Medical records are important resources in evaluation of residents' clinical perfomance. Medical redcords may be audited by the resident himself (self audit). Self audit is more convenient and effective than peer review in modifing a doctor's clinical behavior. The purpose of this study is to evaluate the validity and reliability of structured self audit protocol for Family Medicine residents. Medical records of the hypertensive patients who visited Seoul National University Hospital Family Practice Center from May to August of 1991 were selected randomly and audited by both the residents themselves and fellows. Validity was evaluated by item by item comparison of audits by residents and fellows using rates calculated by kappa statistics. Reliability was evaluated by item by item comparison of selected charts between three groups of paired residents. The agreement rate of response of the residents and fellows was relatively high (agreement rate=77.1%, kappa=0.5874) and that of groups of paired residents was also high (agreement rate=77.1%, kappa=0.5870). We concluded that this self audit protocol has both good reliability and validity to evaluate medical records of residents in Family Medicine.

Some clinical data were obtained about 616 cases of Gastrofiberscopy done from Jan, 1989 to Jan, 1990 at the department of Family Medicine and Internal Medicine, in a general hospital near Seoul. The results were as follows.
1. Of the tatal 616 cases, 362 cases(58.8%) were men and 254 cases(41.2%) were women
2. Of the 616 cases, the 677 kinds of disease were found including those patients having two or more diseases at the same time. The final diagnoses were gastritis(54.9%), duodenal ulcer(13.4%), gastric ulcer(9.9%) and gastric cancer(3.1%) in order.
3. Of the 372 patients with gastritis, 210(56.5%) cases were male and 162(43.5%) cases were female. The peak incidence of gastritis was 3rd and 4th decade. The most frequent type of gastritis was superficial gastritis 280(75.2%).
4. Of the 91 cases of duodenal ulcer, 70(76.9%) cases were male and 21(23.1%) cases were female. The peak incidence of duodenal ulcer was 4th decade 35(38.5%) cases and 3rd decade in 28(30.8%) cases.
5. Of the 67 cases of gastric ulcer, 51(76.1%) cases were male and 16(23.9%) cases were female. Single ulcer was 48(71.6%) cases, multiple ulcer was 16(23.9%), and bleeding ulcer was 3(4.5%), and the most prevalent site of the ulcer was antrum in 28(41.8%) cases and body in 13(19.4%) cases.
6. Of the 21 cases of gastric cancer, 14(66.7%) cases were male and 7(33.5%) cases were female. The peak incidence was 7th decade(47.7%) and 6th decade, 5th decade in order. The prevalent site of the gastric cancer was body 10(47.7%) and antrum(42.9%). The most frequent type of gastric cancer was type Ⅱ in Borrmann's classification(33.3%).

This clinical study was performed on 15 cases of breast cancer and 49 cases of benign breast disease which were confirmed by pathology and preoperative mammography was taken during the period from July 1989 to June 1990.
The results were as follows :
1. Among the breast CA(carcinoma), the most prevalent age group was fourth & fifth decades and mean age was 46 years. benign breast disease, the popular age group was third decades and mean age was 35 years.
2. Among the breast CA chief complaints were palpable mass(80%), and pain(20%). In benign breast disease, chief complaints were palpable mass(82%) and mass(18%).
3. Many of the breast CA revealed cases with 2-5cm sized mass were 23cases(80%).
4. In benign disease, cases with less than 5cm sited mass were 42cases(86%).
5. In breast CA, locations of tumor were OUQ(53%), IUQ(20%), OLQ(13%), central(13%) area, In benign disease, they were OUQ(39%), IUQ(31%), central(8%), ILQ(8%), others(8%).
6. The efficacy of mammography to detect breast CA. was as followed : sensitivity was 73%, specificity was 87% and positive predictive value was 64%.

One of the most frequent chief complaints at outpatient department is upper gastrointestinal symptom. Endoscopy is a necessary method in the observation of intragastric lesions.
We reviewed 414 cases of upper gastrointestinal endoscopy for diagnosis in primary care.

The results were as follows :
1. The ratio of male to female was 1:1.5, and the most frequent age groups were fourth, fifth and third decades which occupied about 75% of all cases. third and fourth decades were more frequent in men, and fourth and fifth decades were more frequent in women.
2. The most frequent chief complaints were epigastric pain, epigastric discomport and hunger pain. There were no significant differences of symptoms between men and women.
3. There were no significant associations between age groups and symptoms.
4. The findings of 205 cases(49.5%) were normal and 209 cases(50.0%) were abnormal.
Normal findings were more frequent in women(64.2%) than in men(26.5%).
5. There were no significant associations between symptoms and endoscopic findings.
6. Abnormal findings were more frequent in old age group in both men and women.
In conclusion, we obtained the results that there were no significant associations between symptoms and endoscopic findings, and abnormal findings were more frequent in old age group in both men and women.

