Tuesday, October 20, 2015

A patient’s perspective on a patient-centered conference: Highlights from #PCORI2015 (Part 2)



Patients are changing from research subjects to research partners. -Dr. Harlan Krumholz, PCORI board of governors and faculty member at Yale School of Medicine

Day 2

Dr. Joe Selby, executive director of the Patient-Centered Outcomes Research Institute, opened day 2 the PCORI Annual Meeting by giving an overview of the type of research PCORI funds: patient-centered comparative effectiveness research. CER, he said, compares two or more options about things that matter to patients. According to Dr. Selby, this research should be conducted in "real world" settings and should ideally pay attention to differences in effectiveness for different sub-groups of people (e.g. does a particular treatment work better for women than men).

When PCORI began awarding research contracts just a few years ago, most of the funding they offered fell into four broad categories: (1) assessing prevention, diagnosis, and treatment options; (2) addressing disparities; (3) improving health care systems; and (4) communication and dissemination research. Now, PCORI funding mechanisms are becoming increasingly targeted, addressing specific diseases or other topics that have been identified as high priority. These include programs that focus on asthma, MS, and reducing long-term opioid use, among others. PCORI has also become increasingly interested in funding large studies that better represent the entire population.

The morning's keynote presentation was given by Dr. Victor Montori, an endocrinologist and health services researcher at the Mayo Clinic. Dr. Montori gave a compelling presentation on the importance of involving patients in decision making. What's best for a person, he said, depends on what that person values. Dr. Montori also lamented the curent research funding process, which leaves about 85% of scientific proposals unfunded. To do the type of large studies PCORI aims to fund, he argued, research institutions need to end competition and encourage collaboration instead.

During the following panel, which included a number of stakeholders from various health care organizations, Nancy Brown of the American Heart Association said that if patients really understood how the research process worked, they would be horrified. She also said that people don't want to waste their time thinking about their health--it's only when they become sick that health care becomes the center of everything. In the same panel, former U.S. congressman Tony Coelho spoke about the role patient advocacy organizations play in bringing the patient experience to our legislature. He also noted that we all need to advocate for PCORI so that it doesn't disappear in 2018.

After a series of several plenary presentations, I was eager to break out into smaller group sessions. The two breakout sessions I attended on Day 2 highlighted examples of successful awardees from the Communication and Dissemination Research (CDR) program and the Eugene Washington Engagement Awards. In the CDR panel, shared decision-making tools featured prominently as a means of improving communication between patients and their doctors. Some awardees used focus groups to develop and refine their decision-making tools. Research teams found it was crucial to solicit feedback from providers like doctors and nurses in addition to patients so that these tools could realistically be used in the clinic. In the second breakout session, Engagement Award recipients shared examples of "pre-research" activities they had conducted. Some projects used Engagement funds to conduct a needs assessment in their target population. Other projects used their award to build a curriculum to train people to better understand and conduct patient-centered comparative effectiveness research.

During the final breakout session of day 2, I presented as part of a panel discussion on the Pipeline to Proposals. The Pipeline program provides funding to individuals or groups who would not ordinarily receive research funding from PCORI, and trains us step-by-step, so that--theoretically--in three years we will have built the foundation for a successful, full-scale PCORI award application. (Read more about our project.) I enjoyed participating in this session because it gave me a much-needed opportunity to connect with follow Pipeline awardees, but also because I believe this program is truly emblematic of the type of patient-driven research collaborations PCORI was designed to support.

A recent Time magazine article (that I found in the airport on my way home from the PCORI conference) addresses a patient-centered research question about breast cancer treatment.


Day 3

Day 3 of the meeting featured a keynote presentation by NIH director Dr. Francis Collins. Even though PCORI is technically a nonprofit entity, not a federal agency like the National Institutes of Health, it was impactful to have the head of AHRQ and the head of NIH lend their time to this conference. I think it helps legitimize PCORI as a credible, scientifically rigorous organization, even though the work they fund is quite a bit different.

On day 3, I attended two very different breakout sessions: one on comparative effectiveness research methods and one on how to use your patient story to make a difference in research.

