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Pragmatic Free Trial Meta<br><br>Pragmatic Free Trial Meta is a non-commercial, open data platform and infrastructure that facilitates research on pragmatic trials. It is a platform that collects and shares clean trial data and ratings using PRECIS-2, allowing for multiple and diverse meta-epidemiological research studies to examine the effects of treatment across trials that have different levels of pragmatism and other design features.<br><br>Background<br><br>Pragmatic trials are increasingly acknowledged as providing evidence from the real world for clinical decision making. However, the use of the term "pragmatic" is inconsistent and its definition and [https://shorl.com/jujybihumese 프라그마틱 무료] assessment requires further clarification. Pragmatic trials are intended to guide the practice of clinical medicine and policy decisions, not to confirm a physiological hypothesis or clinical hypothesis. A pragmatic trial should also try to be as similar to actual clinical practice as possible, including in the selection of participants, setting and design, the delivery and implementation of the intervention, as well as the determination and analysis of the outcomes, and primary analysis. This is a major distinction from explanatory trials (as described by Schwartz and Lellouch1) which are designed to provide more thorough confirmation of the hypothesis.<br><br>The trials that are truly pragmatic must avoid attempting to blind participants or clinicians as this could result in distortions in estimates of treatment effects. The trials that are pragmatic should also try to enroll patients from a variety of health care settings so that their results are generalizable to the real world.<br><br>Finally the focus of pragmatic trials should be on outcomes that are crucial for patients, such as quality of life or functional recovery. This is particularly relevant when trials involve the use of invasive procedures or could have harmful adverse impacts. The CRASH trial29 compared a 2 page report with an electronic monitoring system for patients in hospitals with chronic heart failure. The catheter trial28 on the other hand was based on symptomatic catheter-related urinary tract infection as its primary outcome.<br><br>In addition to these characteristics, pragmatic trials should minimize the procedures for conducting trials and requirements for data collection to reduce costs. Finally, pragmatic trials should seek to make their findings as applicable to real-world clinical practice as they can by making sure that their primary analysis is based on the intention-to-treat method (as described in CONSORT extensions for pragmatic trials).<br><br>Despite these criteria, many RCTs with features that defy pragmatism have been incorrectly self-labeled pragmatic and published in journals of all kinds. This could lead to false claims about pragmatism, and the use of the term should be made more uniform. The development of a PRECIS-2 tool that can provide a standardized objective assessment of pragmatic features is a first step.<br><br>Methods<br><br>In a pragmatic study the goal is to inform clinical or policy decisions by demonstrating how an intervention would be implemented into routine care. Explanatory trials test hypotheses regarding the causal-effect relationship in idealized settings. In this way, pragmatic trials can have a lower internal validity than studies that explain and be more susceptible to biases in their design, analysis, and conduct. Despite these limitations, pragmatic trials can contribute valuable information to decision-making in the context of healthcare.<br><br>The PRECIS-2 tool assesses the level of pragmatism that is present in an RCT by assessing it on 9 domains, ranging from 1 (very explicative) to 5 (very pragmatic). In this study, the recruit-ment, organization, flexibility in delivery, [https://king-bookmark.stream/story.php?title=pragmatic-slots-free-tips-from-the-most-effective-in-the-business 프라그마틱 정품] flexible adherence and follow-up domains were awarded high scores, however the primary outcome and the procedure for missing data were not at the pragmatic limit. This suggests that it is possible to design a trial using high-quality pragmatic features, without damaging the quality of its results.<br><br>However, it is difficult to judge how pragmatic a particular trial really is because pragmatism is not a binary attribute; some aspects of a study can be more pragmatic than others. A trial's pragmatism could be affected by modifications to the protocol or the logistics during the trial. Koppenaal and colleagues found that 36% of the 89 pragmatic studies were placebo-controlled or conducted prior to licensing. The majority of them were single-center. They are not in line with the usual practice and can only be considered pragmatic if their sponsors agree that such trials aren't blinded.<br><br>A common aspect of pragmatic research is that researchers attempt to make their findings more relevant by studying subgroups within the trial. However, this often leads to unbalanced comparisons and lower statistical power, increasing the chance of not or misinterpreting differences in the primary outcome. In the case of the pragmatic trials included in this meta-analysis, this was a major issue because the secondary outcomes weren't adjusted for the differences in baseline covariates.