Inclusion, Sustainability, and Equity at the Heart of a 5.0 Society

Our everyday reality is perceived as more complex, unpredictable, and filled with barriers created by not-so-evident factors that can stifle thought, reflection, and the desire and energy to act. All of this intertwines with the reduction of physical and psychological well-being for many people, encouraging the presence and escalation of situations of vulnerability which are rapidly increasing nowadays. In addition to the more traditional and known ones, such as vulnerabilities connected to the presence of disabilities or diseases, today other forms of vulnerabilities are strongly emerging, such as environmental vulnerabilities or vulnerabilities connected to climate change, ecologic vulnerabilities, financial vulnerabilities, 'health-related' vulnerabilities, digital vulnerabilities, and professional vulnerabilities. Considering this standpoint, in this chapter we will focus to inclusivity, sustainability, social and environmental justice, human rights. Furthermore, we introduce the construct of Society 5.0 that aims to improve the living conditions of everyone and to relatively resolve problems at the micro-, meso-, and macro-social levels.

Colleagues' Work Attitudes towards Employees with Disability

BACKGROUND

The present study investigates the significance of work inclusion in people with a disability and then aims to examine colleagues' attitudes. Considering Stone and Colella's model, we analyzed the colleagues' attitudes and variables related to the disability, such as type of disability and type of presentation of colleagues with disability, and colleague's characteristics, such as gender, educational level, and experience in work with people with disability.

METHOD

We randomly assigned two hundred eighty-six employees to a standard condition (hypothetical colleagues with a disability presented by the impairments labels) or favorable condition (hypothetical colleagues with a disability presented by their past work experiences).

RESULTS

The type of disability and its presentation influence colleagues' attitudes. Besides employees' gender, educational level and experience in work with people with a disability influences the attitudes toward them.

CONCLUSIONS

Implications for practice were discussed.

Inclusive Socialization? The Relationships between Parents' and Their Child's Attitudes toward Students with Disabilities

Promoting social and school inclusion of children with disabilities has been associated with their health-related quality of life. This study aimed to analyze the connection between parents and children's attitudes toward disabilities as one factor contributing to the inclusion and well-being of individuals with disabilities. Three types of disabilities-i.e., attitudes toward a child with a sensory disability (hearing), a child with an intellectual disability (Down syndrome), and a child with problems with aggressiveness and angry outbursts (behavioral problems)-were examined. A sample of 598 White Italian elementary school students (303 boys and 295 girls) aged 6 to 11 years 33tudes toward students with disabilities, rather than each parent's attitude, contributed to a better understanding of the child's attitudes toward students with disabilities. The theoretical and practical implications of these results are discussed.

Adverse Conditions, Psychological Aspects, and Teachers’ Tendency Toward Sustainability and a Less Conservative Future

This study aimed to examine the effect of cognitive priming linked to the COVID-19 pandemic, through state anxiety and personal need for structure, on teachers’ tendency toward sustainability and teachers’ tendency toward a conservative socio-economic vision. We involved a sample of 984 Italian teachers, and by manipulating the saliency of the COVID-19 pandemic, we found that the saliency of the COVID-19 pandemic positively impacted state anxiety and that state anxiety impacted teachers’ tendency toward sustainability both directly and indirectly through the mediational role of the personal need for structure. Finally, we found that state anxiety only indirectly through the personal need for structure impacted teachers’ tendency toward a conservative socio-economic vision.

In the same boat? An online group career counseling with a group of young adults in the time of COVID-19

An online group of career counseling for unemployed young adults during the COVID-19 pandemic was developed. Twelve participants were involved in online group career counseling intervention, based on the Life Design for an inclusive and sustainable future. Results indicated at post-test on increased scores on career adaptability, resilience, future orientation, and propensity to identify inclusive and sustainable actions for the future than pre-test. Overall, the online group career counseling intervention effectively promoted particular aspects of young adults' life design for an inclusive e-sustainable future.

Italian adolescents' understandings of globalization

INTRODUCTION

Having a clear understanding of the concept of globalization can be particularly relevant for adolescents to comprehend how the world functions and to reflect on the way their personal and professional identity and career future might be affected by globalization. Thus, this mixed design study aimed at examining Northeastern Italian adolescents' thinking about globalization and at exploring the potential role of education (the type of school) in conceptualizing globalization.

METHODS

A total of 163 Italian adolescents (42.3% boys and 57.5% girls) aged 16-19 years, attending a scientific lyceum or a commercial, technological, or professional high school participated in the study. Participants were invited to explain the concept of globalization. Their answers were analyzed using a thematic analysis procedure.

