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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are often characterized as a focus on the practical aspects of designing a study that include the recruitment and consent process, as well as adherence and the use routinely available equipment.

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A pragmatic study that involves a variety investigators and includes participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, that is crucial for pragmatic trials to be valid and to reduce bias in the results, is also necessary. Too much heterogeneity, however, can cause problems with the trial design.

Pragmatic Play is also a major player on the live casino market, offering an array of classic table games such as Blackjack and Roulette in various versions. The company's live studios in Romania and Malta provide a genuine gambling experience for players and offer a full suite of virtual betting options. The company also has several game shows which make online gambling exciting and interactive. Some of these shows have live hosts, whereas others are hosted by famous personalities from the industry.

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Pragmatic Play offers not only mobile-friendly slot machines as well as table games and live casino. Pragmatic Play is licensed and is regulated by various regulatory bodies, including the Malta Gaming Authority and UK Gambling Commission. The games are protected by the latest encryption technology and the security team is always available to assist players with any issues they might have.

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Pragmatic trials aim to mimic real-life settings and achieve maximum external validity. They are usually commissioned by policymakers and practitioners in order to inform their decisions. They can also be used to assess the causality of an intervention and its effects. However, they should not be used to substitute for explanation trials.

The concept of pragmatism is controversial, and there are questions 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 support the validity of a physiological or clinical hypothesis, and pragmatic trials, which inform policy and practice decision-making. They also suggested the framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a pragmatic study that include recruitment, design and delivery of the intervention, as well as the follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the words pragmatic and naturalistic, limited 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 increasingly sensitized to the issue of pragmatic thinking. It is important to note that the majority of these trials were conducted in primary care settings.