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It also has a lucrative Free Spins feature with multipliers that can be as high as 500x bet.<br><br>A practical trial that employs various investigators and participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This type of heterogeneity is necessary for pragmatic trials to be valid and helps reduce bias in the results. Too much heterogeneity, however could cause issues with the design of the trial.<br><br>Pragmatic Play is also a major player on the live casino market, providing an array of table games that are classic such as Blackjack and Roulette in various variations. The live studios of the company in Romania and Malta offer an authentic gaming experience for its customers and offer a full suite of virtual betting options. The company also has several game shows that make online gambling more exciting and interactive. 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They also provide a useful method of determining the cause-effect relationship between an intervention and its outcomes. However, they should not be used to replace explanatory studies.<br><br>The concept of pragmatism is controversial, and there are concerns about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis and pragmatic trials, which guide policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic study which includes the recruitment, design, and delivery of the intervention and follow-up.<br><br>There is a positive trend in the number of pragmatic trials published. A recent Medline query that used the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to keep in mind that the majority of studies were conducted in primary-care settings.