cervical cancer pelvic floor rehabilitation guideline survivorship 2025

/tmp/workspace

"cervical cancer" AND "pelvic floor"

~/attachments/410cf98c-bc79-491d-a353-6c61f54526c9

PMID: 41579191

https://pmc.ncbi.nlm.nih.gov/articles/PMC12696796

python - <<'PY' from pptx import Presentation from pptx.util import Emu p='/tmp/workspace/attachments/410cf98c-bc79-491d-a353-6c61f54526c9/finalcc_properly_arranged.pptx' prs=Presentation(p) print('SIZE',prs.slide_width,prs.slide_height,'slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): print('\n--- SLIDE',i,'layout=',s.slide_layout.name,'---') for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text_frame.text.strip(): print('TEXT:',repr(sh.text_frame.text[:1000])) elif sh.shape_type==13: print('IMAGE', sh.name, round(Emu(sh.left).inches,2),round(Emu(sh.top).inches,2),round(Emu(sh.width).inches,2),round(Emu(sh.height).inches,2)) PY

mkdir -p "/tmp/workspace/cervical-pelvic-floor-conference/assets" "/tmp/workspace/cervical-pelvic-floor-conference/output" "/tmp/workspace/cervical-pelvic-floor-conference/src" && python - <<'PY' import zipfile, os p='/tmp/workspace/attachments/410cf98c-bc79-491d-a353-6c61f54526c9/finalcc_properly_arranged.pptx' out='/tmp/workspace/cervical-pelvic-floor-conference/assets' with zipfile.ZipFile(p) as z: files=[n for n in z.namelist() if n.startswith('ppt/media/')] for n in files: with open(os.path.join(out,os.path.basename(n)),'wb') as f: f.write(z.read(n)) print('\n'.join(files)) PY

python - <<'PY' from PIL import Image,ImageDraw import glob,os,math fs=glob.glob('/tmp/workspace/cervical-pelvic-floor-conference/assets/*') thumbs=[] for f in fs: im=Image.open(f).convert('RGB'); im.thumbnail((240,160)); thumbs.append((f,im.copy(),Image.open(f).size)) out=Image.new('RGB',(800,math.ceil(len(thumbs)/3)*220),'white'); d=ImageDraw.Draw(out) for i,(f,im,size) in enumerate(thumbs): x=(i%3)*265+10;y=(i//3)*220+10;out.paste(im,(x,y));d.text((x,y+165),os.path.basename(f)+' '+str(size),fill='black') out.save('/tmp/workspace/cervical-pelvic-floor-conference/assets/contact.jpg') PY

