Effect of aspirin on prostaglandin E2 and leukotriene B4 production in human colonic mucosa from cancer patients

Elderly persons typically show diminished immune responsiveness to influenza vaccination. Chiron Vaccines has developed a novel oil-in-water adjuvant emulsion, MF59, to enhance vaccine immunogenicity without compromising safety and tolerability. MF59 was shown to augment influenza vaccine immunogenicity in senescent mice. Subsequently, eight similarly designed, randomized, controlled clinical trials of a subunit influenza vaccine combined with MF59 were conducted between 1992 and 1995 in 1807 elderly volunteers (> or = 65 years old). Mild, transient, injection-site reactions were increased with MF59, but systemic reactions generally were not. For two of the three vaccine antigens (B and A/H3N2), postimmunization haemagglutinin inhibition geometric mean titres were statistically significantly higher with MF59. During influenza season, fewer deaths occurred among MF59 recipients. This development programme demonstrates how an adjuvant that stimulates effectors associated with immunosenescence can improve the performance of an existing vaccine in elderly persons.     

The impact and cost of influenza in the elderly

BACKGROUND: Traditional methods of measuring the impact and cost of influenza virus have focused on epidemic years and morbidity and mortality due to pneumonia and influenza. METHODS: Annualized age-sex-race adjusted rates of hospitalization for pneumonia and influenza and other diagnoses among elderly Medicare beneficiaries during the epidemic influenza season of 1989 to 1990 and the nonepidemic season of 1990 to 1991 were compared with an interim period in 1990 without influenza virus circulation. RESULTS: The rates of hospitalization for pneumonia and influenza, acute bronchitis, chronic respiratory disease, and congestive heart failure were significantly greater during each influenza period compared with the interim period. The highest rates were found in the epidemic season of 1989 to 1990. The amount reimbursed by Medicare to hospitals to 1990. The amount reimbursed by Medicare to hospitals for the treatment of excess hospitalizations during periods of influenza activity was more than $1 billion in 1989 to 1990 and almost $750 million in 1990 to 1991. CONCLUSIONS: Measures of the impact and cost of influenza in elderly Americans should include all of the diagnoses listed above and should recognize that the impact of influenza virus is significant even in nonepidemic years. There are great opportunities for cost savings if effective control programs are implemented.     

Clinical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers

To investigate the clinical and serological responses to an inactivated influenza vaccine (split-virion A/Singapore/6/86-like strains H1N1 (15 ug HA), A/Beijing/353/89-like H3N2 (15 ug HA) and B/Yamagata/16/88-like strain (15 ug HA): MFV-JECT, Merieux, UK) in persons with HIV infection, diabetes, obstructive lung diseases, elderly adults and healthy volunteers. Forty-nine HIV-infected persons received 2 doses of the vaccine at one-month intervals; 34 healthy volunteers, 30 elderly persons, 29 with insulin and non-insulin diabetes and 14 with obstructive airways diseases were vaccinated with one single dose between October 1992 to January 1993. Serological testing of antibody responses was done using haemagglutination assay. Beta2-microglobulin in HIV-infected persons was measured using radioimmunodiffusion between 1st and 2nd dose. Fructosamine levels in diabetic persons were assessed for diabetic control and peak expiratory flow rate (PEFR) was self monitored in persons with lung diseases. All groups apart from the elderly filled in a symptom score chart for the first 5 days following vaccination. A 4-fold rise in titre equal to or more than 1:64 to all the 3 antigens occurred in 20 (58.8%) of healthy volunteers compared with 13 (44.8%) diabetics, 5 (35.7%) with lung diseases, 10 (33.3%) elderly and 13 (26.5%) with HIV infection. A significant correlation of serological response to number of CD4 count in persons with HIV infection was noted (H1N1 P=0.0013, H3N2 P=0.025, BYAM P=0.0018). Mean beta2-microglobulin levels did not change significantly post 1st and 2nd vaccination. Mean fructosamine level did not change significantly. There was no significant change in PEFR. The vaccine was well tolerated. Persons with HIV infection and low CD4 count do not serologically respond well to influenza vaccine even with 2 doses compared to the other 4 groups. The other 4 groups had adequate protective serologic responses. The vaccine was well tolerated in all groups.     

