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Despite its infancy it has already established itself as a leading gaming platform for casinos. Wolves is one of the latest games, a 5-reel slot machine with a hefty RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat. Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually ordered by policymakers and practitioners in order to inform their decisions. They can be used to determine the causality of an intervention with its outcomes. They should, however, not, be used to replace explanation studies. The pragmatism idea is controversial and there are doubts regarding whether pragmatic trials could be used to replace explanation tests or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials, which guide the practice and policy decisions. They also proposed the framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic study that include the recruitment process, the design and delivery of the intervention, and follow-up. The number of pragmatic trials is growing. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.
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