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Background
Septic shock is often treated with aggressive fluid resuscitation leading to profound fluid overload. The assessment of fluid status relies on suboptimal measures making treatment difficult. Bioelectrical impedance analysis is an alternative but the validity is unclear. The aim of this study was to determine the validity of bioelectrical impedance analysis for fluid measures in patients with septic shock.Methods
Single-center, prospective observational cohort study. We included adult ICU patients with septic shock. We evaluated the agreement between measures on the left and right side of the patient and measures 1 h apart by two bioelectrical impedance devices. Results are presented as Bland Altman plots with 95% Limits of Agreements (LoA) and as correlations between bioelectrical impedance analysis results and clinical markers of fluids.Results
Forty-nine patients were included. The agreement between measures on the left and the right side of the patient and after 1 h was overall without bias, but with wide LoA's. Fluid overload 1 h apart showed the most narrow 95% LoA (−2.4–2.9 L). The same wide limits of agreements were observed when comparing devices. For example, total body water with 95% LoA of −14.8 –16.7 L. Correlations between bioelectrical impedance analysis and clinical measures were low but statistically significant.Conclusions
In patients with septic shock bioelectrical impedance analysis had no systematic errors or bias, but wide limits of agreement, indicating that the devices have a large and uncorrectable random error. Fluid status by bioelectrical impedance analysis is not sufficiently accurate to guide treatment in this group of patients. 相似文献Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis.
Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia.
Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes. 相似文献
Objectives
This study aimed to investigate cross-lagged associations of leaping skill and throwing–catching skills with objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) during school transition from upper primary (Grade 6) to lower secondary school (Grade 7).Design
This study is a one-year prospective follow-up study within Finnish school settings. Students’ MVPA, ST, leaping skill and throwing–catching skills were measured at Grade 6 and subsequently at Grade 7.Methods
A sample of 336 students (163 girls, 173 boys; M age = 12.0 years, SD = 0.4 at Grade 6 participated in the study. Students’ MVPA and ST were measured objectively by hip-worn accelerometers. Leaping skill was measured by 5-leaps test. Throwing and catching skills were measured by throwing–catching combination test. Cross-lagged structural equation modeling was conducted to evaluate the associations between MVPA, ST, leaping skill, and throwing–catching skills at Grade 6 and Grade 7.Results
Results demonstrated three significant cross-lagged associations among girls: (1) leaping skill measured at Grade 6 was negatively associated with ST at Grade 7; (2) objectively measured MVPA at Grade 6 associated positively with leaping skill at Grade 7; and (3) throwing–catching skills measured at Grade 6 associated positively with leaping skill measured at Grade 7. There were no statistically significant cross-lagged associations between the study variables for the sample of boys.Conclusions
The results of this study indicated that supporting opportunities for girls’ engagement in both MVPA and leaping skill development activities during their primary school education is strongly recommended. 相似文献Abbreviations
- CC
- cervical cancer
- FVG
- Friuli Venezia Giulia
- HICs
- high‐income countries
- HPV
- human papillomavirus
- LMICs
- middle‐income countries
- WHO
- World Health Organization
Methods: A postal survey yielded 265 completed questionnaires from 188 dairy farms. The sample was assessed as representative of Finnish dairy farmers. Exploratory factor analysis and a linear mixed model were utilized during the data analyzing process.
Results: The variables lowering work engagement were stressors related to the workload and problems with health. Elevated work engagement was associated with the factors work with farm animals and family. The most important resource variables were “child or children,” “own family,” and “animal health.” Female dairy farmers considered resource variables related to the family, love, and work with cattle as significantly more important than male dairy farmers. Male dairy farmers experienced higher work engagement and, concerning the dimensions, especially higher dedication and absorption than male respondents in a reference sample of workers in difference occupations. A sustainable farm economy and the possibility to have a holiday period were the most important methods to improve overall well-being on dairy farms.
Conclusion: The results indicate that the family, working with cattle, healthy farm animals, a reasonable workload, and a sustainable farm economy have the capacity to create positive impacts on well-being among dairy farmers. Well-being on farms is a part of sustainable food production. 相似文献