Characteristic of humoral response of elderly to inactivated influenza vaccine

Eighty persons immunized with inactivated influenza vaccine in 1990-1991 epidemic season were examined. Serological tests: hemagglutination inhibition (HI), lectin neuraminidase (LN) and Western blot were performed with serum specimens taken before and 3-4 weeks after vaccination. Distribution of anti-influenza antibodies in the subclass was also examined. The results revealed humoral response to vaccine strains of influenza virus and also to strains caused infections in the past.     

Further characterization of stimulus interaction of cat carotid chemoreceptors

Cellular as well as humoral immune reactivity were studied in healthy young (< 30 years; n = 12) and older (> 65 years; n = 12) individuals before as well as 1 month after immunization with a trivalent whole virus influenza vaccine. Before vaccination, peripheral blood mononuclear cell proliferation in response to in vitro stimulation with each of the virus strains was low in both groups. No antibodies against either the H1N1 or the B strain were found in most individuals, while 91% of the young and 75% of the elderly persons had low but protective antibody titres to the H3N2 strain. Vaccination led to a significant enhancement of peripheral blood mononuclear cell reactivity to all three influenza strains in both age groups. However, there was a significant difference in the humoral immune response between the groups. While there was a vigorous antibody response to all three vaccine strains among young persons, protective titres against the H1N1 and the B strains were only just reached in the old. In contrast, antibody production to the H3N2 strain was most abundant in the majority of elderly individuals, leading to significantly higher titres in the old than in the young group. In conclusion, the results demonstrate the preferential induction of antibodies to one particular influenza strain despite equal T cell recruitment to all vaccine strains in healthy aged individuals after immunization with a trivalent influenza vaccine. Our findings underline the complexity of immunological alterations to be expected after vaccination in healthy elderlies.     

Controlling varicella in the healthcare setting: the cost effectiveness of using varicella vaccine in healthcare workers

OBJECTIVE: To determine if varicella vaccination of healthcare workers would result in a net cost savings. DESIGN: A Markov-based decision analysis. SETTING: The analysis was based on a hypothetical population of healthcare workers. Data were obtained from exposure records of a tertiary-care hospital and from the literature. Workers were considered potentially susceptible if they had no past history of varicella. RESULTS: Vaccination of potentially susceptible workers would result in a net cost savings of $59 per person. Serological testing prior to vaccination resulted in smaller net savings. The results were robust across a wide range of assumptions. Importantly, however, the result was very dependent on infection control policy regarding work restrictions for vaccine recipients. If more than 3% of vaccinees were removed from work due to vaccine-associated rash, vaccination no longer would result in a net cost savings. CONCLUSION: Varicella vaccination of potentially susceptible healthcare workers can reduce costs and decrease morbidity. Infection control policy regarding work restrictions for vaccine recipients will play a key role in the feasibility of vaccination.     

Vaccination in elderly patients in rehabilitation: a missed opportunity?

BACKGROUND: Immunization against influenza is recommended for elderly persons in Switzerland, but no national guidelines are currently available regarding immunization of the elderly against pneumococcus and tetanus. In addition, almost no data are available regarding immunization rates of the elderly in the general population. In this study we explored the immunization status for influenza, tetanus and pneumococcus of a selected elderly population admitted to a Swiss rehabilitation facility. POPULATION AND METHODS: The study population (n = 145) were patients admitted to a rehab facility during 3 consecutive winter months. Data on demographics, immunization, previous functional status (BADL, IADL), cognitive (MMSE) and affective status (GDS) were collected upon admission. RESULTS: Subjects' mean age was 79.4 years, 32.4% were male, 42.8% had BADLs dependencies and 81.9% IADLs dependencies. Most patients had normal MMSE and GDS scores. Vaccination rates were 39.3% for influenza, 12.4% for tetanus and only 2.1% for pneumococcus. In univariate analyses, people immunized against influenza were older than those who were not (p = 0.01). This relationship remained in multivariate analyses, controlling for gender, functional, cognitive and affective status. Subjects aged 80 and over were 2.5 times (95% CI 1.2-5.5, p = 0.02) more likely to be immunized against influenza, but were less likely to be immunized against tetanus (OR 0.3, 95% CI 0.1-0.9, p = 0.04). Functional status was not significantly associated with any vaccination status. CONCLUSIONS: Immunization rate for influenza in this selected population is similar to those described in US surveys. The positive association between older age and flu vaccination is surprising and needs further investigation. These results also indicate a need to educate patients and physicians in order to increase vaccination use, especially against pneumococcus.     

