收费全文 | 2883篇 |
免费 | 235篇 |
国内免费 | 150篇 |
耳鼻咽喉 | 9篇 |
儿科学 | 120篇 |
妇产科学 | 114篇 |
基础医学 | 419篇 |
口腔科学 | 122篇 |
临床医学 | 340篇 |
内科学 | 556篇 |
皮肤病学 | 57篇 |
神经病学 | 136篇 |
特种医学 | 443篇 |
外科学 | 244篇 |
综合类 | 58篇 |
一般理论 | 1篇 |
预防医学 | 198篇 |
眼科学 | 89篇 |
药学 | 246篇 |
1篇 | |
肿瘤学 | 115篇 |
2023年 | 17篇 |
2021年 | 44篇 |
2020年 | 21篇 |
2019年 | 31篇 |
2018年 | 42篇 |
2017年 | 25篇 |
2016年 | 26篇 |
2015年 | 34篇 |
2014年 | 46篇 |
2013年 | 101篇 |
2012年 | 81篇 |
2011年 | 91篇 |
2010年 | 80篇 |
2009年 | 73篇 |
2008年 | 91篇 |
2007年 | 188篇 |
2006年 | 113篇 |
2005年 | 124篇 |
2004年 | 110篇 |
2003年 | 61篇 |
2002年 | 89篇 |
2001年 | 91篇 |
2000年 | 83篇 |
1999年 | 84篇 |
1998年 | 98篇 |
1997年 | 92篇 |
1996年 | 91篇 |
1995年 | 77篇 |
1994年 | 56篇 |
1993年 | 69篇 |
1992年 | 50篇 |
1991年 | 77篇 |
1990年 | 61篇 |
1989年 | 108篇 |
1988年 | 77篇 |
1987年 | 75篇 |
1986年 | 65篇 |
1985年 | 57篇 |
1984年 | 39篇 |
1983年 | 32篇 |
1982年 | 44篇 |
1981年 | 26篇 |
1980年 | 20篇 |
1979年 | 23篇 |
1978年 | 24篇 |
1977年 | 28篇 |
1976年 | 46篇 |
1975年 | 25篇 |
1971年 | 21篇 |
1969年 | 17篇 |
Purpose
Cost effectiveness is an increasingly important factor in today’s healthcare environment, and selection of arthroplasty implant is not exempt from such concerns. Quality adjusted life years (QALYs) are the typical tool for this type of evaluation. Using this methodology, joint arthroplasty has been shown to be cost effective; however, studies directly comparing differing prostheses are lacking.Methods
Data was gathered in a single-centre prospective double-blind randomised controlled trial comparing the outcome of modern and traditional knee implants, using the Short Form 6 dimensional (SF-6D) score and quality adjusted life year (QALY) methodology.Results
There was significant improvement in the SF-6D score for both groups at one year (p?<?0.0001). The calculated overall life expectancy for the study cohort was 15.1 years, resulting in an overall QALY gain of 2.144 (95 % CI 1.752–2.507). The modern implant group demonstrated a small improvement in SF-6D score compared to the traditional design at one year (0.141 versus 0.143, p?=?0.94). This difference resulted in the modern implant costing £298 less per QALY at one year.Conclusion
This study demonstrates that modern implant technology does not influence the cost-effectiveness of TKA using the SF-6D and QALY methodology. This type of analysis however assesses health status, and is not sensitive to joint specific function. Evolutionary design changes in implant technology are thus unlikely to influence QALY analysis following joint replacement, which has important implications for implant procurement. 相似文献Patients with pelvic and acetabular fractures often have considerable pain in the perioperative period. Regional anesthesia (RA) including peripheral nerve blocks and spinal analgesia may reduce pain. However, the real-world impact of these modalities on inpatient opioid consumption and outpatient opioid demand is largely unknown. The purpose of this study was to evaluate the impact of perioperative RA on inpatient opioid consumption and outpatient opioid demand.
MethodsThis is a retrospective, observational review of inpatient opioid consumption and outpatient opioid demand in all patients ages 18 and older undergoing operative fixation of pelvic and acetabular fractures at a single Level, I trauma center from 7/1/2013–7/1/2018 (n = 205). Unadjusted and adjusted analyses were constructed to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand while controlling for age, sex, race, body mass index (BMI), smoking, chronic opioid use, ASA score, injury mechanism, additional injuries, open injury, and additional inpatient surgery.
ResultsAdjusted models demonstrated increases in inpatient opioid consumption in patients with RA (12.6 estimated OE’s without RA vs 16.1 OE’s with RA from 48 to 72 h post-op, p < 0.05) but no significant differences at other timepoints (17.5 estimated OE’s without RA vs 16.8 OE’s with RA from 0 to 24 h post-op, 15.3 vs 17.1 from 24 to 48 h post-op, p > 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at discharge to 90 days post-op (and 156.8 vs 207.9 OE’s to 90 days, p < 0.05) but did not differ significantly before that time (121.5 OE’s without RA vs 123.9 with RA from discharge to two weeks, 145.2 vs 177.2 OE’s to 6 weeks, p > 0.05).
DiscussionIn pelvis and acetabulum fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics. Regional anesthesia may not be beneficial for these patients.
相似文献Objectives
In order to address the current deficiency of health utility evidence relevant for economic evaluations involving treatments for rheumatoid arthritis (RA) in the Chinese setting, this study aims to develop a mapping algorithm linking the Health Assessment Questionnaire (HAQ) and EQ-5D-5L in a Chinese population of patients with RA.Methods
An estimation sample was obtained from a cross-sectional study that collected HAQ, the pain Visual Analogue Scale, and EQ-5D-5L in RA patients in two tertiary referral hospitals in China. Mapping algorithms were derived in this study using two alternative regression methods: the beta regression and a multivariate ordered probit regression. The internal validity of the mapping algorithms was assessed in each case by calculating predictive performance using a bootstrapping procedure.Results
Of the several algorithms developed using these data, predictive performance was shown to be better when VAS pain was included as a predictor and when the multivariate ordered probit regression method was used, rather than the beta regression method. The algorithms developed were shown to be comparable, in terms of predictive performance, to existing mapping studies despite the small sample size of the estimation data.Conclusion
It is hoped that the availability of these algorithms will facilitate the development of cost-effectiveness studies evaluating RA treatments in the Chinese health care setting.Methods: Using data from 329 Latino dyads from the Building Strong Families (BSF) Project, a structural equation model examining the actor-partner interactions between partner perceptions of couple functioning and each person's alcohol use was analyzed. Results: Correlation analysis revealed that the dyad's perceptions of couple functioning were positively correlated. Results from the APIM model indicated male's perceptions of couple functioning was positively associated with his own alcohol use, whereas female's perceptions of couple functioning was not significantly related to either partner's alcohol use. Conclusions/Importance: The findings may help clinicians, researchers, and policy makers to better conceptualize how couple functioning may impact alcohol use among Latino dyads. 相似文献