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71.
Unauthorized migrants face health disadvantages in many receiving nations. However, few studies have explored precisely how the condition of “illegality” influences illness experiences, medical treatment, and convalescence. This article presents a case study from Germany (2004–2006 and 2008), where unauthorized migrants face limited access to health care and the threat of deportation results in avoidance of services and treatment delays. This is confounded by unique laws which essentially criminalize health care workers for aiding migrants. This article provides a snapshot of 183 patients who attended a Berlin clinic that functions as the single largest source of medical assistance for unauthorized persons in Germany. The demographic information sketches a picture of labor migrants with a mean age of approximately 29 years. More women than men presented at this clinic, a result of its ability to successfully arrange prenatal care and delivery as well as a reflection of local labor markets. The diversity of countries of origin (n = 55) is surprising, underscoring the utility of using illegal status as a unifying variable to highlight migrants' shared position in the global economy and the resulting barriers to basic medical services. Patients presented with a range of illnesses typical for their age group. However, the effects of illegal status resulted in four areas of disparities: 1) limits to the overall quality and quantity of care for mothers and infants; 2) delayed presentation and difficulties accessing a regular supply of medication for patients with chronic illnesses; 3) difficulties in accessing immediate medical attention for unpredictable injuries and other acute health concerns; and 4) a lack of mental health care options for generalized stress and anxiety affecting health. In Germany, an incoherent policy environment contributes to inadequate services and treatment delays. Solutions must address these legal ambiguities, which represent a primary barrier to equity in a nation with otherwise universal health coverage.  相似文献   
72.
This paper demonstrates the use of non-linear decomposition for identifying discrimination in referral to a cardiac rehabilitation (CR) program. The application is important because the methods are not commonly applied in this context. A secondary data analysis was conducted on a cohort of 2375 patients eligible for referral (as defined) to an Australian hospital outpatient CR program (1 July 1996 to 31 December 2000) on the basis of inpatient discharge diagnosis codes. Data from a population-based disease register were linked to hospital inpatient statistics and CR program records. Cohort selection was established in accordance with first register recorded hospital separations having specified cardiac inpatient diagnoses for which CR was recommended. Using the existing literature as a guide, multivariate logistic regression methods tested the strength of statistical association between independent variables (or ‘endowments’) and CR referral. Compared with males, females had 40% fewer odds of being referred. Non-linear decomposition was performed as a post-logistic regression technique to show the extent to which the sex-based inequality in referral (as defined here) was due to group characteristics (the relative distribution of endowments) compared with other influences not adjusted for in the model. The results showed that approximately 18% of the male–female inequality in referral was not explained by group characteristics, and on this basis was ‘discriminatory’. The extent to which individual endowments contributed to the explained part of the inequality was also of interest. The methods offer potentially useful tools for informing researchers, policy makers, clinicians and others about unfair discriminatory processes that influence access to health and social services.  相似文献   
73.
PurposeAdolescents frequently rely on emergency medical care, rather than using primary care providers (PCPs). Our objectives were to characterize a population of adolescents presenting to a large, urban emergency department (ED) and to examine the reasons why they present to the ED, rather than to their PCP's office.MethodsAdolescents ages 12 to 21 years and their parents/guardians were invited to participate and asked to complete a brief online survey. Demographic data and triage information were collected from electronic medical records.ResultsOf 203 participants, 66% (n = 134) had public insurance, and 40% (n = 82) were triaged as nonurgent. Nearly all (93%, n = 189) reported having a PCP or primary clinic. The most common reasons given for presenting to the ED were participant perception of illness requiring immediate care (34%), followed by PCP referral to the ED (21%). Those with public insurance (odds ratio = 4.44; 95% CI 2.01 to 9.81) or no insurance/unknown insurance status (odds ratio = 4.77; 95% CI 1.34 to 17.01) were more likely to be triaged as nonurgent than those with private insurance.ConclusionsMany adolescents in this study were triaged as nonurgent, with several participants perceiving they were acutely ill requiring immediate physician care. Further analyses revealed that private insurance was significantly associated with urgent triage status. Future studies could educate adolescents and families about appropriate use of the ED or examine PCP offices directly to determine practices for phone triage and ED referrals of adolescents.  相似文献   
74.

Objectives

To ascertain the impact of minor and major depression on self-reported use of and access to diabetes healthcare services, and the care components received in a community-based Quebec sample with type 2 diabetes.

Study design

Adults with type 2 diabetes who took part in baseline and 1-year follow-up telephone interviews for the Diabetes Health Study were assessed (n = 1175).

Methods

Information was collected regarding depression status (i.e. minor or major depression), use of and access to diabetes healthcare services, sociodemographic and diabetes characteristics, treatment, diabetes complications, disability, body mass index, residential area and depression.

Results

People with major depression were more likely to be high users or non-users of diabetes healthcare services. The high users reported more diabetes complications. People with major depression also reported more problems with accessing diabetes healthcare services, specifically having to wait too long between making their appointment and their visit, specialist care not being available in their area, general health deterioration, being unable to leave their house due to their health and problems with transportation. People with major depression were less likely to report having their feet checked by their doctor, and were more likely to report problems with getting advice from their doctor.

