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Osteoporosis Treatment Improved by Simple Intervention

By MedImaging International staff writers
Posted on 05 Nov 2012

Older patients who visited local emergency rooms (ERs) for breathing difficulties or chest pain and underwent chest X-ray exams revealing unknown spinal fractures, were subsequently more likely to receive osteoporosis treatment if simple interventional methods were used.

Treatment rates for osteoporosis considerably improved when patients and their family physicians received follow-up information about the warning signs and risk factors of the condition. It is the first and only trial worldwide that examined spinal osteoporosis. Of those patients who were not targeted with the intervention, only 6% received follow-up treatment or testing for osteoporosis. When physicians were given educational material, the treatment or testing rate jumped to 49%. Furthermore, when both the physicians and patients were informed, the patients being treated or tested rate rose to 65%.

University of Alberta (Edmonton, AB, Canada) faculty of medicine and dentistry researcher Dr. Sumit Majumdar led the study published October 2012 in the American Journal of Medicine. It looked at patients over the age of 60 who visited two Edmonton emergency departments for various complaints and needed a chest X-ray, which incidentally revealed spinal fractures. One group of patients was not contacted for an intervention, only physicians were contacted in another group, and both physicians and their patients were contacted in a third group.

Family physicians targeted in the intervention received a one-page email, fax, or letter from local physicians and nurses that explained osteoporosis treatment guidelines and recommendations. The same nurse phoned some patients to share the same information and answered patients’ questions. These patients also received a pamphlet clarifying the association between spinal fractures and osteoporosis.

“The information we provided was not new. But the fact it was linked to a specific patient and had specific advice, it acted as a reminder about what actions family doctors could take when they next saw that patient,” said Dr. Majumdar. “These fractures identified in chest X-rays are associated with a 20-fold increase of future fractures in people with osteoporosis--and these can be devastating fractures like fractures of the hip that can lead to nursing home admission or death. What was also concerning is that two-thirds of the patients in the study had a previously documented wrist or hip fracture before the X-ray was done, but they never received osteoporosis treatment.”

Dr. Majumdar estimates the healthcare system could save USD 1,000 per patient, if high-risk patients similar to the ones in this study received proper follow-up testing and treatment for osteoporosis. Hip fractures alone cost about USD 50,000 each to treat, and osteoporosis costs the Canadian healthcare system about USD 1 billion a year.

When compared to the costs of the education intervention—USD 34 per physician and USD 42 per patient— “it’s the equivalent of one month’s supply of osteoporosis medication,” said Dr. Majumdar. One concerning revelation he noted in the study was that 25% of the patients were men and none of them received followed-up treatment or testing as part of routine care. Dr. Majumdar ascribed this to the fallacy that “osteoporosis is considered a disease of older women.”

Men have worse fractures and are more at risk to die of hip fractures than women, according to the investigators.

The research was funded by Knowledge Translation Canada, the Canadian Institutes of Health Research (CIH; Ottawa, Ontario, Canada) and Alberta Innovates-Health Solutions (Edmonton, Alberta, Canada). “This is both a research and a knowledge translation success story and CIHR would like to congratulate Dr. Majumdar on this important work,” said Phillip Gardiner of the CIHR Institute of Musculoskeletal Health and Arthritis. “The healthcare costs associated with osteoporosis can be reduced and treatments improved when creative approaches like this are developed and implemented.”

Dr. Majumdar reported that this educational intervention program could be a model for other disorders that could be diagnosed in the ER, with follow-up care being managed by nurses or pharmacists.

Related Links:
University of Alberta
Knowledge Translation Canada, the Canadian Institutes of Health Research

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60 (163.07830810547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

61 (!!!!! 4696.8460083008): 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 (891.92390441895): SELECT fid FROM jos_deeppockets WHERE id=294743237 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743237 AND published='1' LIMIT 1

63 (476.83715820312): 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 (98.943710327148): select jos_twitters.link from jos_twitters where cat=10

65 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

66 (40.054321289062): 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 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=294743237 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743237 AND published='1' LIMIT 1

69 (41.961669921875): 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 (319.9577331543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (326.87187194824): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (63.180923461914): 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 (73.909759521484): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): 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 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (81.062316894531): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743237 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=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (47.922134399414): 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 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (121.11663818359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

105 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (396.0132598877): 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

109 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

110 (76.055526733398): 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (576.01928710938): 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (970.12519836426): 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 (!!!!! 4050.9700775146): 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 (358.81996154785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

115 (333.07075500488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

116 (301.12266540527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

117 (550.98533630371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

118 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

119 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

120 (190.01960754395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

121 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

122 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 74453.830718994): 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 (736.95182800293): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743237 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743237 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 20642.995834351): ( 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 (74.863433837891): ( 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 (38.862228393555): 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 (29.087066650391): 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 (44.822692871094): 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 (29.087066650391): 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 (304.9373626709): 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 (66.041946411133): 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 (28.133392333984): 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 (509.97734069824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (413.89465332031): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (188.11225891113): SELECT name FROM jos_deeppockets WHERE id=211

138 (130.89179992676): SELECT name FROM jos_deeppockets WHERE id=211

139 (730.03768920898): 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 (729.08401489258): 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 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

142 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

143 (!!!!! 7318.9735412598): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1063.8236999512): 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (83.92333984375): 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=294743237 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (549.0779876709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

149 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

150 (!!!!! 1363.0390167236): 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 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

152 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

153 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743237 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743237 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (565.0520324707): 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 (44.107437133789): 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 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

158 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743237 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743237 AND published='1' LIMIT 1

159 (39.100646972656): select jos_twitters.link from jos_twitters where cat=10

160 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

161 (27.179718017578): select jos_google_plus.link from jos_google_plus where cat=10

162 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

163 (252.00843811035): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 2974.9870300293): insert into jos_banners_delta values (14615,'2025-08-19 14:02:09','216.73.216.0','view'),(14202,'2025-08-19 14:02:09','216.73.216.0','view'),(14203,'2025-08-19 14:02:09','216.73.216.0','view')

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