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Bojan Ignatovski
I N V E S T I C I J S K I
P R O G R A M
O S I J E K , 2017. GODINE
Antal Balog i Bojan Ignatovski: Investicijski program opremanja klinike za
plastičnu i estetsku kirurgiju Arkadia u Daruvaru
Naslov: Investicijski program opremanja klinike za plastičnu i estetsku kirurgiju Arkadia u Daruvaru
[Elektronička građa] / Antal Balog, Bojan Ignatovski
Izdanje: 1. izd
Napomene: Zahtjevi sustava: PC, Windows XP, Adobe Reader IX. - Publikacija u formatu PDF ; sadrži
115 str.
Autori
Antal Balog
Bojan Ignatovski
I N V E S T I C I J S K I
P R O G R A M
O S I J E K , 2017. GODINE
Antal Balog i Bojan Ignatovski:
Investicijski program opremanja klinike za plastičnu i estetsku kirurgiju
Arkadija u Daruvar u
s A E} Ft Z A J
I DIO
1. UVOD ...5.2
2. PREGLED DOBAVLJACA ....5.2
3. PREDVIDENE KOLICINE
ZA GODINU DANA RADA ...5.3
A. POLIKLINICKA A'.IBULANTA ..5.3
B. OPERACIJSKA JEDINICA ....3.6
c. STACI0NAR .....5.9
D. REKAPITULAtrIJA 5.13
VI DIO
b. ANALI ZA LOKACIJE
1. SIRA LOKAtrIJA .....6.2
2. UZA LOKACIJA .6.2
VI I DIO
IX DIO
X DIO
10. FINANCIJSKA ANAL TZA U PRIPREI.II
INVESTICIJSKE STUDIJE
1. INVESTICIJE U OSNOVNA SREDSTVA .TO.2
1. 1. INVESTICIJE U GRADEVINSKE OBJEKTE ..LO.z
1. 2. INVESTICIJE U OPREHU .LO.z
1. 3. INVESTItrIJE U OSNIVACKA ULACANJA.. .,1O.3
2. INVESTICIJE U OBRTNA SREDSTVA ...1O.4
3. REKAPITULACIJA ULAGANJA PO PROGRAT'IU. .1O.4
4. FORFIIRANJE UKUPNOG PRIHODA I OBRACUN TROSKOVA
RADA KLINIKE., ...1O.5
4- 1. FORI'IIRANJE UKUPNOG PRIHODA U GODINI
NOR].IALNOG RADA PROJEKTA (L992}.... ..1O.5
4. 2. RASPORED UKUPNOG PRIHODA ..1O.5
4. 3. OBRACUN TROSKOVA POSLOVANJA.- ..10.6
5. OBRACUN AI'TORTIZACIJE I OSTATKA
VRIJEDNOSTI PROJEKTA ..1O.7
6. OBRACUN BRUTO OSOBNIH DOHODAKA ..1O.8
7. IZVORI FINANCIRANJA I OBVEZE PREHA NJII'IA ..1O.A
7. 1. IZVORI I UVJETI FINANCIRANJA ...1O.A
7. 2. PLAN OTPLATE KREDITA .1O.9
XI DIO
XII DIO
XIII DIO
1. UVODNA IZLAGANJA
L.2
D ARKADIA ( Klinika za plastiCnu i estetsku kirurgiju' DARUVAR
SAzETAK I NVEST IC I JSKOE PROERA]'IA
2. SAZETAK
A. Investitor
1.1. ,D ARKADIA ( Klinika za plastiCnu i estetsku ki
rurg ij u ,
L .2. Daruvar
1.3. MatiCni broj:
1.4. Sifra preovladujuCe djelatnosti: 13O131
1.5. Osnovna banka: Privredna banka, PJ 34
,Daruvar.
B. Projekat
2.L. Naziv investicijskog projekta: Investicijski
program opremanja Klinike za plastiCnu i estetsku
kirurgiju,
2.2. Lokacija projekta: Daruvar, krug "Daruvarskih to
pI ica" ,
2.3. Sifra djelatnosti projekta: 130131
2.4. Karakter investicije: Adaptacija i opremanjer
2.3. Cilj investicije: Potetak nove djelatnosti, novo
, zapo*ljavanjer profit,
2.6. TerminEki plan
2.6.L. PoCetak adaptacije: 15.02.1991.
2.6.2. ZavrBetak adaptacije: 30.O5.1991.
2.6.3. Podetak uhodavanja rada: 01.O7.L99L.
?.6.4. PoCetak redovnog rada: 01.08.1991.
2.4. Predvieleni ekonomski vijek projekta: 10 godina
2.9. Cijene po kojima su izvedeni obraCuni u
investicijskom programu: travanj, 1991.
2.LO. Predratunska vrijednost ulaganja po programu
( travanj , 1991. ) : 9.73O.OOO dinara
1.3
D ARKADIA tt Klinika za plastidnu i estetsku kirurgiju, DARUVAR
SAzETAK INVESTICIJSKOE PROGRAT,IA
Red . OP I S I z n o s Struktura
b roj u '/.
