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1.
《Pancreatology》2022,22(5):598-607
BackgroundResections for intraductal papillary mucinous neoplasia (IPMN) have increased dramatically during the last decade. Recurrence pattern and impact of adjuvant chemotherapy for solid pancreatic ductal adenocarcinoma (PDAC) is well known, but not for invasive IPMN (inv-IPMN).ObjectivesTo elucidate the impact of spatio-temporal recurrence pattern and adjuvant chemotherapy on overall survival for inv-IPMN compared with PDAC.MethodsWe conducted a retrospective single-center observational study of consecutive patients ≥18 years of age who underwent resection for inv-IPMN or PDAC at Karolinska University Hospital, between 2009 and 2018. Different initial recurrence sites and time frames as well as predictors for death were assessed with multivariable Cox and logistic regressions. Survival analyses were performed using the Kaplan-Meier model and log rank test.ResultsOf 396 resected patients, 92 were inv-IPMN and 304 PDAC. Both recurrence rate and death rate within three-years were lower for inv-IPMN compared to PDAC (p = 0.006 and p = 0.007 respectively). Across the whole cohort, the most common recurrence patterns were multi-site (25%), single-site liver (21%) and single-site locoregional (10%) recurrence. The most prominent predictors for death in multivariable Cox regression, especially if occurred within the first year, were multi-site (HR 17.0), single-site peritoneal (HR 13.6) and single-site liver (HR 13.1) recurrence. These predictors were less common in inv-IPMN compared to PDAC (p = 0.007). The effect of adjuvant chemotherapy was similar in the two groups.ConclusionResected inv-IPMN exhibits a less aggressive recurrence pattern than PDAC that translates into a more favorable overall survival.  相似文献   
2.
BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.  相似文献   
3.
提出一种面向医院患者的视觉监控跌倒检测算法,解决患者由于意外跌倒不能被及时发现的问题,为医护人员快速处理患者跌倒等异常行为提供必要的技术保障。方法:首先,基于深度神经网络模型检测监控图像中人体关节点(如肩部、肘部、腕部、胯部、膝关节等)在图像中的位置,再根据亲和度向量场模型提取人体骨架,最后计算患者躯干、腿部与地面的夹角作为判别性特征,判断监控区域内是否有患者出现意外跌倒。结果:实验结果表明,本文所提算法在实际的医院监护环境中的处理速度高达25帧/s,检测准确率高达96%。结论:该方法能够实时、准确地提取医院环境下患者的行为特征,并针对意外跌倒情况发出警报,为医护人员监测患者跌倒等异常行为提供更准确、方便的计算机辅助医疗护理方法。  相似文献   
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目的 了解粤西某市城区寄宿的中学生饮食行为现状与影响因素,为探索干预方法提供依据。方法 自编调查问卷,2021年10月对某城区全部有食宿条件的10所中学,用分层抽样法现场调查547名初一至高二学生,对5种饮食行为与相关因素进行描述分析和logistic回归分析。结果 饮食的5种行为不良率从高到低依次为:吃外卖(49.0%)、不吃早餐(31.7%)、喝奶茶(24.3%)、吃夜宵(11.8%)、零食代餐(1.3%);“学生可支配费用少于100元/星期”“学校饭堂饮食口味评价——不满意”两个因素均能促成5种不良饮食行为发生(P<0.05),“饮食重要性感知意识——不重要”因素对“喝奶茶”“吃夜宵”行为影响强度最大(OR=4.386,P=0.019;OR=5.780,P=0.006);女生能促成“吃外卖”(OR=1.586,P=0.015)和“喝奶茶”(OR=1.770,P=0.010),“每星期可支配消费超过200元以上”能促成“吃外卖”和“吃夜宵”(OR=2.346,P=0.001;OR=2.585,P=0.009)。结论 城区寄宿学校中学生不良饮食行为问题突出,不满学校饭堂饮食口味对促发不良饮食行为影响最广,“认为饮食不重要”是促发不良行为产生的最强因素,亟须加强寄宿中学饮食支持条件的管理,加强学生饮食健康教育,控制当前城市寄宿学校中学的学生不健康饮食行为。  相似文献   
6.