cat > "/tmp/workspace/cervical-pelvic-floor-conference/src/build.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_CONNECTOR from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.shapes import MSO_SHAPE_TYPE from pptx.enum.dml import MSO_LINE_DASH_STYLE from pptx import Presentation import os OUT='/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] NAVY=RGBColor(12,35,57); TEAL=RGBColor(0,137,137); MINT=RGBColor(212,241,235); CORAL=RGBColor(232,104,91); GOLD=RGBColor(238,179,73); INK=RGBColor(29,42,54); MUTED=RGBColor(94,111,123); PALE=RGBColor(244,248,248); WHITE=RGBColor(255,255,255); LINE=RGBColor(213,225,225) def rect(s,x,y,w,h,fill, radius=False, line=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius 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 if line else fill if radius: sh.adjustments[0]=0.10 return sh def text(s,txt,x,y,w,h,size=18,color=INK,bold=False,align=None,font='Aptos',val=None): tb=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0 p=tf.paragraphs[0];p.text=txt;p.font.name=font;p.font.size=Pt(size);p.font.bold=bold;p.font.color.rgb=color if align:p.alignment=align if val:tf.vertical_anchor=val return tb def title(s,kicker,heading,sub=None,num=None): text(s,kicker.upper(),.6,.38,4,.25,9,TEAL,True) text(s,heading,.6,.68,12.0,.65,27,NAVY,True) if sub:text(s,sub,.6,1.38,11.8,.34,11,MUTED) rect(s,.6,1.85,12.15,.018,LINE) if num:text(s,f'{num:02d}',12.1,.42,.65,.3,11,TEAL,True,PP_ALIGN.RIGHT) def footer(s,n): text(s,'REBUILDING THE BASE | CERVICAL CANCER SURVIVORSHIP',.6,7.13,8,.18,7,MUTED,True) text(s,str(n),12.2,7.10,.55,.2,8,MUTED,True,PP_ALIGN.RIGHT) def bullets(s,items,x,y,w,fs=15,leading=.55,color=INK): for i,it in enumerate(items): text(s,'•',x,y+i*leading,.22,.28,fs,TEAL,True) text(s,it,x+.28,y+i*leading,w-.28,.38,fs,color) def card(s,x,y,w,h,head,body,accent=TEAL): rect(s,x,y,w,h,WHITE,True,LINE); rect(s,x,y,.08,h,accent) text(s,head,x+.28,y+.25,w-.5,.34,15,NAVY,True) text(s,body,x+.28,y+.72,w-.55,h-.9,11,MUTED) def circle(s,x,y,d,fill, label, fs=18): 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 text(s,label,x,y+.15,d,d-.25,fs,WHITE,True,PP_ALIGN.CENTER,val=MSO_ANCHOR.MIDDLE) # 1 s=prs.slides.add_slide(blank);rect(s,0,0,13.333,7.5,NAVY);rect(s,0,0,.22,7.5,TEAL);text(s,'CONFERENCE PRESENTATION | CLINICAL SURVIVORSHIP',.75,.65,6,.25,10,MINT,True);text(s,'Rebuilding\nthe Base',.75,1.25,7,1.85,42,WHITE,True);text(s,'Pelvic floor rehabilitation in cervical cancer survivorship',.8,3.48,8.4,.4,20,MINT);rect(s,.78,4.22,2.2,.06,CORAL);text(s,'From treatment-related morbidity to functional recovery',.8,4.5,7.5,.35,16,WHITE);circle(s,10.0,1.35,1.9,TEAL,'PF',25);circle(s,10.9,2.85,1.3,CORAL,'+',18);text(s,'Presenter | Institution | Conference | 2026',.8,6.6,7,.25,10,MINT) # 2 s=prs.slides.add_slide(blank);title(s,'Why this matters','Survival is not the end of care','Pelvic health must be treated as a core survivorship outcome.',2) for i,(n,l,c) in enumerate([('~660k','new cervical cancer cases globally each year',TEAL),('~350k','deaths globally each year',CORAL),('Decades','of life potentially affected after curative treatment',GOLD)]): x=.75+i*4.05;rect(s,x,2.35,3.55,2.35,PALE,True);text(s,n,x+.25,2.75,3,.55,30,c,True);text(s,l,x+.25,3.55,2.95,.55,13,INK,True) text(s,'The opportunity: pair oncologic follow-up with early screening, skilled assessment and a named rehabilitation pathway.',.8,5.55,11.5,.55,20,NAVY,True);text(s,'Global estimates: IARC GLOBOCAN 2022. Local burden and service capacity should guide implementation.',.8,6.38,10,.22,9,MUTED);footer(s,2) # 3 anatomy s=prs.slides.add_slide(blank);title(s,'Foundation','The pelvic floor is a coordinated system','Function depends on muscle, fascia, nerves, viscera, breathing and safety.',3) # stylized anatomy for x,y,d,c,l in [(1.0,2.45,1.1,TEAL,'Bladder'),(3.0,2.45,1.1,CORAL,'Uterus'),(5.0,2.45,1.1,GOLD,'Rectum')]: circle(s,x,y,d,c,'',1);text(s,l,x-.05,3.72,1.2,.25,11,INK,True,PP_ALIGN.CENTER) rect(s,.9,4.25,5.45,.22,TEAL,True);text(s,'Levator ani and connective-tissue support',1.15,4.67,5,.3,15,NAVY,True) card(s,7.15,2.25,5.2,1.0,'Support','Continence, organ support and load transfer',TEAL);card(s,7.15,3.55,5.2,1.0,'Coordination','Relaxation for voiding, defecation and intimacy',CORAL);card(s,7.15,4.85,5.2,1.0,'Adaptability','Capacity to respond to treatment, movement and stress',GOLD);footer(s,3) #4 mechanisms s=prs.slides.add_slide(blank);title(s,'Clinical context','Different treatments, converging pelvic consequences','Treatment history is the first rehabilitation hypothesis.',4) for i,(h,body,c) in enumerate([('Radical surgery','Autonomic nerve injury\nScar and altered support\nVoiding or defecatory dysfunction',TEAL),('Radiotherapy ± brachytherapy','Fibrosis and reduced compliance\nMucosal change and stenosis\nIrritative bladder and bowel symptoms',CORAL),('Systemic effects','Menopause symptoms\nFatigue and deconditioning\nMood, body image and fear',GOLD)]): card(s,.8+i*4.05,2.35,3.55,2.8,h,body,c) text(s,'Clinical implication',.8,5.75,2,.28,13,TEAL,True);text(s,'Do not prescribe a diagnosis-based protocol. Match rehabilitation to tissue status, tone, symptom phenotype and survivor priorities.',.8,6.08,11.5,.35,16,NAVY,True);footer(s,4) #5 ask four s=prs.slides.add_slide(blank);title(s,'First step','Ask four questions at every follow-up','Symptoms are often underreported unless explicitly invited.',5) qs=[('Bladder','Leakage, urgency, frequency, emptying?'),('Bowel','Urgency, bleeding, incontinence, constipation?'),('Pain','Pelvic pain, tightness, fear of movement?'),('Intimacy','Dryness, stenosis, desire, dyspareunia?')] for i,(h,b) in