A. OSNOVNA SREDSTVA 7 .530. OOO 77r39
1 . Gra8evinsk i obj ek ti ? .650 . OOO 27 r24
2. 0prema 4 ,430 . OOO 45, 53
3 . Osn ivatka u I aganj a 450. OOO 4 ,62
1.4
D ARKADIA <t Klinika za plastitnu i. estetsku kirurgijur DARUVAR
SAZETAK INVESTIC I JSKOG PROERAMA
OPERACIJE PLASTICNE I
ESTETSKE KIRURGIJE t7 .500 250 4 .373. OOO
1.5
> ARKADIA tt Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
SAZETAK INVEST IC I JSKOG PROGRAI.IA
PROGRA}I I ZRADILI :
L.6
p ARKADIA a Klinika za plastiCnu i estetsku kirurgijur DARWAR
ANALI ZA RAZVOJNIH MBEUCNOSTI INVESTITORA
2.2
) ARKADIA tt Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA RAZVOJNIH FIOGUCNOSTI INVESTI TORA
1) Sterilizacijar
2, Operac i j ska dvorana,
3 ) Pri rprerna ,
4 ) Separe sa tajnclm kuhinjom
za dnevni boravak oscrbljat
5 ) Bolesnitke sclbe,
6) Ordinacija,
7 l Hodnik
2.3
D ARKADIA ( KI inika za plastitnu i estetsku k irurg ij u , DARUVAR
ANALTTA RAZVOJNIH HOGUCNBSTI INVESTITORA
2,4
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA RAZVOJNIH ]'IOGUCNOSTI INVESTI TORA
DIREKTOR
POLI KLINICKA
AFlBULANTA
OPERACIJSKA
JEDINICA
STACIONAR
?.3
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA RAZVOJNIH I.IOGUCNOSTI INVESTITORA
njegov dalji razvclj i ukupne prof i tne i proi zvodne efek te " I nves-
titor Ce u okviru ovog programa usvoj i ti i odgCIvara j uC i in f orrna-
cijski sistem,
5 , Na clsn ovu konatna ocijena je da je inves-
sveg a retenog,
ti tor sposoban u l agati u svoj r azvoj te j e sposoban pri hvati ti
odgcrvarajuCe obaveze po kreditima.
2.6
,} ARKADIA ( Klinika za plastitnu i estetsku kirLrrgiju, DARUVAR
ANALIZA TRZ ISTA PRODAJE
3,2
D ARKADIA (( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA TRZ ISTA PRODAJE
2. PLANIRANA PRODAJA
ZDRAVSTVENIH USLUGA
3.3
D ARKADIA ct KI inika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA TRZ ISTA PRODAJE
3.4
D ARKADIA (( Klinika za plastitnu 1 eEtetsku kirurgiju, DARUVAR
ANALTZA TEHNICKOG RJESENJA
4.2
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA TEHNICKOG RJESENJA
4,3
D ARKADIA ( Klinika za plastiCnu i eEtetsku kirurgiju, DARUVAR
ANALTZA TRZISTA NABAVE
5- AI\IAI-IZ-A
-TFtZ I S-TA ]\IAE}AVE
1. UVOD
2. PREGLED DOEAVLJACA
3. PREDVIBENE KOLICINE
ZA EODINU DANA RADA
A. POLI KL INICKA AFIBULANTA
B. OPERACIJSKA JEDINICA
E. STAtrIONAR
D. REKAPITULAtrIJA
UVOD
2. PREELED DOBALJACA
Red . BP I S
broj
FARMAPLAST, AI ibunar,
2 ALKALOID, Skopje,
3 BAYER-PHARHA, Jugos I avij a, Lj ub I j ana,
5.1
3. PREDVTEENE KOLICINE
ZA EODINU DANA RADA
5.3
D ARKADIA n Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
ANALI ZA TRZ ISTA NABAVE
UKUPNO 24.95grOO
5.4
,D ARKADIA a Klinika za plastiEnu i estetsku kirurgiju, DARUVAR
ANALIZA TRz ISTA NABAVE
EE.
.-rl r uf
Ukupno 2A1 .3 L7 , OO
B. OPERACIJSKA JEDINItrA
5.6
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALIZA TREISTA NABAVE
UKUPNO 11O.O54rOO
3.7
D ARKADIA ( Klinika za plastiCnu i estetsku kirurgiju' DARUVAR
ANALIZA TRZISTA NABAVE
5.8
r ARKADIA tt Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
ANALIZA TREISTA NABAVE
UKUPNO 656.926rOO
C. STACIONAR
I. LIJEKOVI ZA STACIONAR
5.9
,D ARKADIA tt Klinika za plastiCnu i estetsku kirurgijur DARUVAR
ANALIZA TRZISTA NABAVE
5.10
,D ARKADIA ( Klinika za plastiEnu i estetsku kirurgiju, DARUVAR
ANALTZA TRzTSTA NABAVE
5.11
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALIZA TRz ISTA NABAVE
5. 12
D ARKADIA lt Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
ANALIZA TRZISTA NABAVE
UKUPNO 65.919, OO
D. REKAPITULACIJA
5. 13
,D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ShIAT-I ZA LOKAC IJE
6I A[\IAI- I Z.A
I_[3KAE IJE
1. SIRA LOKACIJA
?" UZA LOKACIJA
1. SIRA LOKAtrIJA
2. UZA LOKACIJA
6.2
,) ARKADIA ( Klinika za plastiEnu i estetsku kirurgiju, DARUVAR
ANAL TZA ORGAN I ZAC I JSK I H ASPEKATA
5.3
)) ARKADIA ( Klinika za plastitnu i estetsku kirurgijur DARUVAR
ANALIZA ZASTITE COVJEKOVE OKOLINE I ZASTITE NA RADU
2. ZASTITA NA RADU
7.2
D ARKADIA (( KIinika za pIastitnu i estetsku kirurgiju, DARUVAR
ANALIZA ZASTITE COVJEKOVE OKOLINE I ZASTITE NA RADU
7.3
D ARKADIA ( Klinika za plastiCnu i estetsku kirurgijur DARUVAR
ANAL I ZA ORGANI ZACI JSK IH ASPEKATA
El -r AF\lAl_ I z_A
[}FIT=AI\|IZACIJSKIH
ASPE}<ATA
(f ) KIRURG . r . . t . . . r r . r . r r r . . . . . r . . . r 2
a.?
