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Pragmatic trials are those that are designed to inform the practice of clinical trials in real life. They are often characterized as a focus on the practical aspects of design that include the recruitment and consent process, as well as adherence and the use of routinely available equipment.
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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which employed a variety of investigators and had participants from different geographic areas. This type of heterogeneity is required for pragmatic trials to be valid and also reduces bias in the results. However, too much heterogeneity can cause problems with the design of the trial.
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Legality
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 established itself as a top casino gaming platform. Wolves is one of the latest games which is a five-reel slot machine with a healthy RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat.
The aim of pragmatic trials is to mimic real-life situations and achieve the highest level of validity externally. Usually, they are commissioned by policymakers and practitioners in order to inform their decisions. They can also be used to assess the cause-effect relationship of an intervention and its effects. However, they shouldn't be used to substitute for the use of explanation trials.
The pragmatism idea is controversial and there are concerns about whether pragmatic trials should replace tests for explanations or if they should be an alternative to them. Schwartz and Lellouch1 proposed an distinction between explanation-based studies, which support the physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform policy and practice decision-making. They also suggested an approach to pragmatic trials, which they called PRECIS.2 This tool attempted to define the characteristics of a pragmatic trial which includes the recruitment process, the design and implementation of the intervention, and monitoring.
There is a positive increase in the number of pragmatic trials that are published. A recent Medline query that used 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 more aware of the importance of pragmatism. It is important to keep in mind that the majority of these studies were conducted in primary care settings.