Reading Time:

11 minutes

How Important is a Laboratory Test Result?

Proper procedures are absolutely crucial when evaluating and diagnosing a patient. The results of lab tests affect the decision-making process that medical professionals go through when formulating the best strategy for treatment, not to mention their role when doctors inform patients about their illness or lack thereof! If lab tests are mistaken, the patient’s health will be compromised and the situation can escalate to a life-threatening level.

There are many standard operating procedures, resources, supplies, and equipment involved in a lab test. Without the proper tools, every level of patient care thereafter will, in all likelihood, be a mistake.

As the results from the work ‘Factors that can affect laboratory investigations‘ published in The Best Practice Advocacy Centre explains: “If a sample is being collected at the practice, it is important to be familiar with the type of collection container and sample medium that is required by the laboratory for the specific test, as this can affect results, sometimes markedly. For example, a swab for PCR testing for pertussis should be transported in a dry tube or a tube with a universal viral transport medium, but not in a tube with charcoal transport medium (which is acceptable for swab culture).” 1

The American Association for Clinical Chemistry (AACC) on their publication ‘How Reliable is Laboratory Testing’ regarding specific requirements established by the US Food and Drug Administration (FDA) perfectly indicates that:

“All laboratory test methods must meet scientifically rigorous criteria before they can be used in clinical practice. For commercial tests in the U.S., the Food and Drug Administration (FDA) reviews the scientific evidence to ensure that:

  • The test is accurately able to detect or measure the substance it claims to detect or measure, and
  • The measurement or detection of this substance provides important information about an illness or about health status that assists in the diagnosis, treatment, or monitoring of a patient.

A laboratory must demonstrate that it is able to perform that test in a clinically acceptable way. State and federal regulatory agencies monitor the laboratory and set standards that a laboratory must meet in order to be allowed to perform the test. Some of these standards are:

  • Laboratories must perform routine quality control tests, usually every day, and in many cases, several times a day. Quality control tests usually include normal and abnormal samples to ensure that the equipment, the technologist, and the reagents used in the test are performing to established standards.
  • Laboratories must participate in proficiency testing programs in addition to quality control testing. For proficiency testing, an external agency sends “challenge” samples to be tested. The laboratory must report results back to the agency. The agency has already evaluated each of the challenge samples and knows the expected results. This evaluation also compares results to other participating laboratories, noting similarities or differences that may be attributed to the testing methodologies used. The laboratory must get the right result in order to be allowed to continue to test patient samples. If the lab repeatedly fails to get the right result, it is prohibited from continuing the performance of that test until it can demonstrate that it has corrected the problems that led to the unacceptable results.
  • Laboratories must demonstrate that they have written policies and procedures in place to specifically document how the sample is collected, transported, evaluated, and reported in an appropriate manner.

These requirements ensure that the tests performed by clinical laboratories for patient care will generate results that are reproducible and can be trusted.2

According to statistics, 1.5 out of 20 adults in the US receive a test result with incorrect information. As you can see, errors are more common than you may think. More than 12.5 billion tests are carried out in clinical laboratories every year in the US and based the aforementioned statistic, it means that false lab results account for just under 1 billion lab tests per year.

As results from Scientific American statistical investigations show on their work ‘What Everyone Should Know About Lab Tests’: “In the United States, some 251,000 deaths per year occur because of errors in medical care. This makes medical errors the third leading cause of death, only after heart disease and cancer. Though this is alarming and concerning, it highlights a much larger problem, as many medical errors aren’t lethal.”

Medical error are defined as “an act of omission or commission in planning or execution that contributes or could contribute to an unintended result.”3

Also, according to laboratory samples quality control information provided by the AACC   (American Association for Clinical Chemistry):

“Laboratory testing is subject to many factors that potentially could adversely affect the integrity of the sample and prevent the timely reporting of an accurate test result to your provider. Typically these are grouped into three areas that track the sample from beginning to end of the process.

  • Pre-Analytical is the term used to describe things that happen from the time the test is ordered to the time the sample arrives in the lab.
  • Analytical is the term used to describe the things that happen during the handling and analysis of the sample in the laboratory.
  • Post-Analytical is the term used to describe what happens after a result is obtained and includes how and when it is reported to your provider.

Pre-Analytic Activities
From the time a test is ordered, a chain of events is set into motion. All these steps must be done the right way to ensure that an acceptable sample arrives at the lab. The following are some of the areas where errors can occur, even though standard procedures are in place to prevent such errors.

