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Pragmatic trials are studies designed to inform real-world clinical practice. They are typically 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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A practical trial that employs different investigators and participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, that is crucial for a pragmatic trial to be reliable and to reduce bias in the results, is also necessary. However too much heterogeneity could result in problems with the design of the trial.
Pragmatic Play is a major player on the live casino market offers various classic table games, including Blackjack and Roulette. The live studios of the company in Romania and Malta offer customers an authentic gaming experience as well as a broad range of virtual betting options. The company also hosts a variety of game shows which make online gambling enjoyable and engaging. Some of these shows feature live hosts, whereas others are hosted by prominent personalities from the industry.
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Pragmatic Play has gained a reputation for offering high-quality games and a superior user experience. Its software is designed to work with mobile devices and supports different languages. Despite its relatively young age, it has already established itself as a premier gaming platform for casinos. Wolves is one of its latest releases that is a 5-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 settings and achieve maximum external validity. They are usually requested by policy makers and practitioners to inform their decision making. They can also be used to assess the causality of an intervention and its effects. However, they shouldn't be used to substitute for explanation studies.
The concept of pragmatism is controversial and there are concerns about whether pragmatic trials should replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which support the validity of a physiological or clinical hypothesis, as well as pragmatic trials, that inform policy and practice decision-making. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool sought to define the features of a pragmatic study which includes the recruitment process, the design and delivery of the intervention, and monitoring.
The number of pragmatic trials is increasing. A recent Medline query using the keywords pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health science community is becoming more sensitive to the subject of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.