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SI Digital Innovations in Learning is pleased to present
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The Jorge Lazarus Lecture Series on the origin and development of ideas in the clinical neurosciences. This course series consists of seven one-hour lectures with discussion
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The Speaker will be Jorge Lazarev, Emeritus Professor of Neurosurgery, Department of Neurosurgery, Ronald Reagan, UCLA Medical Center, Los Angeles, California, USA
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This is Dr. Lazarus introductory comments to his lecture series, and we quote, The most significant number of patients with diseases of the central nervous system live in low and middle income
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countries for no other reason than the majority of people are living in low and middle income countries.
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Let's start over.
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This is Dr. Lazarus' introductory comments to his lecture series, and we quote,
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The most significant number of patients with diseases of the central nervous system live in low and middle-income countries for no other reason than the majority of people are living in low and
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middle-income countries Nonetheless, neurosurgeons and neurologists from high-income countries offer most research papers on clinical neurosciences.
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This disparity is prejudicial to the neurosciences as a whole.
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We designed the course as an introduction to some of the tools that promote the genesis and development of research ideas
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This series of lectures are provided free to bring the advances in clinical and basic neuroscience to physicians and patients everywhere.
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One out of every five people in the world suffer from a neurologically related disease.
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Lecture one is titledAn Introduction to the Concepts of Research on the Nervous System
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First of all, hello everybody, I hope you are doing well. We are honored here to attend this
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course, which is the origin and development of IDEA and the clinical neuroscience provided voluntarily by Professor Jorge Lazaref, his emeritus professor of neurosurgery and
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the department of neurosurgery in the University of California and to the
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CCLA. This course is a question. be include six or seven lecture one per week and with the length of a lecture around 60 minutes and
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for the registration now we have 118 participants and they include around 80 medical students, 23 graduate and seven to 18 young in your resurgence. Also the participants are included from 11 to 12
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countries till now and this is a very nice start and
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I guess I want to say that we have three students dedicated to be a team leader and they will answer your question and if you have any question during the presentation please put it in the chat and
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the team leader who's known and know around the summer will try to figure out and at the end maybe share some of the questions, saying that we are happy to be there. We are happy to enjoy those
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scientific moments and I'm introducing one of the well-known pediatric neurosurgeon around the world who is Dr. Lazaref and the Mike yours. Thank you Thank you. Good evening to all of you. I
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appreciate the effort you are doing to come to this lecture series or lectures or seminar series and
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this alone is volume of your commitment to learning that you have to be raised for that. That's 75 or more than my fourth so now and then we are meeting a new collector are willing to spend time with
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the evening to present this, this is an enormous achievement that you all should feel proud of.
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First acknowledgement, English is not your first language, English is not my first language. So many of the presentation of the slides would be words for you to and for us to get a better
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communication, but more importantly, except today, because it's the first lecture and introduction per se, you all will receive a PDF format of more or less the slides of the presentations before
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the presentation. So by Thursday next week, you should have through the student leaders, you should have the PDF of what I wanted to be said. Of course, what I say at spans is not limited to you
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have an orientation. Furthermore, I would like to put this lecture in an expanded version and have it as a textbook per se, where we will summon all the contributors in there, all the 79 or
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doesn't matter with Dr. Haas as the leader rightly. And thirdly,
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this is being recorded and this will be uploaded to the site of surgical neurology international for you to review the
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concepts. So again, you will receive the PDF the day before you will be receiving and participating in the elaboration of a final test on. this is going to be uploaded, I acknowledge that I speak
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with an accent, I acknowledge that English is not your first language, and I acknowledge that I cannot speak your language. Unfortunately or fortunately, we have a universal language today, which
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happens to be English universal language for this type of communication. So, we adhere to that specific language.
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This is my email address, Jay Lasaref, my name and last name, magnet, it is you, for you to use it anytime that you have a question about the subject that we discussed or anything that you might
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like to discuss. that I can be of help relevant to neurology, to the neurosciences, or to the clinical neurosciences. As Professor Haus said,
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the intended of the lectures is gonna be about, now I am to do it less, but as I will be speaking slowly, maybe we'll reach the hour, but will not be tremendously dense. My hope is that with the
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material, I will say to you every week, the themes that I didn't say during the presentation will be
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expanded over the end. Now, does the image of the, does
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the image of a presenting thing, origin and ideas of. in clinical neurosciences, joined now by distinguished intellectual member from Argentina.
