Resident Hours Research Articles

Learn playfully, operate seriously : The new era of surgical training

Traditional surgical training and further education has historically involved long working hours and hands-on experience within the framework of a teacher-apprentice relationship; however, changes in regulatory policy in the USA and subsequently in Switzerland and the European Union from 2003, led to restrictions in the working hours of medical residents. As aresult the traditional method of surgical training "see one, do one, teach one" has come under scrutiny, prompting asearch for alternative training methods beyond the confines of the operating theater. This publication highlights the possibilities and limitations associated with the use of virtual reality (VR) and gamification in surgical training and further education. It examines the ability of these technological resources to enhance the effectiveness and engagement of medical residents and the feasibility of incorporating them into the surgical training curriculum. The study was based on aliterature search for current developments in surgical training, VR and gamification. Furthermore, various studies and projects that investigated the use of VR and gamification in medical training and further education were analyzed. In this investigation it could be shown that the use of VR reduces the perioperative risks and improves the training environment and learning. The use of gamification also increases the motivation and engagement of the medical residents. As a result the quality of medical education can be improved by the fusion of VR and gamification.

Looking beyond duty hours: Offering a balanced quantitative-qualitative approach to resident burnout.

Burnout, stress and overwork are highly prevalent amongst junior training physicians worldwide, which explains the widespread phenomenon of physicians leaving the field and organised protests/strikes for better working conditions. Back in 2003, the mandatory duty hour restriction was a landmark intervention rolled out by the Accreditation Council for Graduate Medical Education that formally mandated limiting working hours of trainee residents to no more than 80 h per week, and not exceeding 24-h shifts with 6 added hours for education and handover. Nonetheless, 20 years later, this measure continues to be subject to multiple debates on its purported efficacy in achieving its intended objectives and fails to adequately prevent physician burnout and exodus. In our view, the current duty hour restriction model is, in and of itself, inadequate for combating burnout amongst medical residents for several reasons, including insignificant reduction in duty hours with suboptimal adherence/reporting, failure to account for off-site clinical and non-clinical duties, as well as nature of clinical work which typically involves high work intensity in less-than-optimal/unconducive work environments and significant psychoemotional stress. In this article, we offer our perspectives on pursuing a balanced approach towards both meaningful quantitative reduction in working hours as well as practical qualitative improvement in nature of clinical and non-clinical work that could collectively address resident burnout and improve work and training outcomes.

The changing face of surgical education: transfer of surgical and endovascular knowledge to young surgeons.

The goal of vascular surgery education is to provide the best possible training to vascular residents and fellows and to assure the highest standards of care for patients with vascular disease. In the USA, the currently used Vascular Surgery Milestones Program includes milestones as set targets at five levels, from novice to expertise, to assess the trainees' performance in knowledge, skills, attitudes, and other attributes of competencies. Competencies are broad and foundational domains of ability, the most important being the care of the patient. The soon to be introduced Entrustable Professional Activities (EPA) Project, a competency-based assessment, appears to be the best way to evaluate that trainees are ready to practice independently. Transferring surgical and endovascular skills to trainees has been, however, a challenge, because of the decreased number of open surgical procedures, the increasing number of the endovascular interventions, the decreased work hours for residents and that learning on patients in the operating room is no longer acceptable. Simulation laboratories, using 3D reconstructions of real patient's aneurysms has been most helpful to teach even complex endovascular procedures. In open or endovascular simulation laboratories, deliberate practice with focused attention and specific goals of improving performance should be combined with expert feedback. Greatness is not coded into our DNA but comes from deliberate practice, dedication and perseverance.

Local Potential Based-Entrepreneurship Development through Community Service Program

This study aims at investigating the development of local potential-based entrepreneurship through community service (PkM) consisting of several stages including training, production and marketing processes and the constraints experienced. By applying a qualitative analysis in which primary data was collected through interviews, observation, and documentation. The information consists of micro, small and medium enterprises (MSMEs) as well as community leaders at Bindu tourism village, Abian Semal District, Badung Regency-Bali. Data validity using triangulation of sources, methods and theory. Data analysis as an interactive model includes data collection, condensation, presentation and conclusion. The results of the research reveal that the PkM program makes a significant contribution through empowering the tourism village enterprises to produce innovative-creative micro, small and medium scale products. Marketing is done through promotions in various media and market share both at home and abroad. Meanwhile, the constraints experienced the lack of production machines that came from the lack of capital and limited working hours of learning residents.

Incor Residency Program in Adult Cardiology in 2022: 40 Years Preparing Cardiologists for the Demands in Brazil.

