Journal of the Royal Society of Medicine

Older women are not being given the opportunity to benefit from the improvements in both local and systemic treatment for breast cancer. Mammographic screening call/recall system ceases at age 72, making access more difficult. Knowledge about breast cancer in those aged >75 is significantly reduced in terms of understanding symptoms and personal risk but studies have shown that intervention can improve this, at least in the short term. Although older women are more likely to have estrogen receptor positive tumours, nevertheless, more than one-third of women aged over 70 have grade III, aggressive breast cancers. Whenever possible, older women should be offered breast conserving therapy rather than mastectomy since this not only improves their quality of life but also reduces risk of subsequent mental health problems. Endocrine treatment alone should not be used other than in patients with severe co-morbidity and a life-expectancy of less than a year. As adjuvant treatment in those with estrogen receptor positive cancers, the choice between tamoxifen and an aromatase inhibitor will depend upon co-morbidity, side-effects and patient choice.

To investigate whether the h index (a bibliometric tool which is increasingly used to assess and appraise an individual's research performance) could be improved to better measure the academic performance and citation profile for individual healthcare researchers.

Cohort study.

Faculty of Medicine, Imperial College London, UK.

Publication lists from 1 January 2000 until 31 December 2009 for 501 academic healthcare researchers from the Faculty of Medicine.

The h index for each researcher was calculated over a nine-year period. The citation count for each researcher was differentiated into high (h² upper), core (h² centre) and low (h² lower) visibility areas. Segmented regression model (sRM) was used to statistically estimate number of high visibility publications (sRM value). Validity of the h index and other proposed adjuncts were analysed against academic rank and conventional bibliometric indicators.

Construct validity was demonstrated for h index, h² upper, h² centre, h² lower and sRM value (all P < 0.05). Convergent validity of the h index and sRM value was shown by significant correlations with total number of publications (r =0.89 and 0.86 respectively, P<0.05) and total number of citations (r = 0.96 and 0.65, respectively, P<0.05). Significant differences in h index and sRM value existed between non-physician and physician researchers (P < 0.05).

This study supports the construct validity of the h index as a measure of healthcare researcher academic rank. It also identifies the assessment value of our developed indices of h² upper, h² centre, h² lower and sRM. These can be applied in combination with the h index to provide additional objective evidence to appraise the performance and impact of an academic healthcare researcher.