  • Test ordering process – the provider must order the correct test using the correct test name or code.
  • Patient preparation for the test – the patient should have received appropriate instructions about diet, fasting, medications, etc. to ensure that the sample will not contain substances that interfere with the test.
  • Patient identification – the person collecting the sample needs to confirm that the person is indeed the patient on whom the test was ordered. In hospitals, this means checking for a wristband and confirming proper identification of the patient. When you are asked to give your name and some other identifying information, it is to ensure that you and your sample are correctly matched. If this isn’t done when a sample is taken, make sure you check to see that your sample is identified correctly.
  • Completeness of patient information – the sample must be carefully labeled with two identifiers (usually patient name and date of birth or medical record number and the date of service) to ensure that the sample is associated with the correct patient. A hard copy requisition or electronic version must accompany the specimen and includes the tests ordered, patient’s demographics, ordering practitioner’s demographics, date of service, and the phlebotomist’s identification.
  • Specimen collection procedures – the sample must be collected in the correct type of container and mixed with the right preservative, when appropriate. The laboratory staff who collect samples receive special training on how to collect samples for each kind of test.
  • Transport to the lab – some samples need to be kept cold, while some need to be processed and tested within a limited time, so careful handling and prompt transportation are important components to sample integrity. In addition, ambient temperatures during transport, with extremely hot or cold weather, may also have an impact on specimen integrity and must be addressed accordingly.4

Many incorrect lab results occur, as The Best Practice Advocacy Centre specifies, due to an incorrect collection, transportation and handling of the samples. And as they explain:

  • “Blood samples for coagulation studies, including platelet count, D-dimer, prothrombin time, APTT and fibrinogen, should be transported to the laboratory within four hours of collection6
  • Urine specimens for culture should be stored in a fridge prior to transportation to reduce the rate of multiplication of microorganisms.
  • Samples for glucose analysis should be separated as soon as possible after collection; this applies even with samples collected in fluoride or oxalate collection tubes, as a reduction in glucose concentration still occurs for 60–90 minutes.
  • Samples for potassium or phosphate should not be left overnight, especially in the fridge, as results can be markedly altered, e.g. late evening collection with delayed transport to the laboratory.
  • Fecal samples for culture and microscopy should preferably be transported to the laboratory within four hours.
  • Semen samples for fertility testing should be kept by the patient at body temperature, e.g. by storing in a clothing pocket and transported to the laboratory within one hour of collection. The same level of urgency is not required for post-vasectomy semen analysis.” 5

Many people have been told they have a disease after an incorrect reading, making the patient worry unnecessarily, causing negative psychological consequences. This is why it is recommended to ask for a second opinion when a gloomy diagnosis is received. Imagine being incorrectly diagnosed with a terminal disease that never was. How would receiving bad news dictate your actions? False information can have the same influence on a patient’s life as real ones, especially with regards to treatments and the financials involved in dealing with a disease. The impact on your life can be massive if the lab tests turned out to be incorrect or inaccurate.

The American Society for Clinical Pathology on their Lab Medicine publication states that: “Laboratories have spent decades improving analytical quality by establishing internal quality controls (IQC) and external quality assessment (EQA). The role of EQA and proficiency testing (PT) is to provide reliable information allowing laboratories to assess and monitor the quality status of internal procedures and processes, the suitability of the diagnostic systems, the accountability and competence of the staff, along with the definition of measurement uncertainty in laboratory results. The responsibility of laboratory professionals is to appropriately analyze EQA/PT samples and reports, detect trends or bias that may not be apparent in single results, investigate root causes producing unacceptable performances, apply and monitor opportune actions for removing the underlying cause(s), verify the effectiveness, and, above all, determine whether the problem affected clinical decision making.6

Some medical facilities have mistaken the patient’s records for another or performed tests to the incorrect patient. If one inaccuracy can affect the outcome of treatment negatively, imagine what would happen if a triple blunder transpired: an inaccurate result from an incorrect procedure for the wrong patient!

As The Best Practice Advocacy Centre describes in ‘Best Tests investigation results’ in the laboratory investigation ‘Factors that can affect laboratory investigations’, it can also be a matter of: “selecting the right test, at the right time, for the right patient. After making the decision that an investigation is necessary, and selecting the most appropriate test, consideration must be given to what factors are present that may affect the interpretation of results, or even the decision to proceed with the test at that time.” 7

It is important for patients and family members to ask the laboratory professional that is taking the sample: What is the test for? This is a normal question and they are under obligation to explain why the test needs to be performed. If there has been a mistake with the ordering of the exam, that simple inquiry may nip any issue in the bud before it even begins.

The National Academies of Sciences, Engineering, and Medicine states, you need to:

  • Be an Informed Consumer.
  • Learn about your illness.
  • Know the names of your medications (both generic and brand names). For example, Tylenol (brand name) and acetaminophen (generic name) – Know what the medication is for.
  • Make sure about the amount (dose) you need to take.
  • The time(s) you need to take it during the day.
  • The side effects to watch for and report to your clinician.
  • If the medication interacts with any food or drugs.8

Make sure you have the correct instructions prior to the test. Double check with your doctor or the laboratory professional to be sure what you should and shouldn’t do. Patients not following instructions before taking a lab test is one of the most common reasons test errors occur, not because of a mistake on the lab’s part.

