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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 shares cleaned trial data and ratings using PRECIS-2 allowing for multiple and diverse meta-epidemiological studies that evaluate the effect of treatment on trials that have different levels of pragmatism and other design features.<br><br>Background<br><br>Pragmatic trials provide evidence from the real world that can be used to make clinical decisions. The term "pragmatic", however, is used inconsistently and its definition and measurement require clarification. The purpose of pragmatic trials is to guide the practice of clinical medicine and policy choices, rather than prove a physiological or clinical hypothesis. A pragmatic trial should also strive to be as close to the real-world clinical environment as possible, such as the 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 difference between explanation-based trials, as defined by Schwartz and Lellouch1 which are designed to test the hypothesis in a more thorough manner.<br><br>Truely pragmatic trials should not be blind participants or the clinicians. This can lead to an overestimation of treatment effects. Pragmatic trials should also seek to recruit patients from a wide range of health care settings, so that their results are generalizable to the real world.<br><br>Furthermore, pragmatic trials should focus on outcomes that are vital for patients, such as quality of life or functional recovery. This is especially important in trials that require invasive procedures or have potentially harmful adverse effects. The CRASH trial29, for example was focused on functional outcomes to evaluate a two-page case report with an electronic system to monitor the health of patients admitted to hospitals with chronic heart failure, and the catheter trial28 utilized urinary tract infections that are symptomatic of catheters as its primary outcome.<br><br>In addition to these characteristics, pragmatic trials should minimize the procedures for conducting trials and data collection requirements in order to reduce costs. Finaly these trials should strive to make their findings as relevant to real-world clinical practices as possible. This can be accomplished by ensuring that their analysis is based on an intention-to treat method (as described in CONSORT extensions).<br><br>Despite these requirements, a number of RCTs with features that challenge pragmatism have been incorrectly self-labeled pragmatic and published in journals of all types. This can 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 offers a standardized objective evaluation of the pragmatic characteristics is a first step.<br><br>Methods<br><br>In a pragmatic trial the goal is to inform policy or clinical decisions by demonstrating how the intervention can be incorporated into real-world routine care. This is distinct from explanation trials, which test hypotheses about the cause-effect relationship in idealised settings. Therefore, pragmatic trials might be less reliable than explanatory trials and may be more susceptible to bias in their design, conduct and analysis. Despite these limitations, pragmatic trials may be a valuable source of information for decision-making in the context of healthcare.<br><br>The PRECIS-2 tool evaluates the level of pragmatism that is present in an RCT by scoring it across 9 domains ranging from 1 (very explicative) to 5 (very pragmatic). In this study the areas of recruitment, organisation as well as flexibility in delivery flexibility in adherence,  [https://pragmatickr-com86420.frewwebs.com/31039441/10-quick-tips-for-pragmatic-authenticity-verification 프라그마틱 게임] and follow-up scored high. However, the main outcome and method of missing data was scored below the pragmatic limit. This suggests that it is possible to design a trial with excellent pragmatic features without harming the quality of the results.<br><br>It is hard to determine the amount of pragmatism within a specific trial because pragmatism does not possess a specific characteristic. Some aspects of a study may 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 the 89 pragmatic trials identified by Koppenaal et al were placebo-controlled, or [https://bookmarkusers.com/story18132747/why-nobody-cares-about-pragmatic-korea 프라그마틱 슬롯 체험] conducted prior to approval and a majority of them were single-center. They are not in line with the usual practice, and can only be called pragmatic if their sponsors agree that such trials aren't blinded.<br><br>A common aspect of pragmatic studies is that researchers try to make their findings more meaningful by analyzing subgroups within the trial sample. However, this often leads to unbalanced results and lower statistical power, thereby increasing the likelihood of missing or incorrectly detecting differences in the primary outcome. This was the case in the meta-analysis of pragmatic trials because secondary outcomes were not adjusted for covariates that differed at the time of baseline.