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1.
《Brain stimulation》2022,15(5):1269-1278
BackgroundDeep brain stimulation of the internal globus pallidus (GPi DBS) is an invasive therapeutic modality intended to retune abnormal central nervous system patterns and relieve the patient of dystonic or other motor symptoms.ObjectivesThe aim of the presented research was to determine the neuroanatomical signature of GPi DBS modulation and its association with the clinical outcome.MethodsThis open-label fixed-order study with cross-sectional validation against healthy controls analysed the resting-state functional MRI activity changes induced by GPi DBS in 18 dystonia patients of heterogeneous aetiology, focusing on both global (full brain) and local connectivity (local signal homogeneity).ResultsCompared to the switched-off state, the activation of GPi DBS led to the restoration of global subcortical connectivity patterns (in both putamina, diencephalon and brainstem) towards those of healthy controls, with positive direct correlation over large-scale cortico-basal ganglia-thalamo-cortical and cerebellar networks with the clinical improvement. Nonetheless, on average, GPi DBS also seemed to bring local connectivity both in the cortical and subcortical regions farther away from the state detected in healthy controls. Interestingly, its correlation with clinical outcome showed that in better DBS responders, local connectivity defied this effect and approached healthy controls.ConclusionsAll in all, the extent of restoration of both these main metrics of interest towards the levels found in healthy controls clearly correlated with the clinical improvement, indicating that the restoration of network state towards more physiological condition may be a precondition for successful GPi DBS outcome in dystonia.  相似文献   
2.
公立医院的利益相关者众多,利益诉求存在差异,而且只有少数利益相关者处于主导地位,非均衡博弈不利于公益性的实现。公立医院利益相关者的利益均衡需要建立良好的利益协调机制,保证各利益相关者利益的有效实现。公立医院的利益协调不是通过政府、市场或社会单方面可以实现的,需要整合各方力量,优势互补,有必要建立利益相关者共同治理机制,实现利益的整合和协调。  相似文献   
3.
《Vaccine》2020,38(45):7118-7128
IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.  相似文献   
4.
Background/PurposeA small number of Hirschsprung disease (HD) patients develop inflammatory bowel disease (IBD)-like symptoms after pullthrough surgery. The etiology and pathophysiology of Hirschsprung-associated IBD (HD-IBD) remains unknown. This study aims to further characterize HD-IBD, to identify potential risk factors and to evaluate response to treatment in a large group of patients.MethodsRetrospective study of patients diagnosed with IBD after pullthrough surgery between 2000 and 2021 at 17 institutions. Data regarding clinical presentation and course of HD and IBD were reviewed. Effectiveness of medical therapy for IBD was recorded using a Likert scale.ResultsThere were 55 patients (78% male). 50% (n = 28) had long segment disease. Hirschsprung-associated enterocolitis (HAEC) was reported in 68% (n = 36). Ten patients (18%) had Trisomy 21. IBD was diagnosed after age 5 in 63% (n = 34). IBD presentation consisted of colonic or small bowel inflammation resembling IBD in 69% (n = 38), unexplained or persistent fistula in 18% (n = 10) and unexplained HAEC >5 years old or unresponsive to standard treatment in 13% (n = 7). Biological agents were the most effective (80%) medications. A third of patients required a surgical procedure for IBD.ConclusionMore than half of the patients were diagnosed with HD-IBD after 5 years old. Long segment disease, HAEC after pull through operation and trisomy 21 may represent risk factors for this condition. Investigation for possible IBD should be considered in children with unexplained fistulae, HAEC beyond the age of 5 or unresponsive to standard therapy, and symptoms suggestive of IBD. Biological agents were the most effective medical treatment.Level of EvidenceLevel 4  相似文献   
5.
BackgroundMeasurement of sexual function typically uses self-report, which, to work as intended, must use language that is understood consistently by diverse respondents. Commonly used measures employ multiple terms, primarily (sexual) interest, desire, and arousal, that might not be understood in the same way by laypeople and professionals.AimTo inform self-reported measurement efforts for research and clinical settings by examining how US men and women recruited from a health care setting understand and interpret different terms.MethodsWe conducted 10 focus groups in Durham, NC (N = 57). Discussions were audio-recorded and transcribed, and the content of the discussions was systematically analyzed in 2 phases of coding by the research team, facilitated by Nvivo qualitative analysis software (QSR International, Doncaster, VIC, Australia).OutcomesPatient focus group discussions about the meanings and connotations of multiple terms related to sexual function, especially interest, desire, and arousal.Results5 groups included male participants and 5 included female participants. Participants characterized (sexual) interest as a cognitive phenomenon and a situational response to a specific person. Similarly, they characterized (sexual) desire as a situational person-specific experience with some support for it as a cognitive phenomenon but more support for it as a physical phenomenon. In contrast, participants characterized sexual arousal as a physical phenomenon occurring in response to physical or visual stimulation and not related to a specific person.Clinical ImplicationsThese results can help us understand how laypeople are using and responding to these terms when they are used in clinical and research settings.Strengths and LimitationsPatient participants in these groups were diverse in age, gender, sexual orientation, and health, with the potential to voice diverse perspectives on sexual functioning; however, the sample was limited to a single city in the southeastern United States.ConclusionThe meanings of interest, desire, and arousal were defined, compared, and contrasted in the context of patient focus groups. Qualitative coding showed that interest was considered the most “cognitive,” arousal the most “physical,” and desire somewhere in between.DeLamater JD, Weinfurt KP, Flynn KE. Patients' Conceptions of Terms Related to Sexual Interest, Desire, and Arousal. J Sex Med 2017;14:1327–1335.  相似文献   
6.