<br><br>Additionally, studies that are pragmatic may pose challenges to collection and interpretation of safety data. It is because adverse events are typically self-reported and are susceptible to delays, inaccuracies or coding differences. Therefore, it is crucial to improve the quality of outcomes assessment in these trials, ideally by using national registries rather than relying on participants to report adverse events in the trial's own database.<br><br>Results<br><br>Although the definition of pragmatism does not mean that trials must be 100 100% pragmatic, there are advantages to incorporating pragmatic components into clinical trials. These include:<br><br>By incorporating routine patients, the results of the trial can be more quickly translated into clinical practice. However, pragmatic trials may have disadvantages. For example, the right type of heterogeneity could help the trial to apply its results to different patients and settings; however the wrong kind of heterogeneity may reduce the assay's sensitivity, and thus reduce the power of a trial to detect small treatment effects.<br><br>Many studies have attempted classify pragmatic trials using a variety of definitions and scoring methods. Schwartz and Lellouch1 created a framework to distinguish between explanation-based trials that support the clinical or physiological hypothesis and pragmatic trials that inform the choice of appropriate therapies in real-world clinical practice. The framework was comprised of nine domains that were scored on a 1-5 scale with 1 being more explanatory while 5 being more pragmatic. The domains included recruitment, [https://world-news.wiki/wiki/10_Pragmatic_Demo_Tricks_All_Pros_Recommend 프라그마틱 슬롯 무료] [http://www.kaseisyoji.com/home.php?mod=space&uid=1140530 프라그마틱 데모] ([https://clinfowiki.win/wiki/Post:The_10_Worst_Pragmatic_Sugar_Rush_Mistakes_Of_All_Time_Could_Have_Been_Prevented this website]) setting up, delivery of intervention, flexible adhering to the program and primary analysis.<br><br>The original PRECIS tool3 was based on a similar scale and domains. Koppenaal and colleagues10 created an adaptation of the assessment, known as the Pragmascope which was more user-friendly to use for systematic reviews. They discovered that pragmatic systematic reviews had a higher average scores in the majority of domains but lower scores in the primary analysis domain.<br><br>The difference in the primary analysis domain can be explained by the way most pragmatic trials analyze data. Some explanatory trials, however don't. The overall score for pragmatic systematic reviews was lower when the areas of organization, flexible delivery, and follow-up were merged.<br><br>It is important to understand that the term "pragmatic trial" does not necessarily mean a low quality trial, and indeed there is an increasing number of clinical trials (as defined by MEDLINE search, however this is not specific or sensitive) that employ the term 'pragmatic' in their title or abstract. The use of these terms in titles and abstracts could suggest a greater awareness of the importance of pragmatism however, it is not clear if this is evident in the content of the articles.<br><br>Conclusions<br><br>As appreciation for the value of real-world evidence grows commonplace the pragmatic trial has gained traction in research. They are randomized studies that compare real-world treatment options with experimental treatments in development. They include patient populations more closely resembling those treated in regular care. This method can help overcome the limitations of observational research, such as the biases associated with the reliance on volunteers, and the lack of codes that vary in national registers.<br><br>Other benefits of pragmatic trials include the possibility of using existing data sources, as well as a higher chance of detecting meaningful changes than traditional trials. However, these tests could be prone to limitations that undermine their validity and generalizability. Participation rates in some trials may be lower than anticipated due to the healthy-volunteering effect, financial incentives or competition from other research studies. The need to recruit individuals quickly restricts the sample size and impact of many pragmatic trials. Additionally certain pragmatic trials do not have controls to ensure that the observed differences are not due to biases in trial conduct.<br><br>The authors of the Pragmatic Free Trial Meta identified 48 RCTs self-labeled as pragmatist and published from 2022. The PRECIS-2 tool was employed to determine the pragmatism of these trials. It covers areas such as eligibility criteria as well as recruitment flexibility and adherence to intervention and follow-up. They found 14 trials scored highly pragmatic or pragmatic (i.e. scoring 5 or higher) in at least one of these domains.<br><br>Trials with a high pragmatism rating tend to have higher eligibility criteria than traditional RCTs, which include very specific criteria that aren't likely to be used in the clinical setting, and contain patients from a broad range of hospitals. The authors claim that these characteristics could make pragmatic trials more meaningful and  [https://valetinowiki.racing/wiki/5_Pragmatic_Slot_Manipulation_Lessons_From_The_Professionals 프라그마틱 무료 슬롯버프] useful for everyday practice, but they don't necessarily mean that a trial conducted in a pragmatic manner is free from bias. The pragmatism characteristic is not a fixed attribute; a pragmatic test that doesn't have all the characteristics of an explanation study may still yield valuable and valid results.