<br><br>Furthermore the pragmatic trials may be a challenge in the collection and interpretation of safety data. This is because adverse events are generally reported by the participants themselves and prone to delays in reporting, inaccuracies or coding errors. It is therefore crucial to improve the quality of outcome ascertainment in these trials, in particular by using national registries rather than relying on participants to report adverse events in the trial's own database.<br><br>Results<br><br>While the definition of pragmatism may not require that all trials be 100 100% pragmatic, there are benefits of including pragmatic elements in clinical trials. These include:<br><br>Enhancing sensitivity to issues in the real world,  [https://wisesocialsmedia.com/story3610067/10-basics-on-pragmatic-game-you-didn-t-learn-at-school 프라그마틱 추천] [https://growthbookmarks.com/story18233692/what-is-the-reason-pragmatic-ranking-is-fast-increasing-to-be-the-hottest-trend-of-2024 프라그마틱 무료 슬롯버프]체험 ([https://pragmatickr-com76420.blogdosaga.com/30378036/the-10-most-scariest-things-about-live-casino simply click the up coming internet site]) reducing the size of studies and their costs and allowing the study results to be faster transferred into real-world clinical practice (by including routine patients). But pragmatic trials can be a challenge. The right type of heterogeneity for instance, can help a study extend its findings to different settings or patients. However, the wrong type can decrease the sensitivity of the test and, consequently, lessen the power of a trial to detect minor treatment effects.<br><br>A variety of studies have attempted to categorize pragmatic trials using various definitions and scoring systems. Schwartz and Lellouch1 developed an approach to distinguish between explanation-based trials that support a clinical or physiological hypothesis and pragmatic trials that inform the selection of appropriate treatments in real-world clinical practice. The framework was comprised of nine domains, each scored on a scale ranging from 1-5, with 1 indicating more lucid and 5 suggesting more pragmatic. The domains included recruitment setting, setting, intervention delivery, flexible adherence, follow-up and primary analysis.<br><br>The original PRECIS tool3 was built on the same scale and domains. Koppenaal et al10 developed an adaptation of this assessment, known as the Pragmascope which was more user-friendly to use for systematic reviews. They found that pragmatic systematic reviews had higher average scores across all domains, but lower scores 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 don't. The overall score for systematic reviews that were pragmatic was lower when the domains of management, flexible delivery and follow-up were merged.<br><br>It is important to remember that a pragmatic trial does not necessarily mean a low-quality trial, and there is a growing number of clinical trials (as defined by MEDLINE search, however this is neither specific nor sensitive) that employ the term 'pragmatic' in their abstracts or titles. These terms may signal that there is a greater understanding of pragmatism in abstracts and titles, but it isn't clear whether this is reflected in the content.<br><br>Conclusions<br><br>As appreciation for the value of real-world evidence grows commonplace the pragmatic trial has gained momentum in research. They are randomized clinical trials that compare real-world care alternatives rather than experimental treatments under development. They involve populations of patients that are more similar to the ones who are treated in routine care, they use comparisons that are commonplace in practice (e.g., existing drugs), and they depend on the self-reporting of participants about outcomes. This method can help overcome the limitations of observational research like the biases associated with the reliance on volunteers and the limited availability and the coding differences in national registry.<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 still have limitations which undermine their effectiveness and generalizability. The participation rates in certain trials could be lower than expected because of the healthy-volunteering effect, financial incentives or competition from other research studies. The requirement to recruit participants in a timely fashion also restricts the sample size and the impact of many pragmatic trials. Certain pragmatic trials lack controls to ensure that the observed variations aren't due to biases in the trial.<br><br>The authors of the Pragmatic Free Trial Meta identified 48 RCTs that self-labeled themselves as pragmatic and that were published from 2022. The PRECIS-2 tool was used to determine the pragmatism of these trials. It includes areas like 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 above) in at least one of these domains.<br><br>Trials with high pragmatism scores tend to have broader criteria for eligibility than traditional RCTs. They also include populations from various hospitals. The authors argue that these traits can make pragmatic trials more meaningful and useful for everyday clinical practice, however they don't necessarily mean that a trial using a pragmatic approach is free from bias. Furthermore, the pragmatism of a trial is not a predetermined characteristic A pragmatic trial that does not possess all the characteristics of an explanatory trial may yield valuable and reliable results.