《Clinical gerontologist》2013,36(1):101-112
Abstract

This paper describes a novel shared-interest group intervention program to promote socialization and enhance self-efficacy in a sample of 276 older adults who resided in several low-income senior independent living settings. Shared interest groups were initiated and informally evaluated. They were very well received by residents overall, and suggest their value for reducing loneliness and promoting satisfying relationships. Specific recommendations are provided to help initiate such groups in other residential settings.  相似文献   
7.
目的:了解实习护生对基础护理操作项目的兴趣程度并分析其原因,为学校和临床老师的带教提供帮助。方法:采用调查表对实习护生进行问卷调查,了解其对基础护理操作的兴趣程度,及对护士职业的社会地位和发展前景的看法。结果:护生们较感兴趣大多是静脉输液等专业性较强的操作,不感兴趣的大多是床上洗头、吸痰等生活和排泄方面的操作;本科生感兴趣人数的百分比要比专科生明显偏低。结论:护生对基础护理操作项目的兴趣大小与专业思想稳定与否、操作项目的技术含量大小、工作内容的重复单调以及学历的高低有关。  相似文献   
8.
目的调查当前城市工作者的工作价值观的影响因素。方法以南京市943名城市工作者为研究对象,采用问卷调查,通过验证性因素分析、独立样本t检验等方法对数据进行统计处理。结果工作价值观问卷的信效度指标均达到测量学要求。男工作者比女工作者更重视兴趣自主和自我发展(t=2.65,t=2.47,P〈0.05),女工作者比男工作者更重视福利待遇(t=2.89,P〈0.05)。高年龄组男工作者更重视福利待遇(t=2.75,P〈0.01),低年龄组女工作者注重福利待遇和自我发展(t=2.54,P〈0.05;t=2.70,P〈0.01)。高学历男工作者则更重视工作的兴趣自主(t=2.64,P〈0.01),低学历男女工作者均较看重福利待遇(t=2.30,P〈0.05;t=3.24,P〈0.001),且低学历女工作者还注重自我发展(t=3.04,P〈0.01)。结论城市工作者的工作价值观随不同性别、年龄和学历而异。  相似文献   
9.
BackgroundThe experience of distressing low sexual interest/arousal—female sexual interest/arousal disorder (FSIAD)—is prevalent in women of all ages and is associated with poorer sexual, relationship, and psychological well-being than women without this difficulty. Women who are partnered are almost 5 times more likely to be distressed by low desire and to receive a diagnosis of FSIAD than unpartnered women, indicating that interpersonal factors are highly relevant, although largely neglected in past research.AimIn a dyadic cross-sectional and longitudinal study, we examined whether partner responses to FSIAD were associated with the sexual, relationship, and psychological well-being of couples, and whether any effects persisted 1 year later.MethodsWomen diagnosed with FSIAD (N = 89) completed a validated measure of perceived partner positive vs negative responses to their low sexual interest/arousal and their partners reported on their own responses, as well as measures of sexual desire, sexual satisfaction, relationship satisfaction, sexual distress, and anxiety. 1 year later, couples (N = 66) completed the outcome measures again. Data were analyzed according to the Actor-Partner Interdependence Model.OutcomesOutcomes included were the Sexual Desire Inventory–Solitary and Partner-Focused Subscales; Global Measure of Sexual Satisfaction; Female Sexual Distress Scale; Couple Satisfaction Index; and State-Trait Anxiety Inventory–Short-Form.ResultsWhen women with FSIAD perceived more positive partner responses (eg, warm, supportive, compassionate) than negative responses (eg, hostile, unsupportive, indifferent), they were more satisfied with the relationship and they and their partners reported lower anxiety. When partners reported more positive than negative responses, they had greater relationship and sexual satisfaction and lower sexual distress and anxiety. Exploratory analyses revealed that women's perceptions of their partners' responses accounted for the link between partners' own responses and women's relationship satisfaction and anxiety. Partner responses did not predict any change in outcomes over time.Clinical ImplicationsFindings support interpersonal conceptualizations of FSIAD and may inform the development of future couple-based interventions.Strengths & LimitationsThis study is one of the few dyadic investigations of FSIAD, as diagnosed via a clinical interview. Significant associations were only observed cross-sectionally, limiting causal conclusions. There was limited power to detect longitudinal effects.ConclusionMore positive responses to women's low sexual interest/arousal by partners is linked to better adjustment among couples affected by FSIAD.Rosen NO, Corsini-Munt S, Dubé JP, et al. Partner Responses to Low Desire: Associations With Sexual, Relational, and Psychological Well-Being Among Couples Coping With Female Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2168–2180.  相似文献   
10.
《医古文》课程的传统教学模式存在较大问题,难以达到良好的教学效果。为了改进教学方法,提升教学质量,现以建构主义和形成性教学评价为理论基础,举例采用两种趣味互动教学方式,培养学生对传统文化的兴趣,夯实学生的基础知识,提高学生的古文应用能力。证明趣味互动教学法符合当今学生的认知规律,具有独到的优势,并值得推广。  相似文献   
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