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Jorge Lassarif, that's me. Why I'm doing this? Was the motivation I have for engagement and joining Dr.
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Hoss in this project? There is a phenomenon which is called
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academic injustice or epistemic injustice.
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Many observations expressed in them, expressed by individuals or scientists from the developing world, are not
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recognized I don't know why. I don't know why. why we are this equal, are not recognized and accepted in the
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rest of the world. This is true. This is an absolutely fact that
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the host and do not need to agree with me in that. But when you say I have this experience gathered from my practice in its country away from the United States, you are not thought to be that
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level. And I want the
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knowledge coming out from your clinical observation. As a student now, as a physician's later, as a clinical neuroscientist later, I want this to be part of your,
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that you are part of the building
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of the city. structure of clinical neurosciences in the Arab world. In this case, and understand that we have from other countries as in the Arab world. So I want the Renaissance of the other
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clinical neurosciences
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The neurology international is the platform.
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One of the giants
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of neurosurgery. And surgical neurology international is the journal that we are going to use in our lectures. When the occasion comes for you to go and see the articles, particularly at the end of
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the lectures
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It's useful for you to get familiar with surgical neurology international because you can look at the
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materials for free. It's a journal that publishes on the web for free and welcomes many publications from the developing world from our part of the world.
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Free, yes, it's free. And yes, we will issue on certificate. The best
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certificate that we have that we have will be your performance five or six or seven or 10 years from now. That would be the best certificate for me. But yes, we will provide a certificate for you
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because those things usually help in the developing of the curriculum. But hopefully we'll establish a relation in which we have
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a conversation between us And I can mentor you. the publication of some of your ideas. And that brings me to this part, the host neurosurgery mentorship.
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Mentor
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comes from the great tradition in the Iliad. When releases or all these sales, he's about to leave. He has
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a child, Telemachus, a boy, a little boy. So he approaches one of his best friends.
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He also cannot join them in the war. To look after the education of his son, of Ulysses' son. The name of that character is mentor. So that's the name and the sentence, the
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meaning of the mentorship. That's what Dr. Summer Hoss is of you. It's your mentor. It will not tell you every day, every thing, what have to do. But it will be that a mentor would fill in the
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name of the meaning of that word. So let's go to our concept, to our thoughts now
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This conversation has a whiff to
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philosophy, as I said. And
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it has a whiff to the idea of knowledge. And the concept of knowledge, how we have ideas and how we develop those ideas and how we present those ideas is an universal concept as a universal concern
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I talked yesterday on the web
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universal - knowledge, and Iraq, and so appears, there is an article in the magazine called Al-Adap Jum, which I believe is from your university, and Professor Mohammed Fadil Abbas, who I
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believe he is a chemist. He talks about philosophy and sense, and he says how science has advanced own philosophy, and how science, I mean how science
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is expanding, but he admits that epistemology, which is the branch of knowledge, is an important branch of philosophy through which we come to know about the development of human knowledge, mean
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and methods of thinking, and this is what we are going to do today, today and in those seven days and the curriculum, we will do how we who are interested. in clinical neurosciences or medicine in
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general, how we means of methods of thinking, thinking and clinical thinking, origin and development of ideas.
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The
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whole issue of this, what the idea is, and
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I say this, I was distracted by the admission. When you say philosophy and medicine, really, philosophy has four main branches, which is moral and ethics, politics, metaphysics and knowledge
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and epistemology. Of those four, two are relevant to medicine, the ethics and the knowledge. So they,
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So yes, we are related to this point, as such, per se, and the knowledge is attained through empirical familiarity with objects in this world, with which one creates universal concepts. It is
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developed through a syllogistic method of reasoning observation lead to proposition statements, which went compound lead to further abstract concepts Don't worry, we will apply this to medicine to
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the brain to the study of the brain. But knowledge, what you know what summer hospital I know will be is attained through the familiarity with the objects around in the world, and the objects
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around in your world are the patients
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can't set, just read the two things on the top. that our knowledge begins with experience cannot be no doubt. There's no knowledge without experience, without seeing. And in respect of time,
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therefore, no knowledge of ours is antecedent to experience, but begins with it.
