Integrated curriculum in the United States pharmacy programs.

INTRODUCTION: In the last decade, significant changes in pharmaceutical sciences have influenced the delivery of pharmacy education in Pharmacy programs. Integrated curriculum is one such method considered. We aimed to describe the perceived level of integrated curriculum among PharmD programs in the US. METHODS: From October 26th, 2021, until January 18th, 2022, faculty administrators across 138 US pharmacy colleges were surveyed. Data was collected regarding each program's perceived curriculum integration and assessment integration. Characteristics of each college, including region and the type of school (public/private), were obtained from the PharmCAS website. Programs were categorized into high-integration and low-integration groups for analysis purposes. Descriptive and comparative analysis by the level of curriculum integration was performed. RESULTS: Overall, 60 colleges completed surveys (participation rate = 43.48%). Most schools were from the South region (38.33%) and public colleges (53.33%). The average perceived curriculum integration was 45% (SD = 23.69), while the average perceived assessment integration was 36% (SD = 25.52). Pharmacy practice [clinical sciences] (76.67%) was the most common discipline considered for integration, and the social and administrative sciences (21.67%) was the discipline least commonly considered for integration. Case-based learning (95%) was the most common pedagogy strategy to integrate knowledge from different disciplines. CONCLUSIONS: Integrated curriculum implementation in the US PharmD programs varied across colleges. While most programs integrated their clinical practice courses, social and administrative sciences was the course least commonly integrated. Very limited progress in assessment integration was perceived.

Patterns of immunotherapy utilization for non-small cell lung cancer in Texas pre- and post-regulatory approval.

PURPOSE: Immunotherapy has shown remarkable benefits for non-small cell lung cancer (NSCLC) since approved by the US Food and Drug Administration (FDA). Texas, however, ranks below the national average in access to treatment for NSCLC. This retrospective cohort study assessed first-line immunotherapy treatment patterns and associated factors pre- and post-FDA approval in Texas. METHODS: Patients ≥18 years diagnosed with NSCLC from the Texas Cancer Registry database (2011-2018) and were stratified into pre- and post-FDA approval era. The rates of immunotherapy utilization were examined, and the average annual percent change (AAPC) in immunotherapy utilization across patient subgroups was compared. Multivariable logistic regression was used to identify associations of patient characteristics with immunotherapy utilization for patients with metastatic- and all-stage NSCLC. RESULTS: A total of 13,501 and 9509 patients with NSCLC were identified in pre-post-approval periods, respectively. Post-approval, immunotherapy utilization increased from 1.7 to 13.0%, and AAPC from 54.8 to 82.7%. Pre-approval, patients living in a county with ≥20% of households below the poverty level were less likely to receive immunotherapy (OR = 0.73, 95% CI = 0.61-0.94) while patients with private insurance were more likely to receive immunotherapy (OR = 1.56, 95% CI = 1.10-2.23). Post-approval, socioeconomic disparities were more prominent (10-19.9 and ≥20% of households below the poverty level: OR = 0.77, 95% CI = 0.66-0.90 and OR = 0.71, 95% CI = 0.60-0.86, respectively). Patients with metastatic NSCLC showed similar patterns of socioeconomic disparities pre- and post-approval. CONCLUSIONS: Our findings suggest that patients' socioeconomic status hinders immunotherapy utilization for NSCLC in Texas. This emphasizes the need for state health policy reforms such as Medicaid expansion and tailored cancer care strategies.

Economic burden of nonadherence to standards of diabetes care.

