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To the Editor:—
Standardization of expressions used in reporting examination findings undoubtedly leads to better understanding of precise meaning and lends much value to comparative studies. In the evaluation of various parameters, objective or subjective, the degree of change from normal or from an accepted criterion is usually indicated by an adjective or numeral.Dr. Levine, in his article (JAMA177:261 [July 29] 1961) reiterating his previous recommendation on gradation of intensity of cardiac murmurs, introduces the problem of different standards. He grades murmur intensity at 6 levels, while many cardiologists still classify murmurs in 4 grades. Personally, I have followed Dr. Levine's suggestions and find them of great pedantic value for interns, students, and myself. However, since many physicians and students have used a 4 grade system, confusion occasionally arises. In order to simplify matters and to create a suitable translation of grades, I have found that utilization
Waldman S. Gradation of Intensity of Cardiac Murmurs. JAMA. 1962;179(2):180–181. doi:10.1001/jama.1962.03050020074018
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