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Why I mention that? Not only to mention something related, how philosophy or epistemology is related to
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clinical neurosciences,
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but because of a poem from Fernando Pessoa, a Portuguese poet in one
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of his many verses, he says, From my village I see as much of the earth as can be seen from the universe. That's why my village is as large as any other bit of earth because I am the size of what I
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see and not the size of my own life.
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It means, again, that what you see in Badat, I use Badat as a generic name. I know that many of you come from other countries, or other cities, or other hospitals. What you see at your hospital,
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when you go tomorrow or Monday, when you go to a lecture, what you see in that hospital is as relevant, as important as anything seen by an American daughter here in Baltimore or in Los Angeles.
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It's the same because what you are seeing is experiencing the presentation of knowledge. To be a clinical neuroscientist, you don't need to have a fantastic electron microscopy. You don't need to
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have a fantastic
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level of research be a clinical neuroscientist, and we'll work on that. Remember, this is the introductory lecture, or the introductory conversation. To be as a such, we need to
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ask to acknowledge that the source of knowledge is the experience and the experience of what, the experience of seeing patients, the experience of seeing the representation of the disease in the
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patients that you see. So what sort of experience is the conversation with a patient on a clinic or a bedside?
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When you converse with a patient, when you think of a patient, you establish a conversation, if you are good, some of them, some of us sometimes do those things automatically But some of us,
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really, we established our conversation informed by science, guided by reason, and motivated by consent for the wellbeing of the patient. That's what we are doing. We are talking to the patient
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informed by science, then thinking guided by the reason. And then, of course, we are motivated for the wellbeing of that person, being a newborn child or a great grandfather of 20. Doesn't
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matter, it's for a person that we are concerned and we are addressing their concern informed by science, guided by reason. So in our group of clinical neuroscientists, we are interested in the
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reality of an individual who has the diagnosis or the presumptive diagnosis of a disease of the nervous system, which leads us to the question.
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And I will ask
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my colleague Anna van Raff if she can close the
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video. So we have, we don't record all our movements. So in our group, we are interested in the reality of an individual who has the diagnosis of the presumptive diagnosis of a disease of the
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nervous system, which leads us to the question, what is the nervous system The nervous system, people understand what a digestive system is. People understand where the endocrine system is, a
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cardiovascular system for spirit to resist to whatever. What is the nervous system was the purpose of the action of the nervous system
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The nervous system is, and I don't know why we don't name it like that. It's a communication system.
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the system that communicates our interior with ourselves and our exterior with ourselves. That's what we have the nervous system for, for communication. And if we think that the problem of the
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patient, the origin of the ideas, how the communication either with internal organs, endocrine, reproductive, with the control of the hypothalamus, or the external communication is affected by
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that, then what is the nervous system, the nervous system is a communication system, if funny enough is the only system that doesn't have the name implied on the
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function implied on the name.
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So that's an individual with an a nervous system, a patient that you may see on Monday or you have seen yesterday, can communicate as an as an impairment on the communication with the environment,
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not that you cannot talk. You cannot communicate with the environment either can't feel well, because as a peripheral nerve damage or a facial policy is not only motor is also sensory, or a spinal
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cord Or a a tumor in the sensory side, or the on the sensory cortex,
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or can't analyze, because he has a problem or a problem in the frontal lobe, or can the response, because it's a damage to the basal ganglia cannot move appropriately has a cerebellar tumor or
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a cellular lesion, or some combination of the above So. If we see, if we come and see the patient, not as somebody who has a tumor or had a sabbarinal hemorrhage, if we think of that patient as
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somebody who can communicate, then we will be able to start structuring the questions about how to do research through what this patient is telling us.
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The beauty of this approach of this research, I think, is that precisely, you only need your two eyes and your senses to start conversing and seeing where the problem is.
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A gentleman who has a tremendous headache because
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of a sudden onset of a saperan hemorrhage. Well, saperan hemorrhage are all the sudden onset, I mean, it's an oxymoron for a
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saperan hemorrhage That person cannot talk. Does he want to talk, does he want to say, you just want to talk to them and say, listen, there is this interesting lecture what about the Champions
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League? No, no, I have a tremendous headache. Help me with my headache. That is the problem of the communication
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represented by the function of the nervous system.
