全文获取类型
| 收费全文 | 4119363篇 |
| 免费 | 296874篇 |
| 国内免费 | 10518篇 |
专业分类
| 耳鼻咽喉 | 58441篇 |
| 儿科学 | 133211篇 |
| 妇产科学 | 114585篇 |
| 基础医学 | 577353篇 |
| 口腔科学 | 119028篇 |
| 临床医学 | 376035篇 |
| 内科学 | 796003篇 |
| 皮肤病学 | 94813篇 |
| 神经病学 | 337768篇 |
| 特种医学 | 159287篇 |
| 外国民族医学 | 1267篇 |
| 外科学 | 618975篇 |
| 综合类 | 92636篇 |
| 现状与发展 | 11篇 |
| 一般理论 | 1658篇 |
| 预防医学 | 320573篇 |
| 眼科学 | 95305篇 |
| 药学 | 304012篇 |
| 16篇 | |
| 中国医学 | 8231篇 |
| 肿瘤学 | 217547篇 |
出版年
| 2018年 | 43408篇 |
| 2017年 | 33472篇 |
| 2016年 | 38339篇 |
| 2015年 | 43143篇 |
| 2014年 | 60117篇 |
| 2013年 | 91458篇 |
| 2012年 | 120731篇 |
| 2011年 | 128620篇 |
| 2010年 | 77369篇 |
| 2009年 | 73773篇 |
| 2008年 | 120445篇 |
| 2007年 | 128924篇 |
| 2006年 | 130466篇 |
| 2005年 | 125981篇 |
| 2004年 | 121596篇 |
| 2003年 | 117567篇 |
| 2002年 | 113488篇 |
| 2001年 | 188444篇 |
| 2000年 | 193774篇 |
| 1999年 | 163789篇 |
| 1998年 | 48334篇 |
| 1997年 | 42888篇 |
| 1996年 | 42650篇 |
| 1995年 | 41244篇 |
| 1994年 | 38124篇 |
| 1993年 | 35759篇 |
| 1992年 | 129771篇 |
| 1991年 | 125934篇 |
| 1990年 | 122401篇 |
| 1989年 | 118501篇 |
| 1988年 | 109479篇 |
| 1987年 | 107625篇 |
| 1986年 | 101883篇 |
| 1985年 | 97583篇 |
| 1984年 | 73567篇 |
| 1983年 | 62584篇 |
| 1982年 | 37620篇 |
| 1981年 | 33824篇 |
| 1979年 | 67555篇 |
| 1978年 | 48275篇 |
| 1977年 | 41350篇 |
| 1976年 | 38128篇 |
| 1975年 | 41513篇 |
| 1974年 | 49386篇 |
| 1973年 | 47445篇 |
| 1972年 | 44679篇 |
| 1971年 | 41798篇 |
| 1970年 | 38838篇 |
| 1969年 | 37180篇 |
| 1968年 | 34439篇 |
排序方式： 共有10000条查询结果，搜索用时 19 毫秒
21.
Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献22.
