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Report Advocates Ultrasound Use in Fields Outside of Cardiology

By MedImaging International staff writers
Posted on 03 Feb 2014

Investigators recently reported that there is increasing evidence regarding the utility of ultrasound in areas outside its traditional field of cardiology, with increasing use reported in general hospital rooms, clinics, and even prehospital settings. More...

The study’s findings were published in the January 2014 issue of Global Heart, the journal of the World Heart Federation, and authored by Assoc. Prof. Bret Nelson and Dr. Amy Sanghvi, from Mount Sinai School of Medicine (New York, NY, USA). “The pervasive use of focused ultrasound is perhaps most evident in the advent of ultrasound training in undergraduate medical curricula,” reported the authors. They refer to a 2011 review article that emphasized the rising use of point-of-care ultrasound by clinicians in over 20 specialties. “Increased training by clinicians across many specialties, coupled with technology improvements yielding lower cost and better quality studies, have contributed to this trend,” they added.

In emergency medicine care, as well as providing faster and accurate diagnoses in most patients compared with physical examinations by themselves, the investigators reported that the prognostic value of emergency physician-performed cardiac ultrasound has been validated. Several studies have demonstrated that no cardiac arrest patients without cardiac activity evident on ultrasound survived resuscitation.

Many studies have addressed the use of point-of-care ultrasound in general hospital wards and clinics. A clinic-based study of first-year medical students instructed in the use of ultrasound demonstrated they were able to identify pathology in 75% of patients with known cardiac disease, where board-certified cardiologists using stethoscopes could detect only 49%. Pocket-sized ultrasound devices were used by general practitioners (GPs) in Norway to assess left ventricular function in patients with suspected heart failure. In that country, 92 patients were evaluated by GPs as well as cardiologists, and the measurements obtained with ultrasound by GPs correlated well with those obtained by cardiologists.

Outside the clinic, ultrasound has also been proving its worth. In setting where ambulances are staffed by physicians, the researchers evaluated patients in cardiac arrest as well as those receiving peri-arrest care. The FEEL (Focused Echocardiography Evaluation in Life Support) study demonstrated that cardiac ultrasound changed management in 89% of the cardiac arrest patients and 66% of peri-arrest patients. The opportunity also exists for ambulances to transmit ultrasound images to the in-hospital emergency teams awaiting the arrival of the incoming patient, with potentially life-saving implications.

Moreover, the authors refer to wide-ranging examples of ultrasound being included in the latest medical education curricula in the United States and Germany. Many countries worldwide are increasingly seeing the benefits of educating their medical students in this important technique.

The authors concluded, “Dramatic technology advancements continue to change the face of medicine. In the first several decades of medical ultrasound use, machine cost, size, and significant training requirements meant the technology was used mainly by radiology, obstetrics, and cardiology departments. As the machines progressed into less expensive, portable devices and other specialties demonstrated the value of qualitative point-of-care assessments, there has been an explosion of specialties using ultrasound. The need for comprehensive sonographic assessments by specialist consultants is unlikely to wane with the advent of point-of-care ultrasound. As our healthcare system becomes increasingly interested in cost-effective and evidence-based care, we are likely to see clinician-performed focused examinations complemented by comprehensive specialist studies with clear clinical indications.”

Prof. Jagat Narula, editor-in-chief of Global Heart, added, “As the ultrasound training becomes a universal part of training in medical schools, hand-held devices would be carried by physicians, just as stethoscopes are today.”

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55 (471.83036804199): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

56 (111.10305786133): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (622.98774719238): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1845.121383667): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

59 (920.05729675293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

60 (608.92105102539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

61 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

62 (!!!!! 3967.0467376709): 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

63 (!!!!! 6389.856338501): SELECT fid FROM jos_deeppockets WHERE id=294750514 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294750514 AND published='1' LIMIT 1

64 (216.96090698242): 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=214 ORDER BY `ordering`

65 (952.00538635254): select jos_twitters.link from jos_twitters where cat=10

66 (!!!!! 3867.1493530273): select jos_facebook.link from jos_facebook where cat=10

67 (311.85150146484): select jos_google_plus.link from jos_google_plus where cat=10

68 (504.0168762207): select jos_linkedin.link from jos_linkedin where cat=10

69 (218.15299987793): SELECT fid FROM jos_deeppockets WHERE id=294750514 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294750514 AND published='1' LIMIT 1

70 (154.01840209961): 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=214 ORDER BY `ordering`

71 (!!!!! 2542.0188903809): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (499.96376037598): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (408.88786315918): 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`

74 (195.98007202148): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (247.00164794922): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (200.03318786621): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (195.98007202148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (154.01840209961): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (171.89979553223): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (195.98007202148): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (340.22331237793): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (!!!!! 3221.0350036621): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (269.88983154297): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (636.81602478027): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (178.81393432617): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (207.90100097656): 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`

91 (443.93539428711): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (155.92575073242): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (174.04556274414): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (142.09747314453): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (129.93812561035): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (191.92695617676): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (174.04556274414): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (202.89421081543): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (472.06878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

106 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

107 (153.0647277832): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (172.13821411133): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (706.19583129883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

110 (165.22407531738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

111 (73.909759521484): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (990.86761474609): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (878.81088256836): 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 (602.00691223145): 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

115 (222.20611572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

116 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

117 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

118 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

119 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

120 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

121 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

122 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

123 (466.10832214355): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 26447.057723999): 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

125 (849.00856018066): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750514 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750514 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 17582.893371582): ( 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 (92.983245849609): ( 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

128 (51.021575927734): 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 (68.902969360352): 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

130 (60.081481933594): 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 (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

132 (458.95576477051): 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 (68.187713623047): 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

134 (43.869018554688): 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 (36.001205444336): 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

136 (771.99935913086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (480.89027404785): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (47.922134399414): SELECT name FROM jos_deeppockets WHERE id=214

139 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=214

140 (861.88316345215): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (720.02410888672): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

143 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

144 (!!!!! 13210.05821228): TRUNCATE TABLE jos_trademed_module

145 (162.83988952637): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (78.916549682617): 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=294750514 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (602.96058654785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

150 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

151 (!!!!! 1599.0734100342): 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

152 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

153 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

154 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750514 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750514 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (41.007995605469): 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=214 or channel_id is null)

156 (41.007995605469): 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=214 or channel_id is null)

157 (62.942504882812): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

159 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750514 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750514 AND published='1' LIMIT 1

160 (43.153762817383): select jos_twitters.link from jos_twitters where cat=10

161 (48.87580871582): select jos_facebook.link from jos_facebook where cat=10

162 (52.928924560547): select jos_google_plus.link from jos_google_plus where cat=10

163 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

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