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So we said before is informed by science
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What is science? Maybe we always use this word, science. Oh, I am a scientist. What is science? What is science? And Carl Sagan and
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American Astronomist and Devoulator of Science. He had a fantastic definition. He says science is more than a body of knowledge. It is a way of thinking, a way of skeptically interrogating the
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universe with a fine understanding of human beings. availability. Think about it. You all can be scientists. You are a scientist.
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You are a scientist because you are here. You is more than above your knowledge. Somebody who has been a neurosurgeon for 20 years is not more a scientist than somebody who has been a neurosurgeon
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for one day.
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It's a way of thinking, a way of interrogating the universe or a patient, with understanding, yes, that you are human, that you are valuable, that you may get something right to run. And this
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is a definition by a great scientist. So science science is not just a body, an accumulation of knowledge. And that is the emphasis of these lectures or seminars or course, in which we will
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emphasize the way of thinking of
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the scientists. I have to move this out for some reason, the idea.
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So what are the
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clinical neurosciences? It's a way of thinking about the neural system guided by anatomy and physiological reasoning and motivated for the concern of the condition of the capability to communicate a
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power fellow human being who happens to be there with us.
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The ability
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to understand the anatomy and the physiology of that particular person who has an inability to communicate and is asking for your help
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I miss this slide, say, what is the scientific way of thinking. The scientific way of thinking is being able to ask a question in such a fashion that you answer with a yes or a no. At
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the end of this course, I will send you five questions, five clinical cases And you, you will have to ask a question that in a such a fashion that can be answered with a yes or a no
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Let me give
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this a sample.
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the professor who's going through the rounds and says, this patient
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has a brain tumor
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is not doing a perfect science because this patient has a brain tumor is an affirmation. It's not a question. It's not the way of interrogating. Does this patient has a brain tumor? Goes for a yes
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or for a no? Well, the patient is, I mean, please, yeah, it could be for a tumor, it could be for a stroke.
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There are two options or two alternatives. You are asking the question in a way that can be answered with a yes or with a no.
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Somebody decides to study epidemiologically, let me see, I have to view the, I'm meeting two more people here. Somebody's decided to study how many brain tumors are in one particular area of town,
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how many brain tumors are in Basra. That's not a scientific question, that's a question for epidemiology for that thing. Are there many more brain tumors in Basra than inner deal? Yes or no? That
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is a scientific question.
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Are there many more brain tumors near power station for cell phones? Yes or no? That is a scientific question. When you approach a patient in the round, you say this patient has a brain tumor is
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not a scientific question. If you approach this patient on the ground and then you ask, has this patient a brain tumor? Yes or no? Does it have yes or no at a stroke? That is a scientific
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attitude. Sounds easy. Sounds simple. It's not that simple. And I will tell you, I will send you at the end of the course. This five thing is independent of you completely or not completely in
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order to certificate. It's not an exam. But I will send you at the end of the course, five clinical cases. And I will ask you to
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be able to write at a question, as in one sentence, a question that can be answered or present this case in a yes or a no. And then of course, I will send each one of you my opinion or if it's
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perfect, it needs to be corrected. Which again, is not part of the, is not as an exam. It's such a venue to be able to form all those questions. So informed by science, informed by science, is
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so well you're thinking guided by reason. How we reason in front of a patient? How we reason in front of a patient? How we reason in front of the problem we had with the sound in the beginning? My
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problem, and according to Professor Haus, his problem according to me. But I mean, we had the double thing in here. So, how we reason? We reason in three ways. Not in four ways, not in five,
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not in two, in three
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And not, this is not that because Lassarff is saying that from Los Angeles is because this is how we reason. As you saw, one of the important things of knowledge is one of the important things of
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philosophy is knowledge and the knowledge is the reason. So, we reason through induction, the direction for example, and I wait anybody to raise their hand. What is this? Anybody volunteers,
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what are we looking at?
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by one. Come on. One.
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There's no volunteer there. They're gone.
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Okay. Somebody, two participants raise their hand. Okay. So yes, because Joffer, what are we looking at?
