An initial carbamazepine concentration may initially be supratherapeutic, therapeutic, or even subtherapeutic only to persist to rise over time. The aim of this study was to report the frequency of toxic carbamazepine concentrations continuing to rise and to estimate how often an initially therapeutic or subtherapeutic concentration misrepresents the potential toxicity of an acute carbamazepine overdose. An 8-year retrospective search of all carbamazepine exposures reported to the Illinois Poison Center (January 1, 2001 through December 31, 2008) was reviewed. Inclusion criteria were acute poisonings with a documented carbamazepine concentration of >12 μg/mL at any time. Those with initial concentrations of >12 μg/mL that subsequently increased over time were recorded. Additionally, those cases that initially had therapeutic (4-12 μg/mL) or subtherapeutic (<4 μg/mL) concentration were identified. Descriptive statistics were used to analyze the data. A total of 1424 cases were reported. Of the 523 patients with documented concentrations of >12 μg/mL, 93 patients (17.8%) had initial carbamazepine concentrations >12 μg/mL and continued to rise. Sixteen patients (3.5%) had initial carbamazepine concentrations that were therapeutic (4-12 μg/mL) and 7 patients (1.3%) had initial carbamazepine concentrations <4 μg/mL before rising >12 μg/mL. Certain patients had progressive decreases in level of consciousness corresponding to increasing carbamazepine concentrations. Additionally, several patients with initial levels of therapeutic or subtherapeutic concentration later became comatose and required ventilator management. Initial serum carbamazepine concentrations can be misleading. Serial measurements documenting a declining carbamazepine concentration or prolonged observation are recommended when managing these overdoses.

Background: The Standardized Video Interview (SVI) was developed by the American Association of Medical Colleges to allow applicants to include objective data about professional behaviors and interpersonal and communication skills. Although the SVI pilot was administered to individuals applying to emergency medicine (EM) residency programs during the 2018 Electronic Residency Application Service (ERAS) cycle, little data have been published evaluating the applicant's perceptions. This survey aims to assess EM residency applicant attitudes toward the SVI.Methods: During the 2018 ERAS application season an anonymous survey was administered to interviewees at one urban Accreditation Council for Graduate Medical Education-approved EM residency. Respondents were asked questions regarding the production of their video interviews, thoughts regarding the additive value of the SVI, and individual demographic data such as ethnicity and sex. Participation was optional.Results: A total of 219 of 238 candidates completed the survey representing a 92% response rate. While the majority of applicants did not feel that their ethnicity impacted their application, 58.1% of those who did selfidentified as African American or Asian. A total of 8.7% of respondents felt the SVI added information about their professional behaviors and 11% felt that it added information about interpersonal and communication skills. Only 2.8% of survey respondents felt the SVI should remain a portion of the ERAS application.Conclusions: Most respondents felt that the SVI was not an accurate representation of their interpersonal and communication skills or their professionalism and that it did not add value to their applications. While most cohorts were not concerned about bias regarding sex, ethnicity, sex, or age, a small subset felt that there was a potential for the SVI to bias the party reviewing their applications. Very few applicants felt the SVI should remain a part of the ERAS application. Applicant attitudes toward the SVI are largely negative and require further investigation prior to becoming a standard part of applicants' ERAS files.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist. 1. Proudfit WL, Forteza ME. Micturition syncope. N Engl J Med. 1959;260:328-331. 2. Lyle CB Jr, Monroe JT Jr, Flinn DE, et al. Micturition syncope: report of 24 cases. N Engl J Med. 1961;265:982-986. 3. Kapoor WN, Peterson JR, Karpf M. Micturition syncope-a reappraisal. JAMA. 1985;253:796-798. 4. Sumiyoshi M, Abe H, Kohno R, et al. Age-dependent clinical characteristics of micturition syncope.

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