/tmp/workspace

cervical cancer survivorship pelvic floor rehabilitation

cervical cancer survivorship pelvic floor rehabilitation guidelines

~/attachments/3d837633-6011-492c-b8f9-57256c33a43a

mkdir -p "/tmp/workspace/pelvic-floor-final/src" "/tmp/workspace/pelvic-floor-final/output" && python -c "from pptx import Presentation; import os; paths=[r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship (2).pptx',r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship (3).pptx']; out=r'/tmp/workspace/pelvic-floor-final/src/source_inventory.txt'; f=open(out,'w'); for path in paths: prs=Presentation(path); f.write('\\n'+'='*80+'\\n'+os.path.basename(path)+' | slides='+str(len(prs.slides))+'\\n'); for i,s in enumerate(prs.slides,1): texts=[sh.text.strip().replace('\\n',' | ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()]; f.write('S%02d: %s\\n'%(i,' || '.join(texts))); f.write('\\n'); f.close()"

python -c "from pptx import Presentation; import os; paths=[r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship (2).pptx',r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship (3).pptx']; for path in paths: prs=Presentation(path); print('FILE',os.path.basename(path),'slides',len(prs.slides),'size',prs.slide_width,prs.slide_height) for i,s in enumerate(prs.slides,1): t=' | '.join(sh.text.replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()) print(i, t[:300]) print()"