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It's a plane. It's a soccer soccer. It's something beautiful. Excellent. You boom. And I'm sure Ibrahim also thinks of this of the soccer. But now, okay, what is this? No, I'm not playing
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I went out of life.
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Okay, you don't know what they're playing because this is a game that is played only in Argentina. It's called Pato.
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And it's like similar to the game that is in some part of Afghanistan, where the people runs with a gold. No, there is a, the name escape know that the two teams and they compete for a dead gold
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and they score the gold. Well,
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in Argentina, they play all the same, but with a ball So, in the left, you did inductive reason, inductive reasoning, we have a whole lecture admitted for for that.
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And then, on the next week, in that degree. And it's the reason that this is a soccer. This is the brain tumor. Oh, this is a server loss, boom, goodbye. But the other one, when you find,
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okay, then what you do, you say, okay, it's a game play on horses There
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are apparently there are these teams. Because there is one with a red shirt or the one with a pink shirt. right there, you look, maybe they're not playing in Scandinavia. They don't look
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Scandinavia in those guys and there's no snow, there are not horse Scandinavia. So you go to Google, and then you support in Google, okay, game, play, but horses, true team, competing for a
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wrong ball. And then comes with an answer.
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And then the answer is more or less, and then you compare, then you roll, then you see the answer, and then you check, and yeah, okay, that's the the practice method.
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Now, if I put a, if I present this lecture to Argentinians,
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my country of birth, that was in southern parto.
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But when I did the similar lectures to the Argentinian, I put this day, Busaki, Busakasi, I don't remember the name, the guys are lost, you are with a pateau or as I would be and are as lost as
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when I see patients that have conditions that I don't know about. So those are the two methods, the induction and the deduction. We will expand on those methods on the next lecture of course. So
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we have those two methods, induction and deduction. And among the many other things that is happening now in your brains is this, the induction method and the deduction method, they have a
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cerebral representation. They did functional MRI on individuals who were doing induction and individuals who were doing the deduction. And different areas of the brain flare up. So, in your way of
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thinking of induction, You are a thinking of deduction. It's an anatomical structure. It's not an invention from the philosophers who didn't have anything else to look. It's an absolute reality of
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what you're having. Yeah, induction and the deduction per se, exist. Differential involvement
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of left, prefrontal, inductive and adaptive reasoning. Because again, as I said, there are three ways of reasoning When you sit next to a patient and when you talk to a patient, you are informed
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by science, guided by reason and motivated by compassion or concern. Informed by science, science is a way of thinking and formulate a question that can be answered with a yes or no. And the
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reason that there are the two ways of reasoning and the third one is the one that will make you great scientists. And we will discuss those in the moment.
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This is the induction and the direction again. And this is a, it's started from a paper from a path called hairy, which is called clinical cognition and diagnosis error. So you have patient
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presentation here and you either recognize what happens, like the soccer, or you don't recognize, like the path. And you understand, I say soccer and can be either cephalous and pato can be any
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other diseases that are not familiar to you, to me included, to Dr. Haus, to anybody included. And then you go in a type of processing and reasoning. And again, today is only introduction. In
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type one, the process, the type two process and then you reach to finally reach a diagnosis
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And
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so we have here. we have ABCD and F, all those lesions are similar are iscamered central region with a ringed enhancement.
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Some of them are tumors and glioma, some of them are abscess, some of them are trauma, some of them are lymphoma.
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Okay, but now what you look, how you process the system of reasoning in that zone, the that zone, of that zone. This is the things that we'll be talking in future lectures again. Today is just
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the general presentation of the subject. So, and then not only how to be a good doctor or this is an informant because it's not close to the court that's on the page and blah, blah, blah.
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great clinical neuroscientists, I want you to publish papers. I want you to show to the world the tremendous intellectual capacity of your clinical experience.
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And then
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go to the syllabus, this is just the last part. So this is July 14 was the presentation conversation we just decided to see who we are. And
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you will receive this as a PDF. We agreed on that situation. I know now that is easier for me to make Professor Hoss the co-host so I don't have to interrupt every time to admit the late arrivals.
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That's good.