Considering demographic data related to the cardiologist's fields of work in Brazil, the administrative board of the InCor medical residency program decided for an update of its curriculum content, to adapt the educational process to the cardiologist's work reality. This article aimed to describe the recent updates applied to the InCor medical residency program. In the article, we described the recent updates on the InCor residency program, and compared the current curriculum track with the previous one. We also presented the rationale for these changes, based on the literature on the participation of cardiologists in the labor market. There was a reduction in the working hours of residents in training in the intensive care unit, and an increase in the outpatient activities of primary and secondary prevention. Also, the didactic content was reformulated and became organized by the corresponding division. The update of the curriculum track of the InCor medical residency program was required in order to adapt it to the Brazilian labor market. The commission in charge of this update is aware that this is a dynamic process that may need changes over time.

DDSolver Software Application for Quantitative Analysis of In vitro Drug Release Behavior of the Gastroretentive Floating Tablets Combined with Radiological Study in Rabbits.

Gastroretentive drug delivery systems (GRDDSs) are designed to release the drug in the stomach over a prolonged time; thus, they can reduce drug dosing frequency and dose size and improve patient compliance. GRDDSs are also highly effective in enhancing the bioavailability of the drug that exhibits window absorption in specific segments of the gastrointestinal (GI) tract. Famotidine (FMT), an H2 receptor antagonist, is an example of these drugs. FMT is a slightly watersoluble drug but well soluble in an acidic medium. This research aims to formulate FMT gastroretentive floating tablets (FMT-GRFTs) to improve the bioavailability and therapeutic activity of the drug and increase patients' adherence to treatment. In addition, the in vitro release behavior of the prepared FMT-GRFTs was quantitatively analyzed using the DDSolver software to assist in selecting the successful formulation that was then evaluated in vivo. The direct compression technique prepared numerous tablet formulations and was subjected to the pre-and post-compression evaluation. Data of FMT dissolution in the simulated gastric medium was analyzed by various kinetic models built in the DDSolver program. In addition, the simulated pharmacokinetics (AUC, MDT, and MRT), R2 adjusted, AIC, MSC, correlation of the residuals, and similarity factor (f2) were also generated. The results revealed that FMT release from the candidate formula (FH3) fitted to the first-order kinetic model, with a high value of R2 adjusted and MSC and a low AIC. The release behavior exhibited the Fickian diffusion mechanism. The similarity factor showed no significant difference (p < 0.05) of the test sample compared to the reference product. Nevertheless, the simulated pharmacokinetic parameter, AUC, proved a two-fold enhancement in FMT bioavailability, with a significant increment in the MDT and MRT compared with the reference product.The FT-IR spectroscopy analysis indicated the absence of drug-excipients/polymer interaction.The in vivo X-ray studies on rabbits confirmed that the floating tablets showed nearly eight hours of gastric residence. DDSolver software was helpful in deciding the optimized formulation of FMT floating tablets. The radiological examination in rabbits for gastric retention was consistent with the release data analysis in vitro.

Overwork among resident physicians: national questionnaire survey results

BackgroundResidents experience the longest working hours among physicians. Thus, it would be beneficial to perform a nationwide survey in Japan on residents’ long work hours and the background factors promoting upper limits on working hours of Japanese residents. The aim of this study was to study or assess the state of physicians’ excessive work hours and its background factors using a questionnaire survey.MethodsThe survey was sent to 924 hospitals. The physicians’ general attributes, work hours and conditions, and employers’ foundational entities were explored. Multiple logistic regression analysis was performed to elucidate the background factors for long work hours.ResultsOf the 4306 resident physicians who responded, 67% had ≥ 60 in-hospital hours/week and 27% had ≥ 80 h/week; 51% were on-call ≥ four times/month. Many of them hoped for increased remuneration. Additionally, female (reference: male, OR: 0.65, 95% CI: 0.55–0.76), 35–40 years old (reference: 25–30 years old, OR: 1.83, 95% CI: 1.32–2.54), childlessness (reference: child, OR: 1.41, 95% CI: 1.12–1.75), surgical specialization (reference: internal medicine, OR: 2.51, 95% CI: 1.96–3.23), neurosurgical specialization (reference: internal medicine, OR: 4.38, 95% CI: 2.92–6.59) and hospitals with 200–400 physicians (reference: <100 physicians, OR: 1.82, 95% CI: 1.12–2.96) exhibited significant correlations with ≥ 80 in-hospital hours/week.ConclusionUnderstanding the factors that increase the likelihood of residents working very long hours could aid in making targeted changes to address the specific concerns. Moreover, reducing working hours to a reasonable limit can improve resident physicians’ health and the quality of care they provide in their community.