PMID: 39581933

~/pelvic-floor-final

https://pmc.ncbi.nlm.nih.gov/articles/PMC10204585

python -c "import pkgutil; print('pptx',bool(pkgutil.find_loader('pptx'))); print('PIL',bool(pkgutil.find_loader('PIL')))" && cat > "/tmp/workspace/pelvic-floor-final/src/build_final.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE OUT='/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # Palette NAVY=RGBColor(13,38,63); INK=RGBColor(25,39,51); TEAL=RGBColor(0,128,132); MINT=RGBColor(214,241,233); CORAL=RGBColor(230,105,91); GOLD=RGBColor(234,181,76); PAPER=RGBColor(248,249,247); WHITE=RGBColor(255,255,255); GREY=RGBColor(94,107,117); PALE=RGBColor(232,239,239); PALEBLUE=RGBColor(224,239,244) W,H=13.333,7.5 def rect(s,x,y,w,h,fill,line=None,rad=False): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill; sh.line.color.rgb=line or fill if rad: sh.adjustments[0]=0.12 return sh def text(s,x,y,w,h,txt,size=18,color=INK,bold=False,font='Aptos',align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP,margin=.03): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=valign for j,line in enumerate(txt.split('\n')): p=tf.paragraphs[0] if j==0 else tf.add_paragraph(); p.alignment=align; p.space_after=Pt(0); p.space_before=Pt(0) r=p.add_run(); r.text=line; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return sh def rich(s,x,y,w,h,paras): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(.05); tf.margin_top=tf.margin_bottom=Inches(.03) for j,(tx,sz,col,bold,bullet) in enumerate(paras): p=tf.paragraphs[0] if j==0 else tf.add_paragraph(); p.alignment=PP_ALIGN.LEFT; p.space_after=Pt(8); p.level=0 if bullet: p.text='• '+tx else: p.text=tx for r in p.runs: r.font.name='Aptos'; r.font.size=Pt(sz); r.font.bold=bold; r.font.color.rgb=col return sh def line(s,x1,y1,x2,y2,color=PALE,width=1.3): sh=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2)); sh.line.color.rgb=color; sh.line.width=Pt(width); return sh def circle(s,x,y,d,fill,txt='',ts=12,tc=WHITE): sh=s.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x), Inches(y), Inches(d), Inches(d)); sh.fill.solid(); sh.fill.fore_color.rgb=fill; sh.line.color.rgb=fill if txt: text(s,x,y+.01,d,d-.02,txt,ts,tc,True,align=PP_ALIGN.CENTER,valign=MSO_ANCHOR.MIDDLE) return sh def header(s,num,label,title,sub=''): rect(s,0,0,W,.16,TEAL); text(s,.65,.36,1.7,.25,label.upper(),10,TEAL,True); text(s,.65,.69,11.8,.55,title,27,NAVY,True) if sub: text(s,.67,1.30,11.8,.32,sub,12,GREY) text(s,12.05,.37,.6,.25,f'{num:02d}',10,TEAL,True,align=PP_ALIGN.RIGHT) line(s,.65,1.72,12.67,1.72,PALE) def footer(s,n): line(s,.65,7.08,12.67,7.08,PALE,.7); text(s,.65,7.16,7,.18,'CERVICAL CANCER SURVIVORSHIP • PELVIC FLOOR REHABILITATION',8,GREY,True); text(s,12.1,7.16,.55,.18,str(n),8,GREY,True,align=PP_ALIGN.RIGHT) def card(s,x,y,w,h,title,body,accent=TEAL): rect(s,x,y,w,h,WHITE,PALE,True); rect(s,x,y,.07,h,accent,accent); text(s,x+.25,y+.20,w-.45,.28,title,14,INK,True); rich(s,x+.22,y+.62,w-.45,h-.72,[(t,12,GREY,False,True) for t in body]) # 1 s=prs.slides.add_slide(blank); rect(s,0,0,W,H,NAVY); rect(s,0,0,.18,H,TEAL); circle(s,9.74,.85,2.15,TEAL); circle(s,10.5,1.62,.65,GOLD); circle(s,9.18,2.8,1.2,CORAL); line(s,9.25,4.7,12.0,4.7,RGBColor(65,100,125),1) text(s,.8,.78,3.4,.3,'GYNECOLOGIC ONCOLOGY | SURVIVORSHIP',11,MINT,True) text(s,.78,1.50,7.8,1.55,'Rebuilding\nthe Base',41,WHITE,True) text(s,.82,3.48,7.5,.55,'Pelvic floor rehabilitation in cervical cancer survivorship',20,MINT,False) text(s,.82,4.25,6.8,.52,'A function-first pathway from treatment to recovery',15,WHITE,False) text(s,.82,6.55,7.8,.28,'Presenter name | Institution | 2026',11,MINT) text(s,9.1,5.15,2.7,.55,'Screen\nAssess\nRestore',20,WHITE,True,align=PP_ALIGN.RIGHT) #2 s=prs.slides.add_slide(blank); header(s,2,'Why this matters','The cure is not the endpoint','Pelvic symptoms can persist after successful cancer treatment and are often not volunteered.'); text(s,.72,2.15,3.6,.48,'“Can I return to the life\nthat feels like mine?”',24,NAVY,True); rect(s,.72,3.47,3.5,.07,CORAL); text(s,.72,3.72,3.38,1.25,'A survivorship visit may be the first place these concerns are named, normalized and acted on.',16,INK) card(s,4.75,2.15,3.7,1.6,'BLADDER',['Urgency or leakage','Pain or difficult emptying'],TEAL); card(s,8.8,2.15,3.7,1.6,'BOWEL',['Constipation or urgency','Evacuation difficulty or leakage'],GOLD); card(s,4.75,4.10,3.7,1.6,'VAGINAL / SEXUAL',['Dryness, tightness or pain','Stenosis, avoidance, exam intolerance'],CORAL); card(s,8.8,4.10,3.7,1.6,'PARTICIPATION',['Sleep, movement, work, intimacy','Identity and relationships'],TEAL); text(s,.72,6.35,11.7,.32,'Clinical gap: “No recurrence” does not mean “no morbidity.”',15,NAVY,True); footer(s,2) #3 s=prs.slides.add_slide(blank); header(s,3,'Mechanism matters','Different treatments, converging pelvic consequences','The same symptom can arise through different impairments.'); for x,title,bul,ac in [(0.72,'Surgery',['Autonomic nerve disruption','Scar and altered support','Voiding dysfunction'],TEAL),(4.55,'Radiotherapy ± brachytherapy',['Fibrosis and reduced compliance','Mucosal change and shortening','Bowel and bladder irritation'],CORAL),(8.38,'Systemic / menopause effects',['Fatigue and deconditioning','Oestrogen deficiency','Mood, body image, fear'],GOLD)]: card(s,x,2.2,3.45,2.15,title,bul,ac) line(s,2.45,4.7,2.45,5.1,TEAL,2); line(s,6.28,4.7,6.28,5.1,CORAL,2); line(s,10.1,4.7,10.1,5.1,GOLD,2); line(s,2.45,5.1,10.1,5.1,PALE,2) text(s,.72,5.48,2.6,.25,'CONVERGES ON',11,TEAL,True) for x,k,v,c in [(3.35,'B','Bladder',TEAL),(5.55,'B','Bowel',GOLD),(7.75,'S','Sexual health',CORAL),(9.95,'P','Pain & participation',NAVY)]: circle(s,x,5.84,.48,c,k,14); text(s,x+.62,5.92,1.55,.22,v,12,INK,True) text(s,.72,6.55,11.4,.25,'Implication: do not prescribe “Kegels” reflexively. Match rehabilitation to the dominant impairment.',14,NAVY,True); footer(s,3) #4 s=prs.slides.add_slide(blank); header(s,4,'3-minute screen','Make pelvic function visible','At treatment transition and at follow-up: ask permission, normalize and listen.'); qs=[('1','BLADDER','Leakage, urgency, pain or difficulty emptying?'),('2','BOWEL','Urgency, constipation, leakage or bleeding?'),('3','VAGINAL / SEXUAL','Dryness, tightness, pain, change in intimacy or examination tolerance?'),('4','PAIN / FUNCTION','Pelvic pain, heaviness, fear of movement or activity restriction?')] for i,(n,t,q) in enumerate(qs): x=.72+(i%2)*6.05;y=2.15+(i//2)*1.72; circle(s,x,y,.5,TEAL,n,13); text(s,x+.72,y+.02,4.75,.22,t,12,TEAL,True); text(s,x+.72,y+.36,4.75,.55,q,15,INK,False) line(s,.72,5.82,12.6,5.82,PALE); text(s,.72,6.08,11.55,.45,'Use patient-reported symptoms to open the conversation. Targeted examination is consent-led and only undertaken when clinically appropriate.',14,GREY); footer(s,4) #5 s=prs.slides.add_slide(blank); header(s,5,'Phenotype before prescription','The pelvic floor is not a single diagnosis','The assessment identifies the treatable pattern and the survivor’s own goal.'); steps=[('1','History','Onset, triggers, diary, sexual and functional goals'),('2','Safety check','Recurrence concern, infection, fistula, bleeding, obstruction, severe pain'),('3','Examination','Consent-led external and, if appropriate, internal assessment'),('4','Measures','ICIQ-UI, PFDI-20, pain NRS, sexual outcomes or goal attainment')] for i,(n,t,b) in enumerate(steps): x=.72+i*3.0; circle(s,x,2.35,.56,[TEAL,CORAL,GOLD,NAVY][i],n,13); text(s,x,3.12,2.65,.25,t,15,INK,True); text(s,x,3.48,2.55,.72,b,12,GREY) line(s,1.0,2.63,10.2,2.63,PALE,2) rect(s,.72,5.15,11.92,.9,PALEBLUE,PALEBLUE,True); text(s,1.02,5.35,11.25,.46,'Clinical rule: strengthening is not the answer to every pelvic symptom.',18,NAVY,True,align=PP_ALIGN.CENTER); text(s,1.02,6.25,11.35,.28,'Pain, guarding or hypertonicity may require down-training, breathing, manual techniques and graded exposure first.',13,GREY,align=PP_ALIGN.CENTER); footer(s,5) #6 s=prs.slides.add_slide(blank); header(s,6,'The rehabilitation toolkit','A tailored bundle, not a one-size-fits-all exercise sheet','Dose, supervision, adherence and education shape response.'); data=[('Overactivity / pain','Down-training, diaphragmatic breathing, pain education, graded exposure, manual therapy when indicated',CORAL),('Weakness / leakage','Motor learning, progressive strengthening, “the knack”, functional loading, bladder training',TEAL),('Incoordination / bowel','Toileting mechanics, coordinated breathing and relaxation, fiber/fluid review',GOLD),('Tissue restriction / stenosis','Education, lubricants or moisturizers, graded vaginal rehabilitation or dilators when appropriate',NAVY)] for i,(t,b,c) in enumerate(data): x=.72+(i%2)*6.0;y=2.15+(i//2)*2.0; rect(s,x,y,5.55,1.6,WHITE,PALE,True); circle(s,x+.26,y+.28,.36,c); text(s,x+.78,y+.25,4.45,.25,t,14,INK,True); text(s,x+.28,y+.75,4.95,.58,b,12,GREY) text(s,.72,6.35,11.7,.3,'Rehabilitation