Serum lipids level were studied in 281 non-insulin dependent diabetic patients who were admitted at Yonsei University Hospital from January 1989 to December 1989.
The results obtained were as follows :
1. There was significant difference according to sex in cholesterol, LDL : cholesterol and HDL : cholesterol in diabetic patients.
2. There was no significant difference according to age and treatment modality in serum lipid level.
3. There was significant difference according to the duration of diabetes in cholesterol and LDL-cholesterol.
4. There was significant difference accrding to fasting blool sugar in triglyceride.
5. There was significant difference according to duration of diabetes in cholesterol and LDL-cholesterol.
6. There was significant difference between hypertensive and normotensive patients in cholesterol and LDL-cholesterol.

Smoking is one of the major health risk factors of various chronic conditions of cardiovascular and pulmonary system and it is known that the practice of quit smoking through the advice of physicians who frequently contact smokers can prevent much of those conditions.
The purpose of this study was to survey the physicians' knowledge, attitude and practice on smoking and their practice of advice of quit smoking for the smoking patients.
During one month in Sep. 1989, we sent out the questionnaire by mail, and made telephones, and interviews to physicians of selected health maintenace organizations(HMO) and general hospitals. Data were statistically analyzed by X²-test.
The results obtained from the study were as follows.
1. Among total 70 repondents, HMO physicians such as preventive medicine practitioners were 14 and the rest of them were clinicians working at the departments of internal medicine and family medicine. In age distribution, HMO physicians were much older than clinicians 21.4 percent of HMO physicians and 25.0 percent of clinicians were women doctors.
2. Out of 14 HMO physicians, 5(35.7%) never smoked whereas 51.8% of clinicians did not smoke ever. However, current smokers were fewer among HMO physicians(28.6%) than clinicians(41.1%). 59.3% of currently smoking physicians were planning to quit smoking.
3. Of the total, 91.4% said that smoking was extremely dangerous to health, 82.6% responded that counseling about smoking was valuable for smokers to quit and they were quite effective. However, 74.3% did not pay as much attention as they should for counseling about smoking.
4. 14.3% of HMO physicians and clinicians did not spend any minute for smoking counseling. Half of the HMO physicians were advising their patients to quit smoking every time they visit the physicians whereas only 12.5% of clinicians were doing same practice(p<0.05).
5. In actual practice of smoking counseling, more clinicians were recording smoking history of the patients on the charts than HMO physicians(p<0.05). However, giving educational materials, putting slogans or posters for quit smoking in clinics and referring smokers to stop smoking program were practiced more frequently by HMO physicians than clinicians.
Practice of putting slogans or posters were statistically different(p<0.05).
6. The most important barrier in helping patients to quit smoking was lack of training for counseling(71.4%) and the next was not enough time(66.3%) and the third was smokers not interested in smoking counseling(54.3%).
In conclusion, almost physicians had a positive attitude that smoking was extremely dangerous to health but did not practice well and most important barrier of counseling about quit smoking was lack of training for counseling skill. So this study suggests that giving motivation and the educational training about detail methods of quit smoking and changing life style for health maintenence in both of HMO physicians and clinicians is very much important.

For women in Korea, the overall incidence of breast cancer has been increasing recently. Long-term survival in breast cancer currently rests on detection and appropriate therapy at the earliest possible stage, with survival being excellent in patients whose cnacers are discovered at small size and without dissemination. Discovery of lesions at the smallest possible size is therefore desirable.
From July 1st, 1990 through Sep. 30th, 1990, KAP on early detection of breast cancer survey among 260 women over age 35 was carried out at Youngdong Severance, Chungmu and Cha Hospital.
The results were as follows:
1. Film-mammography users are better educated(p<0.05) and higher economic status(p<0.05) than nonusers.
2. Regarding BSE(Breast Self Examination), 17.7% said they practiced BSE monthly and there is no significant difference on practical aspect of BSE between users and nonusers.
3. Women's attitudes toward breast cancer, users have more appropriate insight(p<0.05).
4. Women's attitudes toward screening mammography, users show more active response on breast cancer screening in asymptomatic period(p<0.05), and 58.7% women knew that mammography was useful in detecting breast cancer at an early stage.
5. When nonusers were asked why they did not have a mammography, the most common responses related to poor information(27.9%) and not knowing the test was necessary(22.1%).
6. The experience of film-mammography itself dose not seem to be a negative one, and more acceptible cost was cited for screening test.