lancet-submission

Submission Preflight (lancet-submission)

When to trigger

• The manuscript is "done" and you are about to upload.
• You want a single gate that confirms every other lancet-* skill's output landed.
• A revision is going back and you need to confirm nothing regressed.

Master preflight checklist

Importance & framing

• Clears the importance / global-relevance / practice-or-policy bar (lancet-fit rung ≥ 3).
• Equity/global-health angle articulated where relevant.
• Title declarative and specific; reflects design (e.g., "a randomised controlled trial").

Registration & design

• Trial registered prospectively; registration number in the abstract and Methods.
• Protocol + pre-specified SAP available; primary outcome matches the registered one.
• RCT: randomisation, allocation concealment, blinding, ITT — described.

Reporting guideline & flow diagram

• Correct EQUATOR guideline (CONSORT / STROBE / PRISMA / SPIRIT / ...) with completed checklist, page/line-mapped.
• Flow diagram present (CONSORT for RCT, PRISMA for review); numbers reconcile with Table 1 and analysis populations.

Statistics

• Effect estimates with 95% CI; exact P; absolute + relative effects (NNT where relevant).
• Pre-specified primary analysis; ITT primary + per-protocol sensitivity; missing-data handling.
• Multiplicity strategy for secondary endpoints; subgroups pre-specified + interaction tests.

Structured abstract

• ≤300 words under Background, Methods, Findings, Interpretation, Funding (exact headings).
• Registration number in Methods; primary outcome with effect size + 95% CI; funder named.

Research in context panel

• All three parts present (Evidence before / Added value / Implications).
• "Evidence before this study" documents a systematic search (databases + terms + dates).

Figures & tables

• Table 1 baseline characteristics (no baseline P in an RCT).
• Kaplan–Meier with numbers at risk / forest plot / map — as the design warrants; CIs shown.

Ethics, declarations & data

• Ethics approval + consent (all sites) + Declaration of Helsinki.
• Declaration of interests for all authors (ICMJE).
• Role of the funding source statement (funder role + data access + final responsibility to submit).
• Data sharing statement (ICMJE-compliant for trials).
• ICMJE author contributions (incl. who verified the data); SAGER sex/gender + equity reporting; PPI statement.

References & required files

• References within budget (~30 for an Article), correct style; all in-text citations resolve.
• Main text (IMRaD + panel), abstract, tables, figures + legends, appendix/supplement.
• Reporting checklist; protocol/SAP; cover letter; authors/affiliations/ORCIDs; corresponding author.

Final integrity sweep

• No over-claiming: causal language matches design; no superiority claim from a non-inferiority trial.
• All abstract / flow-diagram / Table 1 / text numbers reconcile.
• Registration number, ethics references, and any data-repository identifiers are correct and live.
• Headings are Findings / Interpretation (not Results / Conclusions).

Templates

• templates/checklist.md — copyable preflight checklist.
• templates/cover_letter_template.md — clinical/global-importance cover-letter scaffold.

Desk-reject patterns to clear before you upload

The Lancet declines most submissions without external review, so the preflight is really a pre-triage simulation. The editor reads the cover letter and abstract for one thing first: does this change clinical practice or public-health policy for a globally relevant problem. Then the submission system enforces the artifacts. Clear these before upload, because each is a fast bounce-back.

Pre-triage failure	Where it surfaces	Pre-upload fix
Not practice/policy-changing for a broad, global audience	Cover letter + abstract Interpretation	Re-run lancet-fit; if rung < 3, reroute to a family title
Trial not prospectively registered	Methods + abstract	Disclose timing honestly; if retrospective, flag it explicitly
Wrong abstract headings	Structured abstract	Use Findings / Interpretation / Funding, not Results / Conclusions
No CONSORT/PRISMA flow diagram	Figures	Add the diagram; reconcile every number
Missing role-of-funding / data-sharing statement	Declarations	Add both; ICMJE data-sharing is mandatory for trials
Research in context panel absent or search-free	Main text	Build the three-part panel on a documented search

Cover-letter pitch: the one load-bearing paragraph

The Lancet editor wants the practice/policy claim in the first lines, calibrated to the design. State the clinical or public-health problem, the single most important finding with its effect and 95% CI, and what guideline or decision it changes — for whom, and where (the global-relevance hook). Do not pad with adjectives; editors discount "novel" and "important" unless the numbers carry them.

Worked micro-example (illustrative numbers — not real data)

A hypothetical pragmatic, cluster-randomised trial of a community health-worker intervention to improve hypertension control across districts in three low- and middle-income countries.

Preflight verdict (illustrative):
  Fit: rung 4 (establishes a scalable public-health intervention) -> GO
  Registration: prospective, ISRCTN in abstract + Methods -> OK
  Reporting: CONSORT-Cluster + flow diagram, page/line-mapped -> OK
  Abstract: 296 words; headings Background/Methods/Findings/Interpretation/Funding -> OK
  Primary outcome in Findings: BP control 38.1% vs 27.4%,
    adjusted risk difference 10.6 pp (95% CI 7.2-14.0), NNT ~10 (illustrative)
  Panel: Evidence-before search (MEDLINE+Embase+Global Index Medicus, dates+terms) -> OK
  Declarations: role-of-funding + data-sharing + SAGER -> OK
  Cover-letter pitch: "scalable, equity-focused, policy-relevant in LMIC primary care"
  VERDICT: GO

Every other lancet-* skill's output has a line on this sheet; the preflight passes only when each lands, the numbers reconcile across abstract/diagram/Table 1, and the cover letter states the policy change in one sentence.

Reviewer / editor-pushback patterns and the venue-specific fix

• "Global-health relevance / equity not addressed." → Add the equity framing (PROGRESS-Plus, LMIC generalisability) in Interpretation and the cover letter; re-check lancet-fit.
• "Trial not prospectively registered." → Disclose registration timing transparently; if retrospective, flag it — the editor may decline, so address it head-on.
• "Primary outcome differs from the registered one." → Reconcile to the registered outcome or explain the dated change explicitly (see lancet-study-design).
• "Reporting checklist incomplete." → Complete and page/line-map the EQUATOR checklist before upload; confirm any current file-format requirement against the journal's author guidelines.

Output format

【Blocking gaps】 [...]  (must fix before upload)
【Warnings】 [...]       (should fix)
【Files ready】 main / abstract / panel / figures+tables / reporting checklist / protocol+SAP / cover letter / declarations
【Verdict】 GO / NO-GO + the top 3 fixes
【Next】 submit | lancet-rebuttal (after decision)

Anti-patterns

• Do not upload a trial that lacks prospective registration without flagging it.
• Do not submit an RCT without a CONSORT flow diagram or a review without a PRISMA one.
• Do not skip the role-of-the-funding-source or data-sharing statements.
• Do not rely on memory; run the checklist top to bottom.