Pragmatic Free Trial Meta<br><br>Pragmatic Free Trial Meta is a free and non-commercial open data platform and infrastructure that supports research on pragmatic trials. It collects and shares cleaned trial data and ratings using PRECIS-2, permitting multiple and varied meta-epidemiological research studies to compare treatment effects estimates across trials that have different levels of pragmatism and other design features.<br><br>Background<br><br>Pragmatic trials provide evidence from the real world that can be used to make clinical decisions. The term "pragmatic", however, is a word that is often used in contradiction and its definition and evaluation require further clarification. Pragmatic trials are intended to inform clinical practices and policy decisions, not to prove a physiological or clinical hypothesis. A pragmatic trial should try to be as close as possible to actual clinical practices that include recruiting participants, setting up, delivery and implementation of interventions, determining and analysis results, as well as primary analyses. This is a significant difference between explanation-based trials, as defined by Schwartz and Lellouch1, which are designed to confirm a hypothesis in a more thorough way.<br><br>Trials that are truly pragmatic must be careful not to blind patients or healthcare professionals, as this may result in bias in estimates of the effects of treatment. 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 studies that are pragmatic should focus on outcomes that are crucial for patients, such as quality of life or functional recovery. This is especially important when it comes to trials that involve invasive procedures or those with potential serious adverse events. The CRASH trial29 compared a two-page report with an electronic monitoring system for hospitalized patients with chronic cardiac failure. The catheter trial28, on the other hand utilized symptomatic catheter-related urinary tract infection as the primary outcome.<br><br>In addition to these features, pragmatic trials should minimize the requirements for data collection and trial procedures to cut down on costs and time commitments. Furthermore, pragmatic trials should seek to make their findings as applicable to clinical practice as is possible by ensuring that their primary analysis follows the intention-to treat approach (as described in CONSORT extensions for pragmatic trials).<br><br>Many RCTs that do not meet the requirements for pragmatism but have features that are in opposition to pragmatism, have been published in journals of various types and incorrectly labeled as pragmatic. This could lead to misleading claims of pragmatism, [https://digitaltibetan.win/wiki/Post:Pragmatic_Free_Game_The_Good_The_Bad_And_The_Ugly 프라그마틱 환수율] and the use of the term needs to be standardized. The development of a PRECIS-2 tool that offers a standardized objective evaluation of the pragmatic characteristics is the first step.<br><br>Methods<br><br>In a practical study the aim is to inform policy or clinical decisions by demonstrating how an intervention could be integrated into routine care in real-world contexts. This is distinct from explanation trials that test hypotheses about the causal-effect relationship in idealized situations. Therefore, [https://www.google.co.ao/url?q=https://anotepad.com/notes/fimcg8ws 프라그마틱 정품확인] 슬롯 [http://bbs.qupu123.com/space-uid-2823270.html 프라그마틱 무료체험 메타] ([http://planforexams.com/q2a/user/cornetboot80 visit this web page link]) pragmatic trials could have lower internal validity than explanatory trials, and could be more susceptible to bias in their design, conduct, and analysis. Despite these limitations, pragmatic trials may be a valuable source of information for 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 areas of recruitment, organization as well as flexibility in delivery flexibility in adherence, and follow-up scored high. However, the principal outcome and the method for missing data were scored below the practical limit. This suggests that a trial could be designed with effective practical features, yet not damaging the quality.<br><br>It is hard to determine the amount of pragmatism within a specific trial because pragmatism does not have a binary characteristic. Some aspects of a research study can be more pragmatic than others. Furthermore, logistical or protocol modifications made during an experiment can alter its score in pragmatism. Koppenaal and colleagues found that 36% of the 89 pragmatic studies were placebo-controlled, or conducted prior to licensing. Most were also single-center. They aren't in line with the standard practice and are only called pragmatic if the sponsors agree that these trials aren't blinded.<br><br>Additionally, a typical feature of pragmatic trials is that researchers try to make their results more meaningful by analysing subgroups of the sample. This can lead to unbalanced analyses with less statistical power. This increases the risk of missing or misdetecting differences in the primary outcomes. In the case of the pragmatic studies that were included in this meta-analysis this was a significant problem because the secondary outcomes weren't adjusted for the differences in baseline covariates.