RESULTS

& Conclusions:. The analyses revealed adolescents' limited and inaccurate understandings of globalization, with almost exclusive emphasis on the positive aspects of globalization, and without a critical understanding of its consequences. Moreover, no differences related to their educational experience (the type of school they attended) or socio-economic status emerged when reporting their understanding of globalization. The results suggested the relevance of a training process for the promotion of critical thinking, especially in the field of career guidance.

The Role of Career Adaptability, the Tendency to Consider Systemic Challenges to Attain a Sustainable Development, and Hope to Improve Investments in Higher Education

Based on the life design paradigm and career construction adaptation model and on recent directions from the perspective of sustainable and inclusive career guidance, the study aimed at examining the relationship between career adaptability, the tendency to consider systemic challenges to attain sustainable development, and state personal and social hope and their role on the tendency to invest in higher education. The analyses carried out involving 416 Italian high school students found that career adaptability and the tendency to consider systemic challenges in order to attain sustainable development were directly and indirectly, through state personal and social hope, related to the tendency to invest in higher education. The results obtained allowed to provide new contributions to extend results previously described by the life design approach in career development issues and provided useful suggestions for preventive career interventions.

Stories of courage in a group of adults with Substance Use Disorder

The treatment for drug addiction is considered a difficult path for the most of patients. As matter of fact, individuals with Substance Use Disorder (SUD) experience numerous challenges before, during and after the treatment (e.g. tackling an unpredictable, uncertain and paradoxically negative future, tackling the anxiety and anticipatory fear of physical pain associated with abstinence; decide to go beyond self-justification and self-deception). Courage could be considered a positive and functional resource to help people with SUD to face challenges and difficulties related to treatment. In connection therewith, the aim of this study was to examine, using an embedded mix method analysis, the personal stories of courage of 80 individuals with SUD in order to identify the themes and types of courage used in their life. The analysis carried out showed that individuals with SUD reported more frequently stories of courage related to their SUD condition respect to other life situation. Moreover, the quantitative analysis showed that participants used more frequently psychological courage respect to moral and physical courage when these stories were referred to their SUD condition then other life situations.

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The analysis carried out showed that individuals with SUD reported more frequently stories of courage related to their SUD condition respect to other life situation.

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The analysis carried out showed that participants used more frequently psychological courage respect to moral and physical courage

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The analysis carried out showed that participants used more frequently psychological courage when these stories were referred to their SUD condition then other life situations

A Comparison on the Use of LSA and LDA in Psychology Analysis on “Courage” Definitions

In the present work Latent Semantic Analysis of textual data was applied on texts related to courage, in order to compare and contrast results and evaluate the opportunity of integrating different data sets. To better understand the definition of courage in Italian context, 1199 participants were involved in the present study and was asked to answer to the following question “Courage is[Formula: see text]”. The participants’ definitions of courage were analyzed with the Latent Semantic Analysis (LSA), and Latent Dirichlet Allocation (LDA), in order to study the fundamental concepts arising from the population. An analogous comparison with Twitter posts has been also carried out to analyze if the public opinion emerging from social media provides a challenging and rich context to explore computational models of natural language.

My Career Story

My career story (MCS) comprises a self-guided autobiographical workbook designed to simulate career construction counseling. The MCS contains a series of questions from the Career Construction Interview to elicit a life-career story and reveal a life theme that are then related to a current career problem indicated by the workbook user. Reflecting on the answers to the questions aims to promote key life-design goals of adaptability, narratability, intentionality, and action. After describing its development and use, a case illustration and initial preliminary validity study of the MCS is presented. Latent semantic analysis, a method for determining meaning similarity of words and passages within bodies of text, indicated a mean agreement level of .81 between MCS life portraits constructed by participants ( N =10) and those constructed for the participants by experts in career construction counseling. The MCS shows some initial promise for self-guided career intervention to increase self-reflection and ability to tell and enact one’s career story. Future research is needed to support the validity of the MCS workbook.

Career Adaptability, Hope, Optimism, and Life Satisfaction in Italian and Swiss Adolescents

The consequences of economic crisis are different from one European context to the other. Based on life design (LD) approach, the present study focused on two variables—career adaptability and a positive orientation toward future (hope and optimism)—relevant to coping with the current work context and their role in affecting life satisfaction. A partial mediational model between career adaptability and life satisfaction, through a positive orientation toward future (hope and optimism), was tested across Italian and Swiss countries. Seven hundred twenty-six Italian and 533 Swiss young people between the ages of 12 and 16 years were involved. Results provided support for the model in the Italian group and a full mediation model for the Swiss one. The data suggest that the context may have an effect on how career adaptability has an impact on general life satisfaction. These results have important implications for practice and underscore the need to support adolescents in their LD process.

Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center

Background

Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation.

Methods

We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch’s t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP.

Results

296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders.

Conclusions

A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-016-0947-0) contains supplementary material, which is available to authorized users.

Design My Future

This article reports the development and psychometric requisites of Design My Future, an instrument assessing future orientation and resilience. Three different studies involving Italian preadolescents were conducted. With the first, the items were developed and the factor structure verified; the second confirmed instrument’s multidimensional structure and evaluated its discriminant validity. The third study was conducted to verify the invariance of factorial structure across gender. Results provide strong psychometric support for Design My Future as a valid measure for analyzing middle school students’ thoughts about their future orientation and resilience and for career education and career counseling activities.

Seniors' preferences for cancer screening and medication use based on absolute risk reduction

BACKGROUND

This study was conducted to determine the influence of patient perceptions of absolute risk on choices for cancer screening and use of medications to prevent heart attack, stroke, and hip fracture.

METHODS

At the end of routine office visits, we surveyed all eligible consecutive patients who visited four geriatricians in a Denver practice between November 8, 1993, and February 9, 1994.

RESULTS

We saw a total of 675 outpatients during the study period and completed the interview with 409 patients (75% female, mean age 81, 78% Caucasian). We found a strong correlation between (i) increased probability of detecting cancer and greater preference for cancer screening tests (p <.001) and (ii) increased probability of preventing disease (heart attack, stroke, or hip fracture) and greater preference for preventive medication (p <.0001). There was notable variability in seniors' preferences for a given therapy at each absolute risk threshold. For example, 15% of seniors did not think that highly effective, inexpensive medications to prevent heart attacks were worthwhile for them. At the other end of the spectrum, 22% of seniors felt that low-yield, costly medications to prevent heart attacks were worthwhile.

CONCLUSIONS

Seniors readily understand the probability of benefit expressed in terms of absolute risk reduction. Furthermore, probability of benefit strongly influences seniors' preferences for cancer screening and preventive medication use. Finally, there is variety in the thresholds of prevention at which individuals are willing to accept preventive treatment. The probability of benefit is an essential and useful element for seniors to make informed decisions about routine health services.

Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies

Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P=.025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%]; P=.0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs. only 24% of those due to P. aeruginosa; P=.002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score > or =4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta-lactams, and ciprofloxacin. Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.

In vitro activity of fluconazole and voriconazole against isolates of Candida albicans from patients with haematological malignancies

We evaluated the activity of fluconazole and voriconazole against 83 Candida albicans isolates from patients with haematological malignancies, comparing the NCCLS microdilution method (M27-A) with a modified method with RPMI-2% glucose and MIC endpoint at 50% inhibition. Both drugs were highly active regardless of the year, the site of isolation of the strain and the test method employed. In several strains isolated during the last few years, trailing growth leading to difficulty in interpretation of the endpoint of the test has been observed for both drugs by the NCCLS method, but not by the modified method. In our experience, azole resistance of C. albicans is still not a clinical problem, however, the emerging phenomenon of the 'trailing effect' by the NCCLS method, even though resolvable by technical modifications, seems at least to indicate a reduction in the inhibitory activity of the azoles.

Elderly patients' preferences for long-term life support

OBJECTIVE

To study elderly patients' preferences regarding mechanical ventilation and tube feeding and to compare their preferences for short-term use with their preferences for long-term use of these life support interventions.

DESIGN

Interviews with patients by clinicians during routine office visits.

SETTING

Hospital-based, primary care geriatrics clinic in downtown Denver, Colo.

PATIENTS

Two hundred eighty-seven elderly persons (mean age, 77 years; range, 60-99 years).

MAIN OUTCOME MEASURES

Preferences to use or withhold: (1) short-term mechanical ventilation; (2) long-term mechanical ventilation; (3) short-term tube feeding; and (4) long-term tube feeding.

RESULTS

Of the total sample, 253 patients (88%) would prefer short-term mechanical ventilation if the chance of recovering was reasonably good but only 11 (3.5%) would prefer long-term mechanical ventilation. One hundred eighty-nine (65%) would prefer short-term tube feeding, but only 13 (4.5%) would prefer long-term tube feeding in the setting of significant cognitive impairment.

CONCLUSIONS

Most elderly persons opt for short-term mechanical ventilation or tube feeding if the chance of recovering is reasonably good. Only a small minority would opt for long-term mechanical ventilation or tube feeding.