The National Academies of Sciences, Engineering, and Medicine on their report ‘Improving Diagnosis in Health Care’ clearly indicates important steps you need to follow to help achieve proper diagnosis starting with “Effective communication and collaboration among all members of the diagnostic team are essential to improve health care and outcomes and to reduce the risk of diagnostic error. Although there are a number of challenges to patient engagement in the diagnostic process, a critical step is for healthcare professionals and organizations to create environments in which patients and their families can learn about the diagnostic process and feel comfortable participating in this process.”  

First of all, the National Academies Organization states that: “it is very important to: Know Your Test Results.

  • Make sure both you and your clinician get the results from any tests that are done.
  • Don’t assume that no news is good news; call and check on your test results.
  • Ask what the test results mean and what needs to be done next. Follow Up.
  • Ask when you need to make another appointment (follow up) with your clinician once you start treatment.
  • Ask what to expect from the treatment or what it will do for you.
  • Ask what you need to do if you get new symptoms or start to feel worse. Make Sure It Is the Right Diagnosis.
  • Don’t be afraid to ask “What else could this be?”

After your clinician diagnoses your condition, ask if it could be something else. Make sure you understand what is causing your symptoms. In your own words describe the diagnosis back to your clinician.

  • Encourage your clinicians to think about other possible reasons for your illness.”
  • Inviting someone to go with you.

Bringing someone to your appointment can help you to answer questions and give your clinician information. 9

“In order for the laboratory to have a positive impact on diagnostic errors, it is necessary to become part of the interdisciplinary patient-centered care team. Laboratory professionals need to view their services as contributing to patient outcomes, not just generating results.  Research on diagnostic errors and the laboratory’s role has found that failure to order appropriate diagnostic tests, including lab tests, makes up 55% of missed and delayed diagnoses in the ambulatory setting and 58% of errors in emergency departments. This statistic underscores the need for Clinical Lab Scientists to interact with and provide education to ordering providers on the proper use of the testing we provide. One way that clinical laboratory professionals can affect positive change is by collaborating with other healthcare providers to establish evidence-based decision-making guidance for ordering tests. Providing feedback to providers detailing improper test utilization patterns, both over- and under-utilization, is another way that laboratory professionals can help to reduce diagnostic errors.” As stated by the As Lab Testing Matters Organization states.10

As you can see, accurate laboratory test results may be affected due to different reasons. From the patients’ perspective, it is vital to follow all the indications provided by medical professionals to ensure an accurate measurement. The same goes for the lab itself. Technicians should take all the precautions necessary for the proper handling and processing of the sample taken to guarantee that the best possible treatment strategy is attainable, which is always based on the data they collect and provide.

Reference:

(1, 5, 7) The Best Practice Advocacy Centre. Best Tests. 2013. Factors that can affect laboratory investigations.

https://bpac.org.nz/bt/2015/april/laboratory-investigations.aspx

(3)        Scientific American. What Everyone Should Know about Lab Tests. 2016

https://blogs.scientificamerican.com/guest-blog/what-everyone-should-know-about-lab-tests/

(2, 4)  The American Association for Clinical Chemistry (AACC). Lab Tests Online organization. How reliable is Laboratory Testing? 2015.  

https://labtestsonline.org/articles/laboratory-test-reliability

(6)        The American Society for Clinical Pathology. Laboratory Medicine.

https://academic.oup.com/labmed/article/43/2/41/2505001

(8, 9)    National Academies Organization. The National Academies of Science, Engineering, and Medicine.

http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/Improving-Diagnosis/DiagnosticError_Toolkit.pdf

(10)      As Lab Testing Matters Organization. Do No Harm: Diagnostic Errors and the Lab 2017.

http://www.labtestingmatters.org/do-no-harm-diagnostic-errors-and-the-lab/

Robert Velasquez
10 January, 2019

Written by

Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

11,072 thoughts on “How Important is a Laboratory Test Result?

  1. VERIFIED SELLERSALE] Twitter Account with 5100+ Active Followers *Cheap & 100% Real BUY NOW

    just click the next web page
    https://sellaccs.net

    PM
    Skype & Telegram : congmmo
    ICQ : @652720497
    Email : accsmarket.net@gmail .com

    THX!

  2. Make Your Bitcoin Double In Just 12 Hours.
    The website promises to double your bitcoin with no human intervention required. Our system is fully automated it only needs 12 hours to double your bitcoins.
    Click : https://earnx2btc.com

  3. Invest ETHEREUM double your ETHEREUMs within 12 hours
    Before make an investment on double your ETHEREUM in 24 hours system, please read about plan features & then select which plan is best for your investment.
    Click : https://ether2x.net

  4. Just desire to saay your article is as astounding. The clarity for your
    put up is just spectacular and that i could suppose you’re a professional in this subject.
    Finne with your permission allow me to clutch
    your feed to keep up to date with approaching post.
    Thank you 1,000,000 and please carry on the enjoyable work.