<br><br>Additionally, pragmatic trials can also have challenges with respect to the gathering and interpretation of safety data. This is because adverse events are typically reported by participants themselves and are susceptible to reporting errors, delays, or coding variations. It is important to improve the accuracy and quality of the outcomes in these trials.<br><br>Results<br><br>Although the definition of pragmatism doesn't require that all clinical trials are 100% pragmatic There are advantages of including pragmatic elements in trials. These include:<br><br>Increasing sensitivity to real-world issues which reduces the size of studies and their costs, and enabling the trial results to be more quickly transferred into real-world clinical practice (by including routine patients). However, pragmatic trials may also have drawbacks. The right kind of heterogeneity, for example, can help a study extend its findings to different patients or settings. However the wrong kind of heterogeneity can reduce the assay sensitivity and thus decrease the ability of a study to detect minor treatment effects.<br><br>A variety of studies have attempted to classify pragmatic trials using a variety of definitions and scoring methods. Schwartz and Lellouch1 created a framework to discern between explanation-based studies that confirm a physiological or clinical hypothesis, and pragmatic studies that help inform the selection of appropriate treatments in clinical practice. Their framework comprised nine domains that were scored on a scale of 1-5, with 1 indicating more lucid and 5 indicating more practical. The domains included recruitment, setting up, delivery of intervention, flexible compliance and [https://gm6699.com/home.php?mod=space&uid=3470435 프라그마틱 슬롯 무료] primary analysis.<br><br>The original PRECIS tool3 was based on a similar scale and domains. Koppenaal and colleagues10 developed an adaptation of this assessment dubbed the Pragmascope that was simpler to use in systematic reviews. They discovered that pragmatic systematic reviews had higher average scores across all domains, but lower scores in the primary analysis domain.<br><br>This distinction in the analysis domain that is primary could be due to the fact that the majority of pragmatic trials analyse their data in an intention to treat manner while some explanation trials do not. The overall score for pragmatic systematic reviews was lower when the domains of organization, flexible delivery, and following-up were combined.<br><br>It is crucial to keep in mind that a study that is pragmatic does not mean that a trial is of poor quality. In fact, there is an increasing number of clinical trials which use the word 'pragmatic,' either in their abstract or title (as defined by MEDLINE, but that is neither precise nor sensitive). 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 contents of the articles.<br><br>Conclusions<br><br>In recent times, pragmatic trials are gaining popularity in research as the value of real-world evidence is increasingly recognized. They are randomized studies that compare real-world care alternatives to clinical trials in development. They include patient populations closer to those treated in regular medical care. This approach has the potential to overcome the limitations of observational studies which include the limitations of relying on volunteers and limited availability and coding variability in national registry systems.<br><br>Pragmatic trials offer other advantages, including the ability to draw on existing data sources, and a greater chance of detecting significant differences from traditional trials. However, they may have some limitations that limit their reliability 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. The necessity to recruit people quickly reduces the size of the sample and the impact of many practical trials. Practical trials aren't always equipped with controls to ensure that any observed differences aren't due to biases in the trial.<br><br>The authors of the Pragmatic Free Trial Meta identified RCTs published up to 2022 that self-described themselves as pragmatic. The PRECIS-2 tool was employed to assess the pragmatism of these trials. It covers domains such as eligibility criteria as well as recruitment flexibility and adherence to intervention and follow-up. They discovered that 14 of the trials scored highly or pragmatic practical (i.e. scoring 5 or higher) in one or more of these domains and that the majority of these were single-center.<br><br>Trials with a high pragmatism rating tend to have higher eligibility criteria than traditional RCTs that have specific criteria that aren't likely to be used in clinical practice, and they comprise patients from a wide range of hospitals. The authors argue that these characteristics can help make the pragmatic trials more relevant and useful for daily practice, but they do not necessarily guarantee that a pragmatic trial is free from bias. In addition, the pragmatism that is present in a trial is not a predetermined characteristic and a pragmatic trial that does not contain all the characteristics of a explanatory trial can produce valuable and reliable results.