Assessment of sleep quality among postgraduate residents of a tertiary care hospital in Kashmir

Introduction: The Postgraduate medical training is long and emotionally taxing. These occupations are associated with stress and good workload along with night shifts which effects the sleep quality. Studies have documented that high levels of stress among medical residents have been associated with sleep problems. Our study aims to investigate sleep quality among the postgraduate residents of a tertiary care hospital using Pittsburgh Sleep Quality Index. Material and Methods: It was a cross sectional study that was conducted from 1 November 2021 to 31 December 2021. Study participants included Postgraduate medical residents working at a tertiary care hospital in district Srinagar of Kashmir valley. A total of 400 participants took part in the study. Results: The mean age of the participants was 33.4 years (S.D 4.9). Majority of the participants (54%) were females. The mean global Pittsburgh Sleep Quality Index score (±SD) for sleep quality was 8.46 (±4.5) with a median score of 6 and Inter Quartile Range of 6.5. Conclusion: Poor sleep quality was reported in 75% of the residents. This highlights the need for awareness about this problem. There is a need for early interventions in order to introduce flexible working hours for medical residents and to provide shifts of manageable durations.

Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study

The new duty hour (DH) limit for doctors in Japan will begin in 2024, setting the maximum DHs for postgraduate residents at approximately 80 h weekly. To set appropriate limits, understanding the association between DHs and psychological health is necessary. Thus, we assessed the relationship between residents’ psychological health and DHs. We conducted a cross-sectional study involving examinees of the General Medicine In-training Examination 2020. Mental health outcomes were measured dichotomously using the Patient Health Questionnaire-2 for depression and Mini-Z 2.0, for burnout, stress, and satisfaction. Weekly DHs were measured in seven categories at 10-h intervals. The prevalence ratios (PRs) between the DH categories were estimated for each outcome. Of the 6045 residents who provided data on DHs and psychological outcomes, 37.3% showed signs of depression, 21.6% experienced burn out, and 39.2% were highly stressed. In contrast, 62.3% were highly satisfied with their training. Proportions of burnout were higher among residents in Category 6 (≥ 90 and < 100 h; PR 1.36; 95% CI 1.11–1.66) and Category 7 (≥ 100 h; PR 1.36; 95% CI 1.10–1.68) compared with residents in Category 3 (≥ 60 and < 70 h; reference). The results partially support the weekly 80-h DH limit in terms of resident well-being.

Changes in the Health Indicators of Hospital Medical Residents During the Four-Year Training Period in Korea.

BackgroundIn South Korea, the legal maximum working hours per week for medical residents is 88 hours, which are longer than those for other occupations, and the intensity of the workload is also remarkably high. Long working hours and job-related stress can worsen the health status of residents. This study aimed to analyze the four-year annual health checkup (AHC) data of residents to identify changes in their health indicators.MethodsThis study included 457 male residents who received 4 years of training at a university hospital. They underwent an AHC every year during the training period. Changes in health indicators and related factors over the 4 years were investigated.ResultsBody mass indices (BMI), blood pressures (BPs), liver function test (LFT) results, and total cholesterol (TC) levels were significantly worsened during the training period. The increases were the highest in the early training years, between the 2nd and 1st AHC. The working hours of the fourth-year residents were the shortest and showed low smoking and drinking rates and high regular exercise rates. On comparing by department, surgical residents showed the highest increases in BMI, diastolic BP, and fasting blood glucose (FBG), LFT enzyme, and TC levels during the training period, compared to residents from the medical and clinical support departments. Residents who were working ≥ 80 hours showed significantly higher FBG and LFT enzyme levels than those working < 80 hours.ConclusionThis study is meaningful as it is the first study in Korea to investigate the changes in the health of residents through objective health indicators. The possibility of the 4-year training period adversely affecting the health of residents was confirmed. Health indicators were significantly worsened, especially in the early training period, in surgical residents, and in residents who worked for long hours. Efforts are needed to restrict long working hours and distribute workload during the 4-year training period.

Comparing Resident Procedures in Rural Versus Urban Emergency Departments.

