全文获取类型
收费全文 | 138篇 |
免费 | 9篇 |
专业分类
耳鼻咽喉 | 3篇 |
儿科学 | 2篇 |
妇产科学 | 2篇 |
基础医学 | 13篇 |
口腔科学 | 13篇 |
临床医学 | 19篇 |
内科学 | 20篇 |
皮肤病学 | 1篇 |
神经病学 | 7篇 |
特种医学 | 6篇 |
外科学 | 21篇 |
综合类 | 8篇 |
预防医学 | 9篇 |
药学 | 7篇 |
中国医学 | 10篇 |
肿瘤学 | 6篇 |
出版年
2024年 | 1篇 |
2023年 | 5篇 |
2022年 | 16篇 |
2021年 | 4篇 |
2020年 | 9篇 |
2019年 | 26篇 |
2018年 | 28篇 |
2017年 | 19篇 |
2016年 | 6篇 |
2015年 | 5篇 |
2014年 | 13篇 |
2013年 | 9篇 |
2012年 | 2篇 |
2011年 | 2篇 |
2009年 | 1篇 |
2006年 | 1篇 |
排序方式: 共有147条查询结果,搜索用时 46 毫秒
51.
《Mayo Clinic proceedings. Mayo Clinic》2014,89(5):687-696
The impact of second opinions on diagnosis in radiology and pathology is well documented; however, the value of patient-initiated second opinions for diagnosis and treatment in general medical practice is unknown. We conducted a systematic review of patient-initiated second opinions to assess their impact on clinical outcomes and patient satisfaction and to determine characteristics and motivating factors of patients who seek a second opinion. We searched PubMed, EMBASE, Cochrane, and Academic OneFile databases using Medical Subject Headings (MeSH) indexes and keyword searches. Search terms included referral and consultation, patient-initiated, patient preference, patient participation, second opinion, second review, and diagnosis. Multiple reviewers screened abstracts and articles to determine eligibility and extract data. We assessed risk of bias using the Cochrane Risk of Bias Tool and rated study quality using Cochrane's GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. We screened 1342 abstracts and reviewed full text of 41 articles, identifying 7 articles that reported clinical agreement data and 10 that discussed patient characteristics, motivation, and satisfaction. We found that a second opinion typically confirms the original diagnosis or treatment regimen but that 90% of patients with poorly defined conditions remain undiagnosed. However, 10% to 62% of second opinions yield a major change in the diagnosis, treatment, or prognosis. A larger fraction of patients receive different advice on treatment than on diagnosis. Factors motivating a second opinion include diagnosis or treatment confirmation, dissatisfaction with a consultation, desire for more information, persistent symptoms, or treatment complications. Patients generally believed that second opinions were valuable. Second opinions can result in diagnostic and treatment differences. The literature on patient-initiated second opinions is limited, and the accuracy of the second opinion through follow-up is generally unknown. Standardized methods and outcome measures are needed to determine the value of second opinions, and the potential of second opinions to reduce diagnostic errors merits more rigorous evaluation. 相似文献
53.
Fan Zhang Yuan Yang Han Lei Jingfu Qiu Yang Wang Dayi Hu Laura Skrip Fangchun Chen 《Human immunology》2013
The present meta-analysis was conducted to investigate the association between the −1082G/A and −819C/T polymorphisms of the IL-10 gene and risk of type 2 diabetes mellitus (T2DM). Relevant articles were identified by searching PubMed, Embase, and Web of Science. Pooled odds ratios (ORs) were used to assess the strength of the association between target polymorphisms and the risk of T2DM. Significant associations between the −1082G/A polymorphism and T2DM were found for the allele contrast (OR = 0.90, 95% CI: [0.83, 0.98], P = 0.02), homozygote contrast (OR = 0.82, 95% CI: [0.69, 0.97], P = 0.02), and recessive genetic model (OR = 0.85, 95% CI: [0.74, 0.96], P = 0.01). However, no significant association was found for the dominant genetic model (OR = 0.91, 95% CI: [0.80, 1.05], P = 0.08). The association between −819C/T polymorphism and T2DM was significant for the allele contrast (OR = 0.73, 95% CI: [0.64, 0.84], P < 0.01); however, no significant associations were found for −819C/T in the homozygote contrast (OR = 1.01, 95% CI: [0.38, 2.67], P = 0.99), dominant genetic model (OR = 0.94, 95% CI: [0.50, 1.77], P = 0.86), and recessive genetic model (OR = 0.92, 95% CI: [0.50, 1.68], P = 0.78). No significant publication bias was detected. This meta-analysis suggests that allele A of −1082G/A and allele C of −819C/T in the IL-10 gene have potentially protective effects in terms of risk of T2DM. 相似文献
54.