Influenza vaccination in 22 developed countries: an update to 1995

This study expands and updates through 1995 our earlier report on influenza vaccine use in 18 developed countries. Five of the six countries with high levels of vaccine use in 1992 (> or = 130 doses/1000 population) showed little change or slight declines over the subsequent 3 years. The exception was the United States, where a new federal program for vaccination reimbursement for the elderly helped to increase vaccine distribution from 144 to 239 doses/1000 population. The six countries with medium levels of vaccine use in 1992 (76-96 doses/1000 population) increased to > or = 100 doses/1000 population by 1995. Among the six low-use countries in 1992 (< or = 65 doses/1000 population), only Finland showed substantial improvement (96 doses/1000 population) in 1995. Four new countries were added to the study. In Germany, vaccine use increased to 80 doses/1000 population in 1995, but in Ireland it remained at a low level (48 doses/1000 population). In Korea, vaccine use increased from 17 to 95 doses/ 1000 population during the period 1987-1995. In Japan, very high levels of vaccine use (approximately 280 doses/1000 population) in the early 1980s were associated with vaccination programs for school children. However, vaccine use fell precipitously when these programs were discontinued, and only 2 and 8 doses/1000 population were used in 1994 and 1995, respectively. In all 22 countries, higher levels of vaccine use were associated with vaccination reimbursement programs under national or social health insurance and were not correlated with different levels of economic development. Excluding Japan, in 1995 there was still a greater than fourfold difference between the highest and lowest levels of vaccine use among the other 21 countries in the study. Given its well established clinical effectiveness and cost-effectiveness, none of these countries has yet achieved the full benefits of its programs for influenza vaccination.     

Pharmaco-economics of anti-influenza vaccinations]

The types of pharmacoeconomic analysis performed in the assessment of influenza vaccination, including cost-benefit and cost-effectiveness analysis are presented in this study. The studies concerned working adults or high-risk elderly people who were selected from Medline and Embase databases. The primary difference between the two types of vaccination programmes is related to the major type of benefits: direct benefits related to averted hospitalizations for elderly versus indirect benefits of averted production losses for healthy working people. In the group of persons aged over 65 years the disease costs are influenced mainly by complications and hospitalizations. Vaccination is most cost-effective in influenza prophylaxis as compared with other strategies (chemoprophylaxis and treatment using neuraminidase or ion channel inhibitors) and may be recommended from the pharmacoeconomic point of view.     

The provision of influenza vaccine to patients over 65 years by general practitioners

Influenza vaccination for all elderly persons is cost effective. Guidelines in Ireland recommend the vaccine for those with chronic illness and to the elderly in care. The aims of this study are to identify how influenza vaccine is provided to elderly patients and to get GPs opinions on what barriers there are to providing the vaccine to persons 65+ years. Of the 143 GPs contacted 117 (81.8%) replied, of whom 116 (99.1%) provide the vaccine to their patients. Ninety nine (85.3%) believe it to be effective in preventing influenza, and only 8 (6.9%) have reservations about the vaccine. Eighteen (15.5%) GPs had a difficulty in identifying those to be vaccinated and only 11 (9.5%) had a computerised system to assist them. Twenty two (19.0%) GPs had difficulty in getting sufficient vaccine for their patients. Ninety six (82.8%) GPs make the vaccine available to those for whom it is recommended and of these 61 make it available to all patients over 65 years. The main patient barriers to an influenza vaccination programme are the patients fear of getting influenza from the vaccine and that many patients do not consider the vaccine to be of value. Barriers identified for GPs are the low level of reimbursement to GPs for vaccinating eligible patients and the lack of proper systems that help identify and contact those who should be getting the vaccine. All of the barriers identified should be easy to overcome so that those who require influenza vaccine can reap the health and social gains that our health services advocate.     