enumerate(qs): x=.8+(i%2)*6.1;y=2.35+(i//2)*1.7;circle(s,x,y,.72,[TEAL,CORAL,GOLD,NAVY][i],str(i+1),15);text(s,h,x+.95,y+.05,3,.25,16,NAVY,True);text(s,b,x+.95,y+.42,4.6,.38,12,MUTED) rect(s,.8,6.05,11.75,.55,MINT,True);text(s,'Normalise the conversation: “These symptoms are common after treatment and we have ways to help.”',1.05,6.2,11,.2,13,NAVY,True);footer(s,5) #6 assessment s=prs.slides.add_slide(blank);title(s,'Assessment','A consent-forward, phenotype-led assessment','The examination is optional. The patient determines the pace and boundaries.',6) for i,(h,b) in enumerate([('1. History','Treatment timeline, symptoms, function, goals'),('2. Screen','Red flags, recurrence concerns, infection, fistula'),('3. Observe','Breathing, movement, scars, abdominal wall'),('4. Examine','External or internal only with explicit consent'),('5. Measure','Questionnaire + objective measure + goal review')]): x=.75+i*2.48;circle(s,x,2.35,.68,[TEAL,CORAL,GOLD,NAVY,TEAL][i],str(i+1),14);text(s,h,x,3.28,2.18,.25,13,NAVY,True,PP_ALIGN.CENTER);text(s,b,x,3.68,2.18,.55,10,MUTED,False,PP_ALIGN.CENTER) rect(s,.8,5.35,11.7,1.0,PALE,True);text(s,'Red flags: new bleeding or pain, suspected recurrence, suspected fistula, fever/infection, progressive obstruction or severe unexplained symptoms.',1.1,5.63,11,.35,15,CORAL,True);footer(s,6) #7 phenotypes s=prs.slides.add_slide(blank);title(s,'Decision point','Tone directs treatment','“More Kegels” is not the answer to every pelvic symptom.',7) card(s,.8,2.3,5.65,3.3,'Hypotonic / weak presentation','Often post-surgical\n• graded strengthening\n• endurance and power\n• cough/lift integration\n• motor-control feedback',TEAL);card(s,6.88,2.3,5.65,3.3,'Hypertonic / guarded presentation','Often pain or radiation-associated\n• down-training first\n• diaphragmatic breathing\n• manual and graded exposure\n• restore tolerance before loading',CORAL);text(s,'Reassess: strength alone is not success. Track symptoms, tone, confidence and return to valued activity.',.8,6.25,11.4,.3,14,NAVY,True);footer(s,7) #8 toolbox s=prs.slides.add_slide(blank);title(s,'Rehabilitation toolkit','One plan, matched to the presentation','Use active, goal-directed care and avoid a one-size-fits-all programme.',8) items=[('Pelvic floor training','Strengthening or down-training'),('Manual & scar care','Tissue mobility and symptom modulation'),('Biofeedback','Learn contraction and full release'),('Dilator therapy','Graded vaginal accommodation'),('Bladder / bowel retraining','Organ-specific behavioural strategies'),('Education & pacing','Breathing, pain and self-management')] for i,(h,b) in enumerate(items): x=.8+(i%3)*4.0;y=2.25+(i//3)*1.75;rect(s,x,y,3.55,1.35,WHITE,True,LINE);circle(s,x+.22,y+.3,.55,[TEAL,CORAL,GOLD,NAVY,TEAL,CORAL][i],str(i+1),11);text(s,h,x+.95,y+.28,2.35,.22,13,NAVY,True);text(s,b,x+.95,y+.64,2.3,.3,10,MUTED) footer(s,8) #9 dilator s=prs.slides.add_slide(blank);title(s,'Vaginal rehabilitation','Dilator therapy: graded, supported, individualised','A tool for accommodation and confidence, not a test to pass.',9) for i,(h,b) in enumerate([('Prepare','Explain purpose, consent, lubrication, comfort plan'),('Start','Smallest comfortable size; short, calm exposure'),('Progress','Regular practice, gradual size or duration changes'),('Review','Pain, bleeding, tissue tolerance and adherence barriers')]): x=.8+i*3.05;circle(s,x+1.1,2.25,.7,[TEAL,CORAL,GOLD,NAVY][i],str(i+1),13);text(s,h,x,3.25,2.9,.25,14,NAVY,True,PP_ALIGN.CENTER);text(s,b,x,3.62,2.9,.55,11,MUTED,False,PP_ALIGN.CENTER) rect(s,.8,5.3,11.75,1.0,MINT,True);text(s,'Avoid active mucositis or unexplained bleeding. Stop and seek review for significant pain, bleeding or new symptoms.',1.05,5.6,11,.3,14,NAVY,True);footer(s,9) #10 organ s=prs.slides.add_slide(blank);title(s,'Organ-specific care','Bladder and bowel symptoms need parallel pathways','Rehabilitation supports care. It does not replace medical evaluation.',10) card(s,.8,2.25,5.65,3.5,'Bladder','Post-surgical: emptying assessment, timed voiding, double voiding; urology input for retention.\n\nRadiation-associated: urgency suppression, bladder retraining; evaluate hematuria and severe symptoms.',TEAL);card(s,6.88,2.25,5.65,3.5,'Bowel','Radiation-related: urgency, tenesmus, bleeding and altered stool form need symptom-specific care.\n\nNew or progressive bleeding warrants GI / oncology review; use coordination training for urgency or incontinence.',CORAL);footer(s,10) #11 sexual s=prs.slides.add_slide(blank);title(s,'Sexual health','Rehabilitation restores choice, comfort and connection','Penetration is optional. Recovery is defined by the survivor’s own goals.',11) steps=['Permission to discuss','Non-genital touch','Self-exploration / dilator','Partnered non-penetrative activity','Penetration, if desired'] for i,st in enumerate(steps): x=.65+i*2.5;circle(s,x,2.65,.75,[TEAL,CORAL,GOLD,NAVY,TEAL][i],str(i+1),14);text(s,st,x-.15,3.65,1.1,.55,10,INK,True,PP_ALIGN.CENTER) if i<4: rect(s,x+.8,2.98,1.55,.07,LINE) text(s,'Refer to sex therapy / psycho-oncology for persistent distress, relationship strain or when requested by the survivor or partner.',.8,5.4,11.5,.35,15,NAVY,True);footer(s,11) #12 home s=prs.slides.add_slide(blank);title(s,'Self-management','A home programme people can actually use','Clarity, pacing and feedback improve adherence.',12) for i,(h,b,c) in enumerate([('Specific','Frequency, duration and progression criteria',TEAL),('Trackable','Symptom diary, pain/tightness rating, goal check',CORAL),('Flexible','Setbacks do not erase progress',GOLD),('Escalation-aware','Written reasons to call the clinic',NAVY)]):card(s,.8+(i%2)*6.0,2.25+(i//2)*1.65,5.55,1.25,h,b,c) footer(s,12) #13 pathway s=prs.slides.add_slide(blank);title(s,'Systems