target = function and participation, not a muscle grade in isolation.',15,NAVY,True); footer(s,6) #7 s=prs.slides.add_slide(blank); header(s,7,'Safety before therapy','Triage new, progressive or unexplained symptoms','Do not attribute concerning symptoms automatically to pelvic floor dysfunction.'); rect(s,.72,2.15,4.0,3.85,RGBColor(255,241,238),RGBColor(255,221,216),True); text(s,1.02,2.42,3.35,.3,'RED FLAGS',15,CORAL,True); rich(s,1.0,2.94,3.35,2.7,[(x,13,INK,False,True) for x in ['New or worsening pelvic pain','Vaginal, rectal or urinary bleeding','Suspected infection or fistula','Retention, obstruction or hydronephrosis symptoms','New neurologic or systemic symptoms']]) rect(s,5.05,2.15,3.2,3.85,PALEBLUE,PALEBLUE,True); text(s,5.38,2.42,2.55,.3,'CLINICAL REVIEW',15,NAVY,True); rich(s,5.35,2.94,2.5,2.5,[(x,13,INK,False,True) for x in ['Surveillance status','Treatment and medication history','Focused examination when appropriate','Urology, GI, pain or oncology input']]) rect(s,8.58,2.15,3.98,3.85,MINT,MINT,True); text(s,8.92,2.42,3.1,.3,'THEN REHABILITATE',15,TEAL,True); rich(s,8.88,2.94,3.1,2.5,[(x,13,INK,False,True) for x in ['Pelvic health physiotherapy assessment','Patient-led, trauma-informed care','Shared plan and follow-up','Escalation pathway']]) footer(s,7) #8 s=prs.slides.add_slide(blank); header(s,8,'Build it into the pathway','From prehabilitation to long-term recovery','A named route is more useful than a generic referral.'); phases=[('Before treatment','Baseline symptoms\nEducation and expectations\nRisk stratification',TEAL),('During treatment','Manage irritative symptoms\nMaintain movement\nProtect confidence',GOLD),('0-12 weeks after','Screen recovery\nAddress early dysfunction\nStart targeted rehabilitation',CORAL),('Long-term follow-up','Review function and goals\nTreat late effects\nEscalate complex care',NAVY)] for i,(t,b,c) in enumerate(phases): x=.72+i*3.0; rect(s,x,2.3,2.65,2.85,WHITE,PALE,True); rect(s,x,2.3,2.65,.11,c,c); text(s,x+.25,2.68,2.15,.46,t,15,INK,True); text(s,x+.25,3.48,2.1,1.0,b,13,GREY) if i<3: line(s,x+2.66,3.72,x+2.98,3.72,TEAL,1.5) text(s,.72,5.75,11.85,.32,'At every phase: screen bladder, bowel, pain and intimacy. Document a meaningful goal. Close the loop on response.',15,NAVY,True); footer(s,8) #9 s=prs.slides.add_slide(blank); header(s,9,'Evidence with honesty','Offer evidence-informed care, be clear about uncertainty','Most evidence pools gynecologic cancer populations, rather than cervical cancer alone.'); rect(s,.72,2.12,3.05,3.95,NAVY,NAVY,True); text(s,1.05,2.52,2.4,.3,'2026',15,MINT,True); text(s,1.05,2.98,2.3,.8,'17\nsystematic reviews\nwith meta-analyses',24,WHITE,True); text(s,1.05,4.75,2.4,.52,'92 primary studies across cancer survivor populations',12,MINT) card(s,4.12,2.12,3.95,3.95,'WHAT WE CAN SAY',['Pelvic floor rehabilitation has therapeutic potential across bladder, bowel, sexual-function and quality-of-life outcomes.','Multimodal and individualized programmes are clinically plausible.'],TEAL) card(s,8.42,2.12,4.15,3.95,'WHAT WE CANNOT OVERSTATE',['Certainty varies across outcomes and populations.','Study quality, intervention content and outcome measures are heterogeneous.','Cervical-cancer-specific data remain limited.'],CORAL) text(s,.75,6.38,11.6,.28,'Source: Hao et al. Pelvic floor rehabilitation in cancer survivorship: umbrella review. J Cancer Surviv. 2026. PMID 39581933.',9,GREY); footer(s,9) #10 s=prs.slides.add_slide(blank); header(s,10,'Service model','One door, many skills','The core team varies by setting. Shared language and feedback loops matter.'); circle(s,5.76,3.35,1.35,TEAL,'SURVIVOR\nGOALS',16,WHITE) roles=[(2.0,2.25,'Gyn oncologist','Safety, surveillance, referral',NAVY),(9.25,2.25,'Pelvic health PT','Assessment and rehabilitation lead',TEAL),(1.75,5.1,'Urology / GI','Complex bladder and bowel care',GOLD),(9.2,5.1,'Psychosexual care','Pain, intimacy, mental health',CORAL),(5.4,5.65,'Radiation oncology','Toxicity and tissue effects',NAVY)] for x,y,t,b,c in roles: rect(s,x,y,2.6,.94,WHITE,PALE,True); rect(s,x,y,.08,.94,c,c); text(s,x+.18,y+.18,2.15,.2,t,12,INK,True); text(s,x+.18,y+.47,2.18,.23,b,10,GREY) # connectors visually for a,b in [((4.6,2.7),(5.75,3.6)),((9.25,2.7),(7.1,3.6)),((4.35,5.1),(5.75,4.7)),((9.2,5.1),(7.1,4.7)),((6.7,5.65),(6.45,4.72))]:line(s,*a,*b,PALE,1.2) text(s,.72,6.62,11.5,.22,'Shared language: identify the impairment, name the goal, agree the next step, review the response.',13,NAVY,True); footer(s,10) #11 s=prs.slides.add_slide(blank); header(s,11,'Case application','The right intervention begins with the right question','Illustrative case. Management must be individualized and coordinated with the oncology team.'); rect(s,.72,2.2,3.35,3.9,NAVY,NAVY,True); text(s,1.03,2.55,2.7,.26,'AYA, 42 YEARS',12,MINT,True); text(s,1.03,3.04,2.65,1.05,'6 months after\nchemoradiation + brachytherapy',19,WHITE,True); text(s,1.03,4.58,2.62,.75,'Urgency • pain with penetration • fear of exercise',13,MINT) for y,t,b,c in [(2.25,'ASSESS','Bladder diary, consent-led assessment, tissue safety, pelvic-floor overactivity/coordination, goals',TEAL),(3.55,'PLAN','Education, bladder strategies, down-training and graded exposure; consider vaginal rehabilitation where appropriate',CORAL),(4.85,'OUTCOME','Less urgency, improved exam tolerance and return to valued movement or intimacy goals',GOLD)]: circle(s,4.65,y,.46,c); text(s,5.35,y+.02,1.15,.2,t,12,c,True); text(s,6.5,y,5.55,.58,b,13,INK) line(s,4.88,2.72,4.88,5.13,PALE,1.4); text(s,4.65,6.38,7.3,.28,'Do not assume: “weak pelvic floor,” “needs Kegels,” or “symptoms are expected.”',14,NAVY,True); footer(s,11) #12 s=prs.slides.add_slide(blank); header(s,12,'Start where you are','A 90-day implementation sprint','Build a service, not just a referral.'); for x,num,title,body,c in [(0.72,'0-30','MAP',['Agree red flags','Choose a 4-domain screen','Map referral routes'],TEAL),(4.52,'31-60','PILOT',['Train clinic team','Pilot in one clinic','Create patient handout'],GOLD),(8.32,'61-90','MEASURE',['Audit uptake and delay','Review patient outcomes','Refine pathway'],CORAL)]: rect(s,x,2.25,3.25,3.25,WHITE,PALE,True); text(s,x+.28,2.55,1.3,.25,num+' days',13,c,True); text(s,x+.28,3.05,2.5,.36,title,22,NAVY,True); rich(s,x+.25,3.75,2.65,1.3,[(z,13,GREY,False,True) for z in body]) text(s,.72,6.25,11.65,.34,'Minimum viable pathway: four questions, a clear red-flag process, a named pelvic-health contact and outcome review.',15,NAVY,True); footer(s,12) #13 s=prs.slides.add_slide(blank); rect(s,0,0,W,H,NAVY); rect(s,0,0,.18,H,TEAL); text(s,.82,.72,4.2,.25,'TAKE-HOME MESSAGES',11,MINT,True); text(s,.82,1.18,9.6,.7,'Rebuild the base.\nRestore the life.',33,WHITE,True) msgs=[('01','Ask early','Bladder, bowel, pain and intimacy are survivorship outcomes.',TEAL),('02','Assess the phenotype','Do not prescribe generic strengthening without a symptom and function assessment.',GOLD),('03','Build the pathway','A named, coordinated pelvic-health route makes recovery actionable.',CORAL)] for i,(n,t,b,c) in enumerate(msgs): x=.82+i*4.05; circle(s,x,3.5,.58,c,n,13); text(s,x,4.35,3.45,.3,t,16,WHITE,True); text(s,x,4.82,3.35,.55,b,13,MINT) text(s,.82,6.43,11.7,.25,'“No recurrence” is not “no morbidity.”',16,WHITE,True) #14 references s=prs.slides.add_slide(blank); header(s,14,'Selected references','Evidence base and further reading','References should be adapted to local guideline and institutional requirements.'); refs=['Hao J, et al. Pelvic floor rehabilitation in cancer survivorship: an umbrella review. Journal of Cancer Survivorship. 2026. PMID: 39581933.','Cyr MP, et al. Effectiveness of pelvic floor muscle and education-based therapies in females treated for gynecological cancer: a systematic review. Current Oncology Reports. 2024;26:1400-1429. PMID: 39177709.','Li X, et al. Analysis of the effectiveness of pelvic floor rehabilitation exercise in postoperative patients with cervical cancer. Frontiers in Oncology. 2023;13:1118794. PMCID: PMC10204585.','World Health Organization. Rehabilitation Package: Module 7. 2023.'] rich(s,.82,2.15,11.45,3.4,[(r,14,INK,False,True) for r in refs]) rect(s,.82,6.02,11.55,.58,PALEBLUE,PALEBLUE,True); text(s,1.1,6.19,10.95,.2,'Educational content only. Clinical assessment and treatment should be individualized within local scope of practice.',11,NAVY,True,align=PP_ALIGN.CENTER); footer(s,14) prs.core_properties.title='Rebuilding the Base: Pelvic Floor Rehabilitation in Cervical Cancer Survivorship'; prs.core_properties.subject='Educational conference presentation'; prs.core_properties.author='' prs.save(OUT) print(OUT) PY python "/tmp/workspace/pelvic-floor-final/src/build_final.py"