OBJECTIVES: To evaluate the effect of nonadherence to American Diabetes Association (ADA) guidelines on health care expenditures for patients with type 2 diabetes (T2D). STUDY DESIGN: Retrospective cross-sectional cohort design, utilizing 2016-2018 Medical Expenditure Panel Survey data. METHODS: Patients with a diagnosis of T2D who completed the supplemental T2D care survey were included in the study. Participants were categorized based on adherence to the 10 processes in the ADA guidelines into adherent (≥ 9 processes) and nonadherent (≤ 6 processes) categories. Propensity score matching was employed using a logistic regression model. After matching, total annual health care expenditure change from baseline year was compared using a t test. Further, imbalanced variables were controlled for in a multivariable linear regression model. RESULTS: A total of 1619 patients representing 15,781,346 (SE = 438,832) individuals met the inclusion criteria, among whom 12.17% received nonadherent care. After propensity matching, those who received nonadherent care had $4031 higher total annual health care expenditures compared with their baseline year, whereas patients who received adherent care had $128 lower total annual health care expenditures compared with their baseline year. Further, multivariable linear regression adjusted for the imbalanced variables indicated that nonadherent care was associated with a mean (SE) $3470 ($1588) increase in the change from baseline health care expenditure. CONCLUSIONS: Nonadherence to the ADA guidelines results in a significant increase in health care expenditures among patients with diabetes. The economic impact of nonadherent care for T2D is a significant and extensive issue that needs to be addressed. These findings emphasize the importance of providing care based on ADA guidelines.

COVID-19 Maternal Prevention Behavior and Future Intention to Vaccinate for Children.

BACKGROUND: During the COVID-19 pandemic, this study aimed to understand how a mother's current COVID-19 prevention behaviors were associated with the mother's future intention to vaccinate their children against COVID-19. METHODS: Using a cross-sectional online survey, mothers who had at least one child between 3 and 15 years old were recruited. COVID-19 prevention behaviors evaluated were wearing a mask, appropriate coughing/sneezing, social distancing, staying home, and handwashing. Participants' age, marital status, race, educational level, incidence of COVID-19 infection in the household, healthcare worker in the household, and future intention to vaccinate children were obtained. RESULTS: Among the 595 participants, 38.3% indicated they did not intend to use the COVID-19 vaccine for their children. Participants with no intention for vaccination had lower mean scores on wearing masks (p < 0.0001), social distancing (p < 0.0001), staying home (p < 0.0001), and handwashing (p < 0.05). The incidence of COVID-19 infection in the household was associated with a lower mean score of staying home (p < 0.01). CONCLUSION: Our findings indicate that most mothers were compliant with the CDC recommended guidelines at the time of the survey. Mothers who indicated high adherence to prevention behaviors had a higher likelihood to consider vaccination for their children. Now that the COVID-19 vaccine is available for children as young as six months, healthcare providers need to be aware of the relationship between current prevention behaviors and future intention to vaccinate. They need to counsel parents appropriately with recommendations for children to keep practicing prevention behaviors.

Incremental health care expenditures for non-Hodgkin lymphoma in comparison with other cancers: Analysis of national survey data.

BACKGROUND: Non-Hodgkin lymphoma (NHL) is among the most common cancers in the United States, with an estimated annual incidence of more than 80,000 and a high survival rate. However, limited national data exist regarding the health care burden of NHL. OBJECTIVE: To evaluate the incremental health care expenditures among patients with NHL using the Medical Expenditure Panel Survey (MEPS) data compared with patients with other cancers. METHODS: This observational cross-sectional study included all patients with NHL (≥ 18 years) and all individuals diagnosed with other cancers from the MEPS 2014-2019. The components of health care expenditures included hospital inpatient care, office-based visits, outpatient care, emergency department, prescription medications, dental, home health, and other expenditures. Patients with NHL and those diagnosed with other cancers were identified from the full-year consolidated MEPS Household Component 2014-2019. Descriptive weighted analysis was used to compare the health care expenditure components between individuals with NHL and all other cancers. A 2-part model using probit and generalized linear models with a log link function was used to estimate the incremental increase in total health care expenditures for NHL compared with all other cancers. RESULTS: According to the MEPS, there were 0.74 million patients with NHL (95% CI = 0.62-0.86) and 27.91 million patients with other cancers (95% CI = 26.69-29.13) annually. Most of the patients with NHL were White (78.36%), male (60.67%), and older than 65 years (45.8%). The unadjusted analysis indicated a total annual expenditure of $21,698 (95% CI = $16,752-$26,645) for NHL, which was significantly higher than the annual expenditure for patients with other cancers ($15,029 [95% CI = $14,476-$15,582]). Most of the total health expenditure of both the NHL group and the other cancers group was distributed in 3 categories of hospital inpatient care (29.15% vs 26.29%), office-based visits (28.10% vs 25.08%), and prescription medications (19.03% vs 22.57%). Based on the 2-part model adjusted for all covariates, the annual health care expenditure for NHL was $7,284 (95% CI = $1,432-$13,135), higher than the expenditure of patients diagnosed with all other cancers. Among the health care expenditure components, the office-based visits were $2,641 higher for patients with NHL compared with the other cancers group (95% CI = $1,129-$4,153). CONCLUSIONS: The economic burden of NHL is higher compared with other cancers. Most of the NHL expenditures were attributable to hospital inpatient services and office-based visits. The study findings can inform value-based care considerations because of a better understanding of utilization and care patterns for NHL. DISCLOSURES: Dr Aparasu has received research funding from Astellas Inc., Incyte Corp., Gilead, and Novartis Inc. for projects unrelated to the current work. The other authors declare no conflicts of interest for this article. We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere.

Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data.

BACKGROUND: Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients. OBJECTIVES: This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data. METHODS: Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression. RESULTS: According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively. CONCLUSIONS: MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.

Investigation of racial differences in survival from non-small cell lung cancer with immunotherapy use: A Texas study.

Background: The use of immunotherapy is associated with improved survival among patients with Non-Small Cell Lung Cancer (NSCLC) and has gained widespread use in its management. However, there is limited information on whether the survival benefits associated with immunotherapy differ among races and ethnicities. Objective: This study aimed to investigate racial differences in survival amongst patients with NSCLC who received immunotherapy as the first-line treatment in Texas. Methods: Patients with NSCLC who received immunotherapy between October 2015 to December 2018 were identified from the Texas Cancer Registry (TCR). Disease-specific survival was evaluated and compared among patients across racial/ethnic categories using the Kaplan-Meier survival analysis, log-rank test, and a multivariable Cox proportional hazard regression model following an inverse probability treatment weighting (IPTW) propensity score analysis. Results: A total of 1453 patients were included in the analysis. Median survival (in months) was longest among Asians (34, 95% CI: 15-Not Estimable), followed by African Americans (AAs) (23, 95% CI: 15-34), Hispanics (22, 95% CI: 16-26), and Whites (19, 95% CI: 17-22). The adjusted regression estimates had no statistically significant differences in survival among AAs (aHR = 0.97; 95% CI = 0.78-1.20; P =0.77) and Hispanics (aHR = 0.96; 95% CI = 0.77-1.19, P =0.73) when compared to White patients. Asians on the other hand, had 40% reduction in mortality risk compared to Whites (aHR = 0.60; 95% CI = 0.39-0.94, P = 0.03). Conclusions: Our study indicated that African Americans and Hispanics do not have poorer survival compared to White patients when receiving immunotherapy as first-line treatment. Asians however had longer survival compared to Whites. Our findings suggest that existing racial disparity in NSCLC survival might be mitigated with the use of immunotherapy and should be considered in providing care to these minority groups.

General Anxiety, Academic Distress, and Family Distress Among Doctor of Pharmacy Students.

