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171.
Research on quality of life with heart transplant patients is complicated by the physical and psychological variables associated with heart failure. This study examined quality of life with several instruments in order to sample more general and more idiosyncratic aspects of quality of life in this particular patient population. We also examined the relationship between various aspects of quality of life and several psychosocial variables, including sensitivity to social desirability effects. The quality of life measures used in this study were found to be significantly correlated with each other and with measures of psychological distress. Implications of these findings are discussed.  相似文献   
172.
The purpose of this study was to examine the relationship of marital status to health outcomes in 818 post-MI, coronary artery bypass surgery, and angioplasty patients (651 males, 157 females) from seven Northern California hospitals who completed 12 months of a nurse-managed, home-based multifactorial risk reduction program. Compared to married patients, nonmarried patients were significantly less likely to complete the program than married patients, more likely to smoke at baseline, and drank significantly less alcohol at baseline. At 12 months there were no significant differences between married and nonmarried groups on smoking cessation rates, HDL, LDL, triglycerides, or exercise treadmill test results. When patients were categorized as married, divorced, separated, widowed, or single, similar results were found for the analyses using two groups (married versus nonmarried), with the following exceptions. Separated patients were significantly less likely to quit smoking. In addition, separated patients showed significantly higher rates of starting (and continuing) to smoke during the time following their MI. Mortality was not significantly different between married and unmarried patients. Implications for intervention with separated patients and the importance of assessing both marital status and marital quality are discussed.  相似文献   
173.
This paper addresses several concerns in teaching engineering ethics. First, there is the problem of finding space within already crowded engineering curricula for meaningful discussions of ethical dimensions in engineering. Some engineering programs may offer entire courses on engineering ethics; however, most do not at present and may not in the foreseeable future. A promising possibility is to weave ethics into already existing courses using case studies, but most current case studies are not well integrated with engineering technical analysis. There is a danger that case studies will be viewed by both instructors and students as departures from “business as usual”—interesting perhaps, but not essentially connected with “real” engineering. We offer a case study, inspired by the National Society of Professional Engineer’s popular video Gilbane Gold, that can be used to make the connection. It requires students to engage in technical analysis, but in a context that makes apparent the ethical responsibility of engineers. Further, the case we present marks a significant departure from more typical cases that primarily focus on wrongdoing and its prevention. We concentrate more positively on what responsible engineering requires. There is a need for more such cases, regardless of whether they are to be used in standard engineering courses or in separate courses in engineering ethics. This article is the product of the NSF/Bovay Endowment “Workshop to Develop Numerical Problems Associated With Ethics Cases for use in Required Undergraduate Engineering Courses” (NSF Grant DUE-9455141) held at Texas A&M University in August 1995. For further information about this project, contact Michael J. Rabins, Director of the Ethics and Professionalism Program in the Look College of Engineering at Texas A&M University. Additional case studies from this workshop are available on the Internet site http://ethics.tamu.edu. The writing of this article was supported in part by “Engineering Ethics: Good Works” (NSF/EVS Grant SBR-930257). Michael Pritchard teaches ethics and is co-author of Engineering Ethics: Concepts and Cases (1995) with C.E. Harris and Michael Rabins (Wadsworth, Belmont CA). Mark Holtzapple teaches chemical engineering and is author of Foundations of Engineering (McGraw-Hill) which includes an ethics chapter suitable for freshman engineering students.  相似文献   
174.
The phenomenon of recognition failure of recallable words shows a remarkable regularity across a wide variety of experimental conditions. A quadratric function, referred to as the Tulving-Wiseman function, summarizes this regularity. A few cases of deviation from this function have been identified and classified into two categories of exceptions to this function. An experiment was designed to deal with one of these categories, namely the exception that occurs because of poor integration between cue and target information of studied word pairs. An index based on confidence ratings of recall responses was developed to assess variability in integration. Poor integration was demonstrated especially for one presentation of low associative word pairs, and significant deviations from the function was obtained for this condition. Hintzman's (1991, 1992) hypothesis about mathematical constraints of the Tulving-Wiseman function was discussed and refuted. Finally, an interpretation of negative deviations from the Tulving-Wiseman function was proposed.  相似文献   
175.
