Safety And Necessity Of Thermal Esophageal Probes During Radiofrequency Ablation For The Treatment Of Atrial Fibrillation.

BACKGROUND: Radiofrequency ablation is extensively used to achieve pulmonary veins isolation for the cure of atrial fibrillation. Luminal esophageal temperature can be monitored by means of suitable probes to prevent the onset of lesions. OBJECTIVE: To compute the thermal field generated by the ablation, to investigate the interaction between the electromagnetic field and the probe sensors, and to provide a safe interpretation of the temperature detected by the probe, supported by clinical data. METHODS: A mathematical model is formulated and the thermal and electromagnetic fields are computed. Experiments have been performed to assess the the influence of the ablator on the probe sensors. Clinical data have been collected during RF isolation of pulmonary veins in patients with atrial fibrillation. RESULTS: The direct interaction between the radiofrequency source and the probe sensors is found to be negligible. Numerical simulations show that the outer esophageal wall can be much warmer than the lumen. Theoretical heating curves are compared with the clinical data selecting the maximal slope as the reference quantity. The clinical values range between 0.01°C/s and 0.15°C/s agree with the computed predictions and demonstrate that reducing the esophagus-atrium distance by 1mm causes a slope increase of 0.06°C/s. CONCLUSION: The use of esophageal thermal probes is absolutely safe and necessary in order to prevent the occurrence of thermal lesions. The model is reliable, and describes effectively the generated thermal field. The external esophageal temperature can be considerably higher than the luminal one.

Budgetary participation and performance: The mediating effects of medical managers' job engagement and self-efficacy.

Professional hybrids in healthcare have attracted a great deal of policy, managerial, and research interest. However, the current literature offers little guidance on (i) how hybrid roles can be supported by the hospital organization they work for as well as (ii) the cognitive and behavioral driving forces underpinning medical managers' managerial work that determine how they inhabit their roles and consequently meet the standards of performance that contribute to organizational effectiveness. Building on engagement theory and social cognitive theory and using data collected from clinical managers working in a large Italian public hospital, the current study focuses on the mediating role of psychological variables associated with the managerial role of medical managers, namely managerial job engagement and managerial self-efficacy, in the budgetary participation-job performance link. The results suggest that the information gained by participating in budgeting impact medical managers' thoughts and feelings about their managerial role and these, in turn, motivate different aspects of their performance. The findings are discussed in relation to theory and their managerial and policy implications.