of care','A practical survivorship pathway','A named route is more useful than a generic referral.',13) steps=[('Ask','4-domain screen'),('Triage','Rule out red flags'),('Support','Education + basics'),('Refer','Pelvic-health assessment'),('Review','Measure, escalate, close loop')] for i,(h,b) in enumerate(steps): x=.65+i*2.5;rect(s,x,2.55,2.05,1.45,WHITE,True,LINE);circle(s,x+.68,2.72,.62,[TEAL,CORAL,GOLD,NAVY,TEAL][i],str(i+1),12);text(s,h,x+.15,3.45,1.75,.22,13,NAVY,True,PP_ALIGN.CENTER);text(s,b,x+.15,3.72,1.75,.2,10,MUTED,False,PP_ALIGN.CENTER) if i<4: text(s,'›',x+2.13,3.05,.25,.3,22,TEAL,True) rect(s,.8,5.25,11.7,.8,MINT,True);text(s,'Close the loop: confirm referral completion, review goal progress and return the plan to the oncology team.',1.1,5.53,11,.25,14,NAVY,True);footer(s,13) #14 team s=prs.slides.add_slide(blank);title(s,'Multidisciplinary care','One survivor, one shared plan','Pelvic rehabilitation works best when oncology, rehabilitation and supportive care communicate.',14) roles=[('Gyn-oncology','Disease surveillance\nmedical safety'),('Pelvic-health PT','Assessment\nrehabilitation plan'),('Urology / GI','Complex bladder\nor bowel symptoms'),('Psycho-oncology / sex therapy','Distress, intimacy\nand relationship support'),('Nursing / navigator','Screening, education\nand referral completion')] for i,(h,b) in enumerate(roles): x=.55+i*2.55;circle(s,x+.65,2.35,1.05,[TEAL,CORAL,GOLD,NAVY,TEAL][i],'',10);text(s,h,x,3.72,2.35,.38,12,NAVY,True,PP_ALIGN.CENTER);text(s,b,x,4.2,2.35,.45,10,MUTED,False,PP_ALIGN.CENTER) text(s,'Shared outcomes: symptom burden, function, sexual well-being, treatment adherence and participation in life.',.8,5.95,11.5,.28,15,NAVY,True);footer(s,14) #15 90 days s=prs.slides.add_slide(blank);title(s,'Implementation','Start where you are: a 90-day sprint','Build a service, not merely a referral list.',15) for i,(h,b,c) in enumerate([('0-30 days | Map','Agree red flags\nChoose the screen\nMap referral routes',TEAL),('31-60 days | Pilot','Train clinic team\nPilot in one clinic\nCreate patient information',CORAL),('61-90 days | Measure','Audit delay and completion\nReview outcomes\nRefine the pathway',GOLD)]): x=.8+i*4.05;rect(s,x,2.25,3.55,2.8,PALE,True);rect(s,x,2.25,3.55,.12,c);text(s,h,x+.28,2.65,3,.35,15,NAVY,True);text(s,b,x+.28,3.35,2.95,1.1,12,MUTED) footer(s,15) #16 measurement s=prs.slides.add_slide(blank);title(s,'Quality improvement','Measure what matters to the survivor','Use a small, consistent data set.',16) for i,(h,b) in enumerate([('Access','Referral completion and time to first visit'),('Symptoms','One bladder/bowel/pain or sexual-health measure'),('Function','Patient-defined activity or participation goal'),('Experience','Safety, consent and usefulness of care')]):card(s,.8+(i%2)*6,2.25+(i//2)*1.6,5.55,1.18,h,b,[TEAL,CORAL,GOLD,NAVY][i]) footer(s,16) #17 case s=prs.slides.add_slide(blank);title(s,'Putting it together','From symptom list to meaningful recovery','The plan follows the phenotype and the survivor’s priorities.',17) text(s,'“I want intimacy to feel safe again and to move without fear.”',.9,2.2,11.4,.5,22,NAVY,True,PP_ALIGN.CENTER) for i,(h,b,c) in enumerate([('Assess','Rule out recurrence/infection. Identify guarding, tissue tolerance and goals.',TEAL),('Plan','Education, down-training, graded exposure and organ-specific strategies.',CORAL),('Review','Track pain, urgency, confidence and return to valued activities.',GOLD)]):card(s,.8+i*4.05,3.35,3.55,1.8,h,b,c) footer(s,17) #18 takehomes s=prs.slides.add_slide(blank);rect(s,0,0,13.333,7.5,NAVY);text(s,'TAKE-HOME MESSAGES',.75,.62,4,.22,10,MINT,True);text(s,'Rebuild the base.\nRestore the life.',.75,1.15,8,1.25,34,WHITE,True) for i,(n,h,b,c) in enumerate([('01','Ask early','Bladder, bowel, pain and intimacy are survivorship outcomes.',TEAL),('02','Assess the phenotype','Generic strengthening is not the answer to every pelvic symptom.',CORAL),('03','Build the pathway','A named pelvic-health route makes recovery actionable.',GOLD)]): x=.8+i*4.15;circle(s,x,3.55,.7,c,n,10);text(s,h,x+.92,3.58,2.7,.22,15,WHITE,True);text(s,b,x,4.32,3.55,.5,12,MINT) text(s,'“No recurrence” is not “no morbidity.”',.8,6.48,8,.3,18,WHITE,True) #19 references s=prs.slides.add_slide(blank);title(s,'Selected references','Evidence and guidance informing this presentation','Adapt local protocols and oncology guidance to your setting.',19) refs=['International Agency for Research on Cancer. Global Cancer Observatory: Cervix uteri factsheet. GLOBOCAN 2022.','Kurtuluş D, et al. Pelvic Floor Dysfunction Following Gynecologic Cancer Surgery and Adjuvant Therapy: a Systematic Review. Int Urogynecol J. 2026. PMID: 41579191.','Tim S, Mazur-Bialy A. Physiotherapy interventions in treatment of pelvic floor dysfunctions after gynaecological oncology procedures: systematic review. J Gynecol Obstet Hum Reprod. 2024;53:102688.','Yang EJ, et al. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: randomized controlled trial. Gynecol Oncol. 2012;123:705-711.','Cochrane review protocol: Pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors. 2025. PMCID: PMC12696796.'] bullets(s,refs,.9,2.25,11.5,13,.78);text(s,'Clinical safety note: new bleeding, progressive pain, suspected infection, fistula or recurrence require medical assessment before rehabilitation progression.',.9,6.38,11.4,.3,11,CORAL,True);footer(s,19) prs.save(OUT) print(OUT) PY python "/tmp/workspace/cervical-pelvic-floor-conference/src/build.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck.pptx'; prs=Presentation(p); print('slides',len(prs.slides),'size',prs.slide_width,prs.slide_height) for i,s in enumerate(prs.slides,1): print(i,len(s.shapes)) PY