M. Iachina P.M. Ljungdalh R.G. Sørensen L. Kaerlev J. Blaakær O. Trosko N. Qvist B.M. Nørgård 《Clinical oncology (Royal College of Radiologists (Great Britain))》2019,31(2):115-123
Aims
To examine the influence of pre-existing psychiatric disorder on the choice of treatment in patients with gynaecological cancer.Materials and methods
The analyses were based on all patients who underwent surgical treatment for endometrial, ovarian or cervical cancer who were registered in the Danish Gynecological Cancer Database in the years 2007–2014 (3059 patients with ovarian cancer, 5100 patients with endometrial cancer and 1150 with cervical cancer). Logistic regression model and Cox regression model, adjusted for relevant confounders, were used to estimate the effect of pre-existing psychiatric disorder on the course of cancer treatment. Our outcomes were (i) presurgical oncological treatment, (ii) macroradical surgery for patients with ovarian cancer, (iii) radiation/chemotherapy within 30 days and 100 days after surgery and (iv) time from surgery to first oncological treatment.Results
In the group of patients with ovarian cancer, more patients with a psychiatric disorder received macroradical surgery versus patients without a psychiatric disorder, corresponding to an adjusted odds ratio of 1.24 (95% confidence interval 0.62–2.41) and the chance for having oncological treatment within 100 days was odds ratio = 1.26 (95% confidence interval 0.77–2.10). As for patients with endometrial cancer, all outcome estimates were close to unity. The adjusted odds ratio for oncological treatment within 30 days after surgery in patients with cervical cancer with a history of psychiatric disorder was 0.20 (95% confidence interval 0.03–1.54).Conclusions
We did not find any significant differences in the treatment of ovarian and endometrial cancer in patients with pre-existing psychiatric diagnoses. When it comes to oncological treatment, we suggest that increased attention should be paid to patients with cervical cancer having a pre-existing psychiatric diagnosis. 相似文献23.
Background
Total knee arthroplasty is a treatment option for debilitating arthritis. In the postoperative period, patients experience moderate to severe pain affecting the rehabilitation, hospital stay, and patient satisfaction. This study aims at utilizing current best evidence to determine whether adductor canal block (ACB) or periarticular injection (PAI) is a better modality for managing short-term postoperative pain and opioid consumption.Methods
Embase, MEDLINE, HealthStar, Emcare, and PubMed were searched for randomized controlled trials from 1946 to August 2018, for literature addressing the comparison of ACB and PAI for pain management in the setting of total knee arthroplasty. A systematic review and meta-analysis were performed.Results
Six studies were included in our meta-analysis. When examining the combined visual analog scale (VAS) pain values for each group, analysis demonstrated greater reduction in scores for the PAI group, and the difference was statistically significant (P = .001). When comparing the VAS scores of subgroups analyzed at specific periods in time, there was a trend toward lower VAS scores in subgroups analyzed at 24 hours and 48 hours postoperatively (at rest and at movement) in the PAI group. Overall opioid consumption was lower in the PAI group, with demonstrated statistical significance (P = .03). When comparing the postoperative subgroups, there was a trend toward decreased opioid use in the PAI group, with 13.25% less opioid use at 48 hours and 9.5% less opioid use at 24 hours.Conclusion
PAI could significantly improve postoperative pain and opioid consumption when compared with ACB. Additional, high-quality studies are required to further address this topic. 相似文献24.
Adilson Cunha Ferreira Edward Araujo Júnior Wellington P. Martins João Francisco Jordão Antônio Hélio Oliani Simon E. Meagher 《The journal of maternal-fetal & neonatal medicine》2015,28(14):1706-1710
Objective: To assess the quality of images and video clips of fetal central nervous (CNS) structures obtained by ultrasound and transmitted via tele-ultrasound from Brazil to Australia.Methods: In this cross-sectional study, 15 normal singleton pregnant women between 20 and 26 weeks were selected. Fetal CNS structures were obtained by images and video clips. The exams were transmitted in real-time using a broadband internet and an inexpensive video streaming device. Four blinded examiners evaluated the quality of the exams using the Likert scale. We calculated the mean, standard deviation, mean difference, and p values were obtained from paired t tests.Results: The quality of the original video clips was slightly better than that observed by the transmitted video clips; mean difference considering all observers = 0.23 points. In 47/60 comparisons (78.3%; 95% CI?=?66.4–86.9%) the quality of the video clips were judged to be the same. In 182/240 still images (75.8%; 95% CI?=?70.0–80.8%) the scores of transmitted image were considered the same as the original.Conclusion: We demonstrated that long distance tele-ultrasound transmission of fetal CNS structures using an inexpensive video streaming device provided images of subjective good quality. 相似文献
25.
26.
27.
28.
29.
30.
Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618