python -c "from pptx import Presentation; from pptx.util import Inches; p=r'/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship.pptx'; prs=Presentation(p); W,H=prs.slide_width,prs.slide_height; print('slides',len(prs.slides)); errors=[] for i,s in enumerate(prs.slides,1): texts=[sh.text.strip().replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] bad=[sh.name for sh in s.shapes if sh.left<0 or sh.top<0 or sh.left+sh.width>W or sh.top+sh.height>H] if bad: errors.append((i,bad)) print(f'{i:02d}: shapes={len(s.shapes):02d} text={len(texts):02d} | '+(' | '.join(texts[:2]))[:160]) print('OUT_OF_BOUNDS',errors) print('size_bytes',__import__('os').path.getsize(p))"

/tmp/workspace

Lindgren Börjeson Dunberger pelvic floor muscle training radiotherapy

Lindgren Borjeson Dunberger 2024 Female Pelvic Cancer Survivors Experiences Pelvic Floor Muscle Training After Pelvic Radiotherapy

PMID: 39623242

python -c "from pptx import Presentation; p=r'/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship.pptx'; prs=Presentation(p); print('slides',len(prs.slides)); print('last:', ' | '.join(sh.text.replace('\\n',' / ') for sh in prs.slides[-1].shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()))"

~/pelvic-floor-final

/tmp/workspace

PMID 39623242 Lindgren Börjeson Dunberger PFMT pelvic radiotherapy 2024

Lindgren Börjeson Dunberger pelvic floor radiotherapy

python -c "from pptx import Presentation; p=r'/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship.pptx'; prs=Presentation(p); print('slides',len(prs.slides)); for i,s in enumerate(prs.slides,1): print(i, ' | '.join(sh.text.replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip())[:180])"

cat > "/tmp/workspace/pelvic-floor-final/src/add_lindgren_evidence_slides.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from copy import deepcopy import os SRC='/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship.pptx' OUT='/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship_with_Lindgren_Evidence.pptx' prs=Presentation(SRC) W,H=13.333,7.5 NAVY=RGBColor(13,38,63); INK=RGBColor(25,39,51); TEAL=RGBColor(0,128,132); MINT=RGBColor(214,241,233); CORAL=RGBColor(230,105,91); GOLD=RGBColor(234,181,76); WHITE=RGBColor(255,255,255); GREY=RGBColor(94,107,117); PALE=RGBColor(232,239,239); PALEBLUE=RGBColor(224,239,244) blank=prs.slide_layouts[6] def rect(s,x,y,w,h,fill,line=None,rad=False): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill; sh.line.color.rgb=line or fill if rad: sh.adjustments[0]=0.12 return sh def text(s,x,y,w,h,txt,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT,valign=MSO_ANCHOR.TOP,margin=.03): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=valign for j,line in enumerate(txt.split('\n')): p=tf.paragraphs[0] if j==0 else tf.add_paragraph(); p.alignment=align; p.space_after=Pt(0); p.space_before=Pt(0) r=p.add_run(); r.text=line; r.font.name='Aptos'; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return sh def rich(s,x,y,w,h,items,space=7): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(.05); tf.margin_top=tf.margin_bottom=Inches(.03) for j,(tx,sz,col,bold,bullet) in enumerate(items): p=tf.paragraphs[0] if j==0 else tf.add_paragraph(); p.alignment=PP_ALIGN.LEFT; p.space_after=Pt(space) p.text=('• ' if bullet else '')+tx for r in p.runs: r.font.name='Aptos'; r.font.size=Pt(sz); r.font.bold=bold; r.font.color.rgb=col return sh def line(s,x1,y1,x2,y2,color=PALE,width=1.2): sh=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2)); sh.line.color.rgb=color; sh.line.width=Pt(width); return sh def circle(s,x,y,d,fill,txt='',ts=12,tc=WHITE): sh=s.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x), Inches(y), Inches(d), Inches(d)); sh.fill.solid(); sh.fill.fore_color.rgb=fill; sh.line.color.rgb=fill if txt: text(s,x,y+.01,d,d-.02,txt,ts,tc,True,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) return sh def header(s,num,label,title,sub=''): rect(s,0,0,W,.16,TEAL); text(s,.65,.36,2.5,.25,label.upper(),10,TEAL,True); text(s,.65,.69,11.5,.55,title,27,NAVY,True) if sub: text(s,.67,1.30,11.8,.32,sub,12,GREY) text(s,12.05,.37,.6,.25,f'{num:02d}',10,TEAL,True,PP_ALIGN.RIGHT) line(s,.65,1.72,12.67,1.72,PALE) def footer(s,n): line(s,.65,7.08,12.67,7.08,PALE,.7); text(s,.65,7.16,7,.18,'CERVICAL CANCER SURVIVORSHIP • PELVIC FLOOR REHABILITATION',8,GREY,True); text(s,12.1,7.16,.55,.18,str(n),8,GREY,True,PP_ALIGN.RIGHT) def card(s,x,y,w,h,title,body,accent): rect(s,x,y,w,h,WHITE,PALE,True); rect(s,x,y,.07,h,accent,accent); text(s,x+.23,y+.17,w-.4,.26,title,14,INK,True); rich(s,x+.22,y+.56,w-.45,h-.65,[(z,12,GREY,False,True) for z in body],6) # New slide 9: evidence at a glance s1=prs.slides.add_slide(blank) header(s1,9,'Evidence spotlight','What did women experience after pelvic radiotherapy?','Lindgren, Börjeson & Dunberger, Supportive Care in Cancer, 2024') # Study card rect(s1,.72,2.13,3.2,3.82,NAVY,NAVY,True) text(s1,1.04,2.45,2.5,.24,'QUALITATIVE INTERVIEW STUDY',11,MINT,True) text(s1,1.04,2.87,2.45,.78,'11 women\naged 47-83 years',22,WHITE,True) line(s1,1.04,3.9,3.35,3.9,RGBColor(74,109,135),1) rich(s1,1.01,4.16,2.58,1.3,[('Pelvic cancer survivors with urinary and/or fecal incontinence',12,MINT,False,True),('Radiotherapy completed 3-60 months before participation',12,MINT,False,True)]) # Program visual text(s1,4.43,2.18,7.6,.26,'3-MONTH PFMT PROGRAMME',15,TEAL,True) items=[('Structured PFMT','Practice plan and daily-routine strategies',TEAL),('Optional physiotherapist support','Individual guidance, biofeedback and group training',GOLD),('Interviews after the programme','Qualitative content analysis of participant experiences',CORAL)] for i,(t,b,c) in enumerate(items): x=4.43+i*2.72; circle(s1,x,2.78,.52,c,str(i+1),13); text(s1,x,3.52,2.45,.38,t,14,INK,True); text(s1,x,4.06,2.4,.77,b,12,GREY) if i<2: line(s1,x+.55,3.04,x+2.6,3.04,PALE,1.5) rect(s1,4.43,5.53,7.75,.46,PALEBLUE,PALEBLUE,True) text(s1,4.67,5.66,7.2,.18,'Interpretation: a qualitative study of perceived experiences, not a standalone efficacy estimate.',10,NAVY,True,PP_ALIGN.CENTER) text(s1,.72,6.4,11.7,.24,'Source: Lindgren A, Börjeson S, Dunberger G. Support Care Cancer. 2024;32:844. PMID 39623242.',9,GREY) footer(s1,9) # New slide 10: reported insights and clinical response s2=prs.slides.add_slide(blank) header(s2,10,'Participant insights','Correct activation, guidance and consistent practice made the difference','Reported experience should guide a supported, individualized approach.') card(s2,.72,2.13,3.72,2.95,'WHAT HELPED',['A structured programme and planned follow-up','Physiotherapist guidance and biofeedback to identify correct activation','Daily-routine strategies, motivation and peer support'],TEAL) card(s2,4.80,2.13,3.72,2.95,'WHAT WOMEN PERCEIVED',['More pelvic floor strength','Less urinary and fecal leakage; better urgency control','Less anxiety, more confidence, activity participation and sexual-health benefits'],GOLD) card(s2,8.88,2.13,3.72,2.95,'WHAT NEEDS INDIVIDUALIZATION',['Home and group formats were both facilitators and barriers','Privacy and travel affected group participation','Pain improved for some but increased for others'],CORAL) rect(s2,.72,5.57,11.88,.66,NAVY,NAVY,True) text(s2,1.02,5.74,11.25,.24,'Clinical implication: PFMT should be offered within pelvic cancer rehabilitation, with assessment, correct activation, individualized progression and physiotherapist support.',13,WHITE,True,PP_ALIGN.CENTER) text(s2,.72,6.46,11.7,.25,'Take-home message: Correct activation + individualized guidance + consistent practice = meaningful pelvic floor rehabilitation.',12,NAVY,True,PP_ALIGN.CENTER) footer(s2,10) # Move the two newly appended slides to after original slide 8 slides_xml=prs.slides._sldIdLst ids=list(slides_xml) for el in ids[-2:]: slides_xml.remove(el) insert_at=8 slides_xml.insert(insert_at, ids[-2]) slides_xml.insert(insert_at+1, ids[-1]) # Renumber original slides after inserted evidence slides: original 9 through 14 become 11 through 16. # Update only the small numeric header/footer text shapes based on exact-string matches. for slide_idx in range(10, len(prs.slides)): old_num=slide_idx-1 # after insertion, slide idx 10 (0-based) is original #9 new_num=slide_idx+1 old_header=f'{old_num:02d}'; new_header=f'{new_num:02d}' for sh in prs.slides[slide_idx].shapes: if not getattr(sh,'has_text_frame',False): continue current=sh.text.strip() if current==old_header: sh.text_frame.paragraphs[0].runs[0].text=new_header elif current==str(old_num): sh.text_frame.paragraphs[0].runs[0].text=str(new_num) # add Lindgren reference to selected references slide and preserve style with an appended paragraph refslide=prs.slides[-1] for sh in refslide.shapes: if getattr(sh,'has_text_frame',False) and 'Hao J, et al.' in sh.text: tf=sh.text_frame p=tf.add_paragraph(); p.text='• Lindgren A, Börjeson S, Dunberger G. Female pelvic cancer survivors’ experiences of pelvic floor muscle training after pelvic radiotherapy. Support Care Cancer. 2024;32:844. PMID: 39623242. doi:10.1007/s00520-024-09041-w.' p.space_after=Pt(6) for r in p.runs: r.font.name='Aptos'; r.font.size=Pt(11); r.font.color.rgb=INK break prs.save(OUT) print(OUT) PY python "/tmp/workspace/pelvic-floor-final/src/add_lindgren_evidence_slides.py"

