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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are usually focused on the practical aspects of study design, such as recruitment and consent as well as adherence to the use of standard 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 type of heterogeneity is required for pragmatic trials to be valid, and it also helps to reduce the chance of bias in the results. However, too much heterogeneity could cause issues with the design of the trial.

Pragmatic Play Pragmatic Play, one of the biggest players on the live casino market offers an array of traditional table games such as Blackjack and Roulette. The company's live studios in Romania and Malta provide a genuine gambling experience for players and offer a wide range 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 famous personalities from the industry.

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Pragmatic trials seek to replicate real-world situations and have the highest external validity. They are usually commissioned by policymakers and practitioners to help guide their decisions. They also provide a useful way to identify the causality between an intervention and its results. However, they should not be used to substitute for the use of explanation studies.

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

The number of pragmatic trials is growing. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, as shown in red in Figure 2. This indicates that the health science community is becoming more sensitive to the subject of pragmatism. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.