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Jess's rule: Improving patient safety in England 'Three strikes and rethink,' an unspoken mantra in healthcare, was legally established on 23rd September 2025, thanks to 'Jess's rule,' the patient safety initiative launched to improve diagnostic practices in primary care across England.The initiative was named after Jessica Brady, a 27-year-old woman who tragically passed away in December 2020 after more than 20 fruitless general practitioner (GP) consultations and a delayed, terminal stage 4 adenocarcinoma of the colon.Advocated by Andrea Brady (Jess's mother) in conjunction with the Royal College of General Practitioners (RCGP) and National Health Services England, the rule mandates GP practices to rethink diagnoses and consider further investigations should patients fail to improve or further deteriorate after three consultations.In several studies assessing the diagnostic time in primary care, young patients and Black, Asian, and Minority ethnic (BAME) group patients consistently had longer intervals between first presentation and diagnosis, compared to their Caucasian counterparts.It is hoped that the new initiative can tackle such diagnostic disparities in the UK and prevent late presentations of disease.Jess's rule, like Martha's rule (the right of the patient or family to advocate for escalation of treatment, if visibly deteriorating), is a key addition to a list of patient safety initiatives within the UK, which promote patient autonomy and place an emphasis on extending safe and effective healthcare to all.It is important to remember that age does not preclude the development of serious disease, and unexplained symptoms should not be ignored.SAHIL SHAH, England ORCID iD: 0009-0006-5328-335X Cough syrup-linked deaths in children in Madhya Pradesh; Probe underway Many children (n=24) have died in Madhya Pradesh in October 2025 because they ingested possibly contaminated cough syrup.The fatalities have been traced to the consumption of Coldrif cough syrup, reportedly manufactured by Sresan Pharmaceuticals, based in Kanchipuram district, Tamil Nadu.Several children in Khandwa and Shivpuri districts presented with acute renal failure after taking the syrup.Preliminary findings from the state health department and the Central Drugs Standard Control Organization (CDSCO) indicated that samples of Coldrif may have contained diethylene glycol (DEG) or ethylene glycol, toxic industrial solvents sometimes used improperly as adulterants in glycerine-based formulations.Both compounds can cause multi-organ failure, particularly acute kidney injury, when ingested.Following the deaths, the Madhya Pradesh government ordered an immediate recall of the product and suspended the company's manufacturing licence.The Drugs Controller General of India (DCGI) has initiated an independent investigation, while joint inspection teams comprising officials from CDSCO