Over the past few years, PCORI has developed comprehensive methodology standards that govern all aspects of the proposal, from how to involve patients in the research process to how to analyze the data collected during a study. The purpose of following these standards is to ensure research findings are valid and can be replicated. Scientific methods are evaluated based on data quality, study design (e.g. randomized controlled trial or observational study), and how the data is interpreted. The PCORI staff member who lead the session emphasized that, while there is no such thing as the perfect study--there will always be trade-offs--it's important to be cognizant of where weaknesses might be so that you can consider how those weaknesses might impact your results.

The last session I participated in was by far the most hands-on. PCORI's engagement staff spoke about storytelling as a "method" of sparking engagement and collaboration. They also shared a tool they created to walk patients through the process of teasing out bits of their patient story that might be relevant to a research question. While the tool was still in draft form, I loved the concept. I also loved to have something tangible I could take home with me after the conference given that so many of the other sessions were very philosophical and not immediately applicable to my daily work.


Finally took the time to do some sightseeing while visiting Washington D.C.


Major themes and takeaways

  • Communicating research results back to the community is essential for building and maintaining trust (bonus points for involving patients and other stakeholders in developing a plan for sharing research results).
  • PCORI funding announcements are becoming increasingly more targeted and aimed at creating large, pragmatic clinical trials that more broadly reflect the "real world."
  • Rigorous research methods and meaningful patient engagement are equally important to PCORI, even though they can sometimes feel at odds with one another. Many applications they reject are dinged, though, because of their lack of the latter.
  • There's no one-size-fits-all model for engagement, but here are some activities that have been successfully used by PCORI awardees to create meaningful engagement: 
    • (1) Including a patient partner as a co-investigator on the project and compensating them financially as such,
    • (2) Include patients, caregivers, and other stakeholders like physicians on project advisory committees, and
    • (3) Address research questions of interest to patients as identified by online surveys, focus groups, or other meetings.
As I mentioned in my first recap post, overall it was a great event. I'm glad I was given the opportunity to attend. I also look forward to seeing further progress towards socializing and truly implementing patient-centered principles in research and clinical practice.

To learn more or view archived videos from the 2015 PCORI Annual Meeting, visit www.pcori.org.

120 comments:

  1. Replies
    1. ✅BINARY SCAM RECOVERY

      ❌ Binary Option, Forex and their likes are a means of making money but it’s more like gambling. There are no sure means to guarantee that a person could make profit with them and that’s why it can also be reasoned to be scam. Let’s not forget that some individuals even give you 💯 % guarantee of making profits and end up running away with your money. The internet today is full of Binary Option Recovery Scam, you see so much testimonies been shared about how a firm or Company helped them recover what they lost to Binary Options. But believe it, it’s just a way to lure more people and end up scamming them.

      ❌ You might have also come across some individuals that say they will give you guarantee on successful trades but they only end up as SCAMMERS as well. You here them say stuffs like 200% guaranteed in just 2 weeks and when you go into trade with them, they start telling you to pay profits percentage before you can get your income. These are all liars please avoid them. But if you have been a victim of this guys, then you should contact PYTHONAX now‼️

      ✳️The big Question is “Can someone Recover their money lost to Binary Option and Scam⁉️
      I will say yes, and will tell you how.

      The only way to Recovery your money back is by hiring HACKERS to help you break into the Firms Database Security System using the information you provide them with, Extract your file and get back your money. It seems like a really impossible thing to do, I will tell you, it should be impossible, but with the use of specially designed softwares known to HACKERS and Authorities (such as The FBI, CIA e.t.c) it is possible and the only way to recover your money.

      ✅ PYTHONAX are a group of hackers who use their hacking skill to hunt down SCAMMERS and help individuals recovery their money from Internet SCAMMERS.
      We just need the contact details of the SCAMMERS and Paymnet Info and within 4-8 hours your money will be return to you.

      ✳️ You can contact us via the emails below-:
      PYTHONAXSERVICES@GMAIL.COM


      We also provide Legit Hacking Services such as-:
      🔸Phone Hacking/Cloning
      🔸Email Hacking & Password Recovery
      🔸Social Media Hacking & Passowrd Recovery
      🔸Deleted Files Recovery 🔸Mobil Tracking
      🔸Virus detection & Elimination.

      Email-: PYTHONAXHACKS@GMAIL.COM




      Pythonax.
      2020 © All Right Reserved.