D ARKADIA tt Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANAL T7A ORGANI ZAC I JSK IH ASPEKATA
2 KIRURSKI ASISTENT 4 2 6
3 ANESTEZTALOSK I ASISTENT 3 3 6
4 ODJELNE SESTRE ? 2 4 b
E
J BOLN I CAR I 2 2 4 6
UKUPNO I 15 15 30
Sadr2aj osoposobljavanja :
A) INSTRUMENTARKE
8.3
D ARKADI A tt Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA ORGANI ZACIJSKIH ASPEKATA
C) ANESTEZIOLOSKI ASISTENT
D) ODJELNE SESTRE
E) BOLNICARI
8.4
D ARKADIA (( Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
ANALIZA IZVODLJIVOSTI I DINAI.IIKE RADOVA
x***xx***x****x*******x**x*********x*****xt(**x********x*xx****xxx
FAZA A.
x x * * t( * * * * * * **t xx * * x* *)x* * x x x x* * * * xx*x*x**** x* x * x* * * * * x * x x x*x * * x * **
PRIPREME 7A NABAVU OPREME do 15. 4, 1991.
NABAVA UREDAJA I
OPREME do 30. 4. 1991.
FAZ A B.
* x* xx* * x * ** ***** t * * *** x*x* * x* * x x* * x x x x * ** x ** ** * * t( * * * * * xt( * * * x x x*x
UVJEZBAVANJE-TRENINE RADNI KA do 1. b. 1991.
9.2
D ARKADIA tt Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANALI ZA I ZVODLJ IVOSTI I DINAHI KE RADOVA
X*tt(***,ft*l(****X***X******l(*'f*X*XXX**X***tt**'r*t*X**rtX*X**X*X***X*
FAZA C.
****t(**t(***,r********xx*****rx*x***{(*x***xx**x*xx**xx**t(x***x***'x*
PUNA ZAPOSLENOST
PREMA PROGRAI4U 1. 8. 1991
TAKLJUCAK
9.3
D ARKADIA ( Klinika za plastidnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALTZA U PRIPREI'II INVESTICIJSKE STUDIJE
1. 2. INVESTICIJE U OPREFIU
10.2
n ARKADIA tt Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPRET'TI INVESTItrIJSKE STUDIJE
10.3
D ARKADIA (( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPRE]'II INVESTICIJSKE STUDIJE
Red . OP I S I z n o s Struktura
b roj u'A
A" OSNOVNA SREDSTVA 7 .330. OOO 77r39
1 . Gradevinsk i obj ek ti 2 .650 . OOO ?7 r24
2. Oprema 4 ,430 . OOO 45 r 53
3. Osnivatka ulaganja 450. OOO 4 ,62
10.4
D ARKADIA c< Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPREI.II INVESTICIJSKE STUDIJE
I" I OD PRODAJE
PR I HOD
PROIZVODA I USLUGA 10 " 508.600 ?5, O3
a) na domatem trt i*tu ?. LOI .72A 19, O1
b) na inozemnom trti*tu B.406. ggo 76rO2
II. PRIHODI OD PRODANE ROBE
I T,IATERIJALA oroo
10. 5
10.6
,) ARKADIA ( Klinika za plastidnu i estetsku kirurgijur DARUVAR
I I . NET,IATRIJALNI TROSKOVI 134. OOO 1r68
I I I . UKALKULIRANI BRUTO OSOBNI DOHOC I 3.IL2.gOO 39, 11
I V. TROSKOVI RAZDOBLJA 5 . 420. 592 58, 1O
V. NABAVNA VR I JEDNOST PRODANE ROBE I
I"IATER I J ALA o, OO
LO.7
D ARKADIA ct Klinika za plastitnu i estetsku kirurgiju, DARUVAR
6. OBRACUN BRUTO OSOBNIH DOHODAKA
HRVATSKI FOND ZA
RAZVOJ, ZAGREB 4 , OOO, OOO 41,11
2 VLASTITA SREDSTVA
I NVEST I TORA 3 .7 30. OOO 58r89
UKUPNO 9.73O.OOO IOOrOO
10. B
10. ?
