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Pragmatic Free Trial Meta<br><br>Pragmatic Free Trial Meta is a free and non-commercial open data platform and infrastructure that facilitates research on pragmatic trials. It collects and distributes cleaned trial data, ratings and evaluations using PRECIS-2. This permits a variety of meta-epidemiological analyses that evaluate the effects of treatment across trials of various levels of pragmatism.<br><br>Background<br><br>Pragmatic trials are becoming more widely recognized as providing real-world evidence to support clinical decision-making. However, the usage of the term "pragmatic" is inconsistent and its definition as well as assessment requires further clarification. The purpose of pragmatic trials is to inform policy and clinical practice decisions, rather than to prove a physiological or clinical hypothesis. A pragmatic trial should strive to be as close to the real-world clinical environment as is possible, including its participation of participants, setting up and design, the delivery and implementation of the intervention, as well as the determination and analysis of outcomes and primary analysis. This is a major distinction between explanatory trials, as described by Schwartz &amp; Lellouch1 that are designed to prove the hypothesis in a more thorough way.<br><br>Studies that are truly pragmatic should not attempt to blind participants or healthcare professionals in order to cause distortions in estimates of treatment effects. Pragmatic trials will also recruit patients from various healthcare settings to ensure that the results can be applied to the real world.<br><br>Finally, pragmatic trials should focus on outcomes that are vital to patients, such as quality of life or functional recovery. This is particularly relevant for trials that involve surgical procedures that are invasive or may have harmful adverse impacts. The CRASH trial29 compared a 2 page report with an electronic monitoring system for [http://rotoguru1.com/cgi-bin/redirect.pl?link=https://pragmatickr.com/ 프라그마틱 무료 슬롯버프] 게임 ([http://www.visitdomaso.com/click.asp?lnk=https%3A%2F%2Fpragmatickr.com%2F&key=KPFEPGQWQUZTFOOWUJVLEGQUY www.visitdomaso.com official]) patients in hospitals suffering from chronic cardiac failure. The catheter trial28, on the other hand, used symptomatic catheter associated urinary tract infections as its primary outcome.<br><br>In addition to these features pragmatic trials should also reduce the procedures for conducting trials and requirements for data collection to cut down on costs and time commitments. In the end the aim of pragmatic trials is to make their findings as relevant to actual clinical practices as they can. This can be accomplished by ensuring that their analysis is based on the intention to treat method (as described within CONSORT extensions).<br><br>Despite these criteria however, a large number of RCTs with features that challenge the concept of pragmatism have been mislabeled as pragmatic and published in journals of all types. This could lead to false claims of pragmatism, and the usage of the term should be made more uniform. The creation of a PRECIS-2 tool that can provide a standardized objective assessment of pragmatic features is the first step.<br><br>Methods<br><br>In a pragmatic study, the aim is to inform clinical or policy decisions by demonstrating how an intervention would be integrated into everyday routine care. This differs from explanation trials, which test hypotheses about the causal-effect relationship in idealized conditions. Therefore, pragmatic trials could have less internal validity than explanatory trials and might be more susceptible to bias in their design, conduct and analysis. Despite their limitations, [http://hairy-ocean.com/fcj/out.php?s=50&url=https%3A%2F%2Fpragmatickr.com%2F 프라그마틱 슬롯 하는법] pragmatic studies can be a valuable source of information for decision-making within the healthcare context.<br><br>The PRECIS-2 tool assesses the degree of pragmatism within an RCT by scoring it across 9 domains, ranging from 1 (very explicative) to 5 (very pragmatic). In this study, the recruitment, organisation, flexibility: delivery and follow-up domains scored high scores, however the primary outcome and the procedure for missing data were not at the pragmatic limit. This indicates that a trial can be designed with well-thought-out practical features, yet not damaging the quality.<br><br>It is, however, difficult to judge how practical a particular trial is, since the pragmatism score is not a binary attribute; some aspects of a trial may be more pragmatic than others. Furthermore, logistical or protocol modifications during the course of a trial can change its score on pragmatism. Additionally 36% of the 89 pragmatic trials discovered by Koppenaal and co. were placebo-controlled or conducted prior to licensing, and the majority were single-center. This means that they are not very close to usual practice and are only pragmatic in the event that their sponsors are supportive of the lack of blinding in such trials.<br><br>Furthermore, a common feature of pragmatic trials is that researchers attempt to make their findings more valuable by studying subgroups of the sample. This can lead to unbalanced analyses with less statistical power. This increases the risk of omitting or ignoring differences in the primary outcomes. This was a problem during the meta-analysis of pragmatic trials because secondary outcomes were not corrected for differences in covariates at the baseline.