cervical cancer AND pelvic floor rehabilitation

cervical cancer survivorship pelvic floor rehabilitation guideline

https://www.nccn.org/patients/guidelines/content/PDF/cervica…

cervical cancer AND pelvic floor

female pelvic floor muscles anatomy diagram levator ani urinary bladder uterus rectum

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gynecologic cancer AND pelvic floor physical therapy

pelvic floor physical therapy gynecologic cancer survivors rehabilitation clinical practice review

Educational medical illustration of the female pelvic floor from a side cutaway view, showing pelvic diaphragm and levator ani supporting bladder, uterus, vagina, and rectum, clear labeled anatomy suitable for a professional clinical conference presentation

mkdir -p "/tmp/workspace/pelvic-floor-cervical-cancer-presentation/src" "/tmp/workspace/pelvic-floor-cervical-cancer-presentation/output" "/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets" && python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/image-gen/880ad20493924f7788793da1ea39ef14.png" > "/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets/image_fetch.json"

python -c "import json,base64; d=json.load(open('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets/image_fetch.json'))[0]; open('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets/pelvic_floor_anatomy.png','wb').write(base64.b64decode(d['base64'].split(',',1)[1]))" && python -c "from PIL import Image; im=Image.open('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets/pelvic_floor_anatomy.png'); print(im.size)"