《Journal of the American Dental Association (1939)》2014,145(2):165-178
BackgroundThe reference standard for the diagnosis of pediatric sleep-disorder breathing (SDB) is a full polysomnography (PSG) (an overnight sleep study). There are many obstacles to children being able to undergo a full PSG; therefore, the authors evaluated the diagnostic value of alternative diagnostic methods (clinical history and physical examination) for pediatric SDB.Types of Studies ReviewedThe authors selected articles in which the investigators' primary objective was to evaluate the diagnostic capability of physical evaluations and questionnaires compared with the current reference standard (that is, a full PSG) to diagnose SDB in children younger than 18 years. The authors searched several electronic databases without limitations.ResultsUsing a two-step selection process, the authors identified 24 articles and used them to conduct a qualitative analysis. They conducted a meta-analysis on 11 of these articles. Among these articles, only one involved a test that had diagnostic accuracy good enough to warrant its use as a screening method for pediatric SDB, but its diagnostic accuracy was not sufficient to be considered a true diagnostic tool (that is, a replacement for full PSG) for pediatric SDB.Practical ImplicationsThe involvement of dentists in the screening process for pediatric SDB can contribute significantly to children's health. The identified questionnaire could be considered an acceptable screening test to determine which children to refer to a sleep medicine specialist. 相似文献
55.
目的 评价近5年中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析的报告质量,以期规范其研究过程和报告方法,提升系统评价/Meta分析质量。方法 计算机检索CNKI、VIP、CBM和Wanfang数据库,搜集中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析研究,检索时限为2015年1月—2020年6月。由2名研究者独立筛选文献、提取资料,采用系统评价和Meta分析优先报告的条目进行报告质量评价;采用Office Excel 2019、Stata 15.0软件对相关数据进行统计和分析。结果 共纳入干预性系统评价/Meta分析176篇,其PRISMA评分为14.5~24.5分(20.17±2.00),其中有1篇研究评分≤15分,有严重信息缺失;122篇评分为15~21分,存在一定报告缺陷;53篇评分为21~27分,报告相对完全。报告质量不足主要表现为结构式摘要(0/176),方案和注册(0/176),检索策略(55/176),研究间偏倚(26/176)和资金支持(0/176)报告不全面。亚组分析结果显示:有基金资助、作者单位性质为医院和单位数为1个可明显提高系统评价/Meta分析报告质量(P<0.05);作者人数对系统评价/Meta分析的报告质量影响不显著(P>0.05)。结论 目前,我国护理领域干预性系统评价/Meta分析的报告质量差异较大。因此,有必要采取相应的措施,加大对PRISMA的宣传和普及,推动其在护理期刊稿约中的引用;研究人员应严格遵守PRISMA相关条目,规范、详细地进行报告;护理期刊的编辑和审稿人在同行评审阶段也要严格遵循PRISMA的指导方针,以期提高系统评价/Meta分析的质量。 相似文献
56.
57.