,D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
t-
BILANCA USPJEHA
NOVOC PROGRAI.IA
( nastavak )
10. 10
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPRET.II INVESTICIJSKE STUDIJE
BILANCA USPJEHA
NOVOG PROGRAI.IA
( nastavak )
10.11
D ARKADIA tc Klinika za plasti€nu i estetsku kirurgijur DARUVAR
FINANCIJSKA ANALIZA U PRIPREHI INVESTICIJSKE STUDIJE
10"12
u ARKADIA a Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPRET.II INVESTICIJSKE STUDIJE
Napomena l 1 + 2 + 3 + 4 + 5 = '1OO
lOO Z
A+ B+C= 7.
9. IrxvrbruosT PRoJEKTA
10. 13
tD ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPREHI INVESTICIJSKE STUDIJE
F I NA NC I JSK I TOK
p roj ekta
I. INVESTICIJA 4.OOO"OOO o o
7. TROSKOVI POSLOVANJA 1"891.42q 1 . gg4 .2A2 2.O14.046
3 . BRUTO OSOBN I DOHOC I 3. O81. 672 3.lL2.BOO 3.159.492
4 . OBVE Zt TZ JOHOT KA T. 3BO. OB4 2 .494 . Bgg 2.535 .bbg
5. OBVEZE 7A TZVORE FIN o 2 . ?49. 573 2.24q, 573
III I ZDACI L2.353.185 9.931.553 g .9 58,7BO
F I NA NCIJSK I TOK
p rojekt a
( nastavak )
10. 14
tD ARKADIA ( Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
FINANCIJSKA ANALIZA U PRIPREI'II INVESTICIJSKE STUDIJE
10.15
D ARKADIA ( Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
FINANCIJSKO TRZISNA OCIJENA PROGRAI.IA
2. STATICNA OCJENA
( rentabi Inost, ekonomitnCIst, proizvodnost )
BILANCA USPJEHA
U NORI,IALNOJ GODINI RADA PROJEKTA
( L""zt
11"2
u ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKO TRZISNA OtrIJENA PROERAHA
Red . ANALITICKI
broj PO KA Z ATELJ I ZNOS
3 Brut to OD po
radn i k u/ mj esetno 2L . bL7
11.3
D ARKADIA ( Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
FINANCIJSKO TRZISNA OCIJENA PROGRAHA
3. DINA].IICNA OCJENA
Ocjena rentabilnosti ( razdoblje vradanja; neto
sada*nja vrijednost projekta; interna stopa
rentabi Inosti )
7a analizu ekonomske efikasnosti projekta kori6tena je
metoda "ekonomskog toka", koja se razIikuje od metode
"financijskog toka" zato *to nisu zastupljene stavke vezane t)z
ll.4
)t ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
FINANCIJSKO TRZ ISNA OCIJENA PROGRAFTA
11.5
D ARKADIA (( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
F I NANtr I JSKO TRZ I SNA OC I JENA PROGRAT.IA
EKONOI.lSKI TOK
1. INVESTICIJA o o o
2, TROSKOV I POSLOVANJA 2.074 .qZL 2. LO6. O45 2. L37.635
3. BRUTO OSOBNI DOHOCI 3.?54.988 3 .303 .AL2 3.353.370
4. OBVEZE T7 DOHOTKA 2.639 . 507 3 . 5q7 .426 3.646.312
5. OBVEZE ZA TZVORE FIN 2 ,249. 573 o o
EKONO ]'ISKI T OK
P rojekt a
( nastavak )
tL.7
D ARKADIA ( Klinika za plastidnu i estetsku kirurgijur DARUVAR
F I NANtr I JSKB TRZ I SNA OC I JENA PROGRA].IA
11.8
D ARKADIA tt Kl inika za plastitnu i estetsku kirurgijuo DARUVAR
F I NANC I JSKO TRZ I SNA OC I JENA PROERAF1A
t=
PT
Period amortizacije investic ij skog u 1 aganj a t in i broj god ina
potreban da se kumulirana akumulacija Lz)ednati sa investic ij sk im
ulaganjem.
PRORACUN RAZDOBLJA POVRATA INVESTICIJE
ll.lo
D ARKADIA (( KI inika za plastitnu i estetsku kirurgiju, DARUVAR
DRUSTVENO EKONOMSKA OCJENA PROGRA]'IA
DRUSTVENI TOK
prtrSekta
L2.2
)) ARKADIA (( Kl inika za plastitnu i estetsku k i rurg ij u, DARUVAR
DRUSTVENO EKONO]-ISKA OCJENA PROGRAMA
DRUSTVENI TOK
proiekta
( nastavak )
L2.3
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
DRUSTVENO EKONOI.ISKA OCJENA PROGRA]-TA
t2.3
D ARKADIA tt Klinika za plastitnu i estetsku kirurgijur DARUVAR
ANAL I ZA OSJETLJ IVOST I PROCRAT'IA
1. UVOD
13.2
}} ARKADIA (( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANAL T7A OSJETLJ IVOSTI PROGRA].IA
13.2
D ARKADIA ( Klinika za plastiEnu i estetsku kirurgijur DARUVAR
ANALTTA OSJETLJ IVOSTI PROGRAT.IA
13.4
D ARKADIA tt Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANAL T7A OSJETLJ IVOSTI PROERAT'IA
13. 5
13.6
tD ARKADIA ( Klinika za plastidnu i estetsku kirurgiju, DARUVAR
ANAL TZA OSJETLJ IVOST I PROGRAT-IA
13.7
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
ANAL T7.A OSJETLJ IVOSTI PROERAI'IA
13.8
D ARKADIA tc Klinika za plastitnu i estetsku kirurgijur DARUVAR
ANAL TZA OSJETLJ IVOST I PROCRAFIA
13.9
D ARKADIA t< Klinika za plastiCnu i estetsku kirurgiju, DARUVAR
ANAL TZA OSJETLJ IVOST I PROGRAF1A
13. 10
D ARKADIA ( Klinika za plastidnu i estetsku kirurgiju, DARUVAR
TBIRNA OCJENA PROERAI'IA
3.4 - Z.E,IFTI\TA
ffcJET\IA
Pf.tClGf-.tA I'{A
14' ?
