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951.
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ObjectiveTraining in clinical hypnosis leads to important transformations in healthcare professionals, in their professional practices as well as in their personal lives. The objective of this study was to explore how health professionals experience the transformations that result from such a training.MethodSemi-structured interviews with health professionals from France and Europe were conducted. The qualitative method used was Interpretative Phenomenological Analysis. Purposive sampling required to include participants from different professions, experience and regions of origin. They had already completed training in clinical hypnosis at different teaching institutions.ResultsTen participants were included. The analysis showed four meta-themes of experience. First, it revealed participants’ motivations for training in clinical hypnosis as one's desire to improve one's practice, leading to extraordinary discoveries, at a particular timing in their life. Second, participants described that hypnosis sometimes set the ground for a relationship verging on the more “intimate”, therefore requiring greater caution so as not to disrupt the patient/healthcare professional relationship. Third, some participants experienced unforeseen personal fulfilment, better self-regulation of emotions and improved quality of life as well as greater comfort at the workplace. Finally, this study shed light on two limitations of training in clinical hypnosis as it can sometimes generate stress for the participants and/or result in bring about potential harmful effects: one of the risks being that the trainer might cross some ethical lines.DiscussionThe level of personal change experienced by the participants is similar to some changes induced by personal psychotherapy. For several participants, issues of power and vulnerability in the relationship using hypnosis were associated with a feeling of instability during the training. In hypnosis, the management of an asymmetrical relationship involves a two-way risk: vulnerability of the hypnotized person to the all-powerful relationship of their therapist as well as destabilization of therapists by the reduction of power asymmetry during hypnotic work with their patients. 相似文献
953.
In developing countries, there is a need for low-cost neurobehavioral (NB) test batteries for vulnerable populations, particularly for children exposed to environmental neurotoxicants. The objective of the current study was to assess the feasibility and test-retest reliability of the Behavioral Assessment and Research System (BARS) in children from a rural community in Bangladesh. Fifty healthy adolescents living in the Health Effects of Arsenic Longitudinal Study (HEALS) area in Araihazar, Bangladesh completed all six tests from the BARS in two test sessions scheduled two weeks apart. The BARS tests evaluated NB functions such as motor coordination, attention, memory, and information processing speed. The reliability assessment, evaluated by test-retest correlations demonstrated moderate to strong correlations (i.e., correlation coefficients ranged from 0.43 to 0.85), which were statistically significant (p < 0.05). Paired t-tests for comparing the test and retest outcomes indicated significant improvement in NB performance, highlighting learning and practice effects. NB performance improved with increasing age in most cases. Adolescent boys performed better than the girls in Finger Tapping, Digit Span, and Simple Reaction Time, whereas the girls performed better in Continuous Performance and Symbol Digit tests. The reliability scores (Pearson’s correlations 0.43−0.85) were consistent with other children studies in different cultural settings. The effects of age and sex on NB tests were also consistent with findings reported in other countries. Overall, the findings of the study support the feasibility of using this computer-based test system to assess vulnerability of brain health due to environmental exposures among rural Bangladeshi children. 相似文献
954.
IntroductionThe aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols.MethodA plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations.ResultsThere was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made.ConclusionsRadiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation.Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence.There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative.Implications for practiceInitial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education. 相似文献
955.
956.
Cheryl Hunter Carolyn Chew-Graham Susanne Langer Alexandra Stenhoff Jessica Drinkwater Elspeth Guthrie Peter Salmon 《Patient education and counseling》2013
Objective
We aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis.Methods
Patients in North-West England with one or more of four long-term conditions were invited to take part in a questionnaire cohort study of healthcare use. Semi-structured interviews were conducted with a sub-sample of fifty consenting patients. Data were analysed qualitatively, using a framework approach.Results
Patients described using emergency care only in response to perceived urgent need. Their judgements about urgency of need, and their choices about what services to use were guided by previous experiences of care, particularly how accessible services were and the perceived expertise of practitioners.Conclusion
Recursivity and candidacy provide a framework for understanding patient decision-making around emergency care use. Patients were knowledgeable and discriminating users of services, drawing on experiential knowledge of healthcare to choose between services. Their sense of ‘candidacy’ for specific emergency care services, was recursively shaped by previous experiences.Practice implications
Strategies that emphasise the need to educate patients about healthcare services use alone are unlikely to change care-seeking behaviour. Practitioners need to modify care experiences that recursively shape patients’ judgements of candidacy and their perceptions of accessible expertise in alternative services. 相似文献957.
Wemke Veldhuijzen Karen Mogendorff Paul Ram Trudy van der Weijden Glyn Elwyn Cees van der Vleuten 《Patient education and counseling》2013
Objective
To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations.Methods
We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory.Results
A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients’ needs and preferences as well as the medical situation and its consequences.Conclusions
GPs’ selection of communicative actions during consultations is situational and goal driven.Practice implications
To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training. 相似文献958.
Barbara W. Bayldon Mariana Glusman Nicole M. Fortuna Adolfo J. Ariza Helen J. Binns 《Patient education and counseling》2013
Objective
Assess accuracy of caregiver understanding of children's prescribed medications and examine factors associated with accurate recall.Methods
Cross-sectional, observational study of English- or Spanish-speaking caregivers of primary care patients aged 0–7 years. Child and visit characteristics and caregiver health literacy (Short Test of Health Literacy in Adults) were assessed. Post-visit, caregivers completed questionnaires on medications prescribed. Caregiver and medical record agreement on medication name and administration (dose and frequency) were examined using chi square and logistic regression.Results
Analyses included 68 caregivers (28% low health literacy); 96% of children had public insurance. Caregivers indicated that the doctor provided clear medication information (100%) and they could follow instructions (98%). 101 medicines were prescribed; 6 were recalled by caregiver only. 71% of medications were accurately named; 37% of administration instructions were accurately recalled. Accurate naming was more often found for patients 3–7 years, without conditions requiring repeat visits, and new medications. Accurate administration responses were associated with having only 1 child at the visit.Conclusion
Unperceived medication instruction understanding gaps exist at physician visits for caregivers of all literacy levels. Communication and care delivery practices need further evaluation.Practice implications
Clinicians should be aware of the frequency of caregiver medication misunderstanding. 相似文献959.
Shannon L. Arntfield Kristen Slesar Jennifer Dickson Rita Charon 《Patient education and counseling》2013
Objective
This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism.Methods
Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred.Results
Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture.Conclusion/Practice implications
Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance. 相似文献960.
Gaye Moore Anna Collins Caroline Brand Michelle Gold Carrie Lethborg Michael Murphy Vijaya Sundararajan Jennifer Philip 《Patient education and counseling》2013