    Here is my site … free silver coins

  5. I think the admin of this web site is truly working hard in support of his site, as here every data
    is quality based information.

  6. Make Your Bitcoin Double In Just 12 Hours.
    The website promises to double your bitcoin with no human intervention required. Our system is fully automated it only needs 12 hours to double your bitcoins.
    Click : https://doublecoins.net

  7. An outstanding share! I’ve just forwarded this onto a co-worker who was doing a little homework on this.
    And he in fact bought me breakfast because I stumbled upon it for him…
    lol. So allow me to reword this…. Thanks for the meal!!

    But yeah, thanx for spending time to talk about this issue here on your blog.

  8. Hello there, You have done an incredible job.
    I’ll definitely digg it and personally recommend to my friends.
    I’m confident they’ll be benefited from this website.

  9. For latest news you have to pay a quick visit world-wide-web and on world-wide-web I found this site as a
    most excellent web site for hottest updates.

  10. I have to thank you for the efforts you’ve put in penning this blog.
    I am hoping to view the same high-grade content from you in the future as well.
    In fact, your creative writing abilities has encouraged me to get my
    very own site now 😉

  11. Путешествуем по Крыму вместе, отдых на море в Крыму. Пляжи, экскурсии, путешествия и оздоровление. Море, солнце и пляж – где отдохнуть, что посмотреть в Крыму? Целебные озера, туристический и пляжный отдых на берегу моря, крымская кухня https://mytravelcrimea.ru/

  12. Every weekend i used to go to see this web page, as i want enjoyment, since this this
    web page conatyions truly good funny information too.

    Feeel free to surf to my blog post – gems brawl Stars

  13. What’s uup everybody, here every one is sharing ssuch know-how, so it’sfastidious to read this website, and I used to
    pay a visit this webpage daily.

    Feel free to surf to my blog :: War Robots Cheat

  14. Hello! Someone in my Myspace group shared this website with us so I came to look it over.
    I’m definitely enjoying the information. I’m bookmarking and
    will be tweeting this to my followers! Terrific blog and outstanding design and style.

  15. Hi there to every body, it’s my first go to see of this web site;
    this weblog includes remarkable and truly good stuff in favor of visitors.

  16. I am not sure where you are getting your information, but good topic.
    I needs to spend some time learning more or understanding more.
    Thanks for wonderful information I was looking for this information for my mission.

  17. If you are going for most excellent contents like
    I do, just pay a quick visit this web site every day for the reason that it gives
    quality contents, thanks

  18. I do trust all the concepts you have introduced to your post. They are very convincing and can certainly work. Nonetheless, the posts are too brief for beginners. Could you please lengthen them a little from subsequent time? Thank you for the post.

  19. I simply could not go away your website prior to suggesting that I really enjoyed the usual information an individual supply for your guests? Is going to be again frequently in order to check up on new posts.

  20. I simply couldn’t leave your website before suggesting that I actually loved the standard info a person supply to your guests? Is going to be again continuously in order to inspect new posts.

  21. Hi there, just become alert to your weblog thru Google, and found that it is really informative. I am going to watch out for brussels. I will appreciate if you proceed this in future. A lot of other people might be benefited out of your writing. Cheers!

  22. Смотреть фильмы в HD качестве. Сериалы, мультфильмы, аниме, передачи и ТВ шоу на нашем киносайте, без регистрации и смс. Фильмы в высоком качестве на HDrezka https://rezka.ws/

  23. Great blog you have got here.. It’s hard to find quality writing like yours nowadays.
    I honestly appreciate people like you! Take care!!

  24. I need to to thank you for this good read!! I certainly
    enjoyed every little bit of it. I’ve got you saved as a favorite to look at new
    stuff you post…

  25. You actually make it appear so easy along with your presentation but I to find this matter to be actually something which I feel I would
    by no means understand. It sort of feels too complex and
    very wide for me. I’m having a look forward on your subsequent publish, I’ll
    attempt to get the cling of it!

  26. I am really loving the theme/design of your web site. Do you ever run into
    any browser compatibility problems? A few of my blog audience have complained about
    my website not operating correctly in Explorer but looks great in Opera.
    Do you have any advice to help fix this issue?

  27. A very good account store, it has been working for a long time. I buy for the purpose of earning money through social networks, on freelance exchanges. Accounts provide only high-quality ones, with different registration terms, and a wide geography. Personally, as a client, I am satisfied with everything, I see no reason to complain, the pricing policy is also reasonable. We plan to continue using the service.
    Click here
    https://accstores.com

  28. With havin so much content and articles do you
    ever run into any issues of plagorism or copyright
    violation? My website has a lot of unique content I’ve either created myself or
    outsourced but it looks like a lot of it is popping it up all
    over the internet without my agreement. Do you know any solutions to help protect against content from being ripped off?
    I’d genuinely appreciate it.