<br><br>Additionally, pragmatic trials can also have challenges with respect to the gathering and interpretation of safety data. It is because adverse events are usually self-reported, and therefore are prone to errors, delays or coding differences. It is essential to increase the accuracy and quality of the results in these trials.<br><br>Results<br><br>While the definition of pragmatism does not require that all clinical trials be 100% pragmatic, there are benefits to including pragmatic components in trials. These include:<br><br>By incorporating routine patients, the results of trials can be more quickly translated into clinical practice. However, pragmatic trials can also have disadvantages. The right type of heterogeneity, like could allow a study to generalise its findings to many different settings or patients. However, the wrong type can decrease the sensitivity of the test and thus reduce a trial's power to detect even minor effects of treatment.<br><br>A variety of studies have attempted to classify pragmatic trials with a variety of definitions and scoring systems. Schwartz and Lellouch1 developed a framework to differentiate between explanation studies that confirm the physiological hypothesis or clinical hypothesis, and pragmatic studies that help inform the selection of appropriate therapies in real world clinical practice. Their framework included nine domains, each scored on a scale ranging from 1 to 5, with 1 indicating more explanatory and 5 indicating more pragmatic. The domains included recruitment of intervention, setting up, delivery of intervention, flex adherence and primary analysis.<br><br>The original PRECIS tool3 was based on a similar scale and domains. Koppenaal et al10 developed an adaptation of this assessment, called the Pragmascope, that was easier to use for systematic reviews. They found that pragmatic reviews scored higher on average across all domains, however they scored lower in the primary analysis domain.<br><br>This difference in the primary analysis domain could be due to the fact that most pragmatic trials process their data in the intention to treat method however some explanation trials do not. The overall score was lower for pragmatic systematic reviews when the domains of organisation, flexible delivery and follow-up were merged.<br><br>It is important to remember that a study that is pragmatic does not necessarily mean a low-quality study. In fact, there are an increasing number of clinical trials which use the term 'pragmatic' either in their abstract or title (as defined by MEDLINE, but that is not precise nor sensitive). These terms may signal that there is a greater appreciation of pragmatism in titles and abstracts, but it isn't clear whether this is evident in content.<br><br>Conclusions<br><br>As the value of evidence from the real world becomes more widespread and pragmatic trials have gained popularity in research. They are clinical trials that are randomized that compare real-world care alternatives rather than experimental treatments under development. They have populations of patients that are more similar to those treated in routine care, they use comparisons that are commonplace in practice (e.g. existing drugs) and depend on the self-reporting of participants about outcomes. This approach has the potential to overcome limitations of observational studies which include the limitations of relying on volunteers and the lack of availability and the variability of coding in national registry systems.<br><br>Other benefits of pragmatic trials include the possibility of using existing data sources, and 프라그마틱 슬롯 무료체험 ([http://akid.s17.xrea.com/p2ime.phtml?enc=1&url=https://pragmatickr.com/ http://Akid.s17.xrea.com/]) a greater probability of detecting significant changes than traditional trials. However, pragmatic tests may still have limitations which undermine their validity and generalizability. Participation rates in some trials could be lower than anticipated due to the healthy-volunteering effect, financial incentives or competition from other research studies. Practical trials are often restricted by the need to recruit participants quickly. Additionally some pragmatic trials lack controls to ensure that the observed differences are not due to biases in the conduct of trials.<br><br>The authors of the Pragmatic Free Trial Meta identified RCTs published up to 2022 that self-described as pragmatic. The PRECIS-2 tool was employed to assess the pragmatism of these trials. It includes domains such as eligibility criteria and flexibility in recruitment as well as adherence to interventions and follow-up. They discovered that 14 of these trials scored pragmatic or highly pragmatic (i.e. scoring 5 or more) in any one or more of these domains, and that the majority of them were single-center.<br><br>Studies with high pragmatism scores tend to have broader criteria for eligibility than traditional RCTs. They also have patients from a variety of hospitals. The authors claim that these characteristics can help make pragmatic trials more effective and relevant to everyday clinical practice, however they do not guarantee that a trial conducted in a pragmatic manner is free from bias. The pragmatism characteristic is not a fixed attribute and a test that does not have all the characteristics of an explicative study could 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 shares clean trial data and ratings using PRECIS-2, which allows for multiple and varied meta-epidemiological research studies to compare treatment effects estimates across trials with different levels of pragmatism as well as other design features.