Revision as of 16:45, 5 January 2025

Pragmatic Free Trial Meta

Pragmatic Free Trial Meta is a free and non-commercial open data platform and infrastructure that supports research on pragmatic trials. It collects and shares cleaned trial data and ratings using PRECIS-2, permitting multiple and varied meta-epidemiological research studies to compare treatment effects estimates across trials that have different levels of pragmatism and other design features.

Background

Pragmatic trials provide evidence from the real world that can be used to make clinical decisions. The term "pragmatic", however, is a word that is often used in contradiction and its definition and evaluation require further clarification. Pragmatic trials are intended to inform clinical practices and policy decisions, not to prove a physiological or clinical hypothesis. A pragmatic trial should try to be as close as possible to actual clinical practices that include recruiting participants, setting up, delivery and implementation of interventions, determining and analysis results, as well as primary analyses. This is a significant difference between explanation-based trials, as defined by Schwartz and Lellouch1, which are designed to confirm a hypothesis in a more thorough way.

Trials that are truly pragmatic must be careful not to blind patients or healthcare professionals, as this may result in bias in estimates of the effects of treatment. Pragmatic trials will also recruit patients from various healthcare settings to ensure that the results can be applied to the real world.

Finally studies that are pragmatic should focus on outcomes that are crucial for patients, such as quality of life or functional recovery. This is especially important when it comes to trials that involve invasive procedures or those with potential serious adverse events. The CRASH trial29 compared a two-page report with an electronic monitoring system for hospitalized patients with chronic cardiac failure. The catheter trial28, on the other hand utilized symptomatic catheter-related urinary tract infection as the primary outcome.

In addition to these features, pragmatic trials should minimize the requirements for data collection and trial procedures to cut down on costs and time commitments. Furthermore, pragmatic trials should seek to make their findings as applicable to clinical practice as is possible by ensuring that their primary analysis follows the intention-to treat approach (as described in CONSORT extensions for pragmatic trials).

Many RCTs that do not meet the requirements for pragmatism but have features that are in opposition to pragmatism, have been published in journals of various types and incorrectly labeled as pragmatic. This could lead to misleading claims of pragmatism, 프라그마틱 환수율 and the use of the term needs to be standardized. The development of a PRECIS-2 tool that offers a standardized objective evaluation of the pragmatic characteristics is the first step.

Methods

In a practical study the aim is to inform policy or clinical decisions by demonstrating how an intervention could be integrated into routine care in real-world contexts. This is distinct from explanation trials that test hypotheses about the causal-effect relationship in idealized situations. Therefore, 프라그마틱 정품확인 슬롯 프라그마틱 무료체험 메타 (visit this web page link) pragmatic trials could have lower internal validity than explanatory trials, and could be more susceptible to bias in their design, conduct, and analysis. Despite these limitations, pragmatic trials may be a valuable source of information for 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 areas of recruitment, organization as well as flexibility in delivery flexibility in adherence, and follow-up scored high. However, the principal outcome and the method for missing data were scored below the practical limit. This suggests that a trial could be designed with effective practical features, yet not damaging the quality.

It is hard to determine the amount of pragmatism within a specific trial because pragmatism does not have a binary characteristic. Some aspects of a research study can be more pragmatic than others. Furthermore, logistical or protocol modifications made during an experiment can alter its score in pragmatism. Koppenaal and colleagues found that 36% of the 89 pragmatic studies were placebo-controlled, or conducted prior to licensing. Most were also single-center. They aren't in line with the standard practice and are only called pragmatic if the sponsors agree that these trials aren't blinded.

