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301.
The authors examined statistical practices in 193 randomized controlled trials (RCTs) of psychological therapies published in prominent psychology and psychiatry journals during 1999-2003. Statistical significance tests were used in 99% of RCTs, 84% discussed clinical significance, but only 46% considered-even minimally-statistical power, 31% interpreted effect size and only 2% interpreted confidence intervals. In a second study, 42 respondents to an email survey of the authors of RCTs analyzed in the first study indicated they consider it very important to know the magnitude and clinical importance of the effect, in addition to whether a treatment effect exists. The present authors conclude that published RCTs focus on statistical significance tests ("Is there an effect or difference?"), and neglect other important questions: "How large is the effect?" and "Is the effect clinically important?" They advocate improved statistical reporting of RCTs especially by reporting and interpreting clinical significance, effect sizes and confidence intervals. 相似文献
302.
This paper uses chronic beryllium disease as a case study to explore some of the challenges for decision-making and some of
the problems for obtaining meaningful informed consent when the interpretation of screening results is complicated by their
probabilistic nature and is clouded by empirical uncertainty. Although avoidance of further beryllium exposure might seem
prudent for any individual whose test results suggest heightened disease risk, we will argue that such a clinical precautionary
approach is likely to be a mistake. Instead, advice on the interpretation of screening results must focus not on risk per
se, but on avoidable risk, and must be carefully tailored to the individual. These points are of importance for individual
decision-making, for informed consent, and for occupational health.
相似文献
Mark GreeneEmail: |
303.
Margaret M. Richards Mark J. Bowers Tammy Lazicki Dan Krall Anne K. Jacobs 《Journal of child and family studies》2008,17(2):241-252
We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment
outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of
caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily
point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated
with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased
ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings
also reflected increased therapists’ attempts to provide additional in-home services in cases where caregivers demonstrated
a decline in their ability to provide for their children’s physical and material needs, or in which therapists discovered
that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many
of these findings. 相似文献
304.
Phil Moore 《Journal of clinical psychology in medical settings》2008,15(4):331-337
A 14 session, structured, mindfulness skills group utilizing short (10 min) practices was undertaken by clinical psychologists
in training as a voluntary lunchtime activity. The present study was a preliminary investigation into whether a short course
of brief mindfulness exercises could facilitate the development of personal understandings of mindfulness without requiring
a significant time commitment that might impinge upon participants’ ability to take part. Quantitative and qualitative evaluations
suggested that the course could be a useful experiential introduction to mindfulness for clinicians. The results also suggested
that the format of frequent, brief exercises could have utility for conducting mindfulness-based training in time-limited
environments but further research is required to examine the effects of frequency and duration of practice on the development
of mindfulness skills. 相似文献
305.
John E. Carr 《Journal of clinical psychology in medical settings》2008,15(1):40-44
Concerns for the integrity of psychology as an independent discipline have caused some psychologists to object to introducing
any knowledge from the biological sciences into the training of psychologists. However, calls for the greater incorporation
of the behavioral sciences in medical education, increased attention to research on the mechanisms of bio-behavioral interaction,
and initiatives in translational medical research and clinical care, have prompted increased interest in interdisciplinary
research, health care, and teaching. These changes, in turn, are resulting in a re-conceptualization of the structure of academic
medicine with increasing emphasis upon multidisciplinary knowledge and interdisciplinary collaboration, and less emphasis
upon disciplinary insularity and competitiveness. If clinical health psychology is to play a role in this evolving concept
of academic health care, it must adequately prepare its trainees to function in interdisciplinary academic health care settings.
This will require not only expertise in the role of behavioral factors relevant to medical disorders, but also some basic
familiarity with the biological processes to which those behavioral factors relate. With the evolution of its fund of knowledge,
clinical health psychology has the potential to utilize its science to discover, describe, interpret, teach and clinically
apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural
and environmental processes. By failing to seize this initiative, clinical health psychology risks becoming irrelevant to
the evolving model of medical research, education and health care.
Presented, in part, to the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. 相似文献
306.
In this article an overview is presented of the emergence of medical psychology in the care of somatically ill patients. The
situation in the Netherlands can be considered as prototypical. For 60 years, clinical psychologists have been working in
general, teaching and academic hospitals. Nowadays, they are an integrated non-medical specialism working in the medical setting
of hospitals in the Netherlands, and are a full-member of the medical board. This paper discusses several topics: the position
of the general hospital in the health care system in the Netherlands, the emergence of medical psychology in Dutch hospitals,
the role of the professional association of medical psychologists, and the characteristics of patients seen by clinical psychologists.
Following the discussion about the situation of medical psychology in other countries, recommendations are formulated for
the further development of medical psychology in the Netherlands as well as in other countries. 相似文献
307.
308.
The clinical representativeness of outcome studies is defined as the generalizability of recruitment processes, assessment/diagnostic procedures, treatment protocols, and therapeutic results from research settings to naturalistic treatment settings. The main goal of the present study was to examine the clinical representativeness of couple therapy in outcome studies. The data set was formed by 50 published clinical trials, including 34 couple therapy outcome studies for marital distress (CTMD) and 16 couple therapy outcome studies for comorbid relational and mental disorders (CTMD + C). The present findings showed that, overall, the clinical representativeness of couple therapy outcome studies is only fair (i.e., the mean global score is slightly lower than the midpoint of the rating scale used to assess representativeness). CTMD + C studies fared better than CTMD studies on many dimensions of clinical relevance. Studies in which pretherapy training was less intensive (for CTMD studies only), treatment was less structured, and therapists were more experienced showed larger effect sizes than those in which such was not the case. 相似文献
309.
Abraham W. Wolf 《Journal of Contemporary Psychotherapy》2007,37(4):229-234
Psychologists who work in hospital settings confront assorted challenges in implementing the scientist–practitioner model.
Clinical psychologists must deal with the tension between an evidence-based model and the realities of clinical practice.
Psychologists can gain a better understanding of what it means to function as a scientist–practitioner by understanding current
debates in both psychology and medicine on the relationship between research and practice. Psychologists are not unique in
the slow pace of implementing research into practice. Psychologists in hospitals can make a contribution to the treatment
of medical patients by emphasizing the role of the treatment relationship in health-care outcomes. Medicine’s use of practice-based
research networks provides a valuable structure for psychologists to emulate in order to function as active participants in
the collection of practice-based evidence rather than passively accommodating to the evidence-based clinical practice guidelines. 相似文献
310.
Huddle TS 《Theoretical medicine and bioethics》2007,28(6):487-496
Medical work is increasingly being subjected to objective assessment as those who pay for it seek to grasp the quality of
that work and how best to improve it. While objective measures have a role in the assessment of health care, I argue that
this role is currently overestimated and that no human practice such as medicine can be fully comprehended by objective assessment.
I suggest that the character of practices, in which formalizations are combined with judgment, requires that valid assessment
involve the perspective of the skilled practitioner. Relying exclusively on objective measures in assessing health care will
not only distort our assessments of it but lead to damage as the incentives of health care workers are directed away from
the important aspects of their work that are not captured by objective measures.
相似文献
Thomas S. HuddleEmail: |