Objective. To examine the prevalence of general anxiety among Doctor of Pharmacy (PharmD) students and the role of academic distress and family distress in causing general anxiety.Methods. A cross-sectional study was conducted among first, second, and third year PharmD students. All students received an online survey consisting of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62) questionnaire and sample characteristics. Variables from CCAPS-62 considered in this study included academic distress and family distress measured on a three-level scale: no, low, and high clinical level. Data on gender, race, work status, and physical activity were also collected. Descriptive and multinomial logistic regression were conducted to identify factors associated with general anxiety.Results. Of the 238 students who took the online survey (63% response rate), the majority were female (67%) and Asian (49%). Overall, 69 first year, 75 second year, and 94 third year students participated. The prevalence of general anxiety was 50%, with equal distribution (25% each) among high-clinical and low-clinical general anxiety groups. High academic distress and high family distress were associated with a greater probability of a student having high general anxiety.Conclusion. General anxiety was quite prevalent among pharmacy students. Identification and implementation of strategies to lower general anxiety as well as academic distress is of great importance. Also, understanding and enhancing the role of family members in students' lives is essential. College administrators can provide support for students as well as for family members to make improvements in these areas.

Combined effect of different teaching strategies on student performance in a large-enrollment undergraduate health sciences course.

Students' course performance is fundamental for any institution to carry out its academic mission. Often, in-class disengagement and lack of after-class course support in large-enrollment classes trigger academic problems for students. This leads to poor exam performance and an increased rate of final letter grade of a D or F or student withdrawal (DFW), an indicator of students' poor academic success. Changing teaching strategies by using interventions that incorporate student-student interaction and student-faculty interaction may offer the opportunity to improve course performance. In this retrospective study, we examined the effect of changing teaching strategies on student course performance of 5,553 students enrolled in an undergraduate health sciences course over a span of 20 semesters. Three different interventions namely 1) daily low-stake in-class quizzes, 2) team-based learning, and 3) after-class review sessions were incorporated as teaching strategies. To assess the combined effect of these strategies' students' performance in the intervention period (12 semesters) was compared with control period (8 semesters). Student performance in the course was measured by exam grades; overall score; percentage of students receiving letter grades and A, B, C; and DFW rates. The data indicated that in the intervention period, exam scores increased by 6.6%, overall course score increased by 6.2%, percentage of students receiving letter grade A/B increased by 21.3%, percentage of students receiving letter grade C decreased by 6.9%, and the DFW rates decreased by 14.5%. Overall, changing teaching strategies through incorporation of these interventions improved students' performance in the course.

Lithium protects against spinal cord injury in rats: role of nitric oxide.

OBJECTIVE: Lithium improves locomotor scores after spinal cord injury (SCI) in rats. However, the underlying mechanisms are unknown. Herein, we assess the role of nitric oxide (NO) in this action. METHODS: The first set of experiments were performed to determine a dose of lithium that effectively improves locomotor scores in rats with SCI. Therefore, rats received different doses of lithium chloride (1, 4, 10, and 20 mg/kg intraperitoneally) or saline 1 hour before SCI. In the next step, the role of NO in the effect of lithium on SCI was investigated. For this purpose, rats were co-treated with an effective dose of lithium (20 mg/kg 1 hour before SCI) and a noneffective dose of Nω-nitro-L-arginine methyl ester (L-NAME, a nonselective NO synthase inhibitor; 15 mg/kg intraperitoneally 30 minutes before SCI). SCI was induced by compressing the T9 spinal segment with an aneurysmal clip for 60 seconds in anesthetized rats. Locomotor scores were determined at 1, 3, 5, 7, 14, 21, and 28 days after SCI. Plasma lithium levels were measured 12 hours after SCI. Spinal histopathologies were examined 30 days after SCI. RESULTS: Lithium (20 mg/kg) significantly improved locomotor scores and decreased histopathologic spinal damage. l-NAME (15 mg/kg) reversed the beneficial effects of lithium. The 20-mg/kg dose of lithium resulted in a 0.68 ± 0.02 mEq/L plasma lithium concentration, which is lower than the therapeutic level in humans (0.8-1.2 mEq/L). CONCLUSION: Lithium protects against SCI through an NO-dependent mechanism.

Reduction of epidural fibrosis and dural adhesions after lamina reconstruction by absorbable cement: an experimental study.