Additionally, a typical feature of pragmatic trials is that researchers try to make their results more meaningful by analysing subgroups of the sample. This can lead to unbalanced analyses with less statistical power. This increases the risk of missing or misdetecting differences in the primary outcomes. In the case of the pragmatic studies that were included in this meta-analysis this was a significant problem because the secondary outcomes weren't adjusted for the differences in baseline covariates.

Additionally, pragmatic trials can also have challenges with respect to the gathering and interpretation of safety data. This is because adverse events are typically reported by participants themselves and are susceptible to reporting errors, delays, or coding variations. It is important to improve the accuracy and quality of the outcomes in these trials.

Results

Although the definition of pragmatism doesn't require that all clinical trials are 100% pragmatic There are advantages of including pragmatic elements in trials. These include:

Increasing sensitivity to real-world issues which reduces the size of studies and their costs, and enabling the trial results to be more quickly transferred into real-world clinical practice (by including routine patients). However, pragmatic trials may also have drawbacks. The right kind of heterogeneity, for example, can help a study extend its findings to different patients or settings. However the wrong kind of heterogeneity can reduce the assay sensitivity and thus decrease the ability of a study to detect minor treatment effects.

A variety of studies have attempted to classify pragmatic trials using a variety of definitions and scoring methods. Schwartz and Lellouch1 created a framework to discern between explanation-based studies that confirm a physiological or clinical hypothesis, and pragmatic studies that help inform the selection of appropriate treatments in clinical practice. Their framework comprised nine domains that were scored on a scale of 1-5, with 1 indicating more lucid and 5 indicating more practical. The domains included recruitment, setting up, delivery of intervention, flexible compliance and 프라그마틱 슬롯 무료 primary analysis.

The original PRECIS tool3 was based on a similar scale and domains. Koppenaal and colleagues10 developed an adaptation of this assessment dubbed the Pragmascope that was simpler to use in systematic reviews. They discovered that pragmatic systematic reviews had higher average scores across all domains, but lower scores in the primary analysis domain.

This distinction in the analysis domain that is primary could be due to the fact that the majority of pragmatic trials analyse their data in an intention to treat manner while some explanation trials do not. The overall score for pragmatic systematic reviews was lower when the domains of organization, flexible delivery, and following-up were combined.

It is crucial to keep in mind that a study that is pragmatic does not mean that a trial is of poor quality. In fact, there is an increasing number of clinical trials which use the word 'pragmatic,' either in their abstract or title (as defined by MEDLINE, but that is neither precise nor sensitive). 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 contents of the articles.

Conclusions

In recent times, pragmatic trials are gaining popularity in research as the value of real-world evidence is increasingly recognized. They are randomized studies that compare real-world care alternatives to clinical trials in development. They include patient populations closer to those treated in regular medical care. This approach has the potential to overcome the limitations of observational studies which include the limitations of relying on volunteers and limited availability and coding variability in national registry systems.

Pragmatic trials offer other advantages, including the ability to draw on existing data sources, and a greater chance of detecting significant differences from traditional trials. However, they may have some limitations that limit their reliability 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. The necessity to recruit people quickly reduces the size of the sample and the impact of many practical trials. Practical trials aren't always equipped with controls to ensure that any observed differences aren't due to biases in the trial.

The authors of the Pragmatic Free Trial Meta identified RCTs published up to 2022 that self-described themselves as pragmatic. The PRECIS-2 tool was employed to assess the pragmatism of these trials. It covers domains such as eligibility criteria as well as recruitment flexibility and adherence to intervention and follow-up. They discovered that 14 of the trials scored highly or pragmatic practical (i.e. scoring 5 or higher) in one or more of these domains and that the majority of these were single-center.

Trials with a high pragmatism rating tend to have higher eligibility criteria than traditional RCTs that have specific criteria that aren't likely to be used in clinical practice, and they comprise patients from a wide range of hospitals. The authors argue that these characteristics can help make the pragmatic trials more relevant and useful for daily practice, but they do not necessarily guarantee that a pragmatic trial is free from bias. In addition, the pragmatism that is present in a trial is not a predetermined characteristic and a pragmatic trial that does not contain all the characteristics of a explanatory trial can produce valuable and reliable results.