全文获取类型
| 收费全文 | 62310篇 |
| 免费 | 4749篇 |
| 国内免费 | 187篇 |
专业分类
| 耳鼻咽喉 | 769篇 |
| 儿科学 | 2243篇 |
| 妇产科学 | 1640篇 |
| 基础医学 | 8474篇 |
| 口腔科学 | 1731篇 |
| 临床医学 | 5921篇 |
| 内科学 | 13245篇 |
| 皮肤病学 | 1141篇 |
| 神经病学 | 6458篇 |
| 特种医学 | 2125篇 |
| 外国民族医学 | 9篇 |
| 外科学 | 8309篇 |
| 综合类 | 901篇 |
| 一般理论 | 94篇 |
| 预防医学 | 4574篇 |
| 眼科学 | 1749篇 |
| 药学 | 4024篇 |
| 中国医学 | 59篇 |
| 肿瘤学 | 3780篇 |
出版年
| 2022年 | 338篇 |
| 2021年 | 826篇 |
| 2020年 | 534篇 |
| 2019年 | 881篇 |
| 2018年 | 1021篇 |
| 2017年 | 788篇 |
| 2016年 | 868篇 |
| 2015年 | 984篇 |
| 2014年 | 1375篇 |
| 2013年 | 2191篇 |
| 2012年 | 3132篇 |
| 2011年 | 3393篇 |
| 2010年 | 1905篇 |
| 2009年 | 1756篇 |
| 2008年 | 3184篇 |
| 2007年 | 3549篇 |
| 2006年 | 3443篇 |
| 2005年 | 3417篇 |
| 2004年 | 3318篇 |
| 2003年 | 3187篇 |
| 2002年 | 3165篇 |
| 2001年 | 1355篇 |
| 2000年 | 1368篇 |
| 1999年 | 1250篇 |
| 1998年 | 810篇 |
| 1997年 | 705篇 |
| 1996年 | 621篇 |
| 1995年 | 620篇 |
| 1994年 | 601篇 |
| 1993年 | 606篇 |
| 1992年 | 1075篇 |
| 1991年 | 999篇 |
| 1990年 | 859篇 |
| 1989年 | 874篇 |
| 1988年 | 826篇 |
| 1987年 | 844篇 |
| 1986年 | 822篇 |
| 1985年 | 846篇 |
| 1984年 | 823篇 |
| 1983年 | 727篇 |
| 1982年 | 632篇 |
| 1981年 | 532篇 |
| 1980年 | 571篇 |
| 1979年 | 612篇 |
| 1978年 | 493篇 |
| 1977年 | 453篇 |
| 1976年 | 402篇 |
| 1975年 | 394篇 |
| 1974年 | 407篇 |
| 1973年 | 376篇 |
排序方式： 共有10000条查询结果，搜索用时 31 毫秒
1.
2.
3.
4.
5.
Margaret H. Lauerman Karen Irizarry Clint Sliker Brandon R. Bruns Ronald Tesoriero Thomas M. Scalea Deborah M. Stein 《Injury》2019,50(1):131-136
Background
Current blunt cerebrovascular injury (BCVI) grading grossly differentiates injury characteristics such as luminal stenosis (LS) and aneurysmal disease. The effect of increasing degree of LS beyond the current BCVI grading scale on stroke formation is unknown.Study Design
BCVI over a 3-year period were retrospectively reviewed. To investigate influence of LS beyond the BCVI grading scale within aneurysmal and non-aneurysmal BCVI, grade 2 BCVI were subdivided into BCVI with ≥ 25% and ≤ 50% LS and BCVI with > 50% and ≤ 99% LS. Grade 3 BCVI were subdivided into BCVI with pseudoaneurysm (PSA) without LS and BCVI with PSA and LS. We hypothesized increased LS beyond the current BCVI grade distinctions would be associated with higher rates of stroke formation.Results
312 BCVI were included, of which 140 were carotid BCVI and 172 vertebral BCVI. Sixteen carotid BCVI underwent endovascular intervention (EI) and 19 suffered a stroke. In carotid BCVI stroke rates increased sequentially with BCVI grade except in grade 3. There was a stroke rate of 12% in grade 1 carotid BCVI, 18% in grade 2, 6% in grade 3, and 31% in grade 4. In subgroup analysis for grade 2 carotid BCVI, BCVI with > 50% and ≤ 99% LS had higher rates of stroke (22% vs. 15%, p?=?0.44) than BCVI with ≥ 25% and ≤ 50% LS. In subgroup analysis of grade 3 carotid BCVI, BCVI with PSA and LS had higher rates of stroke (9% vs. 4%, p?=?0.48) than BCVI with PSA without LS. Higher rates of EI in grade 2 carotid BCVI with > 50% and ≤ 99% LS (22% vs. 5%, p?=?0.14) and grade 3 carotid BCVI with PSA and LS (35% vs. 4%, p?=?0.01) were noted in subgroup analysis.Conclusion
Higher percentage LS beyond the currently used BCVI grading scale has a non-significantly increased rate of stroke in both aneurysmal and non-aneurysmal BCVI. Grade 3 BCVI with PSA and LS seems to be a high-risk subgroup. Use of EI confounds modern measurement of stroke risk in higher LS BCVI. 相似文献6.
Julia Thornton Snider Jesse Sussell Mahlet Gizaw Tebeka Alicia Gonzalez Joshua T. Cohen Peter Neumann 《Value in health》2019,22(3):332-339
Background
Payers frequently rely on budget impact model (BIM) results to help determine drug coverage policy and its effect on their bottom line. It is unclear whether BIMs typically overestimate or underestimate real-world budget impact.Objective
We examined how different modeling assumptions influenced the results of 6 BIMs from the Institute for Clinical and Economic Review (ICER).Study Design
Retrospective analysis of pharmaceutical sales data.Methods
From ICER reports issued before 2016, we collected estimates of 3 BIM outputs: aggregate therapy cost (ie, cost to treat the patient population with a particular therapy), therapy uptake, and price. We compared these against real-world estimates that we generated using drug sales data. We considered 2 classes of BIM estimates: those forecasting future uptake of new agents, which assumed “unmanaged uptake,” and those describing the contemporaneous market state (ie, estimates of current, managed uptake and budget impact for compounds already on the market).Results
Differences between ICER's estimates and our own were largest for forecasted studies. Here, ICER's uptake estimates exceeded real-world estimates by factors ranging from 7.4 (sacubitril/valsartan) to 54 (hepatitis C treatments). The “unmanaged uptake” assumption (removed from ICER's approach in 2017) yields large deviations between BIM estimates and real-world consumption. Nevertheless, in some cases, ICER's BIMs that relied on current market estimates also deviated substantially from real-world sales data.Conclusions
This study highlights challenges with forecasting budget impact. In particular, assumptions about uptake and data source selection can greatly influence the accuracy of results. 相似文献7.
Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献8.
9.
We present the case of 7‐year‐old African American girl with loose anagen syndrome. Although this is a common cause of hair loss in Caucasian children, and there have been reports of cases occurring in dark‐skinned children of North African and Middle Eastern descent, to our knowledge there have been no cases reported in black children of sub‐Saharan African ancestry. We present this case to broaden the differential diagnosis of hair loss in African Americans. 相似文献
10.