python -c "from pptx import Presentation; import os; p=r'/tmp/workspace/pelvic-floor-final/output/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship_with_Lindgren_Evidence.pptx'; prs=Presentation(p); W,H=prs.slide_width,prs.slide_height; print('slides',len(prs.slides),'bytes',os.path.getsize(p)); errors=[] for i,s in enumerate(prs.slides,1): bad=[sh.name for sh in s.shapes if sh.left<0 or sh.top<0 or sh.left+sh.width>W or sh.top+sh.height>H] texts=[sh.text.strip().replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] if bad: errors.append((i,bad)) print(f'{i:02d}: '+(' | '.join(texts[:3]))[:180]) print('OUT_OF_BOUNDS',errors)"

/tmp/workspace

cervical cancer survivorship pelvic floor rehabilitation evidence 2024 2025 guideline

cervical cancer pelvic floor rehabilitation survivorship

~/attachments/3d837633-6011-492c-b8f9-57256c33a43a

mkdir -p "/tmp/workspace/pelvic-floor-professional/src" "/tmp/workspace/pelvic-floor-professional/output" && python -c "from pptx import Presentation; import os; paths=[r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_MERGED (1).pptx',r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_Final_Cervical_Cancer_Survivorship_with_Lindgren_Evidence.pptx']; out=r'/tmp/workspace/pelvic-floor-professional/src/audit.txt'; f=open(out,'w'); for path in paths: p=Presentation(path); f.write('\\n'+'='*80+'\\n'+os.path.basename(path)+f' | slides={len(p.slides)} | dimensions={p.slide_width}x{p.slide_height}\\n') for i,s in enumerate(p.slides,1): tx=[sh.text.strip().replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()]; f.write(f'S{i:02d} ({len(s.shapes)} objects): '+' || '.join(tx)+'\\n') f.close()"

python -c "from pptx import Presentation; p=r'/tmp/workspace/attachments/3d837633-6011-492c-b8f9-57256c33a43a/Rebuilding_the_Base_MERGED (1).pptx'; prs=Presentation(p); for i,s in enumerate(prs.slides,1): ts=[sh.text.strip().replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()]; print(f'{i:02d}: '+(' | '.join(ts[:3]))[:260])"