  29. Aw, this was an exceptionally good post. Taking the time and
    actual effort to make a great article… but what can I say…
    I hesitate a lot and don’t seem to get nearly anything done.

  30. Everything is very open with a clear description of the
    issues. It was definitely informative. Your website is
    useful. Thank you for sharing!

  31. Удвоенная присоска означает, что она легко прилипает к ветровому стеклу, однако ее длина означает, что
    она имеет тенденцию слегка качаться на неровных поверхностях.

    Visit my web site: автодержатель для планшета

  32. Aw, this was a very nice post. Taking the time and actual effort to generate a superb article…

    but what can I say… I procrastinate a whole lot and
    don’t seem to get nearly anything done.

  33. I think that everything posted made a great deal of sense.
    However, think on this, suppose you were to create a awesome headline?
    I ain’t saying your information is not good., but what if you added a title that
    grabbed folk’s attention? I mean How Important is a Laboratory Test
    Result? – Laboratory Blog is kinda vanilla. You ought to look at Yahoo’s home page and see how
    they create post titles to get people to open the links.
    You might add a video or a picture or two to grab people interested about what you’ve got to say.
    In my opinion, it might bring your posts a little bit more interesting.

  34. Hello to every body, it’s my first go to see of this web
    site; this weblog contains awesome and in fact good stuff for readers.

  35. What’s up to all, since I am actually eager of reading this weblog’s post to
    be updated on a regular basis. It consists of pleasant stuff.

  36. Hmm it seems like your blog ate my first comment (it was
    super long) so I guess I’ll just sum it up what I had written and say,
    I’m thoroughly enjoying your blog. I too am an aspiring
    blog writer but I’m still new to everything. Do you have any helpful hints for first-time blog
    writers? I’d definitely appreciate it.

  37. Every weekend i used to go to see this site, because i wish for enjoyment,
    since this this website conations actually fastidious funny information too.

  38. I’ve been exploring for a little for any high quality articles
    or blog posts on this kind of house . Exploring in Yahoo I eventually stumbled upon this site.
    Studying this info So i’m glad to convey that I’ve
    a very excellent uncanny feeling I found out just what I needed.
    I such a lot indubitably will make certain to don?t omit this web site and provides it a glance regularly.

  39. Tremendous things here. I’m very glad to look your post.
    Thank you so much and I’m taking a look forward to touch you.
    Will you please drop me a e-mail?

  40. Great web site. Plenty of useful information here. I’m sending it to a few friends ans also sharing in delicious.

    And certainly, thanks to your sweat!

  41. Hello there, There’s no doubt that your blog could be having web browser compatibility problems.

    Whenever I take a look at your site in Safari, it looks fine however, when opening in I.E.,
    it’s got some overlapping issues. I just wanted to provide you with a quick heads up!
    Besides that, fantastic blog!

  42. annen varmı annen oruspu çocuğu
    I visit every day some sites and sites to read articles, except this
    website offers quality based writing.

  43. Write more, thats all I have to say. Literally, it seems as though
    you relied on the video to make your point.
    You definitely know what youre talking about, why throw away your intelligence on just
    posting videos to your blog when you could be giving us something informative to read?

  44. Hey there just wanted to give you a brief heads up and let you
    know a few of the images aren’t loading correctly. I’m not sure
    why but I think its a linking issue. I’ve tried it in two different web browsers and both show the same results.

  45. Great site you have here but I was curious about if you knew of any message boards
    that cover the same topics talked about in this article?
    I’d really love to be a part of group where I can get feed-back from other experienced individuals that share the
    same interest. If you have any recommendations, please let me know.
    Thanks!

  46. You made some good points there. I looked on the internet for the
    subject and found most individuals will agree with your blog.

  47. you are in point of fact a excellent webmaster.
    The site loading pace is amazing. It seems that you are doing any distinctive trick.

    Also, The contents are masterpiece. you’ve performed a fantastic activity in this topic!

  48. I’m curious to find out what blog system you happen to be using?
    I’m having some small security issues with my latest blog and I would like
    to find something more risk-free. Do you have any solutions?

    my blog: cheap taxi nice airport

  49. Ferari88 Adalah merupakan tempat bermain situs agen Judi Togel Online ,Slot Online,Sportbook,
    Casino Online Terpercaya & Situs Paling Aman,Fast Respon,Terbesar,Terbaik dan Terpercaya di Seluruh Pelosok
    Indonesia

  50. I simply could not leave your web site prior to suggesting that I
    extremely loved the standard information an individual provide for your guests?
    Is gonna be back frequently to investigate cross-check new posts

  51. Hey there, You have done an excellent job. I’ll definitely digg
    it and personally suggest to my friends. I am confident they will be benefited from this web site.

  52. Heya just wanted to give you a quick heads up and let you know a
    few of the pictures aren’t loading properly.
    I’m not sure why but I think its a linking issue. I’ve tried it in two different web browsers and both show
    the same outcome.

