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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are often described as focusing on practical aspects of designing a study that include the recruitment process and consent, adhering and the use of routinely available equipment.

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A pragmatic trial that uses various investigators and participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity is essential for pragmatic trials to be able to prove their validity, and it also reduces the chance of bias in the results. However, too much heterogeneity can lead to issues with the design of the trial.

Pragmatic Play is also a major player in the live casino market, offering a wide selection of table games that are classic such as Blackjack and Roulette in a variety of versions. The live studios of Pragmatic Play's offices in Romania and Malta offer customers an authentic gaming experience as well a full variety of betting options via virtual. The company has also created various interactive games to make online gambling fun. Some of these shows have a live host, while others are hosted by celebrities from the industry.

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Pragmatic Play is a relatively new player in the world of online casinos however, it has established itself by offering mobile-friendly slots. Their games are optimized for mobile devices and operate on HTML5 technology. They are also regulated and certified by trusted gaming authorities, ensuring fairness and transparency. This is a good indicator for players because it indicates that the games have been tested and validated to ensure randomness and unbiased results of every game.

Pragmatic Play offers not only mobile-friendly slot machines but also table games and live casino. Pragmatic Play is licensed by several regulatory bodies, including Malta Gaming Authority and UK Gambling Commission. The games are protected by top-of-the-line encryption technology, and the company's security team is always on hand to help players solve any issues they might have.

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Legality

Pragmatic Play has gained a reputation for offering top-notch games and an exceptional user experience. Its software is accessible on mobile devices and in multiple languages. It has been recognized as one of the leading gaming platforms for casinos despite its relative infancy. Wolves is one of the latest games, a 5-reel slot machine that has a high RTP and stunning graphics. Other notable titles include Wolf Gold and Chilli Heat.

The goal of pragmatic trials is to mimic real-life situations and achieve the highest level of validity externally. Usually, they are commissioned by policymakers and practitioners to help guide their decisions. They can also be a great method to determine the causality between an intervention and its outcomes. However, they should not be used as a substitute for explanation studies.

The pragmatism concept is controversial, and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also suggested a framework dubbed PRECIS for pragmatic trials.2 This tool attempted to define the traits of a pragmatic study which includes recruitment, design, implementation of the intervention, and follow-up.

The number of pragmatic trials is growing. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to note that the majority of these trials were conducted in primary care settings.