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91.
Posttraumatic Stress and Complicated Grief in Family Members of Patients in the Intensive Care Unit
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Background Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a
patient’s ICU stay.
Objectives To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in
family members of ICU patients.
Design Prospective, longitudinal cohort study.
Participants Fifty family members of patients in ICUs at a large university hospital participated.
Measurements We used the Control Preferences Scale to determine participants’ role preferences for surrogate decision-making. We used the
Hospital Anxiety and Depression Scale, Impact of Event Scale, and Inventory of Complicated Grief to measure anxiety and depression
(at enrollment, 1 month, 6 months), posttraumatic stress (6 months), and complicated grief (6 months).
Results We interviewed all 50 participants at enrollment, 39 (78%) at 1 month, and 34 (68%) at 6 months. At the three time points,
anxiety was present in 42% (95% CI, 29–56%), 21% (95% CI, 10–35%), and 15% (95% CI, 6–29%) of participants. Depression was
present in 16% (95% CI, 8–28%), 8% (95% CI, 2–19%), and 6% (95% CI, 1–18%). At 6 months, 35% (95% CI, 21–52%) of participants
had posttraumatic stress. Of the 38% who were bereaved, 46% (95% CI, 22–71%) had complicated grief. Posttraumatic stress was
not more common in bereaved than nonbereaved participants, and neither posttraumatic stress nor complicated grief was associated
with decision-making role preference or with anxiety or depression during the patient’s ICU stay.
Conclusions Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of
posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief. 相似文献
92.
Parotid metastatic disease from cutaneous squamous cell carcinoma: Prognostic role of facial nerve sacrifice,lateral temporal bone resection,immune status and P‐stage
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Toby A. Eyre Lindsey E. Roeker Christopher P. Fox Satyen H. Gohill Renata Walewska Harriet S. Walter Francesco Forconi Angus Broom Arvind Arumainathan Danielle M. Brander John N. Allan Stephen J. Schuster Brian T. Hill Frederick Lansigan Bruce D. Cheson Nicole Lamanna Catherine C. Coombs Paul M. Barr Alan P. Skarbnik Mazyar Shadman Chaitra S. Ujjani Laurie Pearson John M. Pagel Ryan Jacobs Anthony R. Mato 《British journal of haematology》2020,188(6):918-923
Elderly chronic lymphocytic leukaemia (CLL) patients treated outside of trials have notably greater toxicity with the Bruton's tyrosine kinase inhibitor ibrutinib compared to younger patients. It is not known whether the same holds true for the B-cell lymphoma 2 inhibitor venetoclax. We provide a comprehensive analysis of key safety measures and efficacy in 342 patients comparing age categories ≥75 and <75 years treated in the relapsed, refractory non-trial setting. We demonstrate that venetoclax has equivalent efficacy and safety in relapsed/refractory CLL patients who are elderly, the majority of whom are previous ibrutinib-exposed and therefore may otherwise have few clear therapeutic options. 相似文献
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Anthony P. Lombardo PhD Jan E. Angus RN PhD Ruth Lowndes RN PhD Naomi Cechetto RN BScN Shamal Khattak Farah Ahmad PhD Arlene S. Bierman MD MS 《Health & social care in the community》2014,22(6):575-587
As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta‐synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta‐study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer‐reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self‐management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long‐term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues. 相似文献
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Charles S. P. Foster Sacha Stelzer-Braid Ira W. Deveson Rowena A. Bull Malinna Yeang Jane-Phan Au Mariana Ruiz Silva Sebastiaan J. van Hal Rebecca J. Rockett Vitali Sintchenko Ki Wook Kim William D. Rawlinson 《Viruses》2022,14(2)
Whole-genome sequencing of viral isolates is critical for informing transmission patterns and for the ongoing evolution of pathogens, especially during a pandemic. However, when genomes have low variability in the early stages of a pandemic, the impact of technical and/or sequencing errors increases. We quantitatively assessed inter-laboratory differences in consensus genome assemblies of 72 matched SARS-CoV-2-positive specimens sequenced at different laboratories in Sydney, Australia. Raw sequence data were assembled using two different bioinformatics pipelines in parallel, and resulting consensus genomes were compared to detect laboratory-specific differences. Matched genome sequences were predominantly concordant, with a median pairwise identity of 99.997%. Identified differences were predominantly driven by ambiguous site content. Ignoring these produced differences in only 2.3% (5/216) of pairwise comparisons, each differing by a single nucleotide. Matched samples were assigned the same Pango lineage in 98.2% (212/216) of pairwise comparisons, and were mostly assigned to the same phylogenetic clade. However, epidemiological inference based only on single nucleotide variant distances may lead to significant differences in the number of defined clusters if variant allele frequency thresholds for consensus genome generation differ between laboratories. These results underscore the need for a unified, best-practices approach to bioinformatics between laboratories working on a common outbreak problem. 相似文献