<br><br>Background<br><br>Pragmatic trials provide real-world evidence that can be used to make clinical decisions. The term "pragmatic" however, is used inconsistently and its definition and measurement need further clarification. Pragmatic trials are designed to inform clinical practices and policy choices, rather than verify a physiological hypothesis or clinical hypothesis. A pragmatic trial should also try to be as similar to actual clinical practice as possible, such as its participation of participants, setting and design of the intervention, its delivery and implementation of the intervention, determination and analysis of the outcomes, and primary analysis. This is a major difference between explanation-based trials, [https://opensourcebridge.science/wiki/What_Is_The_Future_Of_Pragmatic_Play_Be_Like_In_100_Years 프라그마틱 슬롯체험] as defined by Schwartz &amp; Lellouch1 which are designed to test a hypothesis in a more thorough way.<br><br>Trials that are truly pragmatic must avoid attempting to blind participants or the clinicians, as this may cause bias in estimates of the effects of treatment. Practical trials also involve patients from different health care settings to ensure that the results can be generalized to the real world.<br><br>Additionally the focus of pragmatic trials should be on outcomes that are vital for patients, such as quality of life or functional recovery. This is particularly important in trials that require surgical procedures that are invasive or may have serious adverse effects. The CRASH trial29 compared a 2 page report with an electronic monitoring system for hospitalized patients with chronic heart failure. The trial with a catheter, on the other hand, used symptomatic catheter associated urinary tract infections as its primary outcome.<br><br>In addition to these aspects pragmatic trials should reduce the trial's procedures and requirements for data collection to reduce costs. Finally, pragmatic trials should seek to make their findings as applicable to clinical practice as possible by ensuring that their primary analysis is the intention-to-treat approach (as described in CONSORT extensions for pragmatic trials).<br><br>Many RCTs that don't meet the requirements for pragmatism however, they have characteristics that are contrary to pragmatism have been published in journals of varying types and incorrectly labeled as pragmatic. This could lead to false claims about pragmatism, and the term's use should be standardised. The creation of the PRECIS-2 tool, which offers an objective and standard assessment of practical features is a good initial step.<br><br>Methods<br><br>In a practical study the aim is to inform clinical or policy decisions by showing how an intervention can be integrated into routine care in real-world settings. This is distinct from explanation trials that test hypotheses about the causal-effect relationship in idealized situations. In this way, pragmatic trials may have less internal validity than studies that explain and be more prone to biases in their design as well as analysis and conduct. Despite these limitations, [https://lovebookmark.date/story.php?title=why-you-should-concentrate-on-enhancing-pragmatic-korea 프라그마틱 슬롯 팁] pragmatic trials can contribute valuable information to decision-making in the context of healthcare.<br><br>The PRECIS-2 tool evaluates an RCT on 9 domains, ranging between 1 and 5 (very pragmatic). In this study, the recruit-ment, organisation, flexibility: delivery, flexible adherence and follow-up domains were awarded high scores, however, the primary outcome and the method of missing data were below the pragmatic limit. This indicates that a trial can be designed with effective pragmatic features, without damaging the quality.<br><br>It is difficult to determine the level of pragmatism in a particular trial since pragmatism doesn't possess a specific 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. Additionally 36% of 89 pragmatic trials discovered by Koppenaal and colleagues were placebo-controlled or conducted prior to licensing and most were single-center. They are not in line with the usual practice and can only be considered pragmatic if the sponsors agree that the trials aren't blinded.<br><br>Additionally, a typical feature of pragmatic trials is that researchers attempt to make their findings more valuable by studying subgroups of the trial. This can result in imbalanced analyses and less statistical power. This increases the risk of omitting or misinterpreting differences in the primary outcomes. This was a problem in the meta-analysis of pragmatic trials due to the fact that secondary outcomes were not corrected for differences in covariates at the baseline.<br><br>Additionally, studies that are pragmatic can present challenges in the collection and interpretation of safety data. This is due to the fact that adverse events are generally reported by the participants themselves and are prone to delays in reporting, inaccuracies or coding errors. It is therefore crucial to improve the quality of outcomes assessment in these trials, ideally by using national registry databases instead of relying on participants to report adverse events in a trial's own database.