      Delete
  2. We Provide Best Packers And Movers Jaipur List for Get Free Best Quotes, Compare Charges,
    Save Mone And Time,Household Shifting Services @ JaipurPackersandMovers.in
    Packers And Movers Jaipur

    ReplyDelete
  3. In the case of stainless steel to build, replica watches uk table diameter is 47 mm brand classic, military, domineering, for replica watches the love of the fans should watch Panerai is just right. In addition to the traditional black dial and sandwich PAM00687, this is different from the previous table brown -- in fact, is the new replica watches color of the Panerai table in paragraph. From the inside, from shallow to deep texture is very special, and the history of origin panerai.

    ReplyDelete
  4. There's a lot of interesting info here! I'm very grateful for the post! movers and packers Bangalore is here to make your life simpler
    Packers And Movers Bangalore

    ReplyDelete
  5. We Provide Best Packers And Movers Gurgaon List for Get Free Best Quotes, Compare Charges,
    Save Money And Time, Household Shifting Services @ Packers-and-Movers-Gurgaon.in
    Packers And Movers Gurgaon
    Packers And Movers In Gurgaon

    ReplyDelete
  6. Replies
    1. Judi casino atau live casino adalah salah satu permainan judi kasino paling digemari oleh sebagian besar bettor casino. Sekarang ini telah hadir agen situs casino online yang menyediakan game casino seperti blackjack, baccarat, sicbo, roullete, ceme, judi poker domino dan lain sebagainya. Melalui situs agen casino anda bisa melakukan pendaftaran akun casino dan memainkan berbagai permainan judi casino disana. Judi casino di pilih karena memang cukup populer di kalangan casino bettor. Mengenai pelayanan casino sempat kami review di artikel berikut ini. Bandar dan agen casino juga menawarkan berbagai promo serta bonus kasino yang tentunya akan semakin menarik bagi pecinta casino. Banyak website agen casino yang menawarkan berbagai permainan judi online casino seperti judi poker, kasino dan juga sbobet. Salah satunya adalah website agen casino yang bisa anda coba dengan minimal deposit permainan casino yang ringan. Sama seperti situs agen casino lainnya juga menawarakan berbagai promo dan bonus agen casino yang menarik. Artikel mengenai agen casino juga pernah kami ulas di halaman berikut ini. Agen casino merupakan salah satu layanan judi online casino paling terkenal saat ini, ada banyak jenis layanan judi casino online yang bisa anda coba melalui website agen casino. Dengan minimal deposit yang ringan dan dapatkan berbagai promo dan bonus casino yang menarik bagi anda.

      Delete
  7. Replies
    1. Packers and movers in thane@
      http://www.transmoving.in/packers-movers-thane.html
      Packers and movers in varanasi@
      http://www.transmoving.in/packers-movers-varanasi.html
      Packers and movers in surat@
      http://www.transmoving.in/packers-movers-surat.html
      Packers and movers in lucknow@
      http://www.transmoving.in/packers-movers-lucknow.html

      Delete
  8. This comment has been removed by the author.

    ReplyDelete
  9. Gurgaon escorts have been one of the most prominent ways to get fun element into the life of a common client Escorts in Gurgaon

    ReplyDelete
  10. Nice post.Having one of the largest users in the world on its platform, it is no less than fallible to some common errors for which
    outlook support number is the haven for the users facing those errors.keep posting

    ReplyDelete
  11. It is a great article. You will surely like this also because it is a great stufff
    run3unblockedgame.com

    ReplyDelete



  12. شركة سكاي لخدمات نقل العفش والاثاث بالمنطقة العربية السعودية نحن نوفر خدمات نقل اثاث بالرياض ونقل عفش بالمدينة المنورة ونقل عفش بمكة ونقل عفش بالطائف نحن نقدم افضل نقل اثاث بخميس مشيط ونقل عفش بجدة
    شركة سكاي لنقل العفش
    نقل عفش بمكة
    نقل عفش بالرياض

    ReplyDelete
  13. Very interesting blog. Alot of blogs I see these days don't really provide anything that I'm interested in, but I'm most definately interested in this one. Just thought that I would post and let you know

    https://tikibet88.com
    Agen Sbobet Termurah
    Agen Sbobet Terpercaya
    Daftar Agen Sbobet Terpercaya
    Daftar Agen Sbobet Casino
    Daftar Agen Sbobet Resmi