D ARKADIA ( Klinika za plastiEnu i estetsku kirurgiju, DARUVAR
ZBIRNA OCJENA PROGRAMA
INVESTICIJE U OPREMU
14.3
D ARKAD IA (( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
TBIRNA OCJENA PRO6RA},IA
6 BOLNICKO LJECENJE
( BOLNICKI DANI ) 1.?20 9BO 1 .881 .600
PRIHODI OD FINANCIRANJA 300. ooo
I TTVANREDN I PR I HOD I 250. OOO
L4 .4
D ARKADIA ( Klinika z.a plastitnu i estetsku kirurgiju, DARUVAR
ZBIRNA OCJENA PROGRAI'IA
14. 5
Red . ANALITICKI
b roj PO RATATELJ I ZNOS
1 Dohodak prema 3L7 . bg7
broju radnika
2 Akurnulativnost
Akumulaci_la / Tnvestici je ,o6
3 Brutto OD pcl
radn i k u/ mj eseCno 2L .6L7
4 Neto devi zn i ef ek t
Priliv/adIiv 2. LO1 .72C
L4 .6
*)1
l-rI Razdoblje pCIvrata investicije U petoj gcldini
u godinarna praj ek t Ce vra-
titi ulo2ena
Eredstva
?.2. NetCI-sada*nja vrijednost Program doprinosi
prCIBrama uz 4OrO 7. u sada*nj oj vr i-
j ednosti uz 40 r O
NSV 531 . O1g d.s. tTatgr. clsn,
K I in i ke Prog ram
je prihvatljiv sa
stanovi*ta K 1 i-
nike jer -ie NSV
veta od O
2.3. Relativna neto sada*nja vri_]ed-
nCIs t prog rarna ( RSV ) Prog ram na I d in
ostvaruj e O, 19
dinara neto Eada*-
nje vrijednosti.
7.4. In terna stopa ren tabi I nosti Neto sada*nj a
( ISR u 7) vrij ednost proj ek
ta pCIzitivna je i
uz d.s. 45 7., 50 Z
i 55 Z.
To gCIvori da ISR
visoka i da projekt
mo2e pCIdnj eti
kamatnu stopu vedu
od 55 Z na invest.
kredite.
L4.7
,) ARKADIA tt Klinika za plastidnu i estetsku kirurgiju, DARUVAR
ZBIRNA OCJENA PROGRAMA
I V. KONACNA OCJENA
14 .8
D ARKADIA ( Klinika za plastitnu i estetsku kirurgiju, DARUVAR
PR LOZ
m. J Jurkiewicz
Surgeons muEt be very careful
when they take the knife!
Underneath their fine inicisions
stirs the culprit life,
EMILY DICKINSON
In this quatrain Enily Ilickinson describes the essence of a surgeon: the raker of decisions olten in-
volving life itself. She injects the right note of caution rith the nord "careful", Earh of u5 intuitively
knors carefullnes to be the eost iaportant characteristic of a good surgeon. Inseparable froa the terr is rhat
surgpons genarally call jugrent. Elusive to soae, judgrent is acquired b: rost surgpons, but only rith tite and
Exposure to patients, their diseases, and their deaths. Ihat develops a Eugpon's judgrent is experience in the
often lonely task og raling dicisions about sirk patients.
The surgeon is still perceived nuch as Eaiiy Dickinson depicted. The irage ray have grorn sorenhat
fuzzy as a result o{ the baser values and rotives that have perreated radern society - but the surgeon is still
seen as soteone nho does rork that counts. Regardless of the field of surgiral endeavor, ailsurgeons bear the
sare responsihiliti to the sick and the injured.
Beyond the poetic deciription is the folloning delinition offereC hy a scientist rho, as one one aight
expect, analyzes a sur{eon in near-stoichiomtrir terrs:
Asugeon attents to alter certaina phisiral relationship rithin the Brganism srr aE to restore 0r iE-
pruye function, He Gay exicE diseased CIr unnanted, he Eay reorganiia and reshape tissues, hE Tay transplant 0r
iaplarrt tissues 0r Brqans. Hhichever 0f these he is Coing, his goal is noraalitv 0r pherhaps the improveuent Ef
functinn trough effective relatinns betneen organsr tissuse or rells of the patient.