  53. Nice post. I was checking continuously this weblog and I’m inspired!
    Extremely useful information specifically the remaining phase 🙂
    I deal with such information much. I used to be looking for
    this certain information for a very long time. Thank you and best of luck.

  54. Hello, every time i used to check website posts here early in the break of
    day, for the reason that i enjoy to learn more and more.

  55. Excellent post. I used to be checking constantly this blog and
    I am inspired! Very useful information specifically the final phase 🙂 I maintain such information much.
    I used to be seeking this particular information for a
    long time. Thanks and good luck.

  56. It is truly a nice and helpful piece of info. I am glad that you simply shared this helpful information with us.
    Please keep us up to date like this. Thanks for sharing.

  57. Wow that was odd. I just wrote an very long comment but after I clicked submit my comment didn’t appear.
    Grrrr… well I’m not writing all that over again. Anyways,
    just wanted to say wonderful blog!

  58. An interesting discussion is definitely worth comment.
    I do believe that you should write more about this subject, it
    might not be a taboo matter but typically people don’t
    talk about these subjects. To the next! Cheers!!

  59. Hello it’s me, I am also visiting this site regularly, this web
    site is really nice and the users are in fact sharing
    pleasant thoughts.

  60. I do consider all of the ideas you’ve offered for
    your post. They are very convincing and can certainly work.

    Still, the posts are too short for starters. Could you please extend them a
    little from next time? Thank you for the post.

  61. My brother suggesterd I would possibly ike this web site.
    He was once totally right. This submit actually made my day.
    You cann’t imagine simply how so much time I had spent for this information!
    Thank you!

  62. Slot Joker ialah diantara yang lumayan lama serta diketahui tak
    jarang orang di Jakarta. Tak cuma sebab memiliki pengucapan nama yang gampang (dan benar-benar terkenal), Slot Joker mempunyai demikian kerap pilihan. Ada minimal 81
    variasi permainan slot, ditambah 11 jenis permainan fishing (pancing ikan) yang
    disebut yang sungguh-sungguh acap kali macamnya dibandingi provider lainnya, serta lima
    macam permainan single player (casino table). Tentu saja
    ada pula feature search yang dapat kita pakai untuk cari game Joker yang kita kehendaki
    lebih pesat.

    Permainan casino table yang disiapkan terbagi dalam Baccarat, Belangkai, Dragon Tiger,
    HuLu, serta SicBo. Tiga salah satunya yakni permainan casino live yang tentu tak jarang kita jumpai.
    Jadi apabila jemu dengan permainan casino live itu, kita bisa coba permainan semacam di Slot Joker.

    Di halaman pertama lobby slot Joker, kita kapabel diterima dengan 20 Top game yang telah diambil berdasar tingkat kepopulerannya.

    Jadi kita tidak wajib keder untuk pilih apa yang kurang lebih seringkali dimainkan kerap kali orang.

  63. Greetings, I believe your website might be having internet browser
    compatibility issues. Whenever I take a look at your web site in Safari, it looks fine
    however when opening in I.E., it’s got some overlapping issues.
    I merely wanted to provide you with a quick heads up!
    Aside from that, great website!

  64. Having read this I believed it was rather informative. I
    appreciate you spending some time and effort to put this article together.
    I once again find myself personally spending a lot of time both reading and commenting.
    But so what, it was still worthwhile!

  65. Nice post. I learn something new and challenging on blogs I stumbleupon on a daily basis.
    It’s always interesting to read content from other writers and
    use something from their websites.

  66. Helplo There. I foujd your blog using msn. Thiis is a really well written article.
    I’ll be sure to bookmark it and come back to read more
    of your useful information. Thanks for the post.
    I’lldefinitely return.

  67. Ηey this is somewhat of off topic but I was wondering if blogs use WYSӀWYG
    editors or if you have to manually code with HTML.

    I’m starting a blog soon but have no coding know-how so I wanted to get guidance from someone with exрerience.
    Any help w᧐uld be enormously appreciated!

  68. Appreciating the dedication you put into your website and detailed information you offer.
    It’s awesome to come across a blog every once in a while that isn’t
    the same out of date rehashed material. Excellent read!
    I’ve bookmarked your site and I’m including your RSS feeds to my
    Google account.

  69. Hi to all, how is everything, I think every one is getting more from this website, and your views
    are nice in favor of new visitors.

  70. I was wondering if you ever considered changing the page layout of your site?

    Its very well written; I love what youve got to
    say. But maybe you could a little more in the way of content so people could connect
    with it better. Youve got an awful lot of text
    for only having one or two images. Maybe you could space it out better?

  71. You have made soe decent points there. I checked on the net
    for more info about the issue and found most individuals will go along with
    your views on this website.

  72. Incredible! This blog looks just like my old one!
    It’s on a completely different subject but it has pretty
    much the same layout and design. Great choicce of colors!