Clinical effectiveness of influenza vaccination in Manitoba

OBJECTIVE: To assess the clinical effectiveness of influenza vaccination in preventing influenza-associated hospitalization and death. DESIGN: Case-control study. SETTING AND PATIENTS: Noninstitutionalized persons aged 45 years or older living in Manitoba, on December 1, 1982, and December 1, 1985. METHODS: Linked records of the Manitoba population registry, hospital-discharge abstracts, physician claims for ambulatory-patient visits and influenza vaccination, and vital statistics were used. A matched-set analysis estimated the clinical effectiveness of influenza vaccination in preventing hospital admissions and deaths from influenza-associated conditions during influenza A (H3N2) outbreak periods in 1982 to 1983 (12 weeks) and 1985 to 1986 (10 weeks). The analysis adjusted for hospital discharge and ambulatory care for high-risk conditions within the previous 15 months and 3 months, respectively. RESULTS: Influenza vaccination prevented 32% to 39% of hospital admissions with pneumonia and influenza and 15% to 34% of admissions with all respiratory conditions. Vaccination was 43% to 65% effective in preventing hospital deaths with these conditions (all listed diagnoses) and 27% to 30% effective in preventing deaths from all causes. CONCLUSION: Influenza vaccination has substantial clinical effectiveness in preventing hospital admission and death from influenza-associated conditions in noninstitutionalized individuals.     

Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers

OBJECTIVE: To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination. DESIGN: Retrospective cohort study. SETTING: Ten acute care hospitals in Minnesota. PARTICIPANTS: A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine. MAIN OUTCOME MEASURE: Presence or absence of anti-HBs following hepatitis B vaccination. RESULTS: Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P = .01), body mass index (P < .01), and smoking status (P < .01) were associated with lacking anti-HBs only for Recombivax HB recipients; and gender (P = .03) was associated with lacking anti-HBs only for Engerix-B recipients. After controlling for smoking status, age, gender, and body mass index, recipients of Recombivax HB were more likely to lack anti-HBs than recipients of Engerix-B (relative risk, 2.3; 95% confidence interval, 1.1 to 4.7; P = .02). CONCLUSIONS: Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed.     

Recurrent intracranial neurenteric cysts

To determine the efficacy of a single influenza vaccine administration in the elderly receiving annual influenza vaccination, antibody response to influenza vaccine was compared between once and twice injections in a geriatric cohort. Influenza vaccination had been done for 69 inpatients in the year prior to the study, and was administered twice for 34 of them and once for the other 35 during the study period. Influenza vaccine was injected twice to 77 inpatients who had not received influenza vaccine in the year prior to the study. Hemoagglutination inhibition (HI) antibody titer for influenza A/H1N1, A/H3N2, and B was measured before vaccination, after the first vaccination, after the second vaccination, and after the epidemic period, September 1995 to April 1996. HI antibody titer prior to vaccination was significantly higher in the patients who had received influenza vaccination the previous year. The influenza vaccine induced an increase in HI titer in almost all subjects, and the geometric mean of the HI titer after vaccination in the patients who received vaccine once was comparable to that of the patients injected vaccine twice. The number of patients with HI titers of over 128x increased, and the frequency ranged from 60.0% to 97.1% for the influenza viruses of the three subtypes. The frequency of HI titers over 128x was not significantly different among the three groups. The second vaccination did not increase the number of patients with HI titers over 128x when compared with the number after the first injection in the patients who had received influenza vaccine the previous year. These results suggest that prior vaccination does not diminish the antibody response to influenza vaccine in the elderly. The efficacy of a single influenza vaccination is comparable to that achieved by twice injections in the elderly receiving annual influenza vaccination.     