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Pragmatic Free Trial Meta<br><br>Pragmatic Free Trail Meta is an open data platform that facilitates research into pragmatic trials. It collects and distributes clean trial data, ratings and evaluations using PRECIS-2. This allows for a variety of meta-epidemiological studies to compare treatment effect estimates across trials of various levels of pragmatism.<br><br>Background<br><br>Pragmatic trials provide real-world evidence that can be used to make clinical decisions. The term "pragmatic", however, is not used in a consistent manner and its definition and assessment require clarification. Pragmatic trials are designed to inform clinical practices and policy decisions, not to confirm a physiological hypothesis or clinical hypothesis. A pragmatic study should strive to be as close as it is to actual clinical practices, [https://setbookmarks.com/story18133110/8-tips-for-boosting-your-pragmatic-free-trial-game 프라그마틱 무료스핀] including recruitment of participants, setting up, implementation and delivery of interventions, determination and analysis results, as well as primary analyses. This is a major difference between explanatory trials as defined by Schwartz and Lellouch1, which are designed to test the hypothesis in a more thorough way.<br><br>The trials that are truly practical should be careful not to blind patients or clinicians in order to lead to distortions in estimates of the effect of treatment. Pragmatic trials should also seek to attract patients from a wide range of health care settings, to ensure that their findings are generalizable to the real world.<br><br>Additionally studies that are pragmatic should focus on outcomes that are crucial to patients, such as quality of life or [https://tornadosocial.com/story3525755/the-top-5-reasons-why-people-are-successful-at-the-pragmatickr-industry 프라그마틱 이미지] functional recovery. This is particularly important when trials involve the use of invasive procedures or could have dangerous adverse consequences. The CRASH trial29, for instance focused on the functional outcome to evaluate a two-page case report with an electronic system for monitoring of patients admitted to hospitals with chronic heart failure. Similarly, the catheter trial28 utilized symptomatic catheter-associated urinary tract infections as its primary outcome.<br><br>In addition to these aspects, pragmatic trials should minimize the requirements for data collection and trial procedures to cut down on costs and time commitments. Furthermore pragmatic trials should try to make their results as applicable to real-world clinical practice as they can by making sure that their primary analysis is based on the intention-to-treat method (as described in CONSORT extensions for pragmatic trials).<br><br>Despite these requirements, many RCTs with features that challenge pragmatism have been incorrectly self-labeled pragmatic and published in journals of all kinds. This can lead to misleading claims of pragmatism, and the term's use should be standardised. The creation of a PRECIS-2 tool that can provide an objective and standardized evaluation of the pragmatic characteristics is the first step.<br><br>Methods<br><br>In a pragmatic trial the goal is to inform clinical or policy decisions by demonstrating how an intervention would be implemented into routine care. Explanatory trials test hypotheses concerning the cause-effect relation within idealized conditions. Therefore, pragmatic trials could have lower internal validity than explanatory trials and may be more susceptible to bias in their design, conduct and analysis. Despite these limitations, pragmatic trials can be a valuable source of information for decision-making in healthcare.<br><br>The PRECIS-2 tool scores an RCT on 9 domains, ranging between 1 and 5 (very pragmatist). In this study, the recruitment, organization, flexibility in delivery and follow-up domains received high scores, however, the primary outcome and the procedure for missing data were not at the pragmatic limit. This suggests that a trial could be designed with well-thought-out practical features, yet not compromising its quality.<br><br>However, it is difficult to judge how pragmatic a particular trial is since pragmaticity is not a definite characteristic; certain aspects of a trial may be more pragmatic than others. Moreover, protocol or logistic modifications made during the trial may alter its pragmatism score. Koppenaal and colleagues discovered that 36% of 89 pragmatic studies were placebo-controlled, or conducted prior to licensing. They also found that the majority were single-center. They are not in line with the standard practice and can only be referred to as pragmatic if the sponsors agree that the trials aren't blinded.<br><br>Furthermore, a common feature of pragmatic trials is that the researchers attempt to make their findings more valuable by studying subgroups of the sample. However, this can lead to unbalanced comparisons with a lower statistical power, increasing the chance of not or misinterpreting the results of the primary outcome. In the case of the pragmatic trials that were included in this meta-analysis this was a major issue because the secondary outcomes were not adjusted to account for the differences in the baseline covariates.