    ReplyDelete

  14. We also provide deep cleaning services for houses, villas, apartments and furnishings, and use of garden steam cleaners that clean and eliminate germs.
    You can see more of this link:
    شركة الاول للتنظيف و مكافحة الحشرات
    شركة مكافحة حشرات بالرياض شركة مكافحة حشرات بالرياض
    شركة رش مبيدات بالرياض شركة رش مبيدات بالرياض
    شركة رش مبيدات بالاحساء شركة رش مبيدات بالاحساء
    شركة تنظيف بالدمام شركة تنظيف بالدمام

    ReplyDelete
  15. Fajartoto like to read your article because it really helps me. Thank you for sharing this post with us.
    Situs Casino Online
    Prediksi Hongkong

    ReplyDelete
  16. We have Russian Delhi Escorts and escorts all types of escorts service.(call @ 9711199171) Delhi Independent Russian Escorts service we offer you as homemaker escorts.

    Delhi Escorts

    Call girls dwarka

    Call girls Connaught place

    Call girls mahipalpur

    Call girls aerocity

    Call girls rohini

    Call girls nehru place

    Call girls south ex

    Call girls saket

    ReplyDelete
  17. Hi My Dearest Friends I am Puja Priya I am 21 Years Old and Young and Hot Ladies My Husband Divorced Me SO i am very unsatisfied are you single? So follow My Link

    |Escorts In Gurgaon|
    |Call Girls In Gurgaon|
    |Gurgaon Call Girls|

    |Gurgaon Escorts|
    |College Escorts In Gurgoan|

    ReplyDelete
  18. Very interesting blog. Alot of blogs I see these days don't really provide anything that I'm interested in, but I'm most definately interested in this one. Just thought that I would post and let you know

    Agen Sbobet Terpercaya
    Agen Sbobet Termurah
    Agen Sbobet Casino
    Agen Sbobet Resmi
    http://tikipoker88.org
    Poker Ceme

    ReplyDelete
  19. Thanks for your sharing. I have more knowledge because of the posts. Your pieces of advice help me so much. They are awesome and helpful. They tell me exactly what I want to know. I love to read your posts. I wait for them everyday. I’m very excited to enjoy new articles. Once again, thanks a lot. Have a good day!
    If you want to learn more about best massage machine, you visit now

    ReplyDelete
  20. I really appreciate this article Thanks For Sharing People also like this Awesome post

    I have also gone through your other posts too and they are also very much appreciate able and I’m just waiting for your next update to come as I like all your posts.
    If you want to learn more about 10 Best Massage Machine Reviews in 2019, you visit now

    ReplyDelete
  21. I admire what you have done here. I like the part where you say you are doing this to give back but I would assume by all the comments that this is working for you as well.
    I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often
    If you want to learn more about Best Massage Machine Reviews, you visit now

    ReplyDelete
  22. A debt of gratitude is in order for the pleasant web journal. It was extremely valuable for me. I’m upbeat I discovered this site. Much obliged to you for offering to us,I too dependably discover some new information from your post.
    If you want to learn more about Best Massage Machine click here

    ReplyDelete
  23. I would like to express thanks to you just for rescuing me from such a circumstance. Because of exploring through the online world and meeting recommendations which were not helpful, I figured my life was done. Being alive devoid of the strategies to the issues you have solved all through the write-up is a serious case, and ones which might have adversely affected my career if I hadn’t discovered your web blog. Your primary ability and kindness in handling every aspect was very useful. I am not sure what I would’ve done if I had not come upon such a step like this. I am able to at this time look forward to my future. Thank you so much for this skilled and amazing help. I won’t hesitate to recommend your web sites to any person who desires support about this subject matter.
    If you want to learn more about Best Massage Machine click here

    ReplyDelete
  24. I have been exploring for a little bit for any high quality articles or blog posts in this sort of space . Exploring in Yahoo I eventually stumbled upon this web site. Studying this info So i am happy to express that I’ve an incredibly just right uncanny feeling I found out just what I needed. I such a lot for sure will make sure to do not fail to remember this site and provides it a look a relentless basis.
    Want to learn more about Fitness Tools Review you visit now

    ReplyDelete
  25. This is my first time i visit here. I found so many interesting stuff in your blog especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! keep up the good work
    Want to learn more about Fitness Equipmentus you visit now

    ReplyDelete
  26. You have a good point here!I totally agree with what you have said!!Thanks for sharing your views...hope more people will read this article!!!