Qualitative interview study on acceptance of influenza vaccination among the elderly

Nine elderly men and women were interviewed in order to discover factors of importance in accepting influenza vaccinations. The study demonstrated that the fee to be paid by the patients was a considerable barrier to an improvement of the vaccination rate. The elderly informants were all aware that influenza vaccine is available. Some informants expressed uncertainty whether they themselves belonged to the risk groups who should be vaccinated. Sources of information were the general practitioner (GP), relatives, and the mass media. More personal information from the GP to persons at risk was wanted. Influenza vaccination behaviour was found to be consistent with the Health Belief Model. The present organization of influenza vaccinations does not promote a sufficient immunization rate. The threshold for accepting influenza vaccinations appears to be too high for the elderly population.     

The influence of sequential annual vaccination and of DHEA administration on the efficacy of the immune response to influenza vaccine in the elderly

The present study examined the effect of repeated vaccination and of dehydroepiandrosterone (DHEA) treatment on the immune response to influenza vaccine in elderly subjects. Seventy-one elderly volunteers, aged 61-89 years, enrolled in a prospective randomized, double-blind study to receive either DHEA (50 mg qd p.o. for 4 consecutive days starting 2 days before immunization) or placebo. Antibody response against the three strains of vaccine was measured before and 28 days after vaccination, and compared between previously vaccinated and non-vaccinated subjects. DHEA treatment did not enhance established immunity. A significant decrease in attainment of protective antibody titer (titer of 1:40 or greater) against A/Texas in subjects with non-protective baseline antibody titer was recorded following DHEA treatment compared to placebo (52 vs. 84%, P < 0.05). Post-immunization titers against influenza A strains were significantly higher in those subjects who were never immunized before. Additionally, post-vaccination protective titers against the A/Johannesburg strain were more prevalent in those subjects who were never vaccinated before. The results were not the same for anti-B/Harbin antibodies-repeated vaccination caused a non-significant increase in HI titer in previously vaccinated subjects.     

The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenzavirus vaccine in children

BACKGROUND: Influenzavirus vaccine is used infrequently in healthy children, even though the rates of influenza in this group are high. We conducted a multicenter, double-blind, placebo-controlled trial of a live attenuated, cold-adapted, trivalent influenzavirus vaccine in children 15 to 71 months old. METHODS: Two hundred eighty-eight children were assigned to receive one dose of vaccine or placebo given by intranasal spray, and 1314 were assigned to receive two doses approximately 60 days apart. The strains included in the vaccine were antigenically equivalent to those in the inactivated influenzavirus vaccine in use at the time. The subjects were monitored with viral cultures for influenza during the subsequent influenza season. A case of influenza was defined as an illness associated with the isolation of wild-type influenzavirus from respiratory secretions. RESULTS: The intranasal vaccine was accepted and well tolerated. Among children who were initially seronegative, antibody titers increased by a factor of four in 61 to 96 percent, depending on the influenza strain. Culture-positive influenza was significantly less common in the vaccine group (14 cases among 1070 subjects) than the placebo group (95 cases among 532 subjects). The vaccine efficacy was 93 percent (95 percent confidence interval, 88 to 96 percent) against culture-confirmed influenza. Both the one-dose regimen (89 percent efficacy) and the two-dose regimen (94 percent efficacy) were efficacious, and the vaccine was efficacious against both strains of influenza circulating in 1996-1997, A(H3N2) and B. The vaccinated children had significantly fewer febrile illnesses, including 30 percent fewer episodes of febrile otitis media (95 percent confidence interval, 18 to 45 percent; P<0.001). CONCLUSIONS: A live attenuated, cold-adapted influenzavirus vaccine was safe, immunogenic, and effective against influenza A(H3N2) and B in healthy children.     