<br><br>Furthermore the pragmatic trials may present challenges in the gathering and interpretation of safety data. This is due to the fact that adverse events are typically self-reported, and are prone to errors, delays or coding variations. It is important to improve the quality and accuracy of the results in these trials.<br><br>Results<br><br>While the definition of pragmatism may not mean that trials must be 100% pragmatic, there are advantages of including pragmatic elements in clinical trials. These include:<br><br>Enhancing sensitivity to issues in the real world as well as reducing study size and cost as well as allowing trial results to be faster translated into actual clinical practice (by including routine patients). However, pragmatic trials can also have disadvantages. For instance, the right type of heterogeneity could help a study to generalize its results to different settings and patients. However the wrong type of heterogeneity can reduce assay sensitivity and therefore decrease the ability of a study to detect even minor effects of treatment.<br><br>Many studies have attempted classify pragmatic trials using a variety of definitions and [https://socialmediastore.net/story18596960/why-you-ll-need-to-learn-more-about-pragmatic 프라그마틱 정품인증] scoring methods. Schwartz and Lellouch1 developed a framework to distinguish between explanation-based trials that support a clinical or physiological hypothesis, and [https://top10bookmark.com/story17960366/5-pragmatic-slot-manipulation-le%C3%83%C6%92%C3%82-ons-from-the-pros 프라그마틱 슬롯체험] pragmatic trials that help in the selection of appropriate therapies in the real-world clinical setting. Their framework included nine domains, each scored on a scale of 1-5, with 1 indicating more explanatory and 5 indicating more practical. The domains included recruitment of intervention, setting up, delivery of intervention, flexible compliance and primary analysis.<br><br>The original PRECIS tool3 included similar domains and scales from 1 to 5. Koppenaal et al10 devised an adaptation of this assessment, dubbed the Pragmascope that was simpler to use in systematic reviews. They found that pragmatic reviews scored higher across all domains, however they scored lower in the primary analysis domain.<br><br>This distinction in the primary analysis domain can be explained by the way that most pragmatic trials analyze data. Certain explanatory trials however do not. The overall score for pragmatic systematic reviews was lower when the domains of management, flexible delivery and follow-up were merged.<br><br>It is important to note that the term "pragmatic trial" does not necessarily mean a low quality trial, and there is a growing number of clinical trials (as defined by MEDLINE search, but it is neither specific or sensitive) that use the term 'pragmatic' in their abstracts or titles. The use of these terms in abstracts and titles may suggest a greater awareness of the importance of pragmatism but it isn't clear if this is evident in the content of the articles.<br><br>Conclusions<br><br>As appreciation for the value of real-world evidence becomes increasingly popular the pragmatic trial has gained momentum in research. They are randomized trials that evaluate real-world alternatives to new treatments that are being developed. They are conducted with populations of patients closer to those treated in regular care. This method could help overcome the limitations of observational research, such as the biases associated with reliance on volunteers and limited availability and the variability of coding in national registry systems.<br><br>Pragmatic trials have other advantages, like the ability to use existing data sources, and a greater likelihood of detecting meaningful distinctions from traditional trials. However, these trials could still have limitations that undermine their reliability and generalizability. Participation rates in some trials could be lower than expected because of the healthy-volunteering effect, financial incentives or competition from other research studies. A lot of pragmatic trials are restricted by the necessity to recruit participants in a timely manner. In addition, some pragmatic trials don't have controls to ensure that the observed differences aren't due to biases in the conduct of trials.<br><br>The authors of the Pragmatic Free Trial Meta identified RCTs that were published between 2022 and 2022 that self-described themselves as pragmatic. They assessed pragmatism using the PRECIS-2 tool, which includes the eligibility criteria for domains and recruitment criteria, as well as flexibility in adherence to intervention, and follow-up. They found that 14 trials scored highly pragmatic or pragmatic (i.e. scoring 5 or above) in at least one of these domains.<br><br>Trials with high pragmatism scores are likely to have more lenient criteria for eligibility than traditional RCTs. They also include patients from a variety of hospitals. The authors suggest that these characteristics can help make pragmatic trials more effective and relevant to everyday practice, but they do not necessarily guarantee that a pragmatic trial is free of bias. Moreover, the pragmatism of the trial is not a predetermined characteristic and a pragmatic trial that does not contain all the characteristics of a explanatory trial can yield reliable and relevant results.

