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GRADE Working Group grades of evidence High certainty : we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty : we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty : our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty : we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect Explanations All selected studies are small in terms of study size as they are only 830 patients in one group

The accompanying photo shows a hypodermic needle being inserted under the loose skin between the dog's shoulder blades

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