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11.
Copyright 2000 S. Karger AG, Basel 相似文献
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Hospice programs currently have a need to improve the integration of their services across organizational and professional boundaries. Coordination of decision making and client flow patterns are defined in this paper as integrative mechanism which must be employed by all hospice programs which are interorganizational in nature: that is, the program is delivered by a cluster of agencies providing care to the same population of patients. Also discussed are four system characteristics which determine the choice of these integrative mechanisms: scope of service, intensity of service, centrality of the system, and division of labor. The results of an empirical study of two different hospice service delivery systems indicate that as scope and intensity increase, the amount of integration must increase also. If it does not, the findings suggest that a “poor fit” results. It is shown that service integration fit can be measured by a discrepancy score: a high discrepancy is predictive of dissatisfaction with service effectiveness among hospice workers. 相似文献
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Alter DA Iron K Austin PC Naylor CD;SESAMI Study Group 《The Canadian journal of cardiology》2004,20(12):1219-1228
BACKGROUND: Survival after acute myocardial infarction (AMI) varies with socioeconomic status. It is unknown whether these differences can be attributed, in part, to variations in the prevalence of atherogenic risk factors preceding the index AMI event. OBJECTIVES: To examine how cardiovascular risk factors varied according to person-level indicators of income and education among a cohort of younger patients (younger than 65 years of age) hospitalized with AMI in Ontario. METHODS: The Socio-Economic and Acute Myocardial Infarction study (SESAMI) prospectively assembled a cohort of 3335 patients hospitalized with AMI who consented to participate (75% consent rate) from 53 of 57 large-volume institutions (100 AMI cases per year or more) throughout Ontario between December 1, 1999, and June 1, 2002. Given the known challenges inherent in characterizing the socioeconomic status in elderly patients and the ubiquity of atherosclerosis in elderly persons, the study focused on 1635 nonelderly participants. The relationship between income or education and cardiovascular risk factors, after adjustment for age, sex, ethnoracial factors and geography (urban-rural status) was examined. RESULTS: The prevalence of diabetes, hypertension, smoking and pre-existing heart disease was higher among poorer, less educated patients, as were the total number of cardiovascular risk factors. After adjusting for baseline factors, both income (adjusted OR 0.50, 95% CI 0.31 to 0.82, P=0.006) and education (adjusted OR 0.52, 95% CI 0.31 to 0.87, P=0.01) were independently associated with cardiovascular risk factors or pre-existing heart disease. There were no significant interactions between income, education and baseline cardiovascular risk. CONCLUSIONS: Outcome differences across socioeconomic strata following AMI may reflect major income- and education-related differences in atherogenic risk profile. 相似文献
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Globin Chain Electrophoresis: a New Approach to the Determination of the G γ/A γ Ratio in Fetal Haemoglobin and to Studies of Globin Synthesis 总被引:18,自引:0,他引:18
Blanche P. Alter Sabra C. Goff Georgi D. Efremov Marsha E. Gravely Trrus H. J. Huisman 《British journal of haematology》1980,44(4):527-534
Separation of globin chains by electrophoresis provides a simple and rapid method for the determination of the G gamma/A gamma ratio in human fetal haemoglobin, and of biosynthetic rates of the globin chains. Whole haemolysates were analysed by electrophoresis on polyacrylamide gels in urea, acetic acid and Triton X-100. Electrophoresis of haemolysates from newborn infants led to four bands: A gamma, G gamma, beta and alpha. The identity of these bands was indicated by examination of haemoglobins of known globin chain composition. In 15 samples, the % G gamma was similar by Triton gels and by amino acid analysis of the gamma CB-3 peptide. Some mutant globin chains were also separable with the electrophoretic technique. Triton gel electrophoresis provides rapid analysis of very small amounts of haemoglobin, and permits examination of globin chain composition as well as globin synthetic ratios. 相似文献
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One hundred thirty-one patients followed at the New England Hemophilia Center (Worcester, MA) were tested for antibody to hepatitis C virus (HCV). All but two had used factor concentrate that had not undergone viral inactivation; two patients had used only cryoprecipitate. The overall prevalence of HCV antibody positivity was 76.3%. There was no significant difference in age or the amount of non-heat-treated factor concentrate used between the group that was HCV antibody positive and negative. There was also no significant difference between aminotransferase levels in the two groups. There was a positive association between HCV antibody and the presence of antibody to hepatitis B core antigen and antibody to human immunodeficiency virus. A group of 31 patients were tested twice for HCV antibody at intervals of 35 to 71 months. In this subset, 25 were repeatedly seropositive, 4 were repeatedly seronegative, and 2 went from seropositive to seronegative. These data confirm the previous impression that non-A, non-B hepatitis is a major sequela to the use of pooled coagulation factor concentrates. HCV infection may account for most of the chronic liver disease observed in this population. Anti-HCV testing of plasma donors and improved methods of viral inactivation should prevent new cases from developing. 相似文献
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背景目前已开展了对重性精神病患者进提供连续性服务的研究。目的探讨基层对有抑郁症风险患者提供连续性服务的水平,并与对心力衰竭患者的服务水平进行对比。方法采用抑郁症风险患者与心力衰竭患者对比的探索性研究。采用患者问卷评估服务的持续性,包含如下内容:(1)联系的服务提供者数(个人连续性);(2)诊所内服务提供者之间的合作(团队连续性)(6个项目,分数1~5分);(3)诊所外全科医师与服务提供者之间的合作(跨界连续性)(4个项目,分数1~5分)。结果大多数抑郁症风险患者在过去1年中寻遍整个服务提供界联系了几个服务提供者,曾遇到过高水平团队连续性服务及低水平跨界连续性服务。在诊所中可接触到的不同服务提供者要明显多于心力衰竭患者服务提供者(P<0.01)。抑郁症风险患者的服务提供者之间的合作更好一些,每项平均得分4.3分,心力衰竭患者得分为4.0分(P=0.03)。然而,跨界连续性服务方面正好相反:抑郁症风险患者每项平均得分3.5分,心力衰竭患者得分为4.0分(P=0.01)。结论抑郁症风险患者与心力衰竭患者之间的探索性对比显示:体验服务连续性方面的差距不大。对此还应行进一步分析。 相似文献
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Julia C Bartsch Pawel Fidzinski Jojanneke HJ Huck Heide H?rtnagl Richard Kovács Agustin Liotta Josef Priller Christian Wozny Joachim Behr 《Neuropsychopharmacology》2015,40(4):987-995
Dopaminergic hyperfunction and N-methyl-D-aspartate receptor (NMDAR) hypofunction have both been implicated in psychosis. Dopamine-releasing drugs and NMDAR antagonists replicate symptoms associated with psychosis in healthy humans and exacerbate symptoms in patients with schizophrenia. Though hippocampal dysfunction contributes to psychosis, the impact of NMDAR hypofunction on hippocampal plasticity remains poorly understood. Here, we used an NMDAR antagonist rodent model of psychosis to investigate hippocampal long-term potentiation (LTP). We found that single systemic NMDAR antagonism results in a region-specific, presynaptic LTP at hippocampal CA1-subiculum synapses that is induced by activation of D1/D5 dopamine receptors and modulated by L-type voltage-gated Ca2+ channels. Thereby, our findings may provide a cellular mechanism how NMDAR antagonism can lead to an enhanced hippocampal output causing activation of the hippocampus-ventral tegmental area-loop and overdrive of the dopamine system. 相似文献
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