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991.
992.
What does the U.S. Medicare administrative claims database tell us about initial antiepileptic drug treatment for older adults with new‐onset epilepsy? 下载免费PDF全文
993.
Brian KP Goh 《World journal of gastroenterology : WJG》2015,21(34):9833-9837
The management of intraductal papillary mucinous neoplasms(IPMN) is presently evolving as a result of the improved understanding of the natural history and biological behavior of the different pancreatic cystic neoplasms; and better preoperative diagnosis of these neoplasms due to advancement in preoperative diagnostic tools. International consensus guidelines for the management of IPMN were first formulated in 2006 and subsequently revised in 2012. Both these guidelines were constructed based on expert opinion and not on robust clinical data. The main limitation of the original Sendai guidelines was that it had a low positive predictive value resulting in many benign neoplasms being resected. Hence,these guidelines were revised in 2012. However,although the updated guidelines resulted in an improvement in the positive predictive value over the Sendai Guidelines,the results of several studies validating these guidelines demonstrated that its positive predictive value remained low. Furthermore,although both guidelines were associated with high negative predictive values,several investigators have demonstrated that some malignant IPMNs may be missed. Finally,it is imperative to emphasize that major considerations when managing a patient with IPMN including the patient's surgical risk,life-expectancy and even cost of investigations are not taken into account in current guidelines. The management of a patient with IPMN should be individualized and tailored according to a patient's risk benefit profile for resection vs surveillance. 相似文献
994.
995.
Clinically non-functioning pituitary adenoma 总被引:2,自引:0,他引:2
Jaffe CA 《Pituitary》2006,9(4):317-321
Non-functioning pituitary tumors are relatively common. A large number of these tumors are incidentally found pituitary microadenomas
(<1 cm) and are usually of no clinical importance. Those tumors that require treatment are generally macroadenomas and come
to medical attention because of mass effect and/or hypopituitarism. Visual field defects are present in roughly 70% of patients
with non-functioning macroadenoma at the time of diagnosis and the majority of these patients have at least growth deficiency
and hypogonadism. By immunocytochemistry, the large majority of these tumors are glycoprotein producing and less commonly
they are non-functioning somatotroph, lactotroph or corticotoph adenomas. In contrast to the immunocytochemistry results,
only a minority of these tumors actively secrete intact gonadotrophs or glycoprotein subunits. Therapy is directed at eliminating
mass effect and correcting hypopituitarism. There are anecdotal reports of tumor shrinkage during therapy with either dopamine
agonists or somatostatin agonists; however tumor response to medical treatment is not reliable. For most patients, transphenoidal
resection of the tumor is the preferable primary treatment. Surgery improves visual defects in the majority of patients and
a lesser number will recover pituitary function. In the past, pituitary radiation was commonly administered following pituitary
surgery; however the need for routine radiation has recently been reevaluated. Although tumor recurrence at 10 years post
surgery may be as high as 50%, few patients with recurrence will have clinical symptoms. Close follow-up with surveillance
pituitary scans should be performed after surgery and radiation therapy reserved for patients having significant tumor recurrence. 相似文献
996.
Growth hormone deficiency (GHD) in adults may be of either adult or childhood onset and may occur as isolated GHD or as multiple
hormone deficiencies. Adult-onset GHD (AoGHD) usually results from damage to the pituitary gland or hypothalamus. GH is frequently
undetectable in normal subjects and thus GHD cannot be distinguished from the normal state using a single random GH measurement.
In general, a stimulation test is required to recognize GHD. Insulin tolerance test (ITT) has been considered the gold standard
by the most important scientific societies, although alternative tests, in particular GHRH plus arginine have been proposed
as valuable alternative to ITT. The clinical syndrome associated with AoGHD is characterized by a wide array of symptoms and
important chronic complications, such as cardiovascular complications, which may be responsible for an increased mortality.
The rationale for GH replacement in adults GHD patients is justified by the beneficial effects on some clinical end-points,
such as quality of life (QoL) and cardiovascular risk factors, whereas the effects on mortality risk are still controversial.
Over the recent years, guidelines on the use of rhGH as a substitution treatment in adult hypopituitarism have been issued
by international (Growth hormone research society-GRS, Endocrine Society) and relevant national (National Institute of Clinical
Excellence-UK, NICE) institutions. The aim of the paper is to review and discuss these guidelines. 相似文献
997.
Penelope Schofield Justine Diggens Catherine Charleson Rita Marigliani Michael Jefford 《Patient education and counseling》2010
Objective
Justifiable concerns around the use of complementary and alternative medicines (CAM) amongst cancer patients are becoming increasingly prominent. The aim was to develop evidence-based guidelines to assist oncology health professionals (HP) to have respectful, balanced and useful discussions with patients about CAM.Methods
A systematic review was conducted, covering relevant literature from 1997 to 2007. The level of evidence was rated using a standardized rating system. The evidence was qualitatively synthesised into structured recommendations by a multidisciplinary team including a consumer.Results
The search identified 78 original papers; 36 directly related to discussing CAM. No randomized controlled trials specifically addressing the methods or benefits of discussing CAM were identified. Evidence based guidelines are presented as a sequence of recommended steps: (1) Elicit the person's understanding of their situation; (2) Respect cultural and linguistic diversity and different epistemological frameworks; (3) Ask questions about CAM use at critical points in the illness trajectory; (4) Explore details and actively listen; (5) Respond to the person's emotional state; (6) Discuss relevant concerns while respecting the person's beliefs; (7) Provide balanced, evidence-based advice; (8) Summarize discussions; (9) Document the discussion; (10) Monitor and follow-up.Conclusion
This represents the first comprehensive guidelines for discussing CAM.Practice implications
Given the concerns surrounding CAM use, it is critical to encourage informed decision-making about CAM and ultimately, improve outcomes for patients. 相似文献998.
Leslie SJ Hartswood M Meurig C McKee SP Slack R Procter R Denvir MA 《Computers in biology and medicine》2006,36(5):495-506
OBJECTIVE: To develop and evaluate clinical decision support software (CDSS) to aid physicians treat patients with chronic heart failure (CHF). METHODS: The CDSS was developed after discussions with a multidisciplinary panel. Evaluation was performed in three stages over a 6 month period including an editorial check, one-to-one interviews with potential users and educational meetings with general practitioners (GPs), junior doctors and medical students during which the CDSS was assessed in a cross-over design against paper guidelines. Opinions of the CDSS and the computer literacy of the participants were assessed by questionnaire. RESULTS: There were several changes to the CDSS at various stages of development and evaluation. One-to-one interviews generated extensive qualitative feedback. GPs had lower computer literacy scores than junior doctors and students (both p<0.01). There were small trends when comparing the CDSS with paper guidelines. GPs scored less well (CDSS 75% vs. 80%, p=0.41), while junior doctors and medical students appeared to improve their scores (72%-84%, p=0.32 and 66%-77%, p=0.19, respectively). Most (70%) found the CDSS more useful than the written guidelines. CONCLUSION: Development of CDSS using guidelines and expert opinion requires a multidisciplinary iterative process of feedback and software adaptation. Barriers to implementation identified include lower computer literacy among GPs, a lack of complexity within CDSS in addressing non-medical needs of patients and a reluctance among medical staff to consult guidelines during patient consultations. Improving computer skills, integrating CDSS into referral pathways and requests for investigations may be ways of enhancing use of this emerging technology. 相似文献
999.
1000.
J. Roisné M. Delattre S. Rousseau A. Bourlet M.-L. Charkaluk 《Archives de pédiatrie》2018,25(2):95-99