全文获取类型
收费全文 | 1577篇 |
免费 | 112篇 |
国内免费 | 7篇 |
专业分类
耳鼻咽喉 | 7篇 |
儿科学 | 39篇 |
妇产科学 | 53篇 |
基础医学 | 262篇 |
口腔科学 | 13篇 |
临床医学 | 219篇 |
内科学 | 272篇 |
皮肤病学 | 11篇 |
神经病学 | 210篇 |
特种医学 | 17篇 |
外科学 | 132篇 |
综合类 | 4篇 |
预防医学 | 173篇 |
眼科学 | 20篇 |
药学 | 119篇 |
中国医学 | 1篇 |
肿瘤学 | 144篇 |
出版年
2024年 | 4篇 |
2023年 | 21篇 |
2022年 | 15篇 |
2021年 | 35篇 |
2020年 | 34篇 |
2019年 | 33篇 |
2018年 | 42篇 |
2017年 | 28篇 |
2016年 | 32篇 |
2015年 | 43篇 |
2014年 | 57篇 |
2013年 | 74篇 |
2012年 | 100篇 |
2011年 | 138篇 |
2010年 | 61篇 |
2009年 | 73篇 |
2008年 | 125篇 |
2007年 | 118篇 |
2006年 | 95篇 |
2005年 | 102篇 |
2004年 | 99篇 |
2003年 | 101篇 |
2002年 | 82篇 |
2001年 | 15篇 |
2000年 | 14篇 |
1999年 | 17篇 |
1998年 | 14篇 |
1997年 | 18篇 |
1996年 | 13篇 |
1995年 | 8篇 |
1994年 | 7篇 |
1993年 | 10篇 |
1992年 | 5篇 |
1991年 | 7篇 |
1990年 | 7篇 |
1989年 | 7篇 |
1987年 | 3篇 |
1986年 | 2篇 |
1985年 | 2篇 |
1984年 | 5篇 |
1982年 | 5篇 |
1981年 | 4篇 |
1980年 | 2篇 |
1979年 | 2篇 |
1978年 | 5篇 |
1977年 | 2篇 |
1970年 | 1篇 |
1969年 | 1篇 |
1958年 | 1篇 |
1956年 | 2篇 |
排序方式: 共有1696条查询结果,搜索用时 31 毫秒
31.
Yvette van Ierland Gijs Elshout Marjolein Y Berger Yvonne Vergouwe Marcel de Wilde Johan van der Lei Henri?tte A Mol Rianne Oostenbrink 《The British journal of general practice》2015,65(633):e224-e233
BackgroundClinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice.AimTo evaluate the diagnostic value of published CPRs for febrile children in primary care.MethodAlarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area).ResultsA total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months.ConclusionPublished CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. 相似文献
32.
33.
34.
Alexandre N. Cavalcante Yvette N. Martin Juraj Sprung Jasmin Imsirovic Toby N. Weingarten 《Journal of clinical monitoring and computing》2018,32(5):929-935
An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, <?40% predicted minute ventilation for at least 2 min). We evaluated for associations between clinical variables including minute ventilation prior to opioid administration and LMVe following the first PACU administration of opioid. Also assessed was a low respiratory rate (<?8 breaths per minute) as a proxy for LMVe. Of 107 patients, 38 (36%) had LMVe. Affected patients had greater intraoperative opioid dose, P?=?0.05. PACU opioids were administered to 45 (42.1%) subjects, of which 27 (25.2%) had LMVe (P?=?0.42) within 30 min following opioid. Pre-opioid minute ventilation <?70% of predicted normal value was associated with LMVe, P?<?0.01, (sensitivity?=?100%, specificity?=?81%).Low respiratory rate was a poor predictor of LMVe (sensitivity?=?11.8%). Other clinical variables (e.g., obstructive sleep apnea) were not found to be predictors of LMVe. Using RVM we identified that mild, clinically nondetectable, respiratory depression prior to opioid administration in the PACU was associated with the development of substantial subsequent respiratory depression during the PACU stay. 相似文献
35.
Correlations between plasma strontium concentration,components of calcium and phosphate metabolism and renal function in type 2 diabetes mellitus
下载免费PDF全文
![点击此处可从《European journal of clinical investigation》网站下载免费的PDF全文](/ch/ext_images/free.gif)
36.
Ilufredo Y. Tantoy Bruce A. Cooper Anand Dhruva Janine Cataldo Steven M. Paul Yvette P. Conley Marilyn Hammer Fay Wright Laura B. Dunn Jon D. Levine Christine Miaskowski 《Journal of pain and symptom management》2018,55(3):808-834
Context
Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.Objective
Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients.Methods
Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated.Results
Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX.Conclusions
Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions. 相似文献37.
Nikoloas Papachristou Payam Barnaghi Bruce A. Cooper Xiao Hu Roma Maguire Kathi Apostolidis Jo Armes Yvette P. Conley Marilyn Hammer Stylianos Katsaragakis Kord M. Kober Jon D. Levine Lisa McCann Elisabeth Patiraki Steven M. Paul Emma Ream Fay Wright Christine Miaskowski 《Journal of pain and symptom management》2018,55(2):318-333.e4
Context
Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods.Objectives
The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles using latent class analysis and K-modes analysis.Methods
Using data on the occurrence of 25 symptoms from the Memorial Symptom Assessment Scale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen's kappa coefficient was used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric and nonparametric statistics.Results
Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a higher comorbidity profile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes.Conclusion
Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles. 相似文献38.