cat > "/tmp/workspace/pelvic-floor-professional/src/build_professional_deck.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor OUT='/tmp/workspace/pelvic-floor-professional/output/Rebuilding_the_Base_Professional_Conference_Deck.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5); blank=prs.slide_layouts[6] N=RGBColor(12,35,58); T=RGBColor(0,125,130); M=RGBColor(215,241,233); C=RGBColor(220,98,83); G=RGBColor(225,173,68); I=RGBColor(29,43,55); W=RGBColor(255,255,255); GR=RGBColor(92,105,115); P=RGBColor(230,238,239); B=RGBColor(226,240,244) SW,SH=13.333,7.5 def box(s,x,y,w,h,fill,line=None,round=False): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if round else MSO_SHAPE.RECTANGLE,Inches(x),Inches(y),Inches(w),Inches(h)); sh.fill.solid();sh.fill.fore_color.rgb=fill;sh.line.color.rgb=line or fill if round: sh.adjustments[0]=0.12 return sh def tx(s,x,y,w,h,v,sz=16,col=I,bold=False,align=PP_ALIGN.LEFT,vert=MSO_ANCHOR.TOP): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); f=sh.text_frame;f.clear();f.word_wrap=True;f.margin_left=f.margin_right=Inches(.04);f.margin_top=f.margin_bottom=Inches(.02);f.vertical_anchor=vert for k,a in enumerate(v.split('\n')): p=f.paragraphs[0] if k==0 else f.add_paragraph();p.alignment=align;p.space_after=Pt(0);r=p.add_run();r.text=a;r.font.name='Aptos';r.font.size=Pt(sz);r.font.bold=bold;r.font.color.rgb=col return sh def bullets(s,x,y,w,h,arr,sz=13,col=GR): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h));f=sh.text_frame;f.clear();f.word_wrap=True;f.margin_left=f.margin_right=Inches(.05);f.margin_top=Inches(.02) for j,a in enumerate(arr): p=f.paragraphs[0] if j==0 else f.add_paragraph();p.text='• '+a;p.space_after=Pt(8) for r in p.runs:r.font.name='Aptos';r.font.size=Pt(sz);r.font.color.rgb=col return sh def ln(s,x,y,x2,y2,col=P,w=1): sh=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x),Inches(y),Inches(x2),Inches(y2));sh.line.color.rgb=col;sh.line.width=Pt(w) def dot(s,x,y,d,col,label='',fs=13): sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(d),Inches(d));sh.fill.solid();sh.fill.fore_color.rgb=col;sh.line.color.rgb=col if label:tx(s,x,y+.01,d,d-.02,label,fs,W,True,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) def head(s,n,kicker,title,sub=''): box(s,0,0,SW,.16,T);tx(s,.66,.36,3,.2,kicker.upper(),10,T,True);tx(s,.66,.68,11.4,.52,title,26,N,True);tx(s,12.05,.37,.6,.2,f'{n:02d}',10,T,True,PP_ALIGN.RIGHT) if sub:tx(s,.67,1.3,11.6,.25,sub,12,GR) ln(s,.66,1.72,12.67,1.72,P) def foot(s,n): ln(s,.66,7.08,12.67,7.08,P,.7);tx(s,.66,7.15,7,.18,'CERVICAL CANCER SURVIVORSHIP • PELVIC FLOOR REHABILITATION',8,GR,True);tx(s,12.1,7.15,.55,.18,str(n),8,GR,True,PP_ALIGN.RIGHT) def card(s,x,y,w,h,title,items,accent=T,fs=12): box(s,x,y,w,h,W,P,True);box(s,x,y,.07,h,accent,accent);tx(s,x+.25,y+.18,w-.4,.24,title,14,I,True);bullets(s,x+.22,y+.54,w-.42,h-.62,items,fs) def basic(n,k,t,sub,cols): s=prs.slides.add_slide(blank);head(s,n,k,t,sub) cw=(11.85-(len(cols)-1)*.28)/len(cols) for i,(h,items,co) in enumerate(cols):card(s,.72+i*(cw+.28),2.12,cw,3.72,h,items,co) foot(s,n);return s # 1 Title s=prs.slides.add_slide(blank);box(s,0,0,SW,SH,N);box(s,0,0,.16,SH,T) for x,y,d,col in [(9.1,.9,1.55,T),(10.4,1.3,.7,G),(9.7,2.8,.9,C),(11.1,3.25,.45,M)]:dot(s,x,y,d,col) tx(s,.8,.78,4,.2,'CONFERENCE SESSION • CLINICAL SURVIVORSHIP PROGRAM',11,M,True);tx(s,.78,1.55,8,1.35,'Rebuilding\nthe Base',41,W,True);tx(s,.82,3.58,7.4,.38,'Pelvic floor rehabilitation in cervical cancer survivorship',20,M);tx(s,.82,4.28,7.3,.38,'A whole-person, multidisciplinary pathway from treatment to recovery',15,W);tx(s,.82,6.5,8,.25,'Presenter | Institution | Conference | 2026',11,M) #2 objectives basic(2,'Session roadmap','What this session delivers','A practical pathway for oncology, pelvic-health and supportive-care teams.',[ ('1 Recognize',['Screen bladder, bowel, pain and intimacy routinely','Understand common treatment-related mechanisms'],T),('2 Assess',['Use consent-forward, phenotype-led evaluation','Identify red flags and define functional goals'],G),('3 Restore',['Match intervention to impairment','Coordinate referral, review and escalation'],C)]) #3 case s=prs.slides.add_slide(blank);head(s,3,'Framing case','Meet the survivor behind the pathway','Return to this case at the close.');box(s,.72,2.1,4.0,3.95,N,N,True);tx(s,1.03,2.45,3.35,.22,'CASE VIGNETTE',11,M,True);tx(s,1.03,2.94,3.2,1.12,'38 years old\n18 months after chemoradiation + brachytherapy',20,W,True);tx(s,1.03,4.68,3.25,.65,'Dyspareunia • vaginal tightness • pelvic pain • urinary urgency',13,M) card(s,5.08,2.1,3.42,3.95,'WHAT SHE HAS NOT RECEIVED',['Routine pelvic function screen','Pelvic floor assessment','Clear referral pathway','Support for intimacy and partner communication'],T) card(s,8.87,2.1,3.7,3.95,'DISCUSSION PROMPT',['What happens in your clinic today?','Who assesses her first?','What needs medical review before rehabilitation?','Which outcome matters most to her?'],C) foot(s,3) #4 whole person basic(4,'Foundations','Recovery is whole-person, not just “pelvic floor”','Symptoms often share mechanisms and should not be managed in isolated silos.',[ ('Bladder',['Urgency, leakage, difficult emptying','Painful bladder symptoms'],T),('Bowel',['Constipation, urgency, leakage','Evacuation difficulty'],G),('Pain & intimacy',['Dyspareunia, guarding, stenosis','Activity, sleep and relationship impact'],C)]) #5 anatomy functional s=prs.slides.add_slide(blank);head(s,5,'Foundations','Pelvic floor: a functional system','Anatomy matters because symptoms map to muscle, fascia, nerve and tissue change.'); for x,no,ti,bo,co in [(0.72,'1','Support','Levator ani and connective tissue support bladder, vagina and rectum.',T),(4.52,'2','Continence','External urethral and anal sphincters coordinate voluntary closure.',G),(8.32,'3','Coordination','Pudendal and autonomic pathways link bladder, bowel, sexual function and pelvic-floor activity.',C)]: dot(s,x,2.35,.58,co,no);tx(s,x,3.17,3.1,.28,ti,17,I,True);tx(s,x,3.66,3.15,.78,bo,13,GR) ln(s,1.0,2.64,10.7,2.64,P,1.5);box(s,.72,5.46,11.88,.56,B,B,True);tx(s,1,5.63,11.3,.2,'Clinical lens: treatment can affect strength, relaxation, sensation, tissue compliance and coordination.',14,N,True,PP_ALIGN.CENTER);foot(s,5) #6 mechanisms basic(6,'Mechanisms','Different treatments, converging pelvic consequences','History of treatment guides the safety check and the rehabilitation hypothesis.',[ ('Surgery',['Autonomic nerve disruption','Scar and altered support','Voiding or defecatory dysfunction'],T),('Radiotherapy ± brachytherapy',['Fibrosis and reduced compliance','Mucosal change and shortening','Irritative bladder and bowel symptoms'],C),('Menopause / systemic effects',['Dryness and genitourinary symptoms','Fatigue and deconditioning','Mood, body image and fear'],G)]) #7 timeline s=prs.slides.add_slide(blank);head(s,7,'Treatment effects','Radiation injury evolves over time','Late effects can emerge or progress months to years after treatment.'); for x,h,b,co in [(0.72,'Acute\ndays-weeks','Inflammation, oedema, irritative symptoms, fatigue',T),(4.48,'Subacute\nweeks-months','Microvascular injury, early collagen deposition, loss of elasticity',G),(8.24,'Chronic\nmonths-years','Fibrosis, stenosis, hypertonicity, pain and participation restriction',C)]: box(s,x,2.25,3.15,2.65,W,P,True);box(s,x,2.25,3.15,.1,co,co);tx(s,x+.28,2.6,2.5,.55,h,17,I,True);tx(s,x+.28,3.55,2.45,.7,b,13,GR) ln(s,2.1,5.38,10.25,5.38,P,2);tx(s,.72,6.05,11.8,.36,'Therapeutic implication: assess tissue tolerance and guarding before assuming weakness or prescribing strengthening.',15,N,True,PP_ALIGN.CENTER);foot(s,7) #8 gsm basic(8,'Clinical spotlight','Genitourinary syndrome of menopause and radiation effects','These mechanisms commonly overlap. Treat the symptom pattern, not a single label.',[ ('Possible symptoms',['Dryness, burning, irritation','Dyspareunia','Urgency/frequency; recurrent UTI symptoms'],C),('First-line support',['Vaginal moisturizers and lubricants','Education and pelvic-health rehabilitation','Review pain, tissue tolerance and function'],T),('Coordinate care',['Consider local estrogen only when oncologically appropriate','Shared decision-making with gynecologic oncology'],G)]) #9 screen s=prs.slides.add_slide(blank);head(s,9,'Screening','A 3-minute screen makes pelvic function visible','At transition and each relevant follow-up: ask permission, normalize, listen.'); qs=[('1','BLADDER','Leakage, urgency, pain or difficulty emptying?'),('2','BOWEL','Urgency, constipation, leakage or bleeding?'),('3','VAGINAL / SEXUAL','Dryness, tightness, pain, intimacy or examination change?'),('4','PAIN / FUNCTION','Pelvic pain, heaviness, fear of movement or activity restriction?')] for i,(n,a,b) in enumerate(qs): x=.72+(i%2)*6.04;y=2.13+(i//2)*1.65;dot(s,x,y,.5,T,n);tx(s,x+.7,y+.03,4.7,.18,a,12,T,True);tx(s,x+.7,y+.35,4.8,.45,b,14,I) box(s,.72,5.68,11.88,.52,B,B,True);tx(s,.95,5.84,11.4,.18,'Positive screen → document severity and a meaningful goal → triage safety → refer or manage.',13,N,True,PP_ALIGN.CENTER);foot(s,9) #10 assessment basic(10,'Assessment','Phenotype before prescription','Assessment is consent-led. Internal examination is never automatic and only occurs when appropriate.',[ ('Listen',['Treatment timeline and symptom triggers','Bladder/bowel diary','Pain, sexual and functional goals'],T),('Examine',['Movement, breathing, abdominal wall, scars','External and internal assessment with explicit consent','Tone, tenderness, strength, relaxation, mobility'],G),('Measure & classify',['ICIQ-UI, PFDI-20, pain NRS, goal attainment','Overactive/guarding • underactive • incoordination • tissue restriction • mixed'],C)]) #11 safety basic(11,'Safety','Triage before therapy','New, progressive or unexplained symptoms warrant medical evaluation before attribution to pelvic-floor dysfunction.',[ ('Red flags',['New or worsening pain','Vaginal, rectal or urinary bleeding','Suspected infection or fistula','Retention, obstruction or systemic symptoms'],C),('Clinical review',['Recurrence surveillance status','Treatment and medication history','Focused examination when appropriate','Urology, GI or pain input'],G),('Then rehabilitate',['Pelvic health physiotherapy assessment','Trauma-informed, patient-led care','Shared plan, follow-up and escalation route'],T)]) #12 prehab basic(12,'Prehabilitation','Begin before treatment when feasible','Baseline function and expectation-setting can reduce uncertainty and create a future referral route.',[ ('Before treatment',['Baseline bladder, bowel, pain and sexual health','Education on expected effects','Risk stratification and referral plan'],T),('During treatment',['Manage irritative symptoms','Maintain movement and confidence','Support self-management'],G),('After treatment',['Screen recovery and late effects','Initiate phenotype-based rehabilitation','Review response and participation goals'],C)]) #13 toolkit basic(13,'Remedial toolkit','Match treatment to the dominant impairment','Strengthening is one tool, not the default answer for every pelvic symptom.',[ ('Overactivity / pain',['Down-training and diaphragmatic breathing','Pain education and graded exposure','Manual techniques when indicated'],C),('Weakness / leakage',['Motor learning and progressive strengthening','“The knack” and functional loading','Bladder training'],T),('Bowel / tissue restriction',['Toileting mechanics and coordinated breathing','Fiber/fluid review','Graded vaginal rehabilitation or dilators where appropriate'],G)]) #14 PFMT s=prs.slides.add_slide(blank);head(s,14,'Remedial toolkit','Pelvic floor muscle training: match the presentation','Correct activation and progression matter more than a generic exercise sheet.'); for x,h,b,co in [(0.72,'Hypotonic / leakage','Teach isolated contraction, endurance, coordination and functional pre-contraction.',T),(4.52,'Hypertonic / pain','Prioritize relaxation, lengthening, breathing, tissue tolerance and graded exposure first.',C),(8.32,'Incoordination','Train timing with breathing, mobility and bladder/bowel mechanics.',G)]:card(s,x,2.22,3.3,2.55,h,[b],co,13) box(s,.72,5.28,11.88,.68,N,N,True);tx(s,.98,5.47,11.3,.22,'Rule: if PFMT worsens pain, urgency or guarding, reassess the diagnosis, technique, dose and tissue status.',14,W,True,PP_ALIGN.CENTER);foot(s,14) #15 manual etc basic(15,'Remedial toolkit','Adjuncts are indication-led','A multimodal programme combines education, motor retraining and symptom-directed strategies.',[ ('Manual / scar techniques',['Address tissue mobility and tenderness','Use only within consent and tissue-safety parameters'],T),('Biofeedback',['Improves awareness of activation or relaxation','Useful when verbal cueing alone is insufficient'],G),('Vaginal rehabilitation',['Lubricants/moisturizers','Dilator programme when appropriate','Partner-inclusive sexual-health support'],C)]) #16 organ specific basic(16,'Organ-specific care','Bladder and bowel symptoms need parallel management','Pelvic rehabilitation works best alongside diagnosis and medical management of organ-specific conditions.',[ ('Bladder',['Bladder diary and behavioral strategies','Fluid timing, urge suppression, pelvic-floor coordination','Refer persistent retention, hematuria or suspected infection'],T),('Bowel',['Toileting posture, fiber/fluid review, coordinated relaxation','Evaluate bleeding, severe pain and suspected radiation proctitis'],G),('Sexual health',['Normalize the conversation','Treat pain, tissue and muscle contributors','Address fear, body image and relationship impact'],C)]) #17 Lindgren study s=prs.slides.add_slide(blank);head(s,17,'Evidence spotlight','Female pelvic cancer survivors’ PFMT experiences after radiotherapy','Lindgren, Börjeson & Dunberger. Supportive Care in Cancer. 