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from pptx.oxml.xmlchemy import OxmlElement from pptx.oxml.ns import qn from pptx.enum.shapes import MSO_CONNECTOR from pathlib import Path OUT=Path('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/output/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship.pptx') IMG='/tmp/workspace/pelvic-floor-cervical-cancer-presentation/assets/pelvic_floor_anatomy.png' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(19,46,63); TEAL=RGBColor(27,126,132); MINT=RGBColor(210,239,232); CORAL=RGBColor(217,101,83); GOLD=RGBColor(217,174,74); INK=RGBColor(34,48,56); GREY=RGBColor(93,108,114); PALE=RGBColor(246,249,248); WHITE=RGBColor(255,255,255); LAV=RGBColor(235,230,245) # helpers def rect(sl,x,y,w,h,fill,line=None,r=True): sh=sl.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if r 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 r: sh.adjustments[0]=0.08 return sh def line(sl,x1,y1,x2,y2,c=TEAL,width=2): sh=sl.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); sh.line.color.rgb=c; sh.line.width=Pt(width); return sh def txt(sl,text,x,y,w,h,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=MSO_ANCHOR.TOP,margin=0.06): box=sl.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=box.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=val lines=text.split('\n') for i,t in enumerate(lines): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=t; p.alignment=align; p.space_after=Pt(4) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return box def title(sl,n,heading,sub=None): txt(sl,f'{n:02d}',0.46,0.30,0.5,0.32,11,TEAL,True) txt(sl,heading,0.46,0.66,12.2,0.58,29,NAVY,True) if sub: txt(sl,sub,0.48,1.27,12.1,0.34,12,GREY) line(sl,0.46,1.70,12.86,1.70,TEAL,1.3) def footer(sl,section): txt(sl,section.upper(),0.46,7.14,5,0.18,8,TEAL,True) txt(sl,'Pelvic Floor Rehabilitation in Cervical Cancer Survivorship',7.2,7.14,5.65,0.18,8,GREY,False,align=PP_ALIGN.RIGHT) def bullets(sl,items,x,y,w,h,size=18,accent=TEAL): for i,item in enumerate(items): yy=y+i*(h/len(items)); rect(sl,x,yy+0.12,0.12,0.12,accent,r=False); txt(sl,item,x+0.28,yy,w-0.28,h/len(items)-0.03,size,INK) def card(sl,head,body,x,y,w,h,accent=TEAL): rect(sl,x,y,w,h,WHITE,RGBColor(218,228,227)); rect(sl,x,y,0.12,h,accent,r=False) txt(sl,head,x+0.28,y+0.22,w-0.45,0.32,16,NAVY,True) txt(sl,body,x+0.28,y+0.67,w-0.45,h-0.82,13,INK) def notes(sl, text): tf=sl.notes_slide.notes_text_frame tf.text=text # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY,r=False); rect(s,0.58,0.64,0.16,5.95,TEAL,r=False) txt(s,'REBUILDING\nTHE BASE',1.08,0.83,6.6,1.55,37,WHITE,True) txt(s,'Pelvic Floor Rehabilitation in\nCervical Cancer Survivorship',1.1,2.66,7.2,1.12,25,MINT,False) txt(s,'A practical, trauma-informed pathway from symptom recognition to function',1.1,4.15,7.7,0.45,15,WHITE) rect(s,9.1,0.7,3.65,5.75,RGBColor(235,246,243),r=True); s.shapes.add_picture(IMG,Inches(9.28),Inches(1.27),width=Inches(3.28),height=Inches(4.43)) txt(s,'45-minute conference presentation',1.1,6.56,4,0.28,11,MINT,True) notes(s,'Timing: 1 minute. Welcome. Frame the pelvic floor as a functional system, not simply a set of muscles. The aim is a practical pathway clinicians can use tomorrow.') # 2 s=prs.slides.add_slide(blank); title(s,2,'Why rebuilding the base matters','Cervical cancer survival is not the endpoint of care.'); footer(s,'Why it matters') card(s,'The disease is treated','Oncologic control may be excellent, while bladder, bowel, sexual and movement symptoms remain unspoken.',0.55,2.05,3.9,3.55,TEAL) card(s,'The system has changed','Surgery, radiation, menopause, pain, altered sensation, fatigue and fear can each affect pelvic function.',4.72,2.05,3.9,3.55,CORAL) card(s,'Rehabilitation restores options','Assessment, education and individualized therapy can support continence, comfort, confidence and participation.',8.9,2.05,3.9,3.55,GOLD) txt(s,'Core message: ask early, screen routinely, and refer before symptoms become normalized.',0.65,6.2,12,0.42,18,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. Emphasize that survivorship is a phase of active care. The rehabilitation target is meaningful function and participation, not a perfect examination finding.') #3 s=prs.slides.add_slide(blank); title(s,3,'Learning objectives'); footer(s,'Opening') bullets(s,['Recognize treatment-related pathways to pelvic floor dysfunction.','Use a concise, survivorship-focused screen for bladder, bowel, sexual, pain and lymphatic concerns.','Match findings to an individualized rehabilitation plan and appropriate referral.','Communicate