<International Circulation>:Regarding implementation， if there is an evidence rating of ‘A’ and one with a rating of ‘B’ and ‘C’， and so on， how much does it effect implementation?  For instance， if a study had an evidence rating of ‘A’ and there is something unrelated， a category of treatment that has evidence level ‘B’， but there is no other recommendations， how does this effect the doctor implementing this recommendation?

　　《国际循环》：考虑到原则的执行，如果有的文献依据被评为A，另一个则评为B和C等等，它会对原则的执行产生多大的影响？比如，如果一项研究的依据的等级为A，且有些不相关的治疗方法则被评为B，除此多外再无其它建议。那么，医生执行该项建议的效果会如何？
　　Prof. Oparil:  We don’t know how all the users will get into this and focus on the level of recommendation.  It will probably be reflected in the wording of the recommendations with words such as “you must do …” or “you should do …” with the final draft of the guidelines being just a short， few page document.  The wording will be very important because， apart from doctors’ vanishing free will due to insurers refusing to pay when recommendations are not followed， the interpretation and implementation are directly connected to the words we use.  The way the whole thing is disseminated is important， which has a working group working on that specifically.

　　Oparil教授：我们不知道所有的执行者将会如何采纳并关注这个建议的等级。在可能仅仅是几页文件的指导原则的最终草案中，可能会反映一些诸如建议的措辞：“你必须……”或“你应该……”。这些措辞是非常重要的，因为若未遵照指导原则执行，保险公司将拒绝支付治疗费用。这些解释和执行措施直接关系到我们使用的措词。整个指导原则的传播方式是非常重要的，有一个工作小组是专门负责这项工作。

　　<International Circulation>: You cannot talk about your evidence-based strategies for implementation， can you?

　　《国际循环》：您能否谈谈您的循证医学执行策略？
　　Prof. Oparil: No.  One reason is because I don’t know them.  Another is that this project is a tremendous amount of working.  Our committee as a whole has a 90 minute teleconference weekly every Thursday and the executive committee， made up of one of the people from a contractor doing literature searches plus two more people from the other contractor who weighs the evidence， in addition to the two co-chairpersons and an NHLBI representative.  We meet for a teleconference for one hour every Monday， which is 2.5 hours each week plus other preparation time， and we haven’t even written anything yet.  This has been going on for a long time.  I am not doing anything the implementation group would do.  There are independent groups responsible for lifestyle issues， risk assessment， and implementation.  Implementation is a big operation， with their own techniques of getting people to follow the guidelines as written.  It used to be that the pharmaceutical companies would sponsor doctors to give talks and information would get spread that way.  That isn’t used anymore due to restrictions and conflicts of interest.  That used to be a quick way for doctors to learn things.  Very few physicians want to spend all day in their office sitting then to go home and study something online that they have already been working with.  The dissemination is going to be a challenge.  The extent that we get managed care， whether by Kaiser， the VA， or the federal government， and then it will become easier because pay is tied to doing certain things， treat a particular way， or get to a certain goal.  This system is used in the UK and works well.

　　Oparil教授：首先，我们不知道；其次是该项目的工作量非常大。我们委员会每周四都会召开整整90分钟的电话会议，然后由一名负责文献检索的负责人和2名负责评价证据的负责人以及2名副主席和NHLBI代表组成执行委员会。每周一，我们召开1小时的电话会议；加上其它准备时间，每周需要花费2.5小时，而且我们还没有撰写任何材料。这种状态已经持续很长一段时间。我未参与任何执行小组的工作。有个独立的小组专门负责生活方式内容、风险评估和策略执行。执行策略，即通过专门的方式让人们遵守既定的指导原则，这是个浩大的工程。通常是由制药公司赞助医生开展会议，并以这种方式来传播信息。这不存在任何限制和利益冲突，曾经这种途径对是医生的一个快捷的学习方式。极少数医生会花费整天时间待在办公室，然后回家上网学习并研究已采纳的策略。信息传播是一个挑战。我们所制定的指导原则，无论是皇帝、费吉尼亚州或联邦政府，都可将其应用变得更容易，因为金钱可以办妥很多事情，采取特殊的方式或达到既定的目标。这个体系在英国得到行之有效的运行。