    You’ve got some interesting points in this article. I would have never considered any of these if I didn’t come across this. Thanks!.
    Want to learn more about Fitness Tools Guide you visit now

    ReplyDelete
  27. I have bookmarked it, and I am looking forward to reading new articles. Thanks for this article. Keep up the good work! Well, I have also made an article hope you go through it. I hope you and your valuable readers will be like me

    I really appreciate this article Thanks For Sharing People also like this Awesome post
    If you want to learn more about 12 Best Deep Tissue Massagers Review you visit now

    ReplyDelete
  28. When the purpose was given to make you glad at every point then the procedure will during the same and you will experience that. The Bangalore Escort services we created are so enjoyment that you will take pleasure in it in a reassure zone and the whole time gives you so many wonderful moments and with the beautiful Escorts Bangalore beside, her friendly actions, awesome good looks thrills you so you will live the enjoyment rather than enjoying it
    If you want to learn more about Electric Back Massager Reviews you visit now

    ReplyDelete
  29. I enjoyed over read your blog post. Your blog has nice information, I got good ideas from this amazing blog. I am always searching like this type blog post. I hope I will see again.
    If you want to learn more about10 Best Electric Foot Massager Review in 2019 you visit now

    ReplyDelete
  30. Wow! I am really impressed by the way you detailed out everything. It’s very informative and you are obviously very knowledgeable in this field. Thanks for sharing such an amazing post with us.
    If you want to learn more about 10 Best Foot Bath Massager Reviews in 2019 you visit now

    ReplyDelete
  31. Your blog provided us with valuable information to work with. Each & every tips of your post are awesome. Thanks a lot for sharing. Keep blogging,
    If you want to learn more about Foot Bath Massager Reviews you visit now

    ReplyDelete
  32. It is vital in these days to have a social media presence. Many businesses overlook this necessity for future growth. It may be more important than putting in more funding. Pricing properly is key, of course. But investing more is not always the best option. Sometimes it’s better to cut unnecessary costs.
    If you want to learn more about Kitchen and Dining, you visit now

    ReplyDelete
  33. Thanks for your sharing. I have more knowledge because of the posts. Your pieces of advice help me so much. They are awesome and helpful. They tell me exactly what I want to know. I love to read your posts. I wait for them everyday. I’m very excited to enjoy new articles. Once again, thanks a lot. Have a good day!
    If you want to learn more about Kitchen and Dining, you visit now

    ReplyDelete
  34. I like it because my fingers can move fast and and it’s like a challenge and I like it but why sooooo many ads that’s in called for that’s what the problem is you need to fix it so the better this game can be the more u are happy and others. That’s every thing I think of this came
    If you want to learn more about Kitchen and Dining, you visit now

    ReplyDelete
  35. Considerably, the story is in reality the greatest on this noteworthy topic. I agree with your conclusions and will eagerly watch forward to your next updates. Saying nice one will not just be sufficient, for the wonderful clarity in your writing. I will immediately grab your rss feed to stay privy of any updates
    If you want to learn more about Kitchen and Dining, you visit now

    ReplyDelete
  36. Only aspire to mention ones content can be as incredible. This clarity with your post is superb and that i may think you’re a guru for this issue. High-quality along with your concur permit me to to seize your current give to keep modified by using approaching blog post. Thanks a lot hundreds of along with you should go on the pleasurable get the job done.
    If you want to learn more about Kitchen and Dining, you visit now

    ReplyDelete
  37. Greetings from Ohio! I’m bored to death at work so I decided to browse your blog on my iphone during lunch break. I enjoy the knowledge you present here and can’t wait to take a look when I get home. I’m surprised at how fast your blog loaded on my mobile .. I’m not even using WIFI, just 3G .. Anyways, very good blog!
    If you want to learn more about Health Tips, you visit now

    ReplyDelete

  38. Hire Best Packers And Movers Mumbai for hassle-free Household Shifting, ***Office Relocation, ###Car Transporation, Loading Unloading, packing Unpacking at affordable ✔✔✔ Price Quotation. Top Rated, Safe and Secure Service Providers who can help you with 24x7 and make sure a Untroubled Relocation Services at Cheapest/Lowest Rate
    Packers And Movers Mumbai