BACKGROUND CONTEXT: Post-laminectomy epidural fibrosis complicates revision spine surgery and is implicated in cases of "failed back syndrome." Several materials have been used to minimize epidural fibrosis with varying results. PURPOSE: The aim of this study was to examine the impact of reconstruction of laminectomy site with a type of absorbable cement (Jectos) to reduce epidural fibrosis. STUDY DESIGN: This investigation is an experimental controlled study, which is designed to evaluate the preventive effects of laminectomy site reconstruction in rat laminectomy model. METHODS: Twenty wistar rats were included in this study and divided randomly to two equal groups, namely, subject and control. In both groups, laminectomy was performed in L2 and L4 levels. Control group received no additional treatment. In the subject group, L4 levels were reconstructed by Jectos and L2 levels were non-reconstructed as internal controls. Six months after surgery the rats were sacrificed and the dural adhesion and epidural fibrosis were evaluated macroscopically and microscopically. The study was financially supported by Brain and Spinal Cord Injuries Repair Center. None of the authors have any conflict of interest. RESULTS: Non-reconstructed levels in both groups showed dense epidural fibrosis with marked dural adherence. L4 reconstructed levels in subject group showed reduced epidural fibrosis macroscopically (p=.024) and microscopically (p=.041). No foreign body reaction or ossification occurred at reconstructed sites. CONCLUSIONS: In the present study, lamina reconstruction with absorbable cement was a safe method that significantly reduced post-laminectomy epidural fibrosis and dural adhesions in rat laminectomy model.

BMI correlation with psychiatric problems among 10-18 years Iranian students.

Obesity and its related emotional and physical consequences are a worldwide problem. Obese individuals are usually stigmatized. This study is proposed to assess the correlation between body mass index, gender and age with psychiatric symptoms among Iranian students. A number of 9172 students aged 10-18 years (53.5% girls and 46.5% boys) from all provinces of Iran participated in this study. Data was collected using the global school based health survey questionnaire of the World Health Organization (GSHS-WHO). Overall, prevalence of predictors of having emotional problems, depression and anxiety were 27.8%, 29.7% and 11.5% respectively. Girls had significantly higher prevalence of predictors of psychiatric symptoms. Overall obesity was a protective factor against emotional problems OR (CI95%):0.79(0.65-0.98), but it was attributable to obese boys OR (CI95%):0.72(0.55-0.95). Depression and anxiety symptoms were higher in intermediate school girls and high school girls and boys. More attention should be paid to girls' psychological problems. Besides, obesity had an indirect relation with predictors of having psychiatric problems in Iranian boys and it might be due to: (1) parents' beliefs about heaviness as a predictor of healthiness, (2) boys' lower vulnerability to psychological consequences of obesity and (3) lower pressure from parents on their obese sons to lose weight.

Involvement of nitric oxide in granisetron improving effect on scopolamine-induced memory impairment in mice.

Granisetron, a serotonin 5-HT(3) receptor antagonist, widely used as an antiemetic drug following chemotherapy, has been found to improve learning and memory. In this study, effects of granisetron on spatial recognition memory and fear memory and the involvement of nitric oxide (NO) have been determined in a Y-maze and passive avoidance test. Granisetron (3, 10mg/kg, intraperitoneally) was administered to scopolamine-induced memory-impaired mice prior to acquisition, consolidation and retrieval phases, either in the presence or in the absence of a non-specific NO synthase inhibitor, l-NAME (3, 10mg/kg, intraperitoneally); a specific inducible NO synthase (iNOS) inhibitor, aminoguanidine (100mg/kg); and a NO precursor, l-arginine (750 mg/kg). It is demonstrated that granisetron improved memory acquisition in a dose-dependent manner, but it was ineffective on consolidation and retrieval phases of memory. The beneficial effect of granisetron (10mg/kg) on memory acquisition was significantly reversed by l-NAME (10mg/kg) and aminoguanidine (100mg/kg); however, l-arginine (750 mg/kg) did not potentiate the effect of sub-effective dose of granisetron (3mg/kg) in memory acquisition phase. It is concluded that nitric oxide is probably involved in improvement of memory acquisition by granisetron in both spatial recognition memory and fear memory. This article is part of a Special Issue entitled The Cognitive Neuroscience.