This is perception of the erinent geneticist, H. Bentley Elass {1}. He lurther defines surgery es in-
volving not onlu an inrision, hut usually an excision and ahays repair. Eepair ray be outer-directed, aE in
prirary round rlosure hy approxination, or it rry be inner-directed, as in round left to close by the intrinsic
hioloqic processes nf concractisn and epithelialization.
Inscision and exrision are by definition invasive and destructive. The surgicai process is destruc-
tive, surgical repair process {the reordering of tissues! is ronstructive, creative. Ereativity, as Elass
The
pointed nut, is central to all surgery.
filthough repair is essential to all fields of surgical *orh, plastic surgery {frsr the Ereek piassein,
reans ts rold, or to shape) is the surgery of repair. Its roots are the biology of tound healing, its trunk is
care, its hranches are shill procedures.
Eecouse ol the iaportanse ol reconstruction, the plastic surgeon has self consciously added the quali-
fier recanstrustive to plstic surgery. In a sense the plastic and reconstructive surgeon acts as a sr:pport se-
vice fsr reny surqeons rhose atterpts at repair have faild for reatever reeson. Ihus the plastic sugeon ftay be
invoived irr the faild perineal round after a proctocolectory for Crohn's disease, the pharyngocutaneous fistulr
conplirated by irradiation, the hronrhopleural fistula in the obdurate erpyera cavity, the open redian sternot-
ory round, or the open tibia of chronir osteorvelitis. The plastir sugeon also treats patients nith sosatic
defornity inflicted by nature, such as the congenital ralforration o{ firouzon's disease, cleft lir and plate,
or henifarial ricrosorial or patients xith deforrites inflicted by or Ieft in the nake of trauaa, burns, rvul-
sion injury, exrision of a neoplasr, or irradiation.
The fild of plastir surgery es an orgarrized disci.pline hegan because of diflicult repair problers in
the dis{igured, net largely in tlo rord rars. Because the flarerd face is considered the essence of disfigure-
oent, the plastic surgeon is often identified sa one rho repairs faces. This perception has ahays h,een held
not only in the ancient beginnings of plastic surgEry, but clearly in llord Hars i and il. In dthe trench rel-
fare of lord llars I, the face nas the prire body part exposed to eniry fire. Virlay 8lair, oi 5t. Louis. a gen-
eral surgeon rho had a natisnal reputation for surgery of face, rounth, and jars, [as aade chief ol l+plastic
and raxillolacial surgery in the United States of Aray. Robert lvy, of Philadelphia, rhs had degrees in both
dentistry and redicine and ras also a piastic and raxillofacial surgeon, tas second in coreand. In EnQiand.
Harold Eilies, an otolarynqologist rho had long since evoived as a plastic surgeon, ras in charge. Fror these
origins plastic surgery ererged as a reconstructive discipline associated rith the rehahilitation of soldiers
disfigured lroa trench rarfare.
Repair of skin and subcutaneous tissue as an organ care naturally into the dicipline of plastic sur-
gery. Because stin and subcutaneous tissue require suport, the transpiantation of hone and carilage hecam
studied. and the approprate akills acquired. Fror and function both are the goals for proper reconstruction and
rehahiiitation. Thus the plasticsurgeon beraae expert in the autogenous transfer of ali sorts of
resoderral,
ectoderaal, and endodernal tissues - including tendon, tuscule. and nerve, These transiers, parti.cularly rus-
cle, cannot be achieved by a "Eethsenabe" procedure {a riraculous replantation and repair effectd siply by
placing the part barlr. on)! ss a different level if tissue reordering evolved: nicrovascuiar transfer.
0l necessity then, today's piastic surgeon aust be broadiy trained and educated, Brsad training nust
deveiop operational skills until they are alest reflexive and autoaatic- that is, so they can he brought into
Flay nearly suhconsriously to solve the repair probiea. This facilit't is required because each prohleu ran be
difficult and unique, and no sirrgle recipre er rste operation rill do. Josep Panssst, then profes:or of surgery
at lhoaas Jefierson Llniversity in Philadelphia, recognized the inherenttly singuiar character of plastic surgi-
cal procedures in 188{:
The deforrities requiring operations of the class are necessariiy so dissirilar in difierent cases,
(thatl every nex onE bocores a separate study to the surgeons and offers a fresh field for the exercise if his
aind in restoring the lost or deforred parts.
This sslution to clirrical proble*s often requires creativitv, The creativ act, rhether in art. aathe-
ratics, rusic, or an aperation, is intellertual; hence, the broeder the physician's intellectual or edurational
hase, the rore likelu nill be a successful outcore, all things being other;ise equal. This relationship is in-
herent in the concept a{ the preparpd rsientific aind and consequently in the prepared surgical aind.
It takes only repeptition to learn a sill, [reativitiy, sn the other hand, requires that skil]s be
sublirated to the subconscious. Then, rhen flashes of intuition occur in the ainds of trianed surgeins, these
skills enable thes ts carry out each step og the approrriate snlution xith sureness and dispatch.