Theodore D Satterthwaite Joseph W Kable Lillie Vandekar Natalie Katchmar Danielle S Bassett Claudia F Baldassano Kosha Ruparel Mark A Elliott Yvette I Sheline Ruben C Gur Raquel E Gur Christos Davatzikos Ellen Leibenluft Michael E Thase Daniel H Wolf 《Neuropsychopharmacology》2015,40(9):2258-2268
Unipolar and bipolar depressive episodes have a similar clinical presentation that suggests common dysfunction of the brain’s reward system. Here, we evaluated the relationship of both dimensional depression severity and diagnostic category to reward system function in both bipolar and unipolar depression. In total, 89 adults were included, including 27 with bipolar depression, 25 with unipolar depression, and 37 healthy comparison subjects. Subjects completed both a monetary reward task and a resting-state acquisition during 3T BOLD fMRI. Across disorders, depression severity was significantly associated with reduced activation for wins compared with losses in bilateral ventral striatum, anterior cingulate cortex, posterior cingulate cortex, and right anterior insula. Resting-state connectivity within this reward network was also diminished in proportion to depression severity, most notably connectivity strength in the left ventral striatum. In addition, there were categorical differences between patient groups: resting-state connectivity at multiple reward network nodes was higher in bipolar than in unipolar depression. Reduced reward system task activation and resting-state connectivity therefore appear to be a brain phenotype that is dimensionally related to depression severity in both bipolar and unipolar depression. In contrast, categorical differences in reward system resting connectivity between unipolar and bipolar depression may reflect differential risk of mania. Reward system dysfunction thus represents a common brain mechanism with relevance that spans categories of psychiatric diagnosis. 相似文献
39.
de Liefde II Hoeks SE van Gestel YR Bax JJ Klein J van Domburg RT Poldermans D 《The American journal of cardiology》2008,102(7):921-926
The prognostic value of a hypertensive blood pressure (BP) response is still unclear. Therefore, the prognostic value of a hypertensive BP response in patients during single-stage exercise testing for peripheral arterial disease (PAD) on long-term mortality and major adverse cerebrovascular and cardiac events (MACCEs) was investigated. In addition, effects of statin, beta-blocker, and aspirin use in patients with known or suspected PAD were studied. A total of 2,109 patients were enrolled in an observational prospective study from 1993 to 2005. Hypertensive BP response was defined as an increase in systolic BP >/=55 mm Hg (95(th) percentile within our population) after a single-stage treadmill exercise test. The outcome was obtained by using the civil registries, and a questionnaire about cardiac events was sent to all survivals. Hypertensive BP response was associated with increased risk of long-term mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12 to 1.80) and MACCEs (HR 1.47, 95% CI 1.09 to 1.97). After adjustments for clinical risk factors and propensity score, baseline statin use was associated with reduced risk of long-term mortality (HR 0.59, 95% CI 0.44 to 0.79), and statin, beta-blocker, and aspirin use were associated with reduced risk of MACCEs (HR 0.59, 95% CI 0.43 to 0.81; HR 0.75, 95% CI 0.60 to 0.95; HR 0.73, 95% CI, 0.57 to 0.92, respectively). In conclusion, hypertensive BP response at exercise in patients with known or suspected PAD is an important independent risk factor for all-cause long-term mortality and MACCEs, whereas statin, beta-blocker, and aspirin use were associated with an improved outcome. 相似文献
40.
Dunkelgrun M Welten GM Goei D Winkel TA Schouten O van Domburg RT van Gestel YR Flu WJ Hoeks SE Bax JJ Poldermans D 《The American journal of cardiology》2008,102(7):797-801
The role of uric acid as an independent marker of cardiovascular risk is unclear. Therefore, our aim was to assess the independent contribution of preoperative serum uric acid levels to the risk of 30-day and late mortality and major adverse cardiac event (MACE) in patients scheduled for open vascular surgery. In total, 936 patients (76% male, age 68 +/- 11 years) were enrolled. Hyperuricemia was defined as serum uric acid >0.42 mmol/l for men and >0.36 mmol/l for women, as defined by large epidemiological studies. Outcome measures were 30-day and late mortality and MACE (cardiac death or myocardial infarction). Multivariable logistic and Cox regression analysis were used, adjusting for age, gender, and all cardiac risk factors. Data are presented as odds ratios or hazard ratios, with 95% confidence intervals. Hyperuricemia was present in 299 patients (32%). The presence of hyperuricemia was associated with heart failure, chronic kidney disease, and the use of diuretics. Perioperatively, 46 patients (5%) died and 61 patients (7%) experienced a MACE. Mean follow-up was 3.7 years (range: 0 to 17 years). During follow-up, 282 patients (30%) died and 170 patients (18%) experienced a MACE. After adjustment for all clinical risk factors, the presence of hyperuricemia was not significantly associated with an increased risk of 30-day mortality or MACE, odds ratios of 1.5 (0.8 to 2.8) and 1.7 (0.9 to 3.0), respectively. However, the presence of hyperuricemia was associated with an increased risk of late mortality and MACE, with hazard ratios of 1.4 (1.1 to 1.7) and 1.7 (1.3 to 2.3), respectively. In conclusion, the presence of preoperative hyperuricemia in vascular patients is a significant predictor of late mortality and MACE. 相似文献