Maurizio Cutolo Amber Vanhaecke Barbara Ruaro Ellen Deschepper Claudia Ickinger Karin Melsens Yves Piette Amelia Chiara Trombetta Filip De Keyser Vanessa Smith 《Autoimmunity reviews》2018,17(8):775-780
Objectives
A reliable tool to evaluate flow is paramount in systemic sclerosis (SSc). We describe herein on the one hand a systematic literature review on the reliability of laser speckle contrast analysis (LASCA) to measure the peripheral blood perfusion (PBP) in SSc and perform an additional pilot study, investigating the intra- and inter-rater reliability of LASCA.Methods
A systematic search was performed in 3 electronic databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In the pilot study, 30 SSc patients and 30 healthy subjects (HS) underwent LASCA assessment. Intra-rater reliability was assessed by having a first anchor rater performing the measurements at 2 time-points and inter-rater reliability by having the anchor rater and a team of second raters performing the measurements in 15 SSc and 30 HS. The measurements were repeated with a second anchor rater in the other 15 SSc patients, as external validation.Results
Only 1 of the 14 records of interest identified through the systematic search was included in the final analysis. In the additional pilot study: intra-class correlation coefficient (ICC) for intra-rater reliability of the first anchor rater was 0.95 in SSc and 0.93 in HS, the ICC for inter-rater reliability was 0.97 in SSc and 0.93 in HS. Intra- and inter-rater reliability of the second anchor rater was 0.78 and 0.87.Conclusions
The identified literature regarding the reliability of LASCA measurements reports good to excellent inter-rater agreement. This very pilot study could confirm the reliability of LASCA measurements with good to excellent inter-rater agreement and found additionally good to excellent intra-rater reliability. Furthermore, similar results were found in the external validation. 相似文献58.
Etienne St-Louis Nadia Safa Elena Guadagno Robert Baird 《Journal of pediatric surgery》2018,53(5):946-958
Background
Gastrostomy tubes are a common adjunct to the care of vulnerable pediatric patients. This study systematically evaluates the epidemiology and risk-factors for gastrocutaneous fistulae (GCF) after gastrostomy removal in children and reviews treatment options focusing on nonoperative management (NOM).Methods
After protocol registration (CRD-42017059565), multiple databases were searched. Studies describing epidemiology in children and GCF treatment at any age were included. Critical appraisal was performed (MINORS risk-of-bias assessment tool). One-sided meta-analysis was executed to estimate efficacy of therapeutic adjuncts using a random-effects model.Results
Sixteen articles evaluating pediatric GCF were identified. 44% defined GCF as persistence > 1 month which occurred in 31 ± 7% of cases. Risk factors for pediatric GCF include age at gastrostomy, timing of removal, open technique, and fundoplication. Mean MINORS score was 0.60 ± 0.16. Seventeen additional studies were identified reporting 142 patients undergoing NOM (endoscopic, systemic, and local therapies), and one pediatric comparative study was identified. Overall aggregate proportion of GCF closure after any NOM is 77% (80% success rate in local/systemic therapies; 75% success rate in endoscopic approaches). No adverse events were reported.Conclusion
Persistent GCF complicates the management of gastrostomies in 1/3 of children with predictable risk factors. Several treatment options exist that obviate the need for general anesthesia. Their efficacy is unclear. Further prospective investigations are clearly warranted.Level of Evidence
III — Systematic Review and Meta-Analysis Based on Retrospective Case Control Studies. 相似文献59.
Etienne St-Louis Marcus Oosenbrug Tara Landry Robert Baird 《Journal of pediatric surgery》2018,53(5):879-884
Background
Pediatric surgical randomized clinical trials (RCTs) are labor-intensive and costly. This systematic review investigated patient accrual and estimates of study duration in RCTs by interrogating enrollment and registration practices.Methods
We performed a peer-review search of multiple databases from 2000 to 2016 evaluating RCTs salient to the field with inclusion mandated that a self-identified pediatric surgeon be listed as an author. Trial registries were also searched. RCTs were appraised, and predictors of success were evaluated using multivariate logistic regression, with success defined as achievement of recruitment objectives.Results
After screening, 137 RCTs were analyzed. Mean Jadad score was 1.80 (median = 2). CONSORT scores ranged between 17% and 97% (median = 58%). Sixty-seven studies described sample-size determination, 49 reported projected enrollment, and 26 were successful. Among 26 registered RCTs, 15 disclosed their expected completion date, which was achieved by 8. On average, protocols underwent 3.42 iterations. 9% of trials were terminated before completion, most commonly owing to poor recruitment. Trial registration and urgent cases significantly predicted success on multivariable analysis (p < 0.05).Conclusion
Overall quality of reporting in pediatric surgical trials is poor. Sample-size calculation and patient accrual are frequently poorly performed or underestimated, resulting in trial overrun and/or premature termination. These data may help inform subsequent study design and facilitate successful completion.Level of Evidence
Level III—Systematic Review and Observational (Case–Control) Analysis. 相似文献60.
Jiae Choi Ju Ah Lee Zainab Alimoradi Myeong Soo Lee 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1395-1402