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So on July 21 on the next Friday, the doctrine, in the doctrine of that, a theoretical introduction, theoretical and practical. I am a surgeon, as many of you want to be, or many of you will be,
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but anyway, I'm into the practical thing in the doctrine, the doctrine and the actions are
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on July 28
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will be a conversation through apply to cases of historical relevance How induction, abduction and deduction were relevant in similar base case, in the case of the plot promising in the place of the
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helical water below him. How those things were actually used or utilized by the clinical scientists, all of them clinical scientists, none of them had an electron microscope
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Then, in August 4, we'll talk about deduction, induction, abduction. apply to Chiari type one.
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You will see the tremendous variations of knowledge about Chiari type one, the tremendous variation on surgical treatment and the importance of having a critical approach to that particular disease.
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Then on August 11, we'll continue what we did with Chiari but we'll apply to a case of pediatric lioma.
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At least I will tell you about, you will know perhaps through the PDF, the day when I receive you, when I send you on the
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10th. So, induction, deduction as a case for clinical research and a case of pediatric lioma, not how to diagnose a pediatric life, If LYOMA is there, you can see that on the MRI, you don't
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need to do both research. I mean, is that the child is the MRI you can see? Or is it LYOMA? But how we can use induction, the induction, abduction?
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Create a branch of research and create a clinical paper.
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And as it happened to me with two cases, that I will discuss with you and I still receive invitations for those cases. On August 18, we
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will summarize of how to apply to writing of your clinical observations and hypotheses. Okay, I know induction, deduction, abduction. How do I make a paper out of this? Out of the set of
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observations that I found Hopefully we'll be able to, I mean. Hopefully, I will have the courage to get to some old papers of papers published in surgical neurology international and show that even
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a very good journal that surgical neurology has very, very good papers and not so good papers
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And a little paper that a could have been better. But you, knowing induction of that channel and the that channel will be able, oops, I don't know why I went to admitting here, will be able to,
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I have to go back in here So induction, induction, on August 18 you will be able to create a paper using those system based on your clinical observation And then, and remember the three elements of
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the.
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of the paper of the relation of the Genesis and of the philosophy of medicine is that we spoke of compassion or concern. The doctrine, induction and abduction can be applied to a medical, ethical
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dilemma.
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Not to moral dilemma, to medical, ethical dilemma. And we will use that in the doctrine, the doctrine and abduction to apply to ethical dilemma. In essence, to summarize for the late arrivals is,
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you will have a PDF of this. Oh, we have a really late arrival. Now, so summarize for the benefit of this new arrival is you will have at the PDF on the day before, I will send the PDF to the
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student leaders, and they will distribute to you.
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The ideally that PDF
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of the following week will have some improvements from the past week, all the things that I couldn't say because was distracted and the first time so you will have at the PDF test of this. You will
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have this recorded will be uploaded on the web And now we have a real later I
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will record for you on the website of surgical neurology international.
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Thirdly, I should have said that in the beginning is not my intention is not to conflict with any of the lectures that you have at your medical schools I
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would love to expand on neuroanatomy per se. but maybe you have a professor of
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neuronautomie and then that's a different story. And
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the last thing, one of the things you should
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grow and get from the mentorship of Dr. Haas is not a shame of publishing. It's not a shame of showing to the world what is he doing? It's not a shame to actually tell, Yes, I am Summer Haas, I
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trained him by that, and I am very good at what I'm doing. And this is the proof. And that is crucial for all of us. Remember, we need to expand, glow the
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world of clinical
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neurosciences, of the aeroplaneical neuroscience. And you have, and with this, I really finish. I repeat again. I repeat, not repeat again. If you're repeating this again, well, I repeat
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that the major wealth you have is the number of patients that you see. And what you see is what it is. But we'll discuss about this issue, induction, deduction, and abduction, how to contrast
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induction, deduction, and aversion. In any way, with that, and fulfilling the thing,
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I say thank you, you know? We need to have a seat. And Tafilos, I made just a ride to see our thank you. Thank you. And I guess some people had some problems with the hour, with hour per se.
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Any questions so far? We had a 79.
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Artissi Bandham in Chateen-Hair, thank you, thank you to all of you. We hope you enjoyed this presentation.
49:55
The material provided in this program is for informational purposes and is not intended for use as diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical
50:11
professional.
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Send your questions, comments, suggestions and applications for CME Credit 2, osmondsnidigitalorg
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Thank you
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