Despite its general success, not everyone responds to cognitive therapy. Some clients have difficulty complying with assignments and others appear to be frankly resistant. This article considers strategies for dealing with passive noncompliance and active resistance within cognitive therapy. In general, it is argued that the process of therapy is usually facilitated by staying within the cognitive model—that is, by exploring and working through those beliefs and attitudes that underlie noncompliance and resistance in the same manner that other problematic beliefs and attitudes are approached. Also considered are strategies for dealing with unrealistic expectations regarding the pace of change, therapists' errors leading to noncompliance and resistance, and instances in which the therapeutic model is simply insufficient.  相似文献   
176.
This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.  相似文献   
177.
The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as mild (adjustment reaction only) or severe (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of clinically significant elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.  相似文献   
178.
Recent studies of nonlinear dynamics of the long-term variability of heart rate have identified nontrivial long-range correlations and scale-invariant power-law characteristics (1/f noise) that were remarkably consistent between individuals and were unrelated to external or environmental stimuli (Meyer et al., 1998a). The present analysis of complex nonstationary heartbeat patterns is based on the sequential application of the wavelet transform for elimination of local polynomial nonstationary behavior and an analytic signal approach by use of the Hilbert transform (Cumulative Variation Amplitude Analysis). The effects of chronic high altitude hypoxia on the distributions and scaling functions of cardiac intervals over 24 hr epochs and 4 hr day/nighttime subepochs were determined from serial heartbeat interval time series of digitized 24 hr ambulatory ECGs recorded in 9 healthy subjects (mean age 34 yrs) at sea level and during a sojourn at high altitude (5,050 m) for 34 days (Ev-K2-CNR Pyramid Laboratory, Sagarmatha National Park, Nepal). The results suggest that there exists a hidden, potentially universal, common structure in the heterogeneous time series. A common scaling function with a stable Gamma distribution defines the probability density of the amplitudes of the fluctuations in the heartbeat interval time series of individual subjects. The appropriately rescaled distributions of normal subjects at sea level demonstrated stable Gamma scaling consistent with a single scaled plot (data collapse). Longitudinal assessment of the rescaled distributions of the 24 hr recordings of individual subjects showed that the stability of the distributions was unaffected by the subject’s exposure to a hypobaric (hypoxic) environment. The rescaled distributions of 4 hr subepochs showed similar scaling behavior with a stable Gamma distribution indicating that the common structure was unequivocally applicable to both day and night phases and, furthermore, did not undergo systematic changes in response to high altitude. In contrast, a single function stable over a wide range of time scales was not observed in patients with congestive heart failure or patients after cardiac transplantation. The functional form of the scaling in normal subjects would seem to be attributable to the underlying nonlinear dynamics of cardiac control. The results suggest that the observed Gamma scaling of the distributions in healthy subjects constitutes an intrinsic dynamical property of normal heart function that would not undergo early readjustment or late acclimatization to extrinsic environmental physiological stress, e.g., chronic hypoxia.  相似文献   
179.
The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery—while not serving as mediators—exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.Roberta G. Simmons, Ph.D., died on February 15, 1993, during data collection for this paper.  相似文献   
180.
先天性心脏病患儿围手术期心理护理程序研究   总被引:5,自引:0,他引:5  
为提高先天性心脏病患儿围手术期护理质量,应用心理评估和临床实验方法,对4~12岁无陪护患儿的心理特点和心理护理程序进行了系列研究。结果发现,先天性心脏病患儿性格较正常儿童内向.情绪不稳定,其智力和适应能力都明显低于正常儿童,根据上述特点确定了围手术期心理护理目标和行为训练等护理方法.通过对106例患儿的实验对比观察,提出建构围手术期少理护理程序的理论依据和基本模式.  相似文献   
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