Background: Rural rotations can be a valuable experience for emergency medicine (EM) residents. To date, there has not been a retrospective cohort study comparing procedures performed at urban versus rural emergency departments (EDs).Objectives: The purpose of this study was to compare procedures performed by EM residents in urban versus rural EDs, with the hypothesis that there will be no significant difference in the procedures performed.Methods: A retrospective cohort study was conducted comparing procedures performed by second- and third-year EM residents based on medical chart review. The procedures were counted at three locations in West Virginia, including a small rural ED, a large rural ED, and a tertiary care ED. Procedure notes were collected from September 2018 to September 2019. The final analysis included nine months, as three months did not have residents at all locations. Eight procedures were standardized based on the number of procedures performed per 100 hours worked by residents. A comparison of total procedures and complex versus simple procedures was performed. A Kruskal-Wallis H test was performed to compare resident hours for procedures between each of the three locations. To compare each of the hospitals to one another separately, Mann-Whitney U tests were performed.Results: The total resident hours worked included 1,800 at the small rural ED, 13,725.5 at the tertiary care ED, and 5,319 at the large rural ED. A p-value of 0.0311 for the Kruskal-Wallis H Test indicated a difference between at least two of the ED sites. A statistically significant difference exists (p-value = 0.0135) between the urban ED (95% CI: 0.15-0.62) and the large rural ED (95% CI: 0.54-1.53). There was no significant difference in complex versus simple procedures among the three locations (p-value = 0.4159).Conclusions: When compared with the tertiary care ED, residents performed more total procedures at the large rural ED and similar total procedure numbers at the small rural ED when standardized for hours worked. There was no significant difference when comparing complex and simple procedures among the three locations.

Simplifying the Combined Use of Fibula Flap and Anterolateral Thigh Flap for Oromandibular Reconstruction.

Summary:Although the preferred technique for reconstruction of extensive composite oromandibular defects involves the use of a fibula flap for the inner mucosal lining and mandibular bone reconstruction and an anterolateral thigh flap for outer skin coverage and soft tissue replenishment, this approach is complicated and manpower-dependent. It also often involves prolonged operations requiring nighttime surgery with insufficient manpower in an era of restricted working hours for residents, which can negatively affect the surgical outcomes. Traditionally, the mucosal defect is first defined and the fibula flap is then dissected to ensure a size-matching skin flap for the inner lining. This flap is transferred first after mandibulectomy is completed, but is delayed by the fibula bone shaping process. Finalizing the flap inset is a sophisticated process involving the fibula bone, fibula skin, and anterolateral thigh skin. Thus, we developed a strategy to overcome the late start of fibula flap harvest, the delayed initiation of defect-site reconstruction, and the troublesome flap inset. Briefly, we dissected both flaps sequentially or simultaneously from contralateral limbs before the mucosal defect was defined, so that the flaps were ready in the daytime. Once the mandibulectomy was completed, we transferred the anterolateral thigh flap first while the fibula bone was shaped, and simplified the flap inset by using the anterolateral thigh skin for the inner lining and outer coverage and the fibula skin as a monitoring flap. We employed this approach in five patients and completed postmandibulectomy reconstruction in as fast as 4 hours.

Nigerian Surgical Trainees' Work Schedule: It is Time for a Change!

Unregulated work schedules have deleterious effects on trainees' productivity and patients' safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. The mean weekly work hours of surgical residents was 122.72 ± 34.17h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72h per week. One-half (283, 50.1%) of them worked continuously for up to 48-72h during calls, with mean daily sleep hours of 3.53 ± 1.42h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic

OBJECTIVE: To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. METHODOLOGY: Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. RESULTS: During the strict lockdown period, outpatient services continued;however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. CONCLUSION: COVID-19 pandemic elective surgical services were restricted;however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic.

To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. Cross-sectional descriptive study. Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. During the strict lockdown period, outpatient services continued; however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. COVID-19 pandemic elective surgical services were restricted; however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

K-means Clustering Method Based on Kernel Density Estimation to Analysis Residents Travel Features: A Case Study of Chengdu

In order to study the spatiotemporal features of urban centre residents during peak hours during workdays and rest days, based on taxi on and off location information and urban points of interest data, a Geographic Information System (GIS) Kernel density estimation (KED) is used. Combined with the K-means clustering algorithm, the peak hours of residents ‘travel and hotspot areas for boarding and alighting are identified, and the strength of the interaction between residents in each area is analysis using the structured Georgy Voronoi, and the spatiotemporal features of residents’ travel are summarized.

Resident Working Hour Restrictions Increased the Workload of the Medical Emergency Team: A Retrospective Observational Study.