  73. BoomSlot Situs Judi Slot Online, Togel Online, Sportbook, Casino Online, Terpercaya
    Dan Situs Paling Aman Dan fast Respon Deposit Pulsa Tanpa Potongan

  74. If some one needs expert view concerning runnikng a blog afterward i advise him/her too pay a quick visit this blog, Keep up the good job.

  75. I am really inspired along with your writing talenys and alsoo with the format
    on your weblog. Is that this a paid theme or did you mldify itt your self?

    Anyway keep up the nice quality writing, it’s uncommon to
    peer a great weblog like this oone nowadays..

  76. It is in point of fact a great and helpful piece of information. I’m happy
    that you simply shared this helpful info with us. Please stay us informd like this.
    Thanks for sharing.

  77. Heya superb website! Does running a blog such as this
    require a large amount of work? I’ve very little
    knowledge of coding however I was hoping tto sfart my own blog
    soon. Anyways, should yoou haave any ideas or tipos for new blpg owners please share.
    I ubderstand this is off topic but I simply needed to ask.

    Many thanks!

  78. Excellent weblog right here! Also your site quite a bit up very
    fast! What host are you using? Can I am getting your
    affiliate link to your host? I desire my web site loaded up as fast
    as yours lol

  79. BoomSlot Situs Judi Slot Online, Togel Online,
    Sportbook, Casino Online, Terpercaya Dan Situs Paling Aman Dan fast Respon Deposit
    Pulsa Tanpa Potongan

  80. wonderful points altogether, you simply received a new reader.
    What could you recommend about your publish that you just
    made a few days in the past? Any certain?

  81. Hello, Neat post. There’s an issue together with your site in web explorer, could check this?
    IE still is the marketplace chief and a large component to other folks will pass over your magnificent writing because of this problem.

  82. Howdy excellent website! Does running a blog such as this take a large amount of
    work? I’ve virtually no understanding of coding but I had been hoping to start my own blog
    in the near future. Anyway, should you have any recommendations or tips for new blog owners
    please share. I know this is off subject nevertheless I just had to ask.
    Thanks a lot!

  83. Hey there! I know this is kind of off topic but I was wondering which blog platform are you using for this site?
    I’m getting fed up of WordPress because I’ve had issues with hackers and I’m looking at
    options for another platform. I would be fantastic if you
    could point me in the direction of a good platform.

  84. It’s genuinely very complex in this busy life to
    listen news on Television, therefore I just use internet for that purpose, and obtain the latest news.

  85. I have been surfing on-line greater than 3 hours these days, but I by no means found any
    fascinating article like yours. It’sbeautiful worth enough for me.
    In my view, if aall website owners and bloggers made good content material as you
    robably did, the internet might bbe uch more useful than ever before.

  86. Have you ever considered about including a little bit more than just
    your articles? I mean, what you say is valuable and all. However
    think of if you added some great images or videos to give your posts more,
    “pop”! Your content is excellent but with pics and videos, this website could certainly be one of the greatest in its niche.
    Wonderful blog!

  87. Someone essentially help to make critically articles I might
    state. This is the very first time I frequented your web page and up to now?
    I amazed with the analysis you made to create this actual publish
    extraordinary. Great activity!

  88. I am not sure where you are getting your info, but good topic.
    I needs to spend some time learning more or understanding more.

    Thanks for magnificent information I was looking for
    this information for my mission.

  89. great post, very informative. I ponder why the opposite experts of this
    sector do not notice this. You must continue your writing.

    I am confident, you have a great readers’ base already!

  90. I’ve been surfing on-line greater than 3 hours lately, but
    I by no means found any attention-grabbing article like yours.
    It’s pretty price sufficient for me. In my opinion,
    if all site owners and bloggers made good content
    as you did, the web shall be much more useful than ever before.

  91. What i do not realize is if truth be told how you are no longer really a lot more well-appreciated than you may be
    now. You’re so intelligent. You already know therefore considerably on the
    subject of this subject, produced me in my opinion imagine it from a lot of numerous angles.

    Its like women and men don’t seem to be interested until it is something to accomplish with Lady gaga!
    Your personal stuffs excellent. Always take care of it up!

  92. Hello there! I just wish to give you a huge thumbs up for the great info you have right here
    on this post. I’ll be coming back to your web site for more
    soon.

  93. “I was pretty pleased to find this web site. I want to to thank you for ones time for this particularly fantastic read!! I definitely liked every part of it and I have you book-marked to check out new things on your web site.”

  94. “Right here is the perfect site for anyone who wants to understand this topic. You realize so much its almost tough to argue with you (not that I personally will need toÖHaHa). You certainly put a brand new spin on a subject that has been written about for years. Excellent stuff, just excellent!”

  95. I’ve brainstormed some fairly creative ideas to share with you.
    Marie de Guise, Mary’s mother, was from a powerful
    family within the French courtroom.

  96. Heya i’m for the primary time here. I came
    across this board and I in finding It truly useful & it helped me out much.
    I am hoping to provide one thing back and
    help others like you helped me.