Immunogenicity of pneumococcal vaccine in persons with spinal cord injury

OBJECTIVE: To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). DESIGN: Double-blind, randomized, placebo control study. SETTING: SCI unit in a tertiary care medical center and community. PARTICIPANTS: Eighty-seven persons with recent SCI. INTERVENTION: Participants were randomized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. MAIN OUTCOME MEASURES: Antibody concentrations were measured prior to intervention and 1, 2, and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae. Effects of demographic and injury-related variables on immune response were also evaluated. RESULTS: Timing of vaccination did not influence mean antibody concentrations for any serotype (p > .05). Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35% of placebo groups (p < .01). After 12 months, 93% of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values. CONCLUSIONS: Most participants developed an immune response to at least one serotype that was maintained for at least 12 months. Immune response varied according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during initial hospitalization.     

Successful treatment of transient acantholytic dermatosis with systemic steroids

OBJECTIVE: To compare the effects of different types of computer-generated, mailed reminders on the rate of influenza immunization and to analyze the relative cost-effectiveness of the reminders. DESIGN: Randomized controlled trial. SETTING: Multispecialty group practice. PATIENTS: We studied 24,743 high-risk adult patients aligned with a primary care physician. INTERVENTION: Patients were randomized to one of four interventions: (1) no reminder, which served as control; (2) a generic postcard; (3) a personalized postcard from their physician; and (4) a personalized letter from their physician, tailored to their health risk. MEASUREMENTS: The immunization rate was measured using billing data. A telephone survey was conducted in a subgroup of patients to measure reactions to the mailed reminders. To evaluate the cost-effectiveness, a model was constructed that integrated the observed effect of the interventions with published data on the effect of immunization on future inpatient health care costs. MAIN RESULTS: All three of the reminders studied increased the influenza vaccination rate when compared with the control group. The vaccination rate was 40.6% in the control group, 43.5% in the generic postcard group, 44.7% in the personalized postcard group, and 45.2% in the tailored letter group. The rates of immunization increased as the intensity of the intervention increased (p < .0001). Seventy-eight percent of patients in the letter group deemed the intervention useful, and 86% reported that they would like to get reminders in the future. The cost-effectiveness analysis estimated that in a nonepidemic year, the net savings per 100 reminders sent would be $659 for the personalized postcard intervention and $735 for the tailored letter intervention. When these net cost-savings rates were each applied to the entire high-risk cohort of 24,743 patients, the estimated total net savings was $162,940 for the postcard and $181,858 for the tailored letter. CONCLUSIONS: Although the absolute increase in immunization rates with the use of reminders appeared small, the increases translated into substantial cost savings when applied to a large high-risk population. Personalized reminders were somewhat more effective in increasing immunization, and personalized letters tailored to the patients' condition were deemed useful and important by the individuals who received them and had a beneficial indirect effect on patient satisfaction.     

The effect on costs of the use of half-dose aprotinin for first-time reoperative coronary artery bypass patients

Half-dose aprotinin previously has been shown to reduce bleeding and the need for blood transfusions, but the results of cost-reduction studies have been variable. The purpose of the present retrospective study was to compare, from the perspective of the acute care hospital as health care provider, the costs associated with first-time reoperative coronary artery bypass graft (CABG) surgery in patients who received half-dose aprotinin with the costs in those who did not. Medical records from 46 historical controls (first-time reoperative CABG patients receiving no aprotinin) and 51 half-dose aprotinin-treated patients were reviewed. A total of 36 variables were abstracted from the medical records for analysis. It was found that more aprotinin-treated patients did not require transfusion compared with nontreated patients (47% vs 26%). Twenty-one percent fewer aprotinin-treated patients received red blood cell transfusions, 21% fewer received plateletpheresis packs, and 19% fewer received fresh frozen plasma. Cost savings per patient receiving half-dose aprotinin compared with no aprotinin were approximately $878 in blood products and $1088 in total length of stay (including critical care), for total savings of $1966. When the cost of aprotinin ($450) was subtracted, the approximate net mean savings per patient were $1516. This did not include additional cost savings with aprotinin resulting from a median 19.5-minute shorter pump time. The authors conclude that the use of half-dose aprotinin results in reductions in surgical and associated hospitalization costs because of decreases in the length of hospital stay, including length of stay in critical care, and in the use of blood products.