python - <<'PY' from pptx import Presentation from pptx.enum.shapes import MSO_SHAPE_TYPE from pathlib import Path p=Path('/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck.pptx') prs=Presentation(str(p)); W,H=prs.slide_width,prs.slide_height issues=[]; total_text=0 for i,slide in enumerate(prs.slides,1): for sh in slide.shapes: if sh.left<0 or sh.top<0 or sh.left+sh.width>W or sh.top+sh.height>H: issues.append((i,'out-of-bounds',sh.name)) if getattr(sh,'has_text_frame',False): total_text += len(sh.text_frame.text) for pgh in sh.text_frame.paragraphs: for run in pgh.runs: if run.font.size and run.font.size.pt < 7: issues.append((i,'tiny-font',run.font.size.pt,run.text[:30])) print('File exists:',p.exists(),'bytes:',p.stat().st_size) print('Slides:',len(prs.slides),'total text chars:',total_text) print('Bounds/font issues:',issues if issues else 'none') # ensure no empty slides print('Empty slides:',[i for i,s in enumerate(prs.slides,1) if len(s.shapes)==0]) PY

~/cervical-pelvic-floor-conference/output

/tmp/skills/pptx/scripts

IARC GLOBOCAN 2022 cervical cancer 660000 cases 350000 deaths

"cervical cancer" AND "pelvic floor"

