Unmet need: About 50,000 people in the UK are receiving treatment for incurable kidney failure. Of these, about 44% are treated with haemodialysis which is usually provided in hospital or free-standing 'satellite' units. Patients have to attend the dialysis unit three times a week. It takes the dialysis machine about 4 hours to remove the toxins and fluid that has built up in the patient's body. But with the time taken for the staff to connect and disconnect the patient, and for the patient to travel to and from the unit, attending for dialysis can take over 6 hours. Patients who are able to undertake haemodialysis at home not only avoid the travel time and the risk of developing hospital-acquired infections, but also have the opportunity to try alternative dialysis schedules. Home haemodialysis patients are increasingly moving to short treatment sessions 5 or 6 times and to dialysis overnight while they sleep. These schedules are associated with improved well-being and survival compared to the traditional thrice weekly treatment. Even though patients require their own machine, dialysis at home costs the NHS much less than the labour-intensive centre based treatments. But, despite NICE guidance strongly encouraging renal units to promote home haemodialysis, fewer than 3% of dialysis patients choose this modality.

Solution: In collaboration with D4D, Quanta Fluid Solutions are developing a 'patient-centred' haemodialysis machine, the SelfCare+. This small, user-friendly machine will provide treatment that is just as efficient as a centre-based dialysis. Quanta's first innovative step was to replace the bulky, high maintenance hydraulic systems that prepare the fluid required for dialysis with small plastic components moulded into a disposable cartridge. This means the Selfcare+ can be made light enough to be portable and that it has no internal fluid pathways that require disinfection between treatments. With D4D support, Quanta has obtained an NHS i4i (Invention for Innovation) grant to ensure that the Selfcare+ can meet the needs of potential home haemodialysis patients as fully as possible. Feedback from patients to date is very promising. The SelfCare+ is expected to be approved for sale in Europe in mid-2012. It is hoped that, with more flexible installation requirements, short user training period, rapid set-up and strip-down times and the option of use while travelling, will encourage more haemodialysis patients to opt for, and get the benefits of, self-care in their home.

Unmet need: People with disabilities or neurological impairment who require use of a commode often have difficulty undertaking intimate self-care after toileting. The loss of independence can have profound effects on an individual's feeling of self-worth and toileting is a task that many carers, professional or otherwise, feel uncomfortable providing.

Solution: D4D helped Mr Speechley to develop The Dignity Bidet Commode. The Dignity Bidet Commode is self-controlled, can wash and dry its user without the need for assistance and offers a dignified alternative to the traditional product. D4D helped Mr Speechley to develop his prototype with a team of clinical design engineers, and assisted with ensuring safety and hygiene standards were met.

Unmet need: Lower urinary tract symptoms (LUTS) can cause significant distress to the sufferer and can impair quality of life severely for those affected. Effective treatment of LUTS requires clinical evidence on frequency of events, urine volumes passed and urgency. Current management is based on recording such events using paper diaries.

Solution: A new device, based around NICE guidelines on the identification and management of Lower Urinary Tract Symptoms (LUTS), has been developed by MDTi in collaboration with D4D, to provide real benefits to patients and their healthcare providers. The electronic diary will aid diagnosis and reduce inappropriate referrals by improving utilisation of specialist resources and presenting accurate and summarised clinical data to the clinician.

Unmet need: Paediatric wheelchairs used by children with severe disabilities and their carers are often large and unpleasant to the eye as they need to incorporate the most complex equipment such as ventilators, oxygen cylinders, and large batteries. An improved chair design, whilst still incorporating the equipment needs, would allow them to leave the hospital and be able to get out and about safely, confidently and more independently.

Solution: In collaboration with Frazer-Nash Consultancy, D4D gave children and their carers the opportunity to take part in a Dragon's Den style workshop, hosted by the charity Whizz-Kidz, with the aim of gathering their views and requirements for the development of a new wheelchair concept design.

Unmet need: Children and adults who have severe physical or learning disabilities require support for their body to avoid an uncomfortable and difficult flight. Fear about the lack of provision of seating supports in flight can be a significant factor that prevents families and individuals from spending their holidays abroad.

Solution: D4D in collaboration with the charity MERU and a number of major airline companies (Monarch, British Airways and Virgin) have collected the postural requirements of individuals and their families who have flown or wish to fly, with the ultimate aim of developing and manufacturing a seat insert that responds to their needs, and that is in compliance with the airline regulations.

Unmet need: Potassium (K) is a mineral that controls nerve and muscle (including heart) function. Maintaining K within the normal range is important to maintain a normal heart rhythm and maintain fluid and electrolyte balance in the body. Healthy kidneys remove excess K in the urine to maintain normal levels in the blood. When patients have advanced kidney disease, the kidneys cannot efficiently remove excess K, leading to high potassium levels (hyperkalaemia). The effects of hyperkalaemia include nausea, weakness, irregular heart rate, heart failure and sudden death. In patients who are on dialysis therapy or are approaching the need for dialysis, potassium levels can rise due to high potassium intake in the diet, medications and following surgery. Treatment of hyperkalaemia in these patients is urgent dialysis. Currently electrolytes, including K levels in the blood are measured in the labs and can take up to 24hours to receive the result (within 2 hours if requested urgently in the hospital setting). The ability to monitor K levels of patients in a similar fashion to a glucose meter (see fig) i.e pin-prick test with immediate response, would offer a significant improvement to the current practice and allow immediate treatment.

Solution: Currently, portable monitors are utilised in various settings including, in the community to assess blood gases in patients with respiratory disease and in war zones to monitor measures of kidney function (creatinine). In collaboration with D4D, renal units in Leeds and Sheffield are researching the available technology to assess if a currently available product can be adapted to meet the needs of renal patients. Such a device will provide a simple easy to use potassium monitor that will allow a rapid turnaround of potassium levels to aid patient/clinician discussion. The ultimate goal would be to have a monitor similar to a blood glucose monitor with disposable strips, and tailor made for renal patients that could be used by renal units, local clinics and patients.