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81.
Laura J. Fero Catherine M. Witsberger Susan W. Wesmiller Thomas G. Zullo & Leslie A. Hoffman 《Journal of advanced nursing》2009,65(1):139-148
Title. Critical thinking ability of new graduate and experienced nurses. Aim. This paper is a report of a study to identify critical thinking learning needs of new and experienced nurses. Background. Concern for patient safety has grown worldwide as high rates of error and injury continue to be reported. In order to improve patient safety, nurses must be able to recognize changes in patient condition, perform independent nursing interventions, anticipate orders and prioritize. Methods. In 2004–2006, a consecutive sample of 2144 newly hired nurses in a university‐affiliated healthcare system completed the Performance Based Development System Assessment consisting of 10 videotaped vignettes depicting change in patient status. Results were reported as meeting or not meeting expectations. For nurses not meeting expectations, learning needs were identified in one of six subcategories. Results. Overall, 74·9% met assessment expectations. Learning needs identified for nurses not meeting expectations included initiating independent nursing interventions (97·2%), differentiation of urgency (67%), reporting essential clinical data (65·4%), anticipating relevant medical orders (62·8%), providing relevant rationale to support decisions (62·6%) and problem recognition (57·1%). Controlling for level of preparation, associate (P = 0·007) and baccalaureate (P < 0·0001) nurses were more likely to meet expectations as years of experience increased; a similar trend was not seen for diploma nurses (P = 0·10). Controlling for years of experience, new graduates were less likely to meet expectations compared with nurses with ≥10 years experience (P = 0·046). Conclusion. Patient safety may be compromised if a nurse cannot provide clinically competent care. Assessments such as the Performance Based Development System can provide information about learning needs and facilitate individualized orientation targeted to increase performance level. 相似文献
82.
《International journal of speech-language pathology》2013,15(5):358-365
The purpose of this study was to describe findings and associations at the group level, and predictive accuracy at the individual level, for three measures of language obtained from a single prospective cohort of US children assessed at three ages during another investigation. Participants comprised all children (n = 414) who had a score at each of three ages (3, 4, and 6 years) on three language measures: Peabody Picture Vocabulary Test-Revised (PPVT); mean length of utterance in morphemes (MLU); and total percentage of phonemes correct (TOTPPC) in a nonword repetition task. At the group level, mean differences and correlations over ages were calculated. At the individual level, the extent to which low scores (1.5 SDs or more below the sample mean) at an earlier age increased the relative risk (R’) of low scores at a later age was calculated. At the group level, scores on all measures increased significantly with age. Earlier and later scores on each measure were significantly correlated; r2 values were generally modest (12–59%). A low score at age 3 did not increase the risk of a low score age 4 or age 6 for any of the measures; a low PPVT score at age 4 significantly increased the risk (R’ = 5.0) of a low PPVT score at age 6. For these generally healthy children and these language measures, predictive accuracy at the individual level was generally poor between the ages of 3, 4, and 6 years. Large, longitudinal studies are needed to identify and validate measures for use in identifying preschool children at risk for later language deficits. 相似文献
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84.
The morphology of the central sulcus (CS), at the level of the hand primary motor cortex, has been shown to be related to hand preference and skill. Differences in the cerebral functional organisation of left and right-handers have been described, notably with respect to hemispheric specialisation, which might cause the neural substrate of hand dominance or skill to differ between the two groups. Here, we further explored the relationship between the anatomical variability of the central sulcus and hand skill in two groups of young male subjects differing by handedness (n = 56 right-handers and n = 55 left-handers). Grey matter volume (GMV) in the upper region of the central sulcus was estimated with Voxel Based Morphometry, using a probabilistic region of interest approach, while hand motor skill was measured with the finger tapping test. No significant anatomical differences could be evidenced between the two hand preference groups, a rightward hemispheric asymmetry being observed in both samples. However, multiple regression analyses showed that, in the right-handed group, the maximum tapping rate of the right hand correlated positively with the left central sulcus GMV, but negatively with the right. Similar analyses showed that, in left-handers, the maximum tapping rate of the non-dominant right hand was strongly correlated with the GMV of the ipsilateral CS but not significantly with that of the contralateral CS. These results may be due to differences in the organisation of motor systems between these two groups, possibly concerning a left hemispheric specialisation for fast repetitive movements in right-handers, which would be different in left-handers. 相似文献
85.
1992年,加拿大一个EBM工作组首次提出循证医学的概念,在短短二十几年的时间里,循证医学席卷了整个医学界,冲击了世界,为什么循证医学会在这么短的时间内产生如此巨大的冲击波,循证医学究竟在医学界产生哪些作用,本文述之。 相似文献
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87.
中风是一致死率和致残率极高的危急重症,其急性期的治疗直接关系到疾病的预后。本文探讨将中医辨证与西医医技检查手段相结合以认识、辨治本病,以求提高治愈率,减低致死率和致残率。 相似文献
88.
目的探讨全身炎症反应综合征(SIRS)的中医学病机及治疗对策。方法对366例小儿SIRS进行辨证分型,并在治疗时按病种各自随机分为两组,对照组采用西医治疗,治疗组采用中西医结合治疗;观察两组体温和白细胞计数恢复正常的时间。结果治疗组疗效明显优于对照组。结论SIRS属于中医某些证的范畴,根据八纲辨证原则分实热证、虚热证、气阴虚证、真热假寒证及阴阳衰竭证五大证类,分别施治可简化诊断与治疗。 相似文献
89.
医疗费用供方支付方式比较研究 总被引:13,自引:3,他引:10
本文通过比较预算支付、按人头支付、按服务项目支付和按病种补偿的优缺点,得出:任何支付方式都有正负两方面的作用,将几种支付方式结合起来的支付方式可能抵消各自的缺点,从而可以构造出较好的支付方式。 相似文献
90.
Identifying effective intervention components for smoking cessation: a factorial screening experiment
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