/tmp/workspace

~/cervical-pelvic-floor-conference

mkdir -p "/tmp/workspace/cervical-pelvic-floor-conference/handout" && cat > "/tmp/workspace/cervical-pelvic-floor-conference/src/create_handout.py" <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.pdfgen import canvas from reportlab.lib.colors import HexColor, white from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.lib.units import mm from reportlab.pdfbase.ttfonts import TTFont from reportlab.pdfbase import pdfmetrics from pathlib import Path out=Path('/tmp/workspace/cervical-pelvic-floor-conference/handout/Rebuilding_the_Base_Conference_Handout.pdf') W,H=A4 NAVY=HexColor('#0C2339'); TEAL=HexColor('#008989'); MINT=HexColor('#D4F1EB'); CORAL=HexColor('#E8685B'); GOLD=HexColor('#EEB349'); INK=HexColor('#1D2A36'); MUTED=HexColor('#5E6F7B'); PALE=HexColor('#F4F8F8'); LINE=HexColor('#D5E1E1'); WHITE=white M=13*mm c=canvas.Canvas(str(out),pagesize=A4); c.setTitle('Rebuilding the Base: Pelvic Floor Rehabilitation in Cervical Cancer') def font(name='Helvetica',size=8): c.setFont(name,size) def txt(x,y,s,size=8,col=INK,bold=False): c.setFillColor(col); font('Helvetica-Bold' if bold else 'Helvetica',size); c.drawString(x,y,s) def wrap(s,maxwidth,size=8,bold=False): face='Helvetica-Bold' if bold else 'Helvetica'; out=[]; cur='' for word in s.split(): cand=(cur+' '+word).strip() if stringWidth(cand,face,size)<=maxwidth: cur=cand else: out.append(cur);cur=word if cur:out.append(cur) return out def para(x,y,s,w,size=8,leading=None,col=INK,bold=False): leading=leading or size*1.25;c.setFillColor(col);font('Helvetica-Bold' if bold else 'Helvetica',size) for line in wrap(s,w,size,bold): c.drawString(x,y,line);y-=leading return y def rounded(x,y,w,h,fill,stroke=None,r=4): c.setFillColor(fill);c.setStrokeColor(stroke or fill);c.roundRect(x,y,w,h,r,fill=1,stroke=1 if stroke else 0) def bullet(x,y,s,w,size=7.5,col=INK): c.setFillColor(TEAL);c.circle(x+2,y+2,1.6,fill=1,stroke=0) return para(x+9,y,s,w-9,size,size*1.25,col) def section(x,y,w,h,heading,accent=TEAL): rounded(x,y,w,h,WHITE,LINE);c.setFillColor(accent);c.roundRect(x,y+h-5,w,5,4,fill=1,stroke=0);txt(x+8,y+h-18,heading.upper(),8,NAVY,True) def step(x,y,n,head,body,colour): c.setFillColor(colour);c.circle(x+8,y+8,8,fill=1,stroke=0);c.setFillColor(WHITE);font('Helvetica-Bold',7);c.drawCentredString(x+8,y+5.5,str(n));txt(x+20,y+8,head,7.5,NAVY,True);para(x+20,y-3,body,93,6.6,8.2,MUTED) # Header c.setFillColor(NAVY);c.rect(0,H-53*mm,W,53*mm,fill=1,stroke=0);c.setFillColor(TEAL);c.rect(0,H-53*mm,5*mm,53*mm,fill=1,stroke=0) txt(M,H-14*mm,'CONFERENCE HANDOUT | CLINICAL SURVIVORSHIP',7,MINT,True) txt(M,H-26*mm,'Rebuilding the Base',22,WHITE,True) txt(M,H-34*mm,'Pelvic floor rehabilitation in cervical cancer survivorship',10.5,MINT) txt(M,H-43*mm,'From treatment-related morbidity to functional recovery',8.5,WHITE) # PF badge c.setFillColor(TEAL);c.circle(W-27*mm,H-25*mm,11*mm,fill=1,stroke=0);c.setFillColor(WHITE);font('Helvetica-Bold',13);c.drawCentredString(W-27*mm,H-28*mm,'PF') # headline statement rounded(M,H-67*mm,W-2*M,10*mm,MINT);txt(M+5*mm,H-61*mm,'Pelvic health is a core survivorship outcome, not an optional add-on.',9.2,NAVY,True) # three facts fy=H-89*mm; fw=(W-2*M-8*mm)/3 for i,(big,sub,col) in enumerate([('>660,000','women diagnosed globally in 2022',TEAL),('~350,000','global deaths in 2022',CORAL),('Decades','of survivorship may follow curative care',GOLD)]): x=M+i*(fw+4*mm);rounded(x,fy,fw,17*mm,PALE);txt(x+4*mm,fy+10*mm,big,14,col,True);txt(x+4*mm,fy+5*mm,sub,6.7,INK,True) # content sections left=M; gap=5*mm; col=(W-2*M-gap)/2; right=left+col+gap base=H-171*mm section(left,base,col,73*mm,'1. Screen early',TEAL) y=base+59*mm for b in ['Ask at every follow-up about bladder, bowel, pain and intimacy. Symptoms are frequently not volunteered.','Use a consent-forward assessment: history, red-flag triage, movement/breathing screen, then external or internal examination only if the patient agrees.','Red flags needing medical review first: new bleeding or pain, suspected recurrence, infection, fistula, progressive obstruction or severe unexplained symptoms.']: y=bullet(left+7*mm,y,b,col-14*mm);y-=2.6*mm section(right,base,col,73*mm,'2. Treat the phenotype',CORAL) y=base+59*mm for b in ['Hypotonic / weak presentation: graded pelvic floor strengthening, endurance, cough/lift integration and motor-control feedback.','Hypertonic / guarded presentation: down-training, diaphragmatic breathing, manual techniques and graded exposure before loading.','Treat bladder and bowel symptoms in parallel with medical teams. Rehabilitation supports, but does not replace, diagnostic evaluation.']: y=bullet(right+7*mm,y,b,col-14*mm);y-=2.6*mm # lower pathway path_y=H-218*mm rounded(M,path_y,W-2*M,35*mm,PALE,LINE);txt(M+5*mm,path_y+27*mm,'A practical survivorship pathway',9,NAVY,True) steps=[('Ask','4-domain screen',TEAL),('Triage','Rule out red flags',CORAL),('Support','Education + symptom basics',GOLD),('Refer','Pelvic-health assessment',NAVY),('Review','Measure, escalate, close loop',TEAL)] sx=M+6*mm; sy=path_y+13*mm; sw=(W-2*M-12*mm)/5 for i,(h,b,colr) in enumerate(steps): x=sx+i*sw;c.setFillColor(colr);c.circle(x+7*mm,sy+5*mm,4.5*mm,fill=1,stroke=0);c.setFillColor(WHITE);font('Helvetica-Bold',6);c.drawCentredString(x+7*mm,sy+3.2*mm,str(i+1));txt(x+14*mm,sy+6.5*mm,h,7,NAVY,True);para(x+14*mm,sy-2*mm,b,sw-15*mm,6.1,7.5,MUTED) # practice pearls py=H-257*mm section(M,py,W-2*M,29*mm,'Practice pearls',GOLD) pearls=['“More Kegels” is not the answer to every pelvic symptom.','Pair one patient-reported measure with one objective assessment and a patient-defined functional goal.','Sexual rehabilitation restores choice, comfort and connection. Penetration is optional and never the sole endpoint.'] x=M+8*mm;y=py+18*mm for p in pearls: c.setFillColor(GOLD);c.circle(x+1.8,y+1.6,1.4,fill=1,stroke=0);y=para(x+7,y,p,W-2*M-16*mm,7.3,8.8,INK);y-=1.2*mm # footer c.setStrokeColor(LINE);c.line(M,18*mm,W-M,18*mm) txt(M,13.8*mm,'Selected evidence: IARC GLOBOCAN 2022; Kurtuluş et al., Int Urogynecol J, 2026 (PMID: 41579191);',5.8,MUTED) txt(M,10.8*mm,'Tim & Mazur-Bialy, J Gynecol Obstet Hum Reprod, 2024; Yang et al., Gynecol Oncol, 2012.',5.8,MUTED) txt(W-M-35*mm,10.8*mm,'Conference handout | 2026',5.8,MUTED) c.showPage();c.save();print(out) PY python "/tmp/workspace/cervical-pelvic-floor-conference/src/create_handout.py" python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/cervical-pelvic-floor-conference/handout/Rebuilding_the_Base_Conference_Handout.pdf' r=PdfReader(p); print('exists pages',len(r.pages)); print(r.pages[0].extract_text()[:1500]) PY

python - <<'PY' import fitz p='/tmp/workspace/cervical-pelvic-floor-conference/handout/Rebuilding_the_Base_Conference_Handout.pdf' doc=fitz.open(p); pix=doc[0].get_pixmap(matrix=fitz.Matrix(1.5,1.5),alpha=False); out='/tmp/workspace/cervical-pelvic-floor-conference/handout/handout_preview.png'; pix.save(out); print(out, pix.width,pix.height) PY

python - <<'PY' from pathlib import Path from pypdf import PdfReader p=Path('/tmp/workspace/cervical-pelvic-floor-conference/handout/Rebuilding_the_Base_Conference_Handout.pdf') r=PdfReader(str(p)) text='\n'.join(pg.extract_text() or '' for pg in r.pages) checks={'one_page':len(r.pages)==1,'has_title':'Rebuilding the Base' in text,'has_red_flags':'Red flags' in text,'has_pathway':'survivorship pathway' in text,'has_references':'Selected evidence' in text} print('size_bytes=',p.stat().st_size) print(checks) print('all_pass=',all(checks.values())) PY

cervical cancer pelvic floor rehabilitation survivorship systematic review guideline 2026