  97. “I’m extremely pleased to find this web site. I want to to thank you for ones time for this particularly fantastic read!! I definitely appreciated every part of it and i also have you saved as a favorite to look at new things in your website.”

  98. Heya! I understand this is kind of off-topic
    but I had to ask. Does managing a well-established
    website like yours require a large amount of work?
    I’m brand new to running a blog however I do write in my journal every day.
    I’d like to start a blog so I can easily share my experience and views online.
    Please let me know if you have any recommendations or tips for
    brand new aspiring blog owners. Thankyou!

  99. This is really interesting, You’re a very skilled blogger.
    I have joined your feed and look forward to seeking more of your wonderful
    post. Also, I have shared your website in my social networks!

  100. “I was excited to uncover this great site. I want to to thank you for ones time just for this fantastic read!! I definitely enjoyed every little bit of it and I have you saved as a favorite to check out new information on your website.”

  101. “I would like to thank you for the efforts you’ve put in penning this website. I’m hoping to see the same high-grade blog posts by you in the future as well. In fact, your creative writing abilities has encouraged me to get my own, personal blog now ;)”

  102. Heya this is kind of of off topic but I was wanting to know if blogs use WYSIWYG editors or if
    you have to manually code with HTML. I’m starting a blog
    soon but have no coding know-how so I wanted to get advice from someone with experience.
    Any help would be enormously appreciated!

  103. “I was pretty pleased to uncover this page. I need to to thank you for ones time for this particularly wonderful read!! I definitely appreciated every little bit of it and i also have you book-marked to look at new stuff in your blog.”

  104. “Greetings! Very useful advice in this particular article! It is the little changes that will make the most significant changes. Many thanks for sharing!”

  105. “I must thank you for the efforts you’ve put in writing this site. I’m hoping to view the same high-grade blog posts by you in the future as well. In fact, your creative writing abilities has inspired me to get my very own blog now ;)”

  106. Good blog you have got here.. It’s difficult to find high-quality writing like yours nowadays.
    I truly appreciate people like you! Take care!!

  107. This is the right blog for everyone who hopes to find out about this topic.
    You understand a whole lot its almost tough to argue with you (not that I really
    would want to…HaHa). You certainly put a brand new spin on a
    topic which has been written about for decades. Great
    stuff, just great!

  108. Hey there, I think your website might be having browser
    compatibility issues. When I look at your blog site in Firefox, it looks fine but when opening
    in Internet Explorer, it has some overlapping.
    I just wanted to give you a quick heads up! Other then that,
    terrific blog!

  109. “You need to be a part of a contest for one of the most useful websites on the internet. I most certainly will recommend this blog!”

  110. you are really a good webmaster. The web site loading speed is amazing.
    It sort of feels that you are doing any distinctive trick.
    Moreover, The contents are masterpiece. you have done a excellent task in this subject!

  111. sex aldul, sex child sex,child sex,lồn to,die trum,die biden,die obama,die haha,fucking sit,cuc cut troi,
    web sex
    my sex aldul, sex child sex,child sex,lồn to,die trum,die biden,die
    obama,die haha,fucking sit,cuc cut troi,web sex: website

  112. I don’t even understand how I ended up here, but I thought this post used to be good.
    I don’t realize who you’re but certainly you are going to a famous blogger in the event you aren’t
    already. Cheers!

  113. “When I initially left a comment I appear to have clicked the -Notify me when new comments are added- checkbox and now whenever a comment is added I recieve four emails with the exact same comment. There has to be an easy method you are able to remove me from that service? Cheers!”

  114. istanbul evden eve nakliyat istanbul evden eve nakliyat

    En iyi nakliye sirketi olabilmek için elimizden gelenin en iyisini yaptik.
    Istanbul evden eve nakliyat firmasi olarak bütün Türkiye’ye
    hizmet sunuyoruz.

    istanbul evden eve nakliyat

  115. “After I originally left a comment I appear to have clicked the -Notify me when new comments are added- checkbox and now whenever a comment is added I get four emails with the same comment. There has to be a means you are able to remove me from that service? Thanks a lot!”

  116. Greate post. Keep writing such kind of information on your page.
    Im really impressed by it.
    Hey there, You’ve done a great job. I’ll definitely digg it and individually suggest to my friends.
    I’m confident they’ll be benefited from this web site.

  117. “You ought to take part in a contest for one of the highest quality blogs on the internet. I’m going to recommend this site!”

  118. Hi there to all, the contents existing at this web site are genuinely remarkable for people knowledge, well, keep up the nice work fellows.

  119. Sweet blog! I found it while browsing on Yahoo
    News. Do you have any tips on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get there!
    Thanks

  120. I think the admin of this web site is really working hard for his web page,
    because here every information is quality based data.

  121. проститутки метро алтуфьево, ночные бабочки, и проститутки на посещение и с апартаментами