<br><br>Results<br><br>Although the definition of pragmatism does not require that all trials are 100% pragmatic, there are benefits to including pragmatic components in clinical trials. These include:<br><br>Enhancing sensitivity to issues in the real world as well as reducing the size of studies and their costs as well as allowing trial results to be more quickly transferred into real-world clinical practice (by including patients from routine care). However, pragmatic trials be a challenge. The right kind of heterogeneity for instance could help a study expand its findings to different patients or settings. However the wrong type of heterogeneity could reduce the sensitivity of an assay and, consequently, decrease the ability of a study to detect minor treatment effects.<br><br>Many studies have attempted categorize pragmatic trials using various definitions and scoring methods. Schwartz and Lellouch1 developed an approach to distinguish between research studies that prove a physiological or clinical hypothesis, and pragmatic trials that inform the selection of appropriate treatments in the real-world clinical setting. The framework consisted of nine domains assessed on a scale of 1-5 which indicated that 1 was more lucid while 5 being more pragmatic. The domains included recruitment of intervention, setting up, delivery of intervention, flexible adherence and primary analysis.<br><br>The initial PRECIS tool3 had similar domains and a scale of 1 to 5. Koppenaal et al10 created an adaptation to this assessment dubbed the Pragmascope which was more user-friendly to use in systematic reviews. They discovered that pragmatic systematic reviews had higher average scores in the majority of domains, but lower scores in the primary analysis domain.<br><br>This difference in primary analysis domains can be explained by the way most pragmatic trials analyse data. Certain explanatory trials however don't. The overall score for systematic reviews that were pragmatic was lower when the domains of organization, flexible delivery, and follow-up were merged.<br><br>It is important to understand that a pragmatic trial does not necessarily mean a poor quality trial, and in fact there is a growing number of clinical trials (as defined by MEDLINE search, but this is not specific or sensitive) which use the word "pragmatic" in their title or abstract. These terms could indicate a greater understanding of pragmatism in titles and abstracts, but it's not clear whether this is evident in the content.<br><br>Conclusions<br><br>In recent times, pragmatic trials are increasing in popularity in research because the value of real-world evidence is becoming increasingly acknowledged. They are randomized trials that compare real world alternatives to new treatments that are being developed. They are conducted with populations of patients more closely resembling those treated in regular care. This approach has the potential to overcome the limitations of observational studies, such as the biases associated with reliance on volunteers and the lack of accessibility and coding flexibility in national registry systems.<br><br>Pragmatic trials also have advantages, including the ability to leverage existing data sources and a greater chance of detecting significant differences from traditional trials. However, they may still have limitations that undermine their credibility and generalizability. For example the rates of participation in some trials could be lower than anticipated due to the healthy-volunteer effect and incentives to pay or compete for participants from other research studies (e.g. industry trials). Many pragmatic trials are also restricted by the necessity to recruit participants on time. Some pragmatic trials also lack controls to ensure that observed differences aren't caused by biases during the trial.<br><br>The authors of the Pragmatic Free Trial Meta identified 48 RCTs that self-labeled themselves as pragmatic and were published up to 2022. They assessed pragmatism by using the PRECIS-2 tool,  [https://king-bookmark.stream/story.php?title=ask-me-anything-10-responses-to-your-questions-about-pragmatic-korea 프라그마틱 슬롯체험] 불법 ([https://images.google.com.ly/url?q=https://blogfreely.net/coilflame06/the-under-appreciated-benefits-of-pragmatic-free-trial read this post from Google]) which consists of the eligibility criteria for domains, recruitment, flexibility in adherence to intervention, and follow-up. They discovered that 14 of the trials scored pragmatic or highly practical (i.e., scoring 5 or more) in one or more of these domains and that the majority of them were single-center.<br><br>Trials with a high pragmatism score tend to have more expansive eligibility criteria than traditional RCTs which have very specific criteria that aren't likely to be present in clinical practice, and they include populations from a wide variety of hospitals. The authors suggest that these traits can make pragmatic trials more meaningful and applicable to daily practice, but they don't necessarily mean that a trial using a pragmatic approach is completely free of bias. Furthermore, the pragmatism of the trial is not a fixed attribute A pragmatic trial that doesn't have all the characteristics of a explanatory trial can produce reliable and relevant results.

