收费全文 | 1341篇 |
免费 | 90篇 |
国内免费 | 43篇 |
耳鼻咽喉 | 7篇 |
儿科学 | 30篇 |
妇产科学 | 51篇 |
基础医学 | 159篇 |
口腔科学 | 23篇 |
临床医学 | 123篇 |
内科学 | 385篇 |
皮肤病学 | 25篇 |
神经病学 | 69篇 |
特种医学 | 121篇 |
外科学 | 136篇 |
综合类 | 20篇 |
预防医学 | 64篇 |
眼科学 | 11篇 |
药学 | 71篇 |
中国医学 | 12篇 |
肿瘤学 | 167篇 |
2022年 | 15篇 |
2021年 | 17篇 |
2020年 | 12篇 |
2019年 | 20篇 |
2018年 | 28篇 |
2017年 | 19篇 |
2016年 | 19篇 |
2015年 | 32篇 |
2014年 | 40篇 |
2013年 | 55篇 |
2012年 | 66篇 |
2011年 | 67篇 |
2010年 | 55篇 |
2009年 | 49篇 |
2008年 | 46篇 |
2007年 | 64篇 |
2006年 | 57篇 |
2005年 | 57篇 |
2004年 | 40篇 |
2003年 | 51篇 |
2002年 | 32篇 |
2001年 | 30篇 |
2000年 | 39篇 |
1999年 | 37篇 |
1998年 | 39篇 |
1997年 | 23篇 |
1996年 | 32篇 |
1995年 | 16篇 |
1994年 | 27篇 |
1993年 | 18篇 |
1992年 | 26篇 |
1991年 | 22篇 |
1990年 | 19篇 |
1989年 | 32篇 |
1988年 | 20篇 |
1987年 | 22篇 |
1986年 | 23篇 |
1985年 | 14篇 |
1984年 | 13篇 |
1983年 | 25篇 |
1982年 | 7篇 |
1981年 | 6篇 |
1980年 | 11篇 |
1979年 | 10篇 |
1978年 | 6篇 |
1977年 | 8篇 |
1976年 | 11篇 |
1841年 | 7篇 |
1840年 | 13篇 |
1838年 | 8篇 |
BACKGROUND:
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.OBJECTIVES:
To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.METHODS:
Using the Providence Health Records, a retrospective review of patients admitted to St Paul’s Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.RESULTS:
Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05).CONCLUSIONS:
The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD. 相似文献Acromegaly is a severe chronic endocrine disease. Achieving biochemical control often needs a multimodal treatment approach, including prolonged medical treatment. Aim of the study is to evaluate the burden of treatment direct costs with respect to the different therapeutic strategies, disease control, and follow-up length.
MethodsSingle center retrospective study on 73 acromegaly patients. Costs of acromegaly treatments were computed based on a detailed revision of patients’ clinical charts.
ResultsMedian total treatment cost/patient was €47,343 during the entire follow-up (8 years), while median treatment cost/patient/year was €6811. The majority of patients received medical therapy (71/73, 97.3%). Median cost for first-line medical treatment (first-generation somatostatin receptor ligands) was lower compared to second-line treatments (pegvisomant monotherapy or combination therapies), considering both total (€22,824 vs €76,140; p?<?0.001), and yearly cost/patient (€4927 vs €9161; p?<?0.001). Sixty patients (82.2%) reached biochemical control at last follow-up (IGF-1?≤?1 xULN). The percentage of patients treated with first- or second-line medical therapies was comparable between controlled and uncontrolled patients (p?=?1.000), and the yearly cost/patient did not significantly differ between the two groups (€6936 vs €6680; p?=?0.829). Follow-up duration was significantly longer in controlled patients compared to the uncontrolled ones (8.7 vs 3.5 years; p?=?0.019).
ConclusionsDirect costs for the management of acromegaly have a significant burden on the healthcare systems. However, more than 80% of our patients reached biochemical control using multimodal approaches. Treatment modalities and yearly costs did not significantly differ between controlled and uncontrolled patients, while follow-up length represented a major determinant of biochemical outcome.
相似文献