Nitric oxide involvement in consolidation, but not retrieval phase of cognitive performance enhanced by atorvastatin in mice.

UNLABELLED: Atorvastatin, a widely-used medication in treatment of hypercholesterolemia, has shown some benefits in treating cognition impairment in Alzheimer's disease. In this study, effects of atorvastatin on spatial recognition memory and the involvement of nitric oxide (NO) has been determined on consolidation and retrieval of memory in a two-trial recognition Y-maze test. Memory was impaired using scopolamine (1mg/kg, i.p.); atorvastatin (1, 5mg/kg, p.o.) was administered, either in presence or in absence of a non-specific NO synthase inhibitor, L-NAME (3, 10mg/kg, i.p.); a specific inducible NO synthase inhibitor, aminoguanidine (100mg/kg, i.p.); and a NO precursor, L-arginine (750 mg/kg, i.p.). RESULTS: 1) atorvastatin (5mg/kg) significantly improved memory performance in a dose-dependent manner on consolidation and retrieval stage of memory in scopolamine-treated mice; 2) the beneficial effects of atorvastatin on memory consolidation was significantly reversed by L-NAME (10mg/kg) and aminoguanidine; 3) L-arginine slightly potentiated the effects of sub-effective dose of atorvastatin (1mg/kg) on memory consolidation; 4) either L-NAME (up to 10mg/kg), or aminoguanidine did not affect the memory improvement by atorvastatin on retrieval stage; 5) the effects of sub-effective dose of atorvastatin (1mg/kg) on retrieval of memory were not potentiated by L-arginine. The present study demonstrates that atorvastatin improves both consolidation and retrieval phases of memory. This effect is affected by NO synthase inhibitors and NO precursor, L-arginine, only in memory consolidation phase, but not in retrieval phase. It is concluded that NO might be involved in consolidation of spatial memory improvement by atorvastatin.

Atorvastatin improved scopolamine-induced impairment in memory acquisition in mice: involvement of nitric oxide.

UNLABELLED: Atorvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, widely used in treatment of hypercholesterolemia, slows the progression of mild-to-moderate Alzheimer's disease. In this study, effects of atorvastatin on acquisition of spatial recognition memory and the involvement of nitric oxide (NO) have been determined in a two-trial recognition Y-maze test and passive avoidance. Atorvastatin (1, 5mg/kg, p.o.) was administered prior to acquisition phase, either in presence or in absence of a non-specific NO synthase inhibitor, L-NAME (3, 10mg/kg, i.p.); a specific inducible NO synthase inhibitor, aminoguanidine (100mg/kg); and a NO precursor, l-arginine (750mg/kg). RESULTS: Atorvastatin significantly improved memory performance in a dose-dependent manner in acquisition of recognition memory, in both Y-maze and passive avoidance tests. 1) Atorvastatin (5mg/kg) significantly increased both exploration time and number of arm entries in scopolamine-treated mice in Y-maze. 2) The beneficial effects of atorvastatin on memory acquisition were significantly reversed by L-NAME (3mg/kg) and aminoguanidine (100mg/kg). 3) The effects of sub-effective dose of atorvastatin (1mg/kg) on memory acquisition were not potentiated by l-arginine (750mg/kg); 4) Administration of atorvastatin (5mg/kg) significantly increased step-through latency in scopolamine-induced memory-impaired mice. 5) Beneficial effect of atorvastatin on passive avoidance was not reversed by L-NAME (up to 10mg/kg). 6) The effects of sub-effective dose of atorvastatin (1mg/kg) on passive avoidance were not potentiated by l-arginine (750mg/kg). The present study demonstrates that atorvastatin improved both short-spatial recognition memory and fear memory. As this effect is reversed by L-NAME and aminoguanidine in short-term memory acquisition, it is concluded that NO might be involved in spatial memory improvement by atorvastatin.