~/cervical-pelvic-floor-conference

"gynecological cancer" AND "pelvic floor rehabilitation"

python - <<'PY' from pptx import Presentation p='/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck.pptx' prs=Presentation(p) for i,s in enumerate(prs.slides,1): print(i, getattr(s.shapes.title,'text',None), 'notes=',hasattr(s,'notes_slide')) ns=s.notes_slide print(' notes_shapes',[(sh.name, getattr(sh,'has_text_frame',False), getattr(sh.text_frame,'text','') if getattr(sh,'has_text_frame',False) else '') for sh in ns.shapes]) if i==1: print(dir(ns)) PY

cat > "/tmp/workspace/cervical-pelvic-floor-conference/src/add_speaker_notes.py" <<'PY' from pptx import Presentation from pathlib import Path src=Path('/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck.pptx') out=Path('/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck_with_Speaker_Notes.pptx') notes=[ '''TIME: 0:45 Open with the central premise: survival alone is not the endpoint. Many cervical cancer survivors carry bladder, bowel, pain and sexual-health consequences that change daily life. Today I will focus on a practical clinical response: identify problems early, assess safely, match therapy to the phenotype, and build a reliable referral pathway. Transition: First, why should this be a visible survivorship priority?''', '''TIME: 1:00 Cervical cancer remains a major global health burden. IARC estimates that in 2022, more than 660,000 women were diagnosed and roughly 350,000 died worldwide. The rehabilitation message is not that every survivor has pelvic floor dysfunction. It is that survivors may live for decades after treatment, so treatment-related morbidity has a long horizon and should be anticipated. Transition: To understand the consequences of treatment, we need a simple functional view of the pelvic floor.''', '''TIME: 0:50 Think of the pelvic floor as a coordinated system rather than an isolated muscle. It contributes to support, continence, sexual function, and the ability to relax for voiding and defecation. It works with the diaphragm, abdominal wall, connective tissues and nervous system. This is why a narrow focus on strength alone can miss the clinical problem. Transition: Cervical cancer treatment can disturb several parts of this system at once.''', '''TIME: 1:00 The treatment history is the first rehabilitation hypothesis. Radical surgery may affect autonomic nerves, fascial support and scar mobility. Radiation and brachytherapy can alter tissue compliance, mucosa and vaginal length, and can drive bladder or bowel irritation. Systemic and menopausal effects can add fatigue, dryness, mood changes, body-image concerns and fear. Do not assume the mechanism from the diagnosis alone. Ask what treatment was delivered, when, and what changed afterward. Transition: The simplest action in clinic is to ask directly.''', '''TIME: 1:00 At each follow-up, ask about four domains: bladder, bowel, pain and intimacy. Use direct, normalising language because many people do not volunteer these symptoms. A useful opening is: “These symptoms are common after treatment, and we have ways to help.” That tells the survivor that the question is legitimate and that a pathway exists. Transition: A positive answer should lead to a structured but patient-led assessment.''', '''TIME: 1:15 Start with the survivor’s main concern and desired return to activity. Review the treatment timeline and screen for red flags before progressing to a musculoskeletal or pelvic examination. Consent is an ongoing process, not a single signature. Explain the purpose, offer external or internal options, and make it clear that the patient can pause or decline. New bleeding or pain, suspected recurrence, infection, fistula, obstruction, or severe unexplained symptoms require medical review first. Transition: The most important treatment-direction decision is often the tone phenotype.''', '''TIME: 1:10 Avoid the reflex to prescribe generic Kegels. A weak, hypotonic presentation may need progressive loading and functional integration. A painful, guarded or hypertonic presentation often needs down-training, breathing, tissue tolerance work and graded exposure first. Strength is only one outcome. Reassess symptoms, tone, confidence and function. Transition: With the phenotype defined, we can select from a practical toolkit.''', '''TIME: 1:10 The toolkit is broad but should remain goal-directed. Pelvic floor training, manual or scar approaches, biofeedback, vaginal rehabilitation, bladder and bowel retraining, and education all have a role for selected patients. The evidence base is evolving. Recent systematic and umbrella reviews support pelvic floor rehabilitation as part of cancer survivorship care, while also highlighting heterogeneity and the need for individualized protocols. Transition: Vaginal rehabilitation is one area where sensitive communication matters particularly.''', '''TIME: 1:10 Dilator therapy should be presented as a graded option to support vaginal accommodation, examination tolerance, comfort and confidence. It is not a pass-fail task and it should never be imposed. Prepare the patient with an explanation, a comfort plan and lubrication. Start at a tolerable level, progress gradually, and review barriers without judgment. Avoid progression during active mucositis or unexplained bleeding. Significant pain or bleeding needs review. Transition: Bladder and bowel symptoms need their own parallel medical and rehabilitation pathways.''', '''TIME: 1:10 For bladder symptoms, distinguish postoperative emptying problems from urgency or radiation-associated symptoms. Timed voiding and bladder retraining can help selected patients, but retention, hematuria and severe symptoms need appropriate medical assessment. For bowel symptoms, urgency, altered stool form, tenesmus and bleeding may occur after pelvic treatment. New or progressive bleeding warrants GI or oncology evaluation. The key point is that rehabilitation adds value but does not replace diagnostic workup. Transition: Sexual health requires the same clinical seriousness and an explicitly patient-defined endpoint.''', '''TIME: 1:05 Sexual rehabilitation is about restoring choice, comfort and connection. It is not synonymous with penetrative intercourse. A stepwise approach can begin with permission to discuss concerns, then non-genital touch, self-exploration or dilator work, partnered non-penetrative activity, and penetration only if desired. Refer for sex therapy or psycho-oncology when distress, relationship strain or persistent symptoms call for it. Transition: The plan must also work beyond the clinic visit.''', '''TIME: 0:55 Home programmes succeed when they are specific, measurable and flexible. Give clear frequency and progression guidance, a simple symptom or function log, and written escalation criteria. Frame recovery as active, supported rehabilitation rather than a lifelong burden. Irradiated tissue changes may be slow, and setbacks do not erase progress. Transition: Individual care requires a service pathway around it.''', '''TIME: 1:00 This five-step pathway is designed to be feasible in routine survivorship care. Ask the four questions, triage red flags, provide first-line education, refer for pelvic-health assessment, then review outcomes and escalate when needed. The final step is often missed: close the loop. Confirm that referral occurred and that the plan returns to the oncology team. Transition: No one discipline can deliver every component alone.''', '''TIME: 0:55 The survivor needs one shared plan, not disconnected referrals. Gyn-oncology maintains disease surveillance and safety. Pelvic-health physiotherapy assesses and treats function. Urology, GI, psycho-oncology, sex therapy, nursing and navigation provide specialist support and continuity. Shared outcomes should include symptom burden, function, sexual well-being, participation and patient experience. Transition: If your system does not yet have this pathway, begin with a small implementation cycle.''', '''TIME: 0:55 The first 90 days can be simple. Map red flags and referral routes, pilot a four-domain screen in one clinic, then measure referral completion, delays and patient outcomes. Start with the resources you have. The aim is to build a dependable service, not a perfect protocol on day one. Transition: Measurement should reflect what matters most to survivors.''', '''TIME: 0:50 Use a small, consistent data set. Track access, a symptom measure relevant to the patient, a patient-defined functional goal and patient experience of safety and usefulness. This provides feedback for both individual care and service improvement. It also makes rehabilitation visible within the survivorship programme. Transition: Let us bring the approach together with a representative goal statement.''', '''TIME: 1:00 When a survivor says, “I want intimacy to feel safe again and to move without fear,” do not jump straight to an exercise prescription. First assess safety, recurrence or infection concerns, guarding, tissue tolerance, bladder or bowel patterns and personal goals. Then use education, down-training or loading as indicated, graded exposure and symptom-specific care. Review outcomes that matter to her: pain, urgency, confidence and valued activity. Transition: I will close with three messages.''', '''TIME: 0:50 First, ask early. Bladder, bowel, pain and intimacy belong in survivorship review. Second, assess the phenotype. Generic strengthening is not appropriate for every symptom. Third, build the pathway. A named pelvic-health route turns concern into actionable recovery. Close with this line: “No recurrence” is not the same as “no morbidity.”''', '''TIME: 0:30 These are selected sources underpinning the session. The IARC figures provide the global context. Recent systematic and umbrella reviews support rehabilitation as part of survivorship care but also show that protocols should be individualized and that better trials are still needed. Thank the audience and invite questions about local pathway design, consent-forward assessment, or referral implementation.''' ] prs=Presentation(str(src)) assert len(prs.slides)==len(notes) for slide, note in zip(prs.slides, notes): tf=slide.notes_slide.notes_text_frame tf.clear() tf.paragraphs[0].text=note prs.save(str(out)) print(out) PY python "/tmp/workspace/cervical-pelvic-floor-conference/src/add_speaker_notes.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck_with_Speaker_Notes.pptx' prs=Presentation(p) print('slides=',len(prs.slides)) for i,s in enumerate(prs.slides,1): t=s.notes_slide.notes_text_frame.text.strip() print(i, len(t), t.splitlines()[0] if t else 'MISSING') PY