陈楚媛  沈勤 《护理学杂志》2022,27(20):90-93
目的 了解医养结合机构非卧床老年人衰弱现状,并分析其影响因素,以期为机构内医护人员优化非卧床老年人护理和健康教育方案提供参考依据。方法 采用便利抽样法选取杭州市3家医养结合机构的489名非卧床老年人为研究对象,采用中文版Tilburg衰弱量表对其进行调查。结果 非卧床老年人衰弱得分5.00(3.00,8.00)分,衰弱发生率为53.99%;logistic回归分析显示,文化程度、家人探望频率和刷牙频次是衰弱发生的保护因素,使用移动辅助器具、每日静坐时间和假牙数量是衰弱发生的危险因素(均P<0.05)。结论 医养结合机构非卧床老年人衰弱发生率较高,影响因素较多。护理人员应重视非卧床老年人的衰弱现状,采取综合性策略进行个体化干预。  相似文献   
7.
BackgroundLimited data are available on objectively measured physical activity (PA) and sedentary behavior (SB) among adults with and without visual impairment (VI).ObjectiveTo compare PA and SB levels and patterns in adults with and without VI and to examine how these differ based on sex and day of the week.MethodsThirty-two participants with VI and 32 participants without VI participated in this cross-sectional study. PA and SB were assessed using GT3X ActiGraph accelerometers during waking hours for 7 days, and variables were examined in terms of disability group, sex, and day of the week. Nonparametric Mann–Whitney U test and Wilcoxon signed-rank test were used, and significance was set at p < 0.05.ResultsPA did not differ in terms of sex or day of the week in participants with VI. The PA of participants without VI was significantly higher for men than it was for women and was significantly higher during weekdays than on weekend days. Total sedentary time and the duration of SB breaks were significantly longer for female participants with VI than for those without VI. The number of sedentary bouts lasting ≥10 min during weekend days was significantly higher for participants with VI than for those without VI.ConclusionsMost adults with and without VI did not meet the recommended levels of daily PA and spend a large portion of the day being sedentary. Interventions to enhance PA and reduce sedentary time in adults with and without VI are required.  相似文献   
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9.
ObjectivesOur aim was to evaluate the effect of the updated European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group 2019 definitions for invasive pulmonary aspergillosis (IPA) on patient classification and the related all-cause 12-week mortality.MethodsIn this retrospective cohort study from our tertiary care centre, we reclassified patients with haematological malignancy who underwent bronchoalveolar lavage between 2014 and 2019 for suspected IPA using the novel EORTC 2019 criteria. We performed receiver operating characteristic curve analysis to define the optimal cut-off for positive PCR and galactomannan and present survival analyses and their possible association with these diagnostic criteria through post hoc comparisons with log rank and Cox regression.ResultsFrom 323 episodes of suspected IPA in 282 patients, 73 were reclassified: 31 (42.5%) from possible to probable IPA, 5 (6.8%) from EORTC criteria not met to probable IPA, and 37 (50.7%) from EORTC criteria not met to possible IPA. Probable IPA increased therefore 11.1% (64/323, 19.8% to 100/323, 30.9%), mostly due to positive PCR (31/36, 86.1%). There was no difference in mortality between newly defined possible and probable IPA (log rank p = 0.950). Mortality was higher in probable cases with lower cycle thresholds (Ct values) versus higher Ct values (p = 0.004). Receiver operating characteristic curve analysis showed an optimal Ct value cut-off of 36.8 with a sensitivity of 75% (95% CI 64.9%–85.1%) and a specificity of 61.7% (95% CI 53.5–69.9) for 12-week mortality.DiscussionThe new EORTC criteria led to 11.1% more probable IPA diagnoses, mostly due to Aspergillus PCR. Restricting positive PCR to below a certain threshold might improve the discrimination of the new EORTC IPA categories for mortality.  相似文献   
10.
青少年时期的饮食行为是影响个体营养状况的重要因素,但目前青少年中各种不良饮食行为普遍存在。本文通过中国知网(CNKI)、PubMed等中英文数据库检索收集相关文献,阐述近年来青少年饮食行为的流行情况,包括蔬菜水果摄入、奶类制品摄入、早餐行为、零食行为等,从个体、人际、社会层面探讨青少年饮食行为的影响因素,并总结了基于场所、行为理论和新媒体技术而开展的青少年不良饮食行为及营养干预研究现况,为探索有效的干预策略,促进青少年健康饮食行为及营养健康提供参考。  相似文献   
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