    ReplyDelete
  39. Packers and Movers Pune Provide High Quality ***Household Shifting, Home/Office Relocation, Insurance, Packing, Loading, ###Car Transportation Service Pune and High experiences, Top Rated, Safe and Reliable, Best and Secure Packers and Movers Pune Team List. Get ✔✔✔ Affordable Rate Charts and Compare Quotation and Save Money and Time .
    Packers And Movers Pune

    ReplyDelete
  40. Hey ,
    Learn a lot from your write up. Very nice understanding with users. I have a little demand from you. Could you please share about best handheld massager. I have looking for last 2 days but did not find proper review about it. Do you mention a post?
    Cheers
    Bikash Roy

    ReplyDelete
  41. We are popular as Florist Service in Gurgaon from last 10 Years, we also offers fresh flowers cakes and latest gifts across Gurgaon. Send flowers online and Offline from flower shop for your loved ones and availlable for corporate gifting with fastest delivery.

    Florist Service in Gurgaon
    Online Florist Services in Gurgaon

    ReplyDelete
  42. There are many girls in Lucknow who offer safe and genuine escort services in Lucknow but when it comes to 100% customer satisfaction. If you want to hire bold, seductive and wild Lucknow escorts then simply book from our No.1 premier escort agency-Lucknow escorts girl. Lucknow escorts know how to address physical desires of the customer and can be best partner for female companionship on the bed at night.

    Lucknow Escorts
    Call Girls In Lucknow
    Escorts In Lucknow
    ==========================================================================================
    Mumbai Escorts
    Escorts In Mumbai
    Mumbai Call Girls
    Call Girls In Mumbai
    ==========================================================================================
    Call Girls In Andheri
    Escorts Service In Mumbai
    Mumbai Call Girls
    Call Girls In Lokhanwala

    ==========================================================================================
    Lucknow Escorts
    Call Girls In Lucknow
    Escorts In Lucknow

    ReplyDelete

  43. I am so happy today because I am free from herpes virus (HSV2) . I have been having herpes since the past two years now, and I have passed through many different processes in getting rid of the diseases but nothing was working out. A friend of mine introduced me to a doctor (DR Afrid drafridherbalhome@gmail.com) who sent me herbal medicines which he prepared for me, and my life got transformed and everything was fine and okay with me. Till now I have been going to check up and it is now going to four months and I am still negative.

    ReplyDelete
  44. This is a very joyful day of my life because of the help Dr.Phil has rendered to me , I am out here to spreed this good news to the entire world on how I got my ex love back just yesterday i contacted Dr phil for help ,I was going crazy when my love left me for another girl , But when i met the Email address of Dr Phil (drphilhomeofsolution@gmail.com ) the great messenger to the oracle that he serve,I narrated my problem to Dr Phil about how my ex love left me and also how i needed to get a job in a very big company. He only said to me that i have come to the right place were i will be getting my heart desire without any side effect .He told me what i need to do After it was been done,In the next 24 hours,My love called me on the phone and was saying sorry for living me before now and also in the next one week after my love called me to be pleading for forgiveness,I was called for an interview in my desired company were i needed to work .I am so happy. Contact this great man too for help, his contact: drphilhomeofsolution@gmail.com or call/whats app +1(412)405-1961.

    ReplyDelete
  45. Get Shifting/Relocation Quotation from ###Packers and Movers Delhi. Packers and Movers Delhi 100% Affordable and Reliable ***Household Shifting Services. Compare Transportation Charges and Save Time, Verified and Trusted Packers and Movers in Delhi, Cheap and Safe Local, Domestic House Shifting @
    Packers And Movers Delhi

    ReplyDelete
  46. Packers and Movers Hyderabad Give Certified and Verified Service Providers, Cheap and Best ###Office Relocation Charges, ***Home Shifting, ✔✔✔Goods Insurance worth Rs. 10,000, Assurance for Local and Domestic House Shifting. Safe and Reliable Household Shifting Services in Hyderabad with Reasonable Packers and Movers Price Quotation @ Packers And Movers Hyderabad

    ReplyDelete
  47. Thanks for sharing Such a valuable information.Im very thankful to You That You Had Given Me This opportunity to write on This blog.please visit our website I Assure You That it will be very useful for @ Packers And Movers Delhi
    Packers And Movers Ghazibad
    Packers And Movers Greater Noida
    Packers And Movers Noida

