全文获取类型
收费全文 | 26690篇 |
免费 | 2049篇 |
国内免费 | 62篇 |
专业分类
耳鼻咽喉 | 198篇 |
儿科学 | 967篇 |
妇产科学 | 834篇 |
基础医学 | 3391篇 |
口腔科学 | 467篇 |
临床医学 | 3976篇 |
内科学 | 5651篇 |
皮肤病学 | 484篇 |
神经病学 | 2454篇 |
特种医学 | 664篇 |
外国民族医学 | 8篇 |
外科学 | 2889篇 |
综合类 | 335篇 |
一般理论 | 17篇 |
预防医学 | 2736篇 |
眼科学 | 405篇 |
药学 | 1656篇 |
中国医学 | 15篇 |
肿瘤学 | 1654篇 |
出版年
2022年 | 140篇 |
2021年 | 392篇 |
2020年 | 240篇 |
2019年 | 455篇 |
2018年 | 514篇 |
2017年 | 360篇 |
2016年 | 402篇 |
2015年 | 465篇 |
2014年 | 675篇 |
2013年 | 1046篇 |
2012年 | 1570篇 |
2011年 | 1656篇 |
2010年 | 850篇 |
2009年 | 775篇 |
2008年 | 1528篇 |
2007年 | 1609篇 |
2006年 | 1598篇 |
2005年 | 1537篇 |
2004年 | 1510篇 |
2003年 | 1389篇 |
2002年 | 1367篇 |
2001年 | 543篇 |
2000年 | 451篇 |
1999年 | 522篇 |
1998年 | 326篇 |
1997年 | 240篇 |
1996年 | 240篇 |
1995年 | 195篇 |
1994年 | 211篇 |
1993年 | 184篇 |
1992年 | 393篇 |
1991年 | 363篇 |
1990年 | 370篇 |
1989年 | 348篇 |
1988年 | 287篇 |
1987年 | 303篇 |
1986年 | 287篇 |
1985年 | 296篇 |
1984年 | 233篇 |
1983年 | 202篇 |
1982年 | 158篇 |
1981年 | 136篇 |
1979年 | 233篇 |
1978年 | 178篇 |
1977年 | 161篇 |
1976年 | 133篇 |
1975年 | 161篇 |
1974年 | 184篇 |
1973年 | 153篇 |
1972年 | 161篇 |
排序方式: 共有10000条查询结果,搜索用时 15 毫秒
1.
2.
Joseph F. Levy Rahul Khairnar Alexander V. Louie Timothy N. Showalter C. Daniel Mullins Mark V. Mishra 《Practical radiation oncology》2019,9(2):e172-e179
Purpose
A hydrogel rectal spacer (HRS) is a medical device that is approved by the U.S. Food and Drug Administration to increase the separation between the prostate and rectum. We conducted a cost-effectiveness analysis of HRS use for reduction in radiation therapy (RT) toxicities in patients with prostate cancer (PC) undergoing external beam RT (EBRT).Methods and Materials
A multistate Markov model was constructed from the U.S. payer perspective to examine the cost-effectiveness of HRS in men with localized PC receiving EBRT (EBRT alone vs EBRT + HRS). The subgroups analyzed included site of HRS placement (hospital outpatient, physician office, ambulatory surgery center) and proportion of patients with good baseline erectile function (EF). Data on EF, gastrointestinal and genitourinary toxicities incidence, and potential risks associated with HRS implantation were obtained from a recently published randomized clinical trial. Health utilities and costs were derived from the literature and the 2018 Physician Fee Schedule and were discounted 3% annually. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of RT. Probabilistic sensitivity analysis and value-based threshold analyses were conducted.Results
The per-patient 5-year incremental cost for spacers administered in a hospital outpatient setting was $3578, and the incremental effectiveness was 0.0371 QALYs. The incremental cost-effectiveness ratio was $96,440/QALY for patients with PC undergoing HRS insertion in a hospital and $39,286/QALY for patients undergoing HRS insertion in an ambulatory facility. For men with good baseline EF, the incremental cost-effectiveness ratio was $35,548/QALY and $9627/QALY in hospital outpatient and ambulatory facility settings, respectively.Conclusions
Based on the current Medicare Physician Fee Schedule, HRS is cost-effective at a willingness to pay threshold of $100,000. These results contain substantial uncertainty, suggesting more evidence is needed to refine future decision-making. 相似文献3.
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4.
5.
6.
Diane C. Ling Bryanna L. Moppins Colin E. Champ Vikram C. Gorantla Sushil Beriwal 《Practical radiation oncology》2021,11(1):e30-e35
PurposeRegional nodal irradiation (RNI) improved disease-free survival by 3% to 5% in 2 large randomized trials, but this small absolute advantage relies on accurate contouring and dose delivery. We audited our network to determine compliance on regional nodal coverage, contouring, and dosimetric parameters with respect to accepted guidelines.Methods and MaterialsIn our network, we have established a clinical pathway for patients with node-positive breast cancer that guides indications for RNI and dosimetric goals. We reviewed records of 183 patients with nodal macrometastases after upfront surgery or involved nodes of any size after neoadjuvant chemotherapy. Radiation treatment plans were examined to determine lymph node volumes treated, whether nodes were contoured, quality of nodal contours, and whether target coverage and normal organ dosimetric constraints were met when RNI was delivered.ResultsDespite the presence of macrometastases on sentinel lymph node biopsy, no lymph nodes were treated in 2.2% (4 of 183). Of 179 patients who received nodal irradiation, 18 received radiation to axillary levels 1 and 2 only, and 161 patients received RNI. Overall, regional nodes were not treated despite strong indications in 7.6% (14 of 183). Treated nodes were not contoured for 2.2% (4 of 179), and lymph node contours were unacceptable in 15.4% (27 of 175). Of patients receiving RNI, 14.9% (24 of 161) did not have adequate nodal target volume coverage, mean heart dose was >4 Gy for 3.1% (5 of 161), and lung V20 Gy was >35% for 8.7% (14 of 161).ConclusionsAdherence to indications for regional nodal treatment was high, but nodes were either not contoured or had unacceptable contour quality in 18% of plans, and coverage was inadequate in 15%. Because the small disease-free survival advantage seen in trials may be decreased with these deviations, routine clinical practice requires detailed peer review to fully translate results of clinical trials. 相似文献
7.
8.
Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery 总被引:5,自引:0,他引:5
Arthur M. Carlin M.D. D. Sudhaker Rao MB B.S. F.A.C.P. F.A.C.E. Ali M. Meslemani M.D. Jeffrey A. Genaw M.D. Nayana J. Parikh Shiri Levy M.D. Arti Bhan M.D. Gary B. Talpos M.D. 《Surgery for obesity and related diseases》2006,2(2):696-103
BACKGROUND: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery. METHODS: We prospectively studied 279 morbidly obese patients seeking gastric bypass surgery for vitamin D nutritional status as assessed by serum 25-hydroxyvitamin D level. In addition, serum samples were analyzed for calcium, alkaline phosphatase (AP), intact parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D. RESULTS: Mean patient age was 43 +/- 9 years; 87% of the study patients were women, and 72% were white. Serum calcium and AP levels were normal in 88% and 89% of the patients, respectively. Vitamin D depletion, defined as serum 25-hydroxyvitamin D level 相似文献
9.
Saifudin Rashiq Diane Edlund Bruce D Dick 《BMC medical informatics and decision making》2006,6(1):8-6
Background
There are no published utilities for the post-anesthesia state obtained by the standard gamble method (SG). 相似文献10.