about intimate symptoms with consent, safety and trauma-informed care.'],0.9,2.0,11.6,3.9,20) rect(s,0.9,6.05,11.55,0.55,MINT,r=True); txt(s,'The phrase “do Kegels” is not a rehabilitation plan.',1.05,6.18,11.2,0.25,17,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 1 minute. State the scope. This is not a substitute for oncologic assessment or medical management of recurrence or significant radiation injury.') #4 anatomy s=prs.slides.add_slide(blank); title(s,4,'The pelvic floor is a dynamic system','Support, continence, evacuation, sexual function, breathing and load transfer are linked.'); footer(s,'Foundations') s.shapes.add_picture(IMG,Inches(0.55),Inches(1.92),width=Inches(6.05),height=Inches(4.62)) card(s,'Support + continence','Coordinated closure and support for bladder, uterus/vaginal vault and rectum.',7.05,2.0,5.55,1.1,TEAL) card(s,'Relaxation + excursion','Lengthening and descent are necessary for voiding, defecation, penetration and pain-free movement.',7.05,3.36,5.55,1.1,CORAL) card(s,'Coordination + capacity','Function depends on timing with diaphragm, abdominal wall, hips, nervous system and daily loads.',7.05,4.72,5.55,1.1,GOLD) txt(s,'Illustration is schematic and educational.',0.68,6.62,4,0.18,8,GREY) notes(s,'Timing: 3 minutes. Use the diagram to explain why both weakness and overactivity can produce symptoms. The clinical question is not “Can she squeeze?” but “Can she contract, relax, coordinate and use the system in life?”') #5 s=prs.slides.add_slide(blank); title(s,5,'How cervical cancer treatment can alter function'); footer(s,'Foundations') for i,(h,b,c) in enumerate([('Surgery','Tissue disruption, altered support, autonomic nerve effects, adhesions, scar sensitivity and altered vaginal anatomy.',TEAL),('Radiotherapy','Fibrosis, reduced tissue compliance, mucosal and vascular change, stenosis, bowel/bladder irritation and fatigue.',CORAL),('Systemic and hormonal effects','Treatment-induced menopause, sleep disruption, neuropathy, deconditioning and altered body image can amplify symptoms.',GOLD)]): card(s,h,b,0.75+i*4.15,2.08,3.65,2.65,c) txt(s,'Symptoms are usually multifactorial. A single-discipline, single-modality answer is rarely sufficient.',0.85,5.65,11.6,0.58,18,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. Explain that treatment effects are not deterministic. Assess the specific intervention, dose field when relevant, time since treatment, and the patient’s functional priorities.') #6 s=prs.slides.add_slide(blank); title(s,6,'The survivorship symptom map','Screen across domains, even when the referral says only “pelvic pain” or “urinary leakage.”'); footer(s,'Assessment') items=[('Bladder','Urgency, frequency, leakage, hesitancy, incomplete emptying, nocturia'),('Bowel','Diarrhea, urgency, constipation, obstructed defecation, fecal leakage'),('Sexual + vaginal','Dryness, stenosis, dyspareunia, fear, arousal/orgasm concerns, examination pain'),('Pain + movement','Pelvic/hip/back pain, scar sensitivity, neuropathic features, fatigue, avoidance'),('Lymphatic + psychosocial','Leg/genital swelling, body image, trauma history, distress, relationship impact')] for i,(h,b) in enumerate(items): x=0.65+(i%3)*4.2; y=2.02+(i//3)*2.05; card(s,h,b,x,y,3.75,1.55,[TEAL,CORAL,GOLD,TEAL,CORAL][i]) notes(s,'Timing: 2 minutes. Normalize direct questions. A patient may not volunteer sexual or bowel symptoms unless asked in a private, nonjudgmental way.') #7 s=prs.slides.add_slide(blank); title(s,7,'Routine screen: five questions','A 60-second conversation can make rehabilitation visible.'); footer(s,'Assessment') qs=['Since treatment, has urine leakage, urgency or difficulty emptying affected your day?','Have bowel changes, urgency, constipation or leakage affected your confidence or routine?','Is pelvic pain, vaginal dryness, narrowing or discomfort with examination/intimacy a concern?','Have you noticed swelling, heaviness or skin change in the legs, vulva or lower abdomen?','What activity, role or intimate experience would you most like to feel more comfortable doing?'] for i,q in enumerate(qs): rect(s,0.8,1.95+i*0.88,0.52,0.52,TEAL if i<3 else CORAL,r=True); txt(s,str(i+1),0.8,2.05+i*0.88,0.52,0.18,14,WHITE,True,align=PP_ALIGN.CENTER) txt(s,q,1.55,1.92+i*0.88,10.9,0.5,17,INK) notes(s,'Timing: 2 minutes. Model the language. Add: “You do not have to discuss anything you do not want to, but these are common and treatable.”') #8 s=prs.slides.add_slide(blank); title(s,8,'First assessment: start with safety and consent'); footer(s,'Assessment') bullets(s,['Clarify cancer history: stage, surgery, radiation/brachytherapy, chemotherapy, complications and current surveillance.','Identify red flags and coordinate with oncology before internal examination or progression of treatment.','Agree goals and boundaries. Explain every step, obtain permission, and offer choice of chaperone, position and stopping.','Assess function before impairment: bladder/bowel diary, symptom scales, activity, pain behavior, sexual and psychosocial context.','Use external and internal examination only when indicated, consented to and clinically appropriate.'],0.7,1.92,12,4.5,17) notes(s,'Timing: 3 minutes. Internal examination is not mandatory for pelvic rehabilitation. A trauma-informed examination is opt-in and can be deferred. Explain how findings will change management.') #9 s=prs.slides.add_slide(blank); title(s,9,'Red flags: pause rehabilitation and escalate','New or progressive symptoms may reflect recurrence, infection, fistula, obstruction or significant radiation injury.'); footer(s,'Safety') red=['New vaginal bleeding or unexplained discharge','Hematuria, rectal bleeding, fever or severe urinary/bowel symptoms','New pelvic, hip, back or leg pain that is persistent or worsening','Rapidly increasing unilateral or genital swelling','Acute urinary retention, severe constipation/obstruction symptoms, fecal impaction','Neurologic deficit, saddle sensory change or new weakness'] for i,t in enumerate(red): x=0.8+(i%2)*6.15; y=2.0+(i//2)*1.35; rect(s,x,y,5.55,0.95,RGBColor(253,239,235),CORAL); txt(s,t,x+0.25,y+0.22,5.1,0.48,15,INK,False) txt(s,'When in doubt: communicate directly with the oncology or gynecology team.',0.8,6.3,11.8,0.35,17,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. This slide is a safety anchor. Adapt local escalation pathways. Pelvic floor therapy should never delay appropriate medical evaluation.') #10 s=prs.slides.add_slide(blank); title(s,10,'Classify the dominant pattern before prescribing exercise'); footer(s,'Clinical reasoning') card(s,'Underactive / poor support','Leakage with exertion, reduced closure pressure, low endurance, deconditioning.\n\nFocus: graded strength, timing, load strategy.',0.75,2.0,3.75,3.45,TEAL) card(s,'Overactive / non-relaxing','Pain, urgency, constipation, penetration difficulty, guarding, inability to lengthen.\n\nFocus: down-training, breathing, mobility, desensitization.',4.8,2.0,3.75,3.45,CORAL) card(s,'Mixed / complex','Common after cancer treatment. May include scar, neuropathic pain, tissue change, fear, fatigue and bowel-bladder symptoms.\n\nFocus: paced, multimodal plan.',8.85,2.0,3.75,3.45,GOLD) notes(s,'Timing: 2 minutes. Make clear that a person with urgency or pain may worsen with indiscriminate strengthening. Rehabilitation should follow assessment, not a diagnosis label alone.') #11 s=prs.slides.add_slide(blank); title(s,11,'Intervention toolkit: bladder and bowel'); footer(s,'Rehabilitation') card(s,'Education + self-management','Fluid and bladder habit review, urge-suppression strategies, bowel routine, toileting posture, fiber/medication coordination, symptom diary.',0.7,2.0,3.8,3.7,TEAL) card(s,'Motor retraining','Pelvic floor awareness; contract-relax; coordination with breath and functional tasks; graded endurance and power only when appropriate.',4.77,2.0,3.8,3.7,CORAL) card(s,'Function + participation','Progress to walking, lifting, work, travel, exercise and confidence-building. Measure the activity the survivor values.',8.84,2.0,3.8,3.7,GOLD) txt(s,'Coordinate medical management for radiation-related bladder or bowel toxicity, infection, medication effects and significant gastrointestinal symptoms.',0.8,6.18,11.8,0.4,14,GREY,False,align=PP_ALIGN.CENTER) notes(s,'Timing: 3 minutes. Offer examples of functional cues: exhale with effort, timed response to urgency, relaxed breathing to initiate voiding. Avoid rigid protocols.') #12 s=prs.slides.add_slide(blank); title(s,12,'Pain, dyspareunia and vaginal rehabilitation','Use a biopsychosocial approach that respects tissue health, arousal, safety and choice.'); footer(s,'Rehabilitation') steps=[('1. Exclude/coordinate','Assess for recurrence, infection, severe radiation injury and vaginal tissue concerns.'),('2. Reduce threat','Education, paced breathing, consent-led examination, pain neuroscience and movement confidence.'),('3. Restore mobility','External and internal techniques when appropriate; scar management; hip/pelvic mobility; relaxation.'),('4. Graded exposure','Dilator, finger, device, examination or penetration goals only if chosen by the survivor, with lubrication/moisturizers and