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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are typically described as focusing on practical aspects of design that include recruitment and consent, adherence and the use of standard equipment.

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A practical trial that employs a variety investigators and includes participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This type of heterogeneity is required for pragmatic trials to be able to prove their validity and helps reduce bias in the results. However, too much heterogeneity can result in problems with the design of the trial.

Pragmatic Play is a major player on the live casino market offers an array of traditional table games, including Blackjack and Roulette. The live studios of the company in Romania and Malta offer a real-life gambling experience for players and offer an extensive selection of virtual betting options. The company also has several games which make online gambling enjoyable and engaging. Some of these shows are broadcast live and some feature famous personalities in the field.

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Pragmatic Play offers not only mobile-friendly slot machines as well as live casino and table games. The company is licensed by a variety of regulatory bodies which include Malta Gaming Authority and UK Gambling Commission. The games are supported by the latest encryption technology, and the company's security team is always available to assist players resolve any issues they might face.

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Legality

Pragmatic Play has gained a reputation for offering high-quality games and a superior user experience. Its software is designed to work on mobile devices and is compatible with various languages. Despite its infancy it has already established itself as a leading gaming platform for casinos. Wolves is one of its latest releases which is a five-reel slot machine with a healthy RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat.

Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually commissioned by policy makers and practitioners to guide their decision-making. They can also be used to assess the cause-effect relationship of an intervention with its outcomes. They should not, however be used to replace explanatory studies.

The pragmatism idea is controversial, and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 made the distinction between explanation studies, which support the validity of a physiological or clinical hypothesis, and pragmatic trials, which inform the decision-making process for policy and practice. They also suggested an approach to pragmatic trials, which they called PRECIS.2 This tool attempted to define the characteristics of a pragmatic trial, including the recruitment process, the design and delivery of the intervention, and the follow-up.

There is a growing trend in the number of pragmatic trials that have been published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This is an indication that the health sciences community is becoming increasingly sensitized to the issue of pragmatics. It is important to keep in mind that the majority of studies were conducted in primary-care settings.