Restrictions to residents' working hours have been shown to increase the workload of other medical resources; few studies have measured the effects on medical emergency teams (METs). This study evaluated how limiting residents' working hours affected the workload of MET in a pulmonology unit. This retrospective observational study analyzed MET activity during periods before and after we limited the working hours of residents in our pulmonary unit to 88 h/wk: Period 1, March 2014 to February 2015; and Period 2, March 2015 to February 2016. Medical emergency team activities, dose (activations/1000 admissions), intensive care unit transfers, and mortality were compared between the two periods for weekdays and for weekends and holidays. There were no significant differences between the two periods in MET dose (85.0 in Period 1 versus 91.3 in Period 2, P = 0.675), intensive care unit transfers (P = 0.828), 30-day mortality (P = 0.701), and 60-day mortality (P = 0.531). However, some activities increased significantly or near significantly in Period 2, including portable echocardiography (P < 0.001), arterial line insertion (P = 0.034), mechanical ventilation (P = 0.063), and fluid therapy (P = 0.220). These increases were greater for weekends and holidays than for weekdays. Since December 2017, a specific law for improving the training environment and status of residents has been implemented and applied at all hospitals in Korea. This legal restriction to working hours raises concerns regarding other medical personnel and system improvements to ensure patient safety and care continuity.

Burnout of residents: Overview from various medical institutions - A suggested model for improvement.

Background:Burnout is a common issue among residents across the globe. Although several attempts were made to propose better working hours for residents, burnout is still prevalent as depicted by several studies.Objectives:The aim of the paper is to review several worldwide studies related to burnout in residents and propose potential suggestions.Methods:The following paper summarizes studies pertinent to burnout in residents from different countries categorized into three main regions: North and South America, Europe, and Middle East. The studies were collected from February 2018 to March 2019.Results:Numerous studies across the world have revealed high rates of burnout in residents during the last decades.Conclusions:Various awareness and wellness programs, as well as professional counseling sessions, are proposed to help residents overcome burnout.

The metabolic demands of internal medicine residency

BackgroundNorth American and European accreditation bodies have legislated progressively more strict work hour restrictions for residents in light of evidence that sleep deprivation leads to increased medical errors and decreased wellbeing. The purpose of the study is to determine the physiologic demands of internal medicine training during residency as well as document average sleep (on- and off-call) and physical activity performed using accelerometers.MethodsA total of 40 internal medicine residents working on the clinical teaching unit at a single center were enrolled in the study from November 2011 to March 2016. There were 22 subjects that completed the study and were included in the analysis. SenseWear PRO 2 armband monitors were worn for 5 consecutive days including one call day. The primary outcomes of the study were to quantify and compare the calories per day, steps per day, METs per hour, hours of activity, hours of sleep, and sleep efficiency for on call versus post-call and non-call days.ResultsThe average activity per day, calories per day, steps per day and METs per hour for the call day were 7.6 ± 7.6 h, 2647.0 ± 541.1, 11,261.1 ± 2355.9, and 1.7 ± 0.2 respectively. Each of these parameters had a statistically significant F statistic compared to post-call and non-call days. The subjects had a mean of 1.8 ± 2.0 h of sleep per day with a sleep efficiency of 77.3 ± 23.8% for the call day. The F statistic for sleep per day was significant with a p value < 0.001.ConclusionThis study shows that overnight call has a substantial impact on multiple metabolic parameters. These findings have potentially important implications on future resident working hour restrictions.

Estimation of Cytokines Involved in Acute-Phase Wound Infection with Reference to Residence Time of Patients in Hospitals

Background: Cytokines have a major role in mediating immunity as well as inflammation. The main proinflammatory cytokines are activated after injury and implicated in healing interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). High levels of IL-6 are recorded at initial inflammatory response and start decreasing down to eight day of wounding while TNF-α level remained static and IL-1α levels showed a different pattern of change following injury and consequence of infection. Methodology: This study was conducted in Al-Kindy and Al-Wasity hospitals in Baghdad on 200 patients suffering from wounds. One hundred patients were with acute wounds infection and the other 100 patients wounded but without infection and considered as control. Interleukin-1α (IL-1α), interleukin-TNF-α (TNF-α) and interleukin-6 (IL-60) were determined utilizing ELISA kit sandwich methods (Elabscience, USA). Results: The present study revealed that the values of IL-1α, and TNF-α at 48 hours of hospitalization were 23.547 and 27.177 pg/ml among patients with infected wounds respectively, and 7.05 and 28.127 pg/ml among patients without wound infections respectively. While IL-6 showed a highest level at 96 hours of residence in hospital and the value was 183.43 pg/ml for patients with infected wounds, and the value of the same interleukin was 88.696 pg/ml at 72 hours of residence of patients without wound infections. Conclusions: Interleukin-1α elevated after 24 hr of infection and then decreased. Proinflammatory cytokines (IL-6) was detectable within 24 hr of infection. The highest concentration of IL-6 was seen with mixed bacteria and followed by gram negative bacteria and this probably due to lipopolysaccharide secretion caused an increase of IL-6 in blood circulation. Irregular changes were seen in TNF-α values with durations of patients stay in hospitals.