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We report a young male patient who developed spontaneous renal allograft rupture 7 days after cadaveric renal transplant, complicated by delayed graft function, without evidence of rejection on allograft biopsy. 相似文献
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Timothy R. Holden MD MS Manish N. Shah MD MPH Tommy A. Gibson Robert E. Weiss PhD Annick N. Yagapen MPH CCRP Susan E. Malveau MSBE David H. Adler MD MPH Aveh Bastani MD Christopher W. Baugh MD MBA Jeffrey M. Caterino MD MPH Carol L. Clark MD MBA Deborah B. Diercks MD MPH Judd E. Hollander MD Bret A. Nicks MD MHA Daniel K. Nishijima MD MAS Kirk A. Stiffler MD Alan B. Storrow MD Scott T. Wilber MD Benjamin C. Sun MD MPP 《Academic emergency medicine》2018,25(8):880-890
Objectives
Syncope and near‐syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short‐term outcomes of patients who presented to the ED with syncope or near‐syncope and were assessed by their ED provider to have dementia.Methods
This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near‐syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient‐level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death.Results
Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac‐related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days.Conclusions
Patients with perceived dementia who presented to the ED with syncope or near‐syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal‐concordant care is warranted.5.
There is an increasing recognition of the association between chronic hepatitis C virus (HCV) infection and glomerular diseases.
Renal complications may be the presenting manifestation of HCV infection. Patients may present with systemic vasculitis secondary
to cryoglobulinemia, or they may present with proteinuria, microscopic hematuria, acute renal failure, or nephrotic syndrome.
The pathogenesis of HCV-associated renal disease remains incompletely understood; however, deposition of HCV-containing circulating
immune complexes in the glomeruli (ie, subendothelial space and mesangium) seems to play an important role. The most common
renal pathology associated with HCV infection is type I membranoproliferative glomerulonephritis with or without cryoglobulinemia.
In patients who do not have significant renal impairment, combination therapy with interferon-á and ribavirin is the treatment
of choice. The experience with this combination therapy is quite limited in patients with renal impairment. Prolonged courses
of high-dose interferon-á therapy have been successfully used for these patients; however, relapse of HCV viremia and recurrence
of renal disease is common after discontinuation of therapy. 相似文献
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Fry-Revere Sigrid Chen Deborah Bastani Bahar Golestani Simin Agarwal Rachana Kugathasan Howsikan Le Melissa 《International urology and nephrology》2020,52(12):2403-2414
International Urology and Nephrology - This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. “The experiences of commercial kidney donors: thematic... 相似文献
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Leanne Streja Catherine M. Crespi Roshan Bastani Glenn C. Wong Craig A. Jones John T. Bernert Donald Tashkin S. Katharine Hammond Barbara A. Berman 《Journal of immigrant and minority health / Center for Minority Public Health》2014,16(2):256-264
We report on the results of a low-intensity behavioral intervention to reduce second hand smoke (SHS) exposure of children with asthma from low income minority households in Los Angeles, California. In this study, 242 child/adult dyads were randomized to a behavioral intervention (video, workbook, minimal counseling) or control condition (brochure). Main outcome measures included child’s urine cotinine and parental reports of child’s hours of SHS exposure and number of household cigarettes smoked. Implementation of household bans was also considered. No differences in outcomes were detected between intervention and control groups at follow-up. Limitations included high attrition and low rates of collection of objective measures (few children with urine cotinine samples). There continues to be a need for effective culturally and linguistically appropriate strategies that support reduction of household SHS exposure among children with asthma in low income, minority households. 相似文献
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Victoria M. Taylor Nancy J. Burke Linda K. Ko Channdara Sos Qi Liu H. Hoai Do Jocelyn Talbot Yutaka Yasui Roshan Bastani 《Journal of community health》2014,39(5):857-862
Cervical cancer incidence rates vary substantially among racial/ethnic groups in the United States (US) with women of Southeast Asian descent having the highest rates. Up to 70 % of cervical cancers could be prevented by widespread use of the human papillomavirus (HPV) vaccine. However, there is a lack of information about HPV vaccine uptake among Southeast Asian girls in the US. We conducted a telephone survey of Cambodian women with daughters who were age-eligible for HPV vaccination. Survey items addressed HPV vaccination barriers, facilitators and uptake. Our study group included 86 Cambodian mothers who lived in the Seattle metropolitan area. The proportions of survey participants who reported their daughter had initiated and completed the HPV vaccine series were only 29 and 14 %, respectively. Higher levels of vaccine uptake were significantly associated with mothers having heard about the HPV vaccine from a health professional and having received a recent Pap test. Commonly cited barriers to HPV vaccination included lack of knowledge about the HPV vaccine, not having received a physician recommendation for HPV vaccination and thinking the HPV vaccine is unnecessary in the absence of health problems. Linguistically and culturally appropriate HPV educational programs should be developed and implemented in Cambodian American communities. These programs should aim to enhance understanding of disease prevention measures, increase knowledge about the HPV vaccine and empower women to ask their daughter’s doctors for HPV vaccination. 相似文献