    ReplyDelete
  48. Cara Meningkatkan Peluang Menang Judi Poker Online Indonesia

    Judi poker online saat ini terbilang sebagai salah satu permainan judi online yang sangat terkenal di Indonesia. Bagi anda yang suka berselancar pada dunia maya maka dapat menemukan situs poker online dengan mudah. Bahkan saat ini judi online seperti permainan poker telah menjadi hal yang sangat mudah diakses kapan saja dan dimana saja. Dengan kata lain saat ini permainan judi sudah tidak lagi dibatasi oleh ruang dan waktu. Bagi anda yang gemar bermain taruhan judi online, coba untuk bermain judi poker online dan poker uang asli untuk meraih keuntungan yang jauh lebih besar.
    Permainan judi poker online pada agen poker online terpercaya tentu menjanjukan banyak bonus serta keuntungan besar yang berlipat ganda. Lalu bagaimana cara meningkatkan peluang menang judi poker online?
    Bagi anda para pemain pemula atau yang tengah mengalami kesulitan saat meraih kemenangan pada judi poker online, tidak perlu khawatir karena pada kesempatan kali ini kami akan membagikan cara meningkatkan peluang menang judi poker online. Dalam hal ini yang terkait dengan konsep permainan, teknik hingga ketelitian saat memasang taruhan.

    agen bola


    poker online
    poker uang asli


    jasa seo indonesia



    prediksi bola
    jadwal bola
    agen bola

    ReplyDelete
  49. Packers and Movers Bangalore as a Services providing company can make all the difference to your ###Home Relocation experience. Bangalore based Company which offers versatile solutions, Right team that easily reduce the stress associated with a ✔✔✔Household Shifting, ***Vehicle Transportation. we help things run smoothly and reduce breakages and offer you seamless, Affordable, Reliable Shifting Services, Compare Shifting Charges @ Packers And Movers Bangalore

    ReplyDelete
  50. This is really a pleasant and useful, containing all data furthermore greatly affect the new innovation. Much obliged for sharing it @ Packers And Movers Gurgaon

    ReplyDelete
  51. Nice image visibility and well written blog. Thanks for sharing. I have recently come across a new online service provider company which provides Shifting Services @ Packers And Movers Delhi
    Packers And Movers Gurgaon
    Packers And Movers Ambala
    Packers And Movers Bhiwani
    Packers And Movers Faridabad
    Packers And Movers Fatehabad
    Packers And Movers Hisar

    ReplyDelete
  52. Packers and Movers Chennai Give Safe and Reliable ***Household Shifting Services in Chennai with Reasonable ###Packers and Movers Price Quotation. We Provide Household Shifting, Office Relocation, ✔ ✔ ✔ Local and Domestic Transportation Services, Affordable and Reliable Shifting Service Charges. @ Packers And Movers Chennai

    ReplyDelete
  53. Get Packers and Movers Jaipur List of Top Reliable, 100% Affordable, Verified and Secured Service Provider. Get Free ###Packers and Movers Jaipur Price Quotation instantly and Save Cost and Time. Packers and Movers Jaipur ✔ ✔ ✔ Reviews and Compare Charges for household Shifting, Home/Office Relocation, ***Car Transportation, Pet Relocation, Bike SHifting @ Packers And Movers Jaipur

    ReplyDelete
  54. If you are looking for high profile alluring Dehradun escorts service. Then your searches are over at this place. Our escorts are one of the classy and hot high class escorts services in Dehradun.

    ReplyDelete
  55. Thank you very much for writing such an interesting article on this topic. This has really made me think and I hope to read more. @ Packers and Movers Ahmedabad

    ReplyDelete
  56. Our Call girls in Chandigarh are knowledgeable and professional and they know every single area and highlighted places of Chandigarh city.

    Escorts in Chandigarh
    Dehradun Escorts
    Rishikesh Escorts
    Chandigarh call girls

    ReplyDelete
  57. If you are here for finding happiness then we assure you that our Call girls in Chandigarh are the best option for you to get some entertainment from them and these ladies are ready to serve you their best escorts services.

