So-Hee Park

Purpose: This study aimed to develop a wearable-integrated mobile application prototype for preterm birth risk prevention and to preliminarily evaluate the appropriateness of its content structure and user satisfaction among pregnant women.Methods: A pilot user evaluation study was conducted with 17 community-dwelling pregnant women between 20 and 37 weeks of gestation. Participants used a prototype mobile application integrated with a wearable smart band, Mi Band 7. The application included content on obstetric characteristics, pregnancy stress, preterm birth risk assessment, and QuiPP (quantification of uterine contractions in preterm prediction)-related information. The smart band was used to collect biometric data, with heart rate data included in the present analysis. Preterm birth risk and pregnancy stress were measured using validated short-form scales. Data were analyzed using descriptive statistics and Pearson correlation coefficients.Results: The mean scores for preterm birth risk and pregnancy stress were 10.06±5.02 and 21.35±5.24, respectively. Preterm birth risk was significantly associated with pregnancy stress, r=0.579, p=0.015, supporting the inclusion of pregnancy stress in the application content. No significant associations were found between actual preterm birth and preterm birth risk or pregnancy stress. User satisfaction scores were 3.57±1.27 for the application content and 4.15±0.80 for the smart band.Conclusion: The wearable-integrated mobile application prototype demonstrated preliminary acceptability as an eHealth-based self-monitoring tool for preterm birth risk prevention. Further iterative and longitudinal studies with larger samples are needed to refine the application, validate its predictive potential, and expand it into an artificial intelligence-based personalized nursing intervention.

Background: Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes. Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention—such as mobile apps, web-based programs, or telemedicine—intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung–Knapp–Sidik–Jonkman method and reported as standardized mean differences. Results: A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference –0.45, 95% CI –0.59 to –0.32; 95% prediction interval –0.78 to –0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials. Conclusions: This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should directly compare single versus combined strategies and evaluate implementation across diverse populations and care settings.

Background: The effectiveness of electronic medical record-based alert systems, response protocols for sepsis diagnosis, and treatment in hospitalized patients remains unclear. This study aimed to determine whether the introduction of an electronic medical record-based sepsis response protocol (SRP) along with a 24/7 operating rapid response system affects the prognosis for patients with hospital-onset sepsis.Methods: In August 2022, a SRP based on the National Early Warning Score was implemented in the electronic medical record system at Asan Medical Center. We retrospectively analyzed patients screened by the detection system for 1 year after the SRP implementation. Patients of the first 6 months (preliminary group) and those of the second 6 months (SRP group) were matched 1:1 based on propensity scores. The primary outcome was 30-day mortality.Results: Of the 608 hospitalized patients screened by the system, 176 were assigned to each group after 1:1 propensity score matching. Patients in the SRP group were significantly more likely to receive blood cultures (58.5%) compared with the preliminary group (45.5%) (P=0.019). The SRP group showed a lower 30-day mortality risk (hazard ratio, 0.56; 95% CI, 0.36–0.86; P=0.017) compared to the preliminary group. A restricted cubic spline curve showed that SRP survival benefit began to manifest after the first 4 months (P=0.036).Conclusions: Alongside an existing rapid response system, the National Early Warning Score-based SRP in the electronic medical record reduced mortality for hospital-onset sepsis within 1 year.

BACKGROUND Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention—such as mobile apps, web-based programs, or telemedicine—intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung–Knapp–Sidik–Jonkman method and reported as standardized mean differences. RESULTS A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference –0.45, 95% CI –0.59 to –0.32; 95% prediction interval –0.78 to –0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials. CONCLUSIONS This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should directly compare single versus combined strategies and evaluate implementation across diverse populations and care settings. CLINICALTRIAL