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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are typically described by their focus on practical aspects of study design that include the recruitment process and consent, adhering and the use routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which used various investigators and included participants from various geographical areas. This type of heterogeneity that is crucial for pragmatic trials to be reliable and lessen the chance of bias is also essential. However excessive heterogeneity could result in issues with the design of the trial.

Pragmatic Play, one of the major players in the live casino market offers an array of traditional table games, including Blackjack and Roulette. The company'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 has also developed several interactive game shows to make online gambling enjoyable. Some of these shows are telecast live and others feature famous personalities in the industry.

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The purpose of pragmatic trials is to replicate real-life scenarios and to achieve the highest level of validity externally. They are usually requested by practitioners and policy makers to inform their decision making. They also provide a useful method of determining the causality between an intervention and its outcomes. They should, however, not, be used to replace explanatory studies.

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

The number of pragmatic trials is increasing. A recent Medline search using the keywords 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 sciences community is becoming more aware of the importance of pragmatism. It is important to remember that the majority of these studies were conducted in primary care settings.