Conclusions

People with diabetes need to use healthcare services in order to receive recommended care components. People with major depression and no complications are less likely to report using healthcare services; conversely, people with major depression and complications are more likely to be high users of healthcare services. People with major depression perceive more problems with the health care they receive.  相似文献   
75.
Recent global debates on the research and development (R&D) of health technologies, such as drugs, diagnostics and vaccines, can be seen as a microcosm of discussions on the role of the World Health Organization (WHO) in the global health system more broadly. The global R&D system has come under heightened scrutiny with the publication of a 2012 report by the WHO Consultative Expert Working Group on Research and Development (CEWG), which made a number of recommendations to more equitably meet global health needs. The CEWG report followed a decade-long process of debate at the WHO on the weaknesses of the global R&D system, which include problems of affordability, limited research where market returns are small or uncertain (such as the ‘neglected diseases’ that predominantly affect the world's poorest), inefficient overlap of research efforts, and overuse of medicines such as antibiotics. The CEWG report called on WHO Member States to develop a global framework to improve monitoring, coordination and financing of R&D efforts through the establishment of a Global Health R&D Observatory and the negotiation of a binding treaty on R&D. While the treaty option has been put on the back-burner for several years, Member States nevertheless agreed at the 2013 World Health Assembly (WHA) on concrete steps towards a global framework. Progress at the 2013 WHA reaffirmed the central role of WHO as a convener, and the WHA's decision to create the Observatory within the WHO Secretariat underscored the organization's role as a source of strategic knowledge in the global health system. However, despite WHO's constitutional mandate as the ‘directing and coordinating authority on international health work’, in reality it faces major challenges in coordinating autonomous R&D actors such as states, firms and foundations in the global system. Strengthening its ability to do so requires, at a minimum, reforming its financing arrangements to provide it with a greater degree of independence from its largest donors. In addition, WHO may seem to be the natural arena for negotiating a binding R&D treaty, but negotiating new global agreements in other arenas such as the WTO, WIPO, or plurilateral fora offer the possibility of more enforceable and stronger public health norms. Nevertheless, no single arena in the existing system of global governance is perfectly suitable for the negotiation of progressive, inclusive, binding, enforceable, global health rules. While tradeoffs are inherent in the choice of any particular arena, leadership from either the multilateral institutions or influential governments can make a key difference in how beneficial any R&D treaty may be for health. In the coming years, global R&D debates will remain a critical issue to watch. The evolution of the global R&D system will be a harbinger not only of WHO's place in a rapidly-changing global health system, but also of our collective capacity to strengthen institutions of global governance for health.  相似文献   
76.
Despite efforts to create a universal, single-tiered Irish health system, an unequal "two-tiered" system persists. The future blueprint for Irish health care, Sláintecare, recommends a separation of public and private hospital treatment. This study examines patterns of overall and private hospital utilisation in Ireland that could help identify some of the impacts of the proposed separation of public and private hospital treatment. Using data from EU-SILC (2016) (n = 10,131) the factors associated with inpatient hospitalisation and private inpatient hospitalisation are estimated using probit models.Unsurprisingly, those who are economically inactive are more likely to have had an inpatient stay. Furthermore, those aged over 65, with a chronic illness, with a medical/ GP visit card and private health insurance and those with only private health insurance are also more likely to have had an inpatient stay. Those with only primary education are less likely to report an inpatient stay in private hospital. Those aged over 25 and less than 65, those with a medical/ GP visit card and private health insurance and those with only private health insurance are significantly more likely to opt for a private hospital. Understanding overall and private hospital utilisation patterns is imperative for implementing universal health care and associated resource planning and fulfilling policy recommendations.  相似文献   
77.
BackgroundMany low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits.ObjectiveOne national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility.MethodsTo better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels.ResultsMost participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff’s prior WIC participation and customers’ proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers.ConclusionsThese findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina’s recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.  相似文献   
78.
为加强医疗技术管理,规范新技术准入,从国家、北京市医疗技术监管现状出发,阐述了新技术准入管理范围、分类原则与审查形式、审查内容、工作职责、限制类医疗技术备案等管理实践。建议根据医院功能定位开展新技术准入审批;强化信息化建设,加强监管;建立区域内医院技术审查协同机制,以促进临床新技术开展,更好地保障医疗质量与安全  相似文献   
79.
目的对某院岗前医疗质量与安全准入培训工作进行回顾性分析,为患者安全培训持续发展提供参考。方法在培训结束时及培训结束3个月后,采用电子问卷方式对参与培训的新职工(2018年、2019年)进行培训课程满意度调查,利用SPSS 22.0软件对数据进行分析。结果培训成绩显示,2018年、2019年分别有74.4%、86.73%的新职工考核成绩≥70分;满意度调查结果显示,分别有96.26%(2018年)、97.12%(2019年)的新职工认为授课形式合理;仅7.48%(2018年)、2.88%(2019年)的新职工认为课程具有一定难度;绝大多数(95%以上)的新职工表示培训对临床工作有帮助,培训结束时、培训结束3个月后对于培训实用性的评价较好(P>0.05)。结论培训内容、授课形式、考核形式、师资团队的合理设计是岗前安全准入培训有效推进的基础,课程的优化应基于学员反馈与详尽的数据分析等。  相似文献   
80.
In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015 at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2 h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2 h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2 h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor.  相似文献   
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