Hol can one best prepere a hroad intellectuai base for the practice of plastic and recsnstructj.ve sur-
gery? Sore rould say only a full course of training as a generai Eurgeon xill do. Blair and his foilorers
thought so. For exarple, ehen seeking support in 1938 for the establishnent of national standards of traininq
in plastic surgery through the estabiishaent of an fiaerican Board of Plastic Surgery, Blair xrote the follov-
ing:
In its fullest developrent, plastic surgery rill reach its greatest usefulness, its ridest apntica-
tion, and bring the greatest personal return rhen it is studied and oractied as a divisisn nf general surgery.
The terr general as applide to a surgeon indicates neither the quality of his rork, nor the extnet of his en-
deavors, but irplies a basic grasp ol surgical grinciples that rill pereit deveiopment along any chosen line
Eg practice. Breadth of visionnis essential to qood practice in any field, and is furtherd by broad study,
hroad opportunity. and broad observation.
Reduced ts its essentials, to be educated is to cintinue to learn - to huild upon rhat has learned
before. At bottor it is a solitary proEessi it depends larqely on the individual, not the place or the rpthod
{althsuh both place and aethod can enhance the educational process}. To say that traininig in generai su!'gery
is the only right ray ts further plastic surgery is thus clariy inacrurate. The Arerican Board of Plastic Sur-
Bpry has rec-ognired this, as have training progra! directors. The rsute to rertification in piastic surgery
ray be qualifiration in order surgical specialties, such as otolaryngoiogy, ortopdics, or urology.
The training prorpss in plastic surgery differs according to the surgeon's pariicuiar back-
ground. Plasticc surgeons are involved in rany areas of the body, ,any Ergens systers, and nany tissues - in-
deed, allof ther. Therefore they rust acquire the education and skills to cope effectively rith the problers
inherent in body repair. The plastic surgeon rho ererges lror generai surgery nust undergo e proEEsE of refine-
rent. If, on the other hand, the surgeon mtanorphoses fron a specialized field, the proces rust broaden and
increase those skills deelirrg xith other parts of the body and organ systeas of rhich the surgeon had but dir
ailarpnes5.0nly then should existing skill be refined.
Altrhough rany routes to heroring a thoroughly educated Eurgeon exist, cornon to all af thea is aoti-
vation, native intlligence, and tina. Ihe absolute sininut tire to rahe the transition {rom a recently graduat-
ed nedical student to surgeon in rhatever {ield is 3 years. All diriplines, inrluding general surgery, that
have tried less, suhsequently returned to a rrnirur of 5 years. Hhen Hiliian Stexart Halsted introduced the
residency syster at Johns Hopkins, the rininua tenure ras 10 years. This tire is perhaps tou long, and certain-
ly today it seens too expensive and inpractical. Hon the ideal is rinisur of I years in training and ahor.rt 5
years in practice. During this tire ol training and early pructice the surgeon can develop and habits that that
ray lead to somday raking a lasting contribution to the dicipline of surgery.
Each practicing surgeon ran and should contrihute to the discipline by passing 0n nerly acquired
l.no;ledge to other mrhers of the profession. Rhoads et al, once rrste the folloring:(5]
practicing physician uses aleost entirely lnorledge that has heen transferred to hie and he often
The
rerei.ves payrentlror his services rith ruch thought of his debt to the past. If he cantrihutes nothing either
to the transfer oi oid knorledge to those rho rust Eucceed hir as ts the discovery of knorledge through experi-
ence 0r experirent, he is purely a parasite in his relations xith his proles:ion, He ray stil be a useful iei-
ber of society es a FurveyEr of medical knorledge to the consurer, hut he adds nothing to the continuity or
progrEss af his profession.
Particularly in surgery, auch depends on rlinical experience. Through a proper transfer of knorledge,
the erperienre of one surgeon ray prevent others fror naking ristakes that coast thE lives or ilpair the *el-
i
ARKADIA Klinika za plastitnu i estetsku kirurgiju, DARUVAR
P R L o
fare o{ patients. }lhere a surgeon or a physician speaks ol his experience, he includes the tern tnoxledge rhich
coae ts hin, not only fror his successful cases but also fror his failures. It
is therefore e srious obligation
to pess 0n that rhich he has earned to other. reoebers of his profession. This ray be done by presenting case
reports or nalysisi of series o{ cases ts local or national redical societies an, if
they prove to he ol suffi-
cient value, by publisihg ther in appropriate redilac journals.
flcaderic surgery therefore isnot aplace, bau a state ol rind. It requires intellectual curiosity,
keen sense sl observation, an appreciation of scientifir rethod, and accurate, honest reporting.
Etical dilemas confront the surgeon rhn repairs the deformd. 0ccasionally an ingant is bsrn seeaing-
ly robust but xith hidesus delorrty ol the face, and blind as reli. fit the outsett everyone realizesthat knorn
technique: of reconstruction in such an infant are inadequate, and that the child rili alnays rerain beyond the
pale of acceptable humn appearance. Blind, he canot see hiaself. He is grotesque to others but not te hirself.
Should such patient be reronstructed as ruch as possible, and thus use resources that conceivably aight be
better used on others?
A sinilar exarple is the hadly burned patient lor rihu ineediate resuscitation is nearly alrays suc-
cessful. Shsuld reconstruction he attenpted rhen the rortality rate rith such burns approaches 83 1 90 to ll
and rhen the patient has perranent loss of phisical idnetity and hands inrapable of perforning the sirplest of
body function?
