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that has a healthy RTP and stunning graphics Other notable games include Wolf Gold and Chilli Heat The purpose of pragmatic trials is to mimic real-life scenarios and to achieve the highest level of validity externally They are usually ordered by policymakers and practitioners to help inform their decisions They can also be used to determine the cause-effect relationship of an intervention with its outcomes However, they should not be used to substitute for explanation trials The pragmatism idea is controversial and there are concerns regarding whether pragmatic trials could replace tests for explanations or if they should be an alternative to them Schwartz and Lellouch1 made an distinction between explanation-based studies, which confirm the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the practice and policy decision-making They also proposed a framework called PRECIS for pragmatic trials2 This tool tried to define the elements of a pragmatic study that includes recruitment, design, delivery of the intervention, and follow-up The number of pragmatic trials is growing A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials RCTs, returned 34 articles These are shown in red on Figure 2 This is an indication that the health sciences community is becoming more acquaint to the issue of pragmatism It is important to note that the majority of studies were conducted in primary-care settings