During the analysis of the current system of care, the oblast leaders, facility head physicians, and representatives of the
facility-level teams reviewed the evidence-based literature in collaboration with Russian and U.S.-based clinical content
experts. These individuals began to familiarize themselves with the state-of-the-art, evidence-based medicine for management of PIH from literature and information provided by the U.S. and Russian clinical experts. The international medical community has seen several significant changes in the understanding of the pathology and treatment of PIH over the last 40 years, and many of these changes have not yet been disseminated widely in Russia. Physicians and specialists in Tver, while eager to keep up with clinical advances, had limited access to state-ofthe-art clinical information,reference materials, and articles due to problems of availability, language, and cost.