    Mohali escorts
    Zirakpur escorts
    Panchkula escorts

    ReplyDelete
  58. Data HK adalah result hasil pengeluaran Prediksi Hk yang diupdate setiap harinya dalam bentuk tabel. Serta angka keluaran hk yang diberikan langsung diambil dari situs resmi hongkongpools. Dengan hal tersebutlah tabel yang kami buat sangat berguna sekali dan memiliki banyak fungsi yang bisa menguntungkan. Dimana contohnya Prediksi Togel Hk berguna untuk para pemasangan taruhan untuk melihat hasil result yang cepat.

    Prediksi Togel Hongkong 18agar para pengunjung dapat mudah untuk menebak hasil keluaran togel hk. Semoga ini bermanfaat buat anda pecinta 4d 3d 2d dan membuat anda bisa memperkirakan angka naik di togel hongkong malam hari. Cara Menang Judi Poker Selalu duluankan prediksi Anda Sendiri. Prediksi dari kami berikan hanya Ketika kita bermimpi maka kita akan dapat melihat bayangan secara jelas pada saat tidur dengan sangat nyenyak. Hal ini memang akan menghasilkan beberapa bentuk mimpi yang dapat hadir dalam tidur kita dan proses pembuatan mimpi ini pada dasarnya adalah dapat dengan mudah kita nikmati namun memang kita tidak dapat mengetahui asal usulmya dengan baik. Hal ini memang manghasilkan misteri tersendiri dalam mimpi ini.

    (Baca juga: Kumpulan Tafsir Mimpi Togel Tentang Tikus dalam Togel 2D 3D 4D)

    Kumpulan Arti Mimpi Tentang Ular dalam Togel 2D 3D 4D
    Memang salah satu bentuk dari mimpi yang sering kita saksikan saat tidur adalah keberadaan dari mimpi tentang ular yang memang cukup sulit untuk kita abaikan begitu saja. Memang mimpi tentang hal ini akan hasilkan beberapa makna dan juga Erek Erek Ular yang sangat bisa diandalkan untuk melakukan prediksi angka togel dan juga beberapa peristiwa yang memang sangat dapat dilihat dari makna mimpi itu sendiri.

    Arti Mimpi Melihat Ular Diatas Tempat Tidur
    Tafsir Mimpi Ular diatas tempat tidur maka hal ini bermakna bahwa kita akan mendapatkan masalah besar yang membahayakan kehidupan kita. Angka togel Melihat Ular Diatas Tempat Tidur adalah : 2D (13-48) 3D (119-504) 4D (1834-4012).

    untuk membantu Anda, Pilihan ada ditangan kamu sendiri. Semoga para pemain dan pemasang Prediksi Togel puas dengan data hk yang kami berikan….
    Terima kasih Kami selalu mengucapkan terima kasih bagi pemasang Togel sejati karena telah mengunjungi situs Paito Warna Hk hasil bertapa kami. Jika Nomor keluaran hk hari ini tembus, silahkan hubungi kami untuk bantuan operasional untuk keperluan bertapa malam.

    kumpulan prediktor Paito Warna Sgp dengan rumus togel andalan dan berdasarkan bocoran togel hk yang akan keluar hari ini. Prediksi togel hongkong 01 Juli 2020 yang di rangkum bersama kumpulan prediktor berpengalaman dan handal dalam melakukan kalkulasi angka jitu hk. Prediksi togel hongkong 01 Juli 2020 ini akan kami bagikan kepada semua pengunjungi setia mbahtoto secara cuma-cuma atau gratis.

    ReplyDelete
  59. This is really a pleasant and useful, containing all data furthermore greatly affect the new innovation. Much obliged for sharing it @
    Packers And Movers Gurgaon
    Packers And Movers Gurgaon to Bangalore
    Packers And Movers Gurgaon to Ahmedabad
    Packers And Movers Gurgaon to Jaipur

    ReplyDelete
  60. Amazing article. Your blog helped me to improve myself in many ways thanks for sharing this kind of wonderful informative blogs in live. I have bookmarked more article from this website. Such a nice blog you are providing ! Kindly Visit Us @ Packers and Movers Ahmedabad

    ReplyDelete
  61. Packers and Movers Ahmedabad list, Cheap Packers Movers Ahmedabad Charges, Local, Affordable Household Shifting Ahmedabad @ Packers and Movers Ahmedabad

    ReplyDelete