The influence of perioperative myocardial infarction on long-term prognosis following elective vascular surgery

STUDY OBJECTIVE

The present study was performed to determine the influence of a perioperative myocardial infarction on long-term mortality in patients who have undergone elective vascular surgery.

STUDY DESIGN

This was a 4-year follow-up of patients who had undergone elective vascular procedures at a Veterans Affairs Medical Center. Between January 1989 and December 1990, 115 consecutive patients underwent surgery for either an expanding abdominal aortic aneurysm (AAA) (38%) or for pain in the lower extremities (62%).

RESULTS

Vital status at 4 years postsurgery was determined for all patients. Thirty-day postoperative mortality was 3%, while estimates at 1, 2, 3, and 4 years were 19%, 26%, 35%, and 39%, respectively. Of the 45 patients who died within 4 years following surgery, the major causes of death were cardiac (40%), cancer (18%), cerebrovascular (13%), and peripheral vascular disease (11%). Univariate predictors of 1-year mortality on preoperative evaluation were an abnormal ECG, moderate or greater sized exercise thallium defect and left ventricular ejection fraction < or =40%, and a perioperative myocardial infarction. Univariate predictors of 4-year mortality were non-AAA surgery and diabetes mellitus. Perioperative myocardial infarction was a marginally significant independent predictor of 1-year mortality (p=0.06), while the need for non-AAA surgery was a strong independent predictor at 4 years.

CONCLUSIONS

Cardiac mortality is the major cause of late death among patients undergoing elective vascular surgery. Although preoperative indicators of symptomatic coronary artery disease and nonfatal perioperative myocardial infarction identified those individuals at increased mortality in the first postoperative year, the extent of vascular disease at presentation may be a more important determinant of long-term survival. A randomized trial in such patients is needed to assess the best strategy for treating patients with coexistent coronary artery and vascular diseases.

The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation

BACKGROUND

Studies suggest that a majority of elderly patients would want to undergo cardiopulmonary resuscitation (CPR) if they had a cardiac arrest. Yet few studies have examined their preferences after clinicians have informed them about the outcomes of CPR.

METHODS

To study older patients' preferences regarding CPR, we interviewed as many ambulatory patients as possible in one geriatrics practice in Denver from August 1, 1991, through July 31, 1992.

RESULTS

A total of 371 patients at least 60 years of age were eligible; 287 completed the interview (mean age, 77 years; range, 60 to 99). When asked about their wishes if they had cardiac arrest during an acute illness, 41 percent opted for CPR before learning the probability of survival to discharge. After learning the probability of survival (10 to 17 percent), 22 percent opted for CPR. Only 6 percent of patients 86 years of age or older opted for CPR under these conditions. When asked about a chronic illness in which the life expectancy was less than one year, 11 percent of the 287 patients opted for CPR before learning the probability of survival to discharge. After learning the probability of survival (0 to 5 percent), 5 percent said they would want CPR.

CONCLUSIONS

Older patients readily understand prognostic information, which influences their preferences with respect to CPR. Most do not want to undergo CPR once a clinician explains the probability of survival after the procedure.

Lumbar root compression by a gas-containing cyst in the extradural space. Case report

The case report describes a patient with acute sciatica of three months duration, resulting from lumbar root compression by a gas containing cyst in the extradura space. This condition is related to vacuum disc phenomenon, because the gas appears to have originated from within the adjacent disc space.

Species identification and detection of oxacillin resistance in coagulase-negative Staphylococcus blood isolates from neutropenic patients

One hundred coagulase-negative staphylococcal isolates from septicemic neutropenic patients with hematologic malignancies were identified to a species level by means of the French API STAPH strip system and by the Automicrobic VITEK system. According to these two methods, which concurred in 95% of cases, S. epidermidis (80-82% of the isolates) was the most frequently identified species, followed by S. haemolyticus (6-7% of the isolates). The susceptibility to oxacillin was also evaluated by macrodilution MIC, Automicrobic VITEK system and agar screen, and 76, 78 and 79 of the 100 isolates, respectively, were found resistant to this antibiotic. All oxacillin-resistant isolates according to Automicrobic VITEK were confirmed resistant by agar screen. A 48h incubation was required to determine oxacillin resistance in 11 of 79 isolates with agar screen and in 10 of 76 isolates with macrodilution MIC. Automicrobic VITEK system may represent a useful method for rapid identification to a species level and early recognition of oxacillin resistance in coagulase-negative staphylococci.

