To Comment:
According to our text Melnyk and Fineout-Overholt (2015) external evidence is from research whereas internal evidence is the clinic practice as a result of a quality improvement project or evidence based practice. Porzsolt et al. (2003) define internal evidence as the clinicians "current knowledge" (n.p.).
My internal evidence for my PICOT is the knowledge that 100% of my endoscopic carpal tunnel patients in the past year have required revision with open carpal tunnel release. My external evidence are the randomized controlled trials that I found on my literature search via Ebscohost databases CINAHL and Cochrane determining there is no statistical difference in either procedure in regards to outcome in a 6-month time frame.
Searching utilizing a database to answer a PICOT questions does have its advantages over web-based search. When searching the web, you must ensure that the information is current and valid even when using and academic search engine such as google scholar.
Web based searches often lead to too many results requiring more time for the clinician to weed through relevant information. The internet has made research at bedside possible however the clinician should be aware of the "soundness of the evidence, comprehensiveness and specificity, database ease of use, and access to database" when searching for literature (Hain &Kear, 2015).
Although web base search engines will yield you numerous results you should be conscious as a clinician only relying on this information. Melnyk and Fineout-Overholt (2015) recommend utilizing another source when you find your research on google or google scholar. Many databases have healthcare literature allowing a clinician to narrow by certain criteria.
CINAHL for example allows you to narrow by full text, peer reviewed evidence based literature results. Cochrane database is great for systemic reviews however the disadvantage is most full text articles require a fee. PubMed is a free database for clinicians to use when i the field and holds more citations then MEDLINE (Melnyk&Fineout-Overholt, 2015). However, Hain and Kear (2015) point out PubMed only produces the abstract.