Ihe head and neck cancer patient rhose treatrent xill involve reroval of the entire tongue, rost of
theja;, the larynr, and pharynx is another exarple. Still another is the patient lho to have any hope o{ cure
rust have hoth eyes, both raxillae, and the nose remved in a corbined intracranial-extracranial procedure.
Should such a patinet be treated or sirply kept coafortahie and alloned to die?
'but
Less apparent nevertheless insidious etical dilenras exist, 0lten the plastir surgeon is confront-
ed by the request, 'Dsctor, rill
you rord it
so that ry insurance conpany rili
pay!? Although refusal uay rell
prorpt the patient ts seek arr affir*ativE Ensrpr el:rhere, a Eurgesn rust refuse. To acquiese is to berone de-
based, to cheat society, and finally to be guilty of outright fraud.
Honesty. ethics, and values are to sore extent heritabie, since the'y are a part of riviiizationl an
intellectuai and spirituai traditiorr, They are passed on forr generation ta generation, not as imutable chrr-
acteristics, but leavened, altered, and fror tire to tire deliberately trarpled and destroyed, and {ror tire to
tire deliherately trarpled and destroyed. Sorehor, thouqh, they survive in the rinds and souls of ren and rsl-
en. Values rre best inculcated hy exarple. The csntributin: piastir surgeonsEan rake to the undergraduate redi-
cal curriculul are several.
1. Io teach a reasonahly xell-defined segaent nf surgicai practice concerning disease states having to
do nith corrgenital and acquired deforrity. This segrants shouid include diagnosis and treatrent and relevent
hasic anatoaic, biochericai, physiologic, and pathologic tnorledge.
2, To erphasize the essential huraneness of recsnstructive surgiral practice, Deforaity can be deyas-
tating, not only to phisical rell-being, but also to spiritual and psychologic rll-being. Each of us rishes to
be rhole. The parents of a child born *ith a congenital ralforsation very often have a profound sense of guilt.
The surgeon's honest, perreptive, hurane approach to the deforued child and the parents can aake a lasting ir
pressin on th student and influence the ranner in rhich he or she rill prartire aedicine in in rhetever firld.
Ie bring back. refashion and restore to rholeness the features rhich nature oave but chance destroyed,
not thay ray charr the eye but that they ray he an advantage to the living soul...(2i.
3. To develop an appreciation for and fariliarity rith the probler-solving aspects of surgery. Francis
Eacon outlined the essential aspects of the scientifir rethod in his essential aspects of the scientific rethod
in his systen ol inductive inference, In this syster the scientist fsrrulates a hypothesis, and therr disprnves
or proves it' Then the scientist proposes a syster of alternative hypotheses, systeraticilly exctuding each
hypothesis until a presuret truth is obtained, In the practise of plastic surgery, the patient presents rith an
obvious defortity. Usually, that deforrity's corponent parts rust he analyzed clinically and diagnostically,
and alternative approaches {hypotheses} are presented to solve the probler. The plastic surgeon systeraticaliy
discards each of the hypotheses in lavor of the one that lili best acroaplish the repair. Ta the fullest extent
possibler that decisions should be rade on the basis of data. llhen no appropriate approaches exist, the probler
:huld Iead directly to the developrent of clinical research,
Vnluntary or fuli-tim surgical {aculties in university affiliated hospitals are responsibie for pro-
viding superlative care of the sick, the injured, and the defored and lor organizing the sta{f so that they
csnduct quality clinical investigations in every roor and rard, It ras the belief of [arl lloyer i4] Eixby Pro-
fessor of Surgery at the Hashington llniversitiy $chool sf lledicine ned Ehief of Surgery rt Earnes Haspita! in
St. Louis fror 1951 through 1965, that
the inclusion in hospital staffs of clinical rho have sperialized in sore branch o{ the basic
the only Eure teans of bringing the contributions of biochenistry, bacterioiogy, pharracology, and
5E 181'rE85 15
patholsgy to bear upon the educrtion of undergraduated and graduate students of mdicine.,. Ihe teaching of the
apFlication of the basic sciences to surgery and redirine rust be dsne at the bedside by staff ren or residents
Hho have had special interest and training in the basic scienres and rho have deveioped proficiency in the ap-
plication of the tnorledge to the care of the ill.
REFEREI{CES
1. Elass HB: Eenetic and surgeryl the Ravdin Iecture, Bul I Am [ol I 5urg, l{uv. 1?7?,
?. Enudi l{T and Hebster JP : The I i f e and tines Bf $aspare Tagliacorri, ilen Ynrk, 1?3it, Herhert Reichner,
5. Ivy HH: Sore circuustnces leading to organization 0f the Arerican Board Bf Plastir Surgeryr FR$ 1$r77, 1?55.
4, l{oyer CA: Torsrrsn and tonorrsr; a vaiedictary speeEh delivered tCI the senior class at Hashington University
5c hoo i sf lled i c ine , September , 1?63 .
5. Rhoades JE et al: Surgical philosophy, In Allen,lG et alr Surgery: principles and praEtice, Fhiladelphia,
19i7, JB Liosincott [s.
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