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Studies designed to provide insight into clinical practice in the real world are called pragmatic trials. They are usually characterized by a focus on the practical aspects of the study design, such as recruitment and consent as well as adherence to the use of routinely available equipment.

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A pragmatic study that involves different investigators and participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, which is essential for a pragmatic trial to be valid and lessen the chance of bias, is also necessary. However excessive heterogeneity could result in problems with the design of the trial.

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

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Legality

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The purpose of pragmatic trials is to replicate real-life situations and achieve maximum credibility externally. They are typically commissioned by policy makers and practitioners to guide their decision-making. They are also a good way to identify the causality between the intervention and its effects. However, they should not be used in lieu for explanatory studies.

The pragmatism concept is controversial and there are concerns about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation studies, which prove the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the decision-making process for policy and practice. They also suggested a framework dubbed PRECIS for pragmatic trials.2 This tool attempted to define the traits of a practical study, including recruitment, design, delivery of the intervention and follow-up.

There is a positive trend in the number of pragmatic trials that are published. A recent Medline search using 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 is an indication that the health sciences community is becoming increasingly sensitized to the subject of pragmatism. It is important to remember that the majority of these trials were conducted in primary care settings.