arrives either too late or not at all.

“We were struck by the fact that less than half of patients with acute stroke symptoms did not receive a brain scan within recommended guidelines,” said University of Rochester Medical Center (New York, NY, USA) neurologist Adam Kelly, MD, lead author of the study. “This was the performance of hospitals who are actively participating in a national quality improvement program, so rates in nonparticipating hospitals may be even worse.”

Imaging the brain is an essential tool in the diagnosis of a stroke and determines which treatment option physicians will pursue. Strokes caused by a blockage in one of the arteries that serve the brain--called ischemic strokes--are candidates for the clot-busting drug tissue plasminogen activator (tPA), which can reestablish blood flow and improve clinical outcomes. However, this drug cannot be used when the symptoms are instead caused by a ruptured blood vessel in the brain. Furthermore, in order for tPA to be most effective it must be given as soon as possible and within three hours of the onset of symptoms. It is therefore essential that physicians are able to “see” what is occurring in the brain, and quickly.

Several US organizations, including the American Heart Association (AHA; Dallas, TX, USA), have created guidelines for emergency stroke care. An AHA quality improvement program called “Get with the Guidelines” is used to evaluate and recognize hospitals for their quality of stroke care. The program collects data and quality measures--such as the amount of time to complete a magnetic resonance imaging (MRI) or computed tomography (CT) scan of a suspected stroke patient’s brain--from each enrolled hospital. At the time of the study, 1,199 hospitals across the nation were participating in the Get with the Guidelines program.

The study’s investigators used the AHA data collected by the program to analyze the imaging times for 40,777 stroke patients who were candidates for tPA--had an ischemic stroke, arrived at the hospital within the three hour window, and did not have other conditions that precluded the use of tPA. In addition to low overall compliance with the brain imaging guidelines, the authors also found that individuals were less likely to receive timely brain scans if (1) they did not arrive at the hospital by ambulance (47% less likely); (2) were of nonwhite race, even though blacks and certain other ethnic/racial groups have a higher incidence of stroke; and (3) had specific known risk factors for stroke such as diabetes, a prior history of stroke, over 75 years old, and peripheral vascular disease.

In terms of clinical outcomes, the study showed that delays in diagnostic imaging can translate into missed or delayed treatment as well. Patients who received brain imaging within the recommended 25 minute period were much more likely to receive tPA (63%) compared to those not meeting this recommendation (38%). Furthermore, when tPA was administered, it was given earlier in patients who were imaged quickly. Earlier treatment with tPA is tied to improved functional outcomes in patients with ischemic stroke.

“Despite the strides that have been made in stroke care, it is clear that there is significant room for improvement in the evaluation of patients suspected of stroke,” said Dr. Kelly. “Time is too precious and hospitals cannot be the reason for delay.”

Related Links:
University of Rochester Medical Center
American Heart Association

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60 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

61 (148.05793762207): 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 (595.0927734375): SELECT fid FROM jos_deeppockets WHERE id=294740698 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740698 AND published='1' LIMIT 1

63 (453.94897460938): 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=211 ORDER BY `ordering`

64 (82.969665527344): select jos_twitters.link from jos_twitters where cat=10

65 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

66 (92.983245849609): select jos_google_plus.link from jos_google_plus where cat=10

67 (44.822692871094): select jos_linkedin.link from jos_linkedin where cat=10

68 (72.956085205078): SELECT fid FROM jos_deeppockets WHERE id=294740698 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740698 AND published='1' LIMIT 1

69 (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=211 ORDER BY `ordering`

70 (488.0428314209): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (422.00088500977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (61.03515625): 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 (122.7855682373): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (47.922134399414): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740698 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 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (80.108642578125): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (164.03198242188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

105 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

106 (57.93571472168): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

109 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

110 (138.0443572998): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (457.0484161377): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (744.10438537598): 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 (457.0484161377): 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 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

115 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

116 (110.14938354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

117 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

118 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

119 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

120 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

121 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

122 (441.07437133789): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 22073.984146118): 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 (531.91184997559): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740698 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740698 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (90.122222900391): ( 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 (36.954879760742): ( 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 (34.809112548828): 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 (30.994415283203): 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 (45.061111450195): 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 (36.001205444336): 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 (28.848648071289): 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 (29.087066650391): 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 (48.160552978516): 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 (37.908554077148): 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 (519.0372467041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (335.9317779541): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (253.91578674316): SELECT name FROM jos_deeppockets WHERE id=211

138 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=211

139 (636.10076904297): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (571.96617126465): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

142 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

143 (!!!!! 9057.0449829102): TRUNCATE TABLE jos_trademed_module

144 (128.03077697754): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (98.943710327148): 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=294740698 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (533.8191986084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

149 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

150 (!!!!! 1307.0106506348): 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 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

152 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

153 (51.021575927734): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740698 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740698 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (38.862228393555): 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=211 or channel_id is null)

155 (31.948089599609): 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=211 or channel_id is null)

156 (35.04753112793): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

158 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740698 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740698 AND published='1' LIMIT 1

159 (47.922134399414): select jos_twitters.link from jos_twitters where cat=10

160 (34.093856811523): select jos_facebook.link from jos_facebook where cat=10

161 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

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