Saphenous vein in situ bypass

Revascularization of the ischemic diabetic extremity presents a significant diagnostic and technical challenge. The in situ saphenous bypass provides a conduit that allows revascularization to arteries at the ankle and proximal foot. Evaluation of the distal circulation, the adequacy of the saphenous vein, and routine follow-up after bypass, along with the operative procedure, are described. Balloon inflow occlusion arteriography, duplex mapping of the saphenous vein, operative technique, and follow-up protocol are discussed.

Catheter-related right-sided endocarditis in bone marrow transplant recipients

Bone marrow transplant recipients are at increased risk of severe central venous catheter-related septicemias that may be complicated by endocardial infection. In view of this, we prospectively evaluated 141 consecutive patients receiving allogeneic or autologous bone marrow infusion. Seven (5%) of 141 patients developed eight episodes of a clinical syndrome compatible with catheter-related right-sided infective endocarditis; this diagnosis was confirmed at autopsy in two patients who died. Staphylococcus epidermidis was the most frequent isolate (four cases). Other offending pathogens were, in one case each, Enterococcus faecalis, Corynebacterium jeikeium, Pseudomonas alcaligenes, and Achromobacter xylosoxidans plus Candida species. Three- to 7-week courses of antibacterial therapy were associated with a favorable outcome in six of the seven cases. Infective endocarditis may be a complication of the use of central venous catheters and should be actively sought in septicemic bone marrow transplant recipients.

Candida colonization and systemic infection in neutropenic patients. A retrospective study

The results of surveillance cultures in 424 neutropenic patients with hematologic malignancies were analyzed to evaluate the relationship between colonization and infection by Candida species. Eighteen (32%) of 56 patients with multiple noncontiguous colonized sites developed proven (13 cases) or probable (five cases) systemic candidiasis, versus two patients with proven candidiasis (1.2%) of 170 with one colonized site (P less than 0.00000001), and one patient with proven candidiasis (0.5%) of 198 without any evidence of Candida colonization (P less than 0.00000001). Twenty-two patients with multiple colonized sites who developed a febrile episode resistant to antibiotics were treated with empiric amphotericin B. Nine of 11 given empiric amphotericin B within day 6 survived versus three of 11 receiving antifungal therapy after day 6 (P = 0.014). The above data seem to justify further prospective studies on Candida colonization as indication to early antifungal therapy in febrile neutropenic patients.

Pefloxacin in the treatment of gram-negative infections in patients with hematologic diseases

Quinolones are active against gram-negative strains. They are commonly used for selective intestinal decontamination in patients with hematologic malignancies and prolonged neutropenia due to chemotherapy. In our open study we used pefloxacin, a new fluoroquinolone, for the treatment of fifteen documented gram-negative infections in hematologic patients. Thirteen patients were mildly neutropenic, and in nine cases they received oral treatment as non-hospitalized patients. Cure was achieved in fourteen cases, with microbiological eradication of the offending pathogen.

Treatment of febrile episodes in neutropenic leukemic patients with the antibiotic combinations piperacillin or ceftazidime plus amikacin: results of a randomized study

Seventy-six consecutive neutropenic patients with hematologic malignancies, admitted to the "Department of Hematology" of Rome between March and September 1986, were randomly assigned to receive either piperacillin (300 mg/kg in four divided doses) or ceftazidime (100 mg/kg in four divided doses) plus amikacin (15 mg/kg in two divided doses) whenever they developed a febrile episode (temperature greater than 38 degrees C thrice over 12 hours, not related to drugs or transfusions, or else temperature greater than 38.5 degrees C). After 72 hours of antibiotic therapy, in case of persistent fever, piperacillin or ceftazidime was added to the ceftazidime + amikacin or piperacillin + amikacin combination, respectively. The antibiotic treatment was, however, modified according to in vitro susceptibility if a positive culture was present. Success without regimen modification was observed in both antibiotic combinations in 52.6% of cases. Considering the empiric cross of antibiotics, the response rate reached 78%. Neither toxicity nor side effects were observed in the reported groups. Considering blood isolates, we observed a greater incidence of gram-positive organisms compared with gram-negatives (28 cases vs 5 cases, 84.7% vs 15.3% respectively). Fungal infections were documented in four cases, two in each group. Even though no statistical difference was found between the two groups as far as patients not responding to the first antibiotic combination are concerned, piperacillin seems to have had more efficacy (twelve patients responding to the addition of piperacillin vs seven patients responding to the addition of ceftazidime). Piperacillin + amikacin seems to be as effective as ceftazidime + amikacin in the empirical therapy of febrile episodes in neutropenic patients.