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Wessel Theda Heuing Katharina Schlangen Miriam Schnieders Birgit Algermissen Markus 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2022,65(11):1119-1125
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Menschen mit Seltenen Erkrankungen stehen im Gesundheitssystem vor besonderen Herausforderungen. Die Seltenheit der einzelnen... 相似文献
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Miriam L. Haaksma Debora Rizzuto Inez H.G.B. Ramakers Sara Garcia-Ptacek Alessandra Marengoni Wiesje M. van der Flier Frans R.J. Verhey Marcel G.M. Olde Rikkert René J.F. Melis 《Journal of the American Medical Directors Association》2019,20(2):165-170.e2
Objectives
The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia.Design
Longitudinal clinical cohort study with a follow-up of institutionalization and mortality occurrence across 7 years after baseline.Setting and Participants
331 newly diagnosed dementia patients, originating from 3 Alzheimer centers (Amsterdam, Maastricht, and Nijmegen) in the Netherlands, contributed to the Clinical Course of Cognition and Comorbidity (4C) Study.Measures
We measured comorbidity burden using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and constructed a Frailty Index (FI) based on 35 items. Time-to-death and time-to-institutionalization from dementia diagnosis onward were verified through linkage to the Dutch population registry.Results
After 7 years, 131 patients were institutionalized and 160 patients had died. Compared with a previously developed prediction model for survival in dementia, our Cox regression model showed a significant improvement in model concordance (U) after the addition of baseline CIRS-G or FI when examining mortality across 3 years (FI: U = 0.178, P = .005, CIRS-G: U = 0.180, P = .012), but not for mortality across 6 years (FI: U = 0.068, P = .176, CIRS-G: U = 0.084, P = .119). In a competing risk regression model for time-to-institutionalization, baseline CIRS-G and FI did not improve the prediction across any of the periods.Conclusions
Characteristics such as frailty and comorbidity change over time and therefore their predictive value is likely maximized in the short term. These results call for a shift in our approach to prognostic modeling for chronic diseases, focusing on yearly predictions rather than a single prediction across multiple years. Our findings underline the importance of considering possible fluctuations in predictors over time by performing regular longitudinal assessments in future studies as well as in clinical practice. 相似文献5.
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Dave E. W. van der Kruijssen Auke J. S. van der Kuil Geraldine R. Vink Cornelis J. A. Punt Johannes H. W. de Wilt Sjoerd G. Elias Miriam Koopman 《International journal of cancer. Journal international du cancer》2023,152(7):1360-1369
We studied the prognostic value of primary tumor sidedness in metastatic colorectal cancer over time and across treatment lines. Population data on synchronous metastatic colorectal cancer patients were extracted from the Netherlands Cancer Registry and SEER database. Pubmed, EMBASE and Cochrane library were searched for prospective studies on metastatic colorectal cancer to conduct a meta-analysis. Inclusion criteria consisted of metastatic disease, systemic treatment with palliative intent and specification of primary tumor location. Data were pooled using a random-effects model. For the population-based data, multivariable Cox models were constructed. The Grambsch-Therneau test was conducted to evaluate the potential time-varying nature of sidedness. Meta-regression incorporating treatment-line as variable was conducted to test the pre-specified hypothesis that the prognostic value of sidedness varies over time. Analysis of 12 885 and 16 160 synchronous metastatic colorectal cancer patients registered in the Netherlands Cancer Registry and SEER database, respectively, indicated a time-varying prognostic value of sidedness (P < .01). Thirty-one studies were selected for the meta-analysis (9558 patients for overall survival analysis). Pooled univariable hazard ratioleft-sided/right-sided for overall survival was 0.71 (95% CI: 0.65-0.76) in 1st-line, 0.76 (0.54-1.06) in 2nd-line and 1.01 (0.86-1.19) in 3rd-line studies. Hazard ratios were significantly influenced by treatment line (P = .035). The prognostic value of sidedness of the primary tumor in metastatic colorectal cancer patients treated with palliative systemic therapy decreases over time since diagnosis, suggesting that sidedness may not be a useful stratification factor in late-line trials. This decrease in prognostic value should be taken into account when providing prognostic information to patients. 相似文献
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Laura Bangueses Rodríguez Miriam Vzquez-Campo Yago Mourio Lpez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2021,53(3)
ObjetivoConocer las opiniones de los profesionales sanitarios que trabajan en el Punto de Atención Continuada de Ourense (PAC) con relación a las agresiones laborales.DiseñoEstudio cualitativo con enfoque fenomenológico realizado entre enero y mayo del 2019.EmplazamientoPAC.ParticipantesVeinte profesionales de distintas categorías.MédodoMuestreo estructural. Se emplearon entrevistas abiertas grabadas en audio, previo consentimiento de los participantes.ResultadosLos profesionales entrevistados manifiestas haber sido víctimas de agresiones, sobre todo verbales. Estas agresiones según los participantes son tan habituales que las han normalizado dentro de su jornada laboral. Ninguno ha denunciado nunca este tipo de conductas, en gran medida porque consideran que la burocracia y los trámites administrativos son tediosos, y otros por desconocimiento del procedimiento. Este tipo de situaciones, a nivel laboral, les causa sentimientos de tristeza, rabia e impotencia y son la causa, según ellos, del aumento de la medicina defensiva. Los profesionales consideran que la causa del aumento de las agresiones entre el colectivo es la mala educación y la gestión inadecuada del empoderamiento del paciente.ConclusionesLos profesionales sanitarios sufren continuamente agresiones, sobre todo de tipo verbal, siendo algo habitual en su día a día. Estas agresiones no son denunciadas, pero les causan múltiples sentimientos negativos y disruptivos, llegando a modificar su manera de trabajar.Palabras clave: Violencia laboral, Personal de salud, Agresión, Violencia 相似文献