2024;32:844. PMID 39623242.');box(s,.72,2.15,3.15,3.68,N,N,True);tx(s,1.02,2.46,2.5,.22,'QUALITATIVE STUDY',11,M,True);tx(s,1.02,2.9,2.4,.8,'11 women\naged 47-83 years',22,W,True);bullets(s,1.0,4.26,2.5,1.2,['Urinary and/or fecal incontinence','Radiotherapy completed 3-60 months earlier'],12,M) card(s,4.24,2.15,3.9,3.68,'3-MONTH PFMT PROGRAMME',['PFMT with or without physiotherapist support','Support included individual guidance, biofeedback and group training','Interviews after the programme'],T) card(s,8.5,2.15,4.05,3.68,'INTERPRETATION',['Captures participant experiences and perceived change','Not a standalone efficacy estimate','Adds direct survivor voice to the evidence base'],G) foot(s,17) #18 findings basic(18,'Evidence spotlight','What participants said made PFMT work','Reported experiences reinforce structured, supported and individualized rehabilitation.',[ ('What helped',['Clear programme and daily-routine strategies','Physiotherapist guidance and biofeedback','Motivation from follow-up and peer support'],T),('Perceived benefits',['Less urinary/fecal leakage and better urgency control','More confidence, activity participation and sexual-health benefit','Reduced anxiety and greater freedom'],G),('Caution',['Home and group formats were both facilitators and barriers','Pain improved for some but increased for others','Assess and progress the programme individually'],C)]) #19 larger evidence s=prs.slides.add_slide(blank);head(s,19,'Evidence synthesis','Offer evidence-informed care, be honest about certainty','The evidence supports rehabilitation potential, but intervention content and populations are heterogeneous.');box(s,.72,2.15,3.05,3.75,N,N,True);tx(s,1.04,2.5,2.4,.2,'2026 UMBRELLA REVIEW',11,M,True);tx(s,1.04,2.95,2.1,.85,'17\nreviews with meta-analyses',23,W,True);tx(s,1.04,4.78,2.35,.4,'92 primary studies across cancer survivor populations',12,M) card(s,4.1,2.15,3.95,3.75,'WHAT WE CAN SAY',['Therapeutic potential across bladder, bowel, sexual-function and quality-of-life outcomes','Individualized, multimodal programmes are clinically plausible'],T) card(s,8.4,2.15,4.15,3.75,'WHAT WE CANNOT OVERSTATE',['Quality and certainty vary across outcomes','Cervical-cancer-specific data remain limited','Patient goals and response should guide care'],C) tx(s,.72,6.35,11.8,.22,'Source: Hao J, et al. Pelvic floor rehabilitation in cancer survivorship: umbrella review. J Cancer Surviv. 2026. PMID 39581933.',9,GR);foot(s,19) #20 pathway s=prs.slides.add_slide(blank);head(s,20,'Systems of care','A practical survivorship pathway','A named route is more useful than a generic referral.'); flow=[('1','Every follow-up','Ask 4 questions',T),('2','Positive screen','Rule out red flags; define a goal',G),('3','First-line support','Education and symptom-specific basics',C),('4','Pelvic-health referral','Full assessment and individualized plan',T),('5','Review & escalate','Outcome review; complex-care route',N)] for i,(a,b,c,co) in enumerate(flow): x=.6+i*2.52;dot(s,x,2.45,.5,co,a);tx(s,x,3.22,2.2,.33,b,14,I,True);tx(s,x,3.72,2.2,.55,c,12,GR) if i<4:ln(s,x+.55,2.7,x+2.42,2.7,P,1.5) box(s,.72,5.45,11.88,.58,B,B,True);tx(s,.95,5.62,11.4,.2,'Close the loop: confirm referral completion, measure goal progress and return the plan to the oncology team.',13,N,True,PP_ALIGN.CENTER);foot(s,20) #21 team s=prs.slides.add_slide(blank);head(s,21,'Systems of care','One door, many skills','Core roles vary by setting. Shared language keeps care connected.');dot(s,5.78,3.27,1.25,T,'SURVIVOR\nGOALS',15) roles=[(1.0,2.2,'Gynecologic oncology','Safety, surveillance, referral',N),(9.45,2.2,'Pelvic-health PT','Assessment and rehabilitation lead',T),(1.0,5.05,'Urology / GI','Complex bladder and bowel care',G),(9.45,5.05,'Psychosexual care','Pain, intimacy, mental health',C),(5.35,5.65,'Radiation oncology','Toxicity and tissue effects',N)] for x,y,a,b,co in roles:box(s,x,y,2.75,.86,W,P,True);box(s,x,y,.07,.86,co,co);tx(s,x+.2,y+.15,2.2,.18,a,12,I,True);tx(s,x+.2,y+.45,2.25,.2,b,10,GR) for a,b in [((3.75,2.62),(5.75,3.65)),((9.45,2.62),(7.0,3.65)),((3.75,5.05),(5.75,4.48)),((9.45,5.05),(7.0,4.48)),((6.75,5.65),(6.42,4.54))]:ln(s,*a,*b,P,1.2) foot(s,21) #22 implementation basic(22,'Implementation','Start where you are: a 90-day sprint','Build a service, not just a referral.',[ ('0-30 days: Map',['Agree red flags','Choose the 4-domain screen','Map referral routes'],T),('31-60 days: Pilot',['Train clinic team','Pilot in one clinic','Create patient information'],G),('61-90 days: Measure',['Audit referral completion and delay','Review patient outcomes','Refine the pathway'],C)]) #23 case resolution s=prs.slides.add_slide(blank);head(s,23,'Bringing it together','Return to the case: from symptom list to meaningful recovery','The plan follows the phenotype and the survivor’s priorities.');box(s,.72,2.15,3.2,3.78,N,N,True);tx(s,1.02,2.48,2.5,.2,'HER GOAL',11,M,True);tx(s,1.02,2.95,2.45,1.02,'“I want intimacy to feel safe again and to move without fear.”',20,W,True);tx(s,1.02,4.86,2.45,.42,'Start with safety, consent and shared priorities.',12,M) for y,a,b,co in [(2.22,'ASSESS','Screen; rule out recurrence/infection; assess guarding, tissue tolerance, bladder pattern and goals.',T),(3.55,'PLAN','Education, bladder strategies, down-training and graded exposure; consider vaginal rehabilitation where appropriate.',C),(4.88,'REVIEW','Track urgency, pain, examination tolerance and return to valued activities; escalate if needed.',G)]:dot(s,4.55,y,.45,co);tx(s,5.28,y+.02,1.1,.18,a,12,co,True);tx(s,6.3,y,5.75,.52,b,13,I) ln(s,4.78,2.68,4.78,5.15,P,1.4);foot(s,23) #24 takeaways s=prs.slides.add_slide(blank);box(s,0,0,SW,SH,N);box(s,0,0,.16,SH,T);tx(s,.82,.74,4,.2,'TAKE-HOME MESSAGES',11,M,True);tx(s,.82,1.25,9,.75,'Rebuild the base.\nRestore the life.',33,W,True) for i,(a,b,c,co) in enumerate([('01','Ask early','Bladder, bowel, pain and intimacy are survivorship outcomes.',T),('02','Assess the phenotype','Generic strengthening is not the answer to every pelvic symptom.',G),('03','Build the pathway','A named pelvic-health route makes recovery actionable.',C)]): x=.82+i*4.05;dot(s,x,3.5,.58,co,a);tx(s,x,4.35,3.42,.25,b,16,W,True);tx(s,x,4.82,3.3,.56,c,13,M) tx(s,.82,6.42,11,.24,'“No recurrence” is not “no morbidity.”',16,W,True) #25 refs s=prs.slides.add_slide(blank);head(s,25,'References','Selected evidence and further reading','Adapt to local guideline, institutional policy and scope of practice.'); refs=['Hao J, et al. Pelvic floor rehabilitation in cancer survivorship: an umbrella review. Journal of Cancer Survivorship. 2026. PMID: 39581933.','Lindgren A, Börjeson S, Dunberger G. Female pelvic cancer survivors’ experiences of pelvic floor muscle training after pelvic radiotherapy. Supportive Care in Cancer. 2024;32:844. PMID: 39623242. doi:10.1007/s00520-024-09041-w.','Cyr MP, et al. Effectiveness of pelvic floor muscle and education-based therapies in females treated for gynecological cancer: a systematic review. Current Oncology Reports. 2024. PMID: 39177709.','NCCN Guidelines Insights: Survivorship, Version 2.2024. Journal of the National Comprehensive Cancer Network. 2024.'] bullets(s,.82,2.15,11.45,3.65,refs,13,I);box(s,.82,6.1,11.55,.54,B,B,True);tx(s,1.08,6.26,11,.18,'Educational content only. Clinical assessment and treatment should be individualized within local scope of practice.',10,N,True,PP_ALIGN.CENTER);foot(s,25) prs.core_properties.title='Rebuilding the Base: Pelvic Floor Rehabilitation in Cervical Cancer Survivorship';prs.core_properties.author='';prs.save(OUT);print(OUT) PY python "/tmp/workspace/pelvic-floor-professional/src/build_professional_deck.py"

python -c "from pptx import Presentation; import os; p=r'/tmp/workspace/pelvic-floor-professional/output/Rebuilding_the_Base_Professional_Conference_Deck.pptx'; prs=Presentation(p); W,H=prs.slide_width,prs.slide_height; print('slides',len(prs.slides),'bytes',os.path.getsize(p)); errs=[] for i,s in enumerate(prs.slides,1): bad=[sh.name for sh in s.shapes if sh.left<0 or sh.top<0 or sh.left+sh.width>W or sh.top+sh.height>H] texts=[sh.text.strip().replace('\\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] if bad: errs.append((i,bad)) print(f'{i:02d}: shapes={len(s.shapes):02d}; '+(' | '.join(texts[:3]))[:155]) print('out_of_bounds',errs)"