pacing.'),('5. Expand support','Sexual-health counseling, menopause care, psychology and partner-inclusive care when desired.')] for i,(h,b) in enumerate(steps): x=0.65+(i%3)*4.2; y=2.05+(i//3)*2.15; card(s,h,b,x,y,3.75,1.68,[TEAL,CORAL,GOLD,TEAL,CORAL][i]) notes(s,'Timing: 3 minutes. Clarify that dilators are not a test of adherence or a mandatory intervention. They may be useful for selected goals, but the evidence for prevention of stenosis is mixed and adherence can be difficult. Establish tissue safety and patient priorities first.') #13 s=prs.slides.add_slide(blank); title(s,13,'Lymphedema and movement: do not overlook the lower quarter'); footer(s,'Rehabilitation') bullets(s,['Ask about heaviness, tightness, limb/genital swelling, skin changes, activity restriction and recurrent cellulitis.','Assess in partnership with certified lymphedema services when signs or risk are present.','Support graded activity, strength, mobility and self-monitoring within the oncology plan.','Teach skin care and escalation for rapid change, redness, pain, fever or unilateral swelling.','Consider pelvic girdle, hip and trunk contributors to gait, loading and confidence.'],0.8,1.95,11.9,4.55,18) notes(s,'Timing: 2 minutes. Avoid overpromising. Lymphedema care needs individualized assessment and may include compression, skin care, exercise and specialist input.') #14 s=prs.slides.add_slide(blank); title(s,14,'A practical rehabilitation pathway','Match intensity and modality to readiness, safety and the individual’s main goal.'); footer(s,'Pathway') path=[('SCREEN','Ask five questions\nIdentify red flags'),('TRIAGE','Oncology/medical review\nwhen needed'),('ASSESS','Function, symptoms, goals\nconsent-led examination'),('TREAT','Education + targeted\nmultimodal therapy'),('REVIEW','Measure progress\nprogress or refer')] for i,(h,b) in enumerate(path): x=0.45+i*2.55; rect(s,x,2.55,2.15,1.6,WHITE,RGBColor(210,224,221)); txt(s,h,x+0.15,2.78,1.85,0.28,15,TEAL,True,align=PP_ALIGN.CENTER); txt(s,b,x+0.15,3.18,1.85,0.66,13,INK,False,align=PP_ALIGN.CENTER) if i<4: line(s,x+2.16,3.35,x+2.48,3.35,CORAL,2) rect(s,1.1,5.2,11.1,0.68,MINT,r=True); txt(s,'Success = improved participation and self-efficacy, not only fewer symptoms.',1.25,5.39,10.8,0.25,17,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. This can form a local pathway. It works in oncology follow-up, gynecology, primary care, physiotherapy, nursing and sexual health clinics.') #15 s=prs.slides.add_slide(blank); title(s,15,'Case: “I have not felt normal since treatment”','Use the pattern, not the label, to plan.'); footer(s,'Case application') card(s,'Presentation','46-year-old, 10 months after chemoradiation and brachytherapy. Urgency, loose stools, painful exams, avoidance of intimacy, fatigue and fear of “doing damage.”',0.7,2.0,3.75,3.8,TEAL) card(s,'First decisions','Review red flags and oncology follow-up. Clarify tissue status. Identify top goals: confidence leaving home and tolerating examinations.',4.8,2.0,3.75,3.8,CORAL) card(s,'Initial plan','Bladder/bowel diary; urge and bowel strategies; diaphragmatic down-training; graded walking; education; patient-chosen vaginal rehabilitation; coordinate sexual health and oncology.',8.9,2.0,3.75,3.8,GOLD) notes(s,'Timing: 3 minutes. Invite the audience to identify why immediate strengthening would be premature. The initial pattern suggests urgency, bowel effects, pain and fear requiring education and down-training alongside medical coordination.') #16 s=prs.slides.add_slide(blank); title(s,16,'What does the evidence support?','The evidence base is promising but heterogeneous. Use it to inform, not oversimplify, care.'); footer(s,'Evidence') card(s,'Systematic review','Low-to-moderate certainty evidence supports pelvic floor muscle training and/or dilator therapy for improved sexual function and quality of life in cervical cancer survivors.',0.7,2.0,3.75,3.65,TEAL) card(s,'Clinical synthesis','Recent reviews support individualized pelvic floor therapy and initial conservative interventions for pelvic floor dysfunction after gynecologic malignancy.',4.8,2.0,3.75,3.65,CORAL) card(s,'Guideline-consistent care','NCCN patient guidance identifies pelvic floor physical therapy for bowel/bladder changes and includes dilators, moisturizers and sexual-health support within survivorship care.',8.9,2.0,3.75,3.65,GOLD) txt(s,'Interpretation: select interventions by phenotype, safety, goals and preferences. Do not treat a literature summary as a protocol.',0.8,6.18,11.8,0.36,14,GREY,False,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. Cite