Revision as of 08:40, 5 January 2025

Pragmatic Free Trial Meta

Pragmatic Free Trail Meta is an open data platform that facilitates research into pragmatic trials. It collects and distributes clean trial data, ratings and evaluations using PRECIS-2. This allows for a variety of meta-epidemiological studies to compare treatment effect estimates across trials of various levels of pragmatism.

Background

Pragmatic trials provide real-world evidence that can be used to make clinical decisions. The term "pragmatic", however, is not used in a consistent manner and its definition and assessment require clarification. Pragmatic trials are designed to inform clinical practices and policy decisions, not to confirm a physiological hypothesis or clinical hypothesis. A pragmatic study should strive to be as close as it is to actual clinical practices, 프라그마틱 무료스핀 including recruitment of participants, setting up, implementation and delivery of interventions, determination and analysis results, as well as primary analyses. This is a major difference between explanatory trials as defined by Schwartz and Lellouch1, which are designed to test the hypothesis in a more thorough way.

The trials that are truly practical should be careful not to blind patients or clinicians in order to lead to distortions in estimates of the effect of treatment. Pragmatic trials should also seek to attract patients from a wide range of health care settings, to ensure that their findings are generalizable to the real world.

Additionally studies that are pragmatic should focus on outcomes that are crucial to patients, such as quality of life or 프라그마틱 이미지 functional recovery. This is particularly important when trials involve the use of invasive procedures or could have dangerous adverse consequences. The CRASH trial29, for instance focused on the functional outcome to evaluate a two-page case report with an electronic system for monitoring of patients admitted to hospitals with chronic heart failure. Similarly, the catheter trial28 utilized symptomatic catheter-associated urinary tract infections as its primary outcome.

In addition to these aspects, pragmatic trials should minimize the requirements for data collection and trial procedures to cut down on costs and time commitments. Furthermore pragmatic trials should try to make their results as applicable to real-world clinical practice as they can by making sure that their primary analysis is based on the intention-to-treat method (as described in CONSORT extensions for pragmatic trials).

Despite these requirements, many RCTs with features that challenge pragmatism have been incorrectly self-labeled pragmatic and published in journals of all kinds. This can lead to misleading claims of pragmatism, and the term's use should be standardised. The creation of a PRECIS-2 tool that can provide an objective and standardized evaluation of the pragmatic characteristics is the first step.

Methods

In a pragmatic trial the goal is to inform clinical or policy decisions by demonstrating how an intervention would be implemented into routine care. Explanatory trials test hypotheses concerning the cause-effect relation within idealized conditions. Therefore, pragmatic trials could have lower internal validity than explanatory trials and may be more susceptible to bias in their design, conduct and analysis. Despite these limitations, pragmatic trials can be a valuable source of information for decision-making in healthcare.

The PRECIS-2 tool scores an RCT on 9 domains, ranging between 1 and 5 (very pragmatist). In this study, the recruitment, organization, flexibility in delivery and follow-up domains received high scores, however, the primary outcome and the procedure for missing data were not at the pragmatic limit. This suggests that a trial could be designed with well-thought-out practical features, yet not compromising its quality.

However, it is difficult to judge how pragmatic a particular trial is since pragmaticity is not a definite characteristic; certain aspects of a trial may be more pragmatic than others. Moreover, protocol or logistic modifications made during the trial may alter its pragmatism score. Koppenaal and colleagues discovered that 36% of 89 pragmatic studies were placebo-controlled, or conducted prior to licensing. They also found that the majority were single-center. They are not in line with the standard practice and can only be referred to as pragmatic if the sponsors agree that the trials aren't blinded.

