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《L'évolution Psychiatrique》2021,86(3):573-590
ObjectiveThis interview with the psychiatrist and psychoanalyst Dr. Paul Bercherie attempts to mobilize the major questions that traverse the epistemology of psychiatry and of psychoanalysis. Our conversation covers his work on classical psychiatric knowledge–the subject of his doctoral dissertation–as well as more recent work that questions the conceptual geography of the contemporary psychoanalytic field.MethodIn this open conversation, Paul Bercherie speaks about his training at the end of the 1960s, his various experiences of analysis, and his research path, which led him to develop a singular method of investigation at the interface between practice and theory. The richness of this unique journey is also supported by numerous references to the intellectual context of the time.ResultsReturning to the foundations of psychiatry allows us to revisit the complexity of these texts and illustrates the fruitfulness of the dialogue between French and German psychiatry, which nevertheless has the same objectivist and organicist basis. The author also sheds light on the inconsistency of certain nosographic elaborations. A second series of works serves to resituate Freud in his theoretical context. It results in the demonstration that the discovery of the unconscious is developed within a dated theoretical framework that is poorly suited to its innovation.DiscussionThe Freudian subject of autonomy, the perceptive, cognitive subject, which was that of classical psychology and philosophy, will be called into question by the theories of structuralism, which bases the subject on a heteronomous theory, in which the latter is conceived as a response to the linguistic and social structures which determine it.ConclusionsContemporary psychoanalysis unfolds in the form of separate currents, based on different ethical and theoretical conceptions. However, an analysis shows that the four main currents are individualized from different dimensions already included in the Freudian text. Paul Bercherie argues that these currents should not only be opposed but, instead, that they could benefit from being integrated into a multi-referential clinical orientation. This makes it possible to offer differential but complementary approaches for the patient. 相似文献
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The use of long-term opioid therapy for the management of chronic pain remains controversial. The highlighted consequences of long-term opioid therapy are aberrant drug-taking behaviors, abuse, and dependence. However, the limitations of this treatment modality usually can be attributed to a lack of efficacy and adverse events. Patients that remain refractory to long-term opioid therapy for chronic pain often have a psychiatric disorder that is acting as a barrier to effectiveness. While standardized approaches to the evaluation of a patient to receive long-term opioid therapy are established, little data exists to document their ability to limit opioid abuse or enhance their efficacy. Screening questionnaires and other attempts at predicting or detecting opioid-related substance use disorders fail to determine the presence of comorbid psychiatric disorders. A comprehensive approach for the psychiatric evaluation of patients with chronic pain will address specific barriers to successful chronic pain management and optimize the chances for success with long-term opioid therapy. 相似文献
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目的探讨帕利哌酮在精神科联络会诊中的临床应用及其安全性,旨在提高治疗效果。方法本研究选取2010年1月至2011年4月在泸州医学院附属医院治疗的精神分裂症患者138例作为研究对象。将所有患者随机分为治疗组与对照组,治疗组给予帕利哌酮治疗,对照组给予利培酮治疗。观察并比较两组的治疗效果和不良反应的发生情况。结果帕利哌酮治疗组痊愈14例,显著进步28例,进步14例,无效13例;阿立哌唑组痊愈13例,显著进步27例,进步12例,无效17例。Ridit分析结果显示,两组间差异无统计学意义(P>0.05)。帕利哌酮治疗组在锥体外系反应(EPS)、嗜睡、体质量增加、胃肠道反应及心慌及便秘、体位性低血压等方面的不良反应发生率小于对照组(P<0.05)。结论帕利哌酮治疗精神分裂症在临床疗效,在精神科联络会诊中具有重要的临床应用。 相似文献
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Monique D. Johnson MD CCMEP Robert S. Kennedy MA Sandra Haas Binford MAEd Christina J. Ansted MPH CCMEP 《Health outcomes research in medicine》2011,2(3):e169
Health care providers encounter many patients who have a typical, bread-and-butter symptom presentation and illness course, and for whom developing a treatment plan is relatively straightforward. However, some patients have cases that are challenging because 1) their illnesses are atypical, severe, or treatment-refractory in nature; 2) their conditions are less frequently encountered in the clinical setting; or 3) optimal treatment has not yet been well-studied and clearly defined. In the neurosciences, such challenges often seem to be the rule more than the exception. Continuing medical education (CME) can help clinicians address these challenges and promote clinical competence regarding innovations in neuroscience technologies. In August 2010, psychiatry and neurology health care providers participated in a comprehensive neuroscience CME conference—The 3rd Annual Chair Summit, The Master Class for Neuroscience Professional Development—that featured faculty chairpersons of psychiatry and neurology departments. This 4th article of 5 in a CME-certified companion series presents meeting highlights on managing the complexities of neuropsychiatric care and on scientific advances, especially technology-based innovations. Specifically, clinical topics focus on recognizing attention deficit hyperactivity disorder that persists into adulthood; differential diagnosis of rage and aggression; treating borderline personality disorder; preventing suicide; and implementing care strategies for physician addiction. Rounding out this attention to difficult cases, technology highlights pertained to advanced diagnostic innovations in functional magnetic resonance imaging and to brain stimulation treatment strategies (ie, electroconvulsive therapy, deep brain stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation). This article contains several patient cases and summary points connecting research to clinical practice. 相似文献
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振源胶囊联合文拉法辛缓释片治疗广泛性焦虑障碍疗效观察 总被引:1,自引:0,他引:1
目的探讨振源胶囊联合文拉法辛缓释片治疗广泛性焦虑障碍的疗效和不良反应。方法 80例广泛性焦虑障碍患者随机分成两组,合用组为振源胶囊联合文拉法辛缓释片,单用组为文拉法辛缓释片,疗程为6周。采用汉密尔顿焦虑量表(HAMA)评定疗效,用副反量表(TESS)评定用药不良反应。治疗前、后分别对患者行血常规、肝功能、肾功能、心电图检查以评价安全性。结果治疗6周末,合用组有效率为87.5%,单用组有效率为67.5%,两组比较差异有统计学意义(χ2=4.59,P<0.05),治疗第2周起,两组(HAMA)总分均较治疗前显著下降(t=16.71和t=13.00,P<0.01),合用组治疗2周末起较单用组下降更显著(t=4.71,P<0.01)。两组TESS评分比较差异有显著性(t=3.26,P<0.01)。结论振源胶囊联合文拉法辛缓释片能显著提高广泛性焦虑障碍的临床疗效,安全性高,依从性好。 相似文献