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

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A practical trial that employs different investigators and participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This type of heterogeneity is required for pragmatic trials to be valid and also helps to reduce bias in the results. However, too much heterogeneity can result in issues with the design of the trial.

Pragmatic Play Pragmatic Play, one of the major players in the live casino market offers a variety of classic table games like Blackjack and Roulette. Pragmatic Play's live studios in Romania and Malta offer an authentic gambling experience for players, as well as an extensive selection of virtual betting options. The company also hosts a variety of games which make online gambling exciting and interactive. Some of these shows feature live hosts, whereas others are hosted by celebrities from the industry.

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Pragmatic trials aim to mimic real-world situations and have the highest external validity. They are usually ordered by policymakers and practitioners to inform their decisions. They also provide a useful way to identify the causality between the intervention and its effects. However, they shouldn't be used as a substitute for the use of explanation studies.

The pragmatism concept is controversial and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials that inform policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 This tool tried to define the characteristics of a pragmatic study, including the recruitment, design, and delivery of the intervention and its follow-up.

There is a growing trend in the number of pragmatic trials that are published. A recent Medline search using the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed 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 keep in mind, however, that the majority were conducted in primary-care settings.