evidence transparently. The systematic-review conclusion comes from heterogeneous studies and is not proof that one protocol fits all survivors.') #17 s=prs.slides.add_slide(blank); title(s,17,'Communication changes care','Permission, normalization and choice can reduce barriers to reporting and participation.'); footer(s,'Implementation') quotes=[('Normalize','“Many people notice bladder, bowel or sexual changes after this treatment. Has any of this affected you?”'),('Ask permission','“Would it be okay if I ask a few questions about pelvic and intimate symptoms?”'),('Offer choice','“We can begin with education and external assessment. An internal examination is optional and never required today.”'),('Collaborate','“What would make the biggest difference in your everyday life over the next month?”')] for i,(h,b) in enumerate(quotes): card(s,h,b,0.75+(i%2)*6.1,2.0+(i//2)*2.08,5.55,1.55,[TEAL,CORAL,GOLD,TEAL][i]) notes(s,'Timing: 2 minutes. Encourage a neutral, inclusive vocabulary. Survivors should set the pace of intimate discussion and physical examination.') #18 s=prs.slides.add_slide(blank); title(s,18,'Implementation: make referral the default, not the exception'); footer(s,'Implementation') for i,(h,b,c) in enumerate([('Build a screen','Embed five questions in follow-up, nursing and therapy workflows.',TEAL),('Name the referral','Create a direct pelvic health referral path with oncology context and treatment summary.',CORAL),('Close the loop','Share goals, findings, escalation concerns and functional progress across the team.',GOLD)]): card(s,h,b,0.75+i*4.15,2.15,3.65,2.35,c) txt(s,'Minimum viable service: routine screening + clear escalation + a known pelvic-health contact.',0.85,5.55,11.6,0.48,18,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 2 minutes. Ask audience members to identify one place they can add a screening question or create a referral prompt this month.') #19 s=prs.slides.add_slide(blank); title(s,19,'Take-home messages'); footer(s,'Close') bullets(s,['Pelvic floor dysfunction after cervical cancer is common, multifactorial and often treatable.','Screen bladder, bowel, sexual, pain, lymphatic and psychosocial domains routinely.','Safety, cancer context and consent come before internal examination or exercise prescription.','Individualized, multimodal rehabilitation is more useful than generic strengthening advice.','Measure what matters to the survivor: confidence, comfort, roles, intimacy and participation.'],0.8,1.85,11.8,4.55,19) notes(s,'Timing: 2 minutes. Deliver the five messages slowly. Reiterate that speaking about symptoms is itself an intervention because it opens access to care.') #20 s=prs.slides.add_slide(blank); title(s,20,'References and discussion'); footer(s,'References') refs=['NCCN Guidelines for Patients: Cervical Cancer. 2026. Survivorship section.','Brennen R, Lin K-Y, Denehy L, Frawley HC. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review. Phys Ther. 2020;100:1357-1371. PMID: 32367126.','Ye AL, Johnston EE, Hwang SS. Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies. Curr Oncol Rep. 2024. PMID: 38294706.','Effectiveness of Pelvic Floor Muscle and Education-Based Therapies in Females Treated for Gynecological Cancer: systematic review. 2024. PMCID: PMC11579103.','Huffman LB et al. Sexual health in gynecologic cancer survivors: a review and clinical guide. Gynecol Oncol. 2016;140:359-368.'] for i,r in enumerate(refs): txt(s,r,0.78,1.9+i*0.72,11.8,0.55,13,INK) rect(s,0.78,5.95,11.7,0.66,MINT,r=True); txt(s,'Questions and discussion',0.95,6.13,11.3,0.27,20,NAVY,True,align=PP_ALIGN.CENTER) notes(s,'Timing: 4 minutes. Invite questions. If time is limited, return to the clinical case and ask the group what they will change in their survivorship workflow.') # Save prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/pelvic-floor-cervical-cancer-presentation/src/create_deck.py"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/pelvic-floor-cervical-cancer-presentation/output/Rebuilding_the_Base_Pelvic_Floor_Rehabilitation_Cervical_Cancer_Survivorship.pptx') prs=Presentation(p) print('exists',p.exists(),'bytes',p.stat().st_size,'slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text.strip(): texts.append(sh.text.replace('\n',' | ')) note=s.notes_slide.notes_text_frame.text.strip() print(i, 'text',len(texts),'notes',bool(note), 'title',texts[1] if len(texts)>1 else texts[:1]) PY

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NCCN cervical cancer survivorship pelvic floor physical therapy 2026

cervical cancer AND pelvic floor rehabilitation