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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often described as a focus on the practical aspects of design that include recruitment and consent, adherence and the use of routinely available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which utilized different investigators and participants from different geographic areas. This type of heterogeneity is necessary for pragmatic trials to be valid and helps to reduce the chance of bias in the results. However, too much heterogeneity can result in problems with the design of the trial.

Pragmatic Play is also a major player on the live casino market, offering an extensive selection of classic table games such as Blackjack and Roulette in a variety of versions. The company's live studios in Romania and Malta offer an authentic gambling experience for players and offer an extensive selection of virtual betting options. The company has also created various interactive games to make online gambling fun. Some of these shows have live hosts, while others are hosted by prominent personalities from the industry.

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Pragmatic Play is known for its top-notch games, and for providing a superior user experience. Its software is designed to work with mobile devices and is compatible with various languages. It has been recognized as one of the top gaming platforms in the casino industry despite its relative infancy. The latest releases include Wolves which is a five-reel video slot with a healthy RTP and impressive graphics. The other notable titles include Wolf Gold and Chilli Heat.

The purpose of pragmatic trials is to replicate real-life situations and achieve maximum credibility externally. They are usually commissioned by policy makers and practitioners to guide their decision-making. They are also a good method to determine the causal relationship between the intervention and its effects. However, they shouldn't be used in lieu for explanation studies.

The concept of pragmatism is controversial and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove a physiological or clinical hypothesis and pragmatic trials that inform policy and practice decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 The tool was designed to define the elements of a pragmatic study, including the recruitment, design, and delivery of the intervention, and follow-up.

There is an encouraging trend in the number of pragmatic trials that are published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs) produced 34 articles, as shown in red in Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to remember, however, that the majority of these studies were conducted in primary-care settings.