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71.
The molecular basis of type I or III Protein S deficiency has been investigated in three kindred also showing independent inheritance of factor V (FV) Leiden. A T to C transition in codon 570 (Met-->Thr) was identified in the propositi and shown to segregate with protein S deficiency in all but one of the affected members of two kindred. This individual was heterozygous for a second transition (C to T) causing substitution of serine 624 by leucine. A second member of the same family, with markedly reduced free protein S levels when compared with affected relatives, was heterozygous for both mutations. Haplotype analysis of individuals with the mutated ATG570ACG allele in the two kindred suggested they may have been related by a common ancestor. A G to A transition resulting in substitution of cysteine 145 by tyrosine was detected in the third kindred. All mutations are believed to interfere with protein S binding to C4b-binding protein resulting in reduced free protein S levels. Of the five individuals studied who had experienced thrombotic events, three had combined protein S deficiency and FV Leiden reemphasising the importance of FV Leiden as an additional risk factor for thrombosis in protein S deficiency. 相似文献
72.
Exploring doctor and patient views about risk communication and shared decision-making in the consultation 总被引:2,自引:1,他引:1
Ruth E Davis MPhil BN RGN NDNCert PGCE Gina Dolan BSc MSc Sue Thomas MSc RGN PGCE RNT PNCert Christine Atwell BA PGDRM PGDCG Cert.Ed PGCE FE † Donna Mead PhD MSc DANS Dip N RGN RCNT RNT Sarah Nehammer BSc Laurie Moseley MA Dip Soc Ad MBCS Adrian Edwards MRCP MRCGP ‡ Glyn Elwyn BA FRCGP PhD ‡ 《Health expectations》2003,6(3):198-207
Background There have been significant conceptual developments regarding shared decision‐making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice. Objective To explore, from paired doctor–patient interviews, participants’ perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process. Design Qualitative analysis of semi‐structured interview data. Setting and participants Twenty general practitioners received training packages in ‘risk communication’ (RC) and ‘SDM’ to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages –‘baseline’ [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software. Results Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors’ and patients’ perceptions of the consultations were highly congruent at all phases of the study. Conclusion Shared decision‐making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision‐making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred. 相似文献
73.
Domenico Scrutinio Enrico Ammirati Pietro Guida Andrea Passantino Rosa Raimondo Valentina Guida Simona Sarzi Braga Roberto FE Pedretti Rocco Lagioia Maria Frigerio Raffaella Catanzaro Fabrizio Oliva 《International journal of cardiology》2013
Background
NT-proBNP has been associated with prognosis in acute decompensated heart failure (ADHF). Whether NT-proBNP provides additional prognostic information beyond that obtained from standard clinical variables is uncertain. We sought to assess whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) determination improves risk reclassification of patients with ADHF and to develop and validate a point-based NT-proBNP risk score.Methods
This study included 824 patients with ADHF (453 in the derivation cohort, 371 in the validation cohort). We compared two multivariable models predicting 1-year all-cause mortality, including clinical variables and clinical variables plus NT-proBNP. We calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Then, we developed and externally validated the NT-proBNP risk score.Results
One-year mortalities for the derivation and validation cohorts were 28.3% and 23.4%, respectively. Multivariable predictors of mortality included chronic obstructive pulmonary disease, estimated glomerular filtration rate, sodium, hemoglobin, left ventricular ejection fraction, and moderate to severe tricuspid regurgitation. Adding NT-proBNP to the clinical variables only model significantly improved the NRI (0.129; p = 0.0027) and the IDI (0.037; p = 0.0005). In the derivation cohort, the NT-proBNP risk score had a C index of 0.839 (95% CI: 0.798–0.880) and the Hosmer–Lemeshow statistic was 1.23 (p = 0.542), indicating good calibration. In the validation cohort, the risk score had a C index of 0.768 (95% CI: 0.711–0.817); the Hosmer–Lemeshow statistic was 2.76 (p = 0.251), after recalibration.Conclusions
The NT-proBNP risk score provides clinicians with a contemporary, accurate, easy-to-use, and validated predictive tool. Further validation in other datasets is advisable. 相似文献74.
75.
76.
Low-dose fibrinolytic therapy. Results and new concepts 总被引:2,自引:0,他引:2
Becker GJ; Rabe FE; Richmond BD; Holden RW; Yune HY; Dilley RS; Bang NU; Glover JL; Klatte EC 《Radiology》1983,148(3):663
77.
78.
The use of computed tomography (CT) in demonstrating pure dislocations of the thoracolumbar facets and in predicting the prognosis of this injury was evaluated and compared with radiography retrospectively. The records of 29 patients with pure thoracolumbar bilateral facet dislocation who were admitted to the trauma unit over a 4-year period were reviewed. Twenty-two patients (76%) had a complete neurologic loss that remained complete following immediate surgical stabilization; five (17%) had an incomplete neurologic loss, and two (7%) were normal neurologically. Plain radiographs of the spine, including anteroposterior and lateral views, documented the level and type of fracture but failed to depict the full extent of bony ad soft-tissue injuries. CT provided essential additional information, particularly regarding the status of the posterior elements of the vertebrae and the adequacy of the spinal canal. Pure thoracolumbar facet dislocations have a characteristic appearance on axial CT scans. Sagittal reformation through CT is essential in the evaluation of this type of spinal injury. 相似文献
79.
Surveillance for human immunodeficiency virus type 1 group O infections in the United States 总被引:2,自引:0,他引:2
CP Pau ; DJ Hu ; C Spruill ; C Schable ; E Lackritz ; M Kai ; JR George ; MA Rayfield ; TJ Dondero ; AE Williams ; MP Busch ; AE Brown ; FE McCutchan ; G Schochetman 《Transfusion》1996,36(5):398-400
BACKGROUND: Reports that the human immunodeficiency virus type 1 (HIV- 1) group O variants are not reliably detected by some commercial diagnostic tests have raised concerns about the sensitivity of existing screening tests, especially with regard to blood safety. Although it is unlikely that these divergent strains are prevalent in North America, systematic, continuous surveillance is needed to monitor the potential spread of HIV variants into that region. STUDY DESIGN AND METHODS: Stored serum samples (n = 1072) from both high- and low-risk population groups at several sites in the United States and Puerto Rico were tested by peptide enzyme immunoassays specific for the prototypic HIV-1 group O strains, MVP5180 and ANT70. RESULTS: None of the 1072 samples examined had peptide reactivity that was consistent with HIV-1 group O infection. CONCLUSION: While no evidence of specific HIV-1 group O (MVP5180 or ANT70) infection was found in this study, the sensitivity of current tests has not been fully evaluated against the wide range of genetic variation of HIV. Therefore, it is important to continue active surveillance for HIV-1 and HIV type 2 strains, to characterize any divergent strains, and to judiciously modify tests to correct for any deficiencies in sensitivity. 相似文献