python - <<'PY' from pathlib import Path from pptx import Presentation p=Path('/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck_with_Speaker_Notes.pptx') prs=Presentation(str(p)) assert p.exists() and p.stat().st_size>0 assert len(prs.slides)==19 missing=[]; total=0 for i,s in enumerate(prs.slides,1): n=s.notes_slide.notes_text_frame.text.strip() if not n or 'TIME:' not in n: missing.append(i) total += len(n) print({'file_bytes':p.stat().st_size,'slides':len(prs.slides),'notes_characters':total,'missing_or_invalid_notes':missing}) PY

conference abstract guidelines pelvic floor rehabilitation cervical cancer survivorship 2026

cervical cancer pelvic floor rehabilitation systematic review survivorship 2026

~/attachments/410cf98c-bc79-491d-a353-6c61f54526c9

~/cervical-pelvic-floor-conference/output

"gynecological cancer" AND "pelvic floor rehabilitation"

python - <<'PY' from pptx import Presentation from pathlib import Path files=['/tmp/workspace/attachments/410cf98c-bc79-491d-a353-6c61f54526c9/Rebuilding the base.pptx','/tmp/workspace/cervical-pelvic-floor-conference/output/Rebuilding_the_Base_Conference_Deck_with_Speaker_Notes.pptx'] for f in files: p=Path(f); prs=Presentation(f); print('\n',p.name,'slides=',len(prs.slides),'bytes=',p.stat().st_size) for i,s in enumerate(prs.slides,1): tx=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text_frame.text.strip(): tx.append(sh.text_frame.text.replace('\n',' ')[:100]) print(i, ' | '.join(tx[:2])) PY

IARC GLOBOCAN 2022 cervical cancer 660000 350000

"gynecological cancer" AND "pelvic floor rehabilitation"