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Studies designed to provide insight into clinical practice in the real world are referred to as pragmatic trials. They are often described by their focus on practical aspects of designing a study which include the recruitment and consent process, as well as adherence and the use of routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which employed different investigators and had participants from different geographic areas. This type of heterogeneity is necessary for practical trials to be valid, and it also reduces bias in the results. A high degree of heterogeneity, however can result in problems with the trial design.

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Pragmatic Play is renowned for its top-notch games, and for providing a superior user experience. Its software is designed to work on mobile devices and supports different languages. Despite its relative youth it has already established itself as a premier gaming platform for casinos. Wolves is one of its latest releases which is a five-reel slot machine that has a high RTP and impressive graphics. The other notable titles include Wolf Gold and Chilli Heat.

The goal of pragmatic trials is to replicate real-life scenarios and gain maximum validity externally. They are usually ordered by policymakers and practitioners in order to guide their decisions. They can also be a great way to identify the causality between an intervention and its results. However, they should not be used to substitute for the use of explanation trials.

The idea of pragmatism is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should be an addition to them. Schwartz and Lellouch1 suggested a distinction between explanatory studies, which confirm a physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the decision-making process for policy and practice. They also proposed an approach to pragmatic trials, dubbed PRECIS.2 This tool attempted to define the features of a practical trial that include the recruitment process, the design and implementation of the intervention, as well as the follow-up.

There is an encouraging increase in the number pragmatic trials published. A recent Medline search using the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community is becoming more sensitive to the subject of pragmatics. It is important to remember that the majority of these studies were conducted in primary care settings.