summary Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classijication proposed by Cormack and Lehane. The overall prevalence of dificulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito-atlanto-axial complex have a higher prevalence of dificulty than those with disease below the axis vertebra. Occipito-atlanto-axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of thejrst and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator ofpoor cranio-cervical extension. Dificulty was rare inpatients with class A mandibular protrusion, and invariable in patients with class C protrusion.
Best practice can be defined as that combination of structure, educational technology and content of a learning opportunity, which, in certain contexts and for particular groups of learners, is most likely to achieve the purposes of the main stakeholders. However, the rate of change of technological, political, economic, social and cultural contexts suggests that best practice may become a redundant concept, in that what is judged as best one day may not be so judged the next. This article considers what some significant contributions to the literature on open and distance learning practice have to say about the development and provision of best practice and about the place of critical reflection by stakeholders. It also considers the challenges facing the development of best practice presented by change, concluding with the identification of the most significant areas of development yet to be made.
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