Latest revision as of 17:02, 7 January 2025

Pragmatic Free Trial Meta

Pragmatic Free Trail Meta is an open data platform that facilitates research into pragmatic trials. It shares clean trial data and ratings using PRECIS-2, which allows for multiple and varied meta-epidemiological research studies to compare treatment effects estimates across trials with different levels of pragmatism as well as other design features.

Background

Pragmatic trials provide real-world evidence that can be used to make clinical decisions. The term "pragmatic" however, is used inconsistently and its definition and measurement need further clarification. Pragmatic trials are designed to inform clinical practices and policy choices, rather than verify a physiological hypothesis or clinical hypothesis. A pragmatic trial should also try to be as similar to actual clinical practice as possible, such as its participation of participants, setting and design of the intervention, its delivery and implementation of the intervention, determination and analysis of the outcomes, and primary analysis. This is a major difference between explanation-based trials, 프라그마틱 슬롯체험 as defined by Schwartz & Lellouch1 which are designed to test a hypothesis in a more thorough way.

Trials that are truly pragmatic must avoid attempting to blind participants or the clinicians, as this may cause bias in estimates of the effects of treatment. Practical trials also involve patients from different health care settings to ensure that the results can be generalized to the real world.

Additionally the focus of pragmatic trials should be on outcomes that are vital for patients, such as quality of life or functional recovery. This is particularly important in trials that require surgical procedures that are invasive or may have serious adverse effects. The CRASH trial29 compared a 2 page report with an electronic monitoring system for hospitalized patients with chronic heart failure. The trial with a catheter, on the other hand, used symptomatic catheter associated urinary tract infections as its primary outcome.

In addition to these aspects pragmatic trials should reduce the trial's procedures and requirements for data collection to reduce costs. Finally, pragmatic trials should seek to make their findings as applicable to clinical practice as possible by ensuring that their primary analysis is the intention-to-treat approach (as described in CONSORT extensions for pragmatic trials).

Many RCTs that don't meet the requirements for pragmatism however, they have characteristics that are contrary to pragmatism have been published in journals of varying types and incorrectly labeled as pragmatic. This could lead to false claims about pragmatism, and the term's use should be standardised. The creation of the PRECIS-2 tool, which offers an objective and standard assessment of practical features is a good initial step.

Methods

In a practical study the aim is to inform clinical or policy decisions by showing how an intervention can be integrated into routine care in real-world settings. This is distinct from explanation trials that test hypotheses about the causal-effect relationship in idealized situations. In this way, pragmatic trials may have less internal validity than studies that explain and be more prone to biases in their design as well as analysis and conduct. Despite these limitations, 프라그마틱 슬롯 팁 pragmatic trials can contribute valuable information to decision-making in the context of healthcare.

The PRECIS-2 tool evaluates an RCT on 9 domains, ranging between 1 and 5 (very pragmatic). In this study, the recruit-ment, organisation, flexibility: delivery, flexible adherence and follow-up domains were awarded high scores, however, the primary outcome and the method of missing data were below the pragmatic limit. This indicates that a trial can be designed with effective pragmatic features, without damaging the quality.

It is difficult to determine the level of pragmatism in a particular trial since pragmatism doesn't possess a specific 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. Additionally 36% of 89 pragmatic trials discovered by Koppenaal and colleagues were placebo-controlled or conducted prior to licensing and most were single-center. They are not in line with the usual practice and can only be considered pragmatic if the sponsors agree that the trials aren't blinded.

Additionally, a typical feature of pragmatic trials is that researchers attempt to make their findings more valuable by studying subgroups of the trial. This can result in imbalanced analyses and less statistical power. This increases the risk of omitting or misinterpreting differences in the primary outcomes. This was a problem in the meta-analysis of pragmatic trials due to the fact that secondary outcomes were not corrected for differences in covariates at the baseline.

