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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often characterized as focusing on 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 trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which employed different investigators and participants from different geographic areas. This type of heterogeneity is essential for practical trials to be valid, and it also helps reduce bias in the results. However excessive heterogeneity could cause issues with the design of the trial.

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Pragmatic Play offers not only mobile-friendly slot machines but also table games and live casino. The company is licensed by various regulatory bodies such as Malta Gaming Authority and UK Gambling Commission. The games of the company are protected by high-end encryption, and its security team is on hand to assist players in any situation.

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Pragmatic Play is renowned for its top-quality games and for offering an exceptional 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 most popular casino gaming platforms despite its relatively young age. Wolves is one of the most recent releases, a 5-reel slot machine that has a high RTP and stunning graphics. Its other notable titles are Wolf Gold and Chilli Heat.

Pragmatic trials seek to replicate real-life settings and achieve maximum external validity. Usually, they are commissioned by policymakers and practitioners to help guide their decisions. They can also be used to determine the causality of an intervention and its results. They should not, however, be used to replace the need for explanation studies.

The pragmatism idea is controversial and there are doubts about whether pragmatic trials can replace tests for explanations or if they are an addition to them. Schwartz and Lellouch1 proposed a distinction between explanatory studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform policy and practice decision-making. They also proposed a framework for pragmatic trials, which they called PRECIS.2 This tool sought to define the characteristics of a pragmatic trial which includes the recruitment process, the design and delivery of the intervention, as well as the follow-up.

The number of pragmatic trials is growing. A recent Medline query that used the words 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 is becoming more aware of the importance of pragmatism. It is important to remember that the majority were conducted in primary care settings.