Furthermore, a common feature of pragmatic trials is that the researchers attempt to make their findings more valuable by studying subgroups of the sample. However, this can lead to unbalanced comparisons with a lower statistical power, increasing the chance of not or misinterpreting the results of the primary outcome. In the case of the pragmatic trials that were included in this meta-analysis this was a major issue because the secondary outcomes were not adjusted to account for the differences in the baseline covariates.

Furthermore the pragmatic trials may present challenges in the gathering and interpretation of safety data. This is due to the fact that adverse events are typically self-reported, and are prone to errors, delays or coding variations. It is important to improve the quality and accuracy of the results in these trials.

Results

While the definition of pragmatism may not mean that trials must be 100% pragmatic, there are advantages of including pragmatic elements in clinical trials. These include:

Enhancing sensitivity to issues in the real world as well as reducing study size and cost as well as allowing trial results to be faster translated into actual clinical practice (by including routine patients). However, pragmatic trials can also have disadvantages. For instance, the right type of heterogeneity could help a study to generalize its results to different settings and patients. However the wrong type of heterogeneity can reduce assay sensitivity and therefore decrease the ability of a study to detect even minor effects of treatment.

Many studies have attempted classify pragmatic trials using a variety of definitions and 프라그마틱 정품인증 scoring methods. Schwartz and Lellouch1 developed a framework to distinguish between explanation-based trials that support a clinical or physiological hypothesis, and 프라그마틱 슬롯체험 pragmatic trials that help in the selection of appropriate therapies in the real-world clinical setting. Their framework included nine domains, each scored on a scale of 1-5, with 1 indicating more explanatory and 5 indicating more practical. The domains included recruitment of intervention, setting up, delivery of intervention, flexible compliance and primary analysis.

The original PRECIS tool3 included similar domains and scales from 1 to 5. Koppenaal et al10 devised an adaptation of this assessment, dubbed the Pragmascope that was simpler to use in systematic reviews. They found that pragmatic reviews scored higher across all domains, however they scored lower in the primary analysis domain.

This distinction in the primary analysis domain can be explained by the way that most pragmatic trials analyze data. Certain explanatory trials however do not. The overall score for pragmatic systematic reviews was lower when the domains of management, flexible delivery and follow-up were merged.

It is important to note that the term "pragmatic trial" does not necessarily mean a low quality trial, and there is a growing number of clinical trials (as defined by MEDLINE search, but it is neither specific or sensitive) that use the term 'pragmatic' in their abstracts or titles. The use of these terms in abstracts and titles may suggest a greater awareness of the importance of pragmatism but it isn't clear if this is evident in the content of the articles.

Conclusions

As appreciation for the value of real-world evidence becomes increasingly popular the pragmatic trial has gained momentum in research. They are randomized trials that evaluate real-world alternatives to new treatments that are being developed. They are conducted with populations of patients closer to those treated in regular care. This method could help overcome the limitations of observational research, such as the biases associated with reliance on volunteers and limited availability and the variability of coding in national registry systems.

Pragmatic trials have other advantages, like the ability to use existing data sources, and a greater likelihood of detecting meaningful distinctions from traditional trials. However, these trials could still have limitations that undermine their reliability and generalizability. Participation rates in some trials could be lower than expected because of the healthy-volunteering effect, financial incentives or competition from other research studies. A lot of pragmatic trials are restricted by the necessity to recruit participants in a timely manner. In addition, some pragmatic trials don't have controls to ensure that the observed differences aren't due to biases in the conduct of trials.

The authors of the Pragmatic Free Trial Meta identified RCTs that were published between 2022 and 2022 that self-described themselves as pragmatic. They assessed pragmatism using the PRECIS-2 tool, which includes the eligibility criteria for domains and recruitment criteria, as well as flexibility in adherence to intervention, and follow-up. They found that 14 trials scored highly pragmatic or pragmatic (i.e. scoring 5 or above) in at least one of these domains.

Trials with high pragmatism scores are likely to have more lenient criteria for eligibility than traditional RCTs. They also include patients from a variety of hospitals. The authors suggest that these characteristics can help make pragmatic trials more effective and relevant to everyday practice, but they do not necessarily guarantee that a pragmatic trial is free of bias. Moreover, the pragmatism of the trial is not a predetermined characteristic and a pragmatic trial that does not contain all the characteristics of a explanatory trial can yield reliable and relevant results.