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Summary Objective: To characterize the opinions, emotions, and actions taken by patients who viewed their electronic problem list via an online personal health record (PHR). Materials and Methods: An online survey of patients who viewed their problem lists, as maintained by their healthcare provider, in a web-based PHR linked to an electronic health record for the first time. Results: A total 3,649 patients completed the survey, yielding a response rate of 42.1%. Patient attitudes towards the problem list function were positive overall, with 90.4% rating it at least somewhat useful and 86.7% reporting they would probably or definitely use it again. Nearly half (45.6%) of patients identified at least one major or minor problem missing from their list. After viewing the list, 56.1% of patients reported taking at least one action in response, with 32.4% of patients reporting that they researched a condition on the Internet, 18.3% reported that they contacted their healthcare provider and 16.7% reported changing or planning to change a health behavior (patients could report multiple actions). 64.7% of patients reported feeling at least somewhat happy while viewing their problem list, though others reported feeling sad (30.4%), worried (35.7%) or scared (23.8%) (patients could report multiple emotions). A smaller number of patients reported feeling angry (16.6%) or ashamed (14.3%). Patients who experienced an emotional response were more likely to take action. Conclusion: Overall, patients found the ability to view their problem lists very useful and took action in response to the information. However, some had negative emotions. More research is needed into optimal strategies for supporting patients receiving this information. Citation: Wright A, Feblowitz J, Maloney FL, Henkin S, Ramelson H, Feltman J, Bates DW. Increasing patient engagement: Patients’ responses to viewing problem lists online. Appl Clin Inf 2014; 5: 930–942http://dx.doi.org/10.4338/ACI-2014-07-RA-0057

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Baldwin, Cournand, and Richards (1) have described the following classification of pulmonary insufficiency:1. Ventilatory a. Restrictive, viz., pulmonary fibrosis, kyphoscoliosis. b. Obstructive, viz., pulmonary emphysema. 2. Alveolar-respiratory a. Distributive, viz., pulmonary emphysema. b. Diffusional, viz., pulmonary scleroderma.The two cases to be presented demonstrate ventilatory insufficiency of the restrictive type due ,in the first instance to primary neuromuscular dysfunction and in the second to chronic pleural disease with resulting calcification and restriction of the underlying parenchyma and diaphragm. Of particular interest was the development of congestive heart failure in both of these patients. These On admission the patient appeared chronically ill without respiratory distress but with cyanosis of the lips, nailbeds, and skin. There was a marked dysarthria. His chest cage moved very little on normal respiration but he had good expansion with effort and could clear most of his cyanosis with forced breathing. The heart was not remarkable on examination except for a markedly accentuated P2. The lungs were clear to percussion and auscultation. The abdominal examination was within normal limits. Neurological examination revealed the right pupil to be larger than the left, and both reacted sluggishly to light and accommodation. The external ocular movements were normal but he had diplopia in all fields. The disc margins were slightly blurred nasally and he had small hemorrhages about the discs. His gait was normal. There was weakness of the jaw, right facial, palatal, tongue, neck, and shoulder muscles with fasciculations noted in these groups. In addition there was atrophy of the masseters, platysmae, tongue, neck and shoulder muscles. There were a few fasciculations of the triceps muscles but no weakness or atrophy. The deep tendon reflexes of the arms were two to three plus bilaterally and there was greater finger stretch on the left than on the right. The abdominal reflexes were diminished bilaterally. There was no atrophy or weakness of the legs and the sensory examination was normal.Laboratory examinations including complete blood count, urine analysis, blood chemistries, spinal fluid, serology, chest X-ray, skull plates, and electrocardiographs were all within normal limits.The patient's neurological status remained unchanged while under observation and adequate nutrition was maintained with tube feeding. Two months after admission a medical consultation was requested because of increasing cyanosis. At this time marked cyanosis was observed without respiratory distress. Expansion of the chest cage during ordinary breathing was minimal but with forced inspiration he was capable of a three inch chest expansion. The lungs were clear and examination of the heart was unremarkable except for an accentuated second pulmonic sound. Abdominal examination was negative. There was no peripheral edema or venous engorgement. The red blood count was 6.75 million with a hemoglobin of 19.4 grams and a hemat...

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