Additionally, studies that are pragmatic can present challenges in the collection and interpretation of safety data. This is due to the fact that adverse events are generally reported by the participants themselves and are prone to delays in reporting, inaccuracies or coding errors. It is therefore crucial to improve the quality of outcomes assessment in these trials, ideally by using national registry databases instead of relying on participants to report adverse events in a trial's own database.

Results

Although the definition of pragmatism does not require that all trials are 100% pragmatic, there are benefits to including pragmatic components in clinical trials. These include:

Enhancing sensitivity to issues in the real world as well as reducing the size of studies and their costs as well as allowing trial results to be more quickly transferred into real-world clinical practice (by including patients from routine care). However, pragmatic trials be a challenge. The right kind of heterogeneity for instance could help a study expand its findings to different patients or settings. However the wrong type of heterogeneity could reduce the sensitivity of an assay and, consequently, decrease the ability of a study to detect minor treatment effects.

Many studies have attempted categorize pragmatic trials using various definitions and scoring methods. Schwartz and Lellouch1 developed an approach to distinguish between research studies that prove a physiological or clinical hypothesis, and pragmatic trials that inform the selection of appropriate treatments in the real-world clinical setting. The framework consisted of nine domains assessed on a scale of 1-5 which indicated that 1 was more lucid while 5 being more pragmatic. The domains included recruitment of intervention, setting up, delivery of intervention, flexible adherence and primary analysis.

The initial PRECIS tool3 had similar domains and a scale of 1 to 5. Koppenaal et al10 created an adaptation to this assessment dubbed the Pragmascope which was more user-friendly to use in systematic reviews. They discovered that pragmatic systematic reviews had higher average scores in the majority of domains, but lower scores in the primary analysis domain.

This difference in primary analysis domains can be explained by the way most pragmatic trials analyse data. Certain explanatory trials however don't. The overall score for systematic reviews that were pragmatic was lower when the domains of organization, flexible delivery, and follow-up were merged.

It is important to understand that a pragmatic trial does not necessarily mean a poor quality trial, and in fact there is a growing number of clinical trials (as defined by MEDLINE search, but this is not specific or sensitive) which use the word "pragmatic" in their title or abstract. These terms could indicate a greater understanding of pragmatism in titles and abstracts, but it's not clear whether this is evident in the content.

Conclusions

In recent times, pragmatic trials are increasing in popularity in research because the value of real-world evidence is becoming increasingly acknowledged. They are randomized trials that compare real world alternatives to new treatments that are being developed. They are conducted with populations of patients more closely resembling those treated in regular care. This approach has the potential to overcome the limitations of observational studies, such as the biases associated with reliance on volunteers and the lack of accessibility and coding flexibility in national registry systems.

Pragmatic trials also have advantages, including the ability to leverage existing data sources and a greater chance of detecting significant differences from traditional trials. However, they may still have limitations that undermine their credibility and generalizability. For example the rates of participation in some trials could be lower than anticipated due to the healthy-volunteer effect and incentives to pay or compete for participants from other research studies (e.g. industry trials). Many pragmatic trials are also restricted by the necessity to recruit participants on time. Some pragmatic trials also lack controls to ensure that observed differences aren't caused by biases during the trial.

The authors of the Pragmatic Free Trial Meta identified 48 RCTs that self-labeled themselves as pragmatic and were published up to 2022. They assessed pragmatism by using the PRECIS-2 tool, 프라그마틱 슬롯체험 불법 (read this post from Google) which consists of the eligibility criteria for domains, recruitment, flexibility in adherence to intervention, and follow-up. They discovered that 14 of the trials scored pragmatic or highly practical (i.e., scoring 5 or more) in one or more of these domains and that the majority of them were single-center.

Trials with a high pragmatism score tend to have more expansive eligibility criteria than traditional RCTs which have very specific criteria that aren't likely to be present in clinical practice, and they include populations from a wide variety of hospitals. The authors suggest that these traits can make pragmatic trials more meaningful and applicable to daily practice, but they don't necessarily mean that a trial using a pragmatic approach is completely free of bias. Furthermore, the pragmatism of the trial